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.
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.
Background & Aims Fractionated plasma separation and adsorption (FPSA) is an extracorporeal procedure that supports liver function by removing endogenous toxins that cause complications from ...acute-on-chronic liver failure (AOCLF). We performed a randomized trial to investigate survival of patients with AOCLF treated with FPSA. Methods Patients with AOCLF were randomly assigned to groups given a combination of FPSA and standard medical therapy (SMT) (FPSA group, n = 77) or only SMT (SMT group, n = 68). The Prometheus liver support system was used to provide 8 to 11 rounds of FPSA (minimum of 4 hours each) for 3 weeks. Primary end points were survival probabilities at days 28 and 90, irrespective of liver transplantation. Results Baseline clinical parameters and number of transplant patients were similar between study arms. Serum bilirubin level decreased significantly in the FPSA group but not in the SMT group. In an intention-to-treat analysis, the probabilities of survival on day 28 were 66% in the FPSA group and 63% in the SMT group ( P = .70); on day 90, they were 47% and 38%, respectively ( P = .35). Baseline factors independently associated with poor prognosis were high SOFA score, bleeding, female sex, spontaneous bacterial peritonitis, intermediate increases in serum creatinine concentration, and combination of alcoholic and viral etiology of liver disease. There were no differences between the 2 groups in the incidence of side effects. Conclusions Among all patients with AOCLF, extracorporeal liver support with FPSA does not increase the probability of survival. Further studies are needed to assess whether therapy might be beneficial in specific subsets of patients.
Combined liver and kidney transplantation (CLKT) is indicated in patients with failure of both organs, or for the treatment of end-stage chronic kidney disease (ESKD) caused by a genetic defect in ...the liver. The aim of the present review is to provide the most up-to-date overview of the rare conditions as indications for CLKT. They are major indications for CLKT in children. However, in some of them (
atypical hemolytic uremic syndrome or primary hyperoxaluria), CLKT may be required in adults as well. Primary hyperoxaluria is divided into three types, of which type 1 and 2 lead to ESKD. CLKT has been proven effective in renal function replacement, at the same time preventing recurrence of the disease. Nephronophthisis is associated with liver fibrosis in 5% of cases and these patients are candidates for CLKT. In alpha 1-antitrypsin deficiency, hereditary C3 deficiency, lecithin cholesterol acyltransferase deficiency and glycogen storage diseases, glomerular or tubulointerstitial disease can lead to chronic kidney disease. Liver transplantation as a part of CLKT corrects underlying genetic and consequent metabolic abnormality. In atypical hemolytic uremic syndrome caused by mutations in the genes for factor H, successful CLKT has been reported in a small number of patients. However, for this indication, CLKT has been largely replaced by eculizumab, an anti-C5 antibody. CLKT has been well established to provide immune protection of the transplanted kidney against donor-specific antibodies against class I HLA, facilitating transplantation in a highly sensitized recipient.
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