Association of CYP2C9 gene polymorphism with bleeding as a complication of warfarin therapy.

The aim of this study was to determine the association of bleeding as a complication of warfarin therapy with polymorphism of CYP2C9 gene (alleles 1, 2 and 3). The CYP2C9 is the main enzyme for warfarin metabolism. Study included 181 patients receiving warfarin for at least one month. Allele 1 of CYP2C9 gene (in 94.5%) and genotype *1/*1 (57.5%) prevailed. Allele 3 was found in 12.7% patients. Bleeding side-effects occurred in 18 patients (10%). Patients with allele *1 needed significantly higher maintenance warfarin dose (p=0.011). Those with allele *3 had significantly lower maintenance warfarin dose (p=0.005) and higher prothrombin time (PT) at induction (p=0.034). Bleeding occurred significantly more often in those with lower maintenance warfarin dose (p=0.017). Patients with allele *3 had increased risk of bleeding, with marginal significance (p=0.05). Polymorphism of CYP2C9 could determine dose of warfarin therapy and thus it could be related to the risk of bleeding complications. Allele *3 carriers need lower warfarin dose. Therefore, initially reduced warfarin induction dose in allele *3 carriers could avoid more prolonged PT and decrease the risk of bleeding complication.

[Prevalence of gallstones in patients on hemodialysis]. / Prevalencija zucnih kamenaca u hemodijaliziranih bolesnika.

End-stage renal disease affects all organ systems. Nevertheless, frequency of some pathologic conditions does not differ in end-stage renal disease patients in comparison with their age- and sex-matched controls recruited from general population. The paper presents the results of the survey on the prevalence of gallstones in a relatively big group of hemodialysis patients (n = 114; 49 females, 65 males). The goal of the study was to examine whether the genesis of gallstones could be explained by renal failure itself. Gallstones have been found in 24 of 114 hemodialysis patients (21.05%), predominantly females (n = 14). Gallstones have been found in 28.75% of female patients, and in only 15.38% of male patients. The frequency of gallstones correlated significantly with age of the patients (r = 0.26, p < 0.05), number of pregnancies (r = 0.20, p < 0.005) and deliveries (r = 0.22, p < 0.05). Patients suffering from gallstones were significantly older (60.58 +/- 11.99:51.72 +/- 14.01 years, t = 3.10, p < 0.01), with every third older than 54 affected. The results observed do not differ from the results of other authors that report the morbidity in general population. In conclusion, gallstones in hemodialysis patients show same frequency as in general population and probably result from the same pathophysiologic mechanisms.