Browsing by Author "Schaefer, Franz"

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    Early Effects of Renal Replacement Therapy on Cardiovascular Comorbidity in Children With End-Stage Kidney Disease: Findings From the 4C-T Study
    (2018) Schmidt, Bernhard M. W.; Sugianto, Rizky Indrameikha; Thurn, Daniela; Azukaitis, Karolis; Bayazit, Aysun K.; Canpolat, Nur; Eroglu, Ayse Guler; Caliskan, Salim; Doyon, Anke; Duzova, Ali; Karagoz, Tevfik; Anarat, Ali; Deveci, Murat; Mir, Sevgi; Ranchin, Bruno; Shroff, Rukshana; Baskin, Esra; Litwin, Mieczyslaw; Ozcakar, Z. Birsin; Buscher, Rainer; Soylemezoglu, Oguz; Dusek, Jiri; Kemper, Markus J.; Matteucci, Maria C.; Habbig, Sandra; Laube, Guido; Wuehl, Elke; Querfeld, Uwe; Sander, Anja; Schaefer, Franz; Melk, Anette; https://orcid.org/0000-0002-3316-8032; 28926375; B-5785-2018
    Background The early impact of renal transplantation on subclinical cardiovascular measures in pediatric patients has not been widely investigated. This analysis is performed for pediatric patients participating in the prospective cardiovascular comorbidity in children with chronic kidney disease study and focuses on the early effects of renal replacement therapy (RRT) modality on cardiovascular comorbidity in patients receiving a preemptive transplant or started on dialysis. Methods We compared measures indicating subclinical cardiovascular organ damage (aortal pulse wave velocity, carotid intima media thickness, left ventricular mass index) and evaluated cardiovascular risk factors in 166 pediatric patients before and 6 to 18 months after start of RRT (n = 76 transplantation, n = 90 dialysis). Results RRT modality had a significant impact on the change in arterial structure and function: compared to dialysis treatment, transplantation was independently associated with decreases in pulse wave velocity (ss = -0.67; P < 0.001) and intima media thickness (ss = -0.40; P = 0.008). Independent of RRT modality, an increase in pulse wave velocity was associated with an increase in diastolic blood pressure (ss = 0.31; P < 0.001). Increasing intima media thickness was associated with a larger increase in body mass index (ss = 0.26; P = 0.003) and the use of antihypertensive agents after RRT (ss = 0.41; P = 0.007). Changes in left ventricular mass index were associated with changes in systolic blood pressure (ss = 1.47; P = 0.01). Conclusions In comparison with initiating dialysis, preemptive transplantation prevented further deterioration of the subclinical vascular organ damage early after transplantation. Classic cardiovascular risk factors, such as hypertension and obesity are of major importance for the development of cardiovascular organ damage after renal transplantation.
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    Explaining The Variation in Country Mortality Rates for Paediatric End-Stage Renal Disease Across Europe - An Espn-Era/Edta Registry Analysis
    (2016) Chesnaye, Nicholas C.; Schaefer, Franz; Bonthuis, Marjolein; Holman, Rebecca; Baiko, Sergey; Baskin, Esra; Berbeca, Olga; Cloarec, Sylvie; Cornelissen, Marlies; Espinosa, Laura; Heaf, James; Stone, Rosario; Reisaeter, Anna Varberg; Shtiza, Diamant; Zurowska, Aleksandra; Harambat, Jerome; Jager, Kitty J.; Groothoff, Jaap W.; van Stralen, Karlijn J.; https://orcid.org/0000-0003-4361-8508; B-5785-2018
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    Low-Dose Antibiotic Prophylaxis Induces Rapid Modifications of the Gut Microbiota in Infants With Vesicoureteral Reflux
    (2021) Morello, William; D'Amico, Federica; Serafinelli, Jessica; Turroni, Silvia; Abati, Isabella; Fiori, Jessica; Baskin, Esra; Yalcinkaya, Fatos; Jankauskiene, Augustina; Pennesi, Marco; Zurowska, Aleksandra; Becherucci, Francesca; Drozdz, Dorota; Mekahli, Djalila; Krzemien, Grazyna; La Scola, Claudio; Taranta Janusz, Katarzyna; Mehls, Otto; Schaefer, Franz; Candela, Marco; Montini, Giovanni; 34222145
    Background and Objectives: Maturation of the gut microbiota (GM) in infants is critically affected by environmental factors, with potential long-lasting clinical consequences. Continuous low-dose antibiotic prophylaxis (CAP) is the standard of care for children with vesicoureteral reflux (VUR), in order to prevent recurrent urinary tract infections. We aimed to assess short-term GM modifications induced by CAP in infants. Methods: We analyzed the GM structure in 87 infants (aged 1-5 months) with high-grade VUR, previously exposed or naive to CAP. Microbial DNA was extracted from stool samples. GM profiling was achieved by 16S rRNA gene-based next-generation sequencing. Fecal levels of short- and branched-chain fatty acids were also assessed. Results: 36/87 patients had been taking daily CAP for a median time of 47 days, while 51/87 had not. In all patients, the GM was predominantly composed by Bifidobacteriaceae and Enterobacteriaceae. Subgroup comparative analysis revealed alterations in the GM composition of CAP-exposed infants at phylum, family and genus level. CAP-exposed GM was enriched in members of Enterobacteriaceae and Bacteroidetes, especially in the genera Bacteroides and Parabacteroides, and showed a trend toward increased Klebsiella, often associated with antibiotic resistance. In contrast, the GM of non-CAP children was mostly enriched in Bifidobacterium. No differences were found in fatty acid levels. Conclusions: In infants with VUR, even a short exposure to CAP definitely alters the GM composition, with increased relative abundance of opportunistic pathogens and decreased proportions of health-promoting taxa. Early low-dose antibiotic exposure might bear potential long-term clinical risks.
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    Mortality Risk Disparities in Children Receiving Chronic Renal Replacement Therapy for The Treatment of End-Stage Renal Disease Across Europe: An ESPN-ERA/EDTA Registry Analysis
    (2017) Chesnaye, Nicholas C.; Schaefer, Franz; Bonthuis, Marjolein; Holman, Rebecca; Baiko, Sergey; Bjerre, Anna; Cloarec, Sylvie; Cornelissen, Elisabeth A. M.; Espinosa, Laura; Heaf, James; Stone, Rosario; Shtiza, Diamant; Zagozdzon, Ilona; Harambat, Jerome; Jager, Kitty J.; Groothoff, Jaap W.; van Stralen, Karlijn J.; Baskin, Esra; https://orcid.org/0000-0003-4361-8508; 28336050; B-5785-2018
    Background We explored the variation in country mortality rates in the paediatric population receiving renal replacement therapy across Europe, and estimated how much of this variation could be explained by patient-level and country-level factors. Methods In this registry analysis, we extracted patient data from the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) Registry for 32 European countries. We included incident patients younger than 19 years receiving renal replacement therapy. Adjusted hazard ratios (aHR) and the explained variation were modelled for patient-level and country-level factors with multilevel Cox regression. The primary outcome studied was all-cause mortality while on renal replacement therapy. Findings Between Jan 1, 2000, and Dec 31, 2013, the overall 5 year renal replacement therapy mortality rate was 15.8 deaths per 1000 patient-years (IQR 6.4-16.4). France had a mortality rate (9.2) of more than 3 SDs better, and Russia (35.2), Poland (39.9), Romania (47.4), and Bulgaria (68.6) had mortality rates more than 3 SDs worse than the European average. Public health expenditure was inversely associated with mortality risk (per SD increase, aHR 0.69, 95% CI 0.52-0.91) and explained 67% of the variation in renal replacement therapy mortality rates between countries. Child mortality rates showed a significant association with renal replacement therapy mortality, albeit mediated by macroeconomics (eg, neonatal mortality reduced from 1.31 [95% CI 1.13-1.53], p=0.0005, to 1.21 [0.97-1.51], p=0.10). After accounting for country distributions of patient age, the variation in renal replacement therapy mortality rates between countries increased by 21%. Interpretation Substantial international variation exists in paediatric renal replacement therapy mortality rates across Europe, most of which was explained by disparities in public health expenditure, which seems to limit the availability and quality of paediatric renal care. Differences between countries in their ability to accept and treat the youngest patients, who are the most complex and costly to treat, form an important source of disparity within this population. Our findings can be used by policy makers and health-care providers to explore potential strategies to help reduce these health disparities. Funding ERA-EDTA and ESPN.
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    Response to Intensified Immunosuppressive Therapyand Identification of Genetic Disease are Highly Predictive of Long-Term Renal Outcome in Children with Steroid Resistant Nephrotic Syndrome (Srns)
    (2015) Trautmann, Agnes; Schnaidt, Sven; Ghiggeri, Gian Marco; Ozaltin, Fatih; Saeed, Bassam; Drozdz, Dorota; Caliskan, Salim; Anarat, Ali; Oh, Jun; Bogdanovic, Radovan; Zurowska, Aleksandra; Balat, Ayse; Emre, Sevinc; Jardim, Helena; Kuzma-Mroczkowska, Elzbieta; Erdogan, Ozlem; Tkaczyk, Marcin; Krmar, Rafael T.; Higuita, Lina Maria Serna; Wasilewska, Anna; Baskin, Esra; Pasini, Andrea; Printza, Nikoleta; Firszt-Adamczyk, Agnieszka; Medynska, Anna; Schaefer, Franz; 0000-0003-4361-8508; B-5785-2018