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1. Sensitivity of total body electrical resistance measurements in detecting extracellular volume expansion induced by infusion of NaCl 0.9%

Author

Schotman, J. M., van Borren, M. M. G. J., Wetzels, J. F. M., Kloke, H. J., Reichert, L. J. M., and de Boer, H.

Subjects
Water-electrolyte balance (Physiology) -- Research, Medical research, Medicine, Experimental, Fluid therapy -- Physiological aspects, Impedance, Bioelectric -- Measurement -- Health aspects, Osmoregulation -- Research, Food/cooking/nutrition, Health
Abstract

Background Fluid balance management in hospitalized patients is hampered by the limited sensitivity of currently available tools. The aim of this study was to assess the sensitivity of total body electrical resistance (TBER) measurements for the detection of extracellular volume (ECV) expansion. Methods TBER and plasma resistivity ([rho].sub.plasma) were measured during a 4-h infusion of NaCl 0.9% at a rate of 500 mL/h in 23 patients undergoing a diagnostic saline infusion test for primary hyperaldosteronism. Extracellular fluid gain (EFG) was defined as infusion volume minus urinary volume. Results Infusion of 2.0 L NaCl 0.9% was associated with a mean diuresis of 1.1 [plus or minus] 0.5 L, an EFG of 0.9 [plus or minus] 0.5 L, a decrease in [rho].sub.plasma of 1.1 [plus or minus] 0.7 [OMEGA]·cm or 1.7 [plus or minus] 1.0% (P < 0.001), and a decline in TBER of 23.2 [plus or minus] 10.9 [OMEGA] or 4.6 [plus or minus] 2.2% (P < 0.001). At group level, infusion of 80 mL saline was sufficient to induce a statistically significant decline in mean TBER. At personal level, the decline in TBER was significant on 76% of occasions after an EFG of 0.5-0.75 L, and on all occasions after an EFG of 1.0 L or greater. Conclusion Raw TBER data are very informative for the detection of ECV expansion induced by the infusion of NaCl 0.9%, with a sensitivity at a personal level that is relevant for clinical practice., Author(s): J. M. Schotman [sup.1] , M. M. G. J. van Borren [sup.2] , J. F. M. Wetzels [sup.3] , H. J. Kloke [sup.3] , L. J. M. Reichert [sup.1] [...]

Published
2020
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3. Recovery of dialysis patients with COVID-19: health outcomes 3 months after diagnosis in ERACODA

Author

Hemmelder, M. H., Noordzij, M., Vart, P., Hilbrands, L. B., Jager, K. J., Abrahams, A. C., Arroyo, D., Battaglia, Y., Ekart, R., Mallamaci, F., Malloney, S. -R., Oliveira, J., Rydzewski, A., Sridharan, S., Vogt, L., Duivenvoorden, R., Gansevoort, R. T., Franssen, C. F. M., van der Net, J. B., Essig, M., du Buf-Vereijken, P. W. G., van Ginneken, B., Maas, N., van Jaarsveld, B. C., Bemelman, F. J., Klingenberg-Salahova, F., Heenan-Vos, F., Vervloet, M. G., Nurmohamed, A., Abramowicz, D., Verhofstede, S., Maoujoud, O., Malfait, T., Fialova, J., Melilli, E., Fava, A., Cruzado, J. M., Perez, N. M., Lips, J., Krepel, H., Adilovic, H., Hengst, M., Konings, C. J. A. M., Braconnier, P., Weis, D., Gellert, R., Alferes, D. G., Radulescu, D., Zakharova, E. V., Ambuehl, P. M., Guidotti, R., Walker, A., Lepeytre, F., Rabate, C., Rostoker, G., Marques, S., Azasevac, T., Majstorovic, G. S., Katicic, D., Dam, M. T., Kruger, T., Brzosko, S., Liakopoulos, V., Zanen, A. L., Logtenberg, S. J. J., Fricke, L., Kuryata, O., Slebe, J. J. P., Abd ElHafeez, S., Kemlin, D., van de Wetering, J., Reinders, M. E. J., Hesselink, D. A., van Gestel, J. K., Eiselt, J., Kielberger, L., El-Wakil, H. S., Verhoeven, M. A. M., Logan, I., Canal, C., Facundo, C., Ramos, A. M., Debska-Slizien, A., Veldhuizen, N. M. H., Tigka, E., Polyzou Konsta, M. A., Panagoutsos, S., Postorino, A., Cambareri, F., Matceac, I., Nistor, I., Covic, A., Groeneveld, J. H. M., Jousma, J., Diekmann, F., Oppenheimer, F., Blasco, M., Pereira, T. A., dos Santos Junior, A. C. S., Arias-Cabrales, C., Crespo, M., Llinas-Mallol, L., Buxeda, A., Tarrega, C. B., Redondo-Pachon, D., Arenas Jimenez, M. D., Mendoza-Valderrey, A., Martins, A. C., Mateus, C., Alvila, G., Laranjinha, I., Hofstra, J. M., Siezenga, M. A., Franco, A., Castellano, S., Rodriguez-Ferrero, M. L., Manzanos, S. B., Haridian Sosa Barrios, R., Lemahieu, W., Bartelet, K., Dirim, A. B., Demir, E., Sever, M. S., Turkmen, A., Safak, S., Hollander, D. A. M. J., Kerckhoffs, A., Buttner, S., de Vries, A. P. J., Meziyerh, S., van der Helm, D., Mallat, M., Bouwsma, H., Petruliene, K., Verberk, I., van der Sande, F. M., Christiaans, M. H. L., Mohankumar, N., Luca, M. D., Tuglular, S. Z., Kramer, A., Beerenhout, C., Luik, P. T., Kerschbaum, J., Tiefenthaler, M., Watschinger, B., Adema, A. Y., Stepanov, V. A., Zulkarnaev, A. B., Turkmen, K., Gandolfini, I., Maggiore, U., Fliedner, A., Asberg, A., Mjoen, G., Miyasato, H., de Fijter, C. W. H., Mongera, N., Pini, S., de Biase, C., van de Logt, A. E., Maas, R., Lebedeva, O., Lopez, V., Reichert, L. J. M., Verhave, J., Titov, D., Parshina, E. V., Zanoli, L., Marcantoni, C., van Kempen, G., van Gils-Verrij, L. E. A., Harty, J. C., Meurs, M., Myslak, M., Lentini, P., den Deurwaarder, E., Stendahl, M., Rahimzadeh, H., Schouten, M., Rychlik, I., Cabezas-Reina, C. J., Roca, A. M., Nauta, F., Sahin, I., Goffin, E., Kanaan, N., Labriola, L., Devresse, A., Diaz-Mareque, A., Coca, A., de Arriba, G., Meijers, B. K. I., Naesens, M., Kuypers, D., Desschans, B., Tonnerlier, A., Wissing, K. M., Dedinska, I., Pessolano, G., Malik, S., Dounousi, E., Papachristou, E., Berger, S. P., Meijer, E., Sanders, J. S. F., Ozyilmaz, A., Ponikvar, J. B., Pernat, A. M., Kovac, D., Arnol, M., Molenaar, F. M., van Zuilen, A. D., Meijvis, S. C. A., Dolmans, H., Tantisattamo, E., Esposito, P., Krzesinski, J. -M., Barahira, J. D., Gallieni, M., Martin-Moreno, P. L., Guglielmetti, G., Guzzo, G., Toapanta, N., Soler, M. J., Luik, A. J., van Kuijk, W. H. M., Stikkelbroeck, L. W. H., Hermans, M. M. H., Rimsevicius, L., Righetti, M., Islam, M., Heitink-Ter Braak, N., Nephrology, ACS - Microcirculation, ACS - Diabetes & metabolism, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Clinical sciences, Faculteit Medische Wetenschappen/UMCG, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Groningen Institute for Organ Transplantation (GIOT), Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, ACS - Pulmonary hypertension & thrombosis, APH - Health Behaviors & Chronic Diseases, and Internal Medicine

Subjects
Male, Outcome Assessment, survival, mental health status, COVID-19 Testing, SDG 3 - Good Health and Well-being, Renal Dialysis, functional health status, Outcome Assessment, Health Care, 80 and over, Humans, KIDNEY-TRANSPLANT, AcademicSubjects/MED00340, Aged, Aged, 80 and over, Transplantation, SARS-CoV-2, MORTALITY, COVID-19, Middle Aged, Health Care, Intensive Care Units, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Nephrology, dialysis, Original Article, Female, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11]
Abstract

Background Coronavirus disease 2019 (COVID-19)-related short-term mortality is high in dialysis patients, but longer-term outcomes are largely unknown. We therefore assessed patient recovery in a large cohort of dialysis patients 3 months after their COVID-19 diagnosis. Methods We analyzed data on dialysis patients diagnosed with COVID-19 from 1 February 2020 to 31 March 2021 from the European Renal Association COVID-19 Database (ERACODA). The outcomes studied were patient survival, residence and functional and mental health status (estimated by their treating physician) 3 months after COVID-19 diagnosis. Complete follow-up data were available for 854 surviving patients. Patient characteristics associated with recovery were analyzed using logistic regression. Results In 2449 hemodialysis patients (mean ± SD age 67.5 ± 14.4 years, 62% male), survival probabilities at 3 months after COVID-19 diagnosis were 90% for nonhospitalized patients (n = 1087), 73% for patients admitted to the hospital but not to an intensive care unit (ICU) (n = 1165) and 40% for those admitted to an ICU (n = 197). Patient survival hardly decreased between 28 days and 3 months after COVID-19 diagnosis. At 3 months, 87% functioned at their pre-existent functional and 94% at their pre-existent mental level. Only few of the surviving patients were still admitted to the hospital (0.8–6.3%) or a nursing home (∼5%). A higher age and frailty score at presentation and ICU admission were associated with worse functional outcome. Conclusions Mortality between 28 days and 3 months after COVID-19 diagnosis was low and the majority of patients who survived COVID-19 recovered to their pre-existent functional and mental health level at 3 months after diagnosis.

Published
2022

4. Clinical triage of patients on kidney replacement therapy presenting with COVID-19: An ERACODA registry analysis

Author

Mitra, S., Jayanti, A., Vart, P., Coca, A., Gallieni, M., Ovrehus, M. A., Midtvedt, K., Abd Elhafeez, S., Gandolfini, I., Buttner, S., Franssen, C. F. M., Hemmelder, M. H., Van Der Net, J. B., Essig, M., Du Buf-Vereijken, P. W. G., Van Ginneken, B., Maas, N., Vogt, L., Van Jaarsveld, B. C., Jager, K. J., Bemelman, F. J., Klingenberg-Salahova, F., Heenan-Vos, F., Vervloet, M. G., Nurmohamed, A., Abramowicz, D., Verhofstede, S., Maoujoud, O., Malfait, T., Fialova, J., Melilli, E., Fava, A., Cruzado, J. M., Perez, N. M., Lips, J., Krepel, H., Adilovic, H., Hengst, M., Rydzewski, A., Gellert, R., Oliveira, J., Alferes, D. G., Zakharova, E. V., Ambuehl, P. M., Walker, A., Winzeler, R., Lepeytre, F., Rabate, C., Rostoker, G., Marques, S., Azasevac, T., Katicic, D., Dam, M. T., Kruger, T., Brzosko, S., Zanen, A. L., Logtenberg, S. J. J., Fricke, L., Slebe, J. J. P., Kemlin, D., Van De Wetering, J., Reinders, M. E. J., Eiselt, J., Kielberger, L., El-Wakil, H. S., Verhoeven, M. A. M., Canal, C., Facundo, C., Ramos, A. M., Debska-Slizien, A., Veldhuizen, N. M. H., Tigka, E., Konsta, M. A. P., Panagoutsos, S., Mallamaci, F., Postorino, A., Cambareri, F., Covic, A., Matceac, I., Nistor, I., Cordos, M., Groeneveld, J. H. M., Jousma, J., Marjolijn Van Buren, Diekmann, F., Tiago Assis Pereira, Santos, A. C. S., Arias-Cabrales, C., Crespo, M., Llinas-Mallol, L., Buxeda, A., Tarrega, C. B., Redondo-Pachon, D., Jimenez, M. D. A., Hofstra, J. M., Franco, A., Arroyo, D., Rodriguez-Ferrero, M. L., Manzanos, S. B., Barrios, R. H. S., Avila, G., Laranjinha, I., Mateus, C., Lemahieu, W., Bartelet, K., Dirim, A. B., Sever, M. S., Demir, E., Safak, S., Turkmen, A., Hollander, D. A. M. J., De Vries, A. P. J., Meziyerh, S., Van Der Helm, D., Mallat, M., Bouwsma, H., Sridharan, S., Petruliene, K., Maloney, S. -R., Verberk, I., Van Der Sande, F. M., Christiaans, M. H. L., Mohankumar, N., Di Luca, M., Tuglular, S. Z., Kramer, A., Beerenhout, C., Luik, P. T., Kerschbaum, J., Tiefenthaler, M., Watschinger, B., Adema, A. Y., Stepanov, V. A., Zulkarnaev, A. B., Turkmen, K., Fliedner, A., Asberg, A., Mjoen, G., Miyasato, H., De Fijter, C. W. H., Mongera, N., Pini, S., De Biase, C., Duivenvoorden, R., Hilbrands, L., Kerckhoffs, A., Van De Logt, A. -E., Maas, R., Lebedeva, O., Lopez, V., Verhave, J., Reichert, L. J. M., Titov, D., Parshina, E. V., Zanoli, L., Marcantoni, C., Van Gils-Verrij, L. E. A., Harty, J. C., Meurs, M., Myslak, M., Battaglia, Y., Lentini, P., Den Deurwaarder, E., Stendahl, M., Rahimzadeh, H., Schouten, M., Rychlik, I., Cabezas-Reina, C. J., Roca, A. M., Nauta, F., Goffin, E., Kanaan, N., Labriola, L., Devresse, A., Diaz-Mareque, A., Meijers, B. K. I., Naesens, M., Kuypers, D., Desschans, B., Tonnelier, A., Wissing, K. M., De Arriba, G., Dedinska, I., Pessolano, G., Maggiore, U., Malik, S., Papachristou, E., Gansevoort, R. T., Noordzij, M., Berger, S. P., Meijer, E., Ozyilmaz, A., Sanders, J. S. F., Ponikvar, J. B., Arnol, M., Pernat, A. M., Kovac, D., Ekart, R., Abrahams, A. C., Molenaar, F. M., Van Zuilen, A. D., Meijvis, S. C. A., Dolmans, H., Tantisattamo, E., Esposito, P., Krzesinski, J. -M., Barahira, J. D., Sabiu, G., Martin-Moreno, P. L., Guglielmetti, G., Guzzo, G., Toapanta, N., Soler, M. J., Luik, A. J., Van Kuijk, W. H. M., Stikkelbroeck, L. W. H., Hermans, M. M. H., Rimsevicius, L., Righetti, M., Islam, M., Braak, N. H. -T., Nephrology, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, Groningen Kidney Center (GKC), ACS - Diabetes & metabolism, AII - Inflammatory diseases, AII - Infectious diseases, Internal Medicine, and Clinical sciences

Subjects
kidney, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Pulmonary insufficiency, infectious diseases, Kidney, Second presentation, Interquartile range, Internal medicine, medicine, Humans, Registries, Mortality, AcademicSubjects/MED00340, Dialysis, Aged, Transplantation, second presentation, business.industry, SARS-CoV-2, COVID-19, medicine.disease, mortality, Triage, Hospitalization, Renal Replacement Therapy, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Nephrology, Oxygen Saturation, dialysis, Original Article, Hemodialysis, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], Presentation (obstetrics), business, transplantation
Abstract

Background Patients on kidney replacement therapy (KRT) are at very high risk of coronavirus disease 2019 (COVID-19). The triage pathway for KRT patients presenting to hospitals with varying severity of COVID-19 illness remains ill-defined. We studied the clinical characteristics of patients at initial and subsequent hospital presentations and the impact on patient outcomes. Methods The European Renal Association COVID-19 Database (ERACODA) was analysed for clinical and laboratory features of 1423 KRT patients with COVID-19 either hospitalized or non-hospitalized at initial triage and those re-presenting a second time. Predictors of outcomes (hospitalization, 28-day mortality) were then determined for all those not hospitalized at initial triage. Results Among 1423 KRT patients with COVID-19 [haemodialysis (HD), n = 1017; transplant, n = 406), 25% (n = 355) were not hospitalized at first presentation due to mild illness (30% HD, 13% transplant). Of the non-hospitalized patients, only 10% (n = 36) re-presented a second time, with a 5-day median interval between the two presentations (interquartile range 2–7 days). Patients who re-presented had worsening respiratory symptoms, a decrease in oxygen saturation (97% versus 90%) and an increase in C-reactive protein (26 versus 73 mg/L) and were older (72 vs 63 years) compared with those who did not return a second time. The 28-day mortality between early admission (at first presentation) and deferred admission (at second presentation) was not significantly different (29% versus 25%; P = 0.6). Older age, prior smoking history, higher clinical frailty score and self-reported shortness of breath at first presentation were identified as risk predictors of mortality when re-presenting after discharge at initial triage. Conclusions This study provides evidence that KRT patients with COVID-19 and mild illness can be managed effectively with supported outpatient care and with vigilance of respiratory symptoms, especially in those with risk factors for poor outcomes. Our findings support a risk-stratified clinical approach to admissions and discharges of KRT patients presenting with COVID-19 to aid clinical triage and optimize resource utilization during the ongoing pandemic.

Published
2021

5. COVID-19-related mortality in kidney transplant and haemodialysis patients: a comparative, prospective registry-based study

Author

Goffin, E., Candellier, A., Vart, P., Noordzij, M., Arnol, M., Covic, A., Lentini, P., Malik, S., Reichert, L. J. M., Duivenvoorden, R., Hilbrands, L.B., Maas, R.J.H., Sever, M.S., Watschinger, B., Jager, K.J., Gansevoort, R.T., Goffin, E., Candellier, A., Vart, P., Noordzij, M., Arnol, M., Covic, A., Lentini, P., Malik, S., Reichert, L. J. M., Duivenvoorden, R., Hilbrands, L.B., Maas, R.J.H., Sever, M.S., Watschinger, B., Jager, K.J., and Gansevoort, R.T.

Abstract

Item does not contain fulltext, BACKGROUND: Coronavirus disease 2019 (COVID-19) has exposed haemodialysis (HD) patients and kidney transplant (KT) recipients to an unprecedented life-threatening infectious disease, raising concerns about kidney replacement therapy (KRT) strategy during the pandemic. This study investigated the association of the type of KRT with COVID-19 severity, adjusting for differences in individual characteristics. METHODS: Data on KT recipients and HD patients diagnosed with COVID-19 between 1 February 2020 and 1 December 2020 were retrieved from the European Renal Association COVID-19 Database. Cox regression models adjusted for age, sex, frailty and comorbidities were used to estimate hazard ratios (HRs) for 28-day mortality risk in all patients and in the subsets that were tested because of symptoms. RESULTS: A total of 1670 patients (496 functional KT and 1174 HD) were included; 16.9% of KT and 23.9% of HD patients died within 28 days of presentation. The unadjusted 28-day mortality risk was 33% lower in KT recipients compared with HD patients {HR 0.67 [95% confidence interval (CI) 0.52-0.85]}. In a fully adjusted model, the risk was 78% higher in KT recipients [HR 1.78 (95% CI 1.22-2.61)] compared with HD patients. This association was similar in patients tested because of symptoms [fully adjusted model HR 2.00 (95% CI 1.31-3.06)]. This risk was dramatically increased during the first post-transplant year. Results were similar for other endpoints (e.g. hospitalization, intensive care unit admission and mortality >28 days) and across subgroups. CONCLUSIONS: KT recipients had a greater risk of a more severe course of COVID-19 compared with HD patients, therefore they require specific infection mitigation strategies.

Published
2021

6. Optimal current frequency for the detection of changes in extracellular water in patients on hemodialysis by measurement of total body electrical resistance

Author

Schotman, J.M., Hazeleger, L.R., Borren, M. van, Wetzels, J., Kloke, H.J., Reichert, L. J. M., Doorenbos, C.J., Boer, H, Schotman, J.M., Hazeleger, L.R., Borren, M. van, Wetzels, J., Kloke, H.J., Reichert, L. J. M., Doorenbos, C.J., and Boer, H

Abstract

Item does not contain fulltext, BACKGROUND & AIMS: Measurement of total body electrical resistance (TBER) to an alternating current is useful to monitor extracellular water (ECW) in patients on hemodialysis (HD). Which current frequency is preferable is subject of ongoing debate. The aim of this study was to quantify the implications of TBER measurements at current frequencies ranging from 0 to 1000 kHz for ECW monitoring in patients on HD. METHODS: Bioimpedance spectroscopy measurements were performed in 39 patients on HD using the Body Composition Monitor (BCM, Fresenius Medical Care). TBER data at 5, 50, 200, 500, and 1000 kHz were compared with the extrapolated TBER at 0 kHz (TBER(0)) assessed by Cole-Cole analysis. Sensitivity of each TBER configuration was evaluated at individual level, by assessment of the smallest ultrafiltration (UF) volume that induced a significant change in TBER, i.e. a change in TBER ≥ 2.7%. RESULTS: TBER precision was very high for all frequencies, with coefficients of variation of 0.25%-0.28%. Baseline TBER decreased with increasing current frequency. TBER was 2.9% lower at 5 kHz (P < 0.001), 11.6% lower at 50 kHz, and up to 22.0% lower at 1000 kHz. This pattern is attributed to a progressive increase in intracellular current conduction at higher frequencies. Sensitivity to volume changes induced by UF also decreased with increasing current frequency. At 0 and 5 kHz, an UF volume ≤ 0.5 L was sufficient to induce a significant increase in TBER in 87% of patients. This decreased to 69% at higher frequencies. CONCLUSION: ECW monitoring by TBER requires measurement at 5 kHz or less to ensure optimal performance.

Published
2021

8. Sensitivity of total body electrical resistance measurements in detecting extracellular volume expansion induced by infusion of NaCl 0.9

Author

Schotman, J.M., Borren, M. van, Wetzels, J., Kloke, H.J., Reichert, L. J. M., Boer, H, Schotman, J.M., Borren, M. van, Wetzels, J., Kloke, H.J., Reichert, L. J. M., and Boer, H

Abstract

Contains fulltext : 229498.pdf (Publisher’s version ) (Closed access), BACKGROUND: Fluid balance management in hospitalized patients is hampered by the limited sensitivity of currently available tools. The aim of this study was to assess the sensitivity of total body electrical resistance (TBER) measurements for the detection of extracellular volume (ECV) expansion. METHODS: TBER and plasma resistivity (ρ(plasma)) were measured during a 4-h infusion of NaCl 0.9% at a rate of 500 mL/h in 23 patients undergoing a diagnostic saline infusion test for primary hyperaldosteronism. Extracellular fluid gain (EFG) was defined as infusion volume minus urinary volume. RESULTS: Infusion of 2.0 L NaCl 0.9% was associated with a mean diuresis of 1.1 ± 0.5 L, an EFG of 0.9 ± 0.5 L, a decrease in ρ(plasma) of 1.1 ± 0.7 Ω·cm or 1.7 ± 1.0% (P < 0.001), and a decline in TBER of 23.2 ± 10.9 Ω or 4.6 ± 2.2% (P < 0.001). At group level, infusion of 80 mL saline was sufficient to induce a statistically significant decline in mean TBER. At personal level, the decline in TBER was significant on 76% of occasions after an EFG of 0.5-0.75 L, and on all occasions after an EFG of 1.0 L or greater. CONCLUSION: Raw TBER data are very informative for the detection of ECV expansion induced by the infusion of NaCl 0.9%, with a sensitivity at a personal level that is relevant for clinical practice.

Published
2020

11. Mortality reduction by post-dilution online-haemodiafiltration: a cause-specific analysis

Author

Nubé, Menso J., Peters, Sanne A E, Blankestijn, Peter J., Canaud, Bernard, Davenport, Andrew, Grooteman, Muriel P C, Asci, Gulay, Locatelli, Francesco, Maduell, Francisco, Morena, Marion, Ok, Ercan, Torres, Ferran, Bots, Michiel L., Moreso, Francesc, Pons, Mercedes, Ramos, Rosa, Mora-Macià, Josep, Carreras, Jordi, Soler, Jordi, Campistol, Josep M., Martinez-Castelao, Alberto, Insensé, B., Perez, C., Feliz, T., Barbetta, M., Soto, C., Mora, J., Juan, A., Ibrik, O., Foraster, A., Nin, J., Fernández, A., Arruche, M., Sánchez, C., Vidiella, J., Barbosa, F., Chiné, M., Hurtado, S., Llibre, J., Ruiz, A., Serra, M., Salvó, M., Poyuelo, T., Maduell, F., Carrera, M., Fontseré, N., Arias, M., Merín, A., Ribera, L., Galceran, J. M., Mòdol, J., Moliner, E., Ramirez, A., Aguilera, J., Alvarez, M., De La Torre, B., Molera, M., Casellas, J., Martín, G., Andres, E., Coll, E., Valles, M., Martínez, C., Castellote, E., Casals, J. M., Gabàs, J., Romero, M., Martinez-Castelao, A., Fulladosa, X., Ramirez-Arellano, M., Fulquet, M., Pelegrí, A., El Manouari, M., Ramos, N., Bartolomé, J., Sans, R., Fernández, E., Sarró, F., Compte, T., Marco, F., Mauri, R., Bronsoms, J., Arnaiz, J. A., Beleta, H., Pejenaute, A., Ríos, J., Lara, J., Ter Wee, P. M., Van Den Dorpel, M. A., Dorval, M., Lévesque, R., Koopman, M. G., Konings, C. J A M, Haanstra, W. P., Kooistra, M., Van Jaarsveld, B., Noordzij, T., Feith, G. W., Peltenburg, H. G., Van Buren, M., Offerman, J. J G, Hoogeveen, E. K., De Heer, F., Van De Ven, P. J., Kremer Hovinga, T. K., Bax, W. A., Groeneveld, J. O., Lavrijssen, A. T J, Schrander-Van Der Meer, A. M., Reichert, L. J M, Huussen, J., Rensma, P. L., Schrama, Y., Van Hamersvelt, H. W., Boer, W. H., Van Kuijk, W. H., Vervloet, M. G., Wauters, I. M P M J, Sekse, I., Toz, Huseyin, Ok, Ebru Sevinc, Kircelli, Fatih, Yilmaz, Mumtaz, Hur, Ender, Demirci, Meltem Sezis, Demirci, Cenk, Duman, Soner, Basci, Ali, Adam, Siddig Momin, Isik, Ismet Onder, Zengin, Murat, Suleymanlar, Gultekin, Yilmaz, Mehmet Emin, Ergin, Mehmet Ozkahya Pinar, Sagdic, Alfert, Kayali, Erkan, Boydak, Can, Colak, Taskin, Caliskan, Sihli, Kaplan, Hakan, Ulas, Hasibe, Kirbiyik, Sait, Berktas, Hakan, Dilbaz, Necati, Cristol, Jean Paul, Leray-Moragues, Hélène, Chenine, Leïla, Picot, Marie Christine, Jaussent, Audrey, Belloc, Claire, Lagarrigue, Mélodie, Chalabi, Lotfi, Debure, Alain, Ouziala, Messaoud, Lefevre, Jean Jacques, Thibaudin, Damien, Mohey, Hesham, Broyet, Christian, Afiani, Aida, Serveaux, Marie Odile, Patrier, Laure, Maurice, François, Rivory, Jean Pierre, Nicoud, Philippe, Durand, Claude, Normand, Michel, Seigneuric, Bruno, Magnant, Eric, Azzouz, Lynda, Islam, Mohamed Shariful, Vido, Sandor, Nzeyimana, Hilaire, Simonin, Danièle, Azymah, Yamina, Farah, Ibrahim, Coindre, Jean Philippe, Puyoo, Olivier, Chabannier, Marie Hélène, Ibos, Richard, Rouleau, Fabienne, Vela, Carlos, Joule, Josiane, Combarnous, François, Turc-Baron, Cécile, Ducret, Francis, Pointet, Philippe, Rey, Isabelle, Potier, Jacky, Bendini, Jean Christophe, Perrin, Franck, Kunz, Kristian, Lefrancois, Gaëlle, Colin, Angélique, Parahy, Sophie, Dancea, Irima, Coupel, Stéphanie, Testa, Angelo, Brunet, Philippe, Lebrun, Gaétan, Jaubert, Dominique, Delcroix, Catherine, Lavainne, Frédéric, Lefebvre, Anne, Guillodo, Marie Paule, Le Grignou, Dominique, Djema, Assia, Maaz, Mehadji, Chiron, Sylvie, Hoffmann, Maxime, Depraetre, Pascale, Haddj-Elmrabet, Atman, Joyeux, Véronique, Fleury, Dominique, Vrigneaud, Laurence, Lemaitre, Vincent, Aguilera, Didier, Guerraoui, Abdallah, Cremault, Alain, Laradi, Achour, Babinet, Francois, VU University Medical Center [Amsterdam], University of Oxford [Oxford], University Medical Center [Utrecht], Fresenius Medical Care Deutschland, University College of London [London] (UCL), Ege university, Alessandro Manzoni Hospital, Hospital Clinic Barcelona, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Universitat Autònoma de Barcelona (UAB), Ege Üniversitesi, Nephrology, ICaR - Circulation and metabolism, Herrada, Anthony, and University of Oxford

Subjects
Male, medicine.medical_specialty, 030232 urology & nephrology, Hemodiafiltration, 030204 cardiovascular system & hematology, haemodiafiltration, Convection, Lower risk, Sudden death, convection volume, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, haemo-diafiltration, 03 medical and health sciences, 0302 clinical medicine, Renal Dialysis, cardiovascular disease, Cause of Death, Internal medicine, Journal Article, medicine, Humans, Intensive care medicine, Aged, Proportional Hazards Models, Randomized Controlled Trials as Topic, Transplantation, integumentary system, business.industry, Mortality rate, Hazard ratio, Middle Aged, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, mortality, Confidence interval, 3. Good health, meta-analysis, Cardiovascular Diseases, Nephrology, Meta-analysis, Cardiology, Number needed to treat, Kidney Failure, Chronic, Female, business
Abstract

WOS: 000398117600023, PubMed ID: 28025382, Background. From an individual participant data (IPD) meta-analysis from four randomized controlled trials comparing haemodialysis (HD) with post-dilution online-haemodiafiltration (ol-HDF), previously it appeared that HDF decreases all-cause mortality by 14% (95% confidence interval 25; 1) and fatal cardiovascular disease (CVD) by 23% (39; 3). Significant differences were not found for fatal infections and sudden death. So far, it is unclear, however, whether the reduced mortality risk of HDF is only due to a decrease in CVD events and if so, which CVD in particular is prevented, if compared with HD. Methods. The IPD base was used for the present study. Hazard ratios and 95% confidence intervals for cause-specific mortality overall and in thirds of the convection volume were calculated using the Cox proportional hazard regression models. Annualized mortality and numbers needed to treat (NNT) were calculated as well. Results. Besides 554 patients dying from CVD, fatal infections and sudden death, 215 participants died from 'other causes', such as withdrawal from treatment and malignancies. In this group, the mortality risk was comparable between HD and ol-HDF patients, both overall and in thirds of the convection volume. Subdivision of CVD mortality in fatal cardiac, non-cardiac and unclassified CVD showed that ol-HDF was only associated with a lower risk of cardiac casualties [0.64 (0.61; 0.90)]. Annual mortality rates also suggest that the reduction in CVD death is mainly due to a decrease in cardiac fatalities, including both ischaemic heart disease and congestion. Overall, 32 and 75 patients, respectively, need to be treated by high-volume HDF (HV-HDF) to prevent one all-cause and one CVD death, respectively, per year. Conclusion. The beneficial effect of ol-HDF on all-cause and CVD mortality appears to be mainly due to a reduction in fatal cardiac events, including ischaemic heart disease as well as congestion. In HV-HDF, the NNT to prevent one CVD death is 75 per year., EuDial working group; European Nephrology and Dialysis Institute; Catalan Society of Nephrology; Fresenius Medical Care; Dutch Kidney Foundation [C02.2019]; Fresenius Medical Care, Netherlands; Gambro Lundia AB, Sweden; Dr E.E. Twiss Fund; International Society of Nephrology/Baxter Extramural Grant Program; Netherlands Organization for Health Research and DevelopmentNetherlands Organization for Health Research and Development [170882802]; national grant from the Health Ministry (Programme Hospitalier de Recherche Clinique, PHRC); Gambro through the Catalan Society of Nephrology; Roche Netherlands, The HDF Pooling project was designed, conducted and analysed independently of the financial contributors of the individual studies as listed below. Study data were collected and retained by the investigators and were not available for the financial contributors of the individual studies. S.A.E.P. and the meetings of the representatives of the combined authors of the four studies were financially supported by the EuDial working group. EuDial is an official working group of the European Renal Association-European Dialysis Transplant Association (ERA-EDTA, http://era-edta.org/eudial/European_Dialysis_Working_Group.html). No industry funding was received for any part of or activity related to the present analysis.; The Turkish HDF study was supported by European Nephrology and Dialysis Institute with an unrestricted grant. The study was performed in Fresenius Medical Care haemodialysis clinics in Turkey. ESHOL was supported by The Catalan Society of Nephrology and by grants from Fresenius Medical Care and Gambro through the Catalan Society of Nephrology. The CONTRAST study was supported by a grant from the Dutch Kidney Foundation (Nierstichting Nederland Grant C02.2019), and unrestricted grants from Fresenius Medical Care, Netherlands, and Gambro Lundia AB, Sweden. Additional support was received from the Dr E.E. Twiss Fund, Roche Netherlands, the International Society of Nephrology/Baxter Extramural Grant Program, and the Netherlands Organization for Health Research and Development (ZONMw Grant 170882802). The French HDF study was supported by a national grant from the Health Ministry (Programme Hospitalier de Recherche Clinique, PHRC) as a means to improve care and outcome of elderly chronic disease patients.

Published
2017

12. Mortality reduction by post-dilution online-haemodiafiltration: A cause-specific analysis

Author

Cardiovasculaire Epi Team 5, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Circulatory Health, MS Nefrologie, MS CGO, MS Medische Oncologie, Cancer, Projectafdeling VCI, Secretariaat en overig CTC, AIOS Anesthesiologie, Nubé, Menso J., Peters, Sanne A E, Blankestijn, Peter J., Canaud, Bernard, Davenport, Andrew, Grooteman, Muriel P C, Asci, Gulay, Locatelli, Francesco, Maduell, Francisco, Morena, Marion, Ok, Ercan, Torres, Ferran, Bots, Michiel L., Moreso, Francesc, Pons, Mercedes, Ramos, Rosa, Mora-Macià, Josep, Carreras, Jordi, Soler, Jordi, Campistol, Josep M., Martinez-Castelao, Alberto, Insensé, B., Perez, C., Feliz, T., Barbetta, M., Soto, C., Mora, J., Juan, A., Ibrik, O., Foraster, A., Nin, J., Fernández, A., Arruche, M., Sánchez, C., Vidiella, J., Barbosa, F., Chiné, M., Hurtado, S., Llibre, J., Ruiz, A., Serra, M., Salvó, M., Poyuelo, T., Maduell, F., Carrera, M., Fontseré, N., Arias, M., Merín, A., Ribera, L., Galceran, J. M., Mòdol, J., Moliner, E., Ramirez, A., Aguilera, J., Alvarez, M., De La Torre, B., Molera, M., Casellas, J., Martín, G., Andres, E., Coll, E., Valles, M., Martínez, C., Castellote, E., Casals, J. M., Gabàs, J., Romero, M., Martinez-Castelao, A., Fulladosa, X., Ramirez-Arellano, M., Fulquet, M., Pelegrí, A., El Manouari, M., Ramos, N., Bartolomé, J., Sans, R., Fernández, E., Sarró, F., Compte, T., Marco, F., Mauri, R., Bronsoms, J., Arnaiz, J. A., Beleta, H., Pejenaute, A., Ríos, J., Lara, J., Ter Wee, P. M., Van Den Dorpel, M. A., Dorval, M., Lévesque, R., Koopman, M. G., Konings, C. J A M, Haanstra, W. P., Kooistra, M., Van Jaarsveld, B., Noordzij, T., Feith, G. W., Peltenburg, H. G., Van Buren, M., Offerman, J. J G, Hoogeveen, E. K., De Heer, F., Van De Ven, P. J., Kremer Hovinga, T. K., Bax, W. A., Groeneveld, J. O., Lavrijssen, A. T J, Schrander-Van Der Meer, A. M., Reichert, L. J M, Huussen, J., Rensma, P. L., Schrama, Y., Van Hamersvelt, H. W., Boer, W. H., Van Kuijk, W. H., Vervloet, M. G., Wauters, I. M P M J, Sekse, I., Toz, Huseyin, Ok, Ebru Sevinc, Kircelli, Fatih, Yilmaz, Mumtaz, Hur, Ender, Demirci, Meltem Sezis, Demirci, Cenk, Duman, Soner, Basci, Ali, Adam, Siddig Momin, Isik, Ismet Onder, Zengin, Murat, Suleymanlar, Gultekin, Yilmaz, Mehmet Emin, Ergin, Mehmet Ozkahya Pinar, Sagdic, Alfert, Kayali, Erkan, Boydak, Can, Colak, Taskin, Caliskan, Sihli, Kaplan, Hakan, Ulas, Hasibe, Kirbiyik, Sait, Berktas, Hakan, Dilbaz, Necati, Cristol, Jean Paul, Leray-Moragues, Hélène, Chenine, Leïla, Picot, Marie Christine, Jaussent, Audrey, Belloc, Claire, Lagarrigue, Mélodie, Chalabi, Lotfi, Debure, Alain, Ouziala, Messaoud, Lefevre, Jean Jacques, Thibaudin, Damien, Mohey, Hesham, Broyet, Christian, Afiani, Aida, Serveaux, Marie Odile, Patrier, Laure, Maurice, François, Rivory, Jean Pierre, Nicoud, Philippe, Durand, Claude, Normand, Michel, Seigneuric, Bruno, Magnant, Eric, Azzouz, Lynda, Islam, Mohamed Shariful, Vido, Sandor, Nzeyimana, Hilaire, Simonin, Danièle, Azymah, Yamina, Farah, Ibrahim, Coindre, Jean Philippe, Puyoo, Olivier, Chabannier, Marie Hélène, Ibos, Richard, Rouleau, Fabienne, Vela, Carlos, Joule, Josiane, Combarnous, François, Turc-Baron, Cécile, Ducret, Francis, Pointet, Philippe, Rey, Isabelle, Potier, Jacky, Bendini, Jean Christophe, Perrin, Franck, Kunz, Kristian, Lefrancois, Gaëlle, Colin, Angélique, Parahy, Sophie, Dancea, Irima, Coupel, Stéphanie, Testa, Angelo, Brunet, Philippe, Lebrun, Gaétan, Jaubert, Dominique, Delcroix, Catherine, Lavainne, Frédéric, Lefebvre, Anne, Guillodo, Marie Paule, Le Grignou, Dominique, Djema, Assia, Maaz, Mehadji, Chiron, Sylvie, Hoffmann, Maxime, Depraetre, Pascale, Haddj-Elmrabet, Atman, Joyeux, Véronique, Fleury, Dominique, Vrigneaud, Laurence, Lemaitre, Vincent, Aguilera, Didier, Guerraoui, Abdallah, Cremault, Alain, Laradi, Achour, Babinet, Francois, Cardiovasculaire Epi Team 5, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Circulatory Health, MS Nefrologie, MS CGO, MS Medische Oncologie, Cancer, Projectafdeling VCI, Secretariaat en overig CTC, AIOS Anesthesiologie, Nubé, Menso J., Peters, Sanne A E, Blankestijn, Peter J., Canaud, Bernard, Davenport, Andrew, Grooteman, Muriel P C, Asci, Gulay, Locatelli, Francesco, Maduell, Francisco, Morena, Marion, Ok, Ercan, Torres, Ferran, Bots, Michiel L., Moreso, Francesc, Pons, Mercedes, Ramos, Rosa, Mora-Macià, Josep, Carreras, Jordi, Soler, Jordi, Campistol, Josep M., Martinez-Castelao, Alberto, Insensé, B., Perez, C., Feliz, T., Barbetta, M., Soto, C., Mora, J., Juan, A., Ibrik, O., Foraster, A., Nin, J., Fernández, A., Arruche, M., Sánchez, C., Vidiella, J., Barbosa, F., Chiné, M., Hurtado, S., Llibre, J., Ruiz, A., Serra, M., Salvó, M., Poyuelo, T., Maduell, F., Carrera, M., Fontseré, N., Arias, M., Merín, A., Ribera, L., Galceran, J. M., Mòdol, J., Moliner, E., Ramirez, A., Aguilera, J., Alvarez, M., De La Torre, B., Molera, M., Casellas, J., Martín, G., Andres, E., Coll, E., Valles, M., Martínez, C., Castellote, E., Casals, J. M., Gabàs, J., Romero, M., Martinez-Castelao, A., Fulladosa, X., Ramirez-Arellano, M., Fulquet, M., Pelegrí, A., El Manouari, M., Ramos, N., Bartolomé, J., Sans, R., Fernández, E., Sarró, F., Compte, T., Marco, F., Mauri, R., Bronsoms, J., Arnaiz, J. A., Beleta, H., Pejenaute, A., Ríos, J., Lara, J., Ter Wee, P. M., Van Den Dorpel, M. A., Dorval, M., Lévesque, R., Koopman, M. G., Konings, C. J A M, Haanstra, W. P., Kooistra, M., Van Jaarsveld, B., Noordzij, T., Feith, G. W., Peltenburg, H. G., Van Buren, M., Offerman, J. J G, Hoogeveen, E. K., De Heer, F., Van De Ven, P. J., Kremer Hovinga, T. K., Bax, W. A., Groeneveld, J. O., Lavrijssen, A. T J, Schrander-Van Der Meer, A. M., Reichert, L. J M, Huussen, J., Rensma, P. L., Schrama, Y., Van Hamersvelt, H. W., Boer, W. H., Van Kuijk, W. H., Vervloet, M. G., Wauters, I. M P M J, Sekse, I., Toz, Huseyin, Ok, Ebru Sevinc, Kircelli, Fatih, Yilmaz, Mumtaz, Hur, Ender, Demirci, Meltem Sezis, Demirci, Cenk, Duman, Soner, Basci, Ali, Adam, Siddig Momin, Isik, Ismet Onder, Zengin, Murat, Suleymanlar, Gultekin, Yilmaz, Mehmet Emin, Ergin, Mehmet Ozkahya Pinar, Sagdic, Alfert, Kayali, Erkan, Boydak, Can, Colak, Taskin, Caliskan, Sihli, Kaplan, Hakan, Ulas, Hasibe, Kirbiyik, Sait, Berktas, Hakan, Dilbaz, Necati, Cristol, Jean Paul, Leray-Moragues, Hélène, Chenine, Leïla, Picot, Marie Christine, Jaussent, Audrey, Belloc, Claire, Lagarrigue, Mélodie, Chalabi, Lotfi, Debure, Alain, Ouziala, Messaoud, Lefevre, Jean Jacques, Thibaudin, Damien, Mohey, Hesham, Broyet, Christian, Afiani, Aida, Serveaux, Marie Odile, Patrier, Laure, Maurice, François, Rivory, Jean Pierre, Nicoud, Philippe, Durand, Claude, Normand, Michel, Seigneuric, Bruno, Magnant, Eric, Azzouz, Lynda, Islam, Mohamed Shariful, Vido, Sandor, Nzeyimana, Hilaire, Simonin, Danièle, Azymah, Yamina, Farah, Ibrahim, Coindre, Jean Philippe, Puyoo, Olivier, Chabannier, Marie Hélène, Ibos, Richard, Rouleau, Fabienne, Vela, Carlos, Joule, Josiane, Combarnous, François, Turc-Baron, Cécile, Ducret, Francis, Pointet, Philippe, Rey, Isabelle, Potier, Jacky, Bendini, Jean Christophe, Perrin, Franck, Kunz, Kristian, Lefrancois, Gaëlle, Colin, Angélique, Parahy, Sophie, Dancea, Irima, Coupel, Stéphanie, Testa, Angelo, Brunet, Philippe, Lebrun, Gaétan, Jaubert, Dominique, Delcroix, Catherine, Lavainne, Frédéric, Lefebvre, Anne, Guillodo, Marie Paule, Le Grignou, Dominique, Djema, Assia, Maaz, Mehadji, Chiron, Sylvie, Hoffmann, Maxime, Depraetre, Pascale, Haddj-Elmrabet, Atman, Joyeux, Véronique, Fleury, Dominique, Vrigneaud, Laurence, Lemaitre, Vincent, Aguilera, Didier, Guerraoui, Abdallah, Cremault, Alain, Laradi, Achour, and Babinet, Francois

Published
2017

14. Optimal current frequency for the detection of changes in extracellular water in patients on hemodialysis by measurement of total body electrical resistance.

Author

Schotman JM, Hazeleger LR, van Borren MMGJ, Wetzels JFM, Kloke HJ, Reichert LJM, Doorenbos CJ, and de Boer H

Subjects
Body Composition, Body Water, Electric Impedance, Humans, Renal Dialysis, Water
Abstract

Background & Aims: Measurement of total body electrical resistance (TBER) to an alternating current is useful to monitor extracellular water (ECW) in patients on hemodialysis (HD). Which current frequency is preferable is subject of ongoing debate. The aim of this study was to quantify the implications of TBER measurements at current frequencies ranging from 0 to 1000 kHz for ECW monitoring in patients on HD., Methods: Bioimpedance spectroscopy measurements were performed in 39 patients on HD using the Body Composition Monitor (BCM, Fresenius Medical Care). TBER data at 5, 50, 200, 500, and 1000 kHz were compared with the extrapolated TBER at 0 kHz (TBER 0 ) assessed by Cole-Cole analysis. Sensitivity of each TBER configuration was evaluated at individual level, by assessment of the smallest ultrafiltration (UF) volume that induced a significant change in TBER, i.e. a change in TBER ≥ 2.7%., Results: TBER precision was very high for all frequencies, with coefficients of variation of 0.25%-0.28%. Baseline TBER decreased with increasing current frequency. TBER was 2.9% lower at 5 kHz (P < 0.001), 11.6% lower at 50 kHz, and up to 22.0% lower at 1000 kHz. This pattern is attributed to a progressive increase in intracellular current conduction at higher frequencies. Sensitivity to volume changes induced by UF also decreased with increasing current frequency. At 0 and 5 kHz, an UF volume ≤ 0.5 L was sufficient to induce a significant increase in TBER in 87% of patients. This decreased to 69% at higher frequencies., Conclusion: ECW monitoring by TBER requires measurement at 5 kHz or less to ensure optimal performance., Competing Interests: Declaration of competing interest All the authors declared that they had no competing interests., (Copyright © 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Published
2021
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15. Cinacalcet for secondary hyperparathyroidism: from improved mineral levels to improved mortality?

Author

Vervloet MG, du Buf-Vereijken PW, Potter van Loon BJ, Manamley N, Reichert LJ, and Smak Gregoor PJ

Subjects
Bone Density drug effects, Calcinosis drug therapy, Calcium blood, Cinacalcet, Heart Valve Diseases drug therapy, Humans, Hyperparathyroidism, Secondary blood, Parathyroid Hormone blood, Calcimimetic Agents therapeutic use, Hyperparathyroidism, Secondary drug therapy, Naphthalenes therapeutic use
Abstract

Secondary hyperparathyroidism is an almost inevitable complication of advanced kidney failure. The introduction of the calcimimetic cinacalcet for the treatment of secondary hyperparathyroidism in patients on dialysis was based on its ability to reduce elevated levels of parathyroid hormone (PTH). Subsequent clinical studies confirmed the beneficial effects of cinacalcet on biochemical parameters reflecting mineral disturbances and bone disease. In this review we summarise the impact of cinacalcet on biochemical, intermediate and clinical outcomes. We also present previously unpublished mineral metabolism data from 144 Dutch dialysis patients treated with cinacalcet who participated in the pan-European ECHO observational study. Although secondary hyperparathyroidism tended to be more severe in our Dutch cohort, compared with the entire ECHO cohort, cinacalcet was nevertheless effective in reducing PTH in these patients. Two recent clinical studies evaluated, respectively, the efficacy of cinacalcet in improving the intermediate endpoint of cardiovascular calcifications (ADVANCE trial), and its impact on clinical outcomes, including all-cause mortality and cardiovascular events (EVOLVE trial). The ADVANCE trial provided evidence that cinacalcet may indeed improve calcification in both large arteries and cardiac valves. The EVOLVE trial, however, did not meet its clinical primary endpoint (time to all-cause mortality, myocardial infarction, hospitalisation for unstable angina, heart failure or a peripheral vascular event), although secondary and sensitivity analysis suggested a beneficial effect. The clinical implications of these important studies are also addressed in this review.

Published
2013

16. [Desmopressin for nocturia in the old: an inappropriate treatment due to the high risk of side-effects?].

Author

ten Doesschate T, Reichert LJ, and Claassen JA

Subjects
Aged, Aged, 80 and over, Antidiuretic Agents therapeutic use, Deamino Arginine Vasopressin therapeutic use, Female, Humans, Risk Assessment, Risk Factors, Sodium blood, Antidiuretic Agents adverse effects, Deamino Arginine Vasopressin adverse effects, Hyponatremia chemically induced, Nocturia drug therapy
Abstract

Desmopressin, a synthetic analog of the antidiuretic hormone, is used in the treatment of enuresis nocturna in children and increasingly also in adults. Nocturia in the elderly causes sleeping disorders and is associated with a higher risk of falling and increased mortality. Desmopressin leads to a significant decrement of nocturia and consequently, a better sleep quality and is for this reason increasingly prescribed in the old. Desmopressin causes borderline hyponatremia (130-135 mmol/l) in 15% and severe hyponatremia in 5% of all adult users. Factors that predispose to hyponatremia are a higher dose, age > 65 years, a low-normal serum sodium, a high 24-hour urine volume and co-medication (thiazide diuretics, tricyclic antidepressants, serotonin-reuptake-inhibitors, chlorpromazine, carbamazipine, loperamide, Non-Steroidal-Anti-Inflammatory-Drugs). Hyponatremia is associated with headache, nausea, vomiting, dizziness, and can cause somnolence, loss of consciousness and death. We present two cases where initiation of desmopressin led to hyponatremia, requiring hospitalization. In view of the high risk of desmopressin-associated hyponatremia in the older population, alternative treatment strategies for nocturia must be considered first. If desmopressin is prescribed, strict follow-up of serum sodium levels is necessary.

Published
2010

17. [Diagnostic image (80). A men with thirst and polyuria. Bladder retention].

Author

Reichert LJ

Subjects
Aged, Diagnosis, Differential, Humans, Hydronephrosis physiopathology, Male, Polyuria etiology, Renal Insufficiency physiopathology, Thirst, Hydronephrosis etiology, Prostatic Hyperplasia complications, Renal Insufficiency etiology, Urinary Retention diagnosis
Abstract

A 69-year-old man was admitted because of polyuria and renal insufficiency. At physical examination a huge bladder retention was found (31). The polyuria was explained by the decreased concentrating ability of the kidney due to impaired tubular function; this was caused by hydronephrosis due to prostate hypertrophy.

Published
2002

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