Showing papers by "Lars Christian Rump published in 2021"
TL;DR: In this article, the authors evaluated the efficacy and safety of endovascular renal denervation in patients with hypertension resistant to three or more antihypertensive medications including a diuretic.
100 citations
TL;DR: In this paper, mycophenolate mofetil (MMF) treatment was evaluated in 225 kidney transplant recipients (KTRs) and compared to 176 controls, and MMF-free regimen was highly associated with seroconversion.
83 citations
TL;DR: In kidney transplantation, the use of minimally invasive damage biomarkers that are more sensitive and specific than plasma creatinine will be crucial to enable early, actionable detection or exclusion of structural kidney damage due to acute or chronic rejection.
Abstract: In kidney transplantation, the use of minimally invasive damage biomarkers that are more sensitive and specific than plasma creatinine will be crucial to enable early, actionable detection or exclusion of structural kidney damage due to acute or chronic rejection. Donor-derived cell-free DNA (dd-cfDNA), which can be quantified, for example, through next-generation sequencing, droplet digital PCR and quantitative PCR, is a candidate biomarker with great potential for enabling comprehensive monitoring of allograft injury. dd-cfDNA has a favourable overall diagnostic performance for the detection of rejection and its high negative predictive value might be especially useful for avoiding unnecessary biopsies. Elevated dd-cfDNA levels have been shown to be detectable before graft injury can be clinically identified using current diagnostic methods. Moreover, dd-cfDNA falls rapidly to baseline levels after successful treatment for rejection owing to its short half-life. dd-cfDNA can detect graft injury caused by immune activation owing to insufficient immunosuppression and might therefore also help guide immunosuppression dosing. The fractional abundance of dd-cfDNA can be affected by changes in the recipient cfDNA (for example, due to infection or physical exercise) but the use of absolute quantification of dd-cfDNA overcomes this limitation. Serial dd-cfDNA determinations might therefore facilitate cost-effective personalized clinical management of kidney transplant recipients to reduce premature graft loss.
48 citations
TL;DR: Patients with kidney failure show a significantly weaker antibody response compared with controls, and only one out of four KTRs developed neutralizing antibodies against SARS-CoV-2 after two doses of vaccine, suggesting that vaccination strategies need modification in K TRs and patients on dialysis.
Abstract: Background Patients with kidney failure on dialysis or after renal transplantation have a high risk for severe COVID-19 infection, and vaccination against SARS-CoV-2 is the only expedient prophylaxis. Generally, immune responses are attenuated in patients with kidney failure, however, systematic analyses of immune responses to SARS-CoV-2 vaccination in patients on dialysis and in kidney transplant recipients (KTRs) are still needed. Methods In this prospective, multicentric cohort study, antibody responses to COVID-19 mRNA vaccines (BNT162b2 [BioNTech/Pfizer] or mRNA-1273 [Moderna]) were measured in 32 patients on dialysis and in 28 KTRs. SARS-CoV-2–specific antibodies and neutralization capacity were evaluated and compared with controls (n=78) of a similar age range. Results After the first vaccination, SARS-CoV-2–specific antibodies were nearly undetectable in patients with kidney failure. After the second vaccination, 93% of the controls and 88% of patients on dialysis but only 37% of KTRs developed SARS-CoV-2–specific IgG above cutoff. Moreover, mean IgG levels were significantly lower in KTRs (54±93 BAU/ml) compared with patients on dialysis (503±481 BAU/ml; P Conclusions Patients with kidney failure show a significantly weaker antibody response compared with controls. Most strikingly, only one out of four KTRs developed neutralizing antibodies against SARS-CoV-2 after two doses of vaccine. These data suggest that vaccination strategies need modification in KTRs and patients on dialysis. Clinical Trial registry name and registration number: Vaccination Against COVID-19 in Chronic Kidney Disease, NCT04743947
32 citations
University of Padua1, University of Glasgow2, University of Paris3, Ludwig Maximilian University of Munich4, Charles University in Prague5, Takeda Pharmaceutical Company6, Radboud University Nijmegen7, University of Ljubljana8, Ljubljana University Medical Centre9, Foothills Medical Centre10, Tohoku University11, University of Düsseldorf12, University of Rostock13, Hudson Institute of Medical Research14, Monash University, Clayton campus15, Medical College of Wisconsin16, Autonomous University of Barcelona17, National Taiwan University18
TL;DR: Resistant hypertension is a common presentation in patients seeking surgical cure of PA; AVS is key for the optimal management of patients with PA due to resistant hypertension; and AVS-guided adrenalectomy allowed resolution of treatment-resistant hypertension.
Abstract: Aims:
We aimed at determining the rate of drug-resistant arterial hypertension in patients with an unambiguous diagnosis of primary aldosteronism (PA). Moreover, we sought for investigating the diagnostic performance of adrenal vein sampling (AVS), and the effect of adrenalectomy on blood pressure (BP) and prior treatment resistance in PA patients subtyped by AVS in major referral centres.
Methods and results:
The Adrenal Vein Sampling International Study-2 (AVIS-2) was a multicentre international study that recruited consecutive PA patients submitted to AVS, according to current guidelines, during 15 years. The patients were over 18 years old with arterial hypertension and had an unambiguous diagnosis of PA. The rate of resistant hypertension was assessed at baseline and after adrenalectomy using the American Heart Association (AHA) 2018 definition. Information on presence or absence of resistant hypertension was available in 89% of the 1625 enrolled PA patients. Based on the AHA 2018 criteria, resistant hypertension was found in 20% of patients, of which about two-thirds (14%) were men and one-third (6%) women (χ2 = 17.1, P < 1*10−4) with a higher rate of RH in men than in women (23% vs. 15% P < 1*10−4). Of the 292 patients with resistant hypertension, 98 (34%) underwent unilateral AVS-guided adrenalectomy, which resolved BP resistance to antihypertensive treatment in all.
Conclusions:
(i) Resistant hypertension is a common presentation in patients seeking surgical cure of PA; (ii) AVS is key for the optimal management of patients with PA due to resistant hypertension; and (iii) AVS-guided adrenalectomy allowed resolution of treatment-resistant hypertension.
14 citations
University of Padua1, University of Paris2, Ludwig Maximilian University of Munich3, Charles University in Prague4, Takeda Pharmaceutical Company5, Radboud University Nijmegen6, University of Ljubljana7, University of Calgary8, Tohoku University9, University of Düsseldorf10, University of Rostock11, Hudson Institute of Medical Research12, Monash University, Clayton campus13, Medical College of Wisconsin14, Pompeu Fabra University15, National Taiwan University16
TL;DR: Rossi GP, Crimi F, Rossitto G, Amar L, Azizi M, Riester A, Reincke M, Degenhart C, Widimsky J, Naruse M, Kocjan T, Negro A, Rossi E, Kline G, Tanabe A, Satoh F, Rump LC, Vonend O, Willenberg HS, Fuller PJ, Yang J, Chee NYN, Magill SB, Shafigullina Z, Quinkler M, Oliveras A, Wu VC, Kratka
Abstract: Supplemental material for the article:
Rossi GP, Crimi F, Rossitto G, Amar L, Azizi M, Riester A, Reincke M, Degenhart C, Widimsky J, Naruse M, Deinum J, Schultze Kool L, Kocjan T, Negro A, Rossi E, Kline G, Tanabe A, Satoh F, Rump LC, Vonend O, Willenberg HS, Fuller PJ, Yang J, Chee NYN, Magill SB, Shafigullina Z, Quinkler M, Oliveras A, Wu VC, Kratka Z, Barbiero G, Seccia TM, Battistel M. Identification of Surgically Curable Primary Aldosteronism by Imaging in a Large Multiethnic International Study. J Clin Endocrinol Metab . 2021 Jul 2;dgab482. doi: 10.1210/clinem/dgab482. Online ahead of print.
13 citations
Queen Mary University of London1, Columbia University Medical Center2, Saarland University3, Massachusetts Institute of Technology4, Erasmus University Rotterdam5, Medical University of South Carolina6, Leipzig University7, Deborah Heart and Lung Center8, Brigham and Women's Hospital9, Utrecht University10, Abbott Northwestern Hospital11, SUNY Downstate Medical Center12, University of Exeter13, University Hospital of Wales14, University of Nevada, Reno15, University of Paris16, French Institute of Health and Medical Research17
TL;DR: In this paper, a post-hoc analysis of the RADIANCE-HTN SOLO study was conducted to identify predictors of patients' response to renal denervation.
Abstract: The blood pressure (BP) lowering response to renal denervation (RDN) remains variable with about one-third of patients not responding to ultrasound or radiofrequency RDN. Identification of predictors of the BP response to RDN is needed to optimize patient selection for this therapy. This is a post-hoc analysis of the RADIANCE-HTN SOLO study. BP response to RDN was measured by the change in daytime ambulatory systolic blood pressure (dASBP) at 2 months post procedure. Univariate regression was used initially to assess potential predictors of outcome followed by multivariate regression analysis. In the univariate analysis, predictors of response to RDN were higher baseline daytime ambulatory diastolic blood pressure (dADBP), the use of antihypertensive medications at screening, and presence of orthostatic hypertension (OHTN) whilst the presence of untreated accessory arteries was a negative predictor of response. Multivariate analysis determined that dADBP and use of antihypertensive medications were predictors of response to RDN with a trend for OHTN to predict response. Obese females also appeared to be better responders to RDN in an interaction model. RDN is more effective in patients with elevated baseline dADBP and those with OHTN, suggesting increased peripheral vascular resistance secondary to heightened sympathetic tone. These assessments are easy to perform in clinical setting and may help in phenotyping patients who will respond better to RDN.
8 citations
University of Padua1, University of Paris2, Ludwig Maximilian University of Munich3, Charles University in Prague4, Takeda Pharmaceutical Company5, Radboud University Nijmegen6, Ljubljana University Medical Centre7, University of Ljubljana8, Foothills Medical Centre9, Tohoku University10, University of Düsseldorf11, University of Rostock12, Hudson Institute of Medical Research13, Monash University, Clayton campus14, Medical College of Wisconsin15, Autonomous University of Barcelona16, National Taiwan University17
TL;DR: Many patients with primary aldosteronism (PA) are denied curative adrenalectomy because of limited availability or failure of adrenal vein sampling as mentioned in this paper, and it has been suggested that the vein s...
Abstract: Many of the patients with primary aldosteronism (PA) are denied curative adrenalectomy because of limited availability or failure of adrenal vein sampling. It has been suggested that adrenal vein s...
7 citations
TL;DR: In this article, the RDN-Zentren are defined, einen national verbindlichen Mindeststandard fur Zentren zur Durchfuhrung der RDN zu definieren sowie uber eine Netzwerkbildung die Betreuung der Patienten with unkontrollierter Hypertonie zu optimieren.
Abstract: Die arterielle Hypertonie gehort in den westlichen Industrienationen durch ihre hohe Pravalenz zu den haufigsten chronischen Erkrankungen und ist ein Hauptrisikofaktor fur kardiovaskulare Morbiditat und Mortalitat. In der Pathophysiologie der unkontrollierten Hypertonie kommt der Uberaktivitat des sympathischen Nervensystems eine wichtige Bedeutung zu. Seit einigen Jahren steht mit der renalen Denervation (RDN) ein katheterbasiertes Verfahren zur selektiven renalen Sympathektomie zur Verfugung. In mehreren randomisierten, durch Scheinprozedur kontrollierten Studien konnte die Wirksamkeit und Sicherheit des Verfahrens bestatigt werden, sodass davon auszugehen ist, dass die RDN auch klinisch zum Einsatz kommen wird. Ziel der Zertifizierung der Renalen-Denervations-Zentren ist es, einen national verbindlichen Mindeststandard fur Zentren zur Durchfuhrung der RDN zu definieren sowie uber eine Netzwerkbildung die Betreuung der Patienten mit unkontrollierter Hypertonie zu optimieren. Institutionen, welche die RDN durchfuhren, wird im Zuge eines Evaluationsverfahrens die Moglichkeit gegeben, entsprechend zertifiziert zu werden.
7 citations
TL;DR: This review article gives an overview concerning etiology, diagnostics, and therapeutic options of PA, and reviews the indication, the technique, and relevance of selective adrenal venous sampling (AVS) in the context of the current literature and the authors' experience.
Abstract: Background Primary aldosteronism (PA) is the most common detectable cause of secondary hypertension. The majority of patients have either an adrenal aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH) demanding different therapeutic approaches. Screening tests and imaging cannot reliably distinguish between a unilateral or bilateral PA. Methods This review article gives an overview concerning etiology, diagnostics, and therapeutic options of PA, and reviews the indication, the technique, and relevance of selective adrenal venous sampling (AVS) in the context of the current literature and the authors’ experience. Results AVS can verify or exclude a unilaterally dominated secretion with a high success rate. Patients with PA and a unilateral APA can be treated curatively by adrenalectomy. Conclusions AVS is an established diagnostic examination for differentiation of unilateral from bilateral adrenal disease in patients with PA. Key Points:
Citation Format
2 citations
TL;DR: In this article, the authors evaluated the relationship between cystatin C, socioeconomic position (SEP) and established cardiovascular risk factors in a population-based study and found that social inequalities seem to play a role in subclinical stages of renal dysfunction which are also related to development of cardiovascular disease.
Abstract: Social inequalities in health and disease are well studied. Less information is available on inequalities in biomarker levels indicating subclinical stages of disease such as cystatin C, an early diagnostic marker of renal dysfunction and predictor for cardiovascular disease. We evaluated the relationship between cystatin C, socioeconomic position (SEP) and established cardiovascular risk factors in a population-based study. In 4475 men and women aged 45-75 years participating in the baseline examination of the Heinz Nixdorf Recall Study cystatin C was measured from serum samples with a nephelometric assay. SEP was assessed by education and household income. Linear regression models were used to analyse the association between SEP and cystatin C as well as the impact of cardiovascular risk factors (i.e., body mass index, blood pressure, blood glucose, diabetes mellitus, blood lipids, C-reactive protein, smoking) on this association. After adjustment for age and sex cystatin C decreased by 0.019 mg/l (95% confidence interval (CI) - 0.030 to - 0.008) per five years of education. While using a categorical education variable cystatin C presented 0.039 mg/l (95% CI 0.017-0.061) higher in men and women in the lowest educational category (≤ 10 years of education) compared to the highest category (≥ 18 years). Concerning income, cystatin C decreased by 0.014 mg/l (95% CI - 0.021 to - 0.006) per 1000 € after adjustment for age and sex. For men and women in the lowest income quartile cystatin C was 0.024 mg/l (95% CI 0.009-0.038) higher compared to the highest income quartile. After adjusting for established cardiovascular risk factors the observed associations were substantially diminished. Social inequalities seem to play a role in subclinical stages of renal dysfunction, which are also related to development of cardiovascular disease. Adjustment for traditional cardiovascular risk factors showed that these risk factors largely explain the association between SEP and cystatin C.
TL;DR: Anamnese et al. as discussed by the authors berichten uber einen 57-jahrigen Patienten, der in unserer Klinik zur geplanten AB0-inkompatiblen Lebendnierentransplantation aufgenommen wurde.
Abstract: Anamnese Wir berichten uber einen 57-jahrigen Patienten, der in unserer Klinik zur geplanten AB0-inkompatiblen Lebendnierentransplantation aufgenommen wurde. Untersuchungen und Diagnose An Tag 3 post operationem bildeten sich laborchemisch eindeutige Hinweise fur eine De-novo-TMA aus. Die renale Entgiftung stagnierte bei initialem regelrechtem Verlauf. Therapie und Verlauf Durch den Einsatz von Eculizumab 900 mg an d3 und d10 post operationem konnten wir die TMA mit einem anhaltenden Erfolg unterbinden. Folgerung Zu diskutieren ist, ob ein fruhzeitiger Einsatz von Eculizumab bei V. a. De-novo-TMA ein sicherer Weg ist, eine Transplantatdysfunktion zu unterbinden und somit die in der Literatur beschriebene schlechte Prognose fur Transplantat und Empfanger zu verbessern.