Browsing by Subject "end-stage renal disease"

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    Heme-Oxygenase and Kidney Transplantation: A Potential for Target Therapy?
    (MDPI, 2020-05-30) Corona, Daniela; Ekser, Burcin; Gioco, Rossella; Caruso, Massimo; Schipa, Chiara; Veroux, Pierfrancesco; Giaquinta, Alessia; Granata, Antonio; Veroux, Massimiliano; Surgery, School of Medicine
    Kidney transplantation is a well-established therapy for patients with end-stage renal disease. While a significant improvement of short-term results has been achieved in the short-term, similar results were not reported in the long-term. Heme-oxygenase (HO) is the rate-limiting enzyme in heme catabolism, converting heme to iron, carbon monoxide, and biliverdin. Heme-oxygenase overexpression may be observed in all phases of transplant processes, including brain death, recipient management, and acute and chronic rejection. HO induction has been proved to provide a significant reduction of inflammatory response and a reduction of ischemia and reperfusion injury in organ transplantation, as well as providing a reduction of incidence of acute rejection. In this review, we will summarize data on HO and kidney transplantation, suggesting possible clinical applications in the near future to improve the long-term outcomes.
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    Personal Attitudes Toward Weight in Overweight and Obese US Hemodialysis Patients
    (Elsevier, 2017-09) Saeed, Zeb; Janda, Kevin M.; Tucker, Bryan; Dudley, Lacey; Cutter, Patricia; Friedman, Allon N.; Medicine, School of Medicine
    Objective Overweight and obesity have become increasingly common among end-stage renal disease patients on hemodialysis. Yet, little attention has been given to what hemodialysis patients themselves think of their weight, how they perceive it affects their health, and their attitudes about or desire for weight reduction. We explored these issues using a survey that we designed specifically for the dialysis population. Design and Methods Sixty-six chronic hemodialysis patients from a US urban center with a body mass index ≥25 kg/m2 and stable weight were recruited to participate in a cross-sectional study. The 12-question weight-related survey was validated by retesting a random portion of the study population. Results Based on test–retest results, the survey had good to excellent validity. Seventy-nine percent of patients were black, 49% were male, 29% were overweight, and 71% were obese. In general, the patients underestimated their weight excess though 73% were interested in weight loss, of whom nearly half reported attempting to do so mostly through diet and exercise. The majority of participants interested in losing weight felt that doing so would improve their physical and emotional health. The most common barrier to weight reduction was a belief that it was too difficult (55%), followed by a lack of motivation, money, time, resources, and knowledge. Diet was the most common weight loss strategy (85%) considered, whereas bariatric surgery was the least common (6.1%). Conclusions A majority of overweight and obese hemodialysis patients believe their excess weight is adversely impacting their health and quality of life and therefore wish to lose weight.
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    Simulation of blood flow past a distal arteriovenous-graft anastomosis at low Reynolds numbers
    (AIP, 2019-09) Bai, Zengding; Zhu, Luoding; Mathematical Sciences, School of Science
    Patients with end-stage renal disease are usually treated by hemodialysis while waiting for a kidney transplant. A common device for vascular access is an arteriovenous graft (AVG). However, AVG failure induced by thrombosis has been plaguing dialysis practice for decades. Current studies indicate that the thrombosis is caused by intimal hyperplasia, which is triggered by the abnormal flows and forces [e.g., wall shear stress (WSS)] in the vein after AVG implant. Due to the high level of complexity, in almost all of the existing works of modeling and simulation of the blood-flow vessel-AVG system, the graft and blood vessel are assumed to be rigid and immobile. Very recently, we have found that the compliance of graft and vein can reduce flow disturbances and lower WSS [Z. Bai and L. Zhu, “Three-dimensional simulation of a viscous flow past a compliant model of arteriovenous-graft anastomosis,” Comput. Fluids 181, 403–415 (2019)]. In this paper, we apply the compliant model to investigate possible effects of several dimensionless parameters (AVG graft-vein diameter ratio Rgv, AVG attaching angle θ, flow Reynolds numbers Re, and native vein speed Vv) on the flow and force fields near the distal AVG anastomosis at low Reynolds numbers (up to several hundreds). Our computational results indicate that the influences of the parameters Rgv, θ, and Re lie largely on the graft and the influence of Vv lies largely on the vein. In any case, the WSS, wall shear stress gradient, and wall normal stress gradient and their averaged values on the graft are significantly greater than those on the vein. ACKNOWLEDGMENTS