Green Dialysis: Let Us Talk about Dialysis Fluid.

BACKGROUND: Hemodialysis is one of the most resources consuming medical intervention. Due to its concept, the proper amount of dialysis fluid passed through dialyzer is crucial to obtain the expected outcomes. The most frequent source of dialysis fluid is production from liquid concentrate (delivered in containers or plastic bags) in dialysis machine. Alternatively, concentrates for dialysis may be produced in dialysis center by dilution in mixing devices dry or semidry premixed compounds connected with system of central dialysis fluid delivery system. Dialysate consumption depends on various factors like type of hemodialysis machine, session duration, prescribed flow, etc. Summary: Modern hemodialysis machines are equipped with the modules which automatically reduce flow rate of dialysis fluid to the patient blood flow and minimize dialysate consumption during preparation and after reinfusion. Smart using of available options offered by manufacturers allows to save additional portion of acid concentrate and water. The weight of concentrates to be delivered to the dialysis center is the major factor influencing the cost (financial and environmental) of transportation from the manufacturer to the final consumer. The crisis on the energy carriers market and extremely high fuel prices made the transportation cost one of the significant costs of the treatment, which must be bear by supplier and finally influence on the price of goods. KEY MESSAGES: The careful choice of the concentrate delivery system can improve cost-effectiveness of dialysis. Such solutions implemented in dialysis unit helps make significant savings and decrease the impact on natural environment by carbon footprint reduction.

Malignancy Prevalence in the Dialyzed Population and in Waitlisted Potential Kidney Transplant Recipients.

Malignancy is the second cause of death in the dialyzed population. However, data on the prevalence of cancer are very scarce. Kidney transplantation improves quality of life, prolongs survival, and is cost-effective but bears some serious complications including malignancy. Therefore, active screening for cancer is of utmost importance. The aim of this study was to assess the prevalence of malignancy in dialyzed patients in relation to status on the on the waiting list and type of dialysis. This cross-sectional study was conducted in 108 hemodialyzed patients (mean age 65 years, 47 women) and 47 peritoneally dialyzed patients (mean age 51 years, 25 women). Among the population studied, 20 patients were actively waitlisted, including 14 peritoneal dialysis patients. Patients who had been active on the cadaver kidney waiting list and not listed did not differ in regard to sex, dialysis vintage, and causes of end-stage renal failure, but were significantly younger. Among hemodialysis patients, 24 of them had a history of malignancy and 10 in the peritoneal dialysis population. The most common were renal cell carcinoma in 6, breast cancer in 4, lung cancer in 3, prostate cancer in 3, hepatocellular cancer in 2, colorectal cancer in 2, esophageal cancer in 2, and others 14. In waitlisted patients, only 2 hemodialysis patients had a history of malignancy. Waitlisted patients represent a very selected and healthier dialyzed population. Malignancy has become a more common comorbidity in dialyzed patients, which may have important clinical implication regarding therapy. Guidelines for cancer screening in potential transplant recipients should be developed, as nowadays there are scarcity of data in this matter.

Kidney Transplant Recipients Have Higher Malignancy Prevalence Than Hemodialyzed Patients.

BACKGROUND: Kidney transplant is the preferred therapy for end-stage kidney disease; however, it has been associated with some serious complications, including malignancy, which became the second leading cause of death among kidney allograft recipients. The aim of this study was to assess the prevalence of malignancy in hemodialyzed patients and in kidney transplant recipients. METHODS: A cross-sectional study was conducted in 114 prevalent hemodialyzed patients, including 7 on the waiting list and 350 kidney allograft recipients. Hemodialyzed patients and kidney allograft recipients did not differ in regard to sex, dialysis vintage, and cause of end-stage renal failure, but were significantly older. RESULTS: Among wait-listed patients, only 1 had a history of malignancy (gastric cancer stage G1). Among kidney allograft recipients, in 70 patients, malignancy developed (in total 20% of the studied population). The leading malignancy was skin cancer (18 cases), followed by post-transplant lymphoproliferative disorder (PTLD) in 10 cases, lung cancer (small cell and non-small cell lung cancer; 4 cases), renal cell carcinoma (3 cases), brain cancer (glioma; 3 cases), colorectal cancer (3 cases), Kaposi sarcoma (2 cases), Merkel carcinoma (2 cases), metastatic disease of unknown origin (2 cases), and other 23 malignancies were in a single patient (including 1 leukemia and 1 multiple myeloma). Twenty-six deaths were recorded in kidney allograft recipients with malignancy, mainly in PTLD, Kaposi sarcoma, Merkel carcinoma, sarcoma, glioma, and melanoma. CONCLUSIONS: Despite the lower prevalence of malignancy on hemodialyzed population, cancer screening in both potential transplant recipients and kidney allograft recipients is a prerequisite, because nowadays there is a scarcity of data in this area. It may be due to previous immunosuppression, long-term dialysis vintage, immunocompromised status, and immunosuppressive therapy after transplant, in particular in high-risk patients.

CANCER IN DIALYSIS PATIENTS.

Cancer in dialysis patients is a common problem and is one of the most common reasons of mordibity and mortality in developed countries. An impaired renal function leads to the accumulation in the blood products of nitrogen transformation, which negatively affect organ function, especially the immune system. The Standardized Cancer Incidence is higher in patients with end-stage kidney failure than in the general population and reaches 1,18-1,42. The cancer risk is three times higher in dialysis patients over age 65 years and is more common among hemodialysis than peritoneal dialysis patients. The most common type of cancer occurring in this group of patients is urinary tract cancer which often develops on the basis of acquired cysts and in patients previously treated with cyclophosphamide. Nonetheless, patients with kidney problems are not regularly tested for these diseases and the only group that is screened for cancer are patients tested for kidney transplantation. Some problems in this topic are briefly presented in this article.

Malignancy Prevalence in Waitlisted Potential Kidney Transplant Recipients Is Very Low Relative to Patients After Kidney Transplantation.

Kidney transplantation improves quality of life, prolongs survival, and is cost-effective, but bears some serious complications including malignancy. The aim of this study was to assess the prevalence of malignancy in dialyzed patients on the waiting list and in kidney allograft recipients. The cross-sectional study was conducted in 50 prevalent patients on the waiting list and 300 kidney allograft recipients. Patients who had been registered in the cadaver kidney waiting list and kidney allograft recipients did not differ in regard to age, sex, dialysis vintage, and causes of end-stage renal failure. In waitlisted patients, only 3 had a history of malignancy. In kidney allograft recipients, 52 patients developed malignancy. The leading malignancy was skin cancer with 9 cases, followed by post-transplant lymphoproliferative disorder in 5 cases, Kaposi sarcoma in 2 cases, brain cancer in 2 cases, Merkel carcinoma in 2 cases, lung cancer (small cell and non--small cell), unknown origin in 2 cases, and the other 22 malignancies were in single patients (including 1 leukemia and 1 multiple myeloma). Seventeen deaths were recorded in kidney allograft recipients with malignancy mainly in post-transplant lymphoproliferative disorder, Kaposi sarcoma, Merkel carcinoma, sarcoma, and brain cancer. Concluding, waitlisted patients represent a very selected and healthier dialyzed population. Guidelines for cancer screening in both potential transplant recipients and kidney allograft recipients should be developed as nowadays a scarcity of data exists in this matter. Minimization of immunosuppressive regimen should be considered, in particular, in high-risk patients.

[The results of treatment patients with hepatorenal syndrome. The analysis of 65 cases]. / Wyniki leczenia zespolu watrobowo-nerkowego. Analiza 65 przypadków.

We analysed medical documentation of 65 patients with alcoholic cirrhosis admitted to the Internal Diseases Department with Dialysis Ward in the hospital in Wolomin between 2002 and 2004 year. Patients were divided into 3 groups according to renal disfunction: patients with HRS-1, patients with HRS-2 and patients with cirrhosis without renal failure. Each diagnosis was established basing on criteria of International Ascites Club. Different factors, which may influence a development of HRS, such as large--volume paracentesis without plasma expansion, bacterial infections, gastrointestinal bleeding and nephrotoxic drugs were analysed. Patients were treated with terlipressin and intravenous albumin infusions, antibiotics, diuretics, dopamine, haemodialysis and paracentesis. 10 patients (3 with HRS-1.5 with HRS-2 and 2 without renal failure) died, which is 15.4% of the all group. The mortality in the group of patients with HRS is high but complex treatment may be effective. Nowadays liver transplantation is the most effective method.

[Hepatorenal syndrome. Cases report]. / Zespól watrobowo-nerkowy. Opis przypadków.

The hepatorenal syndrome is defined as renal failure in patients with severe liver disease. It may be diagnosed by exclusion of other potential factors which may cause renal failure, such as hypovolaemia, nephrotoxic drugs and severe bacterial infection. Liver transplantation is the target treatment leading to recovery of renal function. Other methods such as vasoconstrictors, renal replacement therapy and repeated paracenthesis with intravenous albumin infusions are also presented.