Rachel Armani - Academia.edu (original) (raw)

Papers by Rachel Armani

Frontiers in nephrology, Feb 14, 2023

Introduction: The interaction between blood and dialysis membrane increases the risk of clot form... more Introduction: The interaction between blood and dialysis membrane increases the risk of clot formation. Membrane properties can interfere with coagulation activation during dialysis. Heparin is usually used to ensure anticoagulation, which can be monitored by the Activated Clotting Time (ACT) test. The purpose of this study was to compare the ACT of patients with chronic kidney disease (CKD) undergoing hemodialysis with high-flux (HF) and medium cutoff (MCO) membranes. Methods: This is a prospective, randomized, crossover study in which 32 CKD patients were dialyzed for 12 weeks with each membrane. Blood clotting measured by ACT was evaluated at the beginning, 2nd, and 4th hour of the dialysis session. Throughout the study, there were no changes in the dose or administration method of heparin. Results: Patients mainly were middle-aged, non-black males on hemodialysis for eight years.

Current Hypertension Reports, Mar 25, 2017

New Findings r What is the topic of this review? This review addresses the contribution of the al... more New Findings r What is the topic of this review? This review addresses the contribution of the altered gut microbiome to uraemic syndrome, with specific reference to gut microbiome-derived uraemic toxins. It also discusses the potential treatment options to normalize the disturbed microbiome in chronic kidney disease (CKD). r What advances does it highlight? This review highlights the importance of the gut-kidney connection and how the altered microbial landscape in the intestine contributes to dysmetabolism and inflammation in CKD. Recent findings linking gut-derived uraemic toxins to progression of CKD, cardiovascular disease and mortality are also discussed. Finally, we briefly explain targeted therapies that have been studied to restore intestinal symbiosis in CKD. The human intestine is now recognized as an important metabolic organ powered by gut microbiota. This review addresses the alteration in the gut microbiome in patients with chronic kidney disease (CKD) and its consequence. We describe the major uraemic toxins, p-cresol sulfate, indoxyl sulfate and trimethylamine N-oxide, which are produced by the gut microbiome, and how these metabolites contribute to progression of CKD and associated cardiovascular disease. Translocation of endotoxin from the gut into the systemic circulation contributes to inflammation in CKD. Targeting the gut microbiome to restore symbiosis may prove to be a potent strategy in reducing inflammation and production of these uraemic toxins.

Journal of Renal Nutrition

Frontiers in Nephrology

IntroductionThe interaction between blood and dialysis membrane increases the risk of clot format... more IntroductionThe interaction between blood and dialysis membrane increases the risk of clot formation. Membrane properties can interfere with coagulation activation during dialysis. Heparin is usually used to ensure anticoagulation, which can be monitored by the Activated Clotting Time (ACT) test. The purpose of this study was to compare the ACT of patients with chronic kidney disease (CKD) undergoing hemodialysis with high-flux (HF) and medium cut-off (MCO) membranes.MethodsThis is a prospective, randomized, crossover study in which 32 CKD patients were dialyzed for 12 weeks with each membrane. Blood clotting measured by ACT was evaluated at the beginning, 2nd, and 4th hour of the dialysis session. Throughout the study, there were no changes in the dose or administration method of heparin.ResultsPatients mainly were middle-aged, non-black males on hemodialysis for eight years. Before randomization, ACT values were 132 ± 56, 195 ± 60, and 128 ± 32 seconds at pre-heparinization, 2nd a...

Nephrology Dialysis Transplantation

Background and Aims Endothelial dysfunction (ED) is considered a marker of vascular complications... more Background and Aims Endothelial dysfunction (ED) is considered a marker of vascular complications, especially in patients with chronic kidney disease (CKD). Inflammation and the uremic state contribute to ED in hemodialysis (HD) patients. Recently, the medium cut-off (MCO) HD membrane has been proposed to efficiently remove inflammatory cytokines and higher molecular weight uremic toxins. This study aimed to compare the effect of dialysis with medium cut-off (MCO) or high-flow (HF) membranes on the endothelial function of patients on chronic HD. Method A prospective, randomized, crossover study in which 32 patients with CKD were dialyzed for 12 weeks with each membrane, including a 4-week washout period between treatments. Endothelial function was assessed by flow-mediated dilation (FMD) using brachial artery ultrasound at weeks 1, 12, 16, and 28. Results The population consisted of 59% men, 52.7±13.4 years, 16% non-black, on HD for 8.8(4.1-15.1) years, 72% with arteriovenous fistul...

Nephrology Dialysis Transplantation, 2021

Background Microbiota-derived uremic toxins have been associated with inflammation that could cor... more Background Microbiota-derived uremic toxins have been associated with inflammation that could corroborate with endothelial dysfunction (ED) and increase cardiovascular risk in patients with chronic kidney disease (CKD). This trial aimed to evaluate the effect of the prebiotic fructooligosaccharide (FOS) on endothelial function and arterial stiffness in nondialysis CKD patients. Methods In a double-blind controlled trial, 46 nondiabetic CKD patients were randomized to receive 12 g/day of FOS or placebo (maltodextrin) for 3 months. Total p-cresyl sulfate (PCS) and indoxyl sulfate by high-performance liquid chromatography, urinary trimethylamine N-oxide by mass spectrometry, C-reactive protein, interleukin-6 (IL-6), serum nitric oxide and stroma-derived factor-1 alfa were measured at baseline and at the end of follow-up; endothelial function was assessed through flow-mediated dilatation (FMD) and arterial stiffness by pulse wave velocity (PWV). Results The mean (± standard deviation) a...

Kidney International Reports, 2019

Nephrology Dialysis Transplantation, 2018

BackgroundMicrobial-derived uremic toxins, p-cresyl sulfate (PCS), indoxyl sulfate (IS) and indol... more BackgroundMicrobial-derived uremic toxins, p-cresyl sulfate (PCS), indoxyl sulfate (IS) and indole 3-acetic acid (IAA), have been associated with the burden of chronic kidney disease (CKD). Prebiotics have emerged as an alternative to modulate the gut environment and to attenuate toxin production. This trial aims to investigate the effect of a prebiotic fructooligosaccharide (FOS) on uremic toxins of non-dialysis-dependent CKD (NDD-CKD) patients.MethodsA double-blind, placebo-controlled, randomized trial was conducted for 3 months. In all, 50 nondiabetic NDD-CKD patients [estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2], aged 18–80 years, were allocated to prebiotic (FOS, 12 g/day) or placebo (maltodextrin, 12 g/day) groups. Primary outcomes were changes in serum (total and free) and urinary (total) PCS. Secondary outcomes included changes in IS, IAA, serum markers of intestinal permeability (zonulin), gut-trophic factors (epidermal growth factor and glucagon-like ...

Journal of Renal Nutrition, 2019

Objective: The aim of this study is to evaluate the association between bowel habits and microbia... more Objective: The aim of this study is to evaluate the association between bowel habits and microbial-derived uremic toxins p-cresyl sulfate (PCS) and indoxyl sulfate (IS) in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). Design and Methods: This is a cross-sectional analysis including 43 nondiabetic NDD-CKD patients (58% men; 59.0 6 13.5 years; estimated glomerular filtration rate, 21.3 6 7.9 mL/min/1.73 m 2). Bowel habit was assessed by the Bristol Stool Scale (BSS ,3, characterized by hard consistency of stools and/or low frequency of evacuation and BSS $3, representing a more regular bowel habit) and by the Rome III criteria. PCS and IS (serum, free and total; urinary, total) were determined by high-performance liquid chromatography. Dietary intake was assessed by the 3-day food records. Results: The frequency of constipation assessed by BSS and Rome III criteria was 33% (n 5 14/43) and 35% (n 5 15/43), respectively. The BSS ,3 exhibited higher PCS, independent of renal function and dietary protein-fiber ratio (b [95% confidence interval {CI}]: serum,

Experimental Physiology, 2015