Clinical Management of Hemodialyzed Patients: From Pharmacological Interventions to Advanced Technologies

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 8755

Special Issue Editor

Nephrology and Dialysis Unit, Internal Medicine Department, Papardo Hospital, Contrada Papardo, 98158 Messina, Italy
Interests: chronic kidney disease; acute kidney injury; biomarkers; hemodialysis; immune disfunction in uremic patients; oxidative stress in dialysis; sepsis; septic shock and blood purification
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Special Issue Information

Dear Colleagues,

Uremic toxins represent independent risk factors for the mortality of hemodialyzed (HD) patients, as they are poorly removed through conventional, diffusive techniques.

Several studies have associated middle toxin molecules with the pathological features of uremia, such as immune dysfunction and inflammation, as well as adverse outcomes in HD patients.

Systemic inflammation plays a pivotal role in morbidity and mortality in these patients, contributing to atherosclerosis, cardiovascular disease, and anemia. Furthermore, immune deficiency leads to impaired response to vaccination and increased incidence, severity, and poor outcome of microbial infections.

These two entities are not mutually exclusive, but they could represent two sides of the same coin. In fact, uremic-associated inflammation is closely related to the activation of the innate immune system. Recently, medium cut-off (MCO) dialyzers have utilized a novel class of membranes designed to increase the removal of larger middle molecules in HD, demonstrating non-inferior results when compared with diffusive-convective techniques.

The aim of this Special issue is to carry out an in-depth analysis of pharmacological interventions and new technologies applied to HD patients, designing clinical management based on a personalized medicine.

Papers evaluating new biomarkers of inflammation and altered immunity status in HD patients, as well as noninvasive devices able to detect biological data in real time, are welcome.  

Dr. Paolo Monardo
Guest Editor

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Keywords

  • hemodialysis
  • renal biomarkers
  • biotechnologies
  • inflammation
  • immune dysfunction
  • HD-related comorbidities
  • real-time monitoring

Published Papers (4 papers)

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Editorial

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4 pages, 197 KiB  
Editorial
Clinical Management of Hemodialyzed Patients: From Pharmacological Interventions to Advanced Technologies
by Paolo Monardo and Antonio Lacquaniti
J. Clin. Med. 2022, 11(15), 4310; https://doi.org/10.3390/jcm11154310 - 25 Jul 2022
Viewed by 954
Abstract
Morbidity and mortality have marginally decreased over the last 3 decades in hemodialyzed (HD) patients, despite multiple pharmacological and technological interventions [...] Full article

Research

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9 pages, 2349 KiB  
Article
Effectiveness and Safety of Ultrasound-Guided Local Paricalcitol Injection in Treating Secondary Hyperparathyroidism in ESRD: A Retrospective Study
by Shuqin Xie, Yuan Yu, Yi Liu, Siliang Zhang, Shiyi Yuan, Kui Fan, Bin Tang, Qin Zhou, Yuqing Sun, Rui Liu, Dan Cao, Yong Chen, Yelei Wang, Guangjun Liu, Huan Ma, Chenghui Tao, Li Zeng and Ling Zhong
J. Clin. Med. 2022, 11(22), 6860; https://doi.org/10.3390/jcm11226860 - 21 Nov 2022
Cited by 1 | Viewed by 1407
Abstract
Purpose: To compare the safety and efficacy of percutaneous paricalcitol injection with intravenously administered paricalcitol in treating parathyroid hyperplasia in patients with secondary hyperparathyroidism (SHPT). Methods: This study was approved by the Ethics Committee of our institution. We retrospectively collected data on patients [...] Read more.
Purpose: To compare the safety and efficacy of percutaneous paricalcitol injection with intravenously administered paricalcitol in treating parathyroid hyperplasia in patients with secondary hyperparathyroidism (SHPT). Methods: This study was approved by the Ethics Committee of our institution. We retrospectively collected data on patients who received percutaneous paricalcitol injection (24 patients) and intravenously administered paricalcitol (22 patients) based on their intact parathyroid hormone (iPTH) level. Serum iPTH, calcium, phosphorus, and the volume of the parathyroid gland were measured at several indicated time points after treatment, and adverse events associated with the two treatments were evaluated. Results: After 6 months of follow-up, we found that patients from the percutaneous injection group had significantly decreased levels of iPTH (from 1887.81 ± 726.81 pg/mL to 631.06 ± 393.06 pg/mL), phosphate (from 1.94 ± 0.36 mmol/L to 1.71 ± 0.34 mmol/L), and volume of the parathyroid gland (from 0.87 ± 0.50 cm3 to 0.60 ± 0.36 cm3), with relief from ostealgia within 48–72 h. In the intravenously administered group, the levels of iPTH decreased from 686.87 ± 260.44 pg/mL to 388.47 ± 167.36 pg/mL; while there was no significant change in phosphate levels, the volume of the parathyroid gland and ostealgia relief were observed at the end of follow-up. The serum calcium level did not significantly change, and no severe complications were observed in both groups. In vitro fluorescence-activated single cell sorting (FACS) analysis indicated that paricalcitol induced parathyroid cell apoptosis in a dose-dependent manner. Conclusions: Percutaneous paricalcitol injection is a selective treatment for SHPT in ESRD. Full article
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20 pages, 1709 KiB  
Article
Energy Homeostasis Gene Nucleotide Variants and Survival of Hemodialysis Patients—A Genetic Cohort Study
by Monika Katarzyna Świderska, Adrianna Mostowska, Damian Skrypnik, Paweł Piotr Jagodziński, Paweł Bogdański and Alicja Ewa Grzegorzewska
J. Clin. Med. 2022, 11(18), 5477; https://doi.org/10.3390/jcm11185477 - 18 Sep 2022
Cited by 1 | Viewed by 1768
Abstract
Background: Patients undergoing hemodialysis (HD) therapy have an increased risk of death compared to the general population. We investigated whether selected single nucleotide variants (SNVs) involved in glucose and lipid metabolism are associated with mortality risk in HD patients. Methods: The study included [...] Read more.
Background: Patients undergoing hemodialysis (HD) therapy have an increased risk of death compared to the general population. We investigated whether selected single nucleotide variants (SNVs) involved in glucose and lipid metabolism are associated with mortality risk in HD patients. Methods: The study included 805 HD patients tested for 11 SNVs in FOXO3, IGFBP3, FABP1, PCSK9, ANGPTL6, and DOCK6 using HRM analysis and TaqMan assays. FOXO3, IGFBP3, L-FABP, PCSK9, ANGPTL6, and ANGPTL8 plasma concentrations were measured by ELISA in 86 individuals. The Kaplan–Meier method and Cox proportional hazards models were used for survival analyses. Results: We found out that the carriers of a C allele in ANGPTL6 rs8112063 had an increased risk of all-cause, cardiovascular, and cardiac mortality. In addition, the C allele of DOCK6 rs737337 was associated with all-cause and cardiac mortality. The G allele of DOCK6 rs17699089 was correlated with the mortality risk of patients initiating HD therapy. The T allele of FOXO3 rs4946936 was negatively associated with cardiac and cardiovascular mortality in HD patients. We observed no association between the tested proteins’ circulating levels and the survival of HD patients. Conclusions: The ANGPTL6 rs8112063, FOXO3 rs4946936, DOCK6 rs737337, and rs17699089 nucleotide variants are predictors of survival in patients undergoing HD. Full article
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Review

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14 pages, 771 KiB  
Review
Immune System Dysfunction and Inflammation in Hemodialysis Patients: Two Sides of the Same Coin
by Susanna Campo, Antonio Lacquaniti, Domenico Trombetta, Antonella Smeriglio and Paolo Monardo
J. Clin. Med. 2022, 11(13), 3759; https://doi.org/10.3390/jcm11133759 - 28 Jun 2022
Cited by 29 | Viewed by 4163
Abstract
Biocompatibility in hemodialysis (HD) has considerably improved in recent decades, but remains an open issue to be solved, appearing essential to reduce systemic inflammation and enhance patients’ clinical outcomes. Clotting prevention, reduction in complement and leukocyte activation, and improvement of antioxidant effect represent [...] Read more.
Biocompatibility in hemodialysis (HD) has considerably improved in recent decades, but remains an open issue to be solved, appearing essential to reduce systemic inflammation and enhance patients’ clinical outcomes. Clotting prevention, reduction in complement and leukocyte activation, and improvement of antioxidant effect represent the main goals. This review aims to analyze the different pathways involved in HD patients, leading to immune system dysfunction and inflammation. In particular, we mostly review the evidence about thrombogenicity, which probably represents the most important characteristic of bio-incompatibility. Platelet activation is one of the first steps occurring in HD patients, determining several events causing chronic sub-clinical inflammation and immune dysfunction involvement. Moreover, oxidative stress processes, resulting from a loss of balance between pro-oxidant factors and antioxidant mechanisms, have been described, highlighting the link with inflammation. We updated both innate and acquired immune system dysfunctions and their close link with uremic toxins occurring in HD patients, with several consequences leading to increased mortality. The elucidation of the role of immune dysfunction and inflammation in HD patients would enhance not only the understanding of disease physiopathology, but also has the potential to provide new insights into the development of therapeutic strategies. Full article
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