Extension of Healthy Life Span of Dialysis Patients in the Era of a 100-Year Life

Malnutrition is becoming a more prominent health problem, with an increasing number of elderly CKD patients being put on dialysis. In addition, the presence of inflammation, sarcopenia/frailty, diabetes, and CVD is a definite and independent risk factor associated with higher mortality in this population. Although the restriction of protein intake has been recommended to protect eGFR decline, hyperphosphatemia, and hyperkalemia in CKD patients, it might accelerate the loss of skeletal muscle and adipose mass, leading to a poor prognosis. Therefore, flexible responses are considered regarding whether protein restriction should be continued or loosened in pre-dialysis CKD patients. In undernourished elderly patients undergoing hemodialysis, sufficient calorie/protein intake is necessary to counteract the development of sarcopenia/frailty. It is expected that the application of new drugs including phosphate binders and potassium chelators may achieve both a high enough intake and balanced levels of phosphate and potassium. Furthermore, the improvement of deficient micronutrients and poor appetite is also necessary. Comprehensive care is essential for the wellbeing of elderly patients undergoing hemodialysis. The topicof this Special Issue is “Extension of Healthy Life Span of Dialysis Patients in the Era of a 100-Year Life”

Studies on the Occurrence of Microbial Infections as a Consequence of Frequent Blood Transfusions

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Smoking and Second Hand Smoking in Adolescents with Chronic Kidney Disease: A Report from the Chronic Kidney Disease in Children (CKiD) Cohort Study

The goal of this study was to determine the prevalence of smoking and second hand smoking [SHS] in adolescents with CKD and their relationship to baseline parameters at enrollment in the CKiD, observational cohort study of 600 children (aged 1-16 yrs) with Schwartz estimated GFR of 30-90 ml/min/1.73m2. 239 adolescents had self-report survey data on smoking and SHS exposure: 21 [9%] subjects had “ever” smoked a cigarette. Among them, 4 were current and 17 were former smokers. Hypertension was more prevalent in those that had “ever” smoked a cigarette (42%) compared to non-smokers (9%), p\u3c0.01. Among 218 non-smokers, 130 (59%) were male, 142 (65%) were Caucasian; 60 (28%) reported SHS exposure compared to 158 (72%) with no exposure. Non-smoker adolescents with SHS exposure were compared to those without SHS exposure. There was no racial, age, or gender differences between both groups. Baseline creatinine, diastolic hypertension, C reactive protein, lipid profile, GFR and hemoglobin were not statistically different. Significantly higher protein to creatinine ratio (0.90 vs. 0.53, p\u3c0.01) was observed in those exposed to SHS compared to those not exposed. Exposed adolescents were heavier than non-exposed adolescents (85th percentile vs. 55th percentile for BMI, p\u3c 0.01). Uncontrolled casual systolic hypertension was twice as prevalent among those exposed to SHS (16%) compared to those not exposed to SHS (7%), though the difference was not statistically significant (p= 0.07). Adjusted multivariate regression analysis [OR (95% CI)] showed that increased protein to creatinine ratio [1.34 (1.03, 1.75)] and higher BMI [1.14 (1.02, 1.29)] were independently associated with exposure to SHS among non-smoker adolescents. These results reveal that among adolescents with CKD, cigarette use is low and SHS is highly prevalent. The association of smoking with hypertension and SHS with increased proteinuria suggests a possible role of these factors in CKD progression and cardiovascular outcomes

Progress in Hemodialysis

Hemodialysis (HD) represents the first successful long-term substitutive therapy with an artificial organ for severe failure of a vital organ. Because HD was started many decades ago, a book on HD may not appear to be up-to-date. Indeed, HD covers many basic and clinical aspects and this book reflects the rapid expansion of new and controversial aspects either in the biotechnological or in the clinical field. This book revises new technologies and therapeutic options to improve dialysis treatment of uremic patients. This book consists of three parts: modeling, methods and technique, prognosis and complications

Atherogenesis

This monograph will bring out the state-of-the-art advances in the dynamics of cholesterol transport and will address several important issues that pertain to oxidative stress and inflammation. The book is divided into three major sections. The book will offer insights into the roles of specific cytokines, inflammation, and oxidative stress in atherosclerosis and is intended for new researchers who are curious about atherosclerosis as well as for established senior researchers and clinicians who would be interested in novel findings that may link various aspects of the disease

Treatment of Later Humoral Rejection with Anti-CD20 Monoclonal Antibody Rituximab: A Single Centre Experience

Humoral or vascular rejection is a B cell-mediated production of immunoglobulin (Ig) G antibody against a transplanted organ that results in immune complex deposition on the vascular endothelium, activation of the complement cascade, production of endothelial dysfunction and regional ischaemic injury