Interleukin-1 (IL-1) is a highly active pro-inflammatory cytokine that lowers pain thresholds and damages tissues. Monotherapy blocking IL-1 activity in autoinflammatory syndromes results in a rapid and sustained reduction in disease severity, including reversal of inflammation-mediated loss of sight, hearing and organ function. This approach can therefore be effective in treating common conditions such as post-infarction heart failure, and trials targeting a broad spectrum of new indications are underway. So far, three IL-1-targeted agents have been approved: the IL-1 receptor antagonist anakinra, the soluble decoy receptor rilonacept and the neutralizing monoclonal anti-IL-1β antibody canakinumab. In addition, a monoclonal antibody directed against the IL-1 receptor and a neutralizing anti-IL-1α antibody are in clinical trials.

Treating inflammation by blocking interleukin-1 in a broad spectrum of diseases

Human serum albumin: from bench to bedside.

https://www.kidney-international.org/article/S0085-2538(15)48948-3/pdf

Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients

https://escholarship.org/content/qt5vj8413q/qt5vj8413q.pdf?t=ptt3h0

Fructose, weight gain, and the insulin resistance syndrome

Hypoalbuminemia is the result of the combined effects of inflammation and inadequate protein and caloric intake in patients with chronic disease such as chronic renal failure. Inflammation and malnutrition both reduce albumin concentration by decreasing its rate of synthesis, while inflammation alone is associated with a greater fractional catabolic rate (FCR) and, when extreme, increased transfer of albumin out of the vascular compartment. A vicious cascade of events ensues in which inflammation induces anorexia and reduces the effective use of dietary protein and energy intake and augments catabolism of the key somatic protein, albumin. Hypoalbuminemia is a powerful predictor of mortality in patients with chronic renal failure, and the major cause of death in this population is due to cardiovascular events. Inflammation is associated with vascular disease and likely causes injury to the vascular endothelium, and hypoalbuminemia as two separate expressions of the inflammatory process. Albumin has a myriad of important physiologic effects that are essential for normal health. However, simply administering albumin to critically ill patients with hypoalbuminemia has not been shown to improve survival or reduce morbidity. Thus the inference from these clinical studies suggests that the cause of hypoalbuminemia, rather than low albumin levels specifically, is responsible for morbidity and mortality.

Serum albumin: relationship to inflammation and nutrition.

https://www.ajkd.org/article/S0272-6386(01)80014-7/pdf

Serum ferritin is a marker of morbidity and mortality in hemodialysis patients

CLINICIANS are occasionally confronted with the finding of an elevated serum or plasma potassium level in an otherwise healthy person. Such an abnormality may herald the presence of occult mineralocorticoid deficiency or a defect in renal tubular transport.1 Alternatively, it may represent so-called pseudohyperkalemia, caused by the release of potassium from formed elements in the blood in patients with leukocytosis or thrombocytosis.2 , 3 We report here on a patient in whom pseudohyperkalemia resulted from the common practice of repeatedly clenching and unclenching a fist during venipuncture. This maneuver, which has been passed on from generation to generation of house staff, medical . . .

https://www.nejm.org/doi/pdf/10.1056/NEJM199005033221806

Pseudohyperkalemia Caused by Fist Clenching during Phlebotomy

Extended daily dialysis (EDD) is an easily implemented alternative to continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). Since EDD offers most of the advantages of CRRT, we sought to compare the effectiveness of these two modalities. In this 2-year study, 54 ICU patients with ARF were treated with either continuous hemodialysis (CHD) or EDD. Oliguria was present in 64% of patients who received CHD vs. 73% of EDD patients (p=NS) while 93% of CHD and 81% of EDD patients required mechanical ventilation (p=NS). Patients treated with EDD were younger than those who received CHD (47.0 +/- 12.6 vs. 56.7 +/- 13.7, p=0.009), but there were no significant differences in gender or mean APACHE II scores at the time of randomization. Mean arterial blood pressures measured during treatment were maintained between 70 and 80 mmHg for both EDD and CHD and average daily serum electrolyte levels fell within normal ranges for EDD and CHD. Average daily fluid input and output were 5.8 +/- 3.3 L and 6.0 +/- 3.2 L for CHD vs. 3.3 +/- 2.6 and 3.0 +/- 1.7 L for EDD after exclusion of data from 2 burn patients. Hourly heparin anticoagulation rates were 1080 U/hour for CHD and 643 U/hour for EDD, p=0.02. Anticoagulation-free treatments were performed during 43% of all EDD treatments vs. 21% of all CHD treatments, p<0.001. Clotting of the dialyzer or circuit occurred at least once during 51% of all CHD treatment days vs. 22% of EDD treatments (p<0.001). We conclude that EDD is a safe, effective alternative to CRRT that offers comparable hemodynamic stability and excellent small solute control.

Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure: a two-year single center report.

There is a renewed interest in thalidomide for use in malignancies and systemic inflammatory diseases Reduced renal function is not uncommon among patients with these disease states but the pharmacokinetics has not been fully investigated The aim of this study was to investigate the pharmacokinetics of thalidomide in haemodialysis patients while on and off dialysis and in myeloma patients with varying degrees of renal function Two studies were performed To establish the pharmacokinetics of thalidomide in patients with mild to moderate renal failure, blood samples were taken over 12 weeks from 40 patients with multiple myeloma A second study was performed in six patients with end-stage renal disease both on a non-dialysis day and before and during a haemodialysis session Thalidomide concentration was determined by HPLC A one-compartment open model with first-order absorption and elimination was used to fit total thalidomide concentration to population pharmacokinetics and statistical models using the NONMEM program Clearance and volumes were slightly below 10 L h-1 and 1 L kg-1, respectively, in both patient groups The inter- and intra-patient variability was low Clearance was doubled during dialysis There was no correlation between thalidomide clearance and renal function In conclusion, the pharmacokinetics of thalidomide in patients with renal failure are very similar to values reported by others for patients with normal renal function Although clearance during dialysis is doubled, thalidomide dose need not be changed for patients with decreased kidney function There is also no need for a supplementary dose due to haemodialysis

Burl R. Don

Papers

Serum albumin: relationship to inflammation and nutrition.

Serum ferritin is a marker of morbidity and mortality in hemodialysis patients

Pseudohyperkalemia Caused by Fist Clenching during Phlebotomy

Extended daily dialysis vs. continuous hemodialysis for ICU patients with acute renal failure: a two-year single center report.

Pharmacokinetics of thalidomide in patients with impaired renal function and while on and off dialysis.