[Comparison of the hemodialysis adequacy conducted based on low-flux polysulfone dialyzers and high-flux helixone dialyzers]. / Porównanie adekwatnosci hemodializy prowadzonej z uzyciem niskoprzeplywowych dializatorów polisulfonowych i wysokoprzeplywowych dializatorów helixonowych.

UNLABELLED: Hemodialysis (HD) is a dynamic process, which occurs during movement through a semipermeable membrane, water soluble substances of low molecular weight. Transport across the membranes of low-flux (LF) dialyzers is based mainly on diffusion and through the membranes of high-flux (HF) dialyzers, diffusion and convection. The aim of the study was to compare the adequacy of hemodialyses conducted on the basis of the low-flux dialyzers with polysulfone membrane, and the high-flux dialyzers with helixone membrane. MATERIAL AND METHODS: The study included 60 patients (23 women and 37 men) aged 24-84 years (mean 60.73 +/- 15.75) treated with maintenance hemodialysis (three times per week). The study enrolled clinically stable patients after a minimum 3-months period of HD. Blood tests were performed 1 time a month before the middle week dialysis session. For the first six months HD was based on LF dialyzers with polysulfone membrane, and then for an additional 6 months based on HF dialyzers with helixone membrane. RESULTS: The performed study demonstrated a statistically significant higher values of: spKtV and URR% and lower values of the urea before and after HD sessions performed based on HF-HD as compared with LF-HD (spKt/V LF = 1.26 +/- 0.23 vs. spKtV HF = 1.37 +/- 0.17; p < 0.001, URR% LF = 66.74 +/- 5.86 vs. URR% HF = 70.57 +/- 3.71; p < 0.001, urea before LF-HD = 21.57 +/- 4.57 mmol/I vs. HF-HD = 20.57 +/- 4.21 mmol/I; p < 0.01 and the urea after LF. HD = 7.19 +/- 2.25 mmol/l vs. HF-HD = 6.03 +/- 1.55 mmol/l; p < 0.001). Conclusions: The study showed better adequacy of HD treatment performed based on the high-flux dialyzers with helixone membrane as compared with low-flux dialyzers with polysulfone membrane.

[Comparison of the iron metabolism and effectiveness of anemia treatment in patients on maintenance hemodialysis performed based on polysulfone and helixone dialyzers]. / Prównanie gospodarki zelazem i skutecznosc leczenia niedokrwistosci u chorych hemodializowanych w oparciu o dializatory polisulfonowe i helixonowe.

INTRODUCTION: Anemia is a common complication in patients with chronic renal failure (CRF) especially on maintenance hemodialysis. There are some data that the use of biocompatible high-flux dialyzers is more efficient than low-flux dialyzers in controlling some uremia related diseases including anemia. The aim of the study was to assess the iron metabolism and degree of anemia correction in patients on maintenance hemodialysis performed based on low-flux dialyzers (HD-LF), with polysulfone membrane and high- flux dialyzers (HD-HF), with helixone membrane. MATERIAL AND METHODS: The observation lasted 12 months and involved 60 patients (23 F and 37 M) aged from 24 to 84 years, mean 60.73 ± 15.75 treated on maintenance HD. RESULTS: It was demonstrated a higher mean Hb and Ht values during period of HD-HF as compared with the HD-LF (LF-Hb = 11.09 ± 0.89 vs. HF-Hb = 11.42 ± 0.98; p < 0.01 and LF- Ht = 33.7 ± 2.87% vs. HF-Ht = 34.45 ± 3.08%). Higher values of Hb and Ht during HD-HF were obtained at a comparable average doses of darbepoetin alfa (Aranesp) used in both periods (LF-Aranesp = 8.29 ± 4.17 µg vs. HF-Aranesp = 8.25 ± 3.92 µg; p ≤ 0.29) and statistically significantly lower average doses of intravenous iron administered during HD-HF (LF-iron iv = 17.59 ± 10.44 mg vs. HF-iron iv 12.16 ± 9.04 mg; p < 0.01). It was also shown a statistically significant higher mean corpuscular volume of red blood cells (MCV) in patients during HD-HF (LF-MCV = 91.15 ± 6.6 µm3 vs. HF- MCV = 95.03 ± 5.38 µm3; p ≤ 0.001) and lower mean ferritin values (LF-ferritin = 636.33 ± 704.57 ng/ml vs. HF-ferritin = 538 ± 475.92 ng/ml; p ≤ 0.001). CONCLUSIONS: Lower intravenous iron use during HD-HF, with higher Hb values in these period may indicate on may indicate an increased loss of folates during HD-HF and the necessity of its increased supplementation.

[Kaposi's sarkoma in solid organ recipients]. / Miesak Kaposiego u biorców przeszczepów narzadów litych.

Kaposi's sarkoma (KS) is a malignancy with hyperplastic angio-proliferative lesions with inflammatory changes usually associated with human Herpesvirus 8 (HHV-8) infection. The predominant is skin localization with dark-blue or purplish colour nodules and plaques. Cutaneous changes may be associated with visceral involvement, which as a isolated form is rare. KS is not frequent disease in general population however risk of its development is substantially increased in immunocompromised patients including AIDS or receiving immunosuppression transplant organ recipients. The potency of immunosuppression is a highly relevant factor in the development of KS after transplantation. Patients receiving more intense immunosuppression are at a significantly higher risk of developing post transplant KS. Localized disease may be treated by surgery, kriotherapy or radiotherapy while widespread envolvement usually needs systemic therapy. Reduction or cessation of immunosuppression, especially calcineurin inhibitors, in transplant organs recipients gives positive therapeutic results. Swich from calcineurin inhibitors to rapamycin, immunosuppressive agent with anti-neoplastic activity, is a novel therapeutic option for solid rorgans recipients.