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When chronic kidney disease develops, the capacity of the kidneys to clear metabolic waste products from the body is gradually lost. This process results in the retention of a large array of compounds affecting biochemical and biological functions (uremic toxins), of which several can cause cardiovascular damage. This article reviews the main cardiotoxic mechanisms related to uremic toxin retention (endothelial dysfunction, vascular smooth muscle cell alterations, inflammation, mineral bone disorder, insulin resistance, and thrombogenicity) and the main responsible retention compounds. Therapeutic options are reviewed, such as influencing solute generation by intestinal microbiota.
Sophie Valkenburg; Griet Glorieux; Raymond Vanholder. Uremic Toxins and Cardiovascular System. Cardiology Clinics 2021, 39, 307 -318.
AMA StyleSophie Valkenburg, Griet Glorieux, Raymond Vanholder. Uremic Toxins and Cardiovascular System. Cardiology Clinics. 2021; 39 (3):307-318.
Chicago/Turabian StyleSophie Valkenburg; Griet Glorieux; Raymond Vanholder. 2021. "Uremic Toxins and Cardiovascular System." Cardiology Clinics 39, no. 3: 307-318.
Chronic kidney disease (CKD) induces modifications in lipid and lipoprotein metabolism and homeostasis. These modifications can promote, modulate and/or accelerate CKD and secondary cardiovascular disease (CVD). Lipid and lipoprotein abnormalities — involving triglyceride-rich lipoproteins, LDL and/or HDL — not only involve changes in concentration but also changes in molecular structure, including protein composition, incorporation of small molecules and post-translational modifications. These alterations modify the function of lipoproteins and can trigger pro-inflammatory and pro-atherogenic processes, as well as oxidative stress. Serum fatty acid levels are also often altered in patients with CKD and lead to changes in fatty acid metabolism — a key process in intracellular energy production — that induce mitochondrial dysfunction and cellular damage. These fatty acid changes might not only have a negative impact on the heart, but also contribute to the progression of kidney damage. The presence of these lipoprotein alterations within a biological environment characterized by increased inflammation and oxidative stress, as well as the competing risk of non-atherosclerotic cardiovascular death as kidney function declines, has important therapeutic implications. Additional research is needed to clarify the pathophysiological link between lipid and lipoprotein modifications, and kidney dysfunction, as well as the genesis and/or progression of CVD in patients with kidney disease. Chronic kidney disease (CKD) is associated with alterations in serum lipid profiles that contribute to kidney and cardiovascular disease. Here, the authors examine these changes in serum levels, metabolism and post-translational modifications of lipoproteins and fatty acids that characterize CKD-associated dyslipidaemia.
Heidi Noels; Michael Lehrke; Raymond Vanholder; Joachim Jankowski. Lipoproteins and fatty acids in chronic kidney disease: molecular and metabolic alterations. Nature Reviews Nephrology 2021, 1 -15.
AMA StyleHeidi Noels, Michael Lehrke, Raymond Vanholder, Joachim Jankowski. Lipoproteins and fatty acids in chronic kidney disease: molecular and metabolic alterations. Nature Reviews Nephrology. 2021; ():1-15.
Chicago/Turabian StyleHeidi Noels; Michael Lehrke; Raymond Vanholder; Joachim Jankowski. 2021. "Lipoproteins and fatty acids in chronic kidney disease: molecular and metabolic alterations." Nature Reviews Nephrology , no. : 1-15.
Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of transplantation activity (for example, in the number of transplantations, the number of people with a functioning graft, in rates of living versus deceased donation, and in the use of expanded criteria donors) suggest that there is ample room for improvement. Herein we review the policy and clinical measures that should be considered to increase access to transplantation and improve post-transplantation outcomes. This Roadmap, generated by a group of major European stakeholders collaborating within a Thematic Network, presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation. This framework can be adopted by countries and institutions that are interested in advancing transplantation, both within and outside the European Union. Within this framework, a priority ranking of initiatives is suggested that could serve as the basis for a new European Union Action Plan on Organ Donation and Transplantation. Organ transplantation improves patient survival and quality of life and has a major beneficial impact on public health and the socio-economic burden of organ failure. This Roadmap presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation.
Raymond Vanholder; Beatriz Domínguez-Gil; Mirela Busic; Helena Cortez-Pinto; Jonathan C. Craig; Kitty J. Jager; Beatriz Mahillo; Vianda S. Stel; Maria O. Valentin; Carmine Zoccali; Gabriel C. Oniscu. Organ donation and transplantation: a multi-stakeholder call to action. Nature Reviews Nephrology 2021, 1 -15.
AMA StyleRaymond Vanholder, Beatriz Domínguez-Gil, Mirela Busic, Helena Cortez-Pinto, Jonathan C. Craig, Kitty J. Jager, Beatriz Mahillo, Vianda S. Stel, Maria O. Valentin, Carmine Zoccali, Gabriel C. Oniscu. Organ donation and transplantation: a multi-stakeholder call to action. Nature Reviews Nephrology. 2021; ():1-15.
Chicago/Turabian StyleRaymond Vanholder; Beatriz Domínguez-Gil; Mirela Busic; Helena Cortez-Pinto; Jonathan C. Craig; Kitty J. Jager; Beatriz Mahillo; Vianda S. Stel; Maria O. Valentin; Carmine Zoccali; Gabriel C. Oniscu. 2021. "Organ donation and transplantation: a multi-stakeholder call to action." Nature Reviews Nephrology , no. : 1-15.
Mass disasters, particularly earthquakes, cause many medical problems, including kidney problems, but an organized approach to cope with them was initiated only at the end of previous century, subsequent to the Armenian Spitak earthquake in 1988. Originally, interventions were focused on acute kidney injury (AKI) following crush injury and rhabdomyolysis in victims who had been trapped under the debris of collapsed buildings. However, similar problems were also registered in the context of other catastrophic events, especially man-made disasters like wars and torture. Other kidney-related problems, such as the preservation of treatment continuity in chronic kidney disease (CKD), especially in maintenance dialysis patients, deserved attention as well. Specific therapeutic principles apply to disaster-related kidney problems and these may differ from usual day-to-day clinical practice. Those approaches have been formulated in global and specific country-related guidelines and recommendations. It is clear that a well-conceived and organized management of kidney diseases in disasters benefits outcomes. Furthermore, it may be useful if the model and philosophy that were applied over the last three decades could be adapted by broadening the scope of disasters leading to intervention. Actions should be guided and coordinated by a panel of experts steering ad hoc interventions, rather than applying the “old” static model where a single coordinating center instructs and uses volunteers listed long before a potential event occurs.
Raymond Vanholder; Mehmet Sükrü Sever; Norbert Lameire. Kidney problems in disaster situations. Néphrologie & Thérapeutique 2021, 17, S27 -S36.
AMA StyleRaymond Vanholder, Mehmet Sükrü Sever, Norbert Lameire. Kidney problems in disaster situations. Néphrologie & Thérapeutique. 2021; 17 ():S27-S36.
Chicago/Turabian StyleRaymond Vanholder; Mehmet Sükrü Sever; Norbert Lameire. 2021. "Kidney problems in disaster situations." Néphrologie & Thérapeutique 17, no. : S27-S36.
A brief comprehensive overview is provided of the elements constituting the burden of kidney disease [chronic kidney disease (CKD) and acute kidney injury]. This publication can be used for advocacy, emphasizing the importance and urgency of reducing this heavy and rapidly growing burden. Kidney diseases contribute to significant physical limitations, loss of quality of life, emotional and cognitive disorders, social isolation and premature death. CKD affects close to 100 million Europeans, with 300 million being at risk, and is projected to become the fifth cause of worldwide death by 2040. Kidney disease also imposes financial burdens, given the costs of accessing healthcare and inability to work. The extrapolated annual cost of all CKD is at least as high as that for cancer or diabetes. In addition, dialysis treatment of kidney diseases imposes environmental burdens by necessitating high energy and water consumption and producing plastic waste. Acute kidney injury is associated with further increases in global morbidity, mortality and economic burden. Yet investment in research for treatment of kidney disease lags behind that of other diseases. This publication is a call for European investment in research for kidney health. The innovations generated should mirror the successful European Union actions against cancer over the last 30 years. It is also a plea to nephrology professionals, patients and their families, caregivers and kidney health advocacy organizations to draw, during the Decade of the Kidney (2020–30), the attention of authorities to realize changes in understanding, research and treatment of kidney disease.
Raymond Vanholder; Lieven Annemans; Aminu K Bello; Boris Bikbov; Daniel Gallego; Ron T Gansevoort; Norbert Lameire; Valerie A Luyckx; Edita Noruisiene; Tom Oostrom; Christoph Wanner; Fokko Wieringa. Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clinical Kidney Journal 2021, 14, 1719 -1730.
AMA StyleRaymond Vanholder, Lieven Annemans, Aminu K Bello, Boris Bikbov, Daniel Gallego, Ron T Gansevoort, Norbert Lameire, Valerie A Luyckx, Edita Noruisiene, Tom Oostrom, Christoph Wanner, Fokko Wieringa. Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clinical Kidney Journal. 2021; 14 (7):1719-1730.
Chicago/Turabian StyleRaymond Vanholder; Lieven Annemans; Aminu K Bello; Boris Bikbov; Daniel Gallego; Ron T Gansevoort; Norbert Lameire; Valerie A Luyckx; Edita Noruisiene; Tom Oostrom; Christoph Wanner; Fokko Wieringa. 2021. "Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney." Clinical Kidney Journal 14, no. 7: 1719-1730.
The General Data Protection Regulation (GDPR) became binding law in the European Union Member States in 2018, as a step toward harmonizing personal data protection legislation in the European Union. The Regulation governs almost all types of personal data processing, hence, also, those pertaining to biomedical research. The purpose of this article is to highlight the main practical issues related to data and biological sample sharing that biomedical researchers face regularly, and to specify how these are addressed in the context of GDPR, after consulting with ethics/legal experts. We identify areas in which clarifications of the GDPR are needed, particularly those related to consent requirements by study participants. Amendments should target the following: (1) restricting exceptions based on national laws and increasing harmonization, (2) confirming the concept of broad consent, and (3) defining a roadmap for secondary use of data. These changes will be achieved by acknowledged learned societies in the field taking the lead in preparing a document giving guidance for the optimal interpretation of the GDPR, which will be finalized following a period of commenting by a broad multistakeholder audience. In parallel, promoting engagement and education of the public in the relevant issues (such as different consent types or residual risk for re-identification), on both local/national and international levels, is considered critical for advancement. We hope that this article will open this broad discussion involving all major stakeholders, toward optimizing the GDPR and allowing a harmonized transnational research approach.
Antonia Vlahou; Dara Hallinan; Rolf Apweiler; Angel Argiles; Joachim Beige; Ariela Benigni; Rainer Bischoff; Peter C. Black; Franziska Boehm; Jocelyn Céraline; George P. Chrousos; Christian Delles; Pieter Evenepoel; Ivo Fridolin; Griet Glorieux; Alain J. van Gool; Isabel Heidegger; John P.A. Ioannidis; Joachim Jankowski; Vera Jankowski; Carmen Jeronimo; Ashish M. Kamat; Rosalinde Masereeuw; Gert Mayer; Harald Mischak; Alberto Ortiz; Giuseppe Remuzzi; Peter Rossing; Joost P. Schanstra; Bernd J. Schmitz-Dräger; Goce Spasovski; Jan A. Staessen; Dimitrios Stamatialis; Peter Stenvinkel; Christoph Wanner; Stephen B. Williams; Faiez Zannad; Carmine Zoccali; Raymond Vanholder. Data Sharing Under the General Data Protection Regulation. Hypertension 2021, 77, 1029 -1035.
AMA StyleAntonia Vlahou, Dara Hallinan, Rolf Apweiler, Angel Argiles, Joachim Beige, Ariela Benigni, Rainer Bischoff, Peter C. Black, Franziska Boehm, Jocelyn Céraline, George P. Chrousos, Christian Delles, Pieter Evenepoel, Ivo Fridolin, Griet Glorieux, Alain J. van Gool, Isabel Heidegger, John P.A. Ioannidis, Joachim Jankowski, Vera Jankowski, Carmen Jeronimo, Ashish M. Kamat, Rosalinde Masereeuw, Gert Mayer, Harald Mischak, Alberto Ortiz, Giuseppe Remuzzi, Peter Rossing, Joost P. Schanstra, Bernd J. Schmitz-Dräger, Goce Spasovski, Jan A. Staessen, Dimitrios Stamatialis, Peter Stenvinkel, Christoph Wanner, Stephen B. Williams, Faiez Zannad, Carmine Zoccali, Raymond Vanholder. Data Sharing Under the General Data Protection Regulation. Hypertension. 2021; 77 (4):1029-1035.
Chicago/Turabian StyleAntonia Vlahou; Dara Hallinan; Rolf Apweiler; Angel Argiles; Joachim Beige; Ariela Benigni; Rainer Bischoff; Peter C. Black; Franziska Boehm; Jocelyn Céraline; George P. Chrousos; Christian Delles; Pieter Evenepoel; Ivo Fridolin; Griet Glorieux; Alain J. van Gool; Isabel Heidegger; John P.A. Ioannidis; Joachim Jankowski; Vera Jankowski; Carmen Jeronimo; Ashish M. Kamat; Rosalinde Masereeuw; Gert Mayer; Harald Mischak; Alberto Ortiz; Giuseppe Remuzzi; Peter Rossing; Joost P. Schanstra; Bernd J. Schmitz-Dräger; Goce Spasovski; Jan A. Staessen; Dimitrios Stamatialis; Peter Stenvinkel; Christoph Wanner; Stephen B. Williams; Faiez Zannad; Carmine Zoccali; Raymond Vanholder. 2021. "Data Sharing Under the General Data Protection Regulation." Hypertension 77, no. 4: 1029-1035.
Background Access to various kidney replacement therapy (KRT) modalities for patients with end-stage kidney disease differs substantially within Europe. Methods European adults on KRT filled out an online or paper-based survey about factors influencing and experiences with modality choice (e.g. information provision, decision-making and reasons for choice) between November 2017 and January 2019. We compared countries with low, middle and high gross domestic product (GDP). Results In total, 7820 patients [mean age 59 years, 56% male, 63% on centre haemodialysis (CHD)] from 38 countries participated. Twenty-five percent had received no information on the different modalities, and only 23% received information >12 months before KRT initiation. Patients were not informed about home haemodialysis (HHD) (42%) and comprehensive conservative management (33%). Besides nephrologists, nurses more frequently provided information in high-GDP countries, whereas physicians other than nephrologists did so in low-GDP countries. Patients from low-GDP countries reported later information provision, less information about other modalities than CHD and lower satisfaction with information. The majority of modality decisions were made involving both patient and nephrologist. Patients reported subjective (e.g. quality of life and fears) and objective reasons (e.g. costs and availability of treatments) for modality choice. Patients had good experiences with all modalities, but experiences were better for HHD and kidney transplantation and in middle- and high-GDP countries. Conclusion Our results suggest European differences in patient-reported factors influencing KRT modality choice, possibly caused by disparities in availability of KRT modalities, different healthcare systems and varying patient preferences. Availability of home dialysis and kidney transplantation should be optimized.
Rianne W de Jong; Vianda S Stel; Axel Rahmel; Mark Murphy; Raymond C Vanholder; Ziad A Massy; Kitty J Jager. Patient-reported factors influencing the choice of their kidney replacement treatment modality. Nephrology Dialysis Transplantation 2021, 1 .
AMA StyleRianne W de Jong, Vianda S Stel, Axel Rahmel, Mark Murphy, Raymond C Vanholder, Ziad A Massy, Kitty J Jager. Patient-reported factors influencing the choice of their kidney replacement treatment modality. Nephrology Dialysis Transplantation. 2021; ():1.
Chicago/Turabian StyleRianne W de Jong; Vianda S Stel; Axel Rahmel; Mark Murphy; Raymond C Vanholder; Ziad A Massy; Kitty J Jager. 2021. "Patient-reported factors influencing the choice of their kidney replacement treatment modality." Nephrology Dialysis Transplantation , no. : 1.
Background Acute kidney injury (AKI) is an often neglected but crucial element of clinical nephrology. The aim of the Nephrology and Public Policy Committee (NPPC) of the European Renal Association–European Dialysis and Transplant Association is to promote several key aspects of European nephrology. One of the targets proposed by the NPPC was to advance European nephrology involvement in AKI. Methods We undertook a literature analysis to define the current position of European nephrology in the field of AKI compared with other regions and to determine how different European countries compare with each other. Results It appeared that vis-à-vis countries with a comparable socio-economic status (the USA, Australia, New Zealand and Canada), the European contribution was almost 50% less. Within Europe, Central and Eastern Europe and countries with a lower gross domestic product showed lower scientific output. Nephrologists contributed to less than half of the output. There was no trend of a change over the last decade. Conclusions There is room to improve the contribution of European nephrology in the field of AKI. We propose a model on how to promote clinical collaboration on AKI across Europe and the creation of a pan-European nephrology network of interested units to improve clinical outcomes, increase nephrologist involvement and awareness outside nephrology and stimulate research on AKI in Europe. Accordingly, we also propose a list of research priorities and stress the need for more European funding of AKI research.
Raymond Vanholder; Eric Rondeau; Hans-Joachim Anders; Nicholas Carlson; Danilo Fliser; Mehmet Kanbay; José António Lopes; Patrick T Murray; Alberto Ortiz; Ana B Sanz; Nicholas M Selby; Andrzej Wiecek; Ziad A Massy. EDTAKI: a Nephrology and Public Policy Committee platform call for more European involvement in acute kidney injury. Nephrology Dialysis Transplantation 2021, 1 .
AMA StyleRaymond Vanholder, Eric Rondeau, Hans-Joachim Anders, Nicholas Carlson, Danilo Fliser, Mehmet Kanbay, José António Lopes, Patrick T Murray, Alberto Ortiz, Ana B Sanz, Nicholas M Selby, Andrzej Wiecek, Ziad A Massy. EDTAKI: a Nephrology and Public Policy Committee platform call for more European involvement in acute kidney injury. Nephrology Dialysis Transplantation. 2021; ():1.
Chicago/Turabian StyleRaymond Vanholder; Eric Rondeau; Hans-Joachim Anders; Nicholas Carlson; Danilo Fliser; Mehmet Kanbay; José António Lopes; Patrick T Murray; Alberto Ortiz; Ana B Sanz; Nicholas M Selby; Andrzej Wiecek; Ziad A Massy. 2021. "EDTAKI: a Nephrology and Public Policy Committee platform call for more European involvement in acute kidney injury." Nephrology Dialysis Transplantation , no. : 1.
Background Several protein-bound uraemic toxins (PBUTs) have been associated with cardiovascular (CV) and all-cause mortality in chronic kidney disease (CKD) but the degree to which this is the case per individual PBUT and the pathophysiological mechanism have only partially been unraveled. Methods We compared the prognostic value of both total and free concentrations of five PBUTs [p-cresyl sulfate (pCS), p-cresyl glucuronide, indoxyl sulfate, indole acetic acid and hippuric acid] in a cohort of 523 patients with non-dialysis CKD Stages G1–G5. Patients were followed prospectively for the occurrence of a fatal or non-fatal CV event as the primary endpoint and a number of other major complications as secondary endpoints. In addition, association with and the prognostic value of nine markers of endothelial activation/damage was compared. Results After a median follow-up of 5.5 years, 149 patients developed the primary endpoint. In multivariate Cox regression models adjusted for age, sex, systolic blood pressure, diabetes mellitus and estimated glomerular filtration rate, and corrected for multiple testing, only free pCS was associated with the primary endpoint {hazard ratio [HR]1.39 [95% confidence interval (CI) 1.14–1.71]; P = 0.0014}. Free pCS also correlated with a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (r = −0.114, P < 0.05), angiopoietin-2 (ANGPT2) (r = 0.194, P < 0.001), matrix metallopeptidase 7 (MMP-7; (r = 0.238, P < 0.001) and syndecan 1 (r = 0.235, P < 0.001). Of these markers of endothelial activation/damage, ANGPT2 [HR 1.46 (95% CI 1.25–1.70); P < 0.0001] and MMP-7 [HR 1.31 (95% CI 1.08–1.59); P = 0.0056] were also predictive of the primary outcome. Conclusions Among PBUTs, free pCS shows the highest association with CV outcome in non-dialysed patients with CKD. Two markers of endothelial activation/damage that were significantly correlated with free pCS, ANGPT2 and MMP-7 were also associated with CV outcome. The hypothesis that free pCS exerts its CV toxic effects by an adverse effect on endothelial function deserves further exploration.
Griet Glorieux; Raymond Vanholder; Wim Van Biesen; Anneleen Pletinck; Eva Schepers; Nathalie Neirynck; Marijn Speeckaert; Dirk De Bacquer; Francis Verbeke. Free p-cresyl sulfate shows the highest association with cardiovascular outcome in chronic kidney disease. Nephrology Dialysis Transplantation 2021, 36, 998 -1005.
AMA StyleGriet Glorieux, Raymond Vanholder, Wim Van Biesen, Anneleen Pletinck, Eva Schepers, Nathalie Neirynck, Marijn Speeckaert, Dirk De Bacquer, Francis Verbeke. Free p-cresyl sulfate shows the highest association with cardiovascular outcome in chronic kidney disease. Nephrology Dialysis Transplantation. 2021; 36 (6):998-1005.
Chicago/Turabian StyleGriet Glorieux; Raymond Vanholder; Wim Van Biesen; Anneleen Pletinck; Eva Schepers; Nathalie Neirynck; Marijn Speeckaert; Dirk De Bacquer; Francis Verbeke. 2021. "Free p-cresyl sulfate shows the highest association with cardiovascular outcome in chronic kidney disease." Nephrology Dialysis Transplantation 36, no. 6: 998-1005.
The uremic syndrome is a complex clinical picture developing in the advanced stages of chronic kidney disease (CKD) resulting in a myriad of complications and a high early mortality. This picture is to a significant extent defined by retention of metabolites and peptides that with a preserved kidney function are excreted or degraded by the kidneys. In as far as those solutes have a negative biological/biochemical impact, they are called uremic toxins. Here, we describe the historical evolution of the scientific knowledge about uremic toxins and the role played in this process by the European Uremic Toxin Work Group (EUTox) during the last two decades. The earliest knowledge about a uremic toxin goes back to the early 17th century when the existence of what later would appear to be urea was recognized. It cost about two further centuries to better define the role of urea and its link to kidney failure and one more century to identify the relevance of post-translational modifications caused by urea such as carbamoylation. The knowledge progressively extended, especially from 1980 on, by the identification of more and more toxins and their adverse biological/biochemical impact. Progress of knowledge was paralleled and impacted by evolution of dialysis strategies. The last two decades, when Insights grew exponentially, coincides with the foundation and activity of EUTox. In the final section we summarize the role and accomplishments of EUTox and the part it is likely to play in future action, which should be organized around focus points like biomarker and potential target identification, intestinal generation, toxicity mechanisms and their correction, kidney and extracorporeal removal, patient-oriented outcomes, and toxin characteristics in acute kidney injury and transplantation.
Raymond Vanholder; Angel Argiles; Joachim Jankowski; for the European Uremic Toxin Work Group (EUTox). A history of uremic toxicity and of the European Uremic Toxin Work Group (EUTox). Clinical Kidney Journal 2021, 14, 1514 -1523.
AMA StyleRaymond Vanholder, Angel Argiles, Joachim Jankowski, for the European Uremic Toxin Work Group (EUTox). A history of uremic toxicity and of the European Uremic Toxin Work Group (EUTox). Clinical Kidney Journal. 2021; 14 (6):1514-1523.
Chicago/Turabian StyleRaymond Vanholder; Angel Argiles; Joachim Jankowski; for the European Uremic Toxin Work Group (EUTox). 2021. "A history of uremic toxicity and of the European Uremic Toxin Work Group (EUTox)." Clinical Kidney Journal 14, no. 6: 1514-1523.
This Special Issue of Toxins focusses on the interconnected factors interfering with the immune response in uremic patients
Gerald Cohen; Raymond Vanholder. Special Issue: Immune Dysfunction in Uremia. Toxins 2021, 13, 70 .
AMA StyleGerald Cohen, Raymond Vanholder. Special Issue: Immune Dysfunction in Uremia. Toxins. 2021; 13 (1):70.
Chicago/Turabian StyleGerald Cohen; Raymond Vanholder. 2021. "Special Issue: Immune Dysfunction in Uremia." Toxins 13, no. 1: 70.
Mass disasters result in extensive health problems and make health care delivery problematic, as has been the case during the COVID-19 pandemic. Although COVID-19 was initially considered a pulmonary problem, it soon became clear that various other organs were involved. Thus, many care providers, including kidney health personnel, were overwhelmed or developed burnout. This review aims to describe the spectrum of burnout in mass disasters and suggests solutions specifically for nephrology personnel by extending previous experience to the COVID-19 pandemic. Burnout (a psychologic response to work-related stress) is already a frequent part of routine nephrology practice and, not surprisingly, is even more common during mass disasters due to increased workload and specific conditions, in addition to individual factors. Avoiding burnout is essential to prevent psychologic and somatic health problems in personnel as well as malpractice, understaffing, and inadequate health care delivery, all of which increase the health care burden of disasters. Burnout may be prevented by predisaster organizational measures, which include developing an overarching plan and optimizing health care infrastructure, and ad hoc disaster-specific measures that encompass both organizational and individual measures. Organizational measures include increasing safety, decreasing workload and fear of malpractice, optimizing medical staffing and material supplies, motivating personnel, providing mental health support, and enabling flexibility in working circumstances. Individual measures include training on coping with stress and problematic conditions, minimizing the stigma of emotional distress, and maintaining physical health. If these measures fall short, asking for external help is mandatory to avoid an inefficient disaster health care response. Minimizing burnout by applying these measures will improve health care provision, thus saving as many lives as possible.
Mehmet Sukru Sever; Alberto Ortiz; Umberto Maggiore; Enrique Bac-García; Raymond Vanholder. Mass Disasters and Burnout in Nephrology Personnel. Clinical Journal of the American Society of Nephrology 2021, 16, 829 -837.
AMA StyleMehmet Sukru Sever, Alberto Ortiz, Umberto Maggiore, Enrique Bac-García, Raymond Vanholder. Mass Disasters and Burnout in Nephrology Personnel. Clinical Journal of the American Society of Nephrology. 2021; 16 (5):829-837.
Chicago/Turabian StyleMehmet Sukru Sever; Alberto Ortiz; Umberto Maggiore; Enrique Bac-García; Raymond Vanholder. 2021. "Mass Disasters and Burnout in Nephrology Personnel." Clinical Journal of the American Society of Nephrology 16, no. 5: 829-837.
Raymond Vanholder; Norbert Lameire. COVID-19 and policy changes for kidney disease: the need for a ‘decade of the kidney’. Nephrology Dialysis Transplantation 2020, 36, 8 -11.
AMA StyleRaymond Vanholder, Norbert Lameire. COVID-19 and policy changes for kidney disease: the need for a ‘decade of the kidney’. Nephrology Dialysis Transplantation. 2020; 36 (1):8-11.
Chicago/Turabian StyleRaymond Vanholder; Norbert Lameire. 2020. "COVID-19 and policy changes for kidney disease: the need for a ‘decade of the kidney’." Nephrology Dialysis Transplantation 36, no. 1: 8-11.
Fokko P. Wieringa; Murray Sheldon; Stephen R. Ash; Thomas Groth; Jasper Boomker; Tom Oostrom; Raymond Vanholder. Moving ahead on the Kidney Health Initiative innovation roadmap, a transatlantic progress update. Artificial Organs 2020, 44, 1125 -1134.
AMA StyleFokko P. Wieringa, Murray Sheldon, Stephen R. Ash, Thomas Groth, Jasper Boomker, Tom Oostrom, Raymond Vanholder. Moving ahead on the Kidney Health Initiative innovation roadmap, a transatlantic progress update. Artificial Organs. 2020; 44 (11):1125-1134.
Chicago/Turabian StyleFokko P. Wieringa; Murray Sheldon; Stephen R. Ash; Thomas Groth; Jasper Boomker; Tom Oostrom; Raymond Vanholder. 2020. "Moving ahead on the Kidney Health Initiative innovation roadmap, a transatlantic progress update." Artificial Organs 44, no. 11: 1125-1134.
The development of dialysis by early pioneers such as Willem Kolff and Belding Scribner set in motion several dramatic changes in the epidemiology, economics and ethical frameworks for the treatment of kidney failure. However, despite a rapid expansion in the provision of dialysis — particularly haemodialysis and most notably in high-income countries (HICs) — the rate of true patient-centred innovation has slowed. Current trends are particularly concerning from a global perspective: current costs are not sustainable, even for HICs, and globally, most people who develop kidney failure forego treatment, resulting in millions of deaths every year. Thus, there is an urgent need to develop new approaches and dialysis modalities that are cost-effective, accessible and offer improved patient outcomes. Nephrology researchers are increasingly engaging with patients to determine their priorities for meaningful outcomes that should be used to measure progress. The overarching message from this engagement is that while patients value longevity, reducing symptom burden and achieving maximal functional and social rehabilitation are prioritized more highly. In response, patients, payors, regulators and health-care systems are increasingly demanding improved value, which can only come about through true patient-centred innovation that supports high-quality, high-value care. Substantial efforts are now underway to support requisite transformative changes. These efforts need to be catalysed, promoted and fostered through international collaboration and harmonization.
Jonathan Himmelfarb; Raymond Vanholder; Rajnish Mehrotra; Marcello Tonelli. The current and future landscape of dialysis. Nature Reviews Nephrology 2020, 16, 573 -585.
AMA StyleJonathan Himmelfarb, Raymond Vanholder, Rajnish Mehrotra, Marcello Tonelli. The current and future landscape of dialysis. Nature Reviews Nephrology. 2020; 16 (10):573-585.
Chicago/Turabian StyleJonathan Himmelfarb; Raymond Vanholder; Rajnish Mehrotra; Marcello Tonelli. 2020. "The current and future landscape of dialysis." Nature Reviews Nephrology 16, no. 10: 573-585.
The American Society of Nephrology, the European Renal Association–European Dialysis and Transplant Association and the International Society of Nephrology Joint Working Group on Ethical Issues in Nephrology have identified ten broad areas of ethical concern as priority challenges that require collaborative action. Here, we describe these challenges — equity in access to kidney failure care, avoiding futile dialysis, reducing dialysis costs, shared decision-making in kidney failure care, living donor risk evaluation and decision-making, priority setting in kidney disease prevention and care, the ethical implications of genetic kidney diseases, responsible advocacy for kidney health and management of conflicts of interest — with the aim of highlighting the need for ethical analysis of specific issues, as well as for the development of tools and training to support clinicians who treat patients with kidney disease in practising ethically and contributing to ethical policy-making.
Dominique E. Martin; ASN-ERA-EDTA-ISN Joint Working Group on Ethical Issues in Nephrology; David C. H. Harris; Vivekanand Jha; Luca Segantini; Richard A. Demme; Thu H. Le; Laura McCann; Jeff M. Sands; Gerard Vong; Paul Root Wolpe; Monica Fontana; Gerard M. London; Bert Vanderhaegen; Raymond Vanholder. Ethical challenges in nephrology: a call for action. Nature Reviews Nephrology 2020, 16, 603 -613.
AMA StyleDominique E. Martin, ASN-ERA-EDTA-ISN Joint Working Group on Ethical Issues in Nephrology, David C. H. Harris, Vivekanand Jha, Luca Segantini, Richard A. Demme, Thu H. Le, Laura McCann, Jeff M. Sands, Gerard Vong, Paul Root Wolpe, Monica Fontana, Gerard M. London, Bert Vanderhaegen, Raymond Vanholder. Ethical challenges in nephrology: a call for action. Nature Reviews Nephrology. 2020; 16 (10):603-613.
Chicago/Turabian StyleDominique E. Martin; ASN-ERA-EDTA-ISN Joint Working Group on Ethical Issues in Nephrology; David C. H. Harris; Vivekanand Jha; Luca Segantini; Richard A. Demme; Thu H. Le; Laura McCann; Jeff M. Sands; Gerard Vong; Paul Root Wolpe; Monica Fontana; Gerard M. London; Bert Vanderhaegen; Raymond Vanholder. 2020. "Ethical challenges in nephrology: a call for action." Nature Reviews Nephrology 16, no. 10: 603-613.
Background: Uremic toxins have emerged as potential mediators of morbidity and mortality in patients with chronic kidney disease (CKD). Indole-3-acetic acid (IAA, a tryptophan-derived uremic toxin) might be a useful biomarker in patients with CKD. The objectives of the present study were to (i) describe IAA concentrations in a cohort of non-transplanted patients with CKD and a cohort of transplanted patients with CKD, and (ii) investigate the possible relationship between IAA levels and adverse outcomes in the two cohorts. Methods: Levels of free and total IAA were assayed in the two prospective CKD cohorts (140 non-transplanted patients and 311 transplanted patients). Cox multivariate analyses were used to evaluate the association between IAA levels and outcomes (mortality, cardiovascular events, and graft loss). Results: In the non-transplanted CKD cohort, free and total IAA increased progressively with the CKD stage. In the transplanted CKD cohort, free and total IAA levels were elevated at the time of transplantation but had fallen substantially at one-month post-transplantation. Indole acetic acid concentrations were lower in transplanted patients than non-dialysis non-transplanted patients matched for estimated glomerular filtration rate (eGFR), age, and sex. After adjustment for multiple confounders, the free IAA level predicted overall mortality and cardiovascular events in the non-transplanted CKD cohort (hazard ratio [95% confidence interval]: 2.5 [1.2–5.1] and 2.5 [1.3–4.8], respectively). In the transplanted CKD cohort, however, no associations were found between free or total IAA on one hand, and mortality, CV event, or graft survival on the other. Conclusion: We demonstrated that levels of IAA increase with the CKD stage, and fall substantially, even normalizing, after kidney transplantation. Free IAA appears to be a valuable outcome-associated biomarker in non-transplanted patients, but—at least in our study setting—not in transplanted patients.
Sophie Liabeuf; Solène M. Laville; Griet Glorieux; Lynda Cheddani; François Brazier; Dimitri Titeca Beauport; Raymond Vanholder; Gabriel Choukroun; Ziad A. Massy. Difference in Profiles of the Gut-Derived Tryptophan Metabolite Indole Acetic Acid between Transplanted and Non-Transplanted Patients with Chronic Kidney Disease. International Journal of Molecular Sciences 2020, 21, 2031 .
AMA StyleSophie Liabeuf, Solène M. Laville, Griet Glorieux, Lynda Cheddani, François Brazier, Dimitri Titeca Beauport, Raymond Vanholder, Gabriel Choukroun, Ziad A. Massy. Difference in Profiles of the Gut-Derived Tryptophan Metabolite Indole Acetic Acid between Transplanted and Non-Transplanted Patients with Chronic Kidney Disease. International Journal of Molecular Sciences. 2020; 21 (6):2031.
Chicago/Turabian StyleSophie Liabeuf; Solène M. Laville; Griet Glorieux; Lynda Cheddani; François Brazier; Dimitri Titeca Beauport; Raymond Vanholder; Gabriel Choukroun; Ziad A. Massy. 2020. "Difference in Profiles of the Gut-Derived Tryptophan Metabolite Indole Acetic Acid between Transplanted and Non-Transplanted Patients with Chronic Kidney Disease." International Journal of Molecular Sciences 21, no. 6: 2031.
Whereas the usual way to gain access to the vascular bed for hemodialysis is by inserting two needles, an alternative option based on the introduction of only one needle has been available for several decades. Although single needle hemodialysis gradually lost popularity in the early nineties of last century, this option now seems to make a come-back, with the current change in patient mix towards more elderly and cardio-vascular disease and the appearance of more flexible hardware. Single needle hemodialysis offers several advantages, such as the possibility to puncture small or maturing access systems, a decrease in number of punctures with less potential access damage and subsequent complications, the avoidance of central vein catheter use, and an improved quality of life by reducing puncture-related pain, stress and complications. The main drawback is recirculation which however can be overcome (if considered necessary) by making dialysis somewhat longer and in addition has more impact on removal of small water soluble compounds than on clearance of the more toxic difficult to remove solutes (middle molecules and protein bound compounds). Effective dialyzer blood flow with single needle dialysis cannot be much higher than 300 mL/min, which however also offers advantages by making short dialysis sessions less feasible and thus reducing the likelihood of intradialytic blood pressure falls, organ stunning and other negative outcomes of shorter dialysis. Direct outcome comparisons between single and double needle dialysis are not available but indirect data suggest no differences, in as far as efficient enough access perfusion can keep dialyzer blood flow adequate. The single needle method seems especially suited for the elderly and for home hemodialysis. Recent technological improvements have made the system more accessible and adequate, but further studies are needed to assess with modern methodologies the clearance kinetics of these systems, which could emanate in further technological fine-tuning.
Raymond Vanholder. Single needle hemodialysis: is the past the future? Journal of Nephrology 2019, 33, 49 -58.
AMA StyleRaymond Vanholder. Single needle hemodialysis: is the past the future? Journal of Nephrology. 2019; 33 (1):49-58.
Chicago/Turabian StyleRaymond Vanholder. 2019. "Single needle hemodialysis: is the past the future?" Journal of Nephrology 33, no. 1: 49-58.
Dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume (Kt/Vurea or simply Kt/V) has been used as an index of dialysis adequacy since more than 30 years. This article reviews the flaws of Kt/V, starting with a lack of proof of concept in three randomized controlled hard outcome trials (RCTs), and continuing with a long list of conditions where the concept of Kt/V was shown to be flawed. This information leaves little room for any conclusion other than that Kt/V, as an indicator of dialysis adequacy, is obsolete. The dialysis patient might benefit more if, instead, the nephrology community concentrates in the future on pursuing the optimal dialysis dose that conforms with adequate quality of life and on factors that are likely to affect outcomes more than Kt/V. These include residual renal function, volume status, dialysis length, ultrafiltration rate, the number of intra-dialytic hypotensive episodes, interdialytic blood pressure, serum potassium and phosphate, serum albumin, and C reactive protein.
Raymond Vanholder; Wim Van Biesen; Norbert Lameire. A swan song for Kt/Vurea. Seminars in Dialysis 2019, 32, 424 -437.
AMA StyleRaymond Vanholder, Wim Van Biesen, Norbert Lameire. A swan song for Kt/Vurea. Seminars in Dialysis. 2019; 32 (5):424-437.
Chicago/Turabian StyleRaymond Vanholder; Wim Van Biesen; Norbert Lameire. 2019. "A swan song for Kt/Vurea." Seminars in Dialysis 32, no. 5: 424-437.
Protein-bound uremic toxins (PBUTs) play a role in the multisystem disease that children on hemodialysis (HD) are facing, but little is known about their levels and protein binding (%PB). In this study, we evaluated the levels and %PB of six PBUTs cross-sectionally in a large pediatric HD cohort (n = 170) by comparing these with healthy and non-dialysis chronic kidney disease (CKD) stage 4–5 (n = 24) children. In parallel β2-microglobulin (β2M) and uric acid (UA) were evaluated. We then explored the impact of age and residual kidney function on uremic toxin levels and %PB using analysis of covariance and Spearman correlation coefficients (rs). We found higher levels of β2M, p-cresyl glucuronide (pCG), hippuric acid (HA), indole acetic acid (IAA), and indoxyl sulfate (IxS) in the HD compared to the CKD4–5 group. In the HD group, a positive correlation between age and pCG, HA, IxS, and pCS levels was shown. Residual urine volume was negatively correlated with levels of β2M, pCG, HA, IAA, IxS, and CMPF (rs −0.2 to −0.5). In addition, we found overall lower %PB of PBUTs in HD versus the CKD4–5 group, and showed an age-dependent increase in %PB of IAA, IxS, and pCS. Furhtermore, residual kidney function was overall positively correlated with %PB of PBUTs. In conclusion, residual kidney function and age contribute to PBUT levels and %PB in the pediatric HD population.
Evelien Snauwaert; Els Holvoet; Wim Van Biesen; Ann Raes; Griet Glorieux; Johan Vande Walle; Sanne Roels; Raymond Vanholder; Varvara Askiti; Karolis Azukaitis; Aysun Bayazit; Nur Canpolat; Michel Fischbach; Nathalie Godefroid; Saoussen Krid; Mieczyslaw Litwin; Lukasz Obrycki; Fabio Paglialonga; Bruno Ranchin; Charlotte Samaille; Franz Schaefer; Claus Peter Schmitt; Brankica Spasojevic; Constantinos J. Stefanidis; Maria Van Dyck; Koen Van Hoeck; Laure Collard; Sunny Eloot; Rukshana Shroff. Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population. Toxins 2019, 11, 235 .
AMA StyleEvelien Snauwaert, Els Holvoet, Wim Van Biesen, Ann Raes, Griet Glorieux, Johan Vande Walle, Sanne Roels, Raymond Vanholder, Varvara Askiti, Karolis Azukaitis, Aysun Bayazit, Nur Canpolat, Michel Fischbach, Nathalie Godefroid, Saoussen Krid, Mieczyslaw Litwin, Lukasz Obrycki, Fabio Paglialonga, Bruno Ranchin, Charlotte Samaille, Franz Schaefer, Claus Peter Schmitt, Brankica Spasojevic, Constantinos J. Stefanidis, Maria Van Dyck, Koen Van Hoeck, Laure Collard, Sunny Eloot, Rukshana Shroff. Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population. Toxins. 2019; 11 (4):235.
Chicago/Turabian StyleEvelien Snauwaert; Els Holvoet; Wim Van Biesen; Ann Raes; Griet Glorieux; Johan Vande Walle; Sanne Roels; Raymond Vanholder; Varvara Askiti; Karolis Azukaitis; Aysun Bayazit; Nur Canpolat; Michel Fischbach; Nathalie Godefroid; Saoussen Krid; Mieczyslaw Litwin; Lukasz Obrycki; Fabio Paglialonga; Bruno Ranchin; Charlotte Samaille; Franz Schaefer; Claus Peter Schmitt; Brankica Spasojevic; Constantinos J. Stefanidis; Maria Van Dyck; Koen Van Hoeck; Laure Collard; Sunny Eloot; Rukshana Shroff. 2019. "Uremic Toxin Concentrations are Related to Residual Kidney Function in the Pediatric Hemodialysis Population." Toxins 11, no. 4: 235.