Vascular calcification (VC) is highly prevalent in dialysis (HD) patients, and its mechanism is multifactorial. Most likely that systemic or local inhibitory factor is overwhelmed by promoters of VC ...in these patients. VC increased arterial stiffness, and left ventricular hypertrophy. Thus, the present study aimed to investigate the association of VC and myocardial remodeling and to analyze their relationship with VC promoters (fibroblast growth factor 23-FGF23, Klotho, intact parathormon-iPTH, vitamin D) in 56 prevalent HD patients (median values: age 54 yrs, HD vintage 82 months).
Besides routine laboratory analyzes, serum levels of FGF 23, soluble Klotho, iPTH, 1,25-dihydroxyvitamin D3; pulse wave velocity (PWV); left ventricular (LV) mass by ultrasound; and VCs score by Adragao method were measured.
VC was found in 60% and LV concentric or eccentric hypertrophy in 50% patients. Dialysis vintage (OR 1.025, 95%CI 1.007-1.044, p=0.006) FGF23 (OR 1.006, 95% CI 0.992-1.012, p=0.029) and serum magnesium (OR 0.000, 95%CI 0.000-0.214, p=0.04) were associated with VC. Changes in myocardial geometry was associated with male sex (beta=-0.273, 95% CI -23.967 1.513, p=0.027), iPTH (beta 0.029, 95%CI -0.059-0.001, p=0.027) and vitamin D treatment (beta 25.49, 95%CI 11.325-39.667, p=0.001). Also, patients with the more widespread VC had the highest LV remodeling categories. PWV was associated patient's age, cholesterol, diastolic blood pressure, LV mass (positively) and serum calcium (negatively), indicating potential link with atherosclerotic risk.
Despite to different risk factors for VC and myocardial remodeling, obtained results could indicate that risk factors intertwine in long-term treatment of HD patients and therefore careful and continuous correction of mineral metabolism disorders is undoubtedly of the utmost importance.
This retrospective study aimed to compare risk factors for vascular calcification (VC) between pre-hemodialysis (HD) and prevalent HD adult patients while investigating associations with ...calcification biomarkers. Baseline data from 30 pre-HD and 85 HD patients were analyzed, including iPTH, vitamin D, FGF 23, fetuin-A, sclerostin, and VC scores (Adragao method). Prevalence of VC was similar in both groups, but HD patients had more frequent VC scores ≥ 6. Pre-HD patients were older, with higher prevalence of hypertension and less frequent use of calcium phosphate binders. Both groups showed similar patterns of hyperphosphatemia, low vitamin D, and iPTH. Fetuin-A and sclerostin levels were higher in pre-HD, while FGF 23 was elevated in HD patients. Higher VC risk in pre-HD patients was associated with male gender, older age, lower fetuin-A and higher sclerostin, lower ferritin, and no vitamin D treatment, while in HD patients with higher sclerostin, FGF 23 and urea, and lower iPTH. Conclusion: Biomarkers could be measurable indicators of biological processes underlying VC in CKD patients that may serve as a potential guide for considering personalized therapeutic approaches. Further studies are needed to elucidate the underlying pathways.
Over the past decades, development of engineering sciences has vastly contributed to advancements in medicine by production of numerous devices for diagnostics and treatment. In the middle of the ...20th century, a new scientific field, biomedical engineering (BE), was established, which has developed into an extremely complex scientific discipline requiring a distinctive educational profile. Various study programs in BE have been established at universities around the world but also at several universities in Serbia. Also, intensive research in this field is performed at several scientific institutions in Serbia. In the present paper, short summaries of the research results of several groups of engineers and medical doctors are presented as an illustration of the wide field of BE research and possibilities of its application in diagnosis and therapy of various diseases.
Higher prevalence of chronic kidney disease (CKD) in women than in men was reported all over the world. This difference could be partly explained by longer life expectancy and slower CKD progression ...rate in women. Potential factors associated with sex differences in CKD progression are as follows: difference in glomerular hemodynamic and the response to angiotensin II; sex hormones ? estrogen has protective and testosterone deleterious effects on CKD progression; lifestyle. In most countries, the percentage of men is higher than that of women among incident and prevalent patients on hemodialysis (HD). In HD patients, the Kt/V index overestimates HD adequacy, secondary hyperparathyroidism is more common in women, and women require higher doses of erythropoiesis-stimulating agents for achieving and maintaining the hemoglobin target level. The survival of HD patients is equal for both sexes. In earlier years, an equal percentage of women and men started peritoneal dialysis, but in recent years, a higher percentage of women, especially at younger ages, start peritoneal dialysis. Initial peritoneal transport properties differ between men and women. A smaller percentage of women than men receive deceased donor kidneys, but women are more likely to be living kidney donors. Kidney allograft outcome depends on the sex and age of both the recipient and the donor. Cardiovascular diseases are the most common cause of death for renal replacement therapy patients of both sexes. Although sex-specific differences have been described in CKD patients, the inequality of patients in access to medical care has not been found in most regions of the world.
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.
Endemic nephropathy (EN) is a chronic, tubulointerstitial disease, described 60 years ago in the localized regions of the South-East Europe. In spite of numerous studies, the disease still attracts ...attention of researchers due to a great number of unanswered questions. This study is dedicated to some of those questions. Extensive field research, conducted in all endemic regions, showed the different disease prevalence rates, ranging from 0.3% to 10%. At the beginning of this century, the controversial opinions concerning the disease prevalence occurred, from the assumption that the disease disappears, to the data that the incidence does not change significantly. These differences occur due to a small number of studies conducted over the past thirty years and due to mass migrations from the endemic villages. That is the reason for the lack of exact data on EN prevalence in the endemic regions and for the lack of data on emigrants from endemic regions suffering from EN. EN is a family disease occurring only in the particular foci, thus it is considered that genetic factors, as well as environmental factors, are included in the occurrence of the disease. Currently, there are three hypotheses of EN etiology. One of the oldest assumptions about EN etiology is the one of ochratoxin A, a widely spread mycotoxin. Most of the attention is paid to aristolochic acid as an EN cause, but it is not excluded that, polycyclic aromatic hydrocarbons and other toxic compounds originating from lignite are causes of EN. Thus far, studies have not found out any biomarker which possesses enough specificity and sensitivity to discover and diagnose EN. Therefore, criteria have been defined, consisting of epidemiological, clinical and laboratory parameters which have enabled diagnosis of EN. Over the past decades, various research teams used different diagnostic criteria, thus aggravating results comparison. As a result, a group of experts have recently made a recommendation for screening, diagnosis, classifications and treatment of EN. However, since there is no pathognomonic biomarker for EN, the diagnosis of the disease is established on the basis of proving the presence of defined criteria and excluding other kidney diseases. It indicates that a search for the specific biomarker should be continued. Even after 60 years of endemic nephropathy studies, there are still unanswered questions which require further research by applying contemporary methods.
Introduction. Academy of Medical Science of Serbian Medical Society introduced collaboration between Belgrade nephrologists and general practitioners with the aim of examining the prevalence of ...chronic kidney disease (CKD) in populations at risk as well as of checking whether collaboration with general practitioners contributed to implementation of regular CKD screening. Methods. The research encompassed two studies carried out in four Belgrade Primary Health Care Centers. The screening study involved 619 patients at risk for CKD (348 with hypertension, 206 with diabetes, 65 persons aged > 60 years without hypertension/dia-betes) in whom glomerular filtration rate (eGFR) was estimated by MDRD formula, while urine dipstick test was used for detection of proteinuria and albuminuria (Micral-test® strips).The second study was retrospective analysis of medical records of 450 patients who were examined in the screening study and whose blood pressure and eGFR recording were analyzed during three-year period. Results. In screening study, eGFR below 60 ml/min/1.73m 2 was detected in 121 (19.55%) and albuminuria in 242 (39.10%) patients. During three-year retrospective study, percentage of patients whose blood pressure and eGFR were recorded decreased from 42% to 22% and from 42% to 18%, respectively. Multivariate regression analysis selected health center, systolic blood pressure and hypertension as the variables significantly associated with the number of years in which blood pressure was recorded, while male gender, health center, hypertension and basal eGFR as variables associated with the number of years in which eGFR was recorded. Conclusion. Despite collaboration between nephrologists and general practitioners in screening study, the retrospective three-year study revealed insufficient recording of blood pressure and eGFR in patients' medical records.
Continuous efforts have been made to find out precise and simple method for determination of glomerular filtration rate (GFR). Cystatin C (cysteine proteinase inhibitor = CyC) is a low molecular ...weight (LMW) protein which is produced constantly by all nucleated cells independently of different pathological conditions and eliminated from the blood exclusively by glomeruli. So, CyC closely reflects the GFR. In the present study 75 patients aged between 18 and 74 (44.3 ± 12.2) years were analyzed, with the aim to compare the reciprocal values of serum level of LMW proteins CyC and β2-microglobulin (β2-MG) with creatinine clearance (Ccr) as a measure of GFR. Patients were divided into groups according to sex, age (<60; >60 years) and renal diseases: patients with glomerulonephritis (GN) with and without nephrotic proteinuria, pyelonephritis (PyN), and renal transplant (Tx). High correlation between Ccr and 1 CyC (r = 0.81; p<0.01) and Ccr and 1 β2-MG (r = 0.80; p<0.01) in all examined patients was found. There was significant correlation between Ccr and 1 CyC (0.82 vs. 0.79) and Ccr and 1 β2-MG (0.85 vs. 0.76) in men as well in women, and also in two groups of patients formed according to the age (0.82 vs. 0.77; p<0.01; 0.80 vs. 0.81; p<0.01), without any statistical significant difference between the groups. In studied groups with different renal diseases, there were no differences in correlation coefficients between Ccr and 1 CyC and Ccr and 1 β2-MG (p1 = 0.29; p2 = 0.21; p3 = 0.79; p4 = 0.43), without statistical differences between the groups, except significant difference in correlation coefficients for Ccr and 1 β2-MG between patients with GN with and without nephrotic proteinuria (p<0.032). LMW proteins, serum CyC and β2-MG, are as good markers of GFR as Ccr, regardless sex and age. Both of these LMW proteins are good markers of GFR in patients with GN without nephrotic proteinuria, PyN and Tx patients. In patients with GN and nephrotic proteinuria serum CyC is a better marker of GFR than β2-MG.
Background and objective: Numerous screenings of chronic kidney disease (CKD) have been performed all over the world. This screening study was undertaken with the aim of estimating the prevalence of ...low glomerular filtration rate (eGFR) and microalbuminuria (MAU) and/or proteinuria in a population at risk for CKD and to detect factors associated with these CKD markers. Materials and methods: This cross-sectional study included 1617 patients without previously known kidney disease who came for regular check-ups to their general practitioners in 13 Belgrade health centers over a 3-month period. Patients selected were as follows: 1316 with hypertension, 208 with type 2 diabetes, and 93 older than 60 years without hypertension or diabetes. Screening included a questionnaire, blood pressure measurement, single MAU dipstick measurement (Micral-test® strip) and proteinuria and GFR estimation by Modification of Diet in Renal Disease. Results: MAU was found in 419 (25.9%) patients, proteinuria in 163 (10.1%), and eGFR < 60 mL/min/1.73 m2 in 370 (22.9%). Multivariate logistic regression analysis revealed that female gender, age, duration of hypertension, and smoking were associated with eGFR. Male gender, hypertension, treatment with angiotensin-converting enzyme inhibitors, proteinuria, and systolic blood pressure were associated with MAU. Conclusions: High prevalence of MAU/proteinuria and reduced eGFR were found in high-risk persons for CKD. Besides nonmodifiable, significant modifiable factors for MAU were use of angiotensin-converting enzyme inhibitors and strict regulation of hypertension and the factor for reduced eGFR was smoking.
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