The purpose of organ decellularization is to remove all cellular components whilst preserving the extracellular matrix (ECM). It has been hypothesized that this decellularized ECM can be used as a... Show moreThe purpose of organ decellularization is to remove all cellular components whilst preserving the extracellular matrix (ECM). It has been hypothesized that this decellularized ECM can be used as a scaffold for the development of personalized bioengineered kidneys by repopulating it with patient-derived cells. The renal artery, vein, and ureter are most frequently used for whole kidney repopulation. Cell perfusion through the artery and vein enables revascularization of decellularized kidneys. However, adequate repopulation of the epithelial compartment remains unattainable. Although it has become unlikely that recellularized whole kidneys will be the solution to reduce donor organ shortages within the foreseeable future, advances made within the field of whole organ decellularization and recellularization have paved the way for alternatives that actually may help to solve these shortages. This includes ex vivo refurbishment and personalization of discarded donor organs during machine perfusion. Show less
Background The prevalence of impaired cognitive functioning in older patients with end stage kidney disease (ESKD) is high. We aim to describe patterns of memory, executive function or psychomotor... Show moreBackground The prevalence of impaired cognitive functioning in older patients with end stage kidney disease (ESKD) is high. We aim to describe patterns of memory, executive function or psychomotor speed and to identify nephrologic, geriatric and neuroradiologic characteristics associated with cognitive impairment in older patients approaching ESKD who have not yet started with renal replacement therapy (RRT). Methods The COPE-study (Cognitive Decline in Older Patients with ESRD) is a prospective cohort study including 157 participants aged 65 years and older approaching ESKD (eGFR <= 20 ml/min/1.73 m(2)) prior to starting with RRT. In addition to routinely collected clinical parameters related to ESKD, such as vascular disease burden and parameters of metabolic disturbance, patients received a full geriatric assessment, including extensive neuropsychological testing. In a subgroup of patients (n = 93) a brain MRI was performed. Results The median age was 75.3 years. Compared to the normative data of neuropsychological testing participants memory performance was in the 24th percentile, executive function in the 18th percentile and psychomotor speed in the 20th percentile. Independent associated characteristics of impairment in memory, executive and psychomotor speed were high age, low educational level and low functional status (all p-values < 0.003). A history of vascular disease (p = 0.007) and more white matter hyperintensities on brain MRI (p = 0.013) were associated with a lower psychomotor speed. Conclusion Older patients approaching ESKD have a high prevalence of impaired memory, executive function and psychomotor speed. The patterns of cognitive impairment and brain changes on MRI are suggestive of vascular cognitive impairment. These findings could be of potentially added value in the decision-making process concerning patients with ESKD. Show less
Heart disease is common in patients with renal dysfunction and approximately 20% of patients with kidney disease die each year due to sudden cardiac death. The ICD-2 trial investigated the effect... Show moreHeart disease is common in patients with renal dysfunction and approximately 20% of patients with kidney disease die each year due to sudden cardiac death. The ICD-2 trial investigated the effect of an ICD in the prevention of sudden cardiac death in dialysis patients and is the cornerstone of this thesis. Furthermore the value of CT and biochemic test to identify dialysis patients at risk for sudden cardiac death are described in the current thesis. Lastly, complications related to ICD therapy in patients with end stage renal disease were investigated. Therefore this thesis contributes valuable information for a very vulnerable patient group. Show less
