Agnieszka Próchnicka

Publications

• 1.54

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  Extracorporeal versus peritoneal ultrafiltration in diuretic-resistant congestive heart failure--a review.

  Zofia Wańkowicz, Agnieszka Próchnicka, Anna Olszowska, Daniel Baczyński, Paweł Krzesiński, Mirosław Dziuk

  Medical science monitor : international medical journal of experimental and clinical research. 12/2011; 17(12):RA271-81.

  Diuretic-resistant congestive heart failure in the form of type 2 cardiorenal syndrome is a problem of growing significance in everyday clinical practice because of high morbidity and mortality. There has been scant progress in the treatment of overhydration, the main cause of symptoms in this group... [more] Diuretic-resistant congestive heart failure in the form of type 2 cardiorenal syndrome is a problem of growing significance in everyday clinical practice because of high morbidity and mortality. There has been scant progress in the treatment of overhydration, the main cause of symptoms in this group of patients. The aim of our review is to present recent advances in the ultrafiltration therapy of congestive heart failure, with special attention to the new dedicated device for extracorporeal isolated ultrafiltration, as well as modifications of peritoneal dialysis in the form of peritoneal ultrafiltration with icodextrin solution and incremental peritoneal dialysis. Technical and clinical features, costs and potential risks of available devices for isolated ultrafiltration are presented. This method should be reserved for patients with true diuretic resistance as part of a more complex strategy aiming at the adequate control of fluid retention. Peritoneal ultrafiltration is presented as a viable alternative to extracorporeal ultrafiltration because of medical and psychosocial benefits of home-based therapy, lower costs and more effective daily ultrafiltration. In conclusion, large, properly randomized and controlled clinical trials with long-term follow-up will be essential in assessing the logistics and cost-effectiveness of both methods. Most importantly, however, they should be able to evaluate the impact of both methods on preservation of renal function and delaying the progression of heart failure by interrupting the vicious circle of cardiorenal syndrome. Our review is supplemented with the case report of the use of peritoneal ultrafiltration with a single 12-hour nighttime icodextrin exchange as a life-saving procedure in a patient with congestive heart failure resistant to pharmacological treatment.

• Renal autoregulation in medical therapy of renovascular hypertension.

  Arkadiusz Lubas, Grzegorz Zelichowski, Agnieszka Próchnicka, Magdalena Wiśniewska, Zofia Wańkowicz

  Archives of medical science : AMS. 12/2010; 6(6):912-8.

  Renovascular hypertension (RVH) is caused by renal ischaemia associated with haemodynamically significant renal artery stenosis (RAS). The choice of optimal treatment of atherosclerotic RAS is still controversial. Increase in the renal resistive index (RI) value after captopril administration is con... [more] Renovascular hypertension (RVH) is caused by renal ischaemia associated with haemodynamically significant renal artery stenosis (RAS). The choice of optimal treatment of atherosclerotic RAS is still controversial. Increase in the renal resistive index (RI) value after captopril administration is considered to indicate preserved renal autoregulation. The objective of the study was to assess the effect of medical therapy of RVH on renal autoregulation efficiency in patients with atherosclerotic RAS. 19 persons (38 kidneys) in 2 groups: 1) study: with RVH and stenosis of 1 renal artery - 8 patients; 2) control: - 11 healthy volunteers. Doppler captopril test with RI measurements and estimation of creatinine clearance (CCr) were performed in both groups at baseline, and after a period of controlled medical therapy (CMT) only in the study group. ABPM was evaluated in controls at baseline, and in the study group at the end of CMT. In the study group the mean period of CMT was 8.3 ±2.7 months, the number of antihypertensive drugs was 4.1 ±1.0, and mean 24-hour blood pressure was 138/74 mmHg. Mean CCr was stable during the study. Significant increase of RI after captopril was found only in controls. At baseline, in the group of kidneys with a non-stenotic renal artery, significant lowering of RI was observed, and ΔRI differed significantly from controls. After CMT, ΔRI increased in non-stenotic kidneys in comparison to the baseline, and did not differ from controls. Adequate medical therapy of RVH preserved renal function and improved renal autoregulation efficiency in non-stenotic kidneys.

• Renal vascular response to angiotensin II inhibition in intensive antihypertensive treatment of essential hypertension.

  Arkadiusz Lubas, Grzegorz Zelichowski, Agnieszka Próchnicka, Magdalena Wiśniewska, Marek Saracyn, Zofia Wańkowicz

  Archives of medical science : AMS. 08/2010; 6(4):533-8.

  High blood pressure (BP) leads to target organ damage. It is suggested that regression of early organ lesions is possible on condition of BP normalization. The study objective was to assess whether permanent reduction of BP to the recommended values modifies renal vascular response to acute angioten... [more] High blood pressure (BP) leads to target organ damage. It is suggested that regression of early organ lesions is possible on condition of BP normalization. The study objective was to assess whether permanent reduction of BP to the recommended values modifies renal vascular response to acute angiotensin II inhibition in the Doppler captopril test (DCT) in patients with essential hypertension (EH). Twenty-nine persons (58 kidneys) were found eligible for the study: 18 patients with EH and 11 healthy volunteers constituting the control group. Glomerular filtration rate estimation (eGFR), 24-h ambulatory BP monitoring (ABPM) and DCT with evaluation of renal resistive index change (ΔRI) were performed before and after a 6-month period of intensive antihypertensive therapy (IAT). Additional ABPM was performed at the end of IAT. The mean IAT period was 8.5 ±2.4 months. The mean 24-h values of systolic and diastolic BP in the EH group were significantly lower in the IAT period than at the beginning and at the end of the study. Significantly lower systolic and diastolic BP (p < 0.05) and improvement of renal function (eGFR 121 ±38 vs. 139 ±40 ml/min, p < 0.001) were found after IAT as compared to initial values. Before IAT, ΔRI was significantly lower in the EH group as compared to the controls, but no such differences were found after IAT. In EH patients, intensive BP lowering to the recommended values was associated with improvement of renal function and normalisation of renal vascular response to acute angiotensin II inhibition.

• Peritoneal dialysis as a therapeutic approach in congestive heart failure resistant to pharmacological treatment.

  Agnieszka Próchnicka, Anna Olszowska, Daniel Baczyński, Grzegorz Zelichowski, Zofia Wańkowicz

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):815-9.

  Given an increasing number of patients with congestive heart failure (CHF) refractory to diuretics, new and more effective therapeutic modalities are sought. Peritoneal dialysis (PD), which provides continuous, slow ultrafiltration, may be an alternative to hemodialysis in this population. The curre... [more] Given an increasing number of patients with congestive heart failure (CHF) refractory to diuretics, new and more effective therapeutic modalities are sought. Peritoneal dialysis (PD), which provides continuous, slow ultrafiltration, may be an alternative to hemodialysis in this population. The current paper, based on a comprehensive literature review, addresses the role of PD in improving the quality of life of patients with CHF.

• Peritoneal dialysis as a therapeutic approach in congestive heart failure resistant to pharmacological treatment: case report.

  Agnieszka Próchnicka, Anna Olszowska, Daniel Baczyński, Grzegorz Zelichowski, Arkadiusz Lubas, Magdalena Wiśniewska, Mirosław Dziekiewicz, Zofia Wańkowicz

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):834-7.

  This report describes the use of continuous peritoneal dialysis (PD) as an alternative to hemodialysis (HD) in a patient with type 2 cardiorenal syndrome in the course of congestive heart failure resistant to standard pharmacological treatment. A 39-year-old man presented with a 24-year history of p... [more] This report describes the use of continuous peritoneal dialysis (PD) as an alternative to hemodialysis (HD) in a patient with type 2 cardiorenal syndrome in the course of congestive heart failure resistant to standard pharmacological treatment. A 39-year-old man presented with a 24-year history of progressive heart failure. Ineligibility for heart transplant and previous inefficient treatment with different modifications of HD reduced his treatment options to PD. After 7 months of continuous PD (1 overnight exchange with icodextrin and 2 daily standard continuous ambulatory PD exchanges) his overall condition significantly improved compared with his status while on HD. An increase from NYHA class IV to class II, increase in left ventricular ejection fraction from 50% to 55%, decrease in right ventricular systolic pressure from 73 to 53 mmHg, and improvement in the quality of life enabled him to resume his daily activities.

• Atypical clinical presentation of Churg-Strauss syndrome with rapidly progressive glomerulonephritis: case report.

  Agnieszka Próchnicka, Grzegorz Zelichowski, Anna Wojtecka, Arkadiusz Lubas, Andrzej Bant, Agnieszka Perkowska-Ptasińska, Zofia Wańkowicz

  Polskie archiwum medycyny wewnȩtrznej. 12/2009; 119(12):830-3.

  The case of a 48-year-old man presented in this paper illustrates an atypical clinical course of Churg-Strauss syndrome with rapidly progressive glomerulonephritis with no signs of bronchial asthma.... [more] The case of a 48-year-old man presented in this paper illustrates an atypical clinical course of Churg-Strauss syndrome with rapidly progressive glomerulonephritis with no signs of bronchial asthma.