Browsing by Author "Pejović, Vesna (56856805100)"

Introduction/Objective Heart failure (HF) is the main cause of morbidity and mortality of hemodialysis (HD) patients. The aim of this cross-sectional single-center study was to examine the following: 1. frequency and characteristics of HF phenotypes in prevalent HD patients, 2. association of HF with traditional and non-traditional risk factors for cardiovascular diseases. Methods We included all 96 maintenance HD patients from Special Hospital for Internal Diseases, Lazarevac, Serbia, and determined the prevalence of HF with preserved ejection fraction (HFpEF) (per the 2016 criteria of the European Society of Cardiology) and HF with reduced and moderately reduced EF – HFrEF + HFmrEF – together in a group HFrEF (EF < 50%) using standardized post-HD transthoracic echocardiography. Clinical, routine laboratory and volume status parameters (by bioimpedance spectroscopy) was assessed. Results Sixty-three out of 96 examined patients (65.6%) had HF, among them 42 had HFpEF (66.7%), and 21 had HFrEF (33.3%). HFrEF was more common in older males, with diabetic nephropathy as underlying kidney disease, with a longer dialysis vintage and in those with a previous history of ischemic heart disease. HFpEF was more common in males, with lower HD quality (kT/V) and higher pre-dialytic systolic blood pressure. In multivariable regression analysis, HFrEF was associated with diabetic nephropathy, hypervolemia (positively) and triglycerides (negatively), while HFpEF was associated negatively with hemoglobin, iron, and triglycerides. Conclusion In order to control patients on maintenance HD with HF, in addition to appropriate drug therapy, it is advice to control of volemia and maintaining triglyceride, hemoglobin, and iron concentration approximately within normal limits. © 2022, Serbia Medical Society. All rights reserved.

Introduction/Objective This retrospective longitudinal study aimed to analyze survival factors in prevalent hemodialysis (HD) patients with different heart failure (HF) phenotypes. Methods Over 36 months, 96 patients were monitored, with 51 deaths recorded. Patients were categorized into HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), and non-HF (no HF) groups. Demographic, clinical, and laboratory parameters were analyzed to identify survival predictors within each subgroup. Results Survival curves did not differ among HF subgroups, and mortality was as follows: 42.9% for HFrEF, 52.4% for HFpEF, and 60.6% for no-HF patients. The main causes of death were COVID-19 infection (70%), followed by de novo cardiovascular diseases (myocardial infarction and cerebrovascular insult) (25%). Some demographic (age, male sex, HD vintage) and laboratory differences (anemia, lipids) between the surviving and deceased subgroups of patients have been found. Multivariate analysis identified distinct survival predictors: in HFrEF: pulse rate and interventricular septum thickness; in HFpEF: primary renal disease, cardiac history, and diuretic use; in no-HF: BMI, serum sodium, and HDL/LDL ratios. Conclusion Our results led us to suspect that COVID-19 infection might have masked the expected impact of HF phenotype on patients’ survival. Obtained findings contribute to the evolving understanding of HF in prevalent HD patients in the pandemic era. As HF, dialysis, and COVID-19 intertwine, further investigation is crucial to navigate this intricate finding and optimize patient care. © 2024, Serbia Medical Society. All rights reserved.

Purpose: In the early 1970s, a number of authors described the development of Balkan endemic nephropathy (BEN) in immigrants in endemic regions. The aim of this study was to examine whether immigrants in endemic regions are suffering from BEN today. Methods: The study involved 193 residents of two endemic regions divided into three groups: two groups of native residents—(1) members of BEN families, (2) members of non-BEN families, and (3) immigrants, who had moved from non-affected settlements to the endemic regions of Kolubara (38 years ago) or Semberia (20 years ago). All persons were subjected to an interview, objective examination, kidney ultrasound, and laboratory analysis to detect the presence of BEN consensus diagnostic criteria. Results: The number of immigrants with BEN biomarkers outside cutoff values was significantly lower than for BEN family members. Five BEN family members met diagnostic criteria for BEN and four for suspected BEN. Although five non-BEN family members had different combinations of BEN biomarkers, all of them had diseases other than BEN in which these biomarkers also occurred. None of the immigrants met the criteria for BEN. Nevertheless, one descendant of an immigrant, a 78-year-old male, whose mother was from a non-BEN family in the Kolubara district, exhibited all the criteria for BEN: alpha1-microglobulinuria, chronic renal failure, and anemia. Conclusion: While 30 years ago, BEN was reported equally among immigrants and natives, currently it is diagnosed in some BEN family members in the eighth decade of life, but extremely rarely in immigrants also in old age. © 2018, Springer Science+Business Media B.V., part of Springer Nature.

Balkan endemic nephropathy (BEN) presents an unsolved puzzle despite fifty years of its investigation. Academy of Medical Sciences of the Serbian Medical Society organized a round table discussion on current unsolved problems related to BEN. The present paper summarizes presentations, discussion and conclusions of this meeting. During the last fifty years, the course of BEN prolonged and it shifted towards the older age in all endemic foci. Data on the incidence of BEN have been controversial and frequently based on the data on the number of BEN patients starting haemodialysis treatment. In Serbia, BEN patients present 6.5% of haemodialysis population and this percentage differs among different centres ranging from 5% (Leskovac) to 46% (Lazarevac). Maintenance of high prevalence of BEN patients on regular haemodialysis indicates that BEN is not an expiring disease. In addition, recent data have shown more frequent microalbuminuria and low-molecular weight proteinuria in children from endemic than from nonendemic families. Aetiology of BEN is still unknown despite numerous investigations of environmental and genetic factors. Today, there is a very current hypothesis on the aetiological role of aristolochic acid but the role of viruses, geochemical factors and genetic factors must not be neglected. Morphological features of BEN are nonspecific and characterized by acellular interstitial fibrosis, tubular atrophy and changes on preand postglomerular vessels. New immunohistochemical and molecular biology methods offer a new approach to BEN investigation. Association of BEN with high incidence of upperurothelial tumours is well-known. Recent studies have shown significant changes of demographic characteristics of patients suffering upper-urothelial tumours, their prevalence in different endemic foci and characteristics of tumours. Further studies of BEN should be directed to determination of incidence and prevalence of disease in different endemic foci, investigations of different insufficiently examined aetiological factors as well as pathomorphological features of the disease by the use of modern methods.

[No abstract available]