Kidney Function

Abstract: Background: CD14 is a key molecule in innate immunity that mediates cell activation and signaling in response to endotoxin and other bacterial wall-derived components. CD14 protein exists in soluble (sCD14) and membrane-bound forms. The correlates of sCD14 in persons undergoing long-term hemodialysis (HD) therapy are not known. We hypothesized that increased sCD14 levels in HD patients are associated with proinflammatory cytokine activation and increased mortality.Study Design: Cohort study.Setting & Participants: 310 long-term HD patients who participated in the Nutritional and Inflammatory Evaluation in Dialysis (NIED) Study, a cohort derived from a pool of more than 3,000 HD outpatients during 5 years in 8 DaVita maintenance dialysis facilities in the South Bay Los Angeles, CA, area.Predictors: sCD14 levels in serum.Outcomes: 33-month mortality.Results: Mean sCD14 level was 7.24 ± 2.45 μg/mL. Tumor necrosis factor α level was the strongest correlate of sCD14 level (r = +0.24; P < 0.001), followed by interleukin 6 level (r = +0.18; P = 0.002), serum ferritin level (r = +0.21; P < 0.001), total iron-binding capacity (r = −0.19; P < 0.001), body mass index (r = −0.15; P = 0.008), vintage (r = +0.14; P = 0.01), low-density lipoprotein cholesterol level (r = +0.13; P = 0.03), and body fat (r = −0.11; P = 0.06). During the 33-month follow-up, 71 (23%) patients died. Multivariable Cox proportional analysis adjusted for case-mix and other nutritional and inflammatory confounders, including serum tumor necrosis factor α, C-reactive protein, and interleukin 6 levels, showed that compared with the lowest sCD14 tertile, sCD14 levels in the third tertile (>7.8 μg/mL) were associated with greater death risk (hazard ratio, 1.94; 95% confidence interval, 1.01 to 3.75; P = 0.04).Limitations: Survivor bias in combined incident/prevalent studies.Conclusions: Increased sCD14 level is related positively to markers of inflammation and negatively to nutritional status and is an independent predictor of mortality in long-term HD patients. Additional studies are needed to examine the usefulness of sCD14 level in risk stratification and the clinical decision-making process in HD patients.

Conclusions: The co-existence of PLM is an additional source of sleep disruption in patients with ESRD and SA. Treatment of PLM, in addition to treatment of sleep apnea, may be required to improve sleep quality in this patient population.
Keywords: Sleep apnea, restless legs syndrome, periodic leg movements, dialysis (Source: Journal of Clinical Sleep Medicine : JCSM)

Nephrotoxicity is the most important side effect of cyclosporine use and is also the major “thorn in the side” of this remarkable drug. It is most likely not a coincidence that the two most powerful immunosuppressants in clinical practice, cyclosporine and tacrolimus, have similar modes of immunosuppressant action and similar clinical and pathologic patterns of nephrotoxicity. Theories linking the mechanism of immunosuppresion and nephrotoxicity are very interesting topics of discussion among researchers.

The term “cyclosporine nephrotoxicity” is often used loosely, and it is important to note that this term encompasses several distinct and overlapping dromes which are produced by both functional and morphologic changes within the allograft.