Circulating Klotho levels: clinical relevance and relationship with tissue Klotho expression

Klotho is a protein that exerts paracrine and endocrine functions. In chronic kidney disease (CKD), its expression is decreased in several tissues. This decrease probably plays important roles in various complications associated with CKD, in both a fibroblast growth factor-23 (FGF23)-dependent and an FGF23-independent manner. The clinical diagnosis of Klotho deficiency is not easy. The relevance of circulating Klotho levels, if any, needs to be adequately defined. Serum Klotho may not reflect tissue Klotho concentration

miR-223: An inflammatory oncomiR enters the cardiovascular field

AbstractMicroRNAs (miRNAs) are small, noncoding RNAs of 18–22 nucleotides in length that regulate post-transcriptional expression by base-pairing with target mRNAs. It is now clearly established that miRNAs are involved in most of the cell's physiopathological processes (including carcinogenesis and metabolic disorders). This review focuses on miR-223, which was first described as a modulator of hematopoietic lineage differentiation. We outline the role of miR-223 deregulation in several types of cancers and highlight its inclusion in a newly identified and fast-growing family of miRNAs called oncomiRs. We then look at miR-223's emerging role in inflammatory and metabolic disorders, with a particular focus on muscle diseases, type II diabetes, atherosclerosis and vascular calcification. miR-223 is one of the growing number of RNA biomarkers of various human metabolic diseases and is thus of special interest to both researchers and clinicians in the cardiovascular field

Maintenance haemodialysis with low dialysate flow rates in Senegal

Introduction: The objective of the study reported here was to demonstrate that maintenance haemodialysis using a reduced dialysate flow rate of 300 mL/min (RQD) is not inferior to haemodialysis using the standard flow rate of 500 mL/min (SQD) in respect of the delivered dose of dialysis. Methods: A prospective, single-centre, sequential study was performed at the haemodialysis  centre of Pikine Hospital in Dakar. Twenty patients were included. During the first week, three haemodialysis sessions were performed with SQD and during the second week three haemodialysis  sessions were conducted with RQD for each patient. Results: For SQD, the mean eKt/V was 1.38 ± 0.58. There were 38 (63%) sessions with eKt/V greater than 1.2 and 16 patients (80%) had adequate dialysis, based on the average eKt/V. For RQD, the mean eKt/V was 1.2 ± 0.43 with 25 sessions (42%) having an eKt/V greater than 1.2. There were 11 patients (55%) with adequate dialysis. The dialysis dose was higher with the SQD prescription (P < 0.001). Ten patients with dry weight ≤60 kg had adequate dialysis with RQD. Cases of hypokalaemia were significantly higher with the SQD (P = 0.001). Conclusions: RQD appears to be inferior in terms of dialysis dose. However, for patients with dry weight ≤60 kg, adequate dialysis could be delivered with RQD, consequently allowing substantial saving of water in haemodialysis

Estimated glomerular filtration rate is a poor predictor of the concentration of middle molecular weight uremic solutes in chronic kidney disease

Background: Uremic solute concentration increases as Glomerular Filtration Rate (GFR) declines. Weak associations were demonstrated between estimated GFR (eGFR) and the concentrations of several small water-soluble and protein-bound uremic solutes (MW500Da). Materials and Methods: In 95 CKD-patients (CKD-stage 2-5 not on dialysis), associations between different eGFR-formulae (creatinine, CystatinC-based or both) and the natural logarithm of the concentration of several LMWP's were analyzed: i.e. parathyroid hormone (PTH), Cystatin C (CystC), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), leptin, retinol binding protein (RbP), immunoglobin light chains kappa and lambda (Ig-kappa and Ig-lambda), beta-2-microglobulin (beta M-2), myoglobin and fibroblast growth factor-23 (FGF-23)). Results: The regression coefficients (R-2) between eGFR, based on the CKD-EPI-Crea-CystC-formula as reference, and the examined LMWP's could be divided into three groups. Most of the LMWP's associated weakly (R-2 0.7). Almost identical R-2-values were found per LMWP for all eGFR-formulae, with exception of CystC and beta M-2 which showed weaker associations with creatinine-based than with CystC-based eGFR. Conclusion: The association between eGFR and the concentration of several LMWP's is inconsistent, with in general low R-2-values. Thus, the use of eGFR to evaluate kidney function does not reflect the concentration of several LMWP's with proven toxic impact in CKD

Chronic kidney disease

Chronic kidney disease (CKD) is defined by persistent urine abnormalities, structural abnormalities or impaired excretory renal function suggestive of a loss of functional nephrons. The majority of patients with CKD are at risk of accelerated cardiovascular disease and death. For those who progress to end-stage renal disease, the limited accessibility to renal replacement therapy is a problem in many parts of the world. Risk factors for the development and progression of CKD include low nephron number at birth, nephron loss due to increasing age and acute or chronic kidney injuries caused by toxic exposures or diseases (for example, obesity and type 2 diabetes mellitus). The management of patients with CKD is focused on early detection or prevention, treatment of the underlying cause (if possible) to curb progression and attention to secondary processes that contribute to ongoing nephron loss. Blood pressure control, inhibition of the renin-angiotensin system and disease-specific interventions are the cornerstones of therapy. CKD complications such as anaemia, metabolic acidosis and secondary hyperparathyroidism affect cardiovascular health and quality of life, and require diagnosis and treatmen

A snapshot of European registries on chronic kidney disease patients not on kidney replacement therapy

Non peer reviewe

Blueprint for a european calciphylaxis registry initiative. the european calciphylaxis network (eucalnet)

Calcific uraemic arteriolopathy (CUA) is a rare disease and continues to be a clinical challenge. The typical course of CUA is characterized by painful skin discolouration and induration evolving to necrotic ulcerations. Medial calcification of cutaneous arterioles and extensive extracellular matrix remodelling are the hallmarks of CUA. The epidemiology and risk factors associated with this disease are still not fully understood. Moreover, CUA treatment strategies vary significantly among centres and expert recommendations are heterogeneous. Registries may provide important insights and information to increase our knowledge about epidemiology and clinical aspects of CUA and may help to optimize its therapeutic management. In 2006, we established an internet-based registry in Germany (www.calciphylaxie.de) to allow online notification of patients with established or suspected CUA. The registry includes a comprehensive database with questions covering >70 parameters and items regarding patient-related and laboratory data, clinical background and presentation as well as therapeutic strategies. The next phase will be to allow international patient registration via www.calciphylaxis.net as part of the multinational EuCalNet (European Calciphylaxis Network) initiative, which is supported by the ERA-EDTA scientific working group 'CKD-MBD'. Based on the valuable experience with the previous German CUA registry, EuCalNet will be a useful tool to collect data on the rare disease CUA and may become a basis for prospective controlled trials in the near future