The aim was to determine the cost of hospitalization for a transplant procedure and identify the independent variables associated with the cost of transplantation. The investigation was designed as a ...retrospective single-center cohort study conducted at a tertiary university hospital transplant center in Zagreb, Croatia. The study included 219 consecutive kidney recipients transplanted during the 2007-2013 period at the Merkur University Hospital. There were 141 male and 78 female patients having undergone kidney transplantation during the study period. The majority of kidney transplants were from a deceased donor (n=179), while 40 were from a living donor. The mean cost of a transplantation was 86,140+ or -42,240 HRK (11,460+ or -5,600 euro), ranging from 29,000 HRK (3,860 euro) to 408,000 HRK (54,000 euro). In the bivariate analysis, the variables associated with the cost of transplantation were the length of hospital stay, delayed graft function, death of the patient, graft loss, use of steroids, and death-censored graft loss. In the multivariate analysis, delayed graft function was the only statistically significant variable for the cost of transplantation. Since only delayed graft function had an impact on the cost of transplantation in this study, certain steps such as shortening of the cold ischemia time (better organization of organ transport), better education of family members for living donors, and higher percentage of patients on peritoneal dialysis should be taken to lower the percentage of delayed graft function. Key words: Kidney transplantation; Delayed graft function; Hospital cost; Peritoneal dialysis; Cold ischemia time
Hemodijaliza (HD) je najčešća metoda nadomještanja bubrežne funkcije u svijetu. Tunelirani dijalizni kateteri (TDK) predstavljaju jednu od najčešće korištenih mogućnosti u osiguravanju žilnog ...pristupa za HD. Cilj retrospektivnog istraživanja bio je prikazati desetogodišnje iskustvo u postavljanju dijaliznih katetera u našem središtu. U razdoblju od 2012. do 2021. godine postavljeno je 1.660 dijaliznih katetera, od kojih su 80% bili TDK. Najčešće mjesto pristupa bila je desna unutarnja jugularna vena, potom lijeva unutarnja jugularna vena, femoralne vene te subklavijske vene. Svim bolesnicima dijalizni kateter je uspješno postavljen, a u postupcima je sudjelovalo dvanaest liječnika Zavoda za nefrologiju, od čega je sedam liječnika postavilo 89% svih katetera, a četvero
liječnika ima više od 300 postavljenih dijaliznih katetera po osobi. Zaključno možemo reći da organizirani programi postavljanja katetera osiguravaju velik broj bolesnika i iskustvo operaterima za učinkovito postizanje žilnog pristupa i najsloženijim bolesnicima.
Uvod: IgA-nefropatija (IgAN) ima varijabilnu prezentaciju i prognozu. Međunarodni alat za predviđanje rizika u IgAN-u (IgAN-PT, od engl. International IgA Nephropathy Prediction Tool) predviđa ...napredovanje bubrežne bolesti do završnog stupnja ili smanjenje procijenjene glomerulske filtracije (eGFR) za 50%. Preporučuje se optimalna suportivna terapija najmanje tri mjeseca, praćena šestomjesečnom primjenom glukokortikoida samo u bolesnika s velikim rizikom napredovanja. Cilj: Istražiti koji su bolesnici imali veću vjerojatnost primiti imunosupresivnu terapiju (IS) te ishode liječenih IS-om. Ispitanici i metode: Retrospektivno kohortno istraživanje 48 bolesnika (33 muškarca), medijana dobi 50 godina (interkvartilni raspon, IQR, od engl. interquartile range 35 – 59), medijana praćenja 43 mjeseca (IQR 18 – 54), liječenih u Kliničkoj bolnici Merkur s novodijagnosticiranim idiopatskim IgAN-om u razdoblju od 2012. do 2021. godine. Rezultati: Imunosupresiju je primilo 17 bolesnika i oni su češće imali mezangijsku (M) (82% prema 54%, p=0,05), endokapilarnu hipercelularnost (E) (65% prema
21%, p=0,004) i polumjesece (C) (41% prema 14%, p=0,04). U odnosu na one bez IS-a nije bilo značajne razlike u eGFR-u kod biopsije (52 (IQR 38 – 81) prema 46 (IQR 30 – 72) ml/min/1,73 m2, p<0,05), ali su liječeni IS-om imali veću eGFR nakon dvije godine praćenja (66 IQR 37 – 97 prema 34 IQR 20 – 56 ml/min/1,73 m2, p=0,02). Omjer proteina prema kreatininu u urinu (uPCR) smanjio se nakon liječenja (kod biopsije, 106 IQR 50 – 317 prema završnom 47 IQR 20 – 129 mg/mmol), a nije bilo razlike u početnom i završnom uPCR između
onih koji jesu i nisu primali IS. Zbroj IIgAN se smanjio nakon liječenja (10,56% ± 12,66% prema 8,45% ± 9,22%, p=0,01), bez razlike u smanjenju između liječenih i neliječenih IS-om. Zaključci: Bolesnici s većim M, E i C su bili češće liječeni IS-om i oni su imali bolju eGFR nakon dvije godine; uPCR i zbroj IIgAN na kraju praćenja bili su manji neovisno o IS-u.
Cilj: Kalcijneurinski inhibitori (CNI) temelj su liječenja membranske nefropatije (MN). Nefrotoksičnost CNI-ja neželjeni je učinak koji ograničava njihovu primjenu. Željeli smo istražiti dugoročne ...ishode i bubrežnu funkciju u bolesnika liječenih CNI-jem samostalno ili u kombinaciji s rituksimabom, u usporedbi s drugim protokolima liječenja. Ispitanici i metode: U retrospektivno kohortno istraživanje uključeni su svi bolesnici s MN-om liječeni u KB Merkur koji su imali barem jednu godinu praćenja. Usporedili smo one liječene s CNI-jem najmanje
dva mjeseca s bolesnicima liječenima samo ciklofosfamidom ili rituksimabom bez CNI-ja. Rezultati: Ukupno je bilo 27 bolesnika, 78,8% muškaraca, medijana dobi 54 godine (IQR 43,5 – 59,5). Njih 75,8% imali su nefrotski sindrom. Medijan vremena praćenja bio je 75 mjeseci (IQR 20,5 – 121,5). U CNI skupini bilo je 19 bolesnika, medijana dobi 48 godina (IQR 39 – 55,5), 71,4% muškaraca. U skupini koja nije liječena CNI-jem bilo je 8 bolesnika, medijana dobi 60 godina (IQR 57 – 66), 75% muškaraca. Nije bilo značajne razlike u postotku pozitivnih na protutijela na receptor za fosfolipazu A2 između skupina, 76,5% naspram 50%, P=0,359. Nije nađena značajna razlika u promjeni procijenjene stope glomerulske filtracije (eGFR) nakon jedne godine, P=0,186. Nije bilo značajne razlike u proteinuriji nakon jedne godine. U skupini CNI 89,5% je bilo u kompletnoj remisiji na kraju prve godine prema 87,5% u skupini bez CNI, P=0,663. Prosječni eGFR na posljednjoj kontroli bio je 74,1±22,8 ml/ min/1,73 m2 u skupini CNI, a 72,3±18,1 ml/min/1,73 m2 u skupini bez CNI (P=0,84) i do tada niti jedan bolesnik u obje skupine nije razvio završni stupanj bubrežne bolesti. Zaključak: CNI predstavljaju sigurnu i učinkovitu terapiju MN-a, sami ili u kombinaciji s drugim lijekovima. Potrebna su istraživanja s većim brojem ispitanika kako bi se potvrdili naši rezultati.
Purpose
Data on the seroprevalence of hepatitis E virus (HEV) in heamodialysis (HD) patients are conflicting, ranging from 0 to 44%. The aim of this study was to determine the HEV seroprevalence and ...risk factors among HD patients in Croatia.
Methods
A total of 394 HD patients from six medical facilities in five Croatian cities (three sites in the continental and three sites in the coastal region) were tested for HEV IgM/IgG antibodies using an enzyme-linked immunosorbent assay. Additionally, all samples were tested for HEV RNA by RT-PCR. Sociodemographic data and risk factors were collected using a questionnaire.
Results
HEV IgG antibodies were detected in 110 (27.9%) patients. The seroprevalence varied significantly between dialysis centres, ranging from 5.2 to 43.4% (
p
= 0.001). HEV IgM antibodies were found in 0.04% of IgG positive patients. All patients tested negative for HEV RNA. Factors associated with HEV IgG seropositivity were age > 60 years (OR 8.17; 95% CI 1.08–62.14), living in the continental parts of the country (OR 2.58; 95% CI 1.55–4.30), and transfusion of blood products (OR 1.66; 95% CI 1.01–2.73). After adjusting for age and gender, patients from continental regions had higher odds of HEV seropositivity compared to patients from coastal regions (OR 2.88; 95% CI 1.71–4.85) and those who had RBC transfusions (OR 1.70, 95% CI 1.02–2.69) compared to those who did not.
Conclusion
The study showed a high HEV seropositivity among HD patients in Croatia, with significant variations between geographical regions. Continental area of residence and RBC transfusion were the most significant risk factors for HEV seropositivity. Due to the high seroprevalence, routine HEV screening among HD patients, especially in transplant candidates should be considered.
The decision to initiate dialysis treatment via haemodialysis (HD) or peritoneal dialysis (PD) often involves the consideration of complex factors and remains a matter of debate. The purpose of this ...study was to quantify the inflammatory burden that periodontitis causes in dialysis patients and to examine whether patients on PD and HD differ in terms of the periodontal inflamed surface area (PISA), which can be helpful for selecting the most appropriate dialysis modality.
A cross-sectional study was performed on 58 consecutive patients on HD and 31 consecutive patients on PD. PISA was calculated using measurements of the clinical attachment level, recession and bleeding on probing. We performed the primary analysis using multivariable robust regression.
Patients on PD had a 746 mm
(93%) lower mean PISA than patients on HD after adjustment for 20 possible confounders, including the duration of dialysis. The type of dialysis was independently correlated with the PISA (semipartial correlation: - 0.50; p = 0.017; false discovery rate < 5%). After adjusting for confounding factors, the correlation between the duration and type of dialysis was not significant (F (2,44) = 0.01; p = 0.994; η
= 0.00). Differences in the PISA between patients who had undergone dialysis for less than a year, 2-3 years or ≥ 3 years were not significantly different in either of the two dialysis groups.
PISA levels in Croatian patients on dialysis indicate a high need for periodontal treatment. PD is associated with a smaller PISA independent of many sociodemographic, lifestyle, laboratory and clinical factors. The duration of dialysis does not influence PISA levels.
ISRCTN17887630. A clinical study to investigate gum infection in patients undergoing kidney dialysis.
Aim. To investigate morphological findings of zero-time biopsies analyzed at the Department of Nephropathology and Electron Microscopy, Dubrava University Hospital, Zagreb. Materials and methods. The ...retrospective search of data was performed for the period from 2006 to 2018. A total of 316 zero-time renal biopsies were analyzed. Glomerular basement membrane (GBM) thickness was remeasured in 84 zero-time biopsies and 80 protocol biopsies of the same patients 12 months after transplantation. Results and conclusion. The acute tubular injury was present in 90% and glomerular pathology in 17% of zero-time biopsies, with thin basement membranes (TBM) being the most common entity (13%). Chronic graft changes were evaluated according to Banff classification. Most cases showed Banff scores ci0 (82.6%) and ct0 (65.1%). Banff scores cv2 and cv3 were present in 13% and ah2 and ah3 in 36.4% of specimens. Among 84 remeasured zero-time samples, TBM was present in 26 patients (31%). There were no differences between Banff scores and clinical parameters 12 months after transplantation between recipients with TBM and recipients with normal GBM thickness. Zero-time renal biopsy is of great importance for allograft assessment and comparison with consecutive biopsies. Further investigation is needed to determine the long-term significance of TBM on graft survival. Key words: Zero-time renal biopsies, Glomerular basement membrane, Thin basement membrane
Introduction: primary membranous nephropathy (pMN) is glomerulopathy caused in the majority of cases by autoantibodies to Phospholipase-A2 receptors (PLA2R-AB). This study aimed to evaluate the ...clinical course and outcomes of the patients with pMN regarding PLA2R-AB status. Patients and methods: 32 patients (21 males, 11 females) with renal biopsy-proven pMN were included in the study. PLA2R-AB (ELISA method) and outcomes (defined according to KDIGO) were evaluated after 21 and 64 months of follow-up in 28 patients. Results: 19 patients had positive PLA2R-AB (>20 RU/ml) (59.3%), with median titer of 97 (21-1418 RU/ml). The rate of remission in low PLA2R-AB titer group (< 200 RU/ml) after 21 months was significantly higher than in high PLA2R-AB group (> 200 RU/ml) (90% vs. 50%, p=0.045), and after 64 months the difference was not significant (80% vs. 50%, p=0.210).The relapse rate after 64 months was higher in the high PLA2R-AB group (87% vs. 63%). Multivariant linear regression found serum creatinine (beta=0.682, p<0.001) and PLA2R-AB (beta=0.527, p<0.001) as significant predictors for kidney function at the end of follow-up. Conclusion: higher titers of PLA2R-AB are related to worse kidney function outcome, higher 24-hour proteinuria, and a higher number of relapses in patients with pMN. Key words: membranous nephropathy, M-type phospholipase A2 receptor, autoantibodies, glomerulonephritis
•Data on immunosuppressive regimens used in KTRs in South-eastern Europe are limited.•Triple therapy was the most common immunosuppressive regimen.•The most common regimen was a CNI, an ...antiproliferative drug and corticosteroids.•Individual CNI C0 were below the target range in a substantial proportion of KTRs.
Objective: To examine current immunosuppressive regimens administered to kidney transplant recipients (KTRs) in South-eastern Europe.
Methods: This was a 12-month, multicenter, non-interventional, prospective, observational study of immunosuppressive regimens in adult de novo and maintenance KTRs. The primary endpoint was to identify the number, type, dosage and trough concentrations (C0) of immunosuppressive medications.
Results: Data were available for 1774 KTRs from five countries (Bulgaria n = 109, Croatia n = 339, Romania n = 647, Serbia n = 434 and Slovenia n = 245). The most common immunosuppressive regimen in all countries was a triple therapy regimen (de novo KTRs, 67.9 – 100% at baseline and 67.3 – 100% at end of study; maintenance KTRs, 48.8 – 90.7% and 43.2 – 90.1%, respectively). The most frequent regimen in de novo KTRs comprised tacrolimus, mycophenolate mofetil (MMF) or mycophenolate sodium (MPS), and corticosteroids. In maintenance KTRs, the most frequent regimen was tacrolimus or cyclosporine, and MMF or MPS, with or without corticosteroids. A C0 of <5 ng/mL was recorded in 40.2% of immediate-release and 48.7% of prolonged-release tacrolimus patients; 79.5% of patients taking cyclosporine had a C0 of <75 ng/mL. Infections were the most common adverse event (358/597, 60.0%), mainly urinary tract infections (208/358, 58.1%).
Conclusions: Triple therapy—comprising a calcineurin inhibitor (CNI; tacrolimus or cyclosporine), antiproliferative drugs (MMF or MPS) and corticosteroids—was the most common immunosuppressive regimen used in KTRs in South-eastern Europe. Individual CNI C0 were below the target range in a substantial proportion of KTRs, highlighting the need to maintain therapeutic drug monitoring of immunosuppressive therapy in this patient population.
Renal ischemia-reperfusion (I/R) injury was investigated in inducible nitric oxide synthase (iNOS) knockout mice. After a 26-min bilateral renal pedicle clamp, serum creatinine concentrations (in ...mg/dl) in wild-type mice after a 24-h reperfusion were 0.25 +/- 0.03 in sham-operated controls and 2.3 +/- 0.38 in ischemic mice (P < 0. 01); after 48 h, concentrations (in mg/dl) were 0.25 +/- 0.03 in controls and 2.0 +/- 0.18 in ischemic mice (P < 0.01). iNOS knockout mice demonstrated an attenuation of serum creatinine concentration after renal I/R injury. Serum creatinine concentrations (mg/dl) after a 24-h reperfusion were 2.3 +/- 0.22 in wild-type ischemic and 1.21 +/- 0.25 in iNOS knockout ischemic mice (P < 0.05); after 48 h, concentrations were 2.0 +/- 0.18 in wild-type ischemic and 0.96 +/- 0.25 in iNOS knockout ischemic mice (P < 0.01). Histological scoring of acute tubular necrosis in iNOS knockout mice was decreased compared with that in wild-type controls (0.88 +/- 0.2 vs. 3.3 +/- 0. 3, P < 0.05). iNOS protein in the renal cortex of wild-type mice subjected to renal I/R injury was undetectable up to 48 h. However, a strong upregulation of heat shock protein 72 expression was observed in renal cortex of iNOS knockout mice under basal conditions. In conclusion, kidneys of iNOS knockout mice were protected against ischemic acute renal failure. This protective effect may be related to a compensatory upregulation of heat shock protein 72.