Atrial Fibrillation Had Less Impact on the Risk of Ischemic Stroke in Non-anticoagulated Patients Undergoing Hemodialysis: Insight from the RAKUEN study.

Objective The progress of non-anticoagulated patients with atrial fibrillation (AF) undergoing hemodialysis has not been determined. Using data from the RAKUEN (Registry of Atrial fibrillation in chronic Kidney disease Under hEmodialysis from Niigata) study, we examined the clinical characteristics and outcomes among hemodialysis patients with AF who were not receiving a vitamin K antagonist (VKA). Methods and Results Forty-three of 423 patients undergoing hemodialysis (-10%) were prescribed a VKA. The remaining 380 patients (age 64.8±12.8 years, male 70%) were enrolled in the present study. During a mean observation period of 36 months, AF (n=55) was independently associated with all-cause death (hazard ratio, 1.82; 95% confidence interval, 1.12-2.94; p=0.014), but was not associated with ischemic stroke (hazard ratio, 1.91; 95% confidence interval, 0.74-4.92; p=0.177) and major bleeding (hazard ratio, 1.80; 95% confidence interval, 0.80-4.08; p=0.150). The crude incidence rates of all-cause death and ischemic stroke in the AF patients were 15.75 (2.5-fold higher compared to the non-AF patients) and 3.63 (1.7-fold higher compared to the non-AF patients) per 100 person-years, respectively. Conclusion A great impact on death, but not ischemic stroke, was observed in non-anticoagulated hemodialysis patients with AF in comparison to those without AF from the analysis of the RAKUEN study.

Bone marrow cells contribute to regeneration of damaged glomerular endothelial cells.

BACKGROUND: There is accumulating evidence that adult bone marrow (BM) cells show unexpected plasticity, and can differentiate into a wide range of specialized cells. In the case of intrinsic renal glomerular cells, BM-derived cells have been reported to differentiate into both mesangial cells and podocytes. However, there is controversy on recruitment of glomerular endothelial cells, although endothelial cells in other tissues are known to be recruited from the BM. METHODS: Sprague-Dawley (SD) rats and SD rats made chimeric by transplantation of bone marrow cells from enhanced green fluorescent protein (EGFP) transgenic littermate rats, were injected with anti-Thy-1.1 antibody, followed by unilateral nephrectomy (1-kidney model). Chimeric rats used in 1-kidney model were sacrificed for histologic examination at weeks 2, 4, 8, and 11. We examined isolated glomeruli and frozen sections of kidneys from rats of each group at weeks 2 and 11 by confocal laser scan microsopy (CLSM), both immunohistologically and three dimensionally. RESULTS: In the 1-kidney group, using chimeric rats transplanted with EGFP(+) bone marrow cells, most rats died, presumably of uremia, after 8 to 11 weeks. A CLSM study using isolated glomeruli and frozen sections of kidneys revealed that bone marrow-derived PECAM-1(+), RECA-1(+) cells, and OX-7(+) cells contributed to the structural support for the glomerular capillaries during the chronic course. Global glomerular sclerotic lesions and diffuse tubular atrophic changes, with interstitial cell infiltration, were remarkable at weeks 8 and 11. CONCLUSION: Bone marrow-derived endothelial progenitor cells participated in glomerular endothelial cell turnover after severe damage. Treatment that could target bone marrow-derived endothelial progenitor cells and promote angiogenesis in regions of progressive glomerular lesions may be a promising therapeutic approach for preventing end-stage renal disease.