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1. Association of obesity with 3-month mortality in kidney failure patients with COVID-19

Author

Tantisattamo, Ekamol, Imhof, Celine, Jager, Kitty J., Hilbrands, Luuk B., Guidotti, Rebecca, Islam, Mahmud, Katicic, Dajana, Konings, Constantijn, Molenaar, Femke M., Nistor, Ionut, Noordzij, Marlies, Rodríguez Ferrero, Mariá Luisa, Verhoeven, Martine A. M., de Vries, Aiko P. J., Kalantar-Zadeh, Kamyar, Gansevoort, Ron T., Vart, Priya, van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Maas, Nanda, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Vogt, Liffert, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Radulescu, Daniela, Hengst, Maaike, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, Joaõ, Alferes, Daniela G., Zakharova, Elena V., Ambuehl, Patrice Max, Walker, Andrea, Lepeytre, Fanny, Rabate, Clementine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J. P., Elhafeez, Samar Abd, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Hesselink, Dennis A., Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, el-Wakil, Hala S., Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Covic, Adrian, Groeneveld, J. H. M., Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Pereira, Tiago Assis, Santos, Augusto Cesar S., Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M., Siezenga, Machiel A., Franco, Antonio, Arroyo, David, Castellano, Sandra, Manzanos, Sagrario Balda, Haridian Sosa Barrios, R., Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Safak, Seda, Hollander, Daan A. M. J., Büttner, Stefan, Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petruliene, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Hemmelder, Marc H., Kumar, Mohan N., di Luca, Marina, Tuǧlular, Serhan Z., Ziekenhuis, Martini, Kramer, Andrea B., Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y., Stepanov, Vadim A., Zulkarnaev, Alexey B., Turkmen, Kultigin, Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, Els van de Logt, Anne, Maas, Rutger, Duivenvoorden, Raphaël, Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J. M., Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Schouten, Marcel, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Sahin, Idris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K. I., Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M., Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P., Meijer, Esther, Sanders, Jan Stephan F., Franssen, Casper F. M., Özyilmaz, Akin, Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Soler, Maria Jose, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimsevicius, Laurynas, Righetti, Marco, Heitink-ter Braak, Nicole, Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, Nephrology, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, Clinical sciences, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, ACS - Diabetes & metabolism, Internal Medicine, Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), van der Net, Jeroen B, Essig, Marie, du Buf-Vereijken, Peggy W G, van Ginneken, Betty, Maas, Nanda, van Jaarsveld, Brigit C, Bemelman, Frederike J, Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G, Nurmohamed, Azam, Vogt, Liffert, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M, Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Radulescu, Daniela, Hengst, Maaike, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G, Zakharova, Elena V, Ambuehl, Patrice Max, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, Ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L, Logtenberg, Susan J J, Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J P, ElHafeez, Samar Abd, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E J, Hesselink, Dennis A, Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, El-Wakil, Hala S, Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M, Debska-Slizien, Alicja, Veldhuizen, Nicoline M H, Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Covic, Adrian, Groeneveld, J H M, Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Pereira, Tiago Assis, Santos, Augusto Cesar S, Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M, Siezenga, Machiel A, Franco, Antonio, Arroyo, David, Castellano, Sandra, Manzanos, Sagrario Balda, Haridian Sosa Barrios, R., Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Şafak, Seda, Hollander, Daan A M J, Büttner, Stefan, Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petrulienė, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M, Christiaans, Maarten H L, Hemmelder, Marc H, Kumar N, Mohan, Di Luca, Marina, Tuğlular, Serhan Z, Ziekenhuis, Martini, Kramer, Andrea B, Beerenhout, Charles, Luik, Peter T, Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y, Stepanov, Vadim A, Zulkarnaev, Alexey B, Turkmen, Kultigin, Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W H, Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, Els van de Logt, Anne, Maas, Rutger, Duivenvoorden, Raphaël, Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J M, Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V, Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E A, Harty, John C, Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Schouten, Marcel, Rychlik, Ivan, Cabezas-Reina, Carlos J, Roca, Ana Maria, Nauta, Ferdau, Sahin, İdris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K I, Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M, Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P, Meijer, Esther, Sanders, Jan Stephan F, Franssen, Casper F M, Özyilmaz, Akin, Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C, van Zuilen, Arjan D, Meijvis, Sabine C A, Dolmans, Helma, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Soler, Maria Jose, Luik, Antinus J, van Kuijk, Willi H M, Stikkelbroeck, Lonneke W H, Hermans, Marc M H, Rimševičius, Laurynas, Righetti, Marco, and Heitink-Ter Braak, Nicole

Subjects
Transplantation, COVID-19, infectious diseases, mortality, DIALYSIS PATIENTS, kidney failure, BODY-MASS INDEX, obesity paradox, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], TRANSPLANT, SDG 3 - Good Health and Well-being, Nephrology, ERACODA, reverse epidemiology, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Abstract

Background In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19. Methods Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m2), divided into: Results In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients (N = 2343) and among those living with a kidney transplant (N = 817) (Pinteraction = 0.99), but differed by sex (Pinteraction = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively. Conclusion In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.

Published
2022
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2. COVID-19-related mortality in kidney transplant and haemodialysis patients

Author

Goffin, Eric, Candellier, Alexandre, Vart, Priya, Noordzij, Marlies, Arnol, Miha, Covic, Adrian, Lentini, Paolo, Malik, Shafi, Reichert, Louis J., Sever, Mehmet S., Watschinger, Bruno, Jager, Kitty J., Gansevoort, Ron T., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Vogt, Liffert, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Avitum, B. Braun, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Hengst, Maaike, Rydzewski, Andrzej, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Zakharova, Elena V., Ambuehl, Patrice Max, Walker, Andrea, Winzeler, Rebecca, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Katicic, Dajana, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Slebe, Jeroen J. P., Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Eiselt, Jaromir, Kielberger, Lukas, el-Wakil, Hala S., Verhoeven, Martine A. M., Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Matceac, Irina, Nistor, Ionut, Cordos, Monica, Groeneveld, J. H. M., Jousma, Jolanda, van Buren, Marjolijn, Elhafeez, Samar Abd, Diekmann, Fritz, Pereira, Tiago Assis, Santos, Augusto Cesar S., Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Hofstra, Julia M., Franco, Antonio, Arroyo, David, Rodríguez-Ferrero, Maria Luisa, Manzanos, Sagrario Balda, Barrios, R. Haridian Sosa, Ávila, Gonçalo, Laranjinha, Ivo, Mateus, Catarina, Lemahieu, Wim, Dirim, Ahmet Burak, Demir, Erol, Å afak, Seda, Turkmen, Aydin, Hollander, Daan A. M. J., Büttner, Stefan, de Vries, Aiko P. J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petruliene, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Hemmelder, Marc, Kumar, Mohan N., di Luca, Marina, Tuǧlular, Serhan Z., Kramer, Andrea, Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Adema, Aaltje Y., Stepanov, Vadim A., Zulkarnaev, Alexey B., Turkmen, Kultigin, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Duivenvoorden, Raphaël, Hilbrands, Luuk, Kerckhoffs, Angele, Maas, Rutger, Lebedeva, Olga, Lopez, Veronica, Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Schouten, Marcel, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, Meijers, Björn K. I., Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnelier, Annelies, Wissing, Karl M., de Arriba, Gabriel, Dedinska, Ivana, Pessolano, Giuseppina, Gandolfini, Ilaria, Maggiore, Umberto, Papachristou, Evangelos, Franssen, Casper F. M., Berger, Stefan P., Meijer, Esther, Özyilmaz, Akin, Sanders, Jan Stephan F., Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Tantisattamos, Ekamol, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Sabiu, Gianmarco, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimsevicius, Laurynas, Righetti, Marco, Islam, Mahmud, Braak, Nicole Heitink-Ter, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Internal Medicine, Clinical sciences, Nephrology, ACS - Diabetes & metabolism, AII - Inflammatory diseases, AII - Infectious diseases, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Quality of Care, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, and APH - Global Health

Subjects
medicine.medical_specialty, kidney, Original Article - Dialysis, medicine.medical_treatment, infectious diseases, law.invention, Kidney Failure, SDG 3 - Good Health and Well-being, Renal Dialysis, Risk Factors, law, Internal medicine, medicine, Humans, COVID-19, dialysis, mortality, transplantation, Registries, Renal replacement therapy, Chronic, AcademicSubjects/MED00340, Kidney transplantation, Dialysis, Transplantation, SARS-CoV-2, business.industry, Kidney Transplantation/adverse effects, Hazard ratio, medicine.disease, Kidney Transplantation, Intensive care unit, Comorbidity, Transplant Recipients, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Kidney Failure, Chronic/therapy, Nephrology, Kidney Failure, Chronic, Hemodialysis, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business
Abstract

BACKGROUND AND AIMS: Studies examining kidney failure patients with COVID-19 reported higher mortality in hemodialysis patients than in kidney transplant recipients. However, hemodialysis patients are often older and have more comorbidities. This study investigated the association of type of kidney replacement therapy with COVID-19 severity adjusting for differences in characteristics. METHOD: Data were retrieved from the European Renal Association COVID-19 Database (ERACODA), which includes kidney replacement therapy patients diagnosed with COVID-19 from all over Europe. We included all kidney transplant recipients and hemodialysis patients who presented between February 1st and December 1st 2020 and had complete information reason for COVID-19 screening and vital status at day 28. The diagnosis of COVID-19 was made based on a PCR of a nasal or pharyngeal swab specimens and/or COVID-19 compatible findings on a lung CT scan. The association of kidney transplantation or hemodialysis with 28-day mortality was examined using Cox proportional-hazards regression models adjusted for age, sex, frailty and comorbidities. Additionally, this association was investigated in the subsets of patients that were screened because of symptoms or have had routine screening. RESULTS: A total of 1,670 patients (496 functional kidney transplant recipients and 1,174 hemodialysis patients) were examined. 16.9% of kidney transplant recipients and 23.9% of hemodialysis patients died within 28 days of presentation. In an unadjusted model, the risk of 28-day mortality was 33% lower in kidney transplant recipients compared with hemodialysis patients (hazard ratio (HR): 0.67, 95% CI: 0.52, 0.85). However, in an age, sex and frailty adjusted model, the risk of 28-day mortality was 29% higher in kidney transplant recipients (HR=1.29, 95% CI: 1.00, 1.68), whereas in a fully adjusted model the risk was even 43% higher (HR=1.43, 95% CI: 1.06, 1.93). This association in patients who were screened because of symptoms (n=1,145) was similar (fully adjusted model HR=1.46, 95% CI: 1.05, 2.04). Results were similar when other endpoints were studied (e.g. risk for hospitalization, ICU admission or mortality beyond 28 days) as well as across subgroups. Only age was found to interact significantly, suggesting that the increased mortality risk associated with kidney transplantation was especially present in elderly subjects. CONCLUSION: In this study, kidney transplant recipients had a greater risk of a more severe course of COVID-19 compared with hemodialysis patients when adjusted for age, sex and comorbidities.

Published
2021
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3. Sex differences in COVID-19 mortality risk in patients on kidney function replacement therapy

Author

Vart, Priya, Duivenvoorden, Raphaël, Adema, Aaltje, Covic, Adrian, Finne, Patrik, Braak, Nicole Heijtink-ter, Laine, Kaisa, Noordzij, Marlies, Schouten, Marcel, Jager, Kitty J., Gansevoort, Ron T., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Maas, Nanda, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Vogt, Liffert, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Perez, Nuria Montero, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Radulescu, Daniela, Hengst, Maaike, Konings, Constantijn, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Zakharova, Elena V., Ambühl, Patrice Max, Guidotti, Rebecca, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Majstorovic, Gordana Strazmester, Katicic, Dajana, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J. P., ElHafeez, Samar Abd, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Hesselink, Dennis A., Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, El-Wakil, Hala S., Verhoeven, Martine, Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Konsta, Maria Anna Polyzou, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Nistor, Ionut, Groeneveld, J. H.M., Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Pereira, Tiago Assis, Santos, Augusto Cesar S., Arias-Cabrales, Carlos, Crespo, Marta, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M., Siezenga, Machiel A., Franco, Antonio, Arroyo, David, Castellano, Sandra, Rodríguez-Ferrero, Maria Luisa, Manzanos, Sagrario Balda, Barrios, R. Haridian Sosa, Lemahieu, Wim, Bartelet, Karlijn, Dirim, Ahmet Burak, Demir, Erol, Sever, Mehmet Sukru, Turkmen, Aydin, Şafak, Seda, Hollander, Daan A. M. J., Büttner, Stefan, de Vries, Aiko P. J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petrulienė, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Hemmelder, Marc H., MohanKumar, N., Di Luca, Marina, Tuğlular, Serhan Z., Kramer, Andrea B., Beerenhout, Charles, Luik, Peter T., Kerschbaum, Julia, Tiefenthaler, Martin, Watschinger, Bruno, Stepanov, Vadim A., Zulkarnaev, Alexey B., Turkmen, Kultigin, Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, van de Logt, Anne Els, Maas, Rutger, Hilbrands, Luuk B., Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J. M., Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rahimzadeh, Hormat, Rychlik, Ivan, Cabezas-Reina, Carlos J., Roca, Ana Maria, Nauta, Ferdau, Sahin, İdris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K. I., Naesens, Maarten, Kuypers, Dirk, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M., Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P., Sanders, Jan Stephan F., Franssen, Casper F. M., Özyilmaz, Akin, Ponikvar, Jadranka Buturović, Pernat, Andreja Marn, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Tantisattamo, Ekamol, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Soler, Maria Jose, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimševičius, Laurynas, Righetti, Marco, Islam, Mahmud, Clinical sciences, Nephrology, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Groningen Institute for Organ Transplantation (GIOT), Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, AII - Inflammatory diseases, ACS - Microcirculation, APH - Health Behaviors & Chronic Diseases, Internal Medicine, Department of Medicine, Clinicum, University of Helsinki, Helsinki University Hospital Area, ACS - Diabetes & metabolism, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, and UCL - (SLuc) Service de néphrologie

Subjects
Male, kidney, Transplant, infectious diseases, Kidney, All institutes and research themes of the Radboud University Medical Center, COVID‐19, Renal Dialysis, Risk Factors, risk factors, Humans, Eracoda, Aged, Sex Characteristics, Multidisciplinary, Dialysis patients, Kidney Transplantation/adverse effects, COVID-19, Middle Aged, Kidney Transplantation, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Nephrology, 3121 General medicine, internal medicine and other clinical medicine, mortality risk, Immunosuppressive Agents/therapeutic use, Female, Immunosuppressive Agents
Abstract

In the general population with COVID-19, the male sex is an established risk factor for mortality, in part due to a more robust immune response to COVID-19 in women. Because patients on kidney function replacement therapy (KFRT) have an impaired immune response, especially kidney transplant recipients due to their use of immunosuppressants, we examined whether the male sex is still a risk factor for mortality among patients on KFRT with COVID-19. From the European Renal Association COVID-19 Database (ERACODA), we examined patients on KFRT with COVID-19 who presented between February 1st, 2020, and April 30th, 2021. 1204 kidney transplant recipients (male 62.0%, mean age 56.4 years) and 3206 dialysis patients (male 61.8%, mean age 67.7 years) were examined. Three-month mortality in kidney transplant recipients was 16.9% in males and 18.6% in females (p = 0.31) and in dialysis patients 27.1% in males and 21.9% in females (p = 0.001). The adjusted HR for the risk of 3-month mortality in males (vs females) was 0.89 (95% CI 65, 1.23, p = 0.49) in kidney transplant recipients and 1.33 (95% CI 1.13, 1.56, p = 0.001) in dialysis patients (pinteraction = 0.02). In a fully adjusted model, the aHR for the risk of 3-month mortality in kidney transplant recipients (vs. dialysis patients) was 1.39 (95% CI 1.02, 1.89, p = 0.04) in males and 2.04 (95% CI 1.40, 2.97, p interaction = 0.02). In patients on KFRT with COVID-19, the male sex is not a risk factor for mortality among kidney transplant recipients but remains a risk factor among dialysis patients. The use of immunosuppressants in kidney transplant recipients, among other factors, may have narrowed the difference in the immune response to COVID-19 between men and women, and therefore reduced the sex difference in COVID-19 mortality risk.

Published
2022
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4. Clinical, Functional, and Mental Health Outcomes in Kidney Transplant Recipients 3 Months After a Diagnosis of COVID-19

Author

Duivenvoorden, Raphaël, Vart, Priya, Noordzij, Marlies, Soares Dos Santos, Augusto C., Zulkarnaev, Alex B., Franssen, Casper F. M., Kuypers, Dirk, Demir, Erol, Rahimzadeh, Hormat, Kerschbaum, Julia, Jager, Kitty J., Turkmen, Kultigin, Hemmelder, Marc H., Schouten, Marcel, Rodríguez-Ferrero, María Luisa, Crespo, Marta, Gansevoort, Ron T., Hilbrands, Luuk B., van der Net, Jeroen B., Essig, Marie, du Buf-Vereijken, Peggy W. G., van Ginneken, Betty, Maas, Nanda, Vogt, Liffert, van Jaarsveld, Brigit C., Bemelman, Frederike J., Klingenberg-Salahova, Farah, Heenan-Vos, Frederiek, Vervloet, Marc G., Nurmohamed, Azam, Abramowicz, Daniel, Verhofstede, Sabine, Maoujoud, Omar, Malfait, Thomas, Fialova, Jana, Melilli, Edoardo, Favà, Alexandre, Cruzado, Josep M., Montero Perez, Nuria, Lips, Joy, Krepel, Harmen, Adilovic, Harun, Hengst, Maaike, Konings, Constantijn, Rydzewski, Andrzej, Braconnier, Philippe, Weis, Daniel, Gellert, Ryszard, Oliveira, João, Alferes, Daniela G., Radulescu, Daniela, Zakharova, Elena V., Ambuehl, Patrice Max, Guidotti, Rebecca, Walker, Andrea, Lepeytre, Fanny, Rabaté, Clémentine, Rostoker, Guy, Marques, Sofia, Azasevac, Tijana, Strazmester Majstorovic, Gordana, Katicic, Dajana, ten Dam, Marc, Krüger, Thilo, Brzosko, Szymon, Liakopoulos, Vassilios, Zanen, Adriaan L., Logtenberg, Susan J. J., Fricke, Lutz, Kuryata, Olexandr, Slebe, Jeroen J. P., Abd Elhafeez, Samar, Kemlin, Delphine, van de Wetering, Jacqueline, Reinders, Marlies E. J., Hesselink, Dennis A., Kal-van Gestel, J., Eiselt, Jaromir, Kielberger, Lukas, el-Wakil, Hala S., Verhoeven, Martine, Logan, Ian, Canal, Cristina, Facundo, Carme, Ramos, Ana M., Debska-Slizien, Alicja, Veldhuizen, Nicoline M. H., Tigka, Eirini, Polyzou Konsta, Maria Anna, Panagoutsos, Stylianos, Mallamaci, Francesca, Postorino, Adele, Cambareri, Francesco, Matceac, Irina, Nistor, Ionut, Covic, Adrian, Groeneveld, J. H. M., Jousma, Jolanda, van Buren, Marjolijn, Diekmann, Fritz, Oppenheimer, Federico, Blasco, Miquel, Assis Pereira, Tiago, Arias-Cabrales, Carlos, Llinàs-Mallol, Laura, Buxeda, Anna, Tàrrega, Carla Burballa, Redondo-Pachon, Dolores, Jimenez, Maria Dolores Arenas, Mendoza-Valderrey, Alberto, Martins, Ana Cristina, Mateus, Catarina, Alvila, Goncalo, Laranjinha, Ivo, Hofstra, Julia M., Siezenga, Machiel A., Franco, Antonio, Arroyo, David, Castellano, Sandra, Balda Manzanos, Sagrario, Sosa Barrios, R. Haridian, Lemahieu, Wim, Bartelet, Karlijn, Burak Dirim, Ahmet, Sukru Sever, Mehmet, Turkmen, Aydin, Şafak, Seda, Hollander, Daan A. M. J., Büttner, Stefan, de Vries, Aiko P. J., Meziyerh, Soufian, van der Helm, Danny, Mallat, Marko, Bouwsma, Hanneke, Sridharan, Sivakumar, Petruliene, Kristina, Maloney, Sharon-Rose, Verberk, Iris, van der Sande, Frank M., Christiaans, Maarten H. L., Mohan Kumar, N., di Luca, Marina, Tuǧlular, Serhan Z., Kramer, Andrea, Beerenhout, Charles, Luik, Peter T., Tiefenthaler, Martin, Watschinger, Bruno, Adema, Aaltje Y., Stepanov, Vadim A., Gandolfini, Ilaria, Maggiore, Umberto, Fliedner, Anselm, Åsberg, Anders, Mjoen, Geir, Miyasato, Hitoshi, de Fijter, Carola W. H., Mongera, Nicola, Pini, Stefano, de Biase, Consuelo, Kerckhoffs, Angele, van de Logt, Anne Els, Maas, Rutger, Lebedeva, Olga, Lopez, Veronica, Reichert, Louis J. M., Verhave, Jacobien, Titov, Denis, Parshina, Ekaterina V., Zanoli, Luca, Marcantoni, Carmelita, van Kempen, Gijs, van Gils-Verrij, Liesbeth E. A., Harty, John C., Meurs, Marleen, Myslak, Marek, Battaglia, Yuri, Lentini, Paolo, den Deurwaarder, Edwin, Stendahl, Maria, Rychlik, Ivan, Cabezas-Reina, Carlos J., Maria Roca, Ana, Nauta, Ferdau, Sahin, İdris, Goffin, Eric, Kanaan, Nada, Labriola, Laura, Devresse, Arnaud, Diaz-Mareque, Anabel, Coca, Armando, de Arriba, Gabriel, Meijers, Björn K. I., Naesens, Maarten, Desschans, Bruno, Tonnerlier, Annelies, Wissing, Karl M., Dedinska, Ivana, Pessolano, Giuseppina, Malik, Shafi, Dounousi, Evangelia, Papachristou, Evangelos, Berger, Stefan P., Meijer, Esther, Sanders, Jan Stephan F., Özyilmaz, Akin, Buturović Ponikvar, Jadranka, Marn Pernat, Andreja, Kovac, Damjan, Arnol, Miha, Ekart, Robert, Abrahams, Alferso C., Molenaar, Femke M., van Zuilen, Arjan D., Meijvis, Sabine C. A., Dolmans, Helma, Tantisattamo, Ekamol, Esposito, Pasquale, Krzesinski, Jean-Marie, Barahira, Jean Damacène, Gallieni, Maurizio, Martin-Moreno, Paloma Leticia, Guglielmetti, Gabriele, Guzzo, Gabriella, Toapanta, Nestor, Jose Soler, Maria, Luik, Antinus J., van Kuijk, Willi H. M., Stikkelbroeck, Lonneke W. H., Hermans, Marc M. H., Rimsevicius, Laurynas, Righetti, Marco, Islam, Mahmud, Heitink-ter Braak, Nicole, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, Nephrology, ACS - Diabetes & metabolism, Internal Medicine, Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, and Clinical sciences

Subjects
kidney transplant, Adult, Kidney Disease, Outcome Assessment, Renal and urogenital, infectious diseases, Medical and Health Sciences, clinical, DISEASE, All institutes and research themes of the Radboud University Medical Center, Rare Diseases, SDG 3 - Good Health and Well-being, 7.1 Individual care needs, Clinical Research, Outcome Assessment, Health Care, Humans, Retrospective Studies, Transplantation, SARS-CoV-2, MORTALITY, Rehabilitation, COVID-19, mental health outcomes, survive, Organ Transplantation, Original Clinical Science—General, Middle Aged, SOLID-ORGAN TRANSPLANT, Kidney Transplantation, Transplant Recipients, DIALYSIS PATIENTS, Health Care, functional, Intensive Care Units, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Good Health and Well Being, Nephrology, ERACODA, ERACODA Collaborators, Surgery, Management of diseases and conditions, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Abstract

BACKGROUND: Kidney transplant patients are at high risk for coronavirus disease 2019 (COVID-19)-related mortality. However, limited data are available on longer-term clinical, functional, and mental health outcomes in patients who survive COVID-19.METHODS: We analyzed data from adult kidney transplant patients in the European Renal Association COVID-19 Database who presented with COVID-19 between February 1, 2020, and January 31, 2021.RESULTS: We included 912 patients with a mean age of 56.7 (±13.7) y. 26.4% were not hospitalized, 57.5% were hospitalized without need for intensive care unit (ICU) admission, and 16.1% were hospitalized and admitted to the ICU. At 3 mo follow-up survival was 82.3% overall, and 98.8%, 84.2%, and 49.0%, respectively, in each group. At 3 mo follow-up biopsy-proven acute rejection, need for renal replacement therapy, and graft failure occurred in the overall group in 0.8%, 2.6%, and 1.8% respectively, and in 2.1%, 10.6%, and 10.6% of ICU-admitted patients, respectively. Of the surviving patients, 83.3% and 94.4% reached their pre-COVID-19 physician-reported functional and mental health status, respectively, within 3 mo. Of patients who had not yet reached their prior functional and mental health status, their treating physicians expected that 79.6% and 80.0%, respectively, still would do so within the coming year. ICU admission was independently associated with a low likelihood to reach prior functional and mental health status.CONCLUSIONS: In kidney transplant recipients alive at 3-mo follow-up, clinical, physician-reported functional, and mental health recovery was good for both nonhospitalized and hospitalized patients. Recovery was, however, less favorable for patients who had been admitted to the ICU.

Published
2022
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9. Haemodynamic or metabolic stimulation tests to reveal the renal functional response: requiem or revival?

Author

Moor, Bart De, Vanwalleghem, Johan F, Swennen, Quirine, Stas, Koen J, and Meijers, Björn K I

Abstract

Renal stimulation tests document the dynamic response of the glomerular filtration rate (GFR) after a single or a combination of stimuli, such as an intravenous infusion of dopamine or amino acids or an oral protein meal. The increment of the GFR above the unstimulated state has formerly been called the renal functional reserve (RFR). Although the concept of a renal reserve capacity has not withstood scientific scrutiny, the literature documenting renal stimulation merits renewed interest. An absent or a blunted response of the GFR after a stimulus indicates lost or diseased nephrons. This information is valuable in preventing, diagnosing and prognosticating acute kidney injury and pregnancy-related renal events as well as chronic kidney disease. However, before renal function testing is universally practiced, some shortcomings must be addressed. First, a common nomenclature should be decided upon. The expression of RFR should be replaced by renal functional response. Second, a simple protocol must be developed and propagated. Third, we suggest designing prospective studies linking a defective stimulatory response to emergence of renal injury biomarkers, to histological or morphological renal abnormalities and to adverse renal outcomes in different renal syndromes. [ABSTRACT FROM AUTHOR]

Published
2018
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12. p-Cresyl sulfate serum concentrations in haemodialysis patients are reduced by the prebiotic oligofructose-enriched inulin.

Author

Meijers, Björn K. I., De Preter, Vicky, Verbeke, Kristin, Vanrenterghem, Yves, and Evenepoel, Pieter

Subjects
*HEMODIALYSIS patients, *INULIN, *SERUM, *SULFATES, *CARDIOVASCULAR diseases, *ALBUMINS, *PERITONEAL dialysis
Abstract

Introduction. Protein-bound uraemic retention solutes, including p-cresyl sulfate and indoxyl sulfate, contribute substantially to the uraemic syndrome. These and several other uraemic retention solutes originate from intestinal bacterial protein fermentation. We investigated whether the prebiotic oligofructose-enriched inulin reduced serum concentration of p-cresyl sulfate and indoxyl sulfate, through interference with intestinal generation. [ABSTRACT FROM PUBLISHER]

Published
2010
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13. Heparin-coated dialyzer membranes: is non-inferiority good enough?

Author

Meijers, Björn K I, Poesen, Ruben, and Evenepoel, Pieter

Subjects
*HEPARIN, *HEMODIALYZERS, *BLOOD coagulation, *HEMORRHAGE, *CITRATES
Abstract

Evidence on the optimal anticoagulation regimen for hemodialysis in patients at high bleeding risk is scarce. The HepZero study is the first large multinational study comparing two different anticoagulation strategies to avoid systemic heparinization. The use of a heparin-coated dialysis membrane proved to be non-inferior to saline infusion. Superiority of either treatment, however, could not be demonstrated. These findings challenge current guidelines but equally raise questions on the choice of either strategy as compared with regional citrate anticoagulation. [ABSTRACT FROM AUTHOR]

Published
2014
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14. Phosphorus metabolism in peritoneal dialysis- and haemodialysis-treated patients.

Author

Evenepoel P, Meijers BK, Bammens B, Viaene L, Claes K, Sprangers B, Naesens M, Hoekstra T, Schlieper G, Vanderschueren D, and Kuypers D

Subjects
Aged, Case-Control Studies, Cross-Sectional Studies, Dialysis Solutions, Female, Fibroblast Growth Factor-23, Humans, Male, Middle Aged, Parathyroid Hormone blood, Biomarkers blood, Peritoneal Dialysis, Phosphorus blood, Renal Dialysis
Abstract

Background: Phosphorus control is generally considered to be better in peritoneal dialysis (PD) patients as compared with haemodialysis (HD) patients. Predialysis phosphorus concentrations are misleading as a measure of phosphorus exposure in HD, as these neglect significant dialysis-related fluctuations., Methods: Parameters of mineral metabolism, including parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF-23), were determined in 79 HD and 61 PD patients. In PD, phosphorus levels were determined mid-morning. In HD, time-averaged phosphorus concentrations were modelled from measurements before and after the mid-week dialysis session. Weekly renal, dialytic and total phosphorus clearances as well as total mass removal were calculated from urine and dialysate collections., Results: Time-averaged serum phosphorus concentrations in HD (3.5 ± 1.0 mg/dL) were significantly lower than the mid-morning concentrations in PD (5.0 ± 1.4 mg/dL, P < 0.0001). In contrast, predialysis phosphorus concentrations (4.6 ± 1.4 mg/dL) were not different from PD. PTH and FGF-23 levels were significantly higher in PD. Despite higher residual renal function, total phosphorus clearance was significantly lower in PD (P < 0.0001). Total phosphorus mass removal, conversely, was significantly higher in PD (P < 0.05)., Conclusions: Our data suggest that the time-averaged phosphorus concentrations in patients treated with PD are higher as compared with patients treated with HD. Despite a better preserved renal function, total phosphorus clearance is lower in patients treated with PD. Additional studies are needed to confirm these findings in a population with a different demographic profile and dietary background and to define clinical implications., (© The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)

Published
2016
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17. Measuring total blood calcium displays a low sensitivity for the diagnosis of hypercalcemia in incident renal transplant recipients.

Author

Evenepoel P, Bammens B, Claes K, Kuypers D, Meijers BK, and Vanrenterghem Y

Subjects
Acidosis blood, Acidosis epidemiology, Acidosis etiology, Adult, Aged, Belgium epidemiology, Bicarbonates blood, Biomarkers blood, Chi-Square Distribution, Female, Hospitals, University, Humans, Hypercalcemia blood, Hypercalcemia epidemiology, Hypercalcemia etiology, Incidence, Logistic Models, Male, Middle Aged, Predictive Value of Tests, Prevalence, Prospective Studies, Sensitivity and Specificity, Time Factors, Up-Regulation, Calcium blood, Hypercalcemia diagnosis, Kidney Transplantation adverse effects
Abstract

Background and Objectives: Hypercalcemia is a common complication in renal transplant recipients and has been associated with nephrocalcinosis and poor graft outcome. The performance of total calcium (tCa) in the diagnosis of blood calcium disturbances in renal transplant recipients is unknown., Design, Setting, Participants, & Measurements: We compared the ability of total tCa concentration to identify low, normal, or high ionized calcium (iCa) concentration, i.e., the gold standard, in an unselected cohort of 268 renal transplant recipients. All patients were studied 3 and 12 months after successful engraftment., Results: Hypercalcemia, defined as a iCa >1.29 mmol/L, was present in 58.6 and 44.8% of the patients at months 3 and 12, respectively. tCa concentrations >10.3 mg/dl, conversely, were observed in only 13.1% of the patients. Measuring tCa had a low sensitivity (20.3 and 24.2% at months 3 and 12, respectively) for the diagnosis of hypercalcemia. The agreement (κ coefficient [95% confidence interval]) between tCa concentrations and iCa was poor (month 3: 0.11 [0.05 to 0.17]; month 12: 0.20 [0.11 to 0.30]). The risk for underestimating iCa was increased by a low total bicarbonate concentration. Metabolic acidosis was observed in 48.1 and 37.3% of the patients at months 3 and 12, respectively., Conclusions: Total calcium greatly underestimates the diagnosis of hypercalcemia in incident renal transplant recipients. This is mainly explained by the high prevalence of metabolic acidosis in these patients.

Published
2010
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18. p-Cresol and cardiovascular risk in mild-to-moderate kidney disease.

Author

Meijers BK, Claes K, Bammens B, de Loor H, Viaene L, Verbeke K, Kuypers D, Vanrenterghem Y, and Evenepoel P

Subjects
Aged, Belgium, Biomarkers blood, Cardiovascular Diseases blood, Cardiovascular Diseases mortality, Cardiovascular Diseases physiopathology, Female, Glomerular Filtration Rate, Humans, Kaplan-Meier Estimate, Kidney Diseases complications, Kidney Diseases mortality, Kidney Diseases physiopathology, Male, Middle Aged, Prognosis, Proportional Hazards Models, Prospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Cardiovascular Diseases etiology, Cresols blood, Kidney Diseases blood
Abstract

Background and Objectives: Cardiovascular disease is highly prevalent in chronic kidney disease. Traditional risk factors are insufficient to explain the high cardiovascular disease prevalence. Free p-cresol serum concentrations, mainly circulating as its derivative p-cresyl sulfate, are associated with cardiovascular disease in hemodialysis patients. It is not known if p-cresol is associated with cardiovascular disease in patients with chronic kidney disease not yet on dialysis., Design, Setting, Participants, & Measurements: In a prospective observational study in 499 patients with mild-to-moderate kidney disease, we examined the multivariate association between p-cresol free serum concentrations and cardiovascular events., Results: After a mean follow-up of 33 mo, 62 patients reached the primary end point of fatal or nonfatal cardiovascular events. Higher baseline concentrations of free p-cresol were directly associated with cardiovascular events (univariate hazard ratio [HR] 1.79, P<0.0001). In multivariate analysis, p-cresol remained a predictor of cardiovascular events, independent of GFR and independent of Framingham risk factors (full model, HR 1.39, P=0.04)., Conclusions: These findings suggest that p-cresol measurements may help to predict cardiovascular disease risk in renal patients over a wide range of residual renal function, beyond traditional markers of glomerular filtration. Whether p-cresol is a modifiable cardiovascular risk factor in CKD patients remains to be proven.

Published
2010
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19. The uremic retention solute p-cresyl sulfate and markers of endothelial damage.

Author

Meijers BK, Van Kerckhoven S, Verbeke K, Dehaen W, Vanrenterghem Y, Hoylaerts MF, and Evenepoel P

Subjects
Aged, Biomarkers blood, Cells, Cultured, Chronic Disease, Cresols blood, Female, Humans, Male, Middle Aged, Prospective Studies, Uremia blood, Cresols metabolism, Endothelium, Vascular cytology, Endothelium, Vascular metabolism, Kidney Diseases metabolism, Uremia metabolism
Abstract

Background: Cardiovascular disease is highly prevalent in patients with chronic kidney disease. In hemodialysis patients, the protein-bound uremic retention solute p-cresol is independently associated with cardiovascular disease. The underlying mechanisms have not been elucidated., Study Design: (1) Prospective observational study of humans and (2) in vitro study in human umbilical vein endothelial cells., Setting: Hemodialysis patients., Factor: p-Cresol and its main derivative p-cresyl sulfate., Outcomes: Endothelial dysfunction., Measurements: We studied: (1) the relation between p-cresol and blood markers of endothelial dysfunction, including soluble P-selectin and endothelial microparticles; and (2) direct effects of p-cresol and p-cresyl sulfate on endothelial cell cultures., Results: (1) In a cohort of 100 maintenance hemodialysis patients, free serum p-cresol concentrations (median, 11.7 micromol/L; interquartile range, 15.2) were directly associated with circulating endothelial microparticles (P = 0.007), but not with soluble P-selectin (mean, 37.7 +/- 14.4 [SD] pg/mL). Other independent determinants of the degree of circulating microparticles were greater serum phosphorus (mean, 4.8 +/- 1.5 mg/dL; P = 0.008) and serum calcium concentrations (mean, 9.3 +/- 0.8 mg/dL; P = 0.03), whereas treatment with active vitamin D (P = 0.008) and vintage (median, 25 months; P = 0.04) were inversely associated. (2) In vitro, p-cresyl sulfate induced a dose-dependent increase in the shedding of endothelial microparticles (P < 0.001) by human umbilical vein endothelial cells. Shedding was reduced, but not completely aborted, in the presence of albumin, whereas the selective Rho kinase inhibitor Y-27632 abrogated the p-cresyl sulfate-induced generation of endothelial microparticles., Limitations: The relationship between p-cresyl sulfate and shedding of endothelial microparticles in vivo was not mechanistically explored., Conclusion: p-Cresyl sulfate induces shedding of endothelial microparticles in the absence of overt endothelial damage in vitro and is independently associated with the number of endothelial microparticles in hemodialysis patients. These findings suggest that p-cresyl sulfate alters endothelial function in hemodialysis patients.

Published
2009
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20. Sodium octanoate to reverse indoxyl sulfate and p-cresyl sulfate albumin binding in uremic and normal serum during sample preparation followed by fluorescence liquid chromatography.

Author

de Loor H, Meijers BK, Meyer TW, Bammens B, Verbeke K, Dehaen W, and Evenepoel P

Subjects
Chromatography, Liquid instrumentation, Fluorescence, Humans, Kidney Diseases blood, Kidney Diseases urine, Protein Binding, Sensitivity and Specificity, Albumins metabolism, Caprylates chemistry, Chromatography, Liquid methods, Cresols blood, Indican blood, Indican urine, Sulfuric Acid Esters blood
Abstract

Indoxyl sulfate and p-cresyl sulfate are protein-bound marker molecules in chronic kidney disease. Recent findings suggest that indoxyl sulfate and p-cresyl sulfate directly contribute to the uremic syndrome. A method for quantification of p-cresyl sulfate and indoxyl sulfate total serum concentrations was developed. We used sodium octanoate as competitor to replace non-covalent binding of p-cresyl sulfate and indoxyl sulfate to albumin. Total, within-run, between-run and between-day imprecision for indoxyl sulfate and p-cresyl sulfate were all below 6%. The limit of quantification was 3.2microM for both analytes. Recovery, tested in hemodialysis patients, was 102% for indoxyl sulfate and 105% for p-cresyl sulfate. Deming regression demonstrated good agreement for indoxyl sulfate between this new method and an external HPLC method. Method comparison for p-cresyl sulfate of the new method with our in-house GC-MS method demonstrated good agreement, whereas method comparison with an external HPLC method revealed a small proportional bias. Sodium octanoate binding competition is a novel sample preparation that allows for direct quantification of indoxyl sulfate and p-cresyl sulfate.

Published
2009
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21. A review of albumin binding in CKD.

Author

Meijers BK, Bammens B, Verbeke K, and Evenepoel P

Subjects
Albumins physiology, Chronic Disease, Humans, Kidney Diseases physiopathology, Ligands, Albumins metabolism, Kidney Diseases metabolism, Protein Binding physiology
Abstract

Hypoalbuminemia is associated with excess mortality in patients with kidney disease. Albumin is an important oxidant scavenger and an abundant carrier protein for numerous endogenous and exogenous compounds. Several specific binding sites for anionic, neutral, and cationic ligands were described. Overall, the extent of binding depends on the ligand and albumin concentration, albumin-binding affinity, and presence of competing ligands. Chronic kidney disease affects all these determinants. This may result in altered pharmacokinetics and increased risk of toxicity. Renal clearance of albumin-bound solutes mainly depends on tubular clearance. Dialytic clearance by means of conventional hemodialysis/hemofiltration and peritoneal dialysis is limited. Other epuration techniques combining hemodialysis with adsorption have been developed. However, the benefit of these techniques remains to be proved.

Published
2008
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