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Background: In patients with systemic lupus erythematosus (SLE), disease activity can persist even after initiating dialysis. However, guidelines for the treatment of patients with SLE after dialysis is initiated have not yet been established. Case Presentation: We describe the case of a 54-year-old Japanese woman who was diagnosed with SLE at age 12, progressed to end-stage renal disease (ESRD), and initiated hemodialysis for lupus nephritis. However, SLE activity persisted after hemodialysis. Cyclophosphamide and mycophenolate mofetil were administered in addition to prednisolone and immunoadsorption, but this treatment strategy was limited by side effects. The patient was subsequently treated with belimumab, and the activity of SLE decreased rapidly. Conclusions: ESRD patients with SLE show no significant decrease in transitional B cells and have elevated levels of B-cell activating factor (BAFF). Both transitional B cells and BAFF are important therapeutic targets for belimumab, indicating that patients with ESRD may benefit from belimumab therapy. However, the effects of belimumab may be potentiated in patients with uremia, who may be more susceptible to adverse events such as infections. Patients with SLE who receive belimumab after initiation of hemodialysis therefore require careful follow-up. Here, we report the first case of belimumab administration in a patient with SLE after initiation of hemodialysis. [ABSTRACT FROM AUTHOR]

Endothelial dysfunction is often found in both hyperuricemia and hemodialysis patients. Recent studies have shown that treating hyperuricemia with allopurinol improves endothelial dysfunction. This study is performed to assess the effect of febuxostat on endothelial dysfunction in hemodialysis patients with hyperuricemia. We randomly assigned 53 hemodialysis patients with hyperuricemia to a febuxostat (10 mg daily) group and a control group and measured flow-mediated dilation, serum uric acid ( UA) levels, systolic and diastolic blood pressure, malondialdehyde-modified low-density lipoprotein (MDA-LDL), and highly sensitive C-reactive protein ( hsCRP) at baseline and at the end of a 4-week study period. Flow-mediated dilation increased from 5.3% ± 2.4% to 8.9% ± 3.6% in the febuxostat group but did not change significantly in the control group. Treatment with febuxostat resulted in a significant decrease in serum UA level and a significant decrease in MDA-LDL compared with baseline, but no significant difference was observed in hsCRP level or blood pressure. No significant differences were observed in the control group. Febuxostat improved endothelial dysfunction and reduced serum UA levels and oxidative stress in hemodialysis patients with hyperuricemia. [ABSTRACT FROM AUTHOR]

Aim: The aim of our study was to examine the associations between vascular calcification, arterial stiffness and bone mineral density (BMD) in chronic hemodialysis (HD) patients. Methods: The study subjects were 83 (70 men and 13 women) HD patients. All patients had computed tomography (CT) to determine aortic calcification index (ACI), pulse wave velocity (PWV) using a volume-plethysmographic apparatus, and BMD estimated by digital image processing (DIP). Results: Patients, 84.3% male, 38.6% diabetic, had a mean age of 59.3 ± 11.2 years. In univariate linear regression analysis, ACI correlated positively with age ( r = 0.586, P < 0.0001), dialysis vintage ( r = 0.47, P = 0.002), pulse pressure ( r = 0.311, P = 0.004), C-reactive protein (CRP) ( r = 0.226, P = 0.0397) and PWV ( r = 0.422, P < 0.0001). There was no significant association between ACI and serum markers of mineral metabolism. There was also a positive association between PWV and systolic blood pressure ( P = 0.0004) or pulse pressure ( P < 0.0001), and a trend towards greater PWV with increasing age ( r = 0.494). In multivariate regression analysis only increasing age, pulse pressure, serum levels of albumin and CRP were significantly associated with ACI and PWV. Mean BMD on DIP was 2.7 ± 0.4 mmAL. ACI was inversely correlated with BMD ( r = −0.234, P = 0.0331). Conclusions: Vascular calcification is closely associated with arterial stiffness in HD patients. BMD is inversely correlated with ACI, suggesting that measurement of hand BMD by DIP is a useful tool for assessment of renal bone disease in these patients. [ABSTRACT FROM AUTHOR]

End-stage renal failure (ESRD) induces a clinical state of immunodeficiency with a higher incidence of infections and a higher mortality due to infectious complications compared with the normal population. Using a newly developed immunofluorescent staining of intracellular cytokines for flow cytometric analysis, we studied Th subsets in 22 healthy control subjects, 28 patients with compensated chronic renal failure (CRF), 25 patients on hemodialysis (HD), and 24 patients on continuous ambulatory peritoneal dialysis (CAPD). Our results demonstrate that the percentage of both interferon-γ-positive cells and interleukin-4-positive cells increased in compensated CRF patients compared with those in healthy subjects. Moreover, a significantly higher percentage of CD4-positive cells is characterized by a Th1-type cytokine production pattern in HD patients and by a Th2-type cytokine secretion pattern in CAPD patients. These results suggest that the altered Th1/Th2 balance may be associated with the pathogenesis of ESRD.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Vascular calcification often occurs in patients with uremia. As osteopontin (OPN) is not only involved in the physiological but also the pathological calcification of tissues, OPN may be associated with the pathogenesis of aortic calcification in hemodialysis (HD) patients. Methods: We examined the expression of OPN in atherosclerotic aortas of HD patients. In addition, we performed a prospective longitudinal study by using CT scans to detect aortic calcifications and by measuring the plasma OPN concentration by ELISA in HD patients (20 men, 16 women; mean age 55.2 ± 21.3 years) and in healthy volunteers (18 men, 17 women; mean age 54.0 ± 13.2 years). Results: By immunohistochemical staining, OPN was abundantly localized in atherosclerotic plaques of HD patients. The macrophages surrounding the atheromatous plaques were identified as the OPN-expressing cells. We furthermore found that the concentration of soluble plasma OPN was significantly higher in HD patients as compared with the concentrations in age-matched healthy volunteers (837.3 ± 443.2 vs. 315.1 ± 117.4 ng/ml, p < 0.01). The OPN concentration was positively correlated with the aortic calcification index in HD patients (r = 0.749, p < 0.01). Conclusion: These data suggest that OPN, secreted by macrophages, plays a role in the calcification of atheromatous plaques in HD patients.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Presents a study that evaluated the serum levels of thrombopoietin (TPO) and erythropoietin in hemodialysis patients with or without recombinant human erythropoietin. Methodology; Analysis of the erythropoietic activity of endogenous TPO; Effect of TPO on erythropoiesis; Relation between serum TPO levels and platelet activation.

Presents a study that examined if serum C-reactive protein is associated with the resistance to erythropoietin in patients undergoing chronic hemodialysis. Methodology; Factors that affect response to erythropoietin; Role of two types of hemodialysis membranes on the erythropoeitin requirement of the patients.

Background/Aim: Vascular calcification is thought to be associated with a high cardiovascular mortality rate in patients with end-stage renal disease. Control of hyperphosphataemia is important for the treatment of the vascular calcification. The aim of the present study was to evaluate the effects of sevelamer hydrochloride on the progression of aortic calcification in haemodialysis (HD) patients. Methods: 42 HD patients were studied in this study and divided into two groups (sevelamer vs. calcium). Sevelamer was added and titrated up to achieve serum P control for 6 months. The estimations of aortic calcification index (ACI) by abdominal computed tomography scans were performed twice in each patient. We compared the changes in serum calcium, phosphorus, intact parathyroid hormone, and lipids in two groups. Results: Serum phosphorus levels decreased significantly from 6.7 ± 0.7 to 6.2 ± 0.5 mg/dl with no changes in serum intact parathyroid hormone levels in the sevelamer group (p < 0.01), and increased from 6.5 ± 1.0 to 6.7 ± 1.1 mg/dl in the calcium group (p < 0.05). Serum calcium levels did not change in the sevelamer group and calcium group. The serum levels of total cholesterol decreased significantly from 158.5 ± 20.7 to 146.2 ± 24.1 mg/dl (p = 0.024) and the low-density lipoprotein cholesterol level from 65.3 ± 14.4 to 54.7 ± 11.6 mg/dl (p = 0.014) in the sevelamer group. Serum C-reactive protein decreased significantly from 0.14 ± 0.13 to 0.08 ± 0.11 mg/dl in the sevelamer group (p = 0.038) and significantly increased (0.18 ± 0.09 vs. 0.22 ± 0.12 mg/dl) in the calcium group (p = 0.042). The mean changes in ACI (ΔACI) were 3.6 ± 1.5% in the sevelamer group and 8.2 ± 3.1% in the calcium group. Conclusions: Sevelamer allows a better serum phosphorus control compared with calcium-based phosphate binder and suppresses the progression of aortic calcification in HD patients. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Most published reports indicate that intensified hemodialysis results in better pregnancy outcomes. Here we studied clinical characteristics and the outcomes of 28 pregnant women receiving hemodialysis. We found an association between maternal blood data and birth weight, and gestational age and outcomes. There were 18 surviving infants who were followed up for one year. In the others there were 4 spontaneous abortions, 1 stillbirth, 3 neonatal deaths and 2 deaths after birth. Analysis of blood chemistry for 20 pregnancies from 12 weeks of gestation until delivery showed that the average hemoglobin level was significantly higher in the group that successfully delivered than in the unsuccessful group. There were significant negative relationships between the blood urea nitrogen (BUN) level and the birth weight or gestational age in the latter cohort. A birth weight equal to or greater than 1500 g or a gestational age equal to or exceeding 32 weeks corresponded to BUN levels of 48–49 mg/dl or less. Whether the low BUN is the direct cause of the improved outcome remains to be examined.Kidney International (2009) 75, 1217–1222; doi:10.1038/ki.2009.48; published online 25 February 2009 [ABSTRACT FROM AUTHOR]