BACKGROUND: Retinol concentrations in serum are significantly higher in patients on hemodialysis (HD) compared to healthy controls. Its lower concentrations have been reported to be an independent predictor of mortality. ATRA - all-trans retinoic acid - is an important compound related to retinol. The objective was to determine ATRA concentrations in serum and to find their association with the prognosis of patients on long-term HD. METHODS: ATRA was determined by high-performance liquid chromatography in a group of 247 HD patients (follow-up five years) and 54 healthy controls. RESULTS: Although serum retinol concentrations were higher in the studied cohort of HD patients, ATRA was lower - median 1.13 (interquartile range 0.90-1.60) ng/mL in HD patients versus 1.42 (1.08-1.63) ng/mL in healthy controls, p = 0.02. Lower ATRA was significantly related to overall mortality of HD patients (HR (95%CI) 0.63 (0.47-0.85) per interquartile range, p = 0.003). The best prognosis was observed in patients with concentrations of both ATRA and retinol above the median (p = 0.003). CONCLUSIONS: We detected decreased retinoic acid levels in HD patients compared to healthy controls. Lower concentrations of ATRA represent a significant predictor of mortality and provide additional information to retinol.

• MeSH
• dialýza ledvin MeSH
• lidé MeSH
• prognóza MeSH
• tretinoin * MeSH
• vitamin A * MeSH
• vysokoúčinná kapalinová chromatografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Indoxyl sulfate has been identified as a major factor in the dysregulation of several genes. It is classified as a poorly dialyzable uremic toxin and thus a leading cause in the poor survival rate of dialysis patients. A monocentric, prospective, open cohort study was performed in 43 male patients undergoing chronic renal replacement therapy in a single hemodialysis center. The aim of the study was to determine the influence of acetate- versus citrate-buffered dialysis fluids in hemodialysis (HD) and postdilution hemodiafiltration (HDF) settings on the elimination of indoxyl sulfate. Also, additional factors potentially influencing the serum concentration of indoxyl sulfate were evaluated. For this purpose, the predialysis and postdialysis concentration ratio of indoxyl sulfate and total protein was determined. The difference was of 1.15 (0.61; 2.10), 0.89 (0.53; 1.66), 0.32 (0.07; 0.63), and 0.44 (0.27; 0.77) μmol/g in acetate HD and HDF and citrate HD and HDF, respectively. Acetate HD and HDF were superior when concerning IS elimination when compared to citrate HD and HDF. Moreover, residual diuresis was determined as the only predictor of lower indoxyl sulfate concentration, suggesting that it should be preserved as long as possible. This trial is registered with EU PAS Register of Studies EUPAS23714.

• MeSH
• acetáty farmakologie   MeSH
• dialýza ledvin metody   MeSH
• dialyzační roztoky chemie   farmakologie   MeSH
• hemodiafiltrace metody   MeSH
• hydrogenuhličitany MeSH
• indican krev   farmakokinetika   MeSH
• kyselina citronová krev   farmakologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci ledvin terapie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

Human polyomaviruses such as JC polyomavirus and BK polyomavirus have long been well known pathogens of immunocompromised patients. Several new members of this viral family have been described during the last decade. Human polyomavirus 9 seems to be a novel pathogen of transplanted patients according to some studies. The aim of our study was to determine the presence of human polyomavirus 9 in patients after kidney or stem cell transplantation (SCT) at the University Hospital in Hradec Kralove, Czech Republic. Overall 100 patients, 65 after kidney transplantation and 35 after SCT, were included into the study. At least three follow-up samples from each patient were examined for human polyomavirus 9 DNA presentation with the two previously described in-house PCR protocols. Despite the frequent reactivation of human CMV (14.3% in kidney transplantation and 63.3% after SCT) or BK polyomavirus in our patient group, there was no positivity for human polyomavirus 9 either in blood samples or urine samples. One of the possible reasons for this discrepancy versus previous published studies could be a relatively low proportion of patients treated by induction therapy before kidney transplantation in our study cohort.

• MeSH
• DNA virů genetika   MeSH
• dospělí MeSH
• hostitel s imunodeficiencí * MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nemocnice univerzitní MeSH
• polymerázová řetězová reakce MeSH
• Polyomaviridae genetika   izolace a purifikace   patogenita   MeSH
• polyomavirové infekce epidemiologie   virologie   MeSH
• senioři MeSH
• transplantace kmenových buněk škodlivé účinky   MeSH
• transplantace ledvin škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

BACKGROUND: Pregnancy-associated plasma protein A (PAPP-A) is associated with adverse outcome of long-term hemodialysis patients (HD). The aim of the study was to test whether its homolog pregnancy-associated plasma protein A2 (PAPP-A2) can be detected in serum of HD patients and to define its significance. METHODS: The studied group consisted of 102 long-term HD patients and 25 healthy controls. HD patients were prospectively followed up for five years (2009-2014). PAPP-A2 was measured by surface plasmon resonance biosensor, PAPP-A by time resolved amplified cryptate emission. RESULTS: PAPP-A2, similarly as PAPP-A, was significantly increased in HD patients (median (interquartile range)) PAPP-A2: 6.2 (2.6-10.8) ng/mL, vs. 3.0 (0.7-5.9) ng/mL, p=0.006; PAPP-A: 18.9 (14.3-23.4) mIU/L, vs. 9.5 (8.4-10.5) mIU/L, p<0.001). In HD patients, PAPP-A2 correlated weakly but significantly with PAPP-A (τ=0.193, p=0.004). Unlike PAPP-A, PAPP-A2 was not significant for prognosis of HD patients when tested alone. There was a significant interaction between PAPP-A and PAPP-A2 on the mortality due to infection of HD patients (p=0.008). If PAPP-A was below median, mortality due to infection was significantly higher for patients with PAPP-A2 values above median than for patients with low PAPP-A2 levels (p=0.011). CONCLUSION: PAPP-A2 is increased in HD patients and interacts with PAPP-A on patients ́ prognosis.

• MeSH
• biologické markery krev   MeSH
• chronické selhání ledvin krev   diagnóza   MeSH
• dialýza ledvin MeSH
• infekce mortalita   MeSH
• lidé MeSH
• prognóza MeSH
• prospektivní studie MeSH
• studie případů a kontrol MeSH
• těhotenský plazmatický protein A analýza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: This study was designed to evaluate vitamin D status with separate determination of 25-OH D2 and 25-OH D3 and its relationship to vitamin D binding protein (VDBP) in patients with chronic kidney disease (CKD) and long-term haemodialysis patients (HD). METHODS: 45 CKD patients, 103 HD patients, and 25 controls (C) were included. Plasma vitamin D concentrations were determined using chromatography and VDBP in serum and urine in CKD using enzyme immunoassay. RESULTS: Plasma vitamin D levels were lower in CKD (30.16 ± 16.74 ng/mL) and HD (18.85 ± 15.85 ng/mL) versus C (48.72 ± 18.35 ng/mL), P < 0.0001. 25-OH D3 was the dominant form of vitamin D. Serum VDBP was higher in CKD (273.2 ± 93.8 ug/mL) versus C (222 ± 87.6 ug/mL) and HD (213.8 ± 70.9 ug/mL), P = 0.0003. Vitamin D/VDBP ratio was the highest in C and the lowest in HD; however, there was no correlation between vitamin D and VDBP. Urinary concentration of VDBP in CKD (0.25 ± 0.13 ug/mL) correlated with proteinuria (r = 0.43, P = 0.003). CONCLUSIONS: Plasma levels of vitamin D are decreased in CKD patients and especially in HD patients. 25-OH D3 was the major form of vitamin D. Despite urinary losses of VDBP, CKD patients had higher serum VDBP concentrations, indicating compensatory enhanced production. Vitamin D binding protein is not involved in vitamin D deficiency.

• MeSH
• 25-hydroxyvitamin D 2 krev   MeSH
• chronická renální insuficience krev   komplikace   patologie   MeSH
• dospělí MeSH
• kalcifediol krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nedostatek vitaminu D krev   komplikace   patologie   MeSH
• protein vázající vitamin D krev   MeSH
• senioři MeSH
• vitamin D krev   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: PAPP-A is an independent mortality predictor of long term hemodialysis patients and a prognostic marker of acute coronary syndrome in general population. Cys327Cys PAPP-A polymorphism (SNP) (rs12375498) was found to be of significance in preeclampsia and the C allele of the PAPP-A C/G SNP (rs13290387) was defined as an independent risk factor for acute myocardial infarction. The aim of the study was to test the role of these PAPP-A SNPs in long term hemodialysis patients. DESIGN AND METHODS: The studied group consisted of 464 subjects - 319 long term hemodialysis patients (183 men, 136 women, 62±14years) and 145 controls (65 men, 80 women, 49±14years). A subgroup of 211 hemodialysis patients (118 men, 93 women, 63±13years) was prospectively followed up for 4.5years. During the follow up, 111 patients died, 51 of them due to cardiovascular events. PAPP-A SNPs were analyzed by DNA sequencing and serum PAPP-A was measured by TRACE. RESULTS: Both SNPs were in Hardy-Weinberg equilibrium. Allelic and genotype frequencies did not differ between patients and controls and were not related to serum PAPP-A concentrations. Cys327Cys SNP was significant for patients' survival (HR (95% CI): 1.616 (1.110-2.353), nominal p=0.012, corrected p=0.036) while C/G SNP was not. CONCLUSIONS: Our study shows for the first time the significance of Cys327Cys PAPP-A SNP (rs12375498) for overall mortality of long term hemodialysis patients. Although it does not influence the concentration of PAPP-A it still could affect the correct function of this enzyme which has to be clarified in further studies.

• MeSH
• akutní koronární syndrom genetika   terapie   MeSH
• dialýza ledvin mortalita   MeSH
• genotyp MeSH
• jednonukleotidový polymorfismus genetika   MeSH
• lidé MeSH
• polymorfismus genetický genetika   MeSH
• rizikové faktory MeSH
• těhotenský plazmatický protein A genetika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: EN-RAGE is extracellular newly identified receptor for advanced glycation end-products binding protein playing a role in inflammation. The aim was to test the relationship of EN-RAGE to prognosis of long-term hemodialysis patients (HD). DESIGN AND METHODS: This is a prospective observational cohort study in 261 HD patients followed up for five years. Laboratory parameters were measured at the beginning of the study. RESULTS: EN-RAGE was slightly but unsignificantly increased in HD patients compared with healthy controls and correlated significantly with inflammatory markers. Univariate Cox analysis demonstrated EN-RAGE as a significant predictor for mortality due to infection (HR (95%CI): 1.305 (1.063-1.602), per standard deviation, p=0.01), but this significance disappeared in multivariate Cox analysis when CRP was included into the model. CONCLUSIONS: Our study demonstrates EN-RAGE as an inflammatory biomarker. It is related to mortality of HD patients due to infection, but in our study, it did not provide additional information to CRP.

• MeSH
• biologické markery krev   MeSH
• C-reaktivní protein analýza   MeSH
• časové faktory MeSH
• dialýza ledvin mortalita   MeSH
• infekce metabolismus   mortalita   MeSH
• kardiovaskulární nemoci metabolismus   mortalita   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• multivariační analýza MeSH
• prognóza MeSH
• proporcionální rizikové modely MeSH
• prospektivní studie MeSH
• proteiny S100 krev   MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND/AIMS: Pregnancy-associated plasma protein A (PAPP-A) is a biomarker related to vascular damage. The aim of the study was to focus on PAPP-A and related parameters and their relationship to the prognosis of long-term hemodialysis (HD) patients. METHODS: This is a prospective observational cohort study which included 261 long-term HD patients followed up for 5 years and 66 healthy subjects. PAPP-A, placental growth factor (PlGF), matrix metalloproteinase 2 and 9 (MMP-2, MMP-9), insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein-4 (IGFBP-4), and cardiac, nutritional and inflammatory parameters were measured at the beginning of the study and tested as predictors of mortality. RESULTS: PAPP-A, PlGF, IGF-1, IGFBP-4 and MMP-2 were significantly increased in HD patients compared to controls (PAPP-A 27.6 ± 15.5 mIU/l in HD vs. 9.4 ± 2.5 mIU/l in controls, p < 0.001). Increased PAPP-A was a significant independent predictor of overall mortality and mortality due to infection in the multivariate Cox analysis [HR (95% CI): 1.237 (1.060-1.444), p = 0.007, and 1.416 (1.115-1.798), p = 0.004, per standard deviation, respectively]. PAPP-A was not related to cardiovascular mortality. CONCLUSION: Increased PAPP-A is a significant independent predictor of overall mortality and mortality due to infection but it was not related to cardiovascular mortality in this study.

• MeSH
• biologické markery krev   MeSH
• časové faktory MeSH
• dialýza ledvin mortalita   trendy   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití trendy   MeSH
• následné studie MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• senioři MeSH
• těhotenský plazmatický protein A metabolismus   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

OBJECTIVE: Levels of high-density lipoprotein (HDL) cholesterol as well as its functional roles are suppressed in chronic kidney disease because of ongoing chronic microinflammatory state. We hypothesized that intervention aimed at reducing inflammation may improve the levels and activity of HDL cholesterol as well as survival of our patients. METHODS: In this prospective follow-up study, we selected 67 patients (33 women, 34 men) on chronic hemodialysis (23.5 months [range, 10 to 34], aged 67.5 years [range, 39 to 90 years]). Targeted examination for asymptomatic infective foci or poor function of arterio-venous (AV)-fistula was carried out after a detailed initial clinical examination in all patients. Individual intervention was performed according to examination results. Blood was drawn for analysis of HDL cholesterol; interleukin-6, its soluble receptor, monocyte chemoattractant protein 1 (MCP-1), total iron binding capacity, and high sensitivity C-reactive protein at the beginning of the study and after 3 months. The patients were then closely followed up for 2 years during which the occurrence and cause of death was registered. RESULTS: A significant decrease of inflammatory parameters (Interleukin-6: 4.9 vs. 1.1 pg/mL, P > .001 and MCP-1: 397 vs. 310 pg/mL, P = .02) and increase of HDL cholesterol (1.22 ± 0.55 vs. 1.33 ± 0.55; P = .003) was seen in the entire study population. No difference in survival was found between the different interventional groups. The 2-year death rate was 37%. On using Kaplan-Meier analysis, a significantly better survival in patients with increase of HDL cholesterol (77% vs. 50%; P = .013) and/or a decrease of MCP-1 (81% vs. 53%; P = .04) was found after 3 months of intervention. CONCLUSIONS: It was concluded that individually aimed intervention may improve levels of HDL cholesterol and MCP-1. Changes in these 2 parameters can predict the 2-year survival rates of patients.

• MeSH
• antiflogistika krev   MeSH
• arteriovenózní zkrat MeSH
• balónková angioplastika MeSH
• C-reaktivní protein metabolismus   MeSH
• chemokin CCL2 metabolismus   MeSH
• chronické selhání ledvin mortalita   terapie   MeSH
• dialýza ledvin MeSH
• dospělí MeSH
• HDL-cholesterol krev   MeSH
• interleukin-6 metabolismus   MeSH
• katetrizace MeSH
• LDL-cholesterol krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• následné studie MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• práce podpořená grantem MeSH

Úvod: Hemodialýza (HD) je metóda založená na difúzii a ultrafiltrácii (UF). UF spôsobuje zníženie objemu intravaskulárneho kompartmentu (IVCV Pokles IVC je možné monitorovať a ukazuje sa, že môže bežne dosahovať 10-15 %, ale s individuálne odlišnou hemodynamickou odozvou. V priebehu hemodialýzy toleranciu ultrafiltrácie kontrolujeme meraním krvného tlaku a pulzu, čiže sledujeme systémovú odozvu. Nijako však nesledujeme, či a aká je odozva ultrafiltrácie, resp. zmien intravaskulárneho objemu v mikrocirkulácii. Pacienti s end stage renal disease (ESRD) významne trpia aterosklerózou a artériosklerózou (spolu s mediokalcinózou), ktoré zhoršujú prekrvenie ich periférnou mikrocirkuláciou. Tento stav môže spôsobovať tvorenie kožných defektov a zabraňovať ich úspešnému zhojeniu. Testovali sme hypotézu, že odozva v periférnej mikrocirkulácii sa dá zmerať prístrojom LDLS a že hemodialýza znižuje prietok krvi v koži. Metodika: Merali sme prietok krvi v koži u 36 hemodynamicky stabilných pacientov (22 mužov, 14 žien, 60,5 (36-79) rokov) na chronickej hemodialýze (33 (1-162) mesiacov). K meraniu sme použili prístroj Laser doppler ľme scanner (LDLS). Zhodnotili jsme 10 oblastí na každej ruke každého sledovaného pacienta (dorzum ruky a dorzálna strana prstov). K štatistickému zhodnoteniu sme použili dvojvýberový t- test, Spearmanov korelačný koeficient a Fisherov presný test. Výsledky: Metoda LDLS ukázala významné rozdiely v periférnom prekrvení, aj keď krvný tlak sa nezmenil. V 64 % percentách sledovaných oblastí sme zistili, že prietok klesol. Tendencia k poklesu (73 % oblastí) bola všeobecne vyššia na dorze ruky, na rozdiel od prstov, kde bol v 49 % oblastí pozorovaný pokles a v 51 % žiadna zmena alebo vzostup prekrvenia. Našli sme stredne významnú koreláciu medzi SrAlb, TIBC, Ca x P so zmenou prietoku krvi. Záver: Hemodialýza s UF negatívne ovplyvňujú periférnu mikrocirkuláciu. Túto zmenu je možné neinvazívne sledovať. Zmeny mikrocirkulácie sme pozorovali, aj keď nenastali žiadne zmeny v krvnom tlaku. Zmeny mikrocirkulácie boli natoľko výrazné, že sa domnievame, že môžu napomáhať tvorbe a zhoršovať hojenie kožných defektov.

Introduction: Hemodialysis (HD) is a method based on diffusion and ultrafiltration (UF). UF causes decrease in volume of intrav ascular fluid (IVF). It is possible to monitor this change, which can commonly reach 10-15%, with individually different hemodynamic response, however. We control tolerance of ultrafiltration during hemodialysis by monitoring the systemic response (e.g. measur ing the heart rate and blood pressure). However, we don’t follow the change in microcirculation as response to ultrafiltration or c hange in intravascular fluid. End stage renal disease patients suffer extensively from atherosclerosis and arteriosclerosis (together with mediocalcinosis) that worsen their blood flow in skin microcirculation. This can cause development skin defects and worsen thei r possible healing. We tested the hypothesis that Laser Doppler Line Scanner (LDLS) can measure response to UF in skin microcirculation and that hemodialysis worsens skin blood flow. Methods: We used LDLS to measure skin blood flow in 36 hemodynamically stable patients (22 male, 14 female, 60,5 (36-79) years old) on chronic hemodialysis (33 (1-162) months). We evaluated 10 regions of interest on the dorsal parts of hand and fingers o f every hand in all patients. We used t-test, Fisher exact test and Spearmans rank order correlation for statistical evaluation. Results: LDLS measuring method showed significant differences in peripheral blood flow, even if blood pressure has not changed. We found blood flow decrease in 64% of evaluated regions. The tendency to decrease was more apparent on the dorsal part of the hand than the fingers (73% vs. 49% respectively). Increase/ no change in blood flow was found in 51% of areas on fingers. We found medium strong correlation between albumin (S-Alb), total iron binding capacity (TIBC), calcium-phosphate product (Ca x P) and change in blood flow respectively. Conclusion: Hemodialysis with UF negatively influences peripheral microcirculation. It is possible to monitor this change non-invasively. We found changes in skin microcirculation even if there was no change in blood flow. The changes in skin microcirculation were so significant that we believe they can induce development and worsen healing of skin defects.

• MeSH
• dermatitida etiologie   komplikace   MeSH
• dialýza ledvin metody   škodlivé účinky   MeSH
• finanční podpora výzkumu jako téma MeSH
• financování organizované MeSH
• interpretace statistických dat MeSH
• lidé MeSH
• mikrocirkulace fyziologie   patofyziologie   MeSH
• poruchy výživy metabolismus   terapie   MeSH
• regionální krevní průtok genetika   MeSH
• rychlost toku krve fyziologie   MeSH
• zánět komplikace   MeSH
• Check Tag
• lidé MeSH