Background: Arterial stiffness (AS) and vascular calcification are significantly related to a high cardiovascular mortality risk in hemodialysis (HD) patients. Intravenous sodium thiosulfate (IV STS) can prevent and delay the vascular calcification progression in uremic states; however, the STS effect on AS has not been assessed. This study aimed to evaluate the STS efficacy on vascular calcification and AS in HD patients. Methods: Fifty HD patients with abnormal AS, as measured via the cardio-ankle vascular index (CAVI ≥8), were prospectively randomized to open-label 12.5 g IV STS during the last HD hour twice weekly for 6 months (n = 24) or the usual care (control group; n = 26). Patients and treating physicians were not blinded. The CAVI, coronary artery calcification (CAC) score, hemodynamics, and biochemical parameters were measured at the baseline and at 3 and 6 months. Results: All the baseline parameters were comparable. The IV STS significantly reduced the CAVI when compared to the control group (mean CAVI difference = –0.53; 95% CI –1.00 to –0.06; p = 0.03). A significant CAVI improvement was seen in those patients without diabetes mellitus. The natural logarithm of the CAC volume score was significantly increased in the control group. The high sensitivity C-reactive protein level was slightly lowered in the IV STS group (not significant). Conclusion: The intradialytic STS treatment significantly reduced the AS, as measured by the CAVI, and stabilized the vascular calcification in the HD patients. STS may be a novel therapeutic strategy for delaying and treating the structural and functional vascular wall abnormalities in HD patients.

We checked DSA and stained the specimens with H&E, masson's trichrome, PAS, silver staining and used Banff 09 classification. Immunofluorescence and C4d stainings were also done. Results: Among the 10 patients,20% had a history of acute rejection (AR); of these,10% had acute antibody-mediated rejection (a-AMR).Among the 86 BS of TG,the TG was mild in 35 cases (cg1),moderate in 28 cases (cg2) and severe in 23 cases (cg3).Peritubular capillaritis was present in 74 bs (86%), transplant glomerulitis in 65 (76%),interstitial fibrosis and tubular atrophy (if/ta) in 71 (83%),thickening of the peritubular capillary (ptc) basement membrane in 72 (84%), and interstitial inflammation in 40 (47%).C4d deposition in the ptc was present in 49 bs (57%); 39 of these 49 bs showed diffuse c4d deposits in the ptc (c4d3),while the remaining 10 bs showed focal deposits (c4d2).Diffuse c4d deposition in the glomerular capillaries (GC) was seen in 70 bs (81%), while focal c4d deposition in the GC was seen in 9 (11%). In the assay using plastic beads coated with HLA antigen performed in 67 serum samples obtained in the peri-biopsy period, circulating ant-HLA alloantibody was detected in 55 (82%); in 33 of the 55 (49%) samples, donor-specific antibodies (DSA) were detected. Among our study, the findings in 22 bs (26%) fully met the criteria for c-AMR in banff '09 classification, including TG, c4d deposition in the ptc and presence of DSA, while those in 27 BS were suspicious of c-AMR. Deterioration of the renal allograft function after the biopsies was seen in 31 patients (62%). Conclusions: We suggest that histopathological changes of transplant glomerulopathy might be accompanied by inflammation of the microvasculature, such as transplant glomerulitis and peritubular capillaritis, thickening of the peritubular capillary basement membrane, and circulating anti-HLA antibodies. C4d deposition in the ptc is not always present in biopsy specimens of TG. Anti-HLA antibody class II, particularly when the antibody was DSA class II, appeared to be associated with the development of TG. The prognosis of grafts exhibiting TG was poor even under the currently used standard triple immunosuppressive regimen.

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Peritoneal dialysis (PD) has recently been established as a treatment option for renal replacement therapy (RRT) in patients with acute kidney injury (AKI). Its efficacy in providing fluid and small solute removal has also been demonstrated in clinical trials and is equivalent to hemodialysis (HD). However, effect of RRT modality on renal recovery after AKI remains a controversy. Moreover, the setting of human immunodeficiency virus- (HIV-) infected patients with AKI requiring RRT makes the decision on RRT initiation and modality selection more complicated. The authors report here 2 cases of HIV-infected patients presenting with severe AKI requiring protracted course of acute RRT. PD had been performed uneventfully in both cases for 4–9 months before partial renal recovery occurred. Both patients eventually became dialysis independent but were left in chronic kidney disease (CKD) stage 4. These cases highlight the example of renal recovery even after a prolonged course of dialysis dependence. Thus, PD might be a suitable option for HIV patients with protracted AKI.