Papers by MICHAEL SURANYI
Nephrology, dialysis, transplantation/Nephrology dialysis transplantation, May 1, 2024
PubMed, Jun 1, 1990
The success rate of renal transplantation has improved considerably during the past decade, with ... more The success rate of renal transplantation has improved considerably during the past decade, with substantial improvements in both graft and patient survival. The quality of graft function, however, and not graft survival alone is increasingly determining the standards by which transplantation outcome is being judged. As the demand for kidney transplants continues to rise and transplants are being offered to an ever-increasing number of patients, organs are being sought from new supply pools and efforts are being made to use current resources more efficiently. Improvements in clinical management have allowed short-term complications such as infection and rejection to be better prevented or better diagnosed and treated. Fundamental advances in the understanding of the immunologic processes underlying both allograft rejection and acceptance and the introduction of new immunosuppressive agents have allowed a better use of drug therapy and have moved the goal of acquired transplant tolerance closer to attainment. With improved initial transplant success rates, the long-term transplantation outcome is becoming more important. The role of tissue matching in preventing chronic rejection is becoming more appreciated, and the long-term risks of malignancy, arteriosclerosis, and chronic rejection are being better recognized and managed.
Methods: This randomised controlled study was designed as a pilot study to compare the effi cacy ... more Methods: This randomised controlled study was designed as a pilot study to compare the effi cacy and safety outcomes between a reactive protocol of intermittent bolus intravenous iron administration (RPIB) using Ferrum H boluses (200mg-1000mg) and a proactive protocol of continuous intravenous iron administration (PPCI) using the dialysis heparin pump to co-infuse 10mg Ferrum H per dialysis, in haemodialysis patients in a tertiary teaching Renal Unit with more than 300 dialysis patients Results: The PPCI achieved equivalent measured outcomes to RPIB. Fifty stable haemodialysis patients were randomised at a point of stable Hb, iron stores and erythropoietin (EPO) dose. At the end of six months, the total delivered iron dose was not statistically signifi cantly different, although PPCI tended to deliver more intravenous iron (PPCI 632.3+82.7mg vs RPIB 411.5+571.5mg/6months). PPCI (n=24) maintained an achieved Hb no different to RPIB (n=26) (PPCI 12.0+1.9 vs RPIB 12.1+1.2 (SD)). The EPO doses were not statistically signifi cantly different. However the EPO dose in PPCI group therapy fell progressively over the 6 months, resulting in a 12% reduction in median EPO dose, compared to the RPIB group which showed a small progressive rise, but this did not reach statistical signifi cance. Iron parameters were not different between the two groups at baseline or at six months although there was a trend to higher TSAT in participants receiving RPIB therapy, which did not reach statistical signifi cance (p=ns) at the end of six months. No participants had to cease RPIB for iron overload. Conclusion: PPCI therapy successfully maintained achieved Hb and iron parameters while allowing a small progressive reduction in EPO dose, compared to RPIB therapy, without the risk of iron overload. The administration of Ferrum H in the heparin infusion proved safe and no adverse reactions were detected (24 patients, > 1848 dialyses).
Frontiers in Immunology
The immune response to an allograft activates lymphocytes with the capacity to cause rejection. A... more The immune response to an allograft activates lymphocytes with the capacity to cause rejection. Activation of CD4+CD25+Foxp3+T regulatory cells (Treg) can down-regulate allograft rejection and can induce immune tolerance to the allograft. Treg represent <10% of peripheral CD4+T cells and do not markedly increase in tolerant hosts. CD4+CD25+Foxp3+T cells include both resting and activated Treg that can be distinguished by several markers, many of which are also expressed by effector T cells. More detailed characterization of Treg to identify increased activated antigen-specific Treg may allow reduction of non-specific immunosuppression. Natural thymus derived resting Treg (tTreg) are CD4+CD25+Foxp3+T cells and only partially inhibit alloantigen presenting cell activation of effector cells. Cytokines produced by activated effector cells activate these tTreg to more potent alloantigen-activated Treg that may promote a state of operational tolerance. Activated Treg can be distinguish...
Diabetes Care, 2022
OBJECTIVE Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney ... more OBJECTIVE Finerenone significantly improved cardiorenal outcomes in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) in the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease trial. We explored whether baseline HbA1c level and insulin treatment influenced outcomes. RESEARCH DESIGN AND METHODS Patients with T2D, urine albumin-to-creatinine ratio (UACR) of 30–5,000 mg/g, estimated glomerular filtration rate (eGFR) of 25 to <75 mL/min/1.73 m2, and treated with optimized renin–angiotensin system blockade were randomly assigned to receive finerenone or placebo. Efficacy outcomes included kidney (kidney failure, sustained decrease ≥40% in eGFR from baseline, or renal death) and cardiovascular (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure) composite endpoints. Patients were analyzed by baseline insulin use and by baseline HbA1c <7.5% (58 mmol/mol) or ≥7.5%. RESULTS...
Infection is a leading cause of morbidity and mortality among haemodialysis patients. Some of the... more Infection is a leading cause of morbidity and mortality among haemodialysis patients. Some of the risk factors specific to this population include repeated access to the blood stream through venous cannulation for dialysis as
Hepatitis B viral infection is usually a self-limiting disease in immunocompetent individuals. Ch... more Hepatitis B viral infection is usually a self-limiting disease in immunocompetent individuals. Chronic infection can be seen in up to 5 % of infected patients. Renal manifestations of chronic HBV infection are usually glomerular. We de-scribe here an uncommon presentation of a patient with chronic HBV infection with very high viral load and rap-idly progressive renal failure. Renal biopsy showed fea-tures of tubulointerstitial nephritis and tubular epithelial inclusion bodies suggestive of HBV infection. Entecavir treatment slowed down the progression of his renal dis-ease. Tubulointerstitial nephritis should be considered as a part of the differential diagnosis in patients with HBV infection. Early antiviral treatment may halt the progres-sion of renal disease.
Methods: This randomised controlled study was designed as a pilot study to compare the effi cacy ... more Methods: This randomised controlled study was designed as a pilot study to compare the effi cacy and safety outcomes between a reactive protocol of intermittent bolus intravenous iron administration (RPIB) using Ferrum H boluses (200mg-1000mg) and a proactive protocol of continuous intravenous iron administration (PPCI) using the dialysis heparin pump to co-infuse 10mg Ferrum H per dialysis, in haemodialysis patients in a tertiary teaching Renal Unit with more than 300 dialysis patients Results: The PPCI achieved equivalent measured outcomes to RPIB. Fifty stable haemodialysis patients were randomised at a point of stable Hb, iron stores and erythropoietin (EPO) dose. At the end of six months, the total delivered iron dose was not statistically signifi cantly different, although PPCI tended to deliver more intravenous iron (PPCI 632.3+82.7mg vs RPIB 411.5+571.5mg/6months). PPCI (n=24) maintained an achieved Hb no different to RPIB (n=26) (PPCI 12.0+1.9 vs RPIB 12.1+1.2 (SD)). The EP...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 27, 2017
The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic ... more The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic kidney disease (CKD) is incomplete and largely based on small studies of relatively short duration. FIND-CKD (ClinicalTrials.gov number NCT00994318) was a 1-year, open-label, multicenter, prospective study of patients with nondialysis-dependent CKD, anemia and iron deficiency randomized (1:1:2) to IV ferric carboxymaltose (FCM), targeting higher (400-600 µg/L) or lower (100-200 µg/L) ferritin, or oral iron. A post hoc analysis of adverse event rates per 100 patient-years was performed to assess the safety of FCM versus oral iron over an extended period. The safety population included 616 patients. The incidence of one or more adverse events was 91.0, 100.0 and 105.0 per 100 patient-years in the high ferritin FCM, low ferritin FCM and oral iron groups, respectively. The incidence of adverse events with a suspected relation to study drug was 15.9, 17.8 and 36.7 per 100 patient-years in the...
Transplantation proceedings, 1988
Clinical journal of the American Society of Nephrology : CJASN, Jan 20, 2015
The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but... more The calcimimetic cinacalcet reduced the risk of death or cardiovascular (CV) events in older, but not younger, patients with moderate to severe secondary hyperparathyroidism (HPT) who were receiving hemodialysis. To determine whether the lower risk in younger patients might be due to lower baseline CV risk and more frequent use of cointerventions that reduce parathyroid hormone (kidney transplantation, parathyroidectomy, and commercial cinacalcet use), this study examined the effects of cinacalcet in older (≥65 years, n=1005) and younger (<65 years, n=2878) patients. Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) was a global, multicenter, randomized placebo-controlled trial in 3883 prevalent patients on hemodialysis, whose outcomes included death, major CV events, and development of severe unremitting HPT. The age subgroup analysis was prespecified. Older patients had higher baseline prevalence of diabetes mellitus and CV comorbidity. Annualized rat...
Transplantation proceedings, 1989
Transplantation proceedings, 1990
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Papers by MICHAEL SURANYI