Serum VEGF-C levels as a candidate biomarker of hypervolemia in chronic kidney disease

Sahutoglu, Tuncay/0000-0003-2015-4421; sevinc, mustafa/0000-0003-2804-4884; Hasbal, Nuri Baris/0000-0002-2229-5140WOS: 000400842700005PubMed: 28471955Attaining and maintaining optimal "dry weight" is one of the principal goals during maintenance hemodialysis (MHD). Recent studies have shown a close relationship between Na+ load and serum vascular endothelial growth factor-C (VEGF-C) levels; thus, we aimed to investigate the role of VEGF-C as a candidate biomarker of hypervolemia. Physical examination, basic laboratory tests, N-terminal pro b-type natriuretic peptide (NT-ProBNP), echocardiography, and bioimpedance spectroscopy data of 3 groups of study subjects (euvolemic MHD patients, healthy controls, and hypervolemic chronic kidney disease [CKD] patients) were analyzed. Research data for MHD patients were obtained both before the first and after the last hemodialysis (HD) sessions of the week. Data of 10 subjects from each study groups were included in the analysis. Serum VEGF-C levels were significantly higher in hypervolemic CKD versus in MHD patients both before the first and after the last HD sessions (P=.004 and P=.000, respectively). Healthy controls had serum VEGF-C levels similar to and higher than MHD patients before the first and after the last HD sessions of the week (P=.327 and P=.021, respectively). VEGF-C levels were correlated with bioimpedance spectroscopy results (r(2) 0.659, P=. 000) and edema (r(2) 0.494, P=0.006), but not with ejection fraction (EF) (r(2) -0.251, P=.134), blood pressures (systolic r(2) 0.037, P=0.824, diastolic r(2) -0.067, P=.691), and NT-ProBNP (r(2) -0.047, P=.773). These findings suggest that serum VEGF-C levels could be a potential new biomarker of hypervolemia. the lack of correlation between VEGF-C and EF may hold a promise to eliminate this common confounder. Further studies are needed to define the clinical utility of VEGF-C in volume management

Can eculizumab be discontinued in aHUS? Case report and review of the literature

Nephrolog

Renal Damage Frequency in Patients with Solitary Kidney and Factors That Affect Progression

Background. The aim of this study is to assess renal damage incidence in patients with solitary kidney and to detect factors associated with progression. Methods. Medical records of 75 patients with solitary kidney were investigated retrospectively and divided into two groups: unilateral nephrectomy (group 1) and unilateral renal agenesis/dysplasia (group 2). According to the presence of kidney damage, each group was divided into two subgroups: group 1a/b and group 2a/b. Results. Patients in group 1 were older than those in group 2 (p=0.001). 34 patients who comprise group 1a had smaller kidney size (p=0.002) and higher uric acid levels (p=0.028) than those in group 1b at presentation. Uric acid levels at first and last visit were associated with renal damage progression (p=0.004, 0.019). 18 patients who comprise group 2a were compared with those in group 2b in terms of presence of DM (p=0.038), HT (p=0.003), baseline proteinuria (p=0.014), and uric acid (p=0.032) levels and group 2a showed higher rates for each. Progression was more common in patients with DM (p=0.039), HT (p=0.003), higher initial and final visit proteinuria (p=0.014, for both), and higher baseline uric acid levels (p=0.047). Conclusions. The majority of patients with solitary kidney showed renal damage at presentation. Increased uric acid level is a risk factor for renal damage and progression. For early diagnosis of renal damage and reducing the risk of progression, patients should be referred to a nephrologist as early as possible

Renal Damage Frequency in Patients with Solitary Kidney and Factors That Affect Progression

Background. The aim of this study is to assess renal damage incidence in patients with solitary kidney and to detect factors associated with progression. Methods. Medical records of 75 patients with solitary kidney were investigated retrospectively and divided into two groups: unilateral nephrectomy (group 1) and unilateral renal agenesis/dysplasia (group 2). According to the presence of kidney damage, each group was divided into two subgroups: group 1a/b and group 2a/b. Results. Patients in group 1 were older than those in group 2 ( = 0.001). 34 patients who comprise group 1a had smaller kidney size ( = 0.002) and higher uric acid levels ( = 0.028) than those in group 1b at presentation. Uric acid levels at first and last visit were associated with renal damage progression ( = 0.004, 0.019). 18 patients who comprise group 2a were compared with those in group 2b in terms of presence of DM ( = 0.038), HT ( = 0.003), baseline proteinuria ( = 0.014), and uric acid ( = 0.032) levels and group 2a showed higher rates for each. Progression was more common in patients with DM ( = 0.039), HT ( = 0.003), higher initial and final visit proteinuria ( = 0.014, for both), and higher baseline uric acid levels ( = 0.047). Conclusions. The majority of patients with solitary kidney showed renal damage at presentation. Increased uric acid level is a risk factor for renal damage and progression. For early diagnosis of renal damage and reducing the risk of progression, patients should be referred to a nephrologist as early as possible

Differences in Comorbidity Burden Between those with Chronic Kidney Disease and Normal Renal Function

Introduction and Aims: Chronic kidney disease (CKD) and renal replacement therapy are both associated with significant mortality and morbidity. Co-existing comorbidity is common. The degree to which the increased morbidity and mortality is a result of the CKD, and how much a result of the co-existing comorbidity is less clear. We aimed to describe the range of comorbidity at baseline in a population cohort containing all identified within a healthcare region with CKD, those on RRT and a sample of 20,000 individuals from the same population with normal renal function. Methods: The GLOMMS-II cohort contained all individuals with a low eGFR (<60) ml/min/1.73m2 measured in our healthcare region in 2003 (in 2/3 of these with “CKD” the low eGFR was present for at least 90 days, in 1/3 with “impaired eGFR” it was not present for at least 90 days); all those with raised PCR and ACR; all those receiving RRT and a 20,000 sample of those with only normal eGFR measurements in 2003. Data-linkage to hospital episode statistics in the five years prior gave information on comorbidity in 2003. The prevalence of common comorbidities in the subgroups of the cohort is described. The odds of having each comorbidity at baseline with adjustment for age and sex are presented. Results: The prevalence of most comorbidities was higher in those with more advanced CKD (including RRT, as table). After correction for age and sex, vascular comorbidity, diabetes and haematological malignancy continued to be strongly associated with more advanced CKD. The association for other comorbidities was less marked, particularly for dementia. Impaired eGFR was also associated with many of these comorbidities Conclusions: More advanced CKD was strongly associated with vascular comorbidity and diabetes even after correction for age. This association may in part be due to the role of these comorbidities in the aetiology of CKD, as well as a consequence. In the assessment of outcomes in CKD, the effect of these comorbidities on outcome over and above that of CKD itself should be investigated further