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  1. Article: Role of L-arginine in the pathogenesis and treatment of renal disease.

    Cherla, Gautam / Jaimes, Edgar A

    The Journal of nutrition

    2003  Volume 134, Issue 10 Suppl, Page(s) 2801S–2806S; discussion 2818S–2819S

    Abstract: L-arginine is a semi essential amino acid and also a substrate for the synthesis of nitric oxide (NO), polyamines, and agmatine. These L-arginine metabolites may participate in the pathogenesis of renal disease and constitute the rationale for ... ...

    Abstract L-arginine is a semi essential amino acid and also a substrate for the synthesis of nitric oxide (NO), polyamines, and agmatine. These L-arginine metabolites may participate in the pathogenesis of renal disease and constitute the rationale for manipulating L-arginine metabolism as a strategy to ameliorate kidney disease. Modification of dietary L-arginine intake in experimental models of kidney diseases has been shown to have both beneficial as well as deleterious effects depending on the specific model studied. L-arginine supplementation in animal models of glomerulonephritis has been shown to be detrimental, probably by increasing the production of NO from increased local expression of inducible NO synthase (iNOS). L-arginine supplementation does not modify the course of renal disease in humans with chronic glomerular diseases. However, beneficial effects of L-arginine supplementation have been reported in several models of chronic kidney disease including renal ablation, ureteral obstruction, nephropathy secondary to diabetes, and salt-sensitive hypertension. L-arginine is reduced in preeclampsia and recent experimental studies indicate that L-arginine supplementation may be beneficial in attenuating the symptoms of preeclampsia. Administration of exogenous L-arginine has been shown to be protective in ischemic acute renal failure. In summary, the role of L-arginine in the pathogenesis and treatment of renal disease is not completely understood and remains to be established.
    MeSH term(s) Acute Kidney Injury/drug therapy ; Animals ; Arginine/administration & dosage ; Arginine/adverse effects ; Arginine/therapeutic use ; Chronic Disease ; Diet ; Female ; Glomerulonephritis/physiopathology ; Humans ; Kidney Diseases/chemically induced ; Kidney Diseases/drug therapy ; Kidney Glomerulus/drug effects ; Pre-Eclampsia/drug therapy ; Pregnancy
    Chemical Substances Arginine (94ZLA3W45F)
    Language English
    Publishing date 2003-05-14
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
    ZDB-ID 218373-0
    ISSN 1541-6100 ; 0022-3166
    ISSN (online) 1541-6100
    ISSN 0022-3166
    DOI 10.1093/jn/134.10.2801S
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Can blood flow surveillance and pre-emptive repair of subclinical stenosis prolong the useful life of arteriovenous fistulae? A randomized controlled study.

    Cipleu, Cristian D / Cherla, Gautam V / Merrill, Donna / Asif, Arif

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

    2005  Volume 20, Issue 1, Page(s) 241–2; author reply 242–3

    MeSH term(s) Angiography ; Angioplasty, Balloon/methods ; Arteriovenous Shunt, Surgical/adverse effects ; Constriction, Pathologic/diagnostic imaging ; Constriction, Pathologic/therapy ; Female ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/therapy ; Male ; Regional Blood Flow/physiology ; Renal Dialysis/adverse effects ; Renal Dialysis/methods ; Risk Assessment
    Language English
    Publishing date 2005-01
    Publishing country England
    Document type Clinical Trial ; Comparative Study ; Letter ; Randomized Controlled Trial ; Comment
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfh600
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  3. Article: Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula.

    Asif, Arif / Cherla, Gautam / Merrill, Donna / Cipleu, Cristian D / Briones, Patricia / Pennell, Phillip

    Kidney international

    2005  Volume 67, Issue 6, Page(s) 2399–2406

    Abstract: Objective: Despite their high incidence of complications, costs, morbidity, and mortality, nearly 27% of the chronic hemodialysis (HD) patients are receiving treatment via a tunneled hemodialysis catheter (TDC).: Methods: In this prospective analysis, ...

    Abstract Objective: Despite their high incidence of complications, costs, morbidity, and mortality, nearly 27% of the chronic hemodialysis (HD) patients are receiving treatment via a tunneled hemodialysis catheter (TDC).
    Methods: In this prospective analysis, an interventional nephrology team employed an organized program consisting of vascular access (VA) education and vascular mapping (VM) to TDC-consigned patients. A full range of surgical approaches for arteriovenous fistula (AVF) creation, including vein transpositions, was exercised. Physical examination was performed every 1 to 2 weeks after surgery to assess the development of the AVF. Fistulas that failed to develop adequately to support HD (early failure) underwent salvage [percutaneous transluminal angioplasty (PTA), accessory vein obliteration (AVL)] procedures.
    Results: One hundred twenty-one TDC-consigned patients received VA education. Eighty-six (71%) agreed to undergo VM. Two groups were identified. Group I (N= 66; using TDC for 7.2 +/- 1.8 SD months) had never had an arteriovenous access; group II (N= 20; using TDC for 12.3 +/- 4.0 months) had a history of one or more previously failed arteriovenous accesses. Upon VM, 64/66 (97%) in group I and 18/20 (90%) in group II were found to have adequate veins for AVF creation. Seven patients (11%) in group I and 3 (17%) in group II refused surgery. In group I, 57 (89%) received an arteriovenous access (radiocephalic AVF = 15, brachiocephalic AVF = 35, transposed brachiobasilic AVF = 3, brachiobasilic AVG = 4). In group II, 15 (83%) received a transposed AVF (radiobasilic = 2, brachiobasilic = 13). Sixteen fistulas (30%) in group I and 8 (53%) in group II had early failure. All except for one fistula in each group were salvaged using PTA and/or AVL. All 70 accesses (AVF = 66, AVG = 4) remain functional, with a mean follow-up of 8.5 +/- 3.6 months.
    Conclusion: These results demonstrate that an organized approach based upon a comprehensive program utilizing VA counseling, VM, application of full range of surgical techniques, and salvage procedures can be very successful in providing optimum vascular access to the catheter-dependent patient.
    MeSH term(s) Adult ; Aged ; Arteriovenous Shunt, Surgical/adverse effects ; Arteriovenous Shunt, Surgical/methods ; Catheters, Indwelling ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Renal Dialysis/adverse effects ; Renal Dialysis/methods
    Language English
    Publishing date 2005-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1111/j.1523-1755.2005.00347.x
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  4. Article: Creation of secondary arteriovenous fistulas: maximizing fistulas in prevalent hemodialysis patients.

    Asif, Arif / Unger, Stephen W / Briones, Patricia / Merrill, Donna / Cherla, Gautam / Lenz, Oliver / Roth, David / Pennell, Phillip

    Seminars in dialysis

    2005  Volume 18, Issue 5, Page(s) 420–424

    Abstract: National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) guideline 29 suggests that a patient should be evaluated for a secondary arteriovenous fistula (AVF) following each episode of dialysis access failure. Regretfully, it does not ... ...

    Abstract National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) guideline 29 suggests that a patient should be evaluated for a secondary arteriovenous fistula (AVF) following each episode of dialysis access failure. Regretfully, it does not appear that this approach is used, even though recent data have emphasized that veins suitable for the creation of a secondary AVF can be identified in dialysis patients who are receiving dialysis via a synthetic arteriovenous graft (AVG) or other type of potentially dysfunctional vascular access. In this study nine patients (five with an AVG and four with an AVF) with vascular access dysfunction undergoing percutaneous interventions were evaluated for secondary AVF creation. All were found to have suitable vascular anatomy and had the AVF created. The secondary fistula was successful in all nine patients with a mean follow-up of 4.8 +/- 1.4 months in post-AVG cases and 5.6 +/- 1.7 months in the post-AVF patients. In addition, it was possible to continue uninterrupted dialysis without the use of a tunneled dialysis catheter in three of the patients with AVGs. This experience demonstrates the validity and success of this approach to the management of dialysis access dysfunction. In the ongoing effort to optimize vascular health status, we suggest that during percutaneous interventions, patients should routinely have identification of vessels suitable for creation of a secondary AVF.
    MeSH term(s) Adult ; Aged ; Arteries/pathology ; Arteries/physiopathology ; Arteriovenous Fistula/etiology ; Arteriovenous Fistula/physiopathology ; Arteriovenous Shunt, Surgical/adverse effects ; Female ; Forearm/blood supply ; Humans ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Renal Dialysis/adverse effects ; Vascular Patency ; Veins/pathology ; Veins/physiopathology
    Language English
    Publishing date 2005-09
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1028193-9
    ISSN 1525-139X ; 0894-0959
    ISSN (online) 1525-139X
    ISSN 0894-0959
    DOI 10.1111/j.1525-139X.2005.00080.x
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  5. Article: Inflow stenosis in arteriovenous fistulas and grafts: a multicenter, prospective study.

    Asif, Arif / Gadalean, Florin N / Merrill, Donna / Cherla, Gautam / Cipleu, Cristian D / Epstein, David L / Roth, David

    Kidney international

    2005  Volume 67, Issue 5, Page(s) 1986–1992

    Abstract: Background: Traditionally, arteriovenous hemodialysis access inflow stenosis has been reported to occur infrequently (0% to 4%). In contrast, recent reports have suggested a significantly higher incidence (14% to 42%). Interpretation of these studies ... ...

    Abstract Background: Traditionally, arteriovenous hemodialysis access inflow stenosis has been reported to occur infrequently (0% to 4%). In contrast, recent reports have suggested a significantly higher incidence (14% to 42%). Interpretation of these studies has been complicated by the presence of one or more confounding factors such as retrospective study design, small sample size, arteriovenous fistulas grouped with grafts to determine the incidence of inflow stenosis, inclusion of fistulas that had failed primarily, failure to provide adequate definition of inflow stenosis, and the technique of retrograde angiography. This is a report of a prospective, multicenter study to examine the incidence of inflow stenosis separately in arteriovenous fistulas and grafts.
    Methods: Patients were referred to interventional nephrology either for percutaneous balloon angioplasty or thrombectomy procedures. Angiography to evaluate access inflow (arterial anastomosis and adjacent vascular structures) was performed in all cases. This was accomplished by retrograde angiography using either manual occlusion of the venous side and/or advancing a diagnostic catheter across the arterial anastomosis. Multiple images using digital subtraction angiography were recorded in multiple planes. An inflow stenosis was defined as stenosis within the arterial system, artery-graft anastomosis (graft cases), artery-vein anastomosis (fistula cases) and juxta-anastomotic region (the first 2 cm downstream from the arterial anastomosis). Vascular stenosis was defined as >/=50% reduction in luminal diameter judged by comparison with either the adjacent vessel or graft. A standardized definition for anastomotic stenosis was applied.
    Results: Two hundred and twenty three consecutive procedures (grafts, 122; fistulas, 101) were performed in 158 patients. Inflow stenosis occurred in 36/122 (29%) in graft cases. All had a coexisting stenosis on the venous side. In fistula cases, 41/101 (40%) had inflow stenosis. Of these, 22 (54%) had a coexisting lesion on the venous side. Overall, inflow stenosis occurred in 77/223 procedures (35%).
    Conclusion: This prospective, multicenter study demonstrates that access inflow stenosis occurs in one third of the cases referred to interventional facilities with clinical evidence of venous stenosis or thrombosis. This is much higher than has been traditionally reported.
    MeSH term(s) Adult ; Aged ; Angiography ; Arteriovenous Shunt, Surgical/adverse effects ; Arteriovenous Shunt, Surgical/methods ; Cohort Studies ; Constriction, Pathologic ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Renal Dialysis/adverse effects ; Renal Dialysis/methods
    Language English
    Publishing date 2005-05
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 120573-0
    ISSN 1523-1755 ; 0085-2538
    ISSN (online) 1523-1755
    ISSN 0085-2538
    DOI 10.1111/j.1523-1755.2005.00299.x
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  6. Article: Venous mapping using venography and the risk of radiocontrast-induced nephropathy.

    Asif, Arif / Cherla, Gautam / Merrill, Donna / Cipleu, Cristian D / Tawakol, Jan Bijan / Epstein, David L / Lenz, Oliver

    Seminars in dialysis

    2005  Volume 18, Issue 3, Page(s) 239–242

    Abstract: Venous mapping using venography has been considered to be the gold standard for identifying veins suitable for arteriovenous fistula (AVF) creation. By utilizing a radiocontrast medium, however, venography introduces the risk of radiocontrast-induced ... ...

    Abstract Venous mapping using venography has been considered to be the gold standard for identifying veins suitable for arteriovenous fistula (AVF) creation. By utilizing a radiocontrast medium, however, venography introduces the risk of radiocontrast-induced nephropathy. The risk of this complication in the chronic kidney disease (CKD) population has not been previously studied. Twenty-five consecutive patients (CKD stage 4 and 5) undergoing venography were enrolled in this study. Patients were advised not to fast for the procedure and were encouraged to take oral fluids. Radiocontrast-induced nephropathy was defined as a 20% decrease in the estimated glomerular filtration rate (GFR) from the baseline value at 48 hours after contrast administration. Weekly telephone calls were made for a total of 4 weeks to assess the need for dialysis. Venography was performed by interventional nephrology using 10-20 cc of low osmolarity contrast medium. Data were collected prospectively. Median age was 48.9 +/- 7.8 years and 52% of the patients had diabetes. Complete sets of pre- and postprocedure GFRs were available in 21 patients. At 48 hours, there were no differences between the pre- and postprocedure GFRs. At the third week, one patient developed flu-like symptoms with severe gastroenteritis and was hospitalized for volume depletion. This patient initiated dialysis during the hospital stay. We conclude that at 48 hours, our cohort did not develop radiocontrast-induced nephropathy. During the 4-week phone call follow-up, only one patient needed dialysis. Large-scale studies with a longer follow-up using GFR estimation are needed to confirm these preliminary findings.
    MeSH term(s) Acute Kidney Injury/chemically induced ; Acute Kidney Injury/epidemiology ; Arteriovenous Shunt, Surgical/methods ; Contrast Media/adverse effects ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Phlebography ; Prospective Studies ; Renal Dialysis/utilization
    Chemical Substances Contrast Media
    Language English
    Publishing date 2005-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1028193-9
    ISSN 1525-139X ; 0894-0959
    ISSN (online) 1525-139X
    ISSN 0894-0959
    DOI 10.1111/j.1525-139X.2005.18319.x
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  7. Article ; Online: Chronic kidney disease stages 3-5 and cardiovascular disease in the veterans affairs population.

    Banerjee, Debasish / Contreras, Gabriel / Jaraba, Isabel / Carvalho, Decio / Ortega, Luis / Carvalho, Cristiane / Pezon, Candido / Rosenthal, Stephen P / De La Rosa, Norman / Vemuri, Nuripama / Cherla, Gautam / Nahar, Nilay

    International urology and nephrology

    2009  Volume 41, Issue 2, Page(s) 443–451

    Abstract: Aim: Cardiovascular complications are common in patients with chronic kidney disease in the general population. The study aims to investigate the prevalence and prognosis of CKD stages 3-5 in the veterans affairs (VA) population, which is sicker with ... ...

    Abstract Aim: Cardiovascular complications are common in patients with chronic kidney disease in the general population. The study aims to investigate the prevalence and prognosis of CKD stages 3-5 in the veterans affairs (VA) population, which is sicker with more co-morbid conditions.
    Methods: In this case-controlled study of 6,432 men the associations of risk factors with CKD and its risk of mortality were estimated using, primarily, logistic regression analysis.
    Results: The 1,045 (16.2%) patients with CKD stages 3-5 were older (72 +/- 10 vs. 59 +/- 13 years, P < 0.0001) with more hypertension (53.6 vs. 39.6%, P < 0.0001), diabetes (24.9 vs. 19.8%, P < 0.0002), and CVD (35.3 vs. 17.8%, P < 0.0001) at baseline. Age > or =65 years (odds ratio [95% CI]) (4.95 [4.22-5.82]), hypertension (1.56 [1.34-1.79]), diabetes mellitus (1.21 [1.03-1.43]), CVD (1.71 [1.47-2.00]), and White not Hispanic (1.57 [1.32-1.85]) were independently associated with CKD. The prevalence of CVD at baseline increased with decreasing renal function. Old age (1.98 [1.66-2.35]), CKD (1.94 [1.61-2.33], CVD (1.46 [1.23-1.74]) and tobacco use (1.91 [1.05-3.47]) were independently associated with the 750 (11.7%) deaths.
    Conclusion: Among veterans, traditional cardiovascular risk factors, CVD, and CKD are highly prevalent. CKD is associated with increased risk of baseline CVD and follow-up mortality.
    MeSH term(s) Adult ; Aged ; Cardiovascular Diseases/complications ; Cardiovascular Diseases/epidemiology ; Case-Control Studies ; Cohort Studies ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/epidemiology ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Severity of Illness Index ; Survival Rate ; United States ; Veterans/statistics & numerical data
    Language English
    Publishing date 2009-01-01
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 204048-7
    ISSN 1573-2584 ; 0301-1623 ; 0042-1162
    ISSN (online) 1573-2584
    ISSN 0301-1623 ; 0042-1162
    DOI 10.1007/s11255-008-9514-9
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