Higher Muscle Mass and Higher Serum Prealbumin Levels Are Associated with Better Survival in Hemodialysis Patients during a Five-Year Observation Period.

BACKGROUND: Dialysis is the most commonly used renal replacement therapy in patients with end-stage renal disease. The mortality rate of hemodialysis patients is 15-20%, with cardiovascular complications being the most common. There is an association between the severity of atherosclerosis and both the development of protein-calorie malnutrition and inflammatory mediators. The aim of this study was to assess the relationship between biochemical markers of nutritional status, body composition and survival in hemodialysis patients. METHODS: Fifty-three hemodialysis patients were included in the study. Serum albumin, prealbumin, and IL-6 levels were measured, as well as body weight, body mass index, fat content and muscle mass. The five-year survival of patients was calculated using Kaplan-Meier estimators. The long-rank test was used for univariate comparison of survival curves, and the Cox proportional hazards model was used for multivariate analysis of survival predictors. RESULTS: There were 47 deaths, 34 of which were due to cardiovascular disease. The hazard ratio (HR) for age in the middle-aged group (55-65 years) was 1.28 (confidence interval [CI] 0.58, 2.79) and 5.43 (CI 2.1, 14.07; statistically significant) for the oldest age group (over 65 years). A prealbumin level above 30 mg/dl was associated with an HR of 0.45 (CI 0.24, 0.84). Serum prealbumin (odds ratio [OR] = 5.23; CI 1.41, 19.43; p = 0.013) and muscle mass (OR = 7.5; CI 1.31, 43.03; p = 0.024) were significant predictors of all-cause mortality. CONCLUSIONS: Prealbumin level and muscle mass were associated with increased mortality risk. Identification of these factors may improve the survival of hemodialysis patients.

Anticoagulation in chronic kidney disease patients with atrial fibrillation: old vs new drugs.

In the last two decades a group of novel oral anticoagulants (NOACs) has been developed that directly block the activity of thrombin or activated factor X. No randomized controlled trials have been conducted to verify their efficacy and safety in patients with advanced chronic kidney disease (CKD) and atrial fibrillation. Few studies compared NOACs (dabigatran, rivaroxaban, apixaban, edoxaban) with classic anticoagulants in this unique group, and the results of these analyses remain controversial and inconclusive. Simple extrapolation of recommendations from the general population may be erroneous and lead to an increased risk of complications. Several controlled randomized trials with oral direct anticoagulants in hemodialysis patients are currently underway.

[Kidneys in diffuse systemic sclerosis].

Systemic scleroderma is a chronic, autoimmune disease of the connective tissue that involves skin, subcutaneous tissue, muscles and joints, as well as the internal organs: kidneys, lungs, heart. Depending on the extent it can occur as limited or diffuse clinical variant. In 60-80 % of patients with diffuse scleroderma, autopsy studies have shown pathologic changes in the kidneys. About half of the patients with renal involvement the clinical manifestation is limited to a moderate increase in serum creatinine, mild proteinuria, and moderate hypertension. The most serious complication remains sclerodermal renal crisis. It develops in 5-20 % of patients and is characterized by severe hypertension, acute kidney injury with oliguria, proteinuria and erythrocyturia, and microangiopathic hemolytic anemia with thrombocytopenia. In this article pathogenesis, risk factors, symptoms and treatment of scleroderma renal crisis have been reviewed.

[Pregnancy-related acute kidney injury].

Acute kidney injury (AKI) in obstetrics may be caused by the same disorders that are observed in the general population or may be specific for a pregnancy such as: preeclampsia, HELLP syndrome or acute fatty liver of pregnancy. The renal changes may be only temporary, and resolve within a few weeks postpartum, or may become irreversible leading to a progression of chronic kidney disease (CKD). In the article the most important pregnancy related syndromes associated with AKI have been shortly reviewed.

[Management of diabetic kidney disease: a summary of European Recommendations 2015].

Diabetes mellitus is the leading cause of end-stage renal disease in patients beginning renal replacement therapy. The epidemic of type 2 diabetes contributed to a new approach for diabetic kidney disease, one of the most common complications of diabetes type 1 and 2. The current recommendations of the management in diabetic kidney disease developed by an international group of experts based on analysis of clinical trials and expert opinion have been reviewed in this article. The guidelines concern several issues as renal replacement modality selection, glycaemic control, the choice of glycaemia controlling drugs and cardiovascular risk management aiming to improve the quality of life of the patients, as well as to reduce the costs of the medical care.

[HELLP syndrome]. / Zespól HELLP.

HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) is a relatively rare complication of pregnancy. It usually develops in the IIId trimester or after delivery. HELLP syndrome is associated with increased maternal (placental abruption, disseminated intravascular coagulation, hepatic hematomas and rupture, and acute kidney injury) and neonatal (prematurity, low birth weight) risk complications. In this article the diagnosis, clinical picture and treatment of this disease have been shortly reviewed.

[Recommendations for mineral and bone disorder in chronic kidney disease]. / Zalecenia postepowania w zaburzeniach mineralno-kostnych w przewleklej chorobie nerek.

The current recommendations for the diagnostics and therapy in mineral and bone disorders (MBD) in chronic kidney disease (CKD) developed by an international group of experts KDIGO and the Board of the Polish Nephrology Consultant's Working Group are presented in the paper. MBD--begin already in the early stages of CKD, and are an important cause of increased morbidity and mortality in this population. The main goals of the therapy are to maintain calcium and phosphate homeostasis and to keep serum parathyroid hormone concentrations in the optimal range.

[Diuretics]. / Leki moczopedne.

Diuretics are an important class of medicine used to treat a wide variety of acute and chronic conditions, like: heart failure, hypertension and renal diseases. They act by increasing urinary excretion of water, sodium, and some others electrolytes, at different sites in the nephron. In this paper the mechanisms of action, use, dosing and adverse effects of the commonly used diuretics are reviewed.

Limitations of the of the oscillometric method for blood pressure measurements in dialyzed patients.

BACKGROUND: Despite more frequent use of the oscillometric method (OSC) for arterial blood pressure (BP) measurement, little is known about OSC's accuracy when used with hemodialysed patients. This study was undertaken to determine if hemodialysis (HD) and individual features in examined patients can affect the accuracy of OSC for BP measurement. MATERIAL/METHODS: In 54 hemodialysed patients (57 ± 15 years), during 2 sessions (before and after HD), 3 pairs of BP measurements each were performed on arms, alternately employing OSC and auscultatory method, with mercury manometers by 2 observers (REF). RESULTS: No difference was found in systolic BP measured before and after HD (SBP before HD: REF -147.3 ± 27.3, OSC -147.5 ± 25.0 mmHg, p>0.05, SBP after HD: REF-141.1 ± 33.9, OSC-141.2 ± 31.5 mmHg, p>0.05, respectively), but diastolic BP (DBP) was significantly higher both before and after HD during REF measurement in comparison with OSC (DBP before HD: REF -79.0 ± 17.0, OSC -76.7 ± 15.0 mmHg, DBP after HD: REF -78.6 ± 18.8, OSC -76.7 ± 16.7 mmHg, p<0.001, respectively). No significant correlation between loss of body weight caused by HD and differences in BP measured by REF and OSC after HD was indicated (Pearson's correlation coefficients: for SBP -0.041, for DBP 0.030). However, a significant correlation between differences in BP measured by REF and OSC before HD and differences in BP measured by REF and OSC after HD was observed (Spearman's rank correlation coefficients: for SBP 0.502 and for DBP 0.557, p<0.000001). CONCLUSIONS: Our study found that individual features, not HD, determine the accuracy of OSC for BP measurement in hemodialysed patients.

Determining the accuracy of blood pressure measurement by the Omron HEM-907 before and after hemodialysis.

BACKGROUND: The accuracy of oscillometric blood pressure (BP) measuring devices determined in resting conditions may be distorted in those under hemodialysis (HD). METHODS: The evaluation of accuracy of the Omron HEM-907 was performed in accordance with the International Protocol for validation of BP measuring devices (IP). Out of a group of 49 patients with end-stage renal disease (ESRD) (56.7 +/- 15.6 years), four groups of 33 patients each were selected to ascertain their BP before and after HD. RESULTS: The Omron HEM-907 fulfilled the IP accuracy requirements for systolic BP measurements before and after HD. In the case of diastolic BP before HD, the Omron HEM-907 did not fulfill both requirements for phase 2.2 IP. In only 21 out of 33 patients, the difference between the mean of two observers and the Omron HEM-907 device (Diff) was not more than 5 mmHg, while the requirement was 22 patients. In seven patients, all three Diff were over 5 mmHg, while the accepted limit is three. After HD, the Omron HEM-907 did not fulfill one out of two criteria of phase 2.2 IP - in five people, all three Diff were over 5 mmHg. CONCLUSION: The Omron HEM-907 oscillometric method of BP measurement should not be used to measure BP before and after HD in ESRD patients. In ESRD patients, an alternative method of BP measurement, in the event of a lack of a mercury sphygmomanometer, could be a classical auscultatory method together with the Omron HEM-907, which allows for this type of BP measurement.

Celiac disease manifest in the elderly.

We present a case of a 75-year-old woman with manifestations of celiac disease. Currently, there is an increase in the prevalence atypical celiac disease which is more commonly diagnosed in the elderly. Diagnostic techniques and treatment options of celiac disease, particularly in the elderly have been presented in detail.