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    Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study
    (Amer Soc Nephrology, 2019) Shroff, Rukshana; Smith, Colette; Ranchin, Bruno; Bayazit, Aysun K.; Stefanidis, Constantinos J.; Askiti, Varvara; Azukaitis, Karolis; Canpolat, Nur; Agbas, Ayse; Aitkenhead, Helen; Anarat, Ali; Aoun, Bilal; Aofolaju, Daley; Bakkaloglu, Sevcan Azime; Bhowruth, Devina; Borzych-Duzalka, Dagmara; Bulut, Ipek Kaplan; Buescher, Rainer; Deanfield, John; Dempster, Claire; Duzova, Ali; Habbig, Sandra; Hayes, Wesley; Hegde, Shivram; Krid, Saoussen; Licht, Christoph; Litwin, Mieczyslaw; Mayes, Mark; Mir, Sevgi; Nemec, Rose; Obrycki, Lukasz; Paglialonga, Fabio; Picca, Stefano; Samaille, Charlotte; Shenoy, Mohan; Sinha, Manish D.; Spasojevic, Brankica; Stronach, Lynsey; Vidal, Enrico; Vondrak, Karel; Yilmaz, Alev; Zaloszyc, Ariane; Fischbach, Michel; Schmitt, Claus Peter; Schaefer, Franz
    Background Hypertension and cardiovascular disease are common in children undergoing dialysis. Studies suggest that hemodiafiltration (HDF) may reduce cardiovascular mortality in adults, but data for children are scarce. Methods The HDF, Heart and Height study is a nonrandomized observational study comparing outcomes on conventional hemodialysis (HD) versus postdilution online HDF in children. Primary outcome measures were annualized changes in carotid intima-media thickness (cIMT) SD score and height SD score. Results We enrolled 190 children from 28 centers; 78 on HD and 55 on HDF completed 1-year follow-up. The groups were comparable for age, dialysis vintage, access type, dialysis frequency, blood flow, and residual renal function. At 1 year, cIMT SD score increased significantly in children on HD but remained static in the HDF cohort. On propensity score analysis, HD was associated with a +0.47 higher annualized cIMT SD score compared with HDF. Height SD score increased in HDF but remained static in HD. Mean arterial pressure SD score increased with HD only. Factors associated with higher cIMT and mean arterial pressure SD-scores were HD group, higher ultrafiltration rate, and higher 2-microglobulin. The HDF cohort had lower 2-microglobulin, parathyroid hormone, and high-sensitivity C-reactive protein at 1 year; fewer headaches, dizziness, or cramps; and shorter postdialysis recovery time. Conclusions HDF is associated with a lack of progression in vascular measures versus progression with HD, as well as an increase in height not seen in the HD cohort. Patient-related outcomes improved among children on HDF correlating with improved BP control and clearances. Confirmation through randomized trials is required.
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    Effects of nutritional vitamin D supplementation on markers of bone and mineral metabolism in children with chronic kidney disease
    (Oxford Univ Press, 2018) Lerch, Christian; Shroff, Rukshana; Wan, Mandy; Rees, Lesley; Aitkenhead, Helen; Bulut, Ipek Kaplan; Thurn, Daniela; Bayazit, Aysun Karabay; Niemirska, Anna; Canpolat, Nur; Duzova, Ali; Azukaitis, Karolis; Yilmaz, Ebru; Yalcinkaya, Fatos; Harambat, Jerome; Kiyak, Aysel; Alpay, Harika; Habbig, Sandra; Zaloszyc, Ariane; Soylemezoglu, Oguz; Candan, Cengiz; Rosales, Alejandra; Melk, Anette; Querfeld, Uwe; Leifheit-Nestler, Maren; Sander, Anja; Schaefer, Franz; Haffner, Dieter; Cortina, G.; Arbeiter, K.; Dusek, J.; Harambat, J.; Ranchin, B.; Fischbach, M.; Zalosczyk, A.; Querfeld, U.; Habbig, S.; Galiano, M.; Buescher, R.; Gimpel, C.; Kemper, M.; Melk, A.; Thurn, D.; Schaefer, F.; Doyon, A.; Wuehl, E.; Pohl, M.; Wygoda, S.; Jeck, N.; Kranz, B.; Wigger, M.; Montini, G.; Lugani, F.; Testa, S.; Vidal, E.; Matteucci, C.; Picca, S.; Jankauskiene, A.; Azukaitis, K.; Zurowska, A.; Drodz, D.; Tkaczyk, M.; Urasinski, T.; Litwin, M.; Niemirska, A.; Szczepanska, M.; Texeira, A.; Peco-Antic, A.; Bucher, B.; Laube, G.; Anarat, A.; Bayazit, A. K.; Yalcinkaya, F.; Basin, E.; Cakar, N.; Soylemezoglu, O.; Duzova, A.; Bilginer, Y.; Erdogan, H.; Donmez, O.; Balat, A.; Kiyak, A.; Caliskan, S.; Canpolat, N.; Candan, C.; Civilibal, M.; Emre, S.; Alpay, H.; Ozcelik, G.; Mir, S.; Sozeri, B.; Yavascan, O.; Tabel, Y.; Ertan, P.; Yilmaz, E.; Shroff, R.; Prytula, A.; Bachetta, J.; Haffner, D.; Klaus, G.; Gessner, M.; Schmitt, C. P.; Stabouli, S.; Reusz, G.; Verrina, E.; Groothoff, J.; Tondel, C.; Gamero, M. A.; Petrosyan, E.; Bakkaloglu, S. A.; Dursun, I.; Shroff, R.
    Background. We investigated the effects of nutritional vitamin D supplementation on markers of bone and mineral metabolism, i.e. serum levels of fibroblast growth factor 23 (FGF23), Klotho, bone alkaline phosphatase (BAP) and sclerostin, in two cohorts with chronic kidney disease (CKD). Methods. In all, 80 vitamin D-deficient children were selected: 40 with mild to moderate CKD from the ERGO study, a randomized trial of ergocalciferol supplementation [ estimated glomerular filtration rate (eGFR) 55 mL/min/1.73 m(2)], and 40 with advanced CKD from the observational Cardiovascular Comorbidity in Children with Chronic Kidney Disease (4C) study (eGFR 24 mL/min/1.73 m2). In each study, vitamin D supplementation was started in 20 children and 20 matched children not receiving vitamin D served as controls. Measures were taken at baseline and after a median period of 8 months. Age- and gender-related standard deviation scores (SDSs) were calculated. Results. Before vitamin D supplementation, children in the ERGO study had normal FGF23 (median 0.31 SDS) and BAP (-0.10 SDS) but decreased Klotho and sclerostin (-0.77 and -1.04 SDS, respectively), whereas 4C patients had increased FGF23 (3.87 SDS), BAP (0.78 SDS) and sclerostin (0.76 SDS) but normal Klotho (-0.27 SDS) levels. Vitamin D supplementation further increased FGF23 in 4C but not in ERGO patients. Serum Klotho and sclerostin normalized with vitamin D supplementation in ERGO but remained unchanged in 4C patients. BAP levels were unchanged in all patients. In the total cohort, significant effects of vitamin D supplementation were noted for Klotho at eGFR 40-70 mL/min/1.73 m(2). Conclusions. Vitamin D supplementation normalized Klotho and sclerostin in children with mild to moderate CKD but further increased FGF23 in advanced CKD.