On Whether Ca-125 Is the Answer for Diagnosing Overhydration, Particularly in End-Stage Kidney Disease Patients-A Systematic Review.

Overhydration (OH) is a prevalent medical problem that occurs in patients with kidney failure, but a specific marker has still not been found. Patients requiring kidney replacement therapy suffer from a water imbalance, which is correlated with mortality rates in this population. Currently, clinicians employ techniques such as bioimpedance spectroscopy (BIS) and ultrasound (USG) markers of overhydration or markers of heart and kidney function, namely NT-pro-BNP, GFR, or creatinine levels. New serum markers, including but not limited to Ca-125, galectin-3 (Gal-3), adrenomedullin (AMD), and urocortin-2 (UCN-2), are presently under research and have displayed promising results. Ca-125, which is a protein mainly used in ovarian cancer diagnoses, holds great potential to become an OH marker. It is currently being investigated by cardiologists as it corresponds to the volume status in heart failure (HF) and ventricular hypertrophy, which are also associated with OH. The need to ascertain a more precise marker of overhydration is urgent mainly because physical examinations are exceptionally inaccurate. The signs and symptoms of overhydration, such as edema or a gradual increase in body mass, are not always present, notably in patients with chronic kidney disease. Metabolic disruptions and cachexia can give a false picture of the hydration status. This review paper summarizes the existing knowledge on the assessment of a patient's hydration status, focusing specifically on kidney diseases and the role of Ca-125.

[Current nutrition recommendations for chronic kidney disease]. / Aktualne zalecenia zywienia w przewleklej chorobie nerek.

The paper discusses the current recommendations regarding the supply of individual nutrients in patients with chronic kidney disease (CKD). The recommendations include keeping the energy supply in the range of 25 to 35 kcal per kilogram of proper body weight per day, limiting the consumption of phosphorus to maximum of 1 g per day and limiting sodium to maximum of 2.3 g per day. In patients with eGFR <30 ml / min / 1.73 m2, a potassium restriction should be added so that its concentration in the blood does not exceed 5 mmol / l. Experts' views on the protein restriction in CKD patients are divided. The topic is controversial and more researches are needed to see if reducing protein intake leads to malnutrition and increased risk of death in this population. The results of studies on the use of a vegetarian diet in patients with CKD seem to be promising. It is good to remember about consuming appropriate amounts of products containing trace elements such as zinc, selenium or copper, as well as polyphenols, flavonoids and antioxidants.

Comparison of Different Methods of Urinary Protein Excretion Measurement: Is the King Really Dead?

INTRODUCTION: Assessing proteinuria is of uttermost importance for a nephrologist. It is often indispensable to accurately quantify the amount of protein lost, hence complicated and time-consuming urine collections (the gold standard or "king" of methods - 24-h protein excretion rate [PER]) are often replaced by spot urinary protein to creatinine ratio (PCR). The aim of the study was to determine whether the latter can reliably compare to the gold standard and whether "timing" of a spot urine sample is essential. METHODS: We performed a prospective, single-center study of 143 consecutive adult patients with glomerular proteinuria (a total of 187 cases). Protein and creatinine concentration was measured in 3 consecutive urine samples (starting with the first morning void) and a simultaneous 24-h urine collection. Agreement between 24-h PER and PCR was evaluated with Bland-Altman plots. RESULTS: Compared to PER 3 consecutive PCRs were 0.86, 0.66, and 0.50 higher with wide limits of agreement respectively. The bias between 2 methods was influenced by sex, CKD stage, albumin concentration and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker treatment. In 24 participants, in whom at least 2 measurements at different time points were available, only 88% of differences were lower than the calculated repeatability coefficient. CONCLUSIONS: Unfortunately although random PCR correlates with 24-h protein excretion, the scatter of differences increases as 24-h proteinuria rises (without any significant effect of the sampling time). The observed lack of agreement makes PCR an unsuitable parameter to correctly quantify proteinuria; it is also not useful for monitoring the amount of daily proteinuria in the same patient. Therefore, while searching for new markers, nephrologists can only say: "long live the king!"

How low can we go with the dialysate flow? A retrospective study on the safety and adequacy of a water-saving dialysis prescription.

Background: Green nephrology encompasses all initiatives in kidney care that have a positive impact on climate and environment. To prepare the dialysate, at least 120 L of water are needed for one 4-h session with a dialysate flow (Qd) set at 500 mL/min. A lower dialysate flow rate is associated with a significant reduction in the amount of water used. The aim of this study was to check whether change of Qd from 500 mL/min to 300 mL/min has a significant impact on dialysis adequacy. Methods: The study was a retrospective analysis. Due to administrative issues, a satellite dialysis center reduced their dialysate flow to 300 mL/min for a month. The center then increased Qd to 500 mL/min again. We analyzed laboratory data from 3 months before dialysate flow reduction, in the month with Qd reduced to 300 mL/min, and from 3 months thereafter with Qd set at 500 mL/min. Results: Twenty-four people were included in the final analysis. There were no significant changes in urea reduction ratio caused by lower rate of Qd [64.50 (61.75-71.00) vs 67.00 (63.00-72.25) vs 69.00 (63.75-72.25), analysis of variance F(2,46) = 0.71, P = .50]. Similarly, hemodialysis adequacy expressed by Kt/V did not differ at any Qd [1.23 (1.12-1.41) vs 1.25 (1.18-1.40) vs 1.35 (1.19-1.48), ANOVA F(2,46) = 2.51, P = .09]. There was a small but statistically significant increase in mean predialysis potassium with lower Qd [potassium = 5.18 (95% confidence interval, 95% CI, 4.96-5.44) vs 5.46 (95% CI 5.23-5.69) vs 5.23 (95% CI 4.99-5.47) mmol/L at Qd = 500, 300 and 500 mL/min, respectively, P = .039]. Conclusion: Reduction in dialysate flow rate to 300 mL/min seems safe and does not cause any short-term negative effects in this small study. Thus, we might be able to achieve a similar therapeutic effect while saving water consumption. Larger, long-term studies incorporating patient-reported outcome measures are needed to confirm the efficacy of this approach.

Post-Transplant Nephroptosis as a Cause of Recurrent Urinary Tract Infections: A Case Report.

BACKGROUND: The aim of this study was to present a rare cause of recurrent urinary tract infections (UTIs) in a patient after kidney transplantation. METHODS: The patient's consent was obtained, and full medical documentation was reviewed. After analyzing the literature, only 3 case reports of post-transplant nephroptosis were found. RESULTS: A 32-year-old woman with a history of type 1 diabetes, after kidney and pancreas transplantation a year earlier, was admitted to the hospital due to another incident of fever, dysuria, and pain in the lower abdomen. UTIs had been recurring for several months despite prophylaxis, initially with co-trimoxazole and then with fosfomycin. There were no anatomic abnormalities, and tacrolimus concentrations always remained at the lower range of normal. Kinking of the ureter was suspected because of a change in the position of the transplanted kidney. Ultrasonography performed in the standing and lying positions confirmed the diagnosis. A double J catheter was inserted into the ureter. In the following months, no UTI or urinary retention recurrence was observed. CONCLUSIONS: Nephroptosis of a transplanted kidney is extremely rare. The standard place for graft implantation-the iliac fossa-significantly limits the potential for migration. Kidneys implanted intraperitoneally also do not show clinically significant mobility due to postoperative adhesions. Floating kidneys potentially lead to serious complications. In addition to pain, a migrating graft may cause urine retention, predisposing to UTI and acute kidney injury.

Water - A life-giving toxin - A nephrological oxymoron. Health consequences of water and sodium balance disorders. A review article.

BACKGROUND: This article aims to reveal misconceptions about methods of assessment of hydration status and impact of the water disorders on the progression of kidney disease or renal dysfunction. MATERIALS AND METHODS: The PubMed database was searched for reviews, meta-analyses and original articles on hydration, volume depletion, fluid overload and diagnostic methods of hydration status, which were published in English. RESULTS: Based on the results of available literature the relationship between the amount of fluid consumed, and the rate of progression of chronic kidney disease, autosomal dominant polycystic kidney disease, and kidney stones disease was discussed. Selected aspects of the assessment of the hydration level in clinical practice based on physical examination, laboratory tests, and imaging are presented. The subject of in-hospital fluid therapy is discussed. Based on available randomized studies, an attempt was made to assess, which fluids should be selected for intravenous treatment. CONCLUSIONS: There is some evidence for the beneficial effect of increased water intake in preventing recurrent cystitis and kidney stones, but there are still no convincing data for chronic kidney disease and autosomal dominant polycystic kidney disease. Further studies are needed to clarify the aforementioned issues and establish a reliable way to assess the volemia and perform suitable fluid therapy.

Show Me What You Have Inside-The Complex Interplay between SIBO and Multiple Medical Conditions-A Systematic Review.

The microbiota, as a complex of microorganisms in a particular ecosystem, is part of the wider term-microbiome, which is defined as the set of all genetic content in the microbial community. Imbalanced gut microbiota has a great impact on the homeostasis of the organism. Dysbiosis, as a disturbance in bacterial balance, might trigger or exacerbate the course of different pathologies. Small intestinal bacterial overgrowth (SIBO) is a disorder characterized by differences in quantity, quality, and location of the small intestine microbiota. SIBO underlies symptoms associated with functional gastrointestinal disorders (FGD) as well as may alter the presentation of chronic diseases such as heart failure, diabetes, etc. In recent years there has been growing interest in the influence of SIBO and its impact on the whole human body as well as individual systems. Therefore, we aimed to investigate the co-existence of SIBO with different medical conditions. The PubMed database was searched up to July 2022 and we found 580 original studies; inclusion and exclusion criteria let us identify 112 eligible articles, which are quoted in this paper. The present SIBO diagnostic methods could be divided into two groups-invasive, the gold standard-small intestine aspirate culture, and non-invasive, breath tests (BT). Over the years scientists have explored SIBO and its associations with other diseases. Its role has been confirmed not only in gastroenterology but also in cardiology, endocrinology, neurology, rheumatology, and nephrology. Antibiotic therapy could reduce SIBO occurrence resulting not only in the relief of FGD symptoms but also manifestations of comorbid diseases. Although more research is needed, the link between SIBO and other diseases is an important pathway for scientists to follow.

The Impact of Cardiovascular Risk Factors on the Course of COVID-19.

AIM OF THE STUDY: The aim of our review is to indicate and discuss the impact of cardiovascular risk factors, such as obesity, diabetes, lipid profile, hypertension and smoking on the course and mortality of COVID-19 infection. BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is spreading around the world and becoming a major public health crisis. All coronaviruses are known to affect the cardiovascular system. There is a strong correlation between cardiovascular risk factors and severe clinical complications, including death in COVID-19 patients. All the above-mentioned risk factors are widespread and constitute a significant worldwide health problem. Some of them are modifiable and the awareness of their connection with the COVID-19 progress may have a crucial impact on the current and possible upcoming infection. DATA COLLECTION: We searched for research papers describing the impact of selected cardiovascular risk factors on the course, severity, complications and mortality of COVID-19 infection form PubMed and Google Scholar databases. Using terms, for example: "COVID-19 cardiovascular disease mortality", "COVID-19 hypertension/diabetes mellitus/obesity/dyslipidemia", "cardiovascular risk factors COVID-19 mortality" and other related terms listed in each subtitle. The publications were selected according to the time of their publications between January 2020 and December 2021. From the PubMed database we obtain 1552 results. Further studies were sought by manually searching reference lists of the relevant articles. Relevant articles were selected based on their title, abstract or full text. Articles were excluded if they were clearly related to another subject matter or were not published in English. The types of articles are mainly randomized controlled trial and systematic review. An additional criterion used by researchers was co-morbidities and age of patients in study groups. From a review of the publications, 105 of them were selected for this work with all subheadings included. Findings and Results: The intention of this review was to summarize current knowledge about comorbidities and development of COVID-19 infection. We tried to focus on the course and mortality of the abovementioned virus disease in patients with concomitant CV risk factors. Unfortunately, we were unable to assess the quality of data in screened papers and studies we choose because of the heterogenicity of the groups. The conducted studies had different endpoints and included different groups of patients in terms of nationality, age, race and clinical status. We decide to divide the main subjects of the research into separately described subtitles such as obesity, lipid profile, hypertension, diabetes, smoking. We believe that the studies we included and gathered are very interesting and show modern and present-day clinical data and approaches to COVID-19 infection in specific divisions of patients.

Factors Influencing Longevity of Humoral Response to SARS-CoV-2 Vaccination in Patients with End Stage Kidney Disease Receiving Renal Replacement Therapy.

COVID-19 has severely affected the population of patients with end stage renal disease. Current data have proved a two-dose vaccination schedule against SARS-CoV-2 to be effective among dialyzed patients. There are limited data on the longevity and modulating factors of humoral response after vaccination. We performed a prospective longitudinal cohort study to determine longevity of the humoral response after SARS-CoV-2 vaccine. The study included 191 adult patients on hemodialysis and peritoneal dialysis. All participants had been vaccinated with three doses, either with BNT162b2 (Pfizer-BioNTech) (n = 109) or mRNA-1273 (Moderna) (n = 82). Anti-spike protein receptor-binding domain antibodies (anti-S IgG) were assessed using SARS-CoV-2 (RBD) IgG ELISA EIA-6150 IVD assay at baseline, on the 21st day and 43rd day, before a booster dose and two weeks thereafter. We found that before vaccination, 37.7% of the cohort had anti-S IgG titres concordant with seroconversion. After two-dose vaccination, seroconversion occurred in 97% of patients. The booster dose evoked a ~12-fold increase in antibody level. Obesity increased more than two-fold the odds for a decrease in anti-S IgG. Previous COVID-19 infection enhanced longevity of the humoral response following vaccination. In patients with previous COVID-19 infection, the BNT162b2 vaccine was associated with a higher odds of anti-S IgG waning compared to the mRNA-1273 vaccine. In conclusion, we report that obesity predisposes patients to protective antibody waning, hybrid immunity enhances odds for higher anti-S IgG concentrations and vaccine efficacy may be influenced by previous SARS-CoV-2 infection. The results might provide a rationale for vaccination protocol design.

TRAIL and Cardiovascular Disease-A Risk Factor or Risk Marker: A Systematic Review.

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a pro-apoptotic protein showing broad biological functions. Data from animal studies indicate that TRAIL may possibly contribute to the pathophysiology of cardiomyopathy, atherosclerosis, ischemic stroke and abdominal aortic aneurysm. It has been also suggested that TRAIL might be useful in cardiovascular risk stratification. This systematic review aimed to evaluate whether TRAIL is a risk factor or risk marker in cardiovascular diseases (CVDs) focusing on major adverse cardiovascular events. Two databases (PubMed and Cochrane Library) were searched until December 2020 without a year limit in accordance to the PRISMA guidelines. A total of 63 eligible original studies were identified and included in our systematic review. Studies suggest an important role of TRAIL in disorders such as heart failure, myocardial infarction, atrial fibrillation, ischemic stroke, peripheral artery disease, and pulmonary and gestational hypertension. Most evidence associates reduced TRAIL levels and increased TRAIL-R2 concentration with all-cause mortality in patients with CVDs. It is, however, unclear whether low TRAIL levels should be considered as a risk factor rather than a risk marker of CVDs. Further studies are needed to better define the association of TRAIL with cardiovascular diseases.

Locked Away-Prophylaxis and Management of Catheter Related Thrombosis in Hemodialysis.

Reliable vascular access is necessary for effective hemodialysis. Guidelines recommend chronic hemodialysis via an arteriovenous fistula (AVF), however, in a significant number of patients, permanent central venous catheters (CVCs) are used. The use of a tunneled catheter is acceptable if the estimated dialysis time is less than a year or it is not possible to create an AVF. The main complications associated with CVC include thrombosis and catheter-related bloodstream infections (CRBSIs), which may result in loss of vascular access. The common practice is to use locking solutions to maintain catheter patency and minimize the risk of CRBSI. This paperwork summarizes information on currently available locking solutions for dialysis catheters along with their effectiveness in preventing thrombotic and infectious complications and describes methods of dealing with catheter dysfunction. The PubMed database was systematically searched for articles about locking solutions used in permanent CVCs in hemodialysis patients. Additional studies were identified by searching bibliographies and international guidelines. Articles on end-stage kidney disease patients dialyzed through a permanent CVC were included. Information from each primary study was extracted using pre-determined criteria including thrombotic and infectious complications of CVC use, focusing on permanent CVC if sufficient data were available. Of the currently available substances, it seems that citrate at a concentration of 4% has the best cost-effectiveness and safety profile, which is reflected in the international guidelines. Recent studies suggest the advantage of 2+1 protocols, i.e., taurolidine-based solutions with addition of urokinase once a week, although it needs to be confirmed by further research. Regardless of the type of locking solution, if prophylaxis with a thrombolytic agent is chosen, it should be started from the very beginning to reduce the risk of thrombotic complications. In case of CVC dysfunction, irrespective of the thrombolysis attempt, catheter replacement should be planned as soon as possible.

Serum sirtuin 1 is independently associated with intact PTH among patients with chronic kidney disease.

BACKGROUND: Sirtuin 1 is involved in the pathogenesis of age-related diseases. PURPOSE: The aim of the study was to assess the clinical and diagnostic value of serum sirtuin 1 concentration in patients with CKD. PATIENTS AND METHODS: The serum sirtuin 1 level was evaluated using ELISA kit in 100 CKD patients stratified for five stages and in a control group of 24 healthy volunteers. RESULTS: Serum sirtuin 1 concentration was higher in the CKD group compared with the control group (p<0.05). Sirtuin 1 correlated with conventional CKD biomarkers and eGFR equations, intact parathyroid hormone (iPTH) and age (all p<0.05). Statins, AT1 receptor antagonists and ß-blockers use were associated with decreased sirtuin concentration (p<0.05). Sirtuin 1 was able to distinguish CKD from control group with high sensitivity and specificity (93% and 87%, respectively; AUC=0.954). Surprisingly, after adjustment only iPTH concentration was an independent predictor of sirtuin 1 level. CONCLUSION: The association between sirtuin 1, eGFR equations and iPTH indicates its possible usefulness as a kidney function marker. In terms of iPTH being the only independent predictor of circulating sirtuin 1 it can be considered as an indirect cardiovascular risk biomarker regardless of renal function and provide additional information for patient management. Alternatively, sirtuin 1 is recognized as protective against vascular disease, and we demonstrated a positive correlation with iPTH, which may be related to accumulation of (7-84)-PTH having opposite biological effects to full-length PTH. Further studies are needed to explore the interplay between sirtuin 1, PTH and CKD-related vascular calcification as well as to assess its prognostic value in observational studies.

Sirtuin 1 and Skin: Implications in Intrinsic and Extrinsic Aging-A Systematic Review.

Skin, as the outermost organ of the body, is constantly exposed to both intrinsic and extrinsic causative factors of aging. Intrinsic aging is related to compromised cellular proliferative capacity, and may be accelerated by harmful environmental influences with the greatest significance of ultraviolet radiation exposure, contributing not only to premature aging, but also to skin carcinogenesis. The overall skin cancer burden and steadily increasing global antiaging market provide an incentive for searching novel targets to improve skin resistance against external injury. Sirtuin 1, initially linked to extension of yeast and rodent lifespan, plays a key role in epigenetic modification of proteins, histones, and chromatin by which regulates the expression of genes implicated in the oxidative stress response and apoptosis. The spectrum of cellular pathways regulated by sirtuin 1 suggests its beneficial impact on skin aging. However, the data on its role in carcinogenesis remains controversial. The aim of this review was to discuss the relevance of sirtuin 1 in skin aging, in the context of intrinsic factors, related to genetic premature aging syndromes, as well as extrinsic modifiable ones, with the assessment of its future application. PubMed were searched from inception to 4 January 2021 for relevant papers with further search carried out on ClinicalTrials.gov. The systematic review included 46 eligible original articles. The evidence from numerous studies proves sirtuin 1 significance in both chronological and premature aging as well as its dual role in cancer development. Several botanical compounds hold the potential to improve skin aging symptoms.

Mid-Regional Proadrenomedullin as a New Biomarker of Kidney and Cardiovascular Diseases-Is It the Future?

The increasing prevalence of cardiovascular disease and concomitant chronic kidney disease among the aging populations is responsible for considerable growth of mortality. Additionally, frequent, prolonged hospitalizations and long-term treatment generates progressive decline in bodily functions as well as substantial public health and economic burden. Accessibility to easy, non-invasive prognostic markers able to detect patients at risk of cardiovascular events may improve effective therapy and mitigate disease progression. Moreover, an early diagnosis allows time for implementation of prophylactic and educational programs that may result in decreased morbidity, improved quality of life and reduced public health expenditure. One of the promising candidates for a novel cardiovascular biomarker is mid-regional proadrenomedullin, a derivative of adrenomedullin. Adrenomedullin is a peptide hormone known for its vasodilatory, antioxidant, antiapoptotic and antifibrotic effects. A remarkable advantage of mid-regional proadrenomedullin is its longer half-life which is a prerequisite for plasma measurements. These review aims to discuss the importance of mid-regional proadrenomedullin with reference to its usefulness as a biomarker of increased cardiovascular risk and kidney disease progression.

The Links between Microbiome and Uremic Toxins in Acute Kidney Injury: Beyond Gut Feeling-A Systematic Review.

The last years have brought an abundance of data on the existence of a gut-kidney axis and the importance of microbiome in kidney injury. Data on kidney-gut crosstalk suggest the possibility that microbiota alter renal inflammation; we therefore aimed to answer questions about the role of microbiome and gut-derived toxins in acute kidney injury. PubMed and Cochrane Library were searched from inception to October 10, 2020 for relevant studies with an additional search performed on ClinicalTrials.gov. We identified 33 eligible articles and one ongoing trial (21 original studies and 12 reviews/commentaries), which were included in this systematic review. Experimental studies prove the existence of a kidney-gut axis, focusing on the role of gut-derived uremic toxins and providing concepts that modification of the microbiota composition may result in better AKI outcomes. Small interventional studies in animal models and in humans show promising results, therefore, microbiome-targeted therapy for AKI treatment might be a promising possibility.

Medical Students' Attitude Toward Organ Donation in a Single Medical University.

BACKGROUND: In the modern era, organ transplantation has become an important means of treating certain diseases. Although it is widespread and medically accepted, certain controversies still exist. OBJECTIVES: The aim of this study was to evaluate attitudes toward organ transplantation among medical students. METHODS: The anonymous survey was conducted among 273 medical students (from the departments of medicine, dentistry, nursing, and physiotherapy). The questionnaire was self-designed and contained 15 dichotomous questions. RESULTS: Among students, 99.6% accepted transplantation as a therapeutic method. Live-donor transplantation was accepted by 98.9% of students and transplantation from unrelated donors by 92.6% and 87.6% (depending on the existence of an emotional bond between the donor and the recipient). Interestingly, 12.8% of students approved of the selling of organs as a means of expanding the donor pool, and there were significant differences between divisions. On average, 90.1% of students declared knowledge of the definition of brain death with statistically significant differences between groups. Unfortunately, only 81.3% of students accepted the definition of brain death. Moreover, 98.5% of students would accept an organ if needed but only 93.8% declared willingness to donate organs after death. Interestingly, 26.4% of subjects stated that family should decide whether organs can be retrieved. Only 69.2% of respondents had talked to loved ones about their attitudes concerning organ transplantation. CONCLUSIONS: Although organ transplantation as a therapeutic method is widely accepted, there are still certain areas where considerable controversies exist. A structured, well-planned educational program should be implemented to improve awareness and attitude, especially among medical students.

The Serum Concentration of Anti-Aging Proteins, Sirtuin1 and αKlotho in Patients with End-Stage Kidney Disease on Maintenance Hemodialysis.

INTRODUCTION: Sirtuin1 (SIRT1) acts as an anti-aging protein due to anti-apoptotic, anti-oxidative and anti-inflammatory effect and is implicated in several diseases including diabetes or cardiovascular problems. SIRT1 renal overexpression indicates oxidative stress. Similarly, αKlotho was primarily exposed as anti-aging factor. It is primary produced in kidney. It's deficiency is associated with progression of chronic kidney disease and heart disorders. PURPOSE: The aim of the study was to assess the serum concentration of sirtuin1 and αKlotho in hemodialysis (HD) patients compared to healthy volunteers in regard to age, blood pressure control, residual kidney function (RKF), diabetes, cardiovascular disease, dialysis vintage and type of dialyzer. PATIENTS AND METHODS: The serum level of SIRT1 and αKlotho was evaluated using ELISA tests in 103 HD patients, median age 67 years and in 21 volunteers. Blood pressure, RRF, echocardiography and dialysis parameters were assessed. HD group was divided according to the presence/absence of RKF. RESULTS: The serum SIRT1 level was higher (28.4 vs 2.71ng/mL, p<0.0001) and αKlotho was lower (433.9 vs 756.6pg/mL, p<0.0001) in HD then in control group. αKlotho was lower in those without RKF (387.2 vs 486.2pg/mL, p=0.028). SIRT1 positively correlated with hemodialysis vintage. αKlotho negatively correlated with left ventricular posterior wall thickness. There was no significant relationship between SIRT1 and αKlotho level and age, blood pressure control, type of dialyzer, Kt/V and diabetes. Multivariate analysis revealed association of SIRT1 with ejection fraction (B -0.72; p=0.32). CONCLUSION: Elevated SIRT1 and lower αKlotho concentration are associated with impaired kidney function. The decrease in levels of αKlotho may also indicate heart hypertrophy in hemodialysis patients. The role of anti-aging proteins, particularly SIRT1 as biomarkers/predictors of oxidative stress, inflammation and cardiovascular diseases need further examination.

How to get rid of the bug in the heart-An infected catheter-associated thrombus treated successfully with antibiotics only.

We present a case of a 53-year-old woman with end-stage renal disease, on hemodialysis for 4 years, who was diagnosed with an infected catheter-associated right atrial thrombus (CRAT). CRAT is an underreported and potentially life-threating complication of a central venous catheter and usually warrants a surgical approach. The patient was, however, disqualified by cardiac surgeons due to her overall poor condition. We used a combination of anticoagulation and antibiotics in the reported case as "rescue therapy" and showed that the successful resolution of CRAT complicated by infection might sometimes be feasible with pharmacological treatment only.

Prognostic value of midregional proadrenomedullin in critically ill patients.

INTRODUCTION: Scoring systems can be used to predict the risk of mortality and outcomes in critically ill patients. Acute kidney injury (AKI) is one of the strongest factors negatively influencing patient outcomes. Midregional proadrenomedullin (MR­proADM) shows promising results as an outcome predictor in patients with sepsis. OBJECTIVES: We aimed to evaluate the value of MR­proADM in incident AKI and mortality prognostication among patients admitted to the intensive care unit (ICU) in comparison with commonly used scoring systems. PATIENTS AND METHODS: Our study included a single­center cohort of 77 patients admitted to the ICU. Plasma MR­proADM levels were measured within 24 h of admission. The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) scores were used as a reference. The primary endpoints were incident AKI and in­hospital mortality. RESULTS: Patients who died during hospitalization period had a higher MR­proADM concentrations as compared with patients who survived (2592.5 pg/ml vs 995.3 pg/ml; P <0.001). The levels of MR­proADM correlated positively with the APACHE II or SOFA score (r = 0.3; P = 0.004 and r = 0.3; P = 0.008, respectively). In the receiver operating characteristics analysis, MR­proADM concentration was superior to both scoring systems (P = 0.002 and P = 0.001, respectively). In univariate logistic regression, MR­proADM was associated with in­hospital mortality (odds ratio [OR], 1.22; 95% CI, 1.11-1.35 per 100 pg/ml increase of MR­proADM) and after adjusting for multiple variables remained an independent predictor of death (OR, 1.35; 95% CI, 1.22-1.49 per 100 pg/ml increase of MR­proADM). MR­proADM was not useful in predicting incident AKI. CONCLUSIONS: MR­proADM can be applied in clinical practice as a prognostic tool for mortality but not incident AKI in the general ICU population with at least similar accuracy as APACHE II and SOFA scores.

The effect of nephrectomy on Klotho, FGF-23 and bone metabolism.

BACKGROUND: Increased concentration of fibroblast growth factor 23 (FGF-23) and decreased levels of soluble Klotho (sKL) are linked to negative clinical outcomes among patients with chronic kidney disease and acute kidney injury. Therefore, it is reasonable to hypothesize that GFR reduction caused by nephrectomy might alter mineral metabolism and induces adverse consequences. Whether nephrectomy due to urological indications causes derangements in FGF-23 and sKL has not been studied. The aim of the study was to evaluate the effect of acute GFR decline due to unilateral nephrectomy on bone metabolism, FGF-23 and sKL levels. METHODS: This is a prospective, single-centre observational study of patients undergoing nephrectomy due to urological indications. Levels of C-terminal FGF-23 (c-FGF-23), sKL and bone turnover markers [ß-crosslaps (CTX), bone-specific alkaline phosphatase (bALP) and tartrate-resistant acid phosphatase 5b (TRAP 5b)] were measured before and after surgery (5 ± 2 days). RESULTS: Twenty-nine patients were studied (14 females, age 63.0 ± 11.6, eGFR 87.3 ± 19.2 ml/min/1.73 m2). After surgery, eGFR significantly declined (p < 0.0001). Nephrectomy significantly decreased sKL level [709.8 (599.9-831.2) vs. 583.0 (411.7-752.6) pg/ml, p < 0.001] and did not change c-FGF-23 concentration [70.5 (49.8-103.3) vs. 77.1 (60.5-109.1) RU/ml, p = 0.9]. Simultaneously, alterations in bone turnover markers were observed. Serum concentration of CTX increased [0.49 (0.4-0.64) vs. 0.59 (0.46-0.85) ng/ml, p = 0.001], while bALP and TRAP 5b decreased [23.6 (18.8-31.4) vs. 17.9 (15.0-22.0) U/l, p < 0.0001 and 3.3 (3.0-3.7) vs. 2.8 (2.3-3.2) U/l, p < 0.001, respectively]. CONCLUSIONS: Nephrectomy among patients with preserved renal function before surgery does not increase c-FGF-23 but reduces sKL. Moreover, nephrectomy results in derangements in bone turnover markers in short-term follow-up. These changes may participate in pathogenesis of bone disease after nephrectomy.