Abstract:
BACKGROUND:Dialysis patients have higher cardiovascular events rate than patients with normal renal function. Hyperhomocysteinemia, a risk factor for cardiovascular disease, is frequently detected in dialysis patients. Vitamin B supplementation lowers hyperhomocysteinemia, but it is unknown whether it reduces cardiovascular events rate. We planned a long-term study to analyze the effects of homocysteine-lowering vitamin B therapy on cardiovascular disease in hemodialysis patients. METHODS:We performed a single center open prospective trial. Patients, just on folate therapy at enrolment, were left out from randomization and maintained folate therapy according to study's protocol (group A). Patients, untreated with folic acid at recruitment, were randomly assigned to other 2 groups: patients submitted to folate supplementation according to study's protocol (group B), and untreated ones (group C). We instructed patients to take 5 mg oral daily folic acid or 5 mg every other day whether serum folate levels were up the normal high limit. We measured homocysteine, folate and vitamin B12 plasma levels at baseline and every 4 months. We chose the appearance of fatal and nonfatal cardiovascular events as end-points. RESULTS:We analyzed data of 114 patients for a median follow-up time of 871 days. Stepwise regression analysis demonstrated that baseline homocysteine levels were related to folate (coefficient: -1.02; F: 64.5), creatinine (coefficient: 0.98; F: 11.3), and C reactive protein (coefficient: -0.64; F: 4.3). Patients ended the study for the following reasons: cardiovascular morbidity (n = 44), death (n = 25), renal transplant (n = 9), moved away (n = 4). Cardiovascular events occurred in 58 of 114 patients (51%), in 26 of 63 (41%) treated patients (both group A and group B) and in 32 of 51 (63%; chi2 = 6.0; p = 0.05) untreated patients (group C). Kaplan-Meier survival analysis showed that cardiovascular events were less frequent in treated patients with low homocysteine levels (chi2 24.1; p < 0.0001). Cox regression analysis showed that cardiovascular events were explained by homocysteine, dialysis vintage, past cardiovascular accidents, and age. We noticed not only lower homocysteine levels, but also higher protein catabolic rate values in events-free patients as compared with patients with nonfatal cardiovascular events. After having divided patients into 4 subgroups according to high and low, split at median, Hcy and protein catabolic rate values, we observed in Kaplan-Meier survival curves for cardiovascular events by these subgroups that patients with low Hcy and high protein catabolic rate values showed a significant lower hazard rate than patients with high Hcy and low protein catabolic rate levels (chi2 = 21.7; p < 0.0001). CONCLUSIONS:This trial shows for the first time that homocysteine-lowering folate therapy decreases cardiovascular events in dialysis patients. It is necessary to perform large prospective studies to confirm our results.
journal_name
Blood Purifjournal_title
Blood purificationauthors
Righetti M,Serbelloni P,Milani S,Ferrario Gdoi
10.1159/000093680subject
Has Abstractpub_date
2006-01-01 00:00:00pages
379-86issue
4eissn
0253-5068issn
1421-9735pii
93680journal_volume
24pub_type
杂志文章,随机对照试验abstract::In patients with chronic kidney disease (CKD), peptides and proteins circulate at altered concentrations versus in healthy individuals. We have characterized proteome samples from 7 pooled CKD stage 5 patients not yet on dialysis and with no known co-morbidities. We also analyzed pooled plasma samples from 7 healthy a...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000178773
更新日期:2008-01-01 00:00:00
abstract::Peritoneal transport rates, a critical determinant of peritoneal dialysis efficiency, vary widely among patients and may be easily categorized by standardized peritoneal equilibration test. Measurements of creatinine and glucose transfer are particularly useful in selecting optimal dialysis prescription. Patients with...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000169582
更新日期:1989-01-01 00:00:00
abstract::Critically ill COVID-19 patients are generally admitted to the ICU for respiratory insufficiency which can evolve into a multiple-organ dysfunction syndrome requiring extracorporeal organ support. Ongoing advances in technology and science and progress in information technology support the development of integrated mu...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000508125
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Renal medullary hypoxia precedes the development of acute kidney injury in experimental sepsis and can now be assessed by continuous measurement of urinary oxygen tension (PuO2). OBJECTIVES:We aimed to test if PuO2 measurements in patients with septic shock would be similar to those shown in experimental se...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000501512
更新日期:2019-01-01 00:00:00
abstract::Issues in biocompatibility have traditionally focused on the interaction of membranes or materials with the activation of complement, red blood cell destruction, clotting dysfunctions, and platelet activation. Other studies are concerned with the replacement fluid formulations and host responses. Recent attention has ...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000169968
更新日期:1990-01-01 00:00:00
abstract:BACKGROUND/AIMS:Carpal tunnel syndrome (CTS) is a common clinical presentation of dialysis-related amyloidosis. It was determined whether β(2)-microglobulin (β2M) and advanced glycation end products in serum are predictors of CTS in dialysis patients. METHODS:A total of 385 hemodialysis patients were screened for CTS....
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000338923
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. SUMMARY:The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic infla...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000494583
更新日期:2019-01-01 00:00:00
abstract::At present the treatment of hepatitis C virus infection (HCV) has improved because of combined treatment with interferon (IFN) and ribavirin. The association of these two drugs has obtained a positive response in 40-50% of naive patients treated. Patients with relapse after monotherapy with IFN also show positive resp...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000046996
更新日期:2002-01-01 00:00:00
abstract::For maintenance hemodialysis (MHD) patients, the blood is in low hypercoagulable state due to the use of heparin or low molecular weight heparin during dialysis. It is not rare to see hematoma in the puncture site. In recent years, several cases have been reported of spontaneous kidney rupture, but no hip hematoma, le...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000446177
更新日期:2016-01-01 00:00:00
abstract::Conventional treatment of acute and chronic renal diseases has focused on solute removal. Novel strategies aim to treat the multifactorial disease states of acute kidney injury and chronic kidney disease by mitigating inflammation. Cell-based technologies for the treatment of kidney dysfunction fall under two broad ca...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000341649
更新日期:2012-01-01 00:00:00
abstract:INTRODUCTION:The present study aimed to determine the variables that are associated with a longer dialysis recovery time (DRT) and to define the relationship that exists between DRT and the ultrafiltration rate (UFR) in prevalent chronic hemodialysis (CHD) patients. METHODS:We studied 210 prevalent CHD of 5 hemodialys...
journal_title:Blood purification
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1159/000492919
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Interleukin-10 (IL-10), a potent regulatory monokine produced by activated mononuclear cells, provides an efficient autocrine mechanism for controlling proinflammatory cytokine synthesis. We hypothesized that defective synthesis of IL-10 could contribute to the inflammatory state in hemodialysis (HD) patient...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000066958
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND/AIMS:To test the safety and efficacy of the Aethlon Hemopurifier, a lectin affinity cartridge, in clearing hepatitis C virus (HCV) from the blood of HCV-positive end-stage renal disease patients undergoing dialysis. Viral RNA was measured using real-time quantitative reverse transcriptase polymerase chain re...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000167011
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Omni® (B. Braun, Germany) is a new-generation, continuous renal replacement therapy (CRRT) machine designed to improve user interface, minimize downtime and optimize renal dose delivery. It was never tested in humans. METHODS:We used Omni® to provide CRRT in 10 critically ill patients. We collected therapy ...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000451053
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND/AIMS:Some angiotensin converting enzyme (ACE) inhibitors are efficiently removed from circulation by hemodialysis ('high dialyzability'), whereas others are not ('low dialyzability'). In patients receiving hemodialysis, this may influence the effectiveness of ACE inhibitors. METHODS:Using linked healthcare ...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000438821
更新日期:2015-01-01 00:00:00
abstract::Thirty-four patients with end-stage renal disease requiring hemodialysis developed over the course of 7 years (1987-1994) severe ischemia in the extremity carrying the angioaccess secondary to arterial 'steal'. Seven of these patients were treated with access ligation, 4 with banding reducing the flow through the acce...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000170286
更新日期:1996-01-01 00:00:00
abstract::Therapeutic plasma exchange (TPE) in neonates and small infants is a treatment method at the forefront that may become a potentially life-saving procedure in a wide array of severe conditions. Indications for TPE in the pediatric population have been mainly derived from adult literature, with neonatal hyperbilirubinem...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000470827
更新日期:2017-01-01 00:00:00
abstract:INTRODUCTION:Glycated hemoglobin is used to assess diabetic control although its accuracy in dialysis has been questioned. How does it compare to the Continuous Glucose Monitoring System (CGMS) in peritoneal dialysis (PD) patients? METHODS:We conducted a retrospective analysis of 60 insulin-treated diabetic patients o...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000439242
更新日期:2016-01-01 00:00:00
abstract::The central dialysis fluid delivery system (CDDS) has been working exclusively in Japan since 1970, a fact which proves that CDDS is useful in the multi-patient treatment with in-center regular hemodialysis. It is a cost-effective, labor-saving and time-tested system with 40 years of experience. Microbial safety is im...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000213494
更新日期:2009-01-01 00:00:00
abstract::Chronic kidney disease-mineral and bone disorder is a new term defining a complex syndrome which underlines the need of a systemic approach to disturbances of calcium and phosphate metabolism in patients with renal failure. In recent years, the availability of new phosphorus binders and the appearance of new selective...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000209250
更新日期:2009-01-01 00:00:00
abstract::Endothelial dysfunction of the optic microcirculation is considered to be the main pathogenetic mechanism in nonarteritic ischemic optic neuropathy. The aim of the present work was to assess whether a clinical improvement is correlated with a reduction in the endothelial activation markers by means of LDL apheresis (L...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000094574
更新日期:2006-01-01 00:00:00
abstract::We have investigated the effect of the direction of the dialysate flow during continuous arteriovenous haemodialysis. Under similar conditions countercurrent flow was more efficient than concurrent flow in terms of both urea clearance (mean +/- SEM), 23.5 +/- 0.5 compared to 18.4 +/- 0.4 ml/min (p less than 0.001) and...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000169987
更新日期:1990-01-01 00:00:00
abstract::The second law of thermodynamics applies with local exceptions to patient history and therapy interventions. Living things preserve their low level of entropy throughout time because they receive energy from their surroundings in the form of food. They gain their order at the expense of disordering the nutrients they ...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000345755
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND/AIMS:Chronic kidney disease (CKD) and periodontitis (PD) are serious public-health concerns. Vitamin D is a fat-soluble steroid hormone that interacts with its nuclear receptor (VDR) to regulate a variety of biological processes, such as bone metabolism, immune response modulation and transcription of severa...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000109235
更新日期:2007-01-01 00:00:00
abstract::Hypertension is present in most patients with end-stage renal disease and likely contributes to the premature cardiovascular disease in dialysis patients. Previous practice guidelines have recommended that, in patients on chronic dialysis, blood pressure (BP) should be reduced below 130/80 mm Hg. This is based on opin...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000245631
更新日期:2010-01-01 00:00:00
abstract::While recent developments have allowed greater insight into the vascular pathobiology and intimal hyperplasia, very few of these advances have led to improved clinical care of hemodialysis vascular accesses. Indeed the most common procedure for the treatment of access stenosis and thrombosis is the same model for the ...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000245650
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Hemodiafiltration (HDF) is effective in delaying the surgical need for carpal tunnel syndrome in chronic hemodialysis patients, however, predialysis beta(2)-microglobulin levels were not reduced in most short-term studies. The aim of this study was to assess the effect of long-term and differing frequencies ...
journal_title:Blood purification
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1159/000046958
更新日期:2001-01-01 00:00:00
abstract::Haemodialysis is associated with increased oxidant stress. This appears to be due to (1) an increased production of free radicals during haemodialysis, (2) a net reduction of many antioxidants and (3) factors intrinsic to the uremic state. These alterations can lead to cardiovascular disease and many of the pathologie...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000014384
更新日期:1999-01-01 00:00:00
abstract::Hyporesponsiveness to erythropoietin stimulating agents (ESAs) is a condition associated with increased mortality. Even after identifying the condition, the causes are difficult to treat and only partially reversible in end-stage renal disease patients. Thus, the role of more recent hemodialysis (HD) techniques in imp...
journal_title:Blood purification
pub_type: 杂志文章,评审
doi:10.1159/000485314
更新日期:2018-01-01 00:00:00
abstract::A new plate dialyzer, Gambro PRO-3, with a polycarbonate-polyether membrane (Gambrane) was tested. The membrane thickness is 16 micron and the dialyzer surface area 0.77 m2. 11 regular hemodialysis patients who were treated 3 times per week were studied and 32 dialyses were performed. Clearances of urea, creatinine, u...
journal_title:Blood purification
pub_type: 杂志文章
doi:10.1159/000169426
更新日期:1986-01-01 00:00:00