The Nephrotoxicity of Drugs Used in Causal Oncological Therapies.

In recent years, a dynamic development of oncology has been observed, resulting from the increasingly frequent occurrence of neoplasms and therefore, increasing population of patients. The most effective form of therapy for cancer patients is complex multidisciplinary specialized disease management, including nephro-oncology care. Different forms of renal function impairment are frequently diagnosed in cancer patients. They are caused by different co-morbidities existing before starting the oncologic treatment as well as the direct undesirable effects of this therapy which may cause temporary or irreversible damage of the urinary system-especially kidneys. According to different therapeutic programs, in such cases the degree of renal damage is often crucial for the possibility of further anti-cancer treatment. Medical personnel responsible for delivering care to oncology patients should be properly educated on current methods of prevention and treatment of renal complications resulting from anti-cancer therapy. The development of oncologic medicines design, including especially immuno-oncological agents, obliges us to learn new patomechanisms determining potential adverse effects, including renal complications. This publication is focused on the most important undesirable nephrotoxic effects of the frequently used anti-cancer drugs.

Continuous renal replacement therapy as a treatment of selected acute intoxications.

The methods of extracorporeal elimination remain a particularly useful therapy of selected, most severe intoxications caused by drugs and other chemical substances. The hemodialysis (HD) is the most commonly used therapy, which results from the widest availability of this method. However, due to the gradual spread of modern continuous dialysis techniques, continuous veno-venous hemodialysis (CVVHD) in particular creates a new opportunity of treatment of severe intoxications - especially in patients with cardiovascular complications. The review of literature dealing with the experience in using continuous methods of treatment of selected severe intoxications is presented in the article. Taking into account a lack of analyses assessing the efficacy of different toxicological methods used in large populations of patients, the experiences are mainly based on individual case reports. The presented data indicate that CVVHD may be treated as the preferred method of treatment of severe intoxications in hemodynamically unstable patients. Moreover, CVVHD may be useful as a continuation of therapy following the initial HD treatment.

[Sepsis - still valid economic and epidemiological problem]. / Sepsa ­ wciaz aktualny problem epidemiologiczny i ekonomiczny.

The recognition of sepsis is connected with potentially bad prognosis, high mortality rate and high costs of the therapy. A new definition of sepsis was introduced in 2016. The main role of dysfunction of organs in the course of infection, the potential threat for life and necessity to perform quick diagnosis result from this definition. The review of worldwide literature on sepsis epidemiology and therapy costs was done in the current article. It was observed that the data concerning incidence of sepsis in Polish hospitals are incomplete, related to single observations, and in most cases they come from retrospective analyses. Therefore, the nation-wide registry comprising the data of the sepsis cases should be established.

Changes of peritoneal transport parameters with time on dialysis: assessment with sequential peritoneal equilibration test.

BACKGROUND: Sequential peritoneal equilibration test (sPET) is based on the consecutive performance of the peritoneal equilibration test (PET, 4-hour, glucose 2.27%) and the mini-PET (1-hour, glucose 3.86%), and the estimation of peritoneal transport parameters with the 2-pore model. It enables the assessment of the functional transport barrier for fluid and small solutes. The objective of this study was to check whether the estimated model parameters can serve as better and earlier indicators of the changes in the peritoneal transport characteristics than directly measured transport indices that depend on several transport processes. METHODS: 17 patients were examined using sPET twice with the interval of about 8 months (230 ± 60 days). RESULTS: There was no difference between the observational parameters measured in the 2 examinations. The indices for solute transport, but not net UF, were well correlated between the examinations. Among the estimated parameters, a significant decrease between the 2 examinations was found only for hydraulic permeability LpS, and osmotic conductance for glucose, whereas the other parameters remained unchanged. These fluid transport parameters did not correlate with D/P for creatinine, although the decrease in LpS values between the examinations was observed mostly for patients with low D/P for creatinine. CONCLUSIONS: We conclude that changes in fluid transport parameters, hydraulic permeability and osmotic conductance for glucose, as assessed by the pore model, may precede the changes in small solute transport. The systematic assessment of fluid transport status needs specific clinical and mathematical tools beside the standard PET tests.

Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients.

During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21-87) years; median time on PD 19 (3-100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (α u), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters--rather than solute transport parameters--are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

Can the three pore model correctly describe peritoneal transport of protein?

The three pore model (3PM) includes large pores for the description of protein leak to the peritoneal cavity during peritoneal dialysis. However, the reliability of this description has been not fully tested against clinical data yet. Peritoneal transport parameters were estimated using 3PM, extended 3p model (with estimation of fraction of large pores, ext3PM), ext3PM with modified size of pores and proteins (mext3PM), and simplified two pore (2PM, small and ultrasmall pores) models for 32 patients on peritoneal dialysis investigated using the sequential peritoneal equilibration test (consecutive peritoneal equilibration test [PET]: glucose 2.27%, 4 h, and miniPET: glucose 3.86%, 1 h). Urea, creatinine, glucose, sodium, phosphate, albumin, and IgM concentrations were measured in dialysis fluid and plasma. Ext3PM and mext3PM, with large pore fraction of about 0.14, provided a good description of fluid and small solute kinetics, but their predictions for albumin transport were less accurate. Two pore model precisely described the data on fluid and small solute transport. The 3p models could not describe the diffusive-convective transport of albumin as precisely as the transport of fluid, small solutes, and IgM. The 2p model (not applicable for proteins) was an efficient tool for modeling fluid and small solute transport.

Sequential peritoneal equilibration test: a new method for assessment and modelling of peritoneal transport.

BACKGROUND: In spite of many peritoneal tests proposed, there is still a need for a simple and reliable new approach for deriving detailed information about peritoneal membrane characteristics, especially those related to fluid transport. METHODS: The sequential peritoneal equilibration test (sPET) that includes PET (glucose 2.27%, 4 h) followed by miniPET (glucose 3.86%, 1 h) was performed in 27 stable continuous ambulatory peritoneal dialysis patients. Ultrafiltration volumes, glucose absorption, ratio of concentration in dialysis fluid to concentration in plasma (D/P), sodium dip (Dip D/P Sodium), free water fraction (FWF60) and the ultrafiltration passing through small pores at 60 min (UFSP60), were calculated using clinical data. Peritoneal transport parameters were estimated using the three-pore model (3p model) and clinical data. Osmotic conductance for glucose was calculated from the parameters of the model. RESULTS: D/P creatinine correlated with diffusive mass transport parameters for all considered solutes, but not with fluid transport characteristics. Hydraulic permeability (L(p)S) correlated with net ultrafiltration from miniPET, UFSP60, FWF60 and sodium dip. The fraction of ultrasmall pores correlated with FWF60 and sodium dip. CONCLUSIONS: The sequential PET described and interpreted mechanisms of ultrafiltration and solute transport. Fluid transport parameters from the 3p model were independent of the PET D/P creatinine, but correlated with fluid transport characteristics from PET and miniPET.

Albuminuria and hyperhomocysteinemia as cardiovascular risk factors in potentially healthy soldiers: A long-term observation.

BACKGROUND: To assess the relations between albuminuria and selected cardiovascular risk factors. MATERIAL/METHODS: The study population comprised 200 apparently healthy soldiers aged 28.8±8.1, observed for 36 months. RESULTS: Albuminuria was revealed in 9% of the studied group at the beginning of the study and in 12.7% at the end of the observation. Albumins increased from 97.0±61.0 mg/24 hours to 165.0±25.7 mg/24 hours after 36 months of observation. The increase of diastolic blood pressure, body mass, C-reactive protein (CRP), and low-density lipoprotein (LDL) was found in the "albuminuria subgroup" after 3 years of observation. This subgroup also presented significantly higher homocysteine and CRP serum concentrations in comparison with the "non-albuminuria group" in the first phase of the study and after 3 years of follow-up. CONCLUSIONS: Albuminuria was found to be a relatively frequent and persistent abnormality in the studied group. The study demonstrated the relationship between the occurrence and the severity of albuminuria and selected biochemical and demographic cardiovascular risk factors. Determination of albuminuria is a useful, early marker of cardiovascular risk in young male professional soldiers.

Acute kidney failure complicating carbon monoxide poisoning.

BACKGROUND: Carbon monoxide, albeit common, is rarely associated with renal failure. We report a case of CO-associated kidney failure requiring short-term dialysis. CASE REPORT: A 33 year-old male was found unconscious in a bathroom equipped with a propane-gas heater. The duration of exposure to carbon monoxide was unknown. The patient was transported to a regional hyperbaric centre;the carboxyhaemoglobin concentration in the blood on admission was 38.3%. After 60 min of exposure to hyperbaric oxygen, he regained consciousness and was transferred to the toxicology department. Mild rhabdomyolysis with acute kidney failure was diagnosed and despite two subsequent hyperbaric sessions, haemodialysis was necessary.The kidney failure resolved within two weeks, and the patient made a full recovery.Discussion and conclusions. Carbon monoxide mainly affects the central nervous system and the myocardium;renal failure may occur due to rhabdomyolysis and hypoxia. Therefore, all CO-poisoned patients should be closely monitored for their renal function.

Efficacy of peritoneal dialysis during infusion and drainage procedures.

BACKGROUND: Inadequate dialysis is still a major cause of technique failure in peritoneal dialysis (PD). Mathematical models provide the possibility of direct and precise assessment of peritoneal transport of urea and creatinine throughout the dwell and allow calculation of optimal schedules, dwell times, and predicted adequacy of a prescribed regimen. Kinetic modeling is particularly important for automated PD. If the effectiveness of uremic toxin removal that takes place during infusion and drainage of dialysis fluid is not taken into account, the predicted adequacy of the whole PD session may be underestimated. ♢ AIMS: To estimate the efficacy of urea and creatinine removal during the dialysis fluid exchange procedure. ♢ MATERIAL AND METHODS: 17 patients treated with PD were included in the study. PD effectiveness during dialysate exchange was defined as the quotient k of removed amount of creatinine/BUN during the infusion and drainage of dialysate and during a dwell of the same duration as the dialysate exchange. ♢ RESULTS: The effectiveness of creatinine and urea removal was reduced during the exchange procedure (k(creat) = 0.68 ± 0.43 and k(BUN) = 0.87 ± 0.44) and differed between these 2 solutes (p = 0.0009). The k coefficients for urea and creatinine were well correlated (R(2) = 0.83). ♢ CONCLUSIONS: The effectiveness of peritoneal transport of creatinine and BUN during the inflow/outflow phase was relatively high compared to that during the same dwell time (68% and 87% respectively). This real effectiveness of the dialysate exchange procedure should be taken into account in the process of planning automated PD sessions, otherwise the predicted overall efficacy of creatinine and urea removal throughout the session may be underestimated. This underestimation is proportional to the number of dwells per day.

[Transperitoneal transport of water and substances--between theory and practice]. / Transport przezotrzewnowy wody i substancji--miedzy teoria a praktyka.

The practical use of the own method of prediction of peritoneal dialysis adequacy, based on direct assessment of transperitoneal transport, has been presented in this study.

[Extended assessment of peritoneal transport kinetics of substances and water as an important element of integrated dialysis care]. / Rozszerzona ocena kinetyki transportu przezotrzewnowego czqsteczek i wody jako wazny element koncepcji zintegrowanej opieki dializacyjnej.

UNLABELLED: The concept of integrated dialysis care is based on the choice of the most optimal method of renal replacement therapy for particular patient in particular period of disease. In many cases peritoneal dialysis (PD) is the initial therapy. PD modalities and regimens are modified according to values of parameters of ultrafiltration and adequacy. The routinely used methods of analysis of peritoneal transport are very useful for general assessment of properties of peritoneum as a dialysis membrane. However, the application of these methods do not guarantee the full assessment of peritoneal transport kinetics of water and substances. Therefore, the capabilities of the most adequate modification are limited. The tests based on mathematical models taking into account the kinetics of intraperitoneal dialysate volume seem to be the right supplement of standard methods. MATERIALS AND METHODS: To illustrate the problem mentioned above, the aim of this study was comparison of peritoneal transport of substances and water in two groups of patients: group I with negative ultrafiltration (UF) (n=14) and group II with positive UF (n=6). In the studied groups peritoneal equilibration test (PET) was done, then the assessment of peritoneal water transport was performed using 125I-HSA as dialysate volume marker, and finally the velocity of peritoneal transport of small molecules expressed by solute mass transport rate (SMTR) coefficient was measured. Patients from both groups belonged to the same category of high-average transporters according to PET criteria. RESULTS: On the base of broaden assessment of peritoneal transport of water and substances it was proved that different, "therapeutic approach" should be applied in studied groups to reach the adequate dialysis. Although in group II the minor modification of continuous ambulatory peritoneal dialysis (CAPD) regimen was desired, the radical change of CAPD schedule or transfer to automated peritoneal dialysis was necessary in cases of patients from group I. CONCLUSIONS: The results of the study indicate that the extended assessment of peritoneal transport kinetics of water and substances increases the capabilities of individualisation of PD program. Therefore, it should be treated as an important element of integrated dialysis care.

[Encapsulating peritoneal sclerosis as a serious complication of peritoneal dialysotherapy--current opinions on treatment and prevention]. / Encapsulating peritoneal sclerosis jako powazne powiklanie dializoterapii otrzewnowej--wspólczesne poglady na leczenie i zapobieganie.

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis program. It is characterised by high mortality. This article is a review of current knowledge concerning procedures in EPS. The views on change of renal replacement therapy--from peritoneal dialysis to hemodialysis were discussed. The possibilities of prevention and treatment of this complication were also presented.

Efficacy of automated peritoneal dialysis: from minimum to optimum.

The aim of the study was assessment of theoretical possibilities of the Automated Peritoneal Dialysis (APD) optimization. The analysis of influence of dwells number modification and peritoneal transport character on Nightly Intermittent Peritoneal Dialysis (NIPD) efficacy and adequacy was performed. In the study the alternative method of theoretical foreseeing of peritoneal dialysis efficacy and adequacy was applied. This method was based on direct measurement of the velocity of solute peritoneal transport (SMTR). On the basis of SMTR, the dialysis efficacy expressed as total dialysed urea and dialysis adequacy expressed as Kt/V were estimated. The values of listed parameters were calculated for the different NIPD schedules (4-9 dwells during 8-hours session). It was revealed that the shortening of dwell time with simultaneous multiplying of dwell numbers resulted in increase of dialysis efficacy and adequacy. However, this improvement was non-proportional to the increase of dialysis solution volume and it did not provide the optimum of dialysis nor recommended level of adequacy even during the session consisting of 9 dwells. There were no statistically significant differences of Kt/V values between subgroups of patients with different character of peritoneal transport assessed according to PET test. The tendency to achieve the recommended values of Kt/V was observed in high transporters group. The results of the study indicate the large capabilities of APD optimization. The direct measurement of peritoneal transport velocity allows to provide better individualization of PD program. The prediction of APD efficacy and adequacy on the base of presented method seams to be an interesting alternative.

[Mathematical analysis of the possibilities of automated peritoneal dialysis optimization]. / Matematyczna analiza mozliwosci optymalizacji automatycznej dializy otrzewnowej.

The aim of the study was assessment of theoretical possibilities of the Automated Peritoneal Dialysis (APD) optimization. The analysis of influence of dwells number modification and peritoneal transport character on Nightly Intermittent Peritoneal Dialysis (NIPD) efficacy and adequacy was performed. 20 patients were included in the study. The velocity of urea peritoneal transport expressed as SMTR (solute mass transport rate) was calculated according to the formula: SMTR = delta (CDVD)/delta t, where: delta (CDVD)--change of urea mass in dialysate during delta t time (CD-urea concentration in dialysate, VD-intraperitoneal volume of dialysate). VD was estimated from dilution of volume marker (RISA). On the basis of SMTR, the dialysis efficacy expressed as total dialysed urea and dialysis adequacy expressed as Kt/V were estimated. The values of listed parameters were calculated for the different NIPD schedules (4-9 dwells during 8-hours session). It was revealed that the shortening of dwell time with simultaneous multiplying of dwell numbers resulted in increase of dialysis efficacy and adequacy. However, this improvement was non-proportional to the increase of dialysis solution volume and it did not provide the optimum of dialysis nor recommended level of adequacy even during the session consisting of 9 dwells. There were no significant differences of Kt/V values between subgroups of patients with different character of peritoneal transport assessed according to PET test. The tendency to achieve the recommended values of Kt/V was observed in high transporters group. The results of the study indicate the large capabilities of APD optimization. The direct measurement of peritoneal transport velocity allows to provide better individualization of PD program. The prediction of APD efficacy and adequacy on the base of presented method seams to be an interesting alternative.

[Empirical therapy of peritonitis in peritoneal dialysis patients--it is reasonable to use a new therapeutic schedule?]. / Empiryczne leczenie dializacyjnego zapalenia otrzewnej--czy uzasadnione jest stosowanie nowego schematu terapeutycznego?

The Ad Hoc Advisory Committee on Peritonitis Management recommended in the year 2000 a new protocol of empirical peritonitis therapy in patients on peritoneal dialysis with preserved residual renal function (RRF). This protocol comprises 1st and 3rd generation cephalosporins. According to these recommendations the old protocol of therapy, comprising 1st generation cephalosporin and aminoglycoside may be used only in patients with diuresis lower than 100 ml/day. The aim of the study was a retrospective assessment of the efficacy and cost of peritonitis therapy using "old" and "new" protocols. The analysed episodes of peritonitis were divided into two groups. Group 1 included 22 episodes of peritonitis in 13 patients treated with the old protocol, in whom RRF was lower than 100 ml/day. Group 2 included 6 episodes of peritonitis in 4 patients with preserved RRF treated with the new protocol. The efficacy of the treatment according to the old protocol was 64% and according to the new protocol--33%. The average cost of 14-day therapy with the old and new schedule was 67.1 and 247.2 Euro, respectively. In our studied population a considerably lower efficacy and higher cost were revealed of the new empirical schedule of peritonitis treatment in comparison to the old schedule. The results of the study indicate the need of further estimation of the usefulness of the new peritonitis empirical treatment protocol.