FRAX prognostic and intervention thresholds in the management of major bone fractures in hemodialysis patients: A two-year prospective multicenter cohort study.

PURPOSE: The usefulness of FRAX in predicting major bone fractures in patients with end-stage kidney disease on maintenance hemodialysis treatment has been confirmed in previous studies. For meaningful clinical use, the prognostic and intervention FRAX thresholds need to be established. METHODS: The primary aim of our study was to calculate the optimal cut-off point of FRAX for the best prediction of an increased bone fracture risk in dialysis patients and additionally, to propose its intervention threshold, indicating the need for antifracture pharmacological treatment. The study included 718 hemodialysis patients, who were followed up for two years. Thirty low-energy major bone fractures were diagnosed during the study period. We used the Polish version of FRAX (without the DXA examination) and some particular variables of the FRAX calculator. The optimal cut-off point for prediction of an increased major bone fracture risk was based on the analysis of the sensitivity and specificity curves of FRAX. RESULTS: The analysis revealed FRAX >5% (sensitivity of 70.0%, specificity of 69.8%) as the prognostic threshold for major bone fractures. Its sensitivity for bone fracture prediction was significantly higher, but specificity lower than those of FRAX ≥10%, used in general Polish population. The reason for this can be an underestimation of bone fracture risk with FRAX in dialysis patients. CONCLUSIONS: We conclude that the FRAX prognostic threshold for identification of an increased risk of major bone fractures in hemodialysis patients is >5%. We propose to use this specific value of FRAX as an intervention threshold for pharmacological antifracture treatment in hemodialysis patients.

[Intradialytic hypotension]. / Hipotonia sróddializacyjna.

Intradialytic hypotension is a frequent complication of hemodialysis. Its etiology is complicated and unclear. Preventive and therapeutic procedures include modification of lifestyle as well as parameters of hemodialysis procedure. Due to multifactorial etiology of this complication we should pay attention to proper prophylactic and in the case of its appearance to adjust the treatment to the individual patient.

[Vascular access for hemodialysis--own experiences]. / Dostep naczyniowy do hemodializ--doswiadczenia wlasne.

AIM OF THE STUDY: We present own experiences in creation and/or reconstruction of vascular access for hemodialysis. MATERIAL AND METHODS: 91 pts (63 men, 28 female) aged 18 to 89 years, with irreversible renal failure qualified for renal replacement therapy, 47% of them with diabetic nephropathy. In years 1996-2006, 167 surgical procedures of creation or reconstruction of vascular access for hemodialysis were performed. In the qualification for surgical procedure we used clinical assessment as well as Doppler ultrasound or computed tomography angiography. RESULTS: In 3 cases from all 167 patients we performed fistula ligation due to transfer to peritoneal dialysis. In the 164 others cases we performed 18 types of different procedures among other thing: 95 first or second degree arteriovenous fistulas creation, 35 procedures of revascularisation and 34 procedures of fistula reconstruction. In our material own modification of Cimino-Brescia arteriovenous anastomosis was introduced with positive hemodynamic effects in all cases. In the discussion we stressed the necessity of selection of creation/reconstruction methods individually for every patient especially in ageing and diabetic population of patients with chronic kidney disease with many cardiovascular complications both in predialysis stage of kidney failure as well as in the course of long term dialysotheraphy. CONCLUSION: The assurance in optimal vascular access for hemodialysis is still big challenge especially in patients of advanced age. Individual approach to every case gives the chance of choice the best surgical procedures for optimal vascular access for hemodialysis.

[Severe nephrotic syndrome requiring bilateral renal arteries embolisation in patient with membranous and diabetic nephropathy]. / Ciezki zespól nerczycowy wymagajacy obustronnej embolizacji tetnic nerkowych u chorego z nefropatia bloniasta nalozona na nefropatie cukrzycowa.

On the case of 62 year old patient with diabetes type 2 complicated by diabetic nephropathy, we present diagnostic and therapeutic problems of severe nephrotic syndrome caused by membranous nephropathy confirmed by renal biopsy superimposed on diabetic nephropathy. Special attention was paid to the difficulties in achievement the remission of nephrotic syndrome with typical pharmacological treatment and necessity of using drastic form of treatment which was bilateral embolisation of renal arteries and subsequent continuous renal replacement therapy.

[Asymptomatic intraperitoneal adhesions disease as the potential cause of unfeasibility of creation dialysis access to peritoneal cavity--case reports]. / Bezobjawowa choroba zrostowa otrzewnej jako potencjalna przyczyna niemozliwosci wytworzenia dostepu dializacyjnego do jamy otrzewnowej--opis przypadków.

Peritoneal dialysis is one of three, complementary methods of renal replacement therapy, including also hemodialysis and kidney transplantation. After qualification for peritoneal dialysis program special attention should be paid for creation proper dialysis access through correct implantation of peritoneal catheter. On the basis of three cases we present difficulties of Tenckhoff peritoneal catheter implantation in patients with massive peritoneal adhesions without previous surgical interventions and other risk factors for peritoneal adhesions.

[Diagnosis of haematuria in phase-contrast microscopy--current knowledge]. / Diagnostyka krwinkomoczu w mikroskopie kontrastowo-fazowym--wspólczesny stan wiedzy.

Haematuria present in 4% of adult population is not always connected with clinical symptoms. This article presents the current state of the art of using phase-contrast microscopy in examination of urinary sediment in differential diagnosis of haematuria.

[Report from the XXVIII Congress of ERA-EDTA, Vienna, June, 2001]. / Sprawozdanie z XXXVIII Kongresu ERA-EDTA, Wieden, czerwiec 2001 r.

This paper refers to selected reports on nephrology and renal dialysis therapy presented on the XXXVIII Congress of European Renal Association--European Dialysis and Transplant Association (ERA-EDTA), held in 2001 in Vienna. Special attention was paid to diagnosis and therapy of renal anaemia, calcium-phosphate metabolism, Fabry's disease and vascular access in hemodialysed patients.

[Microalbuminuria and atherosclerosis risk factors in potentially healthy men--preliminary data]. / Mikroalbuminuria u potencjalnie zdrowych meczyzn a obecnosc czynnikw ryzyka miazdzycy--doniesienie wstepne.

UNLABELLED: The aim of the study was the assessment of occurrence of microalbuminuria (MI) and selected biochemical atherosclerosis risk factors in the group of potentially healthy men. MATERIAL AND METHODS: In the studied group were 200 men in mean age 28.7 +/- 8.1 years. In the first part of the study all participants filled environmental inquiry concerning the cardiovascular risk factors. On the basis of qualitatively and then quantitatively MI measurement the whole studied group was divided in two subgroups: A (18 men with MI) and B (182 men without MI). In the second part of the study, in both groups we investigated occurrence of abnormal levels of atherosclerosis risk factors such as: total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, uric acid, glucose, homocysteine (HCYS), C reactive protein (CRP). In the whole group we measured blood pressure, BMI and WHR. RESULTS: In the group with MI we found mean HCYS levels 14.75 micromol/ml. This value was higher then in the group without MI (p < 0.0007). Mean level of CRP in group with MI was 0.24 mg/dl and was higher than in the group without MI (p < 0.04). Levels of HDL and ApoA in the group with MI were 49.05 mg/ml and 1.46 mg/ dl and were lower than in the group B (p < 0.03 and p < 0.036 respectively). The most important factors preceeding MI were age and level of LDL cholesterol. CONCLUSIONS: Our preliminary data suggest that MI might be important atherosclerosis risk factor in potentially healthy men.

[Pseudoaneurysms after femoral arteries cannulations in hemodialysed patients--preliminary data]. / Tetniaki rzekome po kaniulacji tetnicy udowej u chorych hemodializowanych--doniesienie wstepne.

UNLABELLED: Patients undergoing chronic haemodialysis (HD) therapy have higher risk of arterial injury during cannulation for diagnostic and therapeutic procedures. Aim of our study was to evaluate frequency of femoral pseudoaneurysms (FPA) occurring after femoral artery (FA) cannulation (FAC) as well as presentation of ultrasound guided compression (USGC) of FPA. MATERIAL AND METHODS: From the group of 340 HD patients in our Centre in years 1996-2003 37 consecutive HD patients (23M, 14F, aged 55, 5 +/- 8, 2years, on HD 24, 2 +/- 22,6 months) after FAC, indicated from cardiological point of view, underwent regular femoral colour duplex USG. RESULTS: In 21 pts we found no local complications. In 16 of 37 pts 7 hematomas (HM) and 9 femoral pseudoaneurysms (FPA) were found. All HM were treated conservatively. From 9 FPA cases, 2 thrombosed spontaneously and the remaining 7 pts were treated firstly with USG guided controlled compression (UGCC). UGCC resulted in successful thrombosis of FPA in 3 pts with mean volume of FPA 40 +/- 12 ml but failed in 4 other pts with mean volume of FPA 39 +/- 17 ml. CONCLUSION: Our preliminary results show, for the first time in the literature, that occurrence of FA damage might occur rather often in HD pts qualified for this procedure from cardiological point of view. Pseudoaneurysms of FA, being in our material the most frequent pathology, should be promptly diagnosed with colour duplex USG and subsequently treated non surgically with USG guided controlled compression.

[Chlamydia pneumoniae antibodies and other atherosclerosis risk factors in haemodialysed patients. Preliminary report]. / Przeciwciala przeciwko chlamydia pneumoniae a inne czynniki ryzyka miazdzycy u chorych przewlekle hemodializowanych. Doniesienie wstepne.

Nowadays, it is considered that viral or bacterial infections can influence atherosclerosis development rate. One of them is infection by Chlamydia pneumoniae. The aim of the study was to assess the occurrence of anti-Chlamydia pneumoniae antibodies (AChPA) and their relationship with biochemical and clinical atherosclerosis risk factors in haemodialysed patients. There were 38 patients (24M, 14F) at the mean age 63.3 +/- 14.5 years, haemodialysed for 30.9 +/- 26.1 months. Previous Ch. Pneumoniae infection was assessed based on AchPA IgA and IgG concentrations determined using SIMPLE INDEX. The following risk factors for atherosclerosis were checked in the study group: total cholesterol. CRP and iPTH. AChPA indicative for Ch. pneumoniae infection in the past were detected in 28 patients (74%). The study group was divided into two subgroups; A- (n = 28 patients) with serological features of previous Ch. pneumoniae infection and B- (n = 10 patients) without serological features of Ch. pneumoniae infection. We found no statistical difference between the groups in the studied biochemical factors. We found no correlation between AChPA and other atherosclerosis risk factors. Our preliminary report does not confirm the prognostic value of AChPA presence as an atherosclerosis risk factor in haemodialysed patients.

[New diagnostic and therapeutic methods in pseudoaneurysm of arterio-venous fistula for hemodialysis--case report]. / Nowe mozliwosci diagnostyczno-terapeutyczne tetniaka rzekomego przetoki tetniczo-zylnej do hemodializ--opis przypadku.

On the basis of case of 78 years old female patient being on chronic hemodialysis we present the usefulness of spiral computed tomography in the diagnosis of pseudoaneurysm complicating arterio-venous fistula for hemodialysis as well as usefulness of endovascular stent for closing such pseudoaneurysm.

[Mediastinal cyst in a patient on continuous ambulatory peritoneal dialysis successfully treated with video-assisted thoracic surgery (VATS)]. / Torbiel sródpiersia leczona skutecznie torakowideoskopia u chorej leczonej ciaglq ambulatoryjna dializq otrzewnowa.

Renal transplantation is the most effective form of renal replacement therapy of irreversible renal insufficiency. Due to posttransplant long term immunosuppressive treatment careful evaluation of the recipient is essential, especially detection and elimination of all potential sources of malignancy. In this paper, we describe successful video assisted thoracoscopic surgery of mediastinal cyst in peritoneal dialysis patient prepared for renal transplantation.

[Spiral computed tomography in evaluation of arteriovenous fistula for hemodialysis. Preliminary report]. / Zastosowanie spiralnej tomografii komputerowej do oceny przetok tetniczo-zylnych w hemodializach. Doniesienie wstepne.

Failure of arteriovenous fistula (AVFf) still remains the "Achilles'heel" of chronic haemodialysis (HD) programme. Therefore, early, potentially non-invasive diagnosis and prompt surgical correction of AVFf are needed. For these purposes spiral computed tomographic angiography (SCTA) was used for evaluation of clinically suspected AVFf in 19 patients (10M/9F, aged 58.6 +/- 14.6 years, on HD for 34.4 +/- 29.3 months). SCTA was performed using Marconi MX8000 scanner covering whole AVF. After intravenous administration to the peripheral vein of the other leg of 100 ml of non-ionic lomeron 350 contrast (3 ml/s), axial CT images were obtained helically covering whole surface of AVF. Time delay was measured by Trigger function. Maximum Intensity Projections (MIP), 4D-Angio and virtual endoscopy (VE) techniques were used for reconstruction. MIP images demonstrated contrast-enhanced vascular structures and other high-density tissues (calcifications). VE enabled non-invasive simulation of endoscopic procedures and interactive intravascular navigation. Total number of 24 SCTA were performed. We found normal patency of AVF in 5 patients. In the remaining 14 subjects, the following abnormalities were found: stenosis of AVF at the site of anastomosis or in distal segment of efferent vein in 6 SCTA examinations, dilatation in 7 SCTA, acute or chronic thrombosis of AVF in 9 SCTA procedures including total occlusion of AVF in 2 cases. In 2 cases pseudoaneurysms of AVF were found. In 7 SCTA examinations more than one reason of AVFf was found. Photographs of every AVF complication are presented. We noted only one complication of SCTA-rupture of venous vessel on the opposite arm during contrast injection. There were no hypersensitivity reactions to the contrast.

[Pseudoaneurysm of arteriovenous fistula for haemodialysis]. / Tetniak rzekomy przetoki tetniczo-zylnej do hemodializy--opis dwóch przypadków.

On the basis of two cases of haemodialysed patients we present the usefulness of spiral computed tomography in the diagnosis of pseudoaneurysm as a complication of arteriovenous fistula for haemodialysis.