Disc‐like lesions in the intestinal tract after renal transplantation

We report a case of intestinal lesions in a patient with a history of lupus nephritis and renal transplantation. Biopsy revealed an EBV‐driven post‐transplant lymphoproliferative disease (PTLD). An EBV‐driven PTLD is a major complication after renal transplantation and is an important differential diagnostic consideration in the follow‐up of renal transplant recipients.     

Euploidy rates are not affected when embryos are cultured in a continuous (CCM) or sequential culture medium (SCM): a sibling oocyte study

Journal of Assisted Reproduction and Genetics - To determine if euploidy rates and embryo development differ when blastocysts are cultured in CCM or SCM. A single-center retrospective observational...     

Different CO2 settings (6.0% vs 7.0%) do have an impact on extracellular pH of culture medium (pHe) and euploidy rates rather than on blastocyst development: a sibling oocyte study

Journal of Assisted Reproduction and Genetics - To determine whether euploidy rates and blastocyst development differ in a continuous culture medium under different CO2 concentrations. A...     

Differences in quality of life of hemodialysis patients between dialysis centers

Purpose

Hemodialysis patients undergo frequent and long visits to the clinic to receive adequate dialysis treatment, medical guidance, and support. This may affect health-related quality of life (HRQOL). Although HRQOL is a very important management aspect in hemodialysis patients, there is a paucity of information on the differences in HRQOL between centers. We set out to assess the differences in HRQOL of hemodialysis patients between dialysis centers and explore which modifiable center characteristics could explain possible differences.

Methods

This cross-sectional study evaluated 570 hemodialysis patients from 24 Dutch dialysis centers. HRQOL was measured with the Kidney Disease Quality Of Life-Short Form (KDQOL-SF).

Results

After adjustment for differences in case-mix, three HRQOL domains differed between dialysis centers: the physical composite score (PCS, P?=?0.01), quality of social interaction (P?=?0.04), and dialysis staff encouragement (P?=?0.001). These center differences had a range of 11?C21 points on a scale of 0?C100, depending on the domain. Two center characteristics showed a clinical relevant relation with patients?? HRQOL: dieticians?? fulltime-equivalent and the type of dialysis center.

Conclusion

This study showed that clinical relevant differences exist between dialysis centers in multiple HRQOL domains. This is especially remarkable as hemodialysis is a highly standardized therapy.     

Role of Residual Kidney Function and Convective Volume on Change in β2-Microglobulin Levels in Hemodiafiltration Patients

Background and objectives: Removal of β₂-microglobulin (β2M) can be increased by adding convective transport to hemodialysis (HD). The aim of this study was to investigate the change in β2M levels after 6-mo treatment with hemodiafiltration (HDF) and to evaluate the role of residual kidney function (RKF) and the amount of convective volume with this change.Design, setting, participants, & measurements: Predialysis serum β2M levels were evaluated in 230 patients with and 176 patients without RKF from the CONvective TRAnsport STudy (CONTRAST) at baseline and 6 mo after randomization for online HDF or low-flux HD. In HDF patients, potential determinants of change in β2M were analyzed using multivariable linear regression models.Results: Mean serum β2M levels decreased from 29.5 ± 0.8 (±SEM) at baseline to 24.3 ± 0.6 mg/L after 6 mo in HDF patients and increased from 31.9 ± 0.9 to 34.4 ± 1.0 mg/L in HD patients, with the difference of change between treatment groups being statistically significant (regression coefficient −7.7 mg/L, 95% confidence interval −9.5 to −5.6, P < 0.001). This difference was more pronounced in patients without RKF as compared with patients with RKF. In HDF patients, β2M levels remained unchanged in patients with GFR >4.2 ml/min/1.73 m². The β2M decrease was not related to convective volume.Conclusions: This study demonstrated effective lowering of β2M levels by HDF, especially in patients without RKF. The role of the amount of convective volume on β2M decrease appears limited, possibly because of resistance to β2M transfer between body compartments.β₂-microglobulin (β2M, 11.8 kD) accumulates in kidney failure and has been implicated in the development of dialysis-associated amyloidosis (1). In addition, β2M levels have been widely studied as a marker for uremic toxins within the middle molecular weight (MMW) range (≥500 D and <approximately 60,000 D) (2). β2M is eliminated from the extracellular volume almost exclusively by the kidneys. Consequently, serum β2M levels already rise when kidney function is only mildly impaired (3). In hemodialysis (HD) patients, serum β2M levels may be increased by 20-fold or more as compared with the general population, the highest levels being observed in patients without residual kidney function (RKF) (4–6). It has been shown that predialysis β2M levels predict all-cause and infectious-related mortality in these patients (4,7,8).Because of its size, removal of β2M is negligible during low-flux HD. In contrast, significant removal of β2M can be established with high-flux HD, because of convective transport by internal filtration within the dialyzer. The Hemodialysis (HEMO) and the Membrane Permeability Outcome (MPO) study showed lower serum β2M levels in high-flux HD as compared with low-flux HD patients (4,9). In addition, it has been shown that removal of β2M is further increased with online hemodiafiltration (HDF) by using excess ultrafiltration to provide increased convective transport. Actually, lower predialysis β2M levels have been reported after 3 to 12 mo treatment with HDF, as compared with low-flux or high-flux HD (10–15). It has been proposed that the improved survival of HDF patients, as reported in few observational studies (16–18), can be partly attributed to increased removal of β2M and other MMW uremic toxins by convective transport.For optimal efficiency of HDF treatment, the use of large convective volumes has been recommended (19). Indeed, a relation between the delivered convective volume and β2M reduction ratio has been reported during a dialysis session (14,15). In addition, in the Dialysis Outcomes and Practice Patterns Study (DOPPS) a survival benefit was observed only in HDF patients who were treated with high convective volumes (replacement of ≥15 L/treatment) (16). However, as of yet, a direct relationship between the amount of convective volume and decrease in β2M levels in the short or long term has not been investigated.The ongoing CONvective TRAnsport STudy (CONTRAST) has been designed to investigate the effects of increased convective transport by online HDF as compared with low-flux HD on all-cause mortality and cardiovascular morbidity and mortality (20). As part of CONTRAST, predialysis serum β2M levels were measured to evaluate short-term treatment effects. The aim of the study presented here was to investigate the change in β2M levels from baseline to 6 mo in patients randomized to HDF and HD. Because β2M strongly relates to RKF, the change in β2M during the study period was analyzed separately for patients with and without RKF. In addition, the relationships of the extent of RKF and the amount of convective volume with the change in β2M levels were evaluated in HDF patients.