Browsing by Author "Naumovic, R. (55965061800)"

Background: Although urea kinetic modeling indices for measuring dialysis dose are recommended by world expert groups, it is not quite clear whether some of these are superior in predicting the outcome over others. This prospective, single-center study was carried out with the aim to compare predictive value of different indices and methods of measuring dialysis dose. Methods: The analysis included 93 anuric patients having been on hemodialysis for at least 2 years who were followed-up for 75-months. The dialysis dose was measured by Kt/V (formal UKM, 3 and 2 urea samples), Kt/V (Daugirdas), Kt/V (Lowrie), eKt/V (Daugirdas), URR and TAC urea. Results: Correlations between dialysis indices and survival time were significant for all indices (p<0.01) except for TAC. All indices, except for TAC urea, were significant predictors of mortality (multivariate Cox regression analysis; p<0.01) and differences of significant levels among these colinear parameters were small. Conclusion: All examined indices except for TAC urea were highly predictive of patient mortality. Daugirdas and Lowrie simplified Kt/V indices are as predictive of all-cause mortality as more complex formal UKM methods in long-term patients on a 3x4h/week schedule. © Wichtig Editore, 2005.

Background: Although urea kinetic modeling indices for measuring dialysis dose are recommended by world expert groups, it is not quite clear whether some of these are superior in predicting the outcome over others. This prospective, single-center study was carried out with the aim to compare predictive value of different indices and methods of measuring dialysis dose. Methods: The analysis included 93 anuric patients having been on hemodialysis for at least 2 years who were followed-up for 75-months. The dialysis dose was measured by Kt/V (formal UKM, 3 and 2 urea samples), Kt/V (Daugirdas), Kt/V (Lowrie), eKt/V (Daugirdas), URR and TAC urea. Results: Correlations between dialysis indices and survival time were significant for all indices (p<0.01) except for TAC. All indices, except for TAC urea, were significant predictors of mortality (multivariate Cox regression analysis; p<0.01) and differences of significant levels among these colinear parameters were small. Conclusion: All examined indices except for TAC urea were highly predictive of patient mortality. Daugirdas and Lowrie simplified Kt/V indices are as predictive of all-cause mortality as more complex formal UKM methods in long-term patients on a 3x4h/week schedule. © Wichtig Editore, 2005.

Biopsy registries are one of the most important sources of accurate epidemiological data and the clinical presentation of renal diseases. A detailed analysis of clinicopathologic correlations over a period of 20 years (1987–2006) was performed earlier by our centre. The aim of this study was to check the current state and to register possible changes in clinicopathologic findings recorded under better socioeconomical circumstances and new management. Records of 665 renal biopsies performed at our institution were prospectively followed from 2007 to 2014. The results were compared with our previously published data. The average annual incidence of renal biopsies increased by 10% and included more elderly patients. Nephrotic syndrome (NS) remained the most common clinical indication for biopsy, while acute kidney injury participated more frequently than in the previous study (p < 0.001). Membranous nephropathy (MN) was still the most common cause of NS. Primary glomerulonephritis (PGN) remained the most prevalent disease, while MN was the most prevalent PGN. In comparison with the earlier period, MN was a more common diagnosis (p = 0.002), while the prevalence of mesangioproliferative non-IgA nephropathy decreased significantly during the time (p = 0.012). LN remained the most frequent secondary glomerulonephritis. The pathohistological pattern of renal biopsy remained largely unchanged during time. However, acute kidney injury was more frequently an indication for biopsy in the current study. The significant increase of biopsied elderly patients is due to the rise in their relative numbers in our population. © 2018 Elsevier GmbH

Biopsy registries are one of the most important sources of accurate epidemiological data and the clinical presentation of renal diseases. A detailed analysis of clinicopathologic correlations over a period of 20 years (1987–2006) was performed earlier by our centre. The aim of this study was to check the current state and to register possible changes in clinicopathologic findings recorded under better socioeconomical circumstances and new management. Records of 665 renal biopsies performed at our institution were prospectively followed from 2007 to 2014. The results were compared with our previously published data. The average annual incidence of renal biopsies increased by 10% and included more elderly patients. Nephrotic syndrome (NS) remained the most common clinical indication for biopsy, while acute kidney injury participated more frequently than in the previous study (p < 0.001). Membranous nephropathy (MN) was still the most common cause of NS. Primary glomerulonephritis (PGN) remained the most prevalent disease, while MN was the most prevalent PGN. In comparison with the earlier period, MN was a more common diagnosis (p = 0.002), while the prevalence of mesangioproliferative non-IgA nephropathy decreased significantly during the time (p = 0.012). LN remained the most frequent secondary glomerulonephritis. The pathohistological pattern of renal biopsy remained largely unchanged during time. However, acute kidney injury was more frequently an indication for biopsy in the current study. The significant increase of biopsied elderly patients is due to the rise in their relative numbers in our population. © 2018 Elsevier GmbH

Immunosuppression after transplantation renders the transplant recipient susceptible to a broad array of viral pathogens. Of 31 patients transplanted during 2012 in our center, 6 (19.3%) experienced varicella zoster virus (VZV) reactivation. The median time from transplantation to reactivation was 6.2 months. Immunosuppression consisted of antithymocyte globulin in 5 patients and basiliximab in 1, followed by tacrolimus, mycophenolic acid, and prednisolone. Two patients had T-cell-mediated rejection and were treated with pulse doses of corticosteroids. All patients received valganciclovir as prophylaxis of CMV infection. In 3 patients a disseminated vesicular skin rash was the sole manifestation of VZV reactivation. Two were successfully treated with acyclovir and 1 with ganciclovir. Ramsay Hunt syndrome complicated herpes zoster in the fourth patient, whereas the remaining 2 patients had visceral involvement, pneumonitis, and encephalitis, and died in spite of full doses of antiviral therapy. This was the first case of "epidemic" VZV reactivation in the 35-year history of our transplant center. VZV-specific cellular immunity pretransplantation is not sufficient to protect kidney transplant recipients from herpes zoster episodes. Considering the potentially devastating consequences of VZV reactivation, additional treatment options and universal prophylaxis should be contemplated. © 2015 by Elsevier Inc. All rights reserved.

Background: A number of studies have reported lower mortality of overweight hemodialysis patients. This post hoc analysis of an observational prospective single-center study was aimed at elucidating whether both being overweight and surviving longer could result from changes in the hemodialysis modality. Methods: The study included a cohort of 242 patients who were gradually switched from cuprophane membrane and acetate dialysis to polysulfone (including high-flux) membranes and bicarbonate dialysis. The analysis involved 12 months of baseline data obtained during the first calendar year after the patients entered the study (1994-2001) and repeated measurements for up to 132 months of follow-up (until 2004). Anthropometric measurements were made during the winter season and the percentage of body fat (%fat) was calculated from triceps, biceps, subscapular, and suprailiac skinfolds (K/DOQI guidelines). Kt/V, normalized protein catabolic rate, and cardiovascular comorbidity were also determined and laboratory analyses undertaken. Results: Significant correlations were found between %fat and bicarbonate dialysate as well as polysulfone membrane and high-flux membrane. The linear mixed model showed dependence of %fat on polysulfone and high-flux membrane (p<0.01) Multivariate Cox regression (time-dependent covariates) found %fat to be an independent factor for longer survival, in addition to polysulfone and high-flux membranes. Conclusion: Changes in hemodialysis modality were followed by both higher body fat percentage and patient survival. The reverse epidemiology of overweight patients might be at least partially the result of the influence of nonnutritional factors, such as a change in hemodialysis modality (introducing biocompatible high-flux and low-flux membranes and bicarbonate dialysis). © Wichtig Editore, 2009.

Background: A number of studies have reported lower mortality of overweight hemodialysis patients. This post hoc analysis of an observational prospective single-center study was aimed at elucidating whether both being overweight and surviving longer could result from changes in the hemodialysis modality. Methods: The study included a cohort of 242 patients who were gradually switched from cuprophane membrane and acetate dialysis to polysulfone (including high-flux) membranes and bicarbonate dialysis. The analysis involved 12 months of baseline data obtained during the first calendar year after the patients entered the study (1994-2001) and repeated measurements for up to 132 months of follow-up (until 2004). Anthropometric measurements were made during the winter season and the percentage of body fat (%fat) was calculated from triceps, biceps, subscapular, and suprailiac skinfolds (K/DOQI guidelines). Kt/V, normalized protein catabolic rate, and cardiovascular comorbidity were also determined and laboratory analyses undertaken. Results: Significant correlations were found between %fat and bicarbonate dialysate as well as polysulfone membrane and high-flux membrane. The linear mixed model showed dependence of %fat on polysulfone and high-flux membrane (p<0.01) Multivariate Cox regression (time-dependent covariates) found %fat to be an independent factor for longer survival, in addition to polysulfone and high-flux membranes. Conclusion: Changes in hemodialysis modality were followed by both higher body fat percentage and patient survival. The reverse epidemiology of overweight patients might be at least partially the result of the influence of nonnutritional factors, such as a change in hemodialysis modality (introducing biocompatible high-flux and low-flux membranes and bicarbonate dialysis). © Wichtig Editore, 2009.

Background Before 2010, donor detection rate and donor conversion rate at our tertiary level care institution were low. To assess the effectiveness of the implemented organizational changes, an analysis of organizational indicators with the use of the DOPKI (Improving the Knowledge and Practices in Organ Donation) project was conducted. Methods Three groups of DOPKI indicators were used: indicators of the potential for deceased organ donation, indicators on areas for improvement in the deceased donation process, and indicators of program effectiveness. We compared the 3-year period before instituting organizational measures with the 3-year period after the changes. Results Significant differences in almost all DOPKI indicators were found. Most importantly, the number of actual donors has increased significantly, pointing to the effectiveness of the organizational measures that we put in place in 2010. In addition, the study highlights the value of the use of DOPKI indicators in one intensive care unit to improve the transplant program on a hospital level. Conclusions We conclude by arguing that despite the lack of a uniform national database, DOPKI indicators could still be useful for improving the quality of donor programs. © 2015 Elsevier Inc.

Purpose: Because no consensus exists regarding the most accurate calculation to estimate glomerular filtration rate (GFR) based on serum creatinine concentrations (sCr) after kidney transplantation, this study sought to assess the potential role of tubular dysfunction on GFR estimates using various equations as well as the effect of pharmacologic blockades on tubular secretion of creatinine on creatinine clearance (ClCr). Methods: Iohexol GFR (mGFR) was performed in 17 stable kidney transplant recipients(R) at >24 months post-transplantation. Their mean age was 48.3 ± 11.3 years. All R were treated with a calcineurin inhibitor (CNI). At the time of study we measured sCr, 24 hour-ClCr, cystatin C, 24-hour proteinuria, microalbuminuria, FE Na, alfa1-microglobulinuria (alfa1-MG), and CNI concentrations. To block tubular secretion of Cr, recipients were prescribed cimetidine (2400 mg) 2 days before the sCr measurement. Additionally, to exclude dietary influences on sCr, R did not eat meat for 2 days before testing. GFR was estimated using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Cockroft-Gault (C&G), and Cystatin C (Cyst C) GFR equations. Mean kidney graft function over the previous 6 months was used as the control. Pearson correlation was determined between the differences between mGFR and estimatedGFR: Iohexol minus MDRD, EPI, Cyst C or C&G GFR for paired estimates. The diagnostic accuracy of the eGFRs to detect an mGFR of 60 mL/min/1.73 m2 was examined by receiver operating characteristic curves. Results: Mean mGFR was 75.2 ± 35.8 mL/min/1.73 m2. The sCr increased but the 24-hour ClCr, MDRD, EPI, and C&G decreased after vs before cimetidine. The difference was significant for sCr (F = 12.933; P =.002) and MDRD GFR (F = 15.750; P =.001). mGFR was not significantly higher than all pair values of eGFRs, and not significantly lower than 24-hour ClCr before and after cimetidine. However, in comparison to all eGFRs, ClCr after cimetidine most approached mGFR. A significant positive correlation was observed between alfa1-MG and the difference between mGFR and MDRD (before, r =.543 [P =.045]; after cimetidine, 0.568 [P =.034]), EPI (before, r = 0.516 [P =.050]; after cimetidine, r = 0.562 [P =.036]), and ClCr (r = 0.633; P =.016), C&G (P =.581; P =.029) before cimetidine. Accuracy of eGFRs to detect mGFR of 60 mL/min/1.73 m2 showed EPI GFR before cimetidine to show diagnostic accuracy for patients with GFR >60 mL/min/1.73 m2 with a sensitivity of 81.8% and a specificity of 71.4%. Conclusions: Because mGFR is unavailable in many transplant centers, determination of ClCr after cimetidine may help to achieve a more accurate diagnosis of CKD among transplant patients. © 2013 Elsevier Inc. All rights reserved.