Uremic pruritus and serum brain-derived neurotrophic factor in diabetic and non-diabetic haemodialysis patients.

INTRODUCTION: Even though uremic pruritus (UP) is very troublesome for haemodialysis (HD) patients, its underlying mechanism is not fully understood. AIM: Due to the possible role of brain-derived neurotrophic factor (BDNF) and its higher serum concentration in haemodialysis diabetic patients compared to non-diabetic ones, this study is aimed to evaluate its association with UP among diabetic and non-diabetic patients on maintenance HD. MATERIAL AND METHODS: A total of 94 patients were enrolled into the study. A visual analogue scale (VAS) was used to assess pruritus. RESULTS: No differences were found between the observed study groups in terms of BDNF serum concentration, other biochemical markers, sleep disturbances, or pruritus presentation. CONCLUSIONS: BDNF serum concentration was not found to be associated with UP among HD patients, however further studies are worth performing on a larger group of individuals.

[Acetylsalicylic acid in the prevention and treatment of cardiovascular diseases].

Acetylsalicylic acid (ASA) is one of the most popular medicines in the world. ASA preparations have been used for over 100 years as anti-inflammatory, antipyretic and analgesic drugs. Since 1971, ASA has also been used as an antiplatelet drug. The main antiplatelet effect of aspirin is the irreversible inhibition of the key enzyme of arachidonic acid cascade, a prostaglandin H synthetase, also called cyclooxygenase (COX). ASA is a widely used drug in the prevention of cardiovascular diseases. In accordance with the current European guidelines, ASA is indicated in secondary prevention in all patients with established cardiovascular disease (coronary heart disease, previous myocardial infarction, previous stroke, peripheral atherosclerosis). Life therapy with low doses (75-150 mg daily) is recommended. ASA is also used to treat acute myocardial infarction, unstable coronary heart disease, coronary artery bypass surgery and angioplasty, as well as to treat acute stroke. Despite the proven benefits, approximately 10-20% of patients taking ASA are at risk for re-occurring cardiovascular events. In connection with the above, the phenomenon of the so-called resistance to ASA (or high on treatment platelet reactivity despite ASA). This phenomenon was reported in patients after stroke (up to 60% of subjects), in atherosclerosis of the lower limbs (up to 60%), in stable coronary disease (up to 70%) and in patients immediately after myocardial infarction (up to 80%). Despite studies conducted for several years, so far there are no clear guidelines for monitoring platelet function in patients taking ASA, both in primary and secondary stroke prevention.

Pharmacological stroke prevention in the elderly with atrial fibrillation in Poland - Results of PolSenior study.

INTRODUCTION: Atrial fibrillation (AF) is the most frequent clinically significant arrhythmia, especially common in the elderly. As it is known, AF is associated with increased risk of stroke. Little is known about pharmacological cardiovascular prevention in the elderly with AF in Poland. OBJECTIVES: The purpose of the study was to evaluate the frequency of pharmacological stroke prevention among the elderly with AF in Poland and its association with clinical characteristics and concomitant cardiovascular risk factors. PATIENTS AND METHODS: The analysis included elderly (≥65 years) participants of the PolSenior study performed in years 2008-2012. RESULTS: The study group consisted of 4979 people (mean age: 79.3±8.7 years). Among them, there were 875 patients (18.7%) with documented history of AF. Pharmacological prevention with the use of vitamin K antagonists (VKA) was applied by 117 (13.4%) of the elderly with AF, including 15 (1.7%) on dual therapy. Additionally, 386 (45.3%) subjects with AF were using oral antiplatelet therapy (OAPs), mostly aspirin. Acenocoumarol was much more often used than warfarin. New oral anticoagulant drugs (NOACs) were not used at all. Only personal income was associated with the use of VKA. No significant correlation was found for the age, sex, place of residence and level of education. CONCLUSIONS: The study was unique to determine the frequency of pharmacological stroke prevention among elderly people with AF in Poland. It occurred that oral anticoagulant drugs were applied too rarely in this group of patients. Educational programs should be developed among general practitioners concerning current recommendations for patients with AF.

[high on-treatment platelet reactivity in patients with chronic renal failure using acetylsalicylic acid].

Cardiovascular diseases (CVD) are the most common cause of mortality in the world. Acetylsalicylic acid (ASA) is a widely used medicine in primary and secondary prevention of cardiovascular diseases. About 1-60% patients taking aspirin have high platelet reactivity (HOPR) despite aspirin treatment. HOPR is significantly more frequent in patients with chronic kidney disease (CKD) and it increases the risk of adverse cardiovascular events in these patients. The cause of HOPR in patients with CKD may be oxidative stress and inflammation. To the risk factors belong diabetes, female sex or decreased HDL cholesterol level.

Substance P and intensity of pruritus in hemodialysis and peritoneal dialysis patients.

BACKGROUND: Uremic pruritus is a common complication in patients undergoing dialysis. The pathophysiological mechanisms of pruritus in patients with end-stage renal disease remain unknown. Neuropeptides, including substance P, are postulated to play an important role in the pathogenesis of pruritus. The aim of this study was to evaluate the role of substance P in uremic pruritus in patients on hemodialysis and peritoneal dialysis. MATERIAL/METHODS: We included 197 patients with end-stage renal disease: 54 on continuous ambulatory peritoneal dialysis and 143 on hemodialysis. Substance P, calcium, phosphorus, iron, ferritin, CRP, albumin, hemoglobin, Ca×P product, and iPTH level were determined in all participants. The correlation between these parameters and self-reported itching was evaluated in patients on hemodialysis in comparison with peritoneal dialysis patients. RESULTS: The incidence of itching was similar in hemodialysis and peritoneal dialysis patients. No differences in substance P level between the 2 groups were found. There was no correlation between substance P level and the incidence or intensity of pruritus in dialyzed patients. CONCLUSIONS: This study demonstrates that substance P does not play any important role in pruritus in hemodialysed and peritoneal dialyzed patients. However, further studies are necessary to assess the exact role of neuropeptides in uremic pruritus.

Prevalence of high on-treatment platelet reactivity in patients with chronic kidney disease treated with acetylsalicylic acid for stroke prevention.

Introduction Chronic kidney disease (CKD) is one of risk factors for stroke and may be associated with impaired platelet reactivity. Objectives The aim of the study was to evaluate platelet reactivity in patients with CKD treated with acetylsalicylic acid (ASA), using 2 different laboratory methods. Moreover, we searched for factors responsible for the phenomenon of high on-treatment platelet reactivity (HOPR). Patients and methods A total of 108 patients with CKD and 41 controls without CKD using ASA were enrolled in the study. Platelet function was assessed by impedance aggregometry in whole blood, using a multi-channel platelet function analyzer (Multiplate®; ASPItest). Urinary 11-dehydrotromboxane levels were measured by the AspirinWorks® test. Results No significant differences were observed in the prevalence of HOPR between patients with and without CKD. Patients with CKD and HOPR measured by ASPItest had higher creatinine levels (P = 0.05) and were younger (P <0.01) than patients with CKD without HOPR, while patients with CKD and HOPR measured by AspirinWorks® had lower red blood cell count (P = 0.05), hemoglobin (P = 0.05), hematocrit (P = 0.05), and high-density lipoprotein levels (P = 0.05). All patients with HOPR had higher C-reactive protein levels (P <0.05) (AspirinWorks®) and white blood cells (P <0.05) (ASPItest). Conclusions The applied methods allowed to detect HOPR in more than one third of CKD patients taking ASA for stroke prevention. The compatibility of both methods for HOPR assessment was confirmed. The study revealed several potential risk factors for HOPR in CKD, including younger age, higher levels of inflammatory markers, dyslipidemia, and lower hematocrit and hemoglobin levels.

Antiplatelet and anticoagulant therapy in elderly people with type 2 diabetes mellitus in Poland (based on the PolSenior Study).

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is an important and common cardiovascular risk factor. The purpose of the study was to evaluate the frequency of use of oral antiplatelet drugs (OAPs) and oral anticoagulant drugs (OACs) among the elderly with T2DM in Poland. MATERIAL AND METHODS: The study was based on the data collected in the Polish national PolSenior study. RESULTS: Among 4979 PolSenior participants aged 65 and over, 883 (17.8%) had previously diagnosed T2DM. Among them, 441 (49.9%) used at least one drug in pharmacological cardiovascular prevention, i.e. OAPs (mostly ASA) in 405 (45.9%) cases and OACs in 38 (4.3%). The use of these drugs significantly depended on the sex (p = 0.02) and personal income (p = 0.05). Age, place of residence and level of education did not affect the prevalence of pharmacological prevention. Previous stroke and myocardial infarction were mostly associated with OAPs, whereas a history of atrial fibrillation (AF) was related to OAC treatment. Among participants treated with OAPs, therapy was applied as secondary cardiovascular prevention in 211 (52.1%) subjects, and as primary prevention in 194 (47.9%) subjects. Among participants treated with OACs, 24 (64.9%) persons had a history of AF. Secondary cardiovascular pharmacological prevention should be considered in 45 untreated participants (12.5%), and primary cardiovascular pharmacological prevention (SCORE ≥ 10 and/or AF) in 154 participants (42.7%). CONCLUSIONS: Cardiovascular pharmacological prevention in the elderly with T2DM in Poland seems to be unsatisfactory. Educational programmes concerning current recommendations for pharmacological cardiovascular prevention should be developed among general practitioners.

The impact of selected metallic elements in the environment on the occurrence of osteoporosis in the voivodeship of Silesia.

Background. The existence of toxic metallic elements in the environment is one of the most important factors influencing the metabolism of calcium. The aim of our study was to compare the incidence of osteoporosis in Upper Silesia to the level of environmental pollution with lead, cadmium, zinc, and copper. Material and methods. An epidemiological data base gathered by the Silesian Branch of the National Health Fund was used to gather data concerning the incidence and treatment of osteoporosis in Silesia, with and without pathological fractures. Results. The results of our analysis suggest that the frequency of osteoporosis, with or without pathological fractures both, correlates with increased concentrations of lead, cadmium, copper and zinc in the environment. This relation can be noticed especially in the Upper Silesian Industrial District. Conclusions. In regions with increased risk due to the occurrence of significant amounts of heavy, osteotropic elements, programs should be implemented to intensify screening for osteoporosis.