Improved cardiovascular risk prediction in patients with end-stage renal disease on hemodialysis using machine learning modeling and circulating microribonucleic acids
Rationale: To test whether novel biomarkers, such as microribonucleic acids (miRNAs), and nonstandard predictive models, such as decision tree learning, provide useful information for medical decision-making in patients on hemodialysis (HD).Methods: Samples from patients with end-stage renal disease receiving HD included in the AURORA trial were investigated (n=810). The study included two independent phases: phase I (matched cases and controls, n=410) and phase II (unmatched cases and controls, n=400). The composite endpoint was cardiovascular death, nonfatal myocardial infarction or nonfatal stroke. miRNA quantification was performed using miRNA sequencing and RT-qPCR. The CART algorithm was used to construct regression tree models. A bagging-based procedure was used for validation.Results: In phase I, miRNA sequencing in a subset of samples (n=20) revealed miR-632 as a candidate (fold change=2.9). miR-632 was associated with the endpoint, even after adjusting for confounding factors (HR from 1.43 to 1.53). These findings were not reproduced in phase II. Regression tree models identified eight patient subgroups with specific risk patterns. miR-186-5p and miR-632 entered the tree by redefining two risk groups: patients older than 64 years and with hsCRP
Hypertriglyceridemia may be implicated in the high atherosclerotic cardiovascular disease (ASCVD) risk experienced by patients with end –stage renal disease (ESRD). In this post–hoc analysis of the “Die Deutsche Diabetes Dialyse Studie (4D)” clinical trial, we examined incident ASCVD events, defined as myocardial infarction, ischemic stroke, or a coronary revascularization procedure, among 1255 participants with type 2 diabe tes and ESRD treated with hemodialysis. Cox–regression methods were used to evaluate the association of triglycerides, very–low density lipoprotein cholesterol (VLDL...
In conclusion, careful monitoring of patients in the early stages of CKD would result in lower morbidity and mortality. These objectives can be achieved by implementing screening programs and early interventions. PMID: 32509001 [PubMed]
CONCLUSION: Our findings show that CCL2 levels are associated with dyslipidemia, which suggests a role of this cytokine in the pathogenesis of cardiovascular disease in HD patients. A better understanding of this pathogenesis could contribute to the discovery of new therapeutic targets that would reduce cardiovascular complications in these patients. PMID: 31557637 [PubMed - as supplied by publisher]
ConclusionMediacalcosis is a severe complication since it increases the risk of cardiovascular morbidity and mortality in hemodialysis patients, to this end, the individualization of entangled factors involved in its pathophysiology, will slow down or prevent its progression in the future.
Giuseppe Ristagno1*, Francesca Fumagalli1, Barbara Bottazzi2, Alberto Mantovani2,3,4, Davide Olivari1, Deborah Novelli1 and Roberto Latini1 1Department of Cardiovascular Research, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy 2Humanitas Clinical and Research Center-IRCCS, Milan, Italy 3Humanitas University, Milan, Italy 4The William Harvey Research Institute, Queen Mary University of London, London, United Kingdom The long pentraxin PTX3 is a member of the pentraxin family produced locally by stromal and myeloid cells in response to proinflammatory signals and microbial moieties. The p...
Conclusion. AYAs with AL who are disease-free survivors at one-year have favorable long-term HCT outcomes. Long-term survival in this population appears unrelated to a TBI vs. CT-based MAC regimen. Development of cataracts is increased in long-term AYA AML HCT survivors receiving TBI-based MAC. Screening for LEs is important in survivors of AYA HCT for AL, regardless of the use of TBI or CT- based MAC regimens.DisclosuresMuffly: Shire Pharmaceuticals: Research Funding; Adaptive Biotechnologies: Research Funding.
Conclusions: PIVOTAL will provide important information about the optimum dosing of IV iron in HD patients representative of usual clinical practice.Trial Registration: EudraCT number: 2013-002267-25.Am J Nephrol 2018;48:260 –268
rial investigators Abstract BACKGROUND: Intravenous (IV) iron supplementation is a standard maintenance treatment for hemodialysis (HD) patients, but the optimum dosing regimen is unknown. METHODS: PIVOTAL (Proactive IV irOn Therapy in hemodiALysis patients) is a multicenter, open-label, blinded endpoint, randomized controlled (PROBE) trial. Incident HD adults with a serum ferritin
Conclusion: Our pilot study indicates that Grx may be a useful marker for assessing the degree of oxidative stress in CKD, however this needs further investigation in a larger prospective patient cohort.Nephron
Publication date: June 2018Source: American Journal of Kidney Diseases, Volume 71, Issue 6Author(s): Till Keller, Christoph Wanner, Vera Krane, Daniel Kraus, Bernd Genser, Hubert Scharnagl, Winfried März, Christiane DrechslerBackgroundMortality is high among patients undergoing hemodialysis for whom cardiac troponin concentration is a strong predictor of outcome. Modern troponin assays allow measurement of very low concentrations.Study DesignUsing data from a randomized controlled trial, a cohort analysis to evaluate the prognostic value of very low cardiac troponin T (TnT) concentrations.Setting &Participants1,25...