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Article: Patient-reported outcomes (PROs) argue against the limited use of peritoneal dialysis in end-stage renal disease .

de Fijter, Carola W H / van Diepen, Anouk T N / Amiri, Fariba / Dekker, Friedo W / Krediet, Ray T

2018 Volume 90, Issue 2, Page(s) 94–101

Abstract: Aim: Approximately 40% of dialysis patients are durably treated with peritoneal dialysis (PD) in our teaching hospital. Patients' perspectives were studied by patient-reported outcome measurements (PROMs) to find possible explanations for why the ... ...

Abstract	Aim: Approximately 40% of dialysis patients are durably treated with peritoneal dialysis (PD) in our teaching hospital. Patients' perspectives were studied by patient-reported outcome measurements (PROMs) to find possible explanations for why the generally-reported decline in the use of PD hardly occurred in our facility. Materials and methods: All 75 prevalent adult dialysis patients hemodialysis (HD) duration 27, PD 16 months) were included. All had received predialysis care and education for > 6 month. Cross-sectional sociodemographic and clinical data, SF-36, KDQOL-SF, and predialysis anxiety/depression scores were collected in February 2016. Differences in PROMs between PD and HD patients were analyzed. Results: Despite more comorbidity in the PD population, generally-used dialysis parameters were adequate and similar between HD (n = 42) and PD (n = 33) patients as was annual mortality. Many factors associated with a predialysis modality choice for PD were absent. A higher anxiety/depression score was found in pre-HD compared to pre-PD patients. PROMs were returned by 97%. PD patients performed better on a number of PROMs than their HD counterparts. Conclusion: This single-center cross-section with a modest number of patients but an almost 100% patient response shows that having 40% of patients on PD is possible with excellent results in terms of patient-reported outcomes. A structured patient education with attention to personal needs of patients, an adequate infrastructure for PD, and a dedicated team with ongoing patient support are key factors. Sharing best practices may help to slow down or even reverse the decline of PD, which is a pity both for patients and society. .
MeSH term(s)	Aged ; Aged, 80 and over ; Anxiety/psychology ; Cross-Sectional Studies ; Depression/psychology ; Female ; Humans ; Kidney Failure, Chronic/psychology ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Patient Reported Outcome Measures ; Peritoneal Dialysis/methods ; Peritoneal Dialysis/psychology
Language	English
Publishing date	2018-03-26
Publishing country	Germany
Document type	Journal Article
ZDB-ID	185101-9
ISSN	0301-0430
ISSN	0301-0430
DOI	10.5414/CN109369
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Article ; Online: Ethnic differences in the association between waist-to-height ratio and albumin-creatinine ratio

van Valkengoed Irene GM / Agyemang Charles / Krediet Ray T / Stronks Karien

BMC Nephrology, Vol 13, Iss 1, p

the observational SUNSET study

2012 Volume 26

Abstract: Abstract Background Ethnic differences in the association between central obesity and raised albumin-creatinine ratio (ACR) have not been investigated. Our aim was to determine whether the association between central obesity, defined by the waist-to- ... ...

Abstract	Abstract Background Ethnic differences in the association between central obesity and raised albumin-creatinine ratio (ACR) have not been investigated. Our aim was to determine whether the association between central obesity, defined by the waist-to-height ratio (WHtR), and ACR differed between subjects of Hindustani-Surinamese, African-Surinamese and Dutch origin. Methods In total, 334 Hindustani-Surinamese (~South Asian), 589 African-Surinamese (~African), and 493 Dutch (~European) men and women, aged 35–60 years, randomly selected from the municipal register of Amsterdam, participated in an interview and physical examination. We calculated the WHtR by dividing the waist circumference by height and the log ACR (logACR, log mg/mmol) by log-transforming the albumin concentration by the creatinine concentration in urine. The association between WHtR and logACR was studied in the total population and stratified by ethnicity. We also tested for interaction. Results In the total population, a higher WHtR was associated with a higher logACR, after adjustment for sex, age, and smoking, body mass index and the presence of type 2 diabetes or hypertension. Among the Hindustani-Surinamese, the adjusted association between WHtR and logACR appeared somewhat stronger than among the other ethnic groups: for every 0.1 increase in the WHtR, the log-ACR increased by 0.522 (0.096-0.949) log mg/mmol among the Hindustani-Surinamese, by 0.334 (0.047-0.622) among the African-Surinamese and by 0.356 (−0.010-0.721) among the Dutch. However, the interaction was not statistically significant. Conclusions WHtR was associated with a higher ACR among populations of Hindustani-Surinamese, African-Surinamese and Dutch origin. Our study seems to support global use of WHtR in relation to ACR across ethnic groups. However, although not significant, the association appeared slightly stronger among the Hindustani-Surinamese than among the other ethnic groups. If confirmed, this could have implications for use of the WHtR across ethnic groups.
Keywords	Diseases of the genitourinary system. Urology ; RC870-923 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Urology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	390
Language	English
Publishing date	2012-05-01T00:00:00Z
Publisher	BioMed Central
Document type	Article ; Online
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Article ; Online: Ethnic differences in the association between waist-to-height ratio and albumin-creatinine ratio: the observational SUNSET study.

van Valkengoed, Irene G M / Agyemang, Charles / Krediet, Ray T / Stronks, Karien

BMC nephrology

2012 Volume 13, Page(s) 26

Abstract: Background: Ethnic differences in the association between central obesity and raised albumin-creatinine ratio (ACR) have not been investigated. Our aim was to determine whether the association between central obesity, defined by the waist-to-height ... ...

Abstract	Background: Ethnic differences in the association between central obesity and raised albumin-creatinine ratio (ACR) have not been investigated. Our aim was to determine whether the association between central obesity, defined by the waist-to-height ratio (WHtR), and ACR differed between subjects of Hindustani-Surinamese, African-Surinamese and Dutch origin. Methods: In total, 334 Hindustani-Surinamese (~South Asian), 589 African-Surinamese (~African), and 493 Dutch (~European) men and women, aged 35-60 years, randomly selected from the municipal register of Amsterdam, participated in an interview and physical examination.We calculated the WHtR by dividing the waist circumference by height and the log ACR (logACR, log mg/mmol) by log-transforming the albumin concentration by the creatinine concentration in urine. The association between WHtR and logACR was studied in the total population and stratified by ethnicity. We also tested for interaction. Results: In the total population, a higher WHtR was associated with a higher logACR, after adjustment for sex, age, and smoking, body mass index and the presence of type 2 diabetes or hypertension. Among the Hindustani-Surinamese, the adjusted association between WHtR and logACR appeared somewhat stronger than among the other ethnic groups: for every 0.1 increase in the WHtR, the log-ACR increased by 0.522 (0.096-0.949) log mg/mmol among the Hindustani-Surinamese, by 0.334 (0.047-0.622) among the African-Surinamese and by 0.356 (-0.010-0.721) among the Dutch. However, the interaction was not statistically significant. Conclusions: WHtR was associated with a higher ACR among populations of Hindustani-Surinamese, African-Surinamese and Dutch origin. Our study seems to support global use of WHtR in relation to ACR across ethnic groups. However, although not significant, the association appeared slightly stronger among the Hindustani-Surinamese than among the other ethnic groups. If confirmed, this could have implications for use of the WHtR across ethnic groups.
MeSH term(s)	Adult ; Africa/ethnology ; Albuminuria/ethnology ; Albuminuria/urine ; Asia/ethnology ; Body Height ; Comorbidity ; Creatinine/urine ; Female ; Humans ; Male ; Middle Aged ; Netherlands/epidemiology ; Obesity/ethnology ; Obesity/urine ; Prevalence ; Reproducibility of Results ; Risk Factors ; Sensitivity and Specificity ; Waist Circumference
Chemical Substances	Creatinine (AYI8EX34EU)
Language	English
Publishing date	2012-05-07
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/1471-2369-13-26
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Article ; Online: How baseline, new-onset, and persistent depressive symptoms are associated with cardiovascular and non-cardiovascular mortality in incident patients on chronic dialysis.

van Dijk, Sandra / van den Beukel, Tessa O / Kaptein, Adrian A / Honig, Adriaan / le Cessie, Saskia / Siegert, Carl E / Boeschoten, Els W / Krediet, Ray T / Dekker, Friedo W

Journal of psychosomatic research

2013 Volume 74, Issue 6, Page(s) 511–517

Abstract: Objective: Depressive symptoms are associated with mortality among patients on chronic dialysis therapy. It is currently unknown how different courses of depressive symptoms are associated with both cardiovascular and non-cardiovascular mortality.: ... ...

Abstract	Objective: Depressive symptoms are associated with mortality among patients on chronic dialysis therapy. It is currently unknown how different courses of depressive symptoms are associated with both cardiovascular and non-cardiovascular mortality. Methods: In a Dutch prospective nation-wide cohort study among incident patients on chronic dialysis, 1077 patients completed the Mental Health Inventory, both at 3 and 12months after starting dialysis. Cox regression models were used to calculate crude and adjusted hazard ratios (HRs) for mortality for patients with depressive symptoms at 3months only (baseline only), at 12months only (new-onset), and both at 3 and 12months (persistent), using patients without depressive symptoms at 3 and 12months as reference group. Results: Depressive symptoms at baseline only seemed to be a strong marker for non-cardiovascular mortality (HRadj 1.91, 95% CI 1.26-2.90), whereas cardiovascular mortality was only moderately increased (HRadj 1.41, 95% CI 0.85-2.33). In contrast, new-onset depressive symptoms were moderately associated with both cardiovascular (HRadj 1.66, 95% CI 1.06-2.58) and non-cardiovascular mortality (HRadj 1.46, 95% CI 0.97-2.20). Among patients with persistent depressive symptoms, a poor survival was observed due to both cardiovascular (HRadj 2.14, 95% CI 1.42-3.24) and non-cardiovascular related mortality (HRadj 1.76, 95% CI 1.20-2.59). Conclusion: This study showed that different courses of depressive symptoms were associated with a poor survival after the start of dialysis. In particular, temporary depressive symptoms at the start of dialysis may be a strong marker for non-cardiovascular mortality, whereas persistent depressive symptoms were associated with both cardiovascular and non-cardiovascular mortality.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Cardiovascular Diseases/mortality ; Cardiovascular Diseases/psychology ; Cause of Death ; Depression/mortality ; Depression/psychology ; Female ; Humans ; Incidence ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/psychology ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Prognosis ; Renal Dialysis/mortality ; Renal Dialysis/psychology ; Surveys and Questionnaires
Language	English
Publishing date	2013-06
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80166-5
ISSN	1879-1360 ; 0022-3999
ISSN (online)	1879-1360
ISSN	0022-3999
DOI	10.1016/j.jpsychores.2013.03.001
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Article ; Online: Short-term versus long-term effects of depressive symptoms on mortality in patients on dialysis.

van Dijk, Sandra / van den Beukel, Tessa O / Dekker, Friedo W / le Cessie, Saskia / Kaptein, Adrian A / Honig, Adriaan / Siegert, Carl E / Boeschoten, Elisabeth W / Krediet, Ray T / Verduijn, Marion

Psychosomatic medicine

2012 Volume 74, Issue 8, Page(s) 854–860

Abstract: Objective: Depressive symptoms seem to pose a risk factor for mortality among patients on dialysis. It is currently unknown whether the association is only short-lived and whether associations over time depend on specific causes of mortality.: Methods! ...

Abstract	Objective: Depressive symptoms seem to pose a risk factor for mortality among patients on dialysis. It is currently unknown whether the association is only short-lived and whether associations over time depend on specific causes of mortality. Methods: In a prospective nationwide cohort study, 1528 patients with end-stage renal disease starting on dialysis completed the Mental Health Inventory. Patients were observed up to 5 years or until the end of follow-up in April 2011. Cox regression analyses were used to calculate associations between depressive symptoms and short-term (0-6 months), medium-term (6-24 months), or long-term (24-60 months) cardiovascular and noncardiovascular mortality. Results: The adjusted hazard ratio (HR) was 1.43 (95% confidence interval [CI] = 1.08-1.88) for cardiovascular mortality and 2.07 (95% CI = 1.62-2.64) for noncardiovascular mortality. Depressive symptoms posed a strong risk factor for noncardiovascular mortality at the short term (HR = 2.82, 95% CI = 1.58-5.05), medium term (HR = 2.08, 95% CI = 1.40-3.09), and long term (HR = 1.84, 95% CI = 1.26-2.69), whereas the association between depressive symptoms and cardiovascular mortality was not observed during the first 6 months of follow-up (HR = 1.03, 95% CI = 0.49-2.15). Conclusions: Depressive symptoms at the start of dialysis therapy are associated with short-, medium-, and long-term mortality. The cause-specific mortality risk over time may help clinicians to understand multifactorial causes of the association between depressive symptoms and survival.
MeSH term(s)	Adult ; Aged ; Cohort Studies ; Depression/complications ; Depression/mortality ; Female ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/psychology ; Longitudinal Studies ; Male ; Middle Aged ; Netherlands/epidemiology ; Proportional Hazards Models ; Prospective Studies ; Regression Analysis ; Renal Dialysis ; Time Factors
Language	English
Publishing date	2012-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3469-1
ISSN	1534-7796 ; 0033-3174
ISSN (online)	1534-7796
ISSN	0033-3174
DOI	10.1097/PSY.0b013e31826aff0b
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Article: A comparison of measured and estimated glomerular filtration rate in successfully treated HIV-patients with preserved renal function.

Vrouenraets, Saskia M E / Fux, Christoph A / Wit, Ferdinand W N M / Garcia, Evian Fernandez / Brinkman, Kees / Hoek, Frans J / van Straalen, Jan P / Furrer, Hansjakob / Krediet, Ray T / Reiss, Peter

Clinical nephrology

2012 Volume 77, Issue 4, Page(s) 311–320

Abstract: Background: Monitoring of renal function becomes increasingly important in the aging population of HIV-1 infected patients. We compared Cockroft & Gault (C&G), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal ... ...

Abstract	Background: Monitoring of renal function becomes increasingly important in the aging population of HIV-1 infected patients. We compared Cockroft & Gault (C&G), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD), Cystatin C- and 24 h urine-based estimated GFR (eGFR) with the gold standard, measured GFR (mGFR) using [125I]-iothalamate. Methods: Substudy within a randomized, multinational trial comparing continuing zidovudine/ lamivudine with switching to tenofovir/ emtricitabine in patients with suppressed HIV-1 infection. Accuracy (defined as the mean difference between eGFR and mGFR) and precision (defined as standard deviation (SD) of the mean difference between eGFR and mGFR) of the eGFRs were calculated using linear regression and Bland & Altman analysis. Results: We included 19 patients, 18 men, 15 Caucasian, mean (SD) age 46.0 y (± 8.9) and BMI 23.9 kg/m2 (± 3.0). Mean (SD) mGFR was 102 ml/min/1.73 m2 (± 19), 4 patients had mild renal dysfunction. All eGFRs tended to underestimate true GFR, with best accuracy for C&G (-1 ml/min/1.73 m2), CKD-EPI (-1 ml/min/1.73 m2), 24 hcreatinine clearance (-2 ml/min/1.73 m2) and MDRD-6 (0 ml/min/1.73 m2), and worst for cystatin C-based (-9 ml/min/1.73 m2) and MDRD-4 estimations (-10 ml/min/1.73 m2). Accuracy worsened at higher mGFR, but was not significantly influenced by age. C&G tended to overestimate at higher BMI. Precision was comparable for all GFR estimations. Conclusions: In this limited number of patients with preserved renal function and suppressed HIV-infection C&G and CKD-EPI appeared to be the best reflection of real GFR and most practical tool for monitoring GFR.
MeSH term(s)	Adenine/analogs & derivatives ; Adenine/therapeutic use ; Adult ; Anti-HIV Agents/therapeutic use ; Body Mass Index ; Deoxycytidine/analogs & derivatives ; Deoxycytidine/therapeutic use ; Emtricitabine ; Female ; Glomerular Filtration Rate ; HIV Infections/drug therapy ; HIV Infections/physiopathology ; Humans ; Lamivudine/therapeutic use ; Linear Models ; Male ; Middle Aged ; Netherlands ; Organophosphonates/therapeutic use ; Pilot Projects ; Research Design ; Statistics, Nonparametric ; Tenofovir ; Treatment Outcome ; Zidovudine/therapeutic use
Chemical Substances	Anti-HIV Agents ; Organophosphonates ; Deoxycytidine (0W860991D6) ; Lamivudine (2T8Q726O95) ; Zidovudine (4B9XT59T7S) ; Tenofovir (99YXE507IL) ; Emtricitabine (G70B4ETF4S) ; Adenine (JAC85A2161)
Language	English
Publishing date	2012-03-14
Publishing country	Germany
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	185101-9
ISSN	0301-0430
ISSN	0301-0430
DOI	10.5414/cn107214
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Article: Venous and arterial thrombosis in dialysis patients.

Ocak, Gurbey / Vossen, Carla Y / Rotmans, Joris I / Lijfering, Willem M / Rosendaal, Frits R / Parlevliet, Karien J / Krediet, Ray T / Boeschoten, Els W / Dekker, Friedo W / Verduijn, Marion

Thrombosis and haemostasis

2011 Volume 106, Issue 6, Page(s) 1046–1052

Abstract: Whether the risk of both venous and arterial thrombosis is increased in dialysis patients as compared to the general population is unknown. In addition, it is unknown which subgroups are at highest risk. Furthermore, it is unknown whether having a ... ...

Abstract	Whether the risk of both venous and arterial thrombosis is increased in dialysis patients as compared to the general population is unknown. In addition, it is unknown which subgroups are at highest risk. Furthermore, it is unknown whether having a history of venous thrombosis or arterial thrombosis prior to dialysis treatment increases mortality risk. A total of 455 dialysis patients were followed for objectively verified symptomatic thrombotic events between January 1997 and June 2009. The incidence rates in dialysis patients as compared to the general population was 5.6-fold (95% CI 3.1-8.9) increased for venous thrombosis, 11.9-fold (95% CI 9.3-14.9) increased for myocardial infarction, and 8.4-fold (95% CI 5.7-11.5) increased for ischaemic stroke. The combination of haemodialysis, lowest tertile of albumin, history of venous thrombosis, and malignancy was associated with subsequent venous thrombosis. Increased age, renal vascular disease, diabetes, high cholesterol levels, history of venous thrombosis, and history of arterial thrombosis were associated with subsequent arterial thrombosis. The all-cause mortality risk was 1.9-fold (95% CI 1.1-3.3) increased for patients with a history of venous thrombosis and 1.9-fold (95% CI 1.4-2.6) increased for patients with a history of arterial thrombosis. A potential limitation of this study was that in some risk categories associations with venous thrombosis did not reach statistical significance due to small numbers. In conclusion, dialysis patients have clearly elevated risks of venous thrombosis and arterial thrombosis and occurrence of venous thrombosis or arterial thrombosis prior to the start of dialysis is associated with an increased mortality risk.
MeSH term(s)	Aged ; Arteries/pathology ; Dialysis ; Female ; Humans ; Incidence ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/therapy ; Male ; Middle Aged ; Netherlands ; Renal Dialysis ; Risk Factors ; Survival Analysis ; Thrombosis/epidemiology ; Thrombosis/mortality ; Thrombosis/physiopathology ; Thrombosis/therapy ; Veins/pathology
Language	English
Publishing date	2011-12
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	518294-3
ISSN	0340-6245
ISSN	0340-6245
DOI	10.1160/TH11-06-0422
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Article ; Online: Is fetuin-A a mortality risk factor in dialysis patients or a mere risk marker? A Mendelian randomization approach.

Verduijn, Marion / Prein, Robert A / Stenvinkel, Peter / Carrero, Juan Jesús / le Cessie, Saskia / Witasp, Anna / Nordfors, Louise / Krediet, Ray T / Boeschoten, Elisabeth W / Dekker, Friedo W

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

2011 Volume 26, Issue 1, Page(s) 239–245

Abstract: Background: Low levels of circulating fetuin-A are associated with increased mortality in dialysis patients. This study aimed to examine a potential causative role for fetuin-A on mortality by investigating whether a functional polymorphism in the ... ...

Abstract	Background: Low levels of circulating fetuin-A are associated with increased mortality in dialysis patients. This study aimed to examine a potential causative role for fetuin-A on mortality by investigating whether a functional polymorphism in the alpha2-Heremans-Schmid glycoprotein (AHSG) gene associates with mortality, and by estimating the causative effect of fetuin-A levels on mortality using a Mendelian randomization design. Methods: One thousand and forty-three incident dialysis patients were genotyped for the Thr256Ser polymorphism (rs4918) and followed up for 5 years; in 549 patients, serum fetuin-A levels were measured. Results: Carriers of a serine allele displayed lower fetuin-A levels (-0.07 g/L per allele, P < 0.001). A small increased mortality risk was observed for the Thr/Ser and Ser/Ser genotype compared with the Thr/Thr genotype (HR 1.03, 95% CI 0.83-1.28 and HR 1.10, 95% CI 0.78-1.55, respectively). Using the AHSG genotype as an instrumental variable, the causative HR of fetuin-A levels on mortality was estimated as 1.01 per 0.1-g/L increase. Inflammation and diabetes partially modified the association of fetuin-A levels with outcome. Conclusions: The Thr256Ser polymorphism was weakly associated with mortality, and no causative effect of fetuin-A levels on this outcome was observed. Other risk factors, including inflammation and diabetes, might lead to lower fetuin-A levels, and/or modify the effect of low fetuin-A on mortality in end-stage renal disease patients.
MeSH term(s)	Biomarkers/blood ; Blood Proteins/metabolism ; Cohort Studies ; Female ; Follow-Up Studies ; Genotype ; Humans ; Kidney Diseases/therapy ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Genetic/genetics ; Prognosis ; Renal Dialysis/mortality ; Risk Factors ; Survival Rate ; alpha-2-HS-Glycoprotein
Chemical Substances	AHSG protein, human ; Biomarkers ; Blood Proteins ; alpha-2-HS-Glycoprotein
Language	English
Publishing date	2011-01
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfq402
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Article ; Online: Persistent decline in estimated but not measured glomerular filtration rate on tenofovir may reflect tubular rather than glomerular toxicity.

Vrouenraets, Saskia M E / Fux, Christoph A / Wit, Ferdinand W N M / Garcia, Evian Fernandez / Furrer, Hansjakob / Brinkman, Kees / Hoek, Frans J / Abeling, Nico G G M / Krediet, Ray T / Reiss, Peter

AIDS (London, England)

2011 Volume 25, Issue 17, Page(s) 2149–2155

Abstract: Background: Tenofovir disoproxil fumarate (TDF) has been associated with proximal renal tubulopathy and reduction in estimated glomerular filtration rate (eGFR), without accounting for the tubular secretion of creatinine.: Methods: A substudy was ... ...

Abstract	Background: Tenofovir disoproxil fumarate (TDF) has been associated with proximal renal tubulopathy and reduction in estimated glomerular filtration rate (eGFR), without accounting for the tubular secretion of creatinine. Methods: A substudy was performed among 19 participants of a randomized 48-week trial, comparing continuing first-line zidovudine/lamivudine (ZDV/3TC) with switching to TDF/emtricitabine (FTC). GFR was measured with [(125)I]-iothalamate (mGFR) and effective renal plasma flow (ERPF) with [(131)I]-hippuran. eGFR and tubular effects were assessed using plasma and urine samples. Results: Of the 19 patients, 18 were men, 15 whites, mean (SD) age 46.0 (8.9) years, plasma HIV-1 RNA less than 50 copies/ml in all. After 48 weeks, eGFR using Cockcroft-Gault equation and ERPF, but not mGFR, had significantly decreased, and urinary α1-microglobulin/creatinine and microalbumin/creatinine significantly increased in patients on TDF. Although phosphate metabolism on TDF was affected at week 4, differences between groups disappeared during follow-up. Conclusion: Replacing ZDV/3TC with TDF/FTC in this limited sample of virologically suppressed HIV-1-infected adults was associated with mild persistent tubular but not glomerular dysfunction over 48 weeks. The observed persistent decrease in Cockcroft-Gault-based eGFR, but not mGFR, rather than being indicative of glomerular dysfunction may be explained by TDF inhibiting tubular creatinine excretion.
MeSH term(s)	Adenine/adverse effects ; Adenine/analogs & derivatives ; Adult ; Alpha-Globulins ; Anti-HIV Agents/adverse effects ; Creatinine/metabolism ; Female ; Glomerular Filtration Rate/drug effects ; HIV Infections/drug therapy ; HIV-1 ; Humans ; Kidney Glomerulus/drug effects ; Kidney Tubules/drug effects ; Male ; Middle Aged ; Organophosphonates/adverse effects ; Randomized Controlled Trials as Topic ; Renal Plasma Flow, Effective/drug effects ; Serum Albumin/metabolism ; Tenofovir ; Time Factors ; Treatment Outcome
Chemical Substances	Alpha-Globulins ; Anti-HIV Agents ; Organophosphonates ; Serum Albumin ; alpha-1-microglobulin ; Tenofovir (99YXE507IL) ; Creatinine (AYI8EX34EU) ; Adenine (JAC85A2161)
Language	English
Publishing date	2011-11-13
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639076-6
ISSN	1473-5571 ; 0269-9370 ; 1350-2840
ISSN (online)	1473-5571
ISSN	0269-9370 ; 1350-2840
DOI	10.1097/QAD.0b013e32834bba87
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Article: Venous and arterial thrombosis in dialysis patients

Ocak, Gurbey / Vossen, Carla Y. / Rotmans, Joris I. / Lijfering, Willem M. / Rosendaal, Frits R. / Parlevliet, Karien J. / Krediet, Ray T. / Boeschoten, Els W. / Dekker, Friedo W. / Verduijn, Marion

Thrombosis and Haemostasis

2011 Volume 105, Issue 12, Page(s) 1046–1052

Abstract	Whether the risk of both venous and arterial thrombosis is increased in dialysis patients as compared to the general population is unknown. In addition, it is unknown which subgroups are at highest risk. Fur-thermore, it is unknown whether having a history of venous thrombosis or arterial thrombosis prior to dialysis treatment increases mortality risk. A total of 455 dialysis patients were followed for objectively verified symptomatic thrombotic events between January 1997 and June 2009. The incidence rates in dialysis patients as compared to the general population was 5.6-fold (95% CI 3.1–8.9) increased for venous thrombosis, 11.9-fold (95% CI 9.3–14.9) increased for myocardial infarction, and 8.4-fold (95% CI 5.7–11.5) increased for ischaemic stroke. The combination of haemodialysis, lowest tertile of albumin, history of venous thrombosis, and malignancy was associated with subsequent venous thrombosis. Increased age, renal vascular disease, diabetes, high cholesterol levels, history of venous thrombosis, and history of arterial thrombosis were associated with subsequent arterial thrombosis. The all-cause mortality risk was 1.9-fold (95% CI 1.1–3.3) increased for patients with a history of venous thrombosis and 1.9-fold (95% CI 1.4–2.6) increased for patients with a history of arterial thrombosis. A potential limitation of this study was that in some risk categories as-sociations with venous thrombosis did not reach statistical significance due to small numbers. In conclusion, dialysis patients have clearly elev-ated risks of venous thrombosis and arterial thrombosis and occurrence of venous thrombosis or arterial thrombosis prior to the start of dialysis is associated with an increased mortality risk.
Keywords	Dialysis ; venous thrombosis ; arterial thrombosis
Language	English
Publishing date	2011-01-01
Publisher	Schattauer GmbH
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	518294-3
ISSN	2567-689X ; 0340-6245
ISSN (online)	2567-689X
ISSN	0340-6245
DOI	10.1160/TH11-06-0422
Database	Thieme publisher's database

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