Improvements in six aspects of quality of care of incident hemodialysis patients - a real-world experience.

BACKGROUND: The transition from chronic kidney disease stage 5 to initiation of hemodialysis has gained increased attention in recent years as this period is one of high risk for patients with an annual mortality rate exceeding 20%. Morbidity and mortality in incident hemodialysis patients are partially attributed to failure to attain guideline-based targets. This study focuses on improvements in six aspects of quality of dialysis care (adequacy, anemia, nutrition, chronic kidney disease-mineral bone disorder (CKD-MBD), blood pressure and vascular access) aligning with KDIGO guidelines, during the first 6 months of hemodialysis. METHODS: We analyzed patient demographics, practice patterns and laboratory data in all 3 462 patients (mean age 65.9 years, 41% females) on hemodialysis (incident <90 days on hemodialysis, n=603, prevalent ≥90 days on hemodialysis, mean 55 months, n=2 859) from all 56 DaVita centers in Poland (51 centers) and Portugal (5 centers). 80% of patients had hemodialysis and 20% hemodiafiltration. Statistical analyses included unpaired and paired Students t-test, Chi-2 analyses, McNemar test and logistic regression analysis. RESULTS: Incident patients had lower Kt/V (1.4 vs 1.7, p<0.001), lower serum albumin (37 vs 40 g/l, p=0.001), lower Hb (9.9 vs 11.0 g/dl, p<0.001), lower TSAT (26 vs 31%, p<0.001), lower iPTH (372 vs 496 pg/ml, p<0.001), more often a central venous catheter (68 vs 26%, p<0.001), less often an AV fistula (34 vs 70 %, p<0.001) compared with all prevalent patients. Significantly more prevalent patients achieved international treatment targets. Improvements in quality of care was also analyzed in a subgroup of 258 incident patients who were followed prospectively for 6 months. We observed significant improvements in Kt/V (p<0.001), albumin (p<0.001), Hb (p<0.001) transferrin saturation (TSAT, p<0.001), iPTH (p=0.005) and an increased use of AV fistula (p<0.001). Furthermore, logistic regression analyses identified treatment time and TSAT as major factors influencing the attainment of adequacy and anemia treatment targets. CONCLUSION: This large real-world European multicenter analysis of representative incident hemodialysis patients indicates that the use of medical protocols and medical targets assures significant improvements in quality of care, which may correspond to better outcomes. A selection bias of survivors with less comorbidities in prevalent patients may have influenced the results.

[Water-sodium homeostasis in hemodialysis - the eternal problem in nephrology practice]. / Homeostaza wodno-sodowa w hemodializie ­ odwieczny problem w praktyce nefrologicznej.

The kidney is an organ that maintains the body's sodium and water balance and plays a significant role in blood pressure regulation. Chronic kidney disease (CKD) and a progressive loss of its function, among others, leads to sodium and water retention and, as a consequence, to arterial hypertension. The supply of salt and fluids delivered with the diet significantly affects the cardiovascular system's functioning particularly in hemodialysis patients. The critical element in clinical care is maintaining appropriate water and electrolyte homeostasis. Overhydration is manifested as oedema and blood preassure increase, but a more accurate assessment of subtle variations is possible by measuring bioelectric impedance (BIA), which determines the extracellular water index (ECW). Actions to maintain euvolemia include limiting sodium and fluid intake, regular assessment of "dry" body weight, proper selection of ultrafiltration (UF), correction of sodium concentration, and dialysate temperature.

Achievement of renal anemia KDIGO targets by two different clinical strategies - a European hemodialysis multicenter analysis.

BACKGROUND: The optimal treatment algorithm for iron therapy and the use of erythropoiesis-stimulating agents (ESA) in anemic hemodialysis (HD) patients has not been established. Hemoglobin (Hb) target levels can be achieved through more frequent intravenous (IV) iron use with lower ESA dose, or with less iron dosing but higher ESA. ESA therapy to correct anemia may result in severe arterial and venous thrombotic complications and the evidence base evaluating hard clinical outcomes related to the use of IV iron is sparse. METHODS: A total of 1247 maintenance HD patients from 12 dialysis centers in Portugal (n = 730) and Poland (n = 517) were considered. We assessed achievement of KDIGO renal anemia targets with focus on treatment strategies, which typically differ between countries. In Poland the use and dose of IV iron was 35-72% higher than that in Portugal (p <  0.001) during three consecutive months; use and dose of ESA was 61% higher in Portugal (5034 vs 3133 IU (adjusted)/week, p <  0.001). RESULTS: Mean Hb concentration was similar (11.0 vs 11.0 g/dL) in patients treated in both countries and the proportion of patients within KDIGO anemia target was 69.5% in Poland vs 65.8% in Portugal (NS). Ferritin and TSAT levels and the proportion of patients with TSAT > 20 and > 50% were both significantly higher in patients in Poland (88.8 and 14.6%) than in Portugal (76.3 and 5.7% respectively, p <  0.001). Significantly more patients in Poland had a ferritin concentration > 800 µg/L (35.6%) compared to Portugal (15.8%, p <  0.001). The ESA resistance index (ERI) was significantly higher in patients treated in Portugal (p <  0.001). Correlation analyses showed confounding by treatment indication in unadjusted models. Multiple and logistic regression analyses showed that with ferritin within KDIGO recommended range of 200-800 µg/L the odds for Hb within guidelines increased significantly. Annual gross mortality was 16% in Poland and 13% in Portugal (NS); there were no differences in cause-specific mortality. CONCLUSIONS: Administration of high doses of IV iron in routine clinical HD practice may not be associated with considerable harm. However, large randomized controlled trials are needed to provide absolute evidence of iron safety.

C-terminal and intact FGF23 in critical illness and their associations with acute kidney injury and in-hospital mortality.

BACKGROUND: FGF23 proved its value in prognostication of cardiovascular events and mortality among renal patients and general population. Limited data exist whether FGF23 may have any use in prediction of negative outcomes among critically ill patients admitted to intensive care unit (ICU). METHODS: Single center cohort study performed among patients admitted to ICU. The primary exposure was FGF23 plasma concentration measured within 24 h of ICU admission. The primary outcome was incident Acute Kidney Injury (AKI) and in-hospital mortality during the ICU stay. RESULTS: The study enrolled 79 patients admitted to ICU. C-terminal FGF23 (cFGF23) but not intact FGF23 (iFGF23) concentration was significantly elevated in patients, who acquired AKI and non-survivors (p < .001). ROC analysis of cFGF23 yielded an AUC of 0.81 and 0.85 for prediction of incident AKI and death during ICU stay, respectively. Multivariate analysis showed higher odds for AKI (OR 1.80; 95% CI 1.10-2.96) and in-hospital mortality (OR 2.85; 95% CI 1.60-5.06) for one unit increase of log transformed cFGF23. CONCLUSIONS: cFGF23 measurement may serve as a novel biomarker for incident AKI and death among critically ill patients.

[Skin cancers in kidney transplant recipients].

Kidney transplantation is the best treatment for end-stage renal failure. It prolongs the patient's life, improves quality of life and reduces costs associated with renal replacement therapy. Increasingly, newer immunosuppressive regimens allow for the proper functioning of the transplanted organ for many years. The progress in transplantation, qualification patients in older age for the procedure and longer survival of kidney graft lead to an increase in the number of patients receiving immunosuppressive drugs. They are exposed to various side effects associated with long-term suppression of the immune system, including an increased risk of cancer development. The most common malignancies (40- 50%) diagnosed in renal transplant recipients are skin cancers. Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most common types of tumors occurring in this population. The use of immunosuppression resulted in the increase of the incidence of tumors that in the general population are relatively rare such as melanoma, Merkel cell cancer, Kaposi's sarcoma, anogenital cancer as well as sebaceous carcinoma.

Overuse of proton pump inhibitors and its consequences.

Direct inhibition of H+ ion excretion to the gastric lumen makes proton pump inhibitors (PPI) the most effective drugs against gastric acid-related diseases. Over recent years usage of proton pump inhibitors has increased dramatically. Due to the low costs, high efficacy and rarity of adverse effects, their use is prevalent and often it does not correspond with existing medical guidelines. The literature lists stress ulcer prophylaxis among patients with low risk of bleeding, routine 'gastroprotective' medication during treatment and non-specific abdominal symptoms as the most common patterns of off-label PPI use. This article summarizes the influence of PPI therapy on gastric mucosa, absorption and occurrence of adverse effects. The authors note that their low awareness among physicians contributes to wide and imprudent use of drugs of this group.

[Risk factors for cancer development in patients after kidney transplantation].

Kidney transplantation in patients with ESRD (end-stage renal disease) improves quality of life and is associated with an increase in both survival rates and the reduction in medical costs compared with patients waiting for a transplant as well as dialysis population. Cancers, next to the cardiovascular disease and infection, present as one of the most common causes of kidney transplant recipients deaths. Incidence of neoplasm after kidney transplantation is between 2.3 and 31%. Risk factors for carcinogenesis after transplantation can be divided into three main groups which include traditional factors (genetic predisposition, exposure to UVA and UVB radiation, smoking, abuse of painkillers, cancer in the pretransplant period), factors connected with kidney disease (cause and treatment of kidney failure) and related to transplantation (immunosuppressive regimen, chronic viral infection, cancer transition with graft). Immunosuppressive treatment undoubtedly has a huge impact on the development of tumours in patients after transplantation. It is to be remembered to include mTOR inhibitors in immunosuppressive regimen in patients with a history of cancer. In kidney recipients the frequency of reactivation as well as de novo infection of oncogenic virus is increased, particularly: EBV (Epstein-Barr virus), HBV (hepatitis type B virus), HCV (hepatitis type C virus), HPV (human papilloma virus) i HHV8 (human herpes virus type 8). An important aspect is the awareness of patients about the increased risk of cancer development and necessity of respecting and applying of preventive recommendations.

Overcoming Inequity in Access to Kidney Transplantation: A Quality Improvement Project.

BACKGROUND: In 2018, DaVita dialysis clinics in Poland introduced a new pathway to improve the referral of dialysis patients for kidney transplantation. It was designed to meet formal requirements for timely referral for transplant assessment and measures to have the patient "active" on the waiting list. The pathway aimed to mitigate the existing inequitable access to transplantation surgery for patients with end stage kidney disease under the care of ambulatory dialysis clinics. The consequences to the patient of lack of contact with nephrologist when called in for transplant surgery during out-of-office hours was a major concern. We reviewed the effectiveness of whether the new procedure impacted facilitating a patient's call for a transplant surgery when dialysis clinics were not operating. METHODS: We collected data on the number of transplantations performed and the number of calls for surgery according to a conventional or new procedure over a 30-month period. RESULTS: In our study, 269 patients received a deceased donor kidney transplant, and 205 candidates (75%) were called for transplantation during the working hours of dialysis clinics, according to the standard procedure, of which 4 patients were discharged for various reasons. In addition, 69 candidates (25%) were called outside clinic working hours through the new procedure process, of which 1 patient was discharged during a phone call due to infection. CONCLUSIONS: DaVita's Poland new transplant access procedure effectively supports a patient's call for transplantation during outpatient dialysis clinics' closure hours.

Influence of gender and age on haemodialysis practices: a European multicentre analysis.

BACKGROUND: Women of all ages and elderly patients of both genders comprise an increasing proportion of the haemodialysis population. Worldwide, significant differences in practice patterns and treatment results exist between genders and among younger versus older patients. Although efforts to mitigate sex-based differences have been attempted, significant disparities still exist. METHODS: This retrospective cohort study included all 1247 prevalent haemodialysis patients in DaVita units in Portugal (five dialysis centres, n = 730) and Poland (seven centres, n = 517). Demographic data, dialysis practice patterns, vascular access prevalence and the achievement of a variety of Kidney Disease: Improving Global Outcomes (KDIGO) treatment targets were evaluated in relation to gender and age groups. RESULTS: Body weight and the prescribed dialysis blood flow rate were lower in women (P < 0.001), whereas treated blood volume per kilogram per session was higher (P < 0.01), resulting in higher single-pool Kt/V in women than in men (P < 0.001). Haemoglobin was significantly higher in men (P = 0.01), but the proportion of patients within target range (10-12 g/dL) was similar. Men more often had an arteriovenous fistula than women (80% versus 73%; P < 0.01) with a similar percentage of central venous catheters. There were no gender-specific differences in terms of dialysis adequacy, anaemia parameters or mineral and bone disorder parameters, or in the attainment of KDIGO targets between women and men >80 years of age. CONCLUSIONS: This large, multicentre real-world analysis indicates that haemodialysis practices and treatment targets are similar for women and men, including the most elderly, in DaVita haemodialysis clinics in Europe.

Kidney disease is a negative predictor of 30-day survival after acute ischaemic stroke.

BACKGROUND/AIMS: Impaired renal function is a strong risk factor for cardiovascular diseases and worsens a patient's prognosis. Renal dysfunction predicts mortality after acute stroke in the long term. On the other hand, in-hospital mortality after acute stroke is strongly associated with disorders of consciousness at the onset of stroke, severity of stroke, body temperature, blood sugar and some other comorbidities. The aim of the study was to analyze the possible role of renal dysfunction and/or signs of renal disease (proteinuria) on 30-day mortality after acute ischaemic stroke (AIS) based on the hospital medical records of one county. METHODS: Medical records of 312 consecutive patients admitted to Ostroleka County Hospital (Department of Neurology) between March 2000 and October 2002 for AIS were retrieved retrospectively to determine factors influencing 30-day survival. None of patients received thrombolytic therapy. RESULTS: Among the patients analyzed, 74 (23.7%) died during the 30-day period. In a simple Cox proportional hazards regression model, negative predictive factors were: older age, higher pulse rate, lower estimated glomerular filtration rate (eGFR), proteinuria, elevated plasma glucose level, diabetes mellitus, atrial fibrillation and chronic heart failure. In a multivariate analysis, independent negative predictors of 30-day morbidity were: age hazard ratio (HR) 1.05 (95% CI 1.02-1.08), eGFR <60 ml/min HR 1.75 (95% CI 1.21-2.19), dipstick proteinuria HR 2.28 (95% CI 1.74-2.82) and plasma glucose level >100 mg/dl HR 2.96 (95% CI 2.22-3.70). CONCLUSION: The results of this study identify decreased eGFR and presence of dipstick proteinuria as a strong negative predictor of 30-day survival after AIS in patients not treated with thrombolytic agents.

Femoral localization and higher ultrafiltration rate but not concentration of heparin used for canal locking of hemodialysis catheter are negative predictors for its malfunction.

BACKGROUND/AIM: Non-tunneled, temporal hemodialysis (HD) catheters are commonly used as short-term vascular access for the HD procedure. One of their late complications is thrombotic occlusion of the catheter ensuing in their malfunction. A heparin lock is conventionally used for maintaining the patency of the catheter. The aim of the study was to evaluate the influence of heparin concentration used for locking the catheter canals (5,000 vs. 2,500 IU/ml) and some other clinical and laboratory variables at the time of temporal HD catheter functioning. METHODS: Catheter malfunction was defined as the inability to attain and maintain a blood flow of at least 150 ml/min. 174 consecutive HD catheters inserted into jugular or femoral veins (114 patients) were followed up and remained in use for a total of 3,284 days. RESULTS: Catheter thrombosis occurred in 53 cases (30.5%) during the study period, giving an overall rate of 16 episodes per 1,000 catheter-days at risk. In univariate Cox proportional hazard analysis, predictors of catheter dysfunction were: femoral localization (HR 4.92, 95% CI 4.30-5.50), acute renal failure (HR 1.75, 95% CI 1.18-2.32), higher mean ultrafiltration (UF) (HR 1.31, 95% CI 0.99-1.63) and higher concentration of hemoglobin (HR 1.15, 95% CI 0.99-1.33). The concentration of heparin used for canal locking did not influence the time of catheter functioning (HR 1.1, p = 0.7). In multivariate Cox proportional hazard analysis (chi2 = 38.5, d.f. = 4, p < 0.0001) the remaining statistically independent predictors of catheter malfunction were: femoral localization (HR 5.94, 95% CI 5.27-6.61, p < 0.0001) and higher UF (HR 1.60, 95% CI 1.24-1.94, p < 0.01). CONCLUSIONS: A lower concentration of heparin (2,500 IU/ml) prevents catheter thrombosis as effectively as a standard one (5,000 IU/ml). Femoral localization of HD catheters and higher UF during the HD procedure are the factors predisposing for catheter malfunction.

The effect of nephrectomy on Klotho, FGF-23 and bone metabolism.

BACKGROUND: Increased concentration of fibroblast growth factor 23 (FGF-23) and decreased levels of soluble Klotho (sKL) are linked to negative clinical outcomes among patients with chronic kidney disease and acute kidney injury. Therefore, it is reasonable to hypothesize that GFR reduction caused by nephrectomy might alter mineral metabolism and induces adverse consequences. Whether nephrectomy due to urological indications causes derangements in FGF-23 and sKL has not been studied. The aim of the study was to evaluate the effect of acute GFR decline due to unilateral nephrectomy on bone metabolism, FGF-23 and sKL levels. METHODS: This is a prospective, single-centre observational study of patients undergoing nephrectomy due to urological indications. Levels of C-terminal FGF-23 (c-FGF-23), sKL and bone turnover markers [ß-crosslaps (CTX), bone-specific alkaline phosphatase (bALP) and tartrate-resistant acid phosphatase 5b (TRAP 5b)] were measured before and after surgery (5 ± 2 days). RESULTS: Twenty-nine patients were studied (14 females, age 63.0 ± 11.6, eGFR 87.3 ± 19.2 ml/min/1.73 m2). After surgery, eGFR significantly declined (p < 0.0001). Nephrectomy significantly decreased sKL level [709.8 (599.9-831.2) vs. 583.0 (411.7-752.6) pg/ml, p < 0.001] and did not change c-FGF-23 concentration [70.5 (49.8-103.3) vs. 77.1 (60.5-109.1) RU/ml, p = 0.9]. Simultaneously, alterations in bone turnover markers were observed. Serum concentration of CTX increased [0.49 (0.4-0.64) vs. 0.59 (0.46-0.85) ng/ml, p = 0.001], while bALP and TRAP 5b decreased [23.6 (18.8-31.4) vs. 17.9 (15.0-22.0) U/l, p < 0.0001 and 3.3 (3.0-3.7) vs. 2.8 (2.3-3.2) U/l, p < 0.001, respectively]. CONCLUSIONS: Nephrectomy among patients with preserved renal function before surgery does not increase c-FGF-23 but reduces sKL. Moreover, nephrectomy results in derangements in bone turnover markers in short-term follow-up. These changes may participate in pathogenesis of bone disease after nephrectomy.

Carotid atherosclerosis is associated with enhanced beta-chemokine levels in patients on continuous ambulatory peritoneal dialysis.

Increased oxidative stress (SOX) has been reported in continuous ambulatory peritoneal dialysis (CAPD) patients, but its influence on beta-chemokine levels and progression of atherosclerosis remains unknown. We determined three distinct SOX markers: Cu/Zn superoxide dismutase (Cu/Zn SOD), total peroxide and autoantibodies against oxidized LDL (OxLDL-Ab); high sensitivity C-reactive protein (hs CRP); beta-chemokines: monocyte chemoattractant protein-1 (CCL2), macrophage inflammatory proteins (CCL3 and CCL4) and regulated upon activation, normal T cell expressed and secreted (CCL5) and the intima-media thickness (IMT) values in CAPD patients both with and without cardiovascular disease (CVD) and healthy controls. CAPD patients both with and without CVD had significantly increased IMT (p<0.001 and <0.01), Cu/Zn SOD (both p<0.001) and CCL2 levels (p<0.001 and <0.01, respectively) as compared to controls. CCL4 (p<0.01) and hs CRP (p<0.05) were increased only in patients with CVD, whereas there were no differences in the total peroxide, OxLDL-Ab and CCL3 levels between patients and controls. CCL5 concentrations were significantly decreased in both patients subgroup (both p<0.001) versus controls. Multivariate analysis showed that age (p<0.001), male sex (p<0.01), CCL4 and CCL2 levels (both p<0.05) were the independent variables linked to IMT values. Our data suggest a possible role of enhanced beta-chemokine levels in the carotid atherosclerosis in patients treated with CAPD, in addition to age and male sex.

Adiponectin is related to CD146, a novel marker of endothelial cell activation/injury in chronic renal failure and peritoneally dialyzed patients.

Adiponectin has antiatherogenic properties and attenuates endothelial inflammatory responses. CD146 is a novel cell adhesion molecule localized at the endothelial junction. In renal failure, endothelial dysfunction and atherosclerosis are almost universal. We studied possible correlations between adiponectin, CD146, and other markers of endothelial cell injury in patients with chronic renal failure (CRF) on conservative treatment and patients with and without diabetic nephropathy maintained on chronic ambulatory peritoneal dialysis (CAPD). We assessed adiponectin, tissue factor pathway inhibitor (TFPI), plasminogen activator inhibitor (PAI-1), thrombin-activatable fibrinolysis inhibitor, and endothelial function/injury markers: von Willebrand factor, thrombomodulin, vascular cell adhesion molecule (VCAM), intercellular adhesion molecule, and CD146. Adiponectin was elevated in patients with CRF and on CAPD. It correlated significantly, with PAI-1, thrombin-activatable fibrinolysis inhibitor, intercellular adhesion molecule, VCAM, and CD146 in nondiabetics on CAPD. In diabetics, CAPD adiponectin correlated positively with C146 and VCAM and negatively with PAI and TFPI. In multivariate regression analysis, only CD146 remained a positive predictor of adiponectin in all CAPD patients. In CRF, adiponectin correlated with CD146. In healthy volunteers, adiponectin correlated with TFPI and CD146. Elevated adiponectin related to CD146 may be the expression of a counterregulatory response aimed at mitigating the consequences in endothelial damage and increased cardiovascular risk in renal failure.

Risk factors of nontunneled noncuffed hemodialysis catheter malfunction. A prospective study.

BACKGROUND: The use of noncuffed nontunneled central venous catheters is a widely accepted method of gaining temporary vascular access for hemodialysis. Malfunction and bacteremia are the main factors limiting catheter survival. METHODS: We followed up prospectively 73 hemodialysis catheters (HC) (40 internal jugular, 33 femoral) in order to establish factors influencing HC malfunction. HC malfunction was defined as a catheter that was unable to attain and maintain blood flows of at least 150 ml/min. 73 HC were used for a total 1,100 days. RESULTS: HC malfunction occurred in 23 cases (31.51%) during the study period, giving an overall rate of 21 episodes per 1,000 catheter days at risk. An analysis revealed a higher risk of HC malfunction with the catheterization of the femoral vein compared to the internal jugular vein (hazard ratio (HR) 6.3; 95% confidence interval (CI) 5.3-7.3). After correction for confounding factors in multivariate Cox analysis, the site of the catheterization remained a statistically significant predictor of HC malfunction (HR 5.03, 95% CI 3.83-6.23). After the first week malfunction rate was 42 and 8% for femoral and internal jugular site, respectively (relative risk (RR) for malfunction 5.3 (95% CI, 2.5-8). After the second and third week, the incidence of malfunction was 51 and 14% for femoral and internal jugular vein, respectively (RR 3.6, 95% CI 2.2-5.1). CONCLUSIONS: Catheterization of the internal jugular vein is associated with longer catheter survival when compared to the femoral vein. Hemodialysis catheters should be placed, if possible, in internal jugular vein to prevent their premature malfunction.

Thyroid volume and hormone response in the early kidney transplants.

BACKGROUND: Thyroid hormones could affect renal function, and conversely renal function disturbances may affect thyroid function. Disturbances of the thyroid hormone concentration are often connected with thyroid gland enlargement. The aim of study was to estimate the function and morphology of the thyroid and kidney graft after kidney transplantation. As the indicator of thyroid and renal function we have used thyroid gland volume, plasma concentration of T3, reverse rT3, creatinine concentration, and renal arteries RI. MATERIAL/METHODS: Studied group included 17 individuals after kidney transplantation, with stabile graft function. The control group included 18 individuals after various surgical procedures. The estimated parameters were: thyroid volume, renal arteries resistive index, concentrations of creatinine,T3 and rT3.The parameters were controlled before transplantation (surgery), the day after, and at 3rd, 6th and 10th day after surgery. RESULTS: All patients, before and after surgical procedure, were clinically euthyroid. Mean creatinine concentration showed tendency to diminish. Statistical analysis revealed positive correlation between Delta concentration of creatinine and Delta volume of thyroid (R Spearman=0.46, p=0.05). Till the 6th day after transplantation T3 concentration diminished, and at the 10th day presented tendency to rise. We found negative correlation between T3 concentration and renal arteries RI. The rT3 concentration during 10 days after transplantation was above the reference level. CONCLUSIONS: The FT3 level and thyroid volume correlates with kidney transplant function. The supplementary thyroid hormones administration should be considered before and after renal transplantation.

Effects of fluvastatin on homocysteine and serum lipids in kidney allograft recipients.

Hyperhomocysteinemia is now recognized as an independent risk factor for atherosclerotic cardiovascular disease in patients with normal renal function. Hyperhomocysteinemia is common in patients with chronic renal failure. Kidney transplant recipients have a high risk of cardiovascular death. Recently, attention has been paid to the association between homocysteine and cardiovascular disease. Dyslipidemia is also common in kidney transplant recipients. The purpose of this study was to assess whether fluvastatin in a dose of 20 mg affects homocysteine concentration in 10 stable renal transplant recipients. We evaluated Hcy, lipoprotein (a) by the use of commercially available kits as well as plasma fibrinogen and cholesterol, triglycerides and albumin levels. All the parameters were studied before and after 1, 2 and 3 months of fluvastatin treatment. Cholesterol and LDL decreased significantly as early as after 1 month and remained lowered during the therapy. No significant changes in Hcy, lipoprotein (a) and fibrinogen were found during therapy with fluvastatin. Fluvastatin is an effective hypolipemic agent and has no effect on Hcy and fibrinogen concentration in kidney transplant recipients.

[Soy's phytoestrogens and their implication for human health]. / Fitoestrogeny soi i ich znaczenie dla zdrowia czlowieka.

The way of nutrition and particular components of the diet have substantial influence on the development of many diseases. It has been proven by large epidemiological studies dealing with the incidence of cardiovascular diseases and tumours. What is more, the diet may have also an important role in the secondary prevention of myocardial infarction. The role of a soy as a component of the diet with potentially favorable action on human health was discussed in this paper. Special attention was paid to mechanisms of action of soy phytoestrogens and their influence on development of ischaemic heart disease, tumours, osteoporosis and other symptoms related to menopause.