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Supplemental material, Supplementary_Methods for Efficacy of urokinase lock to treat thrombotic dysfunction of tunneled hemodialysis catheters: A retrospective cohort study by Freya Van Hulle, Florence Bonkain, Dieter De Clerck, Dimitri Aerden, Isabelle Vanwijn, Christian Tielemans and Karl Martin Wissing in The Journal of Vascular Access

The target of modern dialyzers is to maximize the permeability of small and middle molecular weight (MW) toxins while retaining albumin. Reduction ratio (RR) of small water-soluble compounds like urea and middle MW molecules like β2 microglobulin are well studied for each dialysis membrane. Differences in clearance of substances with higher MW are less known. Based on higher Stokes' radius and MW, we measured myoglobin RR as a surrogate for uremic toxins with higher MW.

Introduction: The use of tunnelled cuffed hemodialysis catheters (TCC) is complicated by the development of thrombosis and catheter related bacteremia (CRB). The optimal regimen to treat thrombotic complications with thrombolytic locking solutions remains controversial. Methods: We retrospectively collected data on all thrombotic dysfunctions of TCC used between 2010 and 2014 at the UZ Brussel Hemodialysis Unit. We reviewed the efficacy of different treatment regimens with Urokinase thrombolytic catheter locks to restore adequate access blood flows and pump pressures. The advantage of multiple administrations of Urokinase locks between successive dialysis sessions was also investigated. Results: 148 patients had in total 773 thrombotic dysfunctions. Urokinase 50000 IU in each catheter lumen restored adequate access blood flow to more than 250 ml/min in 80% of treatments, with increases of mean blood flow by 54 ml/min. Normalisation of arterial and venous pump pressures occurred in 90% of dysfunctional catheters with a reduction of mean aspiration (arterial) pressure by 25 mm Hg and mean outflow (venous) pressure by 32 mm Hg (all p < 0.0001). Multiple administrations of Urokinase locks during successive dialysis sessions for the same thrombotic event improved access blood flow and pump pressures only in catheters with persistent thrombotic dysfunction after the first lock (p < 0.0001) but had no added value in case full restoration of access function had occurred after the first treatment. Incidence rate of CRB was 0.23/1000 catheter days in this population. Conclusion: Urokinase was effective to treat TCC-related thrombotic dysfunction. Multiple administrations were more effective than one single administration only if normal function was not restored after the first treatment.

Objective Classical cardiovascular risk factors are not so predictive of survival in haemodialysis. Inflammation and malnutrition are the main predictors of mortality in haemodialysis population. As markers of inflammation, total white blood cell count, absolute neutrophil count and to a lesser degree lymphocyte count are associated with adverse cardiovascular outcomes in non-end stage renal disease population and with all-cause mortality in normal and haemodialysis population. This study explores the associations of three markers of inflammation (absolute lymphocyte count, neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios) with mortality in haemodialysis, taking into account additional confounding risk factors of inflammation and malnutrition for patient death. Methods Complete follow up data from 575 out of a total study population of 686 patients receiving maintenance haemodialysis in our centre Universitair Ziekenhuis Brussel from January 1rst 1998 to December 31rst 2011, were collected: age, gender, weight, medical history and laboratory tests (haematocrit, albumin, creatinine, potassium, calcium, phosphorus, bicarbonate, ferritin, CRP, transferrin saturation and differential WBC count) were retrieved. These data were merged with outcome data extracted from the NBVN registry. Association of absolute lymphocyte count, neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios with mortality was evaluated using Kaplan Meier and Cox hazard regression for confounding factors. Results Serum albumin emerged as the strongest risk factor for mortality. A higher absolute lymphocyte count was associated with lower mortality (p < 0.0001). High neutrophil-to-lymphocyte ratio was associated with higher mortality (p < 0.0001). A multivariate Cox hazard regression analysis showed similar results. The association between platelet-to-lymphocyte ratio and mortality was less strong (p=0.002 for Kaplan Meier curve and not significant for hazard regression). Conclusion Increased absolute lymphocyte count and neutrophil-to-lymphocyte ratio are respectively strongly associated with reduced and higher mortality, independently of confounding factors of nutrition (albumine) and inflammation (CRP). An increased neutrophil-to-lymphocyte ratio and a reduced lymphocyte count are independent predictors of higher mortality in haemodialysis patients.

Background and Objectives A high body mass index (BMI) is associated with lower mortality in patients undergoing hemodialysis. Short-term weight gains and losses are also related to lower and higher mortality risk, respectively. The implications of weight gain or loss may, however, differ between obese individuals and their nonobese counterparts.Design, Setting, Participants, & MeasurementsThe Current Management of Secondary Hyperparathyroidism: A Multicenter Observational Study (COSMOS) is an observational study including 6797 European hemodialysis patients recruited between February 2005 and July 2007, with prospective data collection every 6 months for 3 years. Time-dependent Cox proportional hazard regressions assessed the effect of BMI and weight changes on mortality. Analyses were performed after patient stratification according to their starting BMI.ResultsAmong 6296 patients with complete data, 1643 died. At study entry, 42% of patients had a normal weight (BMI, 20-25 kg/m(2)), 11% were underweight,31% were overweight, and 16% were obese (BMI 30 kg/m(2)). Weight loss or gain (1% of body weight) was strongly associated with higher rates of mortality or survival, respectively. After stratification by BMI categories, this was true in nonobese categories and especially in underweight patients. In obese patients, however, the association between weight loss and mortality was attenuated (hazard ratio, 1.28 [95% confidence interval (CI), 0.74 to 2.14]), and no survival benefit of gaining weight was seen (hazard ratio, 0.98 [95% CI, 0.59 to 1.62]).ConclusionsAssuming that these weight changes were unintentional, our study brings attention to rapid weight variations as a clinical sign of health monitoring in hemodialysis patients. In addition, a patient's BMI modifies the strength of the association between weight changes with mortality.

After a short historical background of the Laboratory, the main research topics - renal toxicology, physiopathology of renal interstitial fibrosis and hormonology - are described in the perspective of a partnership between research clinicians and full time scientists. National as well as international scientific collaborations underline the need of combining expertises, stimulating also the training of youngest colleagues to the experimental approach of their future discipline., Supplément, SCOPUS: sh.j, info:eu-repo/semantics/published

Study aims: To survey bone mineral disturbances in the hemodialysis (HD) population in Europe and current clinical practice in Europe for the prevention, diagnosis and treatment of secondary hyperparathyroidism (SHPT) in HD patients. Primary objectives: First, to estimate the prevalence of Kidney Disease Outcomes Quality Initiative (K/DOQI) guideline achievement in a representative sample of European hemodialysis subjects. As part of this objective, we will investigate the prevalence of achievement by type of dialysis, type of center and time on dialysis (less than or greater than 1 year). Among new dialysis subjects (less than 1 year), we will evaluate prevalence of K/DOQI target achievement until the end of the study. The study will run for 3 years. Second, to estimate the association of bone mineral markers (parathyroid hormone [PTH], calcium [Ca], serum phosphorus [P] and calcium phosphate product [Ca×P]) classified by achievement of K/DOQI targets with mortality and overall cardiovascular hospitalization. Third, to characterize the longitudinal changes in bone mineral markers. As part of this objective, we will describe the patterns and predictors of bone mineral markers and achievement, with K/DOQI targets, using repeated measurements on individuals over time. Secondary objectives: First, To estimate the association of bone mineral markers (PTH, Ca, P and Ca×P) classified by achievement of K/DOQI targets with specific cardiovascular outcomes, parathyroidectomy, manifest bone disease (including incidence of symptomatic bone fractures), hospitalizations and vascular access. Second, to evaluate the additional value of albumin and hemoglobin levels in conjunction with bone mineral markers in the prediction of mortality and clinical events.