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Raikou V.D.,National and Kapodistrian University of Athens | Kyriaki D.,General Hospital LAIKO
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2016

The end-stage of renal disease is associated with increased oxidative stress and oxidative modification of low-density lipoproteins (LDLs). Beta2 microglobulin (beta2M) is accumulated in the serum of dialysis patients. Magnesium (Mg) plays a protective role in the development of oxidative stress in healthy subjects. We studied the relationship between concentrations of magnesium and oxidized LDL (ox-LDL) and beta2M in the serum of patients on the end stage of renal disease. In 96 patients on on-line- predilution hemodiafiltration, beta2M and intact parathormone were measured by radioimmunoassays. High-sensitivity C-reactive protein (hsCRP) and ox-LDL were measured using ΕLISA. Serum bicarbonate levels were measured in the blood gas analyser gas machine. We performed logistic regression analysis models to investigate Mg as an important independent predictor of elevated ox-LDL and high beta2M serum concentrations, after adjustment to traditional and specific for dialysis patients' factors. We observed a positive correlation of Mg with ox-LDL (r = 0.383, P = 0.001), but the association of Mg with beta2M, hsCRP, and serum bicarbonate levels was significantly inverse (r = -0.252, P = 0.01, r = -0.292, P = 0.004, and r = -0.282, P = 0.04 respectively). The built logistic-regression analysis showed that Mg act as a significant independent factor for the elevated ox-LDL and beta2M serum concentrations adjusting to traditional and specific factors for these patients. We observed a positive relationship between magnesium and acidosis status- related ox-LDL concentrations, but the inverse association between magnesium and beta2M serum concentrations in hemodialysis patients.


Karatzas T.,National and Kapodistrian University of Athens | Bokos J.,General Hospital Laiko | Katsargyris A.,National and Kapodistrian University of Athens | Diles K.,General Hospital Laiko | And 5 more authors.
Transplantation Proceedings | Year: 2011

Background: The use of kidneys from elderly deceased donors has substantially increased organ supply, although it is associated with worse graft function and survival rates. The risk of kidneys from elderly donors as well as expanded criteria donors (ECDs) on kidney transplant outcome was investigated. Patients and methods: Seventy-five kidney transplants from ECDs over a 5-year period were reviewed retrospectively. Old age and increased donor risk variables were analyzed separately in relation to graft function and survival. Results: Sixty-four of 75 (85.3%) recipients had functioning grafts 5 years posttransplant. The overall actuarial graft survivals from 1 to 5 years were 87.5%, 68.1%, 57.3%, 55.4%, and 47.3%, respectively. Early graft function gave 47 (62.7%) kidneys remarkable actuarial survivals of 100.0%, 88.3%, 75.8%, 75.8%, and 68.4% at 1 to 5 years posttransplant, and 28 (37.3%) kidneys had delayed graft function with substantially decreased actuarial survival rates, ranging from 66.7% to 23.2%. Kidneys from elderly donors had considerable actuarial graft survival rates of 100.0%, 83.3%, 76.9%, 76.9%, and 67.0% from 1 to 5 years, respectively; these were the best graft survival rates compared with kidneys from the other donor categories. The other donor risk variables when associated with advanced age of any had an adverse effect on recipient graft function and survival, but no single risk variable alone, or a combination of any two, showed any statistically significant variability. Conclusion: Elderly kidney donors provided a substantial organ pool expansion without affecting patient and graft survival in many patients. ECDs can be utilized safely if adequate measures are taken. © 2011 Elsevier Inc.


Karatzas T.,National and Kapodistrian University of Athens | Gompou A.,National Transplant Organization of Greece | Bokos J.,General Hospital Laiko | Dimitroulis D.,National and Kapodistrian University of Athens | And 4 more authors.
International Urology and Nephrology | Year: 2011

Background The utilization of kidney grafts from expanded criteria donors (ECDs) needs to be evaluated within the context of critical organ shortage and graft function and survival. The impact of donor risk variables on kidney transplantation (KTx) outcome was investigated. Methods A retrospective review of 75 KTxs from ECDs over a 5-year period was performed. Donor risk factors were analyzed separately and correlated with recipients graft function and survival. Results Sixty-four recipients out of 75 (85.3%) had functioning grafts 5 years post-transplant. The overall actuarial graft survival rates at 1 through 5 years were 87.5, 68.1, 57.3, 55.4, and 47.3%, respectively. Forty-seven kidneys (62.7%) had early function with actuarial survival of 100.0, 88.3, 75.8, 75.8, and 68.4% at 1-5 years post-transplant, and 28 (37.3%) grafts presented delayed function with substantially decreased actuarial survival, ranging from 66.7 to 23.2%. KTxs from elderly donors had remarkable actuarial survival rates ranging from 100.0 to 67.0%, at 1-5 years, being the best graft survival rates among KTxs from other donor categories. The other donor risk variables when associated with old age had an adverse effect on recipient graft function and survival, but none alone or a combination of the two, showed any significant statistical variability. Conclusion ECDs significantly increased the kidney pool and can be utilized safely if adequate measures are taken. © 2011 Springer Science+Business Media, B.V.


Raikou V.D.,National and Kapodistrian University of Athens | Kyriaki D.,General Hospital LAIKO
Journal of Diabetes and Metabolic Disorders | Year: 2015

Background: Hyperglycemia appears to play a significant role on the inflammatory cytokines production. Beta2-microglobulin (beta2M) is accumulated in the circulation of dialysis patients. We studied the relationship between glycemic control defined by glucose serum concentrations and insulin resistance, beta2M and markers of inflammation in patients on renal replacement therapies with or/and without diabetes mellitus. Methods: We enrolled 96 dialyzed patients, 62 males and 34 females. The treatment modalities which were applied were: regular hemodialysis (HD, n = 34), predilution hemodiafiltration (HDF, n = 42) and peritoneal dialysis (PD, n = 20). Dialysis adequacy was defined by Kt/V for urea.Beta2M and insulin serum concentrations were measured by radioimmunoassays. hsCRP and TNF-α serum concentrations were measured by ELISA. Insulin resistance was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR).We examined the association of elevated serum glucose with inflammatory factors and we built a multivariable model to investigate if glucose could be a potential determinant of beta2M serum levels. Results: Serum glucose was positively correlated with beta2M and TNF-α (r= 0.320, p = 0.002 and r = 0.215, p = 0.03 respectively).We observed significant association between the patients with higher serum glucose concentrations and the patients with greater beta2M concentrations (x2 = 4.44, p = 0.03). Multivariable model showed that glucose acts as a significant independent determinant of beta2M adjusting for age, gender, dialysis modality and metabolic acidosis status. Conclusions: The elevated glucose concentrations were positively associated with both, greater beta2M serum concentrations and up-regulated inflammatory procedure in dialysis patients with or/and without diabetes mellitus. © 2015 Raikou and Kyriaki.


Raikou V.D.,National and Kapodistrian University of Athens | Tentolouris N.,National and Kapodistrian University of Athens | Kyriaki D.,General Hospital Laiko | Evaggelatou A.,General Hospital Laiko | Tzanatou H.,National and Kapodistrian University of Athens
Nephron - Clinical Practice | Year: 2011

Background/Aim: Pulse pressure (PP) is a result of arterial stiffness seen in dialysis patients, but may be a consequence of fluid overload. We examined the role of β 2-microglobulin (β 2M) in PP in relation to metabolic alterations in patients on different hemodialysis (HD) modalities. Methods: We studied 76 hemodialyzed patients on regular HD (n = 34), predilution bagged hemodiafiltration (n = 19) and online predilution hemodiafiltration (n = 23). β 2M levels were measured by radioimmunoassay, and the clearance of β 2M was assessed by Kt/V for β 2M. Arterial stiffness was measured as carotid-femoral pulse wave velocity, and PP was derived. Insulin levels were measured using immunoradioassay, and insulin resistance was calculated using homeostasis model assessment insulin resistance (HOMA-IR). Serum bicarbonate levels were measured using a blood gas analyzer, and percent sodium removal was calculated. Results: β 2M levels predict increased PP (p = 0.02) adjusting for age, HD modalities, HD duration, HOMA-IR and percent sodium removal. β 2M was positively associated with HOMA-IR (r = 0.306, p = 0.007). Serum bicarbonate levels and carotid-femoral pulse wave velocity were inversely associated (r = -0.719, p = 0.001). Conclusions: β 2M levels were positively associated with PP, which was influenced mainly by dialysis modality fluid and sodium balance and less by arterial stiffness. β 2M levels were positively associated with insulin resistance. Uremic acidosis may contribute to arterial stiffness. Copyright © 2010 S. Karger AG, Basel.


Chatzipavlou M.,401 General Military Hospital of Athens | Magiorkinis G.,University of Oxford | Koutsogeorgopoulou L.,General Hospital Laiko | Kassimos D.,401 General Military Hospital of Athens
Rheumatology International | Year: 2014

Dietary interventions have been suggested to be a safe cost-efficient way to control hyperuricemia. The aim of the study is to assess the potential of mediterranean diet as intervention to control the level of urate in patients with hyperuricemia in a small sample of patients. Patients with asymptomatic hyperuricemia were recruited from outpatient clinics and were enrolled into personal Mediterranean diet-based programs. Body mass index (BMI), serum urate, lipid profile and indirect calorimetry were measured at the beginning and then monthly for the first 3 months and then at the sixth month. At the same time, patients' compliance with the Mediterranean diet was assessed by a formal interview and standard questionnaire. Only six out of twelve patients managed to complete the diet (dropout rate 50%). Their BMI remained constant during the trial period in the level of 1st degree obesity (BMI = 31.46). The mean value of serum urate at the beginning of the study was 9.12 mg/dl. After the first month, there was a reduction in urate by 20% with mean urate at 6.92 mg/dl. The second, third and sixth month mean urate levels were 6.32, 6.1 and 6.4 mg/dl, respectively. The effect of the mediterranean diet was rapid at the first month and remained constant throughout the dietary intervention, suggesting that it might have a clinically significant effect on urate level thus providing a cost-efficient and safe alternative to pharmaceutical intervention as first-line treatment of hyperuricemia. © Springer-Verlag 2013.


PubMed | General Hospital Laiko
Type: Journal Article | Journal: Nephron extra | Year: 2014

B cells play a central role in the pathogenesis of many autoimmune diseases. Selective targeting can be achieved with the use of the monoclonal antibody rituximab. In addition to being a drug for non-Hodgkins lymphoma, rituximab is also an FDA-approved treatment for refractory rheumatoid arthritis and, since recently, ANCA vasculitis. It has shown efficacy in many autoimmune diseases. This review will discuss current evidence and the rationale of the use of rituximab in glomerular diseases, including randomized controlled trials. The focus will be on the use of rituximab in idiopathic membranous nephropathy, systemic lupus erythematosus and ANCA-associated vasculitis. The emerging role of rituximab in renal transplantation, where it seems to be important for the desensitization protocols for highly sensitized patients as well as for the preconditioning of ABO-incompatible recipients and the treatment of antibody-mediated rejection, will also be addressed.

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