Endotoxaemia in Haemodialysis: A Novel Factor in Erythropoetin Resistance?

Background/Objectives Translocated endotoxin derived from intestinal bacteria is a driver of systemic inflammation and oxidative stress. Severe endotoxaemia is an underappreciated, but characteristic finding in haemodialysis (HD) patients, and appears to be driven by acute repetitive dialysis induced circulatory stress. Resistance to erythropoietin (EPO) has been identified as a predictor of mortality risk, and associated with inflammation and malnutrition. This study aims to explore the potential link between previously unrecognised endotoxaemia and EPO Resistance Index (ERI) in HD patients. Methodology/Principal Findings 50 established HD patients were studied at a routine dialysis session. Data collection included weight, BMI, ultrafiltration volume, weekly EPO dose, and blood sampling pre and post HD. ERI was calculated as ratio of total weekly EPO dose to body weight (U/kg) to haemoglobin level (g/dL). Mean haemoglobin (Hb) was 11.3±1.3 g/dL with a median EPO dose of 10,000 [IQR 7,500–20,000] u/wk and ERI of 13.7 [IQR 6.9–23.3] ((U/Kg)/(g/dL)). Mean pre-HD serum ET levels were significantly elevated at 0.69±0.30 EU/ml. Natural logarithm (Ln) of ERI correlated to predialysis ET levels (r = 0.324, p = 0.03) with a trend towards association with hsCRP (r = 0.280, p = 0.07). Ln ERI correlated with ultrafiltration volume, a driver of circulatory stress (r = 0.295, p = 0.046), previously identified to be associated with increased intradialytic endotoxin translocation. Both serum ET and ultrafiltration volume corrected for body weight were independently associated with Ln ERI in multivariable analysis. Conclusions This study suggests that endotoxaemia is a significant factor in setting levels of EPO requirement. It raises the possibility that elevated EPO doses may in part merely be identifying patients subjected to significant circulatory stress and suffering the myriad of negative biological consequences arising from sustained systemic exposure to endotoxin

Fabrication of current confinement aperture structure by transforming a conductive GaN:Si epitaxial layer into an insulating GaOx layer

We report here a simple and robust process to convert embedded conductive GaN epilayers into insulating GaOx and demonstrate its efficacy in vertical current blocking and lateral current steering in a working LED device. The fabrication processes consist of laser scribing, electrochemical (EC) wet-etching, photoelectrochemical (PEC) oxidation, and thermal oxidization of a sacrificial n(+)-GaN:Si layer. The conversion of GaN is made possible through an intermediate stage of porosification where the standard n-type GaN epilayers can be laterally and selectively anodized into a nanoporous (NP) texture while keeping the rest of the layers intact. The fibrous texture of NP GaN with an average wall thickness of less than 100 nm dramatically increases the surface-to-volume ratio and facilitates a rapid oxidation process of GaN into GaOX. The GaOX aperture was formed on the n-side of the LED between the active region and the n-type GaN layer. The wavelength blueshift phenomena of electroluminescence spectra is observed in the treated aperture-emission LED structure (441.5 nm) when compared to nontreated LED structure (443.7 nm) at 0.1 mA. The observation of aperture-confined electroluminescence from an InGaN LED structure suggests that the NP GaN based oxidation will play an enabling role in the design and fabrication of III-nitride photonic devices