Существует ли связь между средним уровнем mIDkIne и прогнозом заболевания COVID-19?

   The objective was aimed to measure plasma midkine (MK)* levels in patients with COVID-19 and assess its clinical significance.   Materials and Methods. 88 patients observed in our hospital with a diagnosis of COVID-19 were included in the study. The patients’ demographic characteristics, clinical, and laboratory data were studied, and the relationship between MK levels, prognosis, and other parameters was investigated.   Results. Of the 88 patients included in the study, 43 (48.9 %) were female and 45 (51.1%) were male. 24 (27%) patients died. The mean age of non-survivors was 70 ± 12.3 years and the survivors were 61.9 ± 18.2 years. Mortality predictors such as D-dimer, ferritin, troponin, LDH, CRP, and procalcitonin were significantly higher in non-survivors than in survivors (p < 0.05). The median MK level (IR) was 152.5 ± 125 pg/ml in all patients, 143 ± 149 pg/ml in survivors, and 165.5 ± 76 pg/ml in non-survivors (p = 0.546). The difference between these two groups was not statistically significant. The area under the ROC curve was found to be 0.542 (95% CI 0.423–0.661, p = 0.546).   Conclusion. MK is not a biomarker that can replace or reinforce known predictors of mortality in COVID-19 patients.   Цель. Исследование направлено на измерение уровня Midkine (MK)* в плазме крови у пациентов с COVID-19 и оценку его клинической значимости.   Материалы и методы. В исследование включены 88 пациентов, наблюдавшихся в клинике с диагнозом COVID-19. Изучены демографические характеристики пациентов, клинические и лабораторные данные, а также исследована взаимосвязь между уровнями MK, прогнозом и другими параметрами.   Результаты. Из 88 пациентов, включенных в исследование, 43 (48,9 %) были женщинами и 45 (51,1 %) – мужчинами. 24 (27 %) пациента умерли. Средний возраст невыживших составил 70 ± 12,3 года, а выживших – 61,9 ± 18,2 года. Предикторы смертности, такие как D-димер, ферритин, тропонин, ЛДГ, СРБ и прокальцитонин, были значительно выше у умерших, чем у выживших (р < 0,05). Медиана уровня МК (IR) составила 152,5 ± 125 пг/мл у всех пациентов, 143 ± 149 пг/мл у выживших и 165,5 ± 76 пг/мл у умерших (р = 0,546). Разница между этими 2 группами была незначима. Было обнаружено, что площадь под кривой ROC составляет 0,542 (95 % ДИ 0,423–0,661, р = 0,546).   Вывод. МК не является биомаркером, который может заменить или усилить известные предикторы смертности у пациентов с COVID-19

Early Switch to Mammalian Target of Rapamycin Inhibitors Is a Sustainable Treatment Approach in Renal Transplant Recipients: 7-Year Results

PMID = 3098140

Congenital adrenal hyperplasia: A rare cause of renal failure and a successful renal transplantation

PubMed ID: 22790459Congenital adrenal hyperplasia belongs to a group of autosomal recessive disorders affecting steroid biosynthesis; a rare disease with a prevalence of 1 case per 16,000 population. A 30-year-old phenotypically male patient had been diagnosed with 11-ß hydroxylase deficiency at the age of 16; presenting with ambiguous genitalia, growth retardation, presence of menstrual cycles, severe hypertension, hypokalemia and renal dysfunction. He developed end-stage renal disease due to hypertension and was treated with hemodialysis for 3 years. After careful evaluation, he was approved to undergo renal transplantation. The patient has now finished 6th month after transplantation and is currently under follow-up at our out-patient clinic, having no problems related to the transplant. While early treatment to prevent hypertension is mandatory in patients with congenital adrenal hyperplasia, once renal failure occurs, renal transplantation may the best choice of treatment. In this study, we describe the first report of a successful renal transplantation in an adrenal hyperplasia. © 2012 Dustri-Verlag Dr. K. Feistle

The extracellular water corrected for height predicts technique survival in peritoneal dialysis patient

OBJECTIVE: Most patients on peritoneal dialysis (PD) consume a normal Western diet that contains a large amount of salt. This causes increase in extracellular volume ("fluid overload") that has to be removed mostly with the dialysis fluid, as residual renal function (if present) cannot cope with it. In the present study, we prospectively investigated whether an increased extracellular volume (corrected for height) predicted technique survival in PD patients. MATERIAL and METHODS: Ninety-five prevalent PD patients from one center (mean age 50±13 years, 10 of them diabetic) were studied. Extracellular water (ECW), total body water (TBW), and intracellular water (ICW) were measured by multi-frequency bioimpedance analysis (m-BIA). Echocardiography was performed in all patients. Volume status was also evaluated by measuring left atrium diameter (LAD) and left ventricular end-diastolic diameter (LVEDD). Demographical, biochemical analyses, peritoneal equilibration test, weekly total Kt/V urea and weekly total creatinine clearance (CCr) results were obtained from patient chart. We identified a cut-off value for ECW/height by drawing ROC curves that differentiate patients with FO and those without, using LAD and LVEDD measured by echocardiography as confirmatory parameters. Technique survival (TS) was defined as the time on PD treatment until transfer to hemodialysis. Technique survival (TS) was assessed at the end of the follow-up and significant predictors of technique survival were investigated. RESULTS: During the follow-up, 62 patients dropped out. Thirty-six patients were switched to hemodialysis (severe peritonitis in twelve, hernia in one, peritoneal leaks in five, inadequate dialysis in seventeen and unwillingness in one patient), twelve patients received transplants, five patients were transferred to other center and nine patients died (4 patients from infection, 4 patients from cardiovascular disease and 1 patient from malignancy). Patients switched to hemodialysis were older and had higher duration of PD treatment, body mass index, ECW/height and LAD than patients that stayed on PD. Patients that switched to HD also had significantly lower weekly total KT/Vurea, weekly total CCr and daily total urine volume than patients that stayed on PD. On ROC analysis, we found a cut-off value for ECW/height of 10.5 liters/m with specificity of 78 % and sensitivity of 75% for the diagnosis of FO. Patients with the ratio of ECW/height values above the cut-off values had significantly worse technique survival than those with ECW/height below 10.5 L/m (mean survival, 28.7±2.6 vs. 35.1± 1.9 months; p=0.016). On multivariate analysis, weekly total CCr, serum CRP level and ECW/height above 10.5 L/m were independent predictors of technique failure. CONCLUSION: An increased extracellular volume corrected for height as a fluid overload marker is associated with decreased technique survival in PD patients

The aggregate index of systemic inflammation may predict mortality in COVID-19 patients with chronic renal failure

OBJECTIVE: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was first detected in December 2019 and then spread globally, resulting in a pandemic. Initially, it was unknown if chronic kidney disease (CKD) contributed to the mortality caused by COVID-19. The immunosuppression associated with this disease may minimize the COVID-19-described hyper-inflammatory state or immunological dysfunction, and a high prevalence of comorbidities may lead to a poorer clinical prognosis. Patients with COVID-19 have abnormal circulating blood cells associated with inflammation. Risk stratification, diagnosis, and prognosis primarily rely on hematological features, such as white blood cells and their subpopulations, red cell distribution width, mean platelet volume, and platelet count, in addition to their combined ratios. In non-small-cell lung cancer, the aggregate index of systemic inflammation (AISI), (neutrophils x monocytes x platelets/lymphocytes) is evaluated. In light of the relevance of inflammation in mortality, the objective of this study is to determine the impact of AISI on the hospital mortality of CKD patients. PATIENTS AND METHODS: This study is an observational retrospective study. Data and test outcomes of all CKD patients, stages 3-5, hospitalized for COVID-19 and followed between April and October 2021 were analyzed. RESULTS: Patients were divided into two groups according to death (Group 1-Alive, Group 2-Died). Neutrophil count, AISI and C-reactive protein (CRP) levels were increased in Group-2 [10.3±4.6 vs. 7.65±4.22; p=0.001, 2,084.1 (364.8-2,577.5) vs. 628.9 (53.1-2,275); p=0.00 and 141.9 (20.5-318) vs. 84.75 (0.92-195); p=0.00; respectively]. Receiver operating characteristic (ROC) analysis demonstrated 621.1 as a cut-off value for AISI to predict hospital mortality with 81% sensitivity and 69.1% specificity [area under ROC curve 0.820 (95% CI: 0.733-0.907), p<.005]. Cox regression analysis was used to analyze the effect of risk variables on survival. In survival analysis, AISI and CRP were identified as important survival predictors [hazard ratio (HR): 1.001, 95% CI: 1-1.001; p=0.00 and HR: 1.009, 95% CI: 1.004-1.013; p=0.00]. CONCLUSIONS: This study demonstrated the discriminative effectiveness of AISI in predicting disease mortality in COVID-19 patients with CKD. Quantification of AISI upon admission might assist in the early detection and treatment of individuals with a bad prognosis

The impact of membrane permeability and dialysate purity on cardiovascular outcomes

PubMed ID: 23620396The effects of high-flux dialysis and ultrapure dialysate on survival of hemodialysis patients are incompletely understood. We conducted a randomized controlled trial to investigate the effects of both membrane permeability and dialysate purity on cardiovascular outcomes. We randomly assigned 704 patients on three times per week hemodialysis to either high- or low-flux dialyzers and either ultrapure or standard dialysate using a two-by-two factorial design. The primary outcome was a composite of fatal and nonfatal cardiovascular events during aminimum3 years follow-up.We did not detect statistically significant differences in the primary outcome between high- and low-flux (HR=0.73, 95% CI=0.49 to 1.08, P=0.12) and between ultrapure and standard dialysate (HR=0.90, 95% CI=0.61 to 1.32, P=0.60). Posthoc analyses suggested that cardiovascular event-free survival was significantly better in the high-flux group compared with the low-flux group for the subgroup with arteriovenous fistulas, which constituted 82% of the study population (adjusted HR=0.61, 95% CI=0.38 to 0.97, P=0.03). Furthermore, high-flux dialysis associated with a lower risk for cardiovascular events among diabetic subjects (adjusted HR=0.49, 95% CI=0.25 to 0.94, P=0.03), and ultrapure dialysate associated with a lower risk for cardiovascular events among subjectswithmore than 3 years of dialysis (adjustedHR=0.55, 95%CI=0.31 to 0.97, P=0.04). In conclusion, this trial did not detect a difference in cardiovascular event-free survival between flux and dialysate groups. Posthoc analyses suggest that high-flux hemodialysis may benefit patients with an arteriovenous fistula and patients with diabetes and that ultrapure dialysate may benefit patients with longer dialysis vintage. Copyright © 2013 by the American Society of Nephrology