International comparison and time trends of first kidney transplant recipient characteristics across Europe: an ERA Registry study.

BACKGROUND: The aim of this study was to provide an overview of age, sex and primary renal disease (PRD) distribution among first kidney transplant recipients across Europe. METHOD: The European Renal Association (ERA) Registry database was used to obtain data on patients aged 20 years or older receiving their first kidney transplant between 2010 and 2019 from 12 European countries. The numbers and percentages of recipients in each age, sex and PRD group were calculated by country, donor type and year. RESULTS: In total, 99 543 adults received a first kidney transplant. Overall, 23% of the recipients were 65 years or older, 36% were female, and 21% had glomerulonephritis and 15% diabetes mellitus as PRD. Compared with deceased donor kidney transplant recipients, living donor kidney transplant recipients were less often 65 years or older (13% versus 26%), more often had glomerulonephritis (25% versus 20%) and less often diabetes mellitus (8% versus 17%) as PRD. We found large international differences, which were most prominent for age and PRD and less prominent for sex. Over time, the largest change in recipient characteristics was observed for the percentage of recipients aged 65 years or older, increasing from 18% in 2010 to 28% in 2019 for all countries combined with a similar trend in most countries. CONCLUSION: We observed large differences for age and PRD distribution between recipients of living and deceased donor kidneys and between European countries. Over time, the percentage of older first kidney transplant recipients increased.

Biomarkers and their combination in a prediction of decompensation after an index hospitalization for acute heart failure.

Introduction: Heart failure (HF) still remains as one of the most common causes of hospital admission with a high mortality rate. Aim: To investigate the possible prognostic role of brain natriuretic peptide (BNP), high-sensitivity (hs) cardiac troponin (cTn) I, cystatin C, and cancer antigen 125 (CA125) in the prediction of decompensation after an index hospitalization and to investigate their possible additive prognostic value. Patients and Methods: Two hundred twenty-two patients hospitalized with acute HF were monitored and followed for 18 months. Results: BNP at discharge has the highest sensitivity and specificity in the prediction of decompensation. For a cutoff value of 423.3 pg/ml, sensitivity was 64.3% and specificity was 64.5%, with a positive predictive value of 71.6% and an area under the curve (AUC) of 0.69 (P < 0.001). The hazard risk (HR) for decompensation when the discharge BNP was above the cutoff value was 2.18. Cystatin C, at a cutoff value of 1.46 mg/L, had a sensitivity of 57% and specificity of 57.8%, with a positive predictive value of 65.8% and an AUC of 0.59 (P = 0.028). CA125, in the prediction of decompensation in patients with acute heart failure (AHF) and at a cutoff value of 80.5 IU/L, had a sensitivity of 60.5% and specificity of 53.3%, with a positive predictive value of 64.5% and an AUC of 0.59 (P = 0.022). The time till onset of decompensation was significantly shorter in patients with four versus three elevated biomarkers (P = 0.047), with five versus three elevated biomarkers (P = 0.026), and in patients with four versus two elevated biomarkers (P = 0.026). The HR for decompensation in patients with five positive biomarkers was 3.7 (P = 0.001) and in patients with four positive biomarkers was 2.5 (P = 0.014), compared to patients who had fewer positive biomarkers. Conclusion: BNP, cystatin C, and CA125 are predictors of decompensation, and their combined usage leads to better prediction of new decompensation.

The Role of Dyslipidemia in Atherogenesis in Peritoneal Dialysis Patients.

Background: To evaluate atherosclerotic changes in carotid arteries (CCA) in uremic patients before and after 18 months of continuous ambulatory peritoneal dialysis (CAPD) treatment, and to evaluate the impact of dyslipidemia and CAPD treatment on vascular remodeling. Materials and Methods: We conducted a longitudinal, prospective study during 2020 and 2021 at the Clinic for Nephrology, Clinical Center University of Sarajevo. Patients with end-stage renal disease were included and were followed during 18 months of CAPD treatment. All patients were treated using commercially prepared biocompatible balanced dialysis solutions. Carotid intima-media thickness (IMT) and atherosclerotic plaques on the common carotid artery (CCA) were measured by echotomography. Results: A total of 50 patients were included and were followed during 18 months of CAPD treatment. Lipid values in the serum of patients with CAPD were significantly lower after 18 months of CAPD treatment compared to the values before treatment, while the value of high-density lipoprotein (HDL) was significantly increased after 18 months of CAPD treatment. The values of IMT and the diameter of the CCA compared to the basal values were significantly lower (P < 0.001). Conclusion: We demonstrated significantly lower lipid values and higher HDL levels following CAPD treatment. Correct selection of the targeted pharmacological intervention can substantially impact the regression of vascular changes in patients on peritoneal dialysis.

Lipid status and carotid intima-media thickness in patients with end-stage renal disease.

Aim To assess morphological characteristics of carotid blood vessels in uremic patients before to the initiation of the dialysis treatment, and corelate data with various dialysis therapy modules. Methods The study included 30 patients with end-stage renal disease (ERDS) prior to commencing dialysis, 30 patients treated with haemodialysis and 30 patients treated with continuous ambulatory peritoneal dialysis. The control group consisted of 15 subjects with normal kidney function (eGFR>60ml/min). Carotid intima-media thickness (CIMT), as well as lipid status values (cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), apolipoprotein A, apolipoprotein B) were evaluated. Results The significant difference in CIMT was detected between the control and haemodialysis groups (p<0.001), and between the control and the peritoneal dialysis group (p=0.004). In patients in the predialysis group, CIMT was influenced by cholesterol (p=0.013), HDL (p=0.044), LDL (p=0.001) and ApoB (p=0.042) values. A significant difference in CIMT was proved between the haemodialysis and predialysis group of patients (p<0.001). The only variable from the patient's lipometabolic profile significantly associated with the change in IMT in uremic patients was HDL. A significant difference was found in the average value for systolic blood pressure (p<0.001) and diastolic blood pressure (p=0.018) in patients before starting the dialysis treatment compared to patients treated with other dialysis methods. Conclusion Patients on haemodialysis treatment had a significantly greater CIMT, which is in relation with a higher cardiovascular risk.

Minimally invasive coronary artery bypass (MICS CABG) in Bosnia and Herzegovina: a single centre, single surgeon cohort experience.

Aim This is the first research in Bosnia and Herzegovina presenting minimally invasive coronary artery bypass grafting surgery (MICS CABG) experience, advantages, and outcomes as compared to conventional surgery (OPEN CABG). Methods This retrospective cross-sectional study was conducted between January 2019 and November 2022 and included patients with indication for surgical revascularization. Results Among 237 patients, males predominated, 182 (76.7%), with a mean body mass index (BMI) of 28.4±3.9, median The Society of Thoracic Surgery Risk (STS) score of 1.55 (0.8, 4.0), short term STS score of 11.2 (6.8, 23.7), mean age of 64.8±8.7 (ranging 41-83) years, 122 (51.4%) underwent OPEN CABG and 115 (48.6%) MICS CABG. MICS CABG took less time (p<0.001; OPEN 3.5±0.8h; MICS 2.8±0.8h) and needed less mechanical ventilation (p<0.001, OPEN 17.3±11.9h; MICS 13.0±12.5h) than OPEN CABG. Even though there was no difference in hospitalization length between groups (OPEN (7.5±3.2), MICS (7.1±4.0)), patients receiving MICS (2.9±1.5) spent less time in the ICU (p=0.0013) than OPEN CABG (3.6±2.8). OPEN CABG used also more blood derivatives, red blood cells (OPEN 292 vs MICS 55), plasma (OPEN 270 vs MICS 86) and platelets (OPEN 71 vs MICS 28). Conclusion Patients undergoing MICS CABG in Bosnia and Herzegovina had less mechanical ventilation hours and less ICU duration compared to OPEN CABG even though the hospitalization duration was very similar. MICS CABG takes less time to be conducted, has fewer CPRs postoperatively, uses less blood derivatives including red blood cells, plasma and platelets.

Triglyceride level as a potential marker of residual cardiovascular risk and its relation to HeartScore.

BACKGROUND: Atherosclerotic cardiovascular diseases (ASCVD) are still the leading cause of morbidity and mortality in Bosnia and Herzegovina. Elevated LDL-cholesterol is established as a strong marker of cardiovascular risk. Some researchers believe that measuring triglyceride levels gives a good assessment of the residual risk for ASCVD besides the measurement of LDL-cholesterol. OBJECTIVE: The aim of this study was to evaluate the overall prevalence of major risk factors for ASCVD, lipid profile and 10-year fatal cardiovascular risk using the HeartSCORE scoring system. Further, we want to evaluate the prevalence and relationship between elevated triglyceride levels and high 10-year fatal cardiovascular risk calculated as a HeartSCORE. METHODS: This is a cross-sectional study conducted on 832 volunteers aged between 40 and 65 years without a diagnosis of diabetes and without known preexisting cardiovascular disease, as a part of the preventive program conducted at the Family Medicine office. Data were collected for ASCVD risk factors and lipid panel (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides). 10-year fatal cardiovascular risk was calculated using the HeartSCORE scoring system for countries with high CV risk. RESULTS: Among 832 participants included, 565 (67.9%) were female, and 267 (32.1%) were male. We found high prevalence of hypertension (27.7%), obesity (32.2%), and smoking (36.2%). All lipid parameters, except HDL-C, were not optimal. Only 17.4% of participants had normal estimated HeartSCORE risk, while more than one-third (33.9%) had high or very high estimated HeartSCORE risk. Although we found a higher percentage of participants with elevated triglycerides in groups with higher HeartSCORE, there was a very weak positive correlation between values of triglycerides and the 10-year risk of a fatal cardiovascular event (r= 0.249, p= 0.000). CONCLUSION: The high prevalence of major known risk factors and high estimated HeartSCORE risk indicate a high overall risk for ASCVD in the sample. The proportion of participants with elevated triglycerides was increased in patients with high HeartSCORE risk what implicates importance of triglyceride measurement.

Acute Kidney Injury Classifications in the Prediction of In-hospital Mortality and Renal Function Non-recovery.

Background: In the last two decades diagnostic criteria for acute kidney injury (AKI) were developed: Risk, Injury, Failure, Loss of Kidney Function, End-Stage Kidney Disease (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) classifications. Objective: The study aimed to determine the incidence of AKI based on the RIFLE, AKIN, and KDIGO criteria, as well as analyze their predictive value for mortality and renal function outcome. Methods: This was a single-center prospective study of patients diagnosed with AKI. Acute kidney injury was defined and classified according to the RIFLE, AKIN, and KDIGO criteria. The outcomes were renal function outcome and in-hospital mortality. Results: The incidence rates of AKI based on the RIFLE, AKIN, and KDIGO criteria were 13.4%, 14-36%, and 14.64%, respectively. Multiple regression analysis showed that higher stages of AKI according to the KDIGO criteria were independently associated with non-recovery of renal function (p=0.011). However, the predictive ability of RIFLE, AKIN and KDIGO classifications for renal function recovery was poor (Area Under the Receiver Operating Characteristics-AUROC=0.599, AUROC=0.637, AUROC=0.659, respectively). According to the RIFLE and AKIN criteria, in-hospital mortality was statistically significantly higher in stage Failure/3 (p=0.0403 and p=0.0329, respectively) compared to stages Risk/1 and Injury/2. Receiver Operating Characteristics (ROC) analysis showed that all three classifications had poor predictive ability for in-hospital mortality (AUROC=0.675, AUROC=0.66, AUROC=0.681). Conclusions: KDIGO classification is an independent predictor of renal function non-recovery. However, by ROC analysis, all three classifications have poor predictive ability for renal function outcome and mortality.

Serum Creatinine versus Corrected Cockcroft-Gault Equation According to Poggio Reference Values in Patients with Arterial Hypertension.

Introduction: Serum creatinine is not enough sensitive marker for the evaluation of glomerular filtration rate (GFR). Cockcroft-Gault (CG) formula is often used to assess GFR, but it is necessary to correct original one for body surface area (BSA), adipositas, and the creatinine tubular secretion. The values of the estimated creatinine clearance and GFR are considered to Poggio reference ones according to biological parameters (age and gender). The aim of the study was to determine the difference in renal function estimation between serum creatinine and corrected CG equation according to the Poggio reference values in the arterial hypertension patients. Materials and Methods: The research included 124 patients of both gender with arterial hypertension, excluding ones with the already verified chronic kidney disease. We estimated creatinine clearance and GFR by CG method corrected for the BSA, body mass index (BMI), and the creatinine tubular secretion according to Poggio reference values. Results: There was no significant difference in both age and gender groups among patients with physiological and pathological values of the renal function determined by the serum creatinine and estimated creatinine clearance by CG equation corrected for BMI, BSA. In both age and gender groups there was significant difference among subjects with physiological and pathological values of the renal function determined by serum creatinine and estimated GFR by CG method corrected for BMI, BSA, and creatinine tubular secretion. Conclusion: There is the most striking difference in the assessment of renal function between serum creatinine and estimated GFR by CG method with three corrections (BSA, BMI, the creatinine tubular secretion). Estimated GFR by CG method with three corrections can help in the early diagnosis of renal dysfunction and optimal treatment in patients with arterial hypertension.

Hemodialysis Parameters and Pulse Wave Velocity.

Aim: The study aimed to evaluate the acute effect of ultrafiltration on the mechanical properties of the aorta using brachial-ankle pulse wave velocity (PWV) before and after hemodialysis (HD). Patients and Methods: This study included 80 patients who were on a long-term HD program. The input variables were anamnestic data, body composition monitor (BCM) parameters, and echocardiography findings. The assessment of hydration status was determined by BCM, whose work is based on the principle of multifrequency bioimpedance spectroscopy. Another diagnostic procedure was the use of an arteriograph apparatus to assess PWV and Augmentation Index (AIx). All measurements were performed before and after dialysis on the middle dialysis day of the week. Results: The participants were divided into two groups based on hydration status: the experimental group consisted of 40 overhydrated participants and the control group consisted of 40 normovolemic participants. Statistically, the following BCM parameters correlated significantly positively with PWV: total body fat (r = 0.222; P < 0.05), overhydration (r = 0.290; P < 0.001), and relative overhydration (r = 0.290; P < 0.001). From echocardiography findings, only left atrial diameter correlated statistically significantly positively with PWV (r = 0.359; P < 0.001). Comparison of the mean PWV values within the experimental group before and after HD showed a statistically significant decrease from 14.32 ± 2.34 m/s to 8.72 ± 1.52 m/s (Z = 3.254; P = 0.0001). Mean PWV values within the control group did not decrease significantly from 13.39 ± 1.32 m/s to 10.39 ± 1.18 m/s (Z = 0.524; P = 0.742). If we compare the mean values of PWV between groups, then before HD treatment, there was no statistically significant difference between groups with PWV values in the experimental group of 14.32 ± 2.34 m/s and the control group of 13.39 ± 1.32 m/s (Z = 0.762; P = 0.852). According to the results of univariate regression analysis before and after HD treatment, only overhydration showed an absolute effect on PWV before and after HD. Conclusion: Overhydration showed an effect on brachial-ankle PWV before and after HD, and brachial-ankle PWV should be followed in HD patients.

Assessment of Retinal Microangiopathy in Chronic Kidney Disease Patients.

INTRODUCTION: Optical coherence tomography angiography (OCT-A) is a useful diagnostic tool for assessing eyes' health in patients with chronic diseases, such as diabetes, hypertension, Parkinson's disease and chronic kidney disease (CKD). AIM: To detect changes in macular structure and retinal vascular meshwork in the macular area and peripapillary in patients with chronic kidney disease (CKD). METHODS: This cross-sectional study included 80 eyes of patients with CKD in stages 2, 3 or 4, who were followed-up in the Nephrology Clinic of University Clinical Center Sarajevo. All patients were categorized according to the stage of CKD. All patients were scanned by a high-speed 840-nm-wavelength spectral-domain optical coherence tomography instrument (RTVue XR Avanti; Optovue, Inc, Fremont, California, USA). Blood flow was detected using a split-spectrum amplitude-decorrelation angiography algorithm. A fully automated microstructural analysis of the foveal avascular zone (FAZ), FAZ perimeter, foveal vessel density in a 300-µm area around the FAZ (FD), nonflow area, flow index in superficial and deep vascular plexus, choriocapillary flow, vascular density, radial peripapillary capillary density was performed. RESULTS: When comparing patients with CKD stage 2 and stage 3 there were no statistically significant changes in microvascular parameters on OCT angiography, as well as when comparing patients with CKD stage 3 and stage 4. But in the comparison between patients with less developed CKD (stage 2) and terminal CKD (stage 4) there was a significant difference between some microvascular parameters such as FAZ area, FAZ perimeter, choriocapillary flow. CONCLUSION: Many studies demonstrated that evaluation of the microvascular changes in different retinal layers using SS-OCTA may be considered as a key to assessing the systemic perfusion status. Evaluation of retinal microvasculature may ease the management and approach of patients with CKD, having in mind that the retinal and the kidney vascular network are, concerning structure, development and the function, very similar.

Serum malondialdehyde (MDA) level as a potential biomarker of cancer progression for patients with bladder cancer.

INTRODUCTION: Bladder cancer is the most common malignancy involving the urinary system. Recent research tends to emphasize the role of oxidative stress products in the carcinogenesis of bladder cancer. The level of oxidative stress can be measured by assessing the MDA levels. This study aimed to evaluate serum MDA levels in patients with bladder cancer, as well as to determine its potential role as a biomarker in the diagnosis of the disease and progression risk considerations. METHODS: The study was designed as a cross-sectional study and included 90 patients, divided into three groups with 30 patients each: Ta, T1and T2-T4 group, based on histopathological findings after transurethral resection of the tumor. The control group included 30 healthy volunteers. MDA level was determined using the spectrophotometric method. RESULTS: Serum MDA level in patients with bladder cancer [0.86 (0.78-1.05) µmol/L] was significantly higher than the serum MDA level in control group [0.70 (0.69-0.72) µmol/L] (p < 0.001). Serum MDA level in Ta group [0.73 (0.70-1.05) µmol/L], T1 group [0.85 (0.80-1.12) µmol/L] and in T2-T4 group [0.91 (0.84-1.04) µmol/L] was significantly higher than the serum MDA level in control group [0.70 (0.69-0.72) µmol/L] (p < 0.01). MDA level in T1 and T2-T4 group was significantly higher than the MDA level in Ta group (p < 0.01). No significant difference was observed in MDA level between T1 and T2-T4 group (p = NS). A statistically significant positive correlation was found between tumor size and serum MDA level in patients with bladder cancer (rho = 0.254 p < 0.01). CONCLUSIONS: The results of the present study suggest that MDA serum level might play a significant role as a biomarker in the diagnosis of bladder cancer, as well as in the monitoring of its progression.

Panton-Valentine leukocidin and staphylococcal cassette chromosome mec characterization of community acquired methicillin-resistant Staphylococcus aureus.

OBJECTIVES: Staphylococcus aureus (SA) represents one of the most important microorganism that is part of the normal microflora of humans, but in certain conditions can cause very serious infections. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for a wide spectrum of nosocomial and community associated infections worldwide. The aim of this study was to determine community acquired MRSA (CA-MRSA), as well as the frequency of Panton-Valentine leukocidin (PVL) genes and staphylococcal cassette chromosome mec (SCCmec) types in isolates obtained from outpatients in the region of 700,000 people (Canton Sarajevo, Bosnia and Herzegovina) Methods: Our investigation included phenotypic and genotypic markers such as antimicrobial resistance, pulsed-field gel electrophoresis (PFGE), SCC typing, and PVL detection. RESULTS: Antimicrobial susceptibility: all MRSA isolates were resistant to the ß-lactam antibiotics tested, and all isolates were susceptible to trimethoprim sulphamethoxazole, rifampicin, fusidic acid, linezolid, and vancomycin. After the PFGE analysis, the isolates were grouped into five similarity groups: A-E. The largest number of isolates belonged to one of two groups: C - 60% and D - 27%. In both groups C and D, SCCmec type IV was predominant (60% and 88.8%, respectively). A total of 24% of the isolates had positive expression of PVL genes, while 76% showed a statistically significantly greater negative expression of PVL genes. CONCLUSIONS: Using combination techniques, we were able to investigate the origin and genetic background of the strains. PFGE analysis revealed two large, genetically related groups of strains consisting of 87 isolates. Our results suggest failure to apply the screening policy, and a lack of knowledge about multiresistant MRSA strains. This study showed the local epidemiological situation which should be the basis of antimicrobial empiric therapy for non-hospitalized patients.

The Importance of Acinetobacter Species in the Hospital Environment.

INTRODUCTION: Acinetobacter species is associated with health care associated infections especially in patients on respiratory therapy equipment and indwelling catheters. They are becoming increasingly drug resistant. The knowledge of the prevalence and pattern of antimicrobial susceptibility pattern of Acinetobacter spp. is important. AIMS: The study is undertaken to estimate the prevalence rate, risk factors and antimicrobial resistance pattern of isolates. in Acinetobacter spp. from various clinical samples. MATERIAL AND METHODS: The isolates of Acinetobacter species obtained from various clinical specimen. Specimens were processed by standard microbiological techniques. Antimicrobial sensitivity tests of the Acinetobacter isolates were done by modified Kirby-Bauer disc diffusion method. RESULTS: Out of 622 isolates, 399 isolates were from inpatients (62,18%) and 223 were from outpatients (37,82%). More than 90% of isolates displayed resistance to ampicillin, amoxicillin-clavulanic acid, ceftazidime, caftriaxon and amikacin. Resistance to gentamicin, co-trimoxazole and ciprofloxacin were also common. Least resistance was seen to piperacillin-tazobactam and imipenem. A total of 125 Acinetobacter isolates were analyzed, out of which 78.4 % were multi-drug resistant (MDR). Of these MDR isolates, 17.24% were pan-resistant. A. baumannii was the most common species responsible for wound infection (84,8%), pneumonia(96,15%), abscess (72.7%), urinary tract infection (85,7%) and septicemia(89,5%). CONCLUSION: Multi-drug resistant Acinetobacter has emerged as an important nosocomial pathogen. Antibiotic susceptibility testing is critical in the treatment of infections caused by Acinetobacter. Continued surveillance of prevalent organisms in ICUs, combined with preventive measures remains absolutely essential in efforts to prevent or limit the spread of Acinetobacter infection.

The value of gamma glutamyltransferase in predicting myocardial infarction in patients with acute coronary syndrome.

AIM: To assess the utility of gamma-glutamyl transferase (GGT) and C-reactive protein (CRP) in predicting troponin elevation in patients with acute coronary syndrome. PATIENTS: The total of 119 patients were divided into troponin-positive (n = 61) and troponin-negative (n = 58) patients. RESULTS: CRP cut-off value ≥13.4 mg/l had the sensitivity of 68.1% and specificity of 62.5%, while the GGT cut-off value ≥61.5 IU/l had the sensitivity of 66.0% and specificity of 62.0% and combined use of both CRP and GGT had 71.4% sensitivity and 69.6% specificity in predicting troponin increase in acute coronary syndrome patients. CONCLUSION: GGT might be used as an adjuvant marker for risk assessment patients who present with chest pain and are suspected to have acute coronary syndrome.

Typing of Methicillin Resistant Staphylococcus Aureus Using DNA Fingerprints by Pulsed-field Gel Electrophoresis.

BACKGROUND: Methicillin resistant Staphylococcus aureus (MRSA) is responsible for a wide spectrum of nosocomial and community associated infections worldwide. The aim of this study was to analyze MRSA strains from the general population in Canton Sarajevo, B&H. METHODS: Our investigation including either phenotypic and genotypic markers such as antimicrobial resistance, pulsed-field gel electrophoresis (PFGE), SCC typing, and Panton-Valentine leukocidin (PVL) detection. RESULTS: Antimicrobial susceptibility: all MRSA isolates were resistant to the ß-lactam antibiotics tested, and all isolates were susceptible trimethoprim sulphamethoxazole, rifampicin, fusidic acid, linezolid and vancomycin. Sixty-eight per cent of the MRSA isolates were resistant to erythromycin, 5% to clindamycin, 5% to gentamicin and 4% to ciprofloxacin. After the PFGE analysis, the isolates were grouped into five similarity groups: A-E. The largest number of isolates belonged to one of two groups: C: 60 (60%) and D: 27 (27%). In both groups C and D, SCCmec type IV was predominant (60% and 88, 8%, respectively). A total of 24% of the isolates had positive expression of PVL genes, while 76% showed a statistically significantly greater negative expression of PVL genes. CONCLUSION: SCCmec type IV, together with the susceptibility profile and PFGE grouping, is considered to be typical of CA-MRSA.

Prognostic indicators of adverse renal outcome and death in acute kidney injury hospital survivors.

INTRODUCTION: Data regarding prognostic factors of post-discharge mortality and adverse renal function outcome in acute kidney injury (AKI) hospital survivors are scarce and controversial. OBJECTIVES: We aimed to identify predictors of post-discharge mortality and adverse renal function outcome in AKI hospital survivors. PATIENTS AND METHODS: The study group consisted of 84 AKI hospital survivors admitted to the tertiary medical center during 2-year period. Baseline clinical parameters, with renal outcome 3 months after discharge and 6-month mortality were evaluated. According survival and renal function outcome, patients were divided into two groups. RESULTS: Patients who did not recover renal function were statistically significantly older (P < 0.007) with higher Charlson comorbidity index (CCI) score (P < 0.000) and more likely to have anuria and oliguria (P = 0.008) compared to those with recovery. Deceased AKI patients were statistically significantly older (P < 0.000), with higher CCI score (P < 0.000), greater prevalence of sepsis (P =0.004), higher levels of C-reactive protein (CRP) (P < 0.017) and ferritin (P < 0.051) and lower concentrations of albumin (P<0.01) compared to survivors. By multivariate analysis, independent predictors of adverse renal outcome were female gender (P =0.033), increasing CCI (P =0.000), presence of pre-existing chronic kidney disease (P =0.000) and diabetes mellitus (P =0.019) as well as acute decompensated heart failure (ADHF) (P =0.032), while protective factor for renal function outcome was higher urine output (P =0.009). Independent predictors of post-discharge mortality were female gender (P =0.04), higher CCI score (P =0.001) and sepsis (P =0.034). CONCLUSION: Female AKI hospital survivors with increasing burden of comorbidities, diagnosis of sepsis and ADHF seem to be at high-risk for poor post-discharge outcome.

Inflammatory Markers and Procoagulants in Chronic Renal Disease Stages 1-4.

INTRODUCTION: Starting from the point that the chronic kidney disease (CKD) is chronic, inflammatory and hypercoagulable state characterized by an increase in procoagulant and inflammatory markers high cardiovascular morbidity and mortality in these patients could be explained. AIM: The aim of the research was to monitor inflammatory markers and procoagulants in various stages of kidney disease (stage 1-4). MATERIALS AND METHODS: The research included 120 subjects older than 18 years with CKD stages 1-4 examined and monitored in Clinic of Nephrology, University Clinical Centre Sarajevo over a period of 24 months. The research included determining the following laboratory parameters: serum creatinine, serum albumin, C-reactive protein, leukocytes in the blood, plasma fibrinogen, D-dimer, antithrombin III, coagulation factors VII (FC VII) and coagulation factor VIII (FC VIII). RESULTS: With the progression of kidney disease (CKD stages 1-4), there was a significant increase of inflammatory and procoagulant markers: CRP, fibrinogen and coagulation factor VIII, and an increase in the average values of leukocytes and a reduction in the value of antithrombin III, but without statistical significance. Also, there were no significant differences in the values of D-dimer and coagulation factor VII. CONCLUSION: The progression of kidney disease is significantly associated with inflammation, which could in the future be useful in prognostic and therapeutic purposes. Connection of CKD with inflammation and proven connection of inflammation with cardiovascular risk indicates the potential value of some biomarkers, which could in the future identify as predictors of outcome and could have the benefit in the early diagnosis and treatment of cardiovascular disease in CKD.

Influence of Malondialdehyde and Matrix Metalloproteinase-9 on Progression of Carotid Atherosclerosis in Chronic Renal Disease with Cardiometabolic Syndrome.

Objective was to assess whether the concentration of malondialdehyde (MDA) as a marker of lipid peroxidation and serum concentration of matrix metalloproteinase-9 (MMP-9) are involved in the process of atherosclerosis in chronic kidney disease (CKD) patients nondialysis-dependent and those on peritoneal dialysis (PD), both with signs of cardiometabolic syndrome (CMS). Thirty CKD and 22 PD patients were included in a study. All observed patients were divided into three subgroups depending on the degree of atherosclerotic changes in the carotid arteries (CA). Severity of atherosclerotic changes in the CA was evaluated by ultrasonography. We confirmed significantly lower level of serum MDA throughout all the stages of atherosclerosis in PD patients compared with observed CKD patients (P < 0.05) and increased serum concentration of MDA and MMP-9 with the progression of severity atherosclerotic changes in both groups of patients. The multiple regression analysis revealed that MDA and MMP-9 are significant predictors of changes in IMT-CA CKD patients (P < 0.05) and plaque score on CA in these patients (P < 0.05). The results suggest that MDA and MMP-9 could be mediators of CKD-related vascular remodeling in CMS.

The Effect of Preserved Residual Renal Function on Left Ventricular Structure in Non-Anuric Peritoneal Dialysis Patients.

BACKGROUND/AIMS: Residual renal function (RRF) has been shown to influence survival of peritoneal dialysis (PD) patients. This study examined the relations between RRF and left ventricular hypertrophy (LVH) before switching on dialysis treatment and observed during 18 months on PD treatment. METHODS: A prospective longitudinal study was performed in 50 non-anuric (defined as >200 mL urine output in a 24-hour period) PD patients. Echocardiography, RRF and other known risk factors for the increase of LV mass index (LVMi) were determined at study baseline and the end of follow-up. RESULTS: There was 78% patients with LVH in end-stage renal disease (ESRD) baseline and 60% at the end of follow-up. RRF at the start of the study showed no significant difference between patients with normal and increased LVMi, as well as in daily collection of urine. After 18 months, patients with decreased LVMi had better RRF, lower CRP and better Kt/V compared to patients with increased LVMi (p < 0.001). Patients with better preserved RRF not only had significantly higher total Kt/V, but were less anemic and hypoproteinemic and lesser presence of LVH. CONCLUSIONS: PD in non-anuric ESRD patients the first 18 months has a positive effect on the preservation of RRF and partial regression of left ventricular remodeling.

Valvular calcification and left ventricular modifying in peritoneal dialysis patients.

BACKGROUND: Cardiac valve calcification (CVC) and left ventricular (LV) alterations are frequent complication in end-stage renal disease (ESRD). We determined the prevalence of CVC and LV hypertrophy (LVH) in ESRD patients before renal replacement therapy and 12 months after peritoneal dialysis (PD). METHODS: A prospective longitudinal of 50 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1-year of follow-up. CVC and LVH were evaluated by M-mode two-dimensional echocardiography. RESULTS: CVC of the mitral and aortic valves and of both valves were noted in 30, 18 and 10% of patients, respectively. After 12 months of PD regimen, 20% patients had aortic, 24% mitral and 8% had calcification of both valves. After one year of PD, LVH was 62 and 36% in patients with and without CVC, respectively (p < 0.05). Endothelin-1 is an independent predictor of CVC at the baseline, while nitric oxide is inversely an independent predictor at the end of follow-up. CONCLUSIONS: CVC is associated with LVH in PD patients. These findings identified a potential role for monitored markers to be incorporated into therapeutic strategies aimed at detection and treatment of cardiovascular complications and prevention strategies.