Jerzy Chudek
Research interests
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InterestsPlasma leptin concentration, Leptin, Adiponectin, clinical transplantation, Hypertension
Publications
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1.58Impact points
Are plasma levels of visfatin and retinol-binding protein 4 (RBP4) associated with body mass, metabolic and hormonal disturbances in women with polycystic ovary syndrome?
European journal of obstetrics, gynecology, and reproductive biology. 03/2012;
OBJECTIVE: To analyze potential interactions of visfatin and retinol-binding protein 4 (RBP4) levels with body mass, metabolic, and hormonal status in normal weight and obese women with PCOS. STUDY DESIGN: Body composition was determined by bioimpedance in 83 women (44 obese) diagnosed with PCOS and... [more] OBJECTIVE: To analyze potential interactions of visfatin and retinol-binding protein 4 (RBP4) levels with body mass, metabolic, and hormonal status in normal weight and obese women with PCOS. STUDY DESIGN: Body composition was determined by bioimpedance in 83 women (44 obese) diagnosed with PCOS and in 67 women (36 obese) without PCOS. In addition, serum glucose, lipids, androgens, FSH, LH, SHBG, insulin, visfatin, and RBP4 were measured in a fasting state and the free androgen index (FAI) was calculated, as was insulin resistance using the HOMA-IR assessment. RESULTS: Plasma RBP4 levels were significantly higher in women of normal weight compared to obese subjects when both were diagnosed with PCOS (14.1±4.6 vs.10.9±4.5ng/mL, p<0.001); while in non-PCOS subjects the opposite was found (10.8±4.5 vs. 18.4±11.6ng/mL, p<0.01; respectively). Plasma visfatin levels were similar in PCOS and non-PCOS subjects. In non-PCOS subjects, positive correlations between RBP4 level and anthropometric parameters were observed. In PCOS, RBP4 levels inversely correlated with serum insulin levels and HOMA-IR values. No correlation was found between plasma visfatin levels and anthropometric parameters in all study groups. Similarly, no correlation was found in PCOS and non-PCOS subgroups. Additionally, there was an inverse correlation between RBP4 and LH concentrations and LH/FSH ratio in all study subjects. CONCLUSIONS: Plasma visfatin level is not a useful biomarker of insulin resistance and hyperandrogenism. RBP4 level reflects visceral body fat content in non-PCOS women. Decreasing RBP4 release along with increasing insulin resistance and hormonal disturbances may be a compensatory mechanism preventing deterioration in obese PCOS.
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1.71Impact points
Telmisartan Improves Cardiometabolic Profile in Obese Patients with Arterial Hypertension.
Kidney & blood pressure research. 02/2012; 35(4):281-289.
Objective: There are several lines of evidence that telmisartan may improve cardiometabolic profile. The aim of the study was to estimate changes of insulin resistance and plasma concentrations of adipokines after long-term antihypertensive treatment with telmisartan in obese hypertensive patients. ... [more] Objective: There are several lines of evidence that telmisartan may improve cardiometabolic profile. The aim of the study was to estimate changes of insulin resistance and plasma concentrations of adipokines after long-term antihypertensive treatment with telmisartan in obese hypertensive patients. Methods: 34 previously untreated obese adults with arterial hypertension were enrolled. Glucose cellular uptake (M value) and the M to insulin ratio (M/I value) were measured by euglycemic-hyperinsulinemic clamp technique, body fat content (by dual-energy X-ray absorptiometry method), as well as plasma concentrations of selected adipokines and cytokines were estimated before and after 6-month telmisartan therapy in 25 patients who completed the study. Results: Telmisartan therapy was followed by 14.2% decrease of systolic and by 19.6% decrease of diastolic blood pressure. Body fat mass did not change significantly. Both M and M/I values (by 24.4 and by 38.6%, respectively) as well as plasma levels of total and high-molecular-weight adiponectin (by 10.8 and by 23.5%, respectively) increased significantly. Plasma concentrations of high-sensitivity C- reactive protein and interleukin-8 decreased significantly, while those of interleukin-6 and tumor necrosis factor-α tended to decline. Conclusions: Telmisartan monotherapy improves cardiometabolic profile in obese hypertensive patients by improving insulin sensitivity and increasing of plasma adiponectin concentration, including its high-molecular-weight fraction, and by suppressing of microinflammation.
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Changes of bone mineral density in obese perimenopausal women during 5-year follow-up.
Polskie Archiwum Medycyny Wewnetrznej. 02/2012;
INTRODUCTION The beneficial and protective influence of obesity on bone mineral mass has not been definitely established. OBJECTIVES To evaluate the changes of bone mineral density (BMD) in obese perimenopausal women during 5-year follow-up. PATIENTS AND METHODS 54 women with simple obesity were enr... [more] INTRODUCTION The beneficial and protective influence of obesity on bone mineral mass has not been definitely established. OBJECTIVES To evaluate the changes of bone mineral density (BMD) in obese perimenopausal women during 5-year follow-up. PATIENTS AND METHODS 54 women with simple obesity were enrolled into the study. The study group was divided into 2 subgroups according to menopausal status: postmenopausal women – M (n=35) and premenopausal women – P (n=19). Blood analyses (parathyroid hormone, 25-hydroxyvitamin D3, C-terminal telopeptide of type I collagen, osteocalcin, and osteoprotegerin), anthropometric measurements and densitometry were performed twice, in a 5-year interval. The control group consisted of 19 healthy, non-obese women of the same age. RESULTSPostmenopausal obese women were characterized by lower BMD in proximal femur and lumbar spine, higher fracture risk and higher serum concentration of osteocalcin at the beginning of observation. During 5-year follow-up, there was a 1.52% and 6.86% decrease in proximal femur BMD (p<0.01) and 2.34% and 5.17% of lumbar spine BMD in premenopausal and postmenopausal obese women, respectively. In postmenopausal controls, BMD reduction in the evaluated areas was 2.36% and 4.3% respectively. In the combined analysis including all postmenopausal women, there was an inverse correlation between initial body mass index (BMI) (R=-0.252; p<0.05) and changes of proximal femur and lumbar spine BMD (R=-0.280; p=0.08) that occurred over the 5-year period. CONCLUSIONSObesity seems not protect against bone mineral loss in postmenopausal women.
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Biomarkers of calcification and atherosclerosis in patients with degenerative aortic stenosis in relation to concomitant coronary artery disease.
Polskie Archiwum Medycyny Wewnętrznej. 02/2012; 122(1-2):14-21.
There is an ongoing debate regarding aortic valve degenerative processes. Some markers of calcification and atherosclerosis may be potentially useful in establishing their etiology. The aim of the study was to assess the biochemical markers of calcification and atherosclerosis in patients with degen... [more] There is an ongoing debate regarding aortic valve degenerative processes. Some markers of calcification and atherosclerosis may be potentially useful in establishing their etiology. The aim of the study was to assess the biochemical markers of calcification and atherosclerosis in patients with degenerative aortic stenosis (AS) in relation to the aortic valve calcium score (AVCS) and concomitant coronary artery disease (CAD). The study involved 88 patients: 68 patients with degenerative AS (group A), including 44 patients with severe AS (A1; 25 patients with CAD) and 24 patients with moderate AS (A2; 13 patients with CAD) and 20 matched subjects as controls (18 patients with CAD). In all patients, clinical data were assessed, laboratory tests were done (including the analysis of serum interleukin4 [IL‑4], osteoprotegerin [OPG], and fetuin‑A levels), coronary angiography was performed, and the AVCS was measured. Study groups and subgroups had comparable serum IL‑4, OPG, and fetuin‑A levels. There were significant differences in the AVCS between patients with severe AS, moderate AS, and controls (3605+/-2542 Agatston units [AU], 1390+/-1143 AU, 100+/-194 AU, respectively; P <0.001). There were no significant correlations between the AVCS and serum IL‑4, OPG, or fetuin‑A levels. In moderate AS, serum OPG levels were higher in subjects with concomitant CAD (5.84+/-1.4 vs. 4.03+/-1.3 pmol/l, P = 0.036). In severe AS, the mean AVCS was similar in patients with and without CAD. Higher AVCS was observed only in patients with moderate AS and coexisting CAD compared with patients without CAD (1644+/-1285 vs. 902+/-789 AU, P = 0.038). There were no significant differences between patients with and without degenerative AS in selected biochemical markers. The presence of CAD in moderate AS was associated with increased AVCS and serum OPG levels suggesting the effect of atherosclerosis on early valve calcification. In patients with severe AS, there were no correlations between calcification and atherosclerotic markers.
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1.71Impact points
Effect of Low-Dose Atorvastatin on Plasma Concentrations of Adipokines in Patients with Metabolic Syndrome.
Kidney & blood pressure research. 01/2012; 35(4):226-232.
Objective: It has not been conclusively proven whether or not the beneficial effect of statins on the cardiovascular system is mediated through their influence on adipokine secretion. We designed a prospective open-label study to assess the influence of 6 months' atorvastatin therapy on plasma c... [more] Objective: It has not been conclusively proven whether or not the beneficial effect of statins on the cardiovascular system is mediated through their influence on adipokine secretion. We designed a prospective open-label study to assess the influence of 6 months' atorvastatin therapy on plasma concentrations of some adipokines in patients with metabolic syndrome. Subjects: 36 adult patients with metabolic syndrome and serum LDL cholesterol >3.5 mmol/l, previously untreated with statins, were included in the study. Measurements: Plasma concentrations of adiponectin, leptin, resistin and insulin were measured before initiation and after 2, 4 and 6 months of atorvastatin therapy (10 mg), and 2 months after treatment cessation. Results: Treatment with atorvastatin was followed by a 35.6% decline in LDL cholesterol. Plasma adiponectin concentration decreased by 20.7% after 2 months; however, after 4 and 6 months, this did not differ significantly from the initial values. There was a negative correlation between the initial plasma concentration of leptin and changes in HDL cholesterol (R = -0.358; p = 0.04). Conclusions: Firstly, the long-term effect of atorvastatin therapy in patients with metabolic syndrome is not mediated by changes in the secretion of adiponectin, leptin and resistin by adipose tissue. Secondly, plasma leptin concentration seems to be a predictor of HDL cholesterol changes during atorvastatin therapy.
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0.84Impact points
Using NGAL as an early diagnostic test of acute kidney injury.
Renal failure. 01/2012; 34(1):130-3.
Neutrophil gelatinase-associated lipocalin (NGAL) has generated great interest as a novel biomarker for the timely detection of acute kidney injury (AKI). Despite the enthusiasm surrounding NGAL, the research so far details and attempts to minimize a host of limitations that substantially preclude i... [more] Neutrophil gelatinase-associated lipocalin (NGAL) has generated great interest as a novel biomarker for the timely detection of acute kidney injury (AKI). Despite the enthusiasm surrounding NGAL, the research so far details and attempts to minimize a host of limitations that substantially preclude its use as a valuable diagnostic biomarker to detect AKI and guide clinical treatment. In our review of the current research, obvious drawbacks such as variable sensitivity and specificity, even among similar patient populations were discovered. Furthermore, there are not well-defined cutoff values among various patient populations which would permit use of NGAL as a positive or negative diagnostic marker similar to troponin in cardiac injury. Moreover, due to the wide variation in baseline concentration of NGAL among patients, the added requirement of serial measurements, that may not even be accurate in at-risk or chronic kidney injury populations, further degrades the benefit of early detection.
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3.34Impact points
Medical, psychological and socioeconomic aspects of aging in Poland: assumptions and objectives of the PolSenior project.
Experimental gerontology. 12/2011; 46(12):1003-9.
Both descriptive and longitudinal studies of aging are nowadays a subject of growing interest in different countries worldwide. However, in Poland and other Central-Eastern European countries, such comprehensive, nationally representative, multidimensional studies were never performed in the past in... [more] Both descriptive and longitudinal studies of aging are nowadays a subject of growing interest in different countries worldwide. However, in Poland and other Central-Eastern European countries, such comprehensive, nationally representative, multidimensional studies were never performed in the past in elderly population. The present paper describes the PolSenior project including its objectives, sample selection and structure, methods, fieldwork procedures and study flow. The aim of the project was to examine medical, psychological and socioeconomic aspects of aging in Poland. The research sample included 5695 respondents (2899 males and 2796 females) split into six equally sized age groups of elderly individuals (65-69 years, 70-74 years, 75-79 years, 80-84 years, 85-89 years, 90+years) and one group of subjects just about to enter old age (55-59 years). Subjects were recruited using three stage stratified, proportional draw. The response rate was 42% and ranged from 32% to 61% between provinces. The study consisted of three visits performed by trained nurses including questionnaire survey, comprehensive geriatric assessment and blood and urine sampling. The questionnaire consisted of medical and specific socioeconomic questions. The comprehensive geriatric assessment included blood pressure and anthropometric measurements, as well as selected scales and tests routinely used in the examination of elderly subjects. Blood and urine samples were collected from 4737 and 4526 individuals, respectively. More than 50 biochemical parameters were measured, and DNA was isolated and banked. In a selected group of 1018 subjects, a medical examination by a physician was performed. The self-rated health was lower in females than in males in age groups 70-84, but similar in individuals of both sexes aged 65-69 and 85 years. Besides providing data on health and functioning of elderly population, the PolSenior project aims to analyze interrelationships between different elements of health and social status, and between genetics and health status in advanced age. The results of the PolSenior project will facilitate prioritizing the state's public health and social policies in elderly population. Such a program provides also an excellent starting point for longitudinal studies and a basis for comparative analysis between Poland and other European countries or regions.
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1.35Impact points
The effect of three-month pre-season preparatory period and short-term exercise on plasma leptin, adiponectin, visfatin and ghrelin levels in young female handball and basketball players.
Journal of endocrinological investigation. 10/2011;
Objective: The aim of the study was to assess the effect of a 3-month pre-season preparatory period and short-term moderate aerobic exercise and intensive fitness and speed exercise on adipokine and ghrelin levels in young female handball and basketball players. Materials and methods: Fifty healthy ... [more] Objective: The aim of the study was to assess the effect of a 3-month pre-season preparatory period and short-term moderate aerobic exercise and intensive fitness and speed exercise on adipokine and ghrelin levels in young female handball and basketball players. Materials and methods: Fifty healthy young female professional basketball and handball players were enrolled into the study before the opening of the season (after a 2-month holiday with no training or dietary restrictions). Serum estradiol and plasma leptin, adiponectin, visfatin and ghrelin levels were determined at the beginning and the end of a 3-month period of moderate aerobic training. Plasma adipokines and ghrelin levels were additionally assessed after 2 hours of moderate aerobic exercise or after intensive fitness and speed exercise training. Results: Long-term moderate aerobic exercise was followed by a significant decrease in plasma ghrelin and leptin levels (921±300 vs. 575±572pg/mL, p<0.001 and 16.4±15.6 vs. 11.8±16.3ng/mL, p<0.01, respectively); plasma adiponectin and visfatin remained unchanged. No changes were observed in plasma ghrelin and leptin levels after short-term moderate aerobic exercise or after intensive fitness and speed exercise. Plasma visfatin concentration increased significantly after short-term moderate aerobic exercise (22.1±8.7 vs. 27.6±9.0ng/mL, p<0.001), whilst adiponectin increased after intensive fitness and speed exercise (16.7±7.8 vs. 21.0±9.8μg/mL, p<0.001). Conclusions: Regular moderate aerobic training in preparation for the match season is followed by a decline in circulating leptin and ghrelin levels even in athletes without body weight changes. Short-term intensive fitness and moderate aerobic exercise seem to modulate the production of different adipokines.
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0.99Impact points
Systemic vascular hemodynamics and transplanted kidney survival.
Transplantation proceedings. 10/2011; 43(8):2922-5.
High blood pressure and arterial stiffness contribute independently to cardiovascular mortality in uremic patients. High blood pressure is an established risk factor for chronic allograft nephropathy, recently named interstitial fibrosis/tubular atrophy (IF/TA). We sought to assess whether heart aft... [more] High blood pressure and arterial stiffness contribute independently to cardiovascular mortality in uremic patients. High blood pressure is an established risk factor for chronic allograft nephropathy, recently named interstitial fibrosis/tubular atrophy (IF/TA). We sought to assess whether heart afterload determinants: arterial stiffness and vascular resistance or impedance accelerate kidney graft failure upon long-term observation. Using a noninvasive method of blood pressure waveform analysis, (HDI/PulseWave/CR-2000), we studied 160 consecutive kidney transplant recipients, who were at least 3 months after transplantation, for systolic (SBP), diastolic, and mean blood pressure; pulse rate; systemic vascular resistance and impedance as well as large and small artery compliance. The associations of the hemodynamic parameters with relative increases in serum creatinine for every year of graft survival (ΔCreat) were assessed using multiple linear regression analysis. Relationships between systemic hemodynamics and kidney graft loss due to IF/TA were evaluated by Cox regression analysis, including serum creatinine, time after transplantation, delayed graft function, human leukocyte antigen mismatch, panel-reactive antibodies, cold ischemia time, donor age glomerular filtration rate as well as prescribed cardiovascular and immunosuppressive drugs. Over 6.6±0.4 years of follow-up, excluding four noncompliant patients, 11 patients died and 32 lost their kidney grafts, including 25 due to IF/TA. ΔCreat (10.3%±22.0%/y) was independently and positively associated with the initial SBP (β=0.26; P=.001) and serum creatinine values (β=0.16; P=.04). The risk of graft loss due to IF/TA was greater among patients with an increased serum creatinine (relative risk [RR]=59.5 per nlog-unit increase; P<.001) or higher SBP (RR=51.1 per nlog-unit increase; P=.04). Besides SBP, no other hemodynamic parameter was associated with graft failure. The rate of kidney graft function deterioration and risk of transplant loss due to IF/TA are not independently influenced by systemic arterial compliance, resistance, or impedance. SBP appears to be the key circulatory parameter independently affecting the progression of IF/TA, and should be a therapeutic target.
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0.99Impact points
Does simultaneously transplanted pancreas improve long-term outcome of kidney transplantation in type 1 diabetic recipients?
Transplantation proceedings. 10/2011; 43(8):3097-101.
Simultaneous pancreas-kidney transplantation (SPK) is an alternative to kidney transplantation (KTx) for type 1 diabetic patients with end-stage kidney disease. However, a fair comparison of SPK and KTx is difficult because of significant differences in donor, recipient, and transplantation procedur... [more] Simultaneous pancreas-kidney transplantation (SPK) is an alternative to kidney transplantation (KTx) for type 1 diabetic patients with end-stage kidney disease. However, a fair comparison of SPK and KTx is difficult because of significant differences in donor, recipient, and transplantation procedure parameters. The aim of this study was to compare the early and long-term outcomes of SPK versus KTx in southwest Poland. Thirty-five diabetic dialysis patients who had SPK and 64 patients who had KTx were included in the analysis. SPK recipients were younger (38±6 years versus 42±9 years) and received organs from younger donors (25±7 versus 43±12 years) compared to the KTx group. They had shorter kidney cold ischemia time (9±2 hours versus 22±7 hours) but worse HLA class II mismatches (1.4±0.6 versus 1.0±0.5). In the early postoperative period, three patients died from the SPK group and one patient died from the KTx group. Additionally, two SPK patients lost their pancreatic grafts, and five KTx patients lost their kidney grafts. One-year patient survival rates for the SPK and KTx groups were 88% and 98%, respectively, and 5-year, 81% and 93%, respectively. One-year kidney graft survivals rates for the SPK and KTx groups were 100% and 89%, respectively, and 5-years, 89% and 81%, respectively. One-year insulin-free survival among SPK patients was 90% and the 5-year survival rate was 76%. Excretory function of the transplanted kidneys was better among SPK group; however, the difference reached statistical significance only in posttransplant years 2 and 3: 63.5±20.1 versus 50.3±19.7 and 64.9±12.9 versus 51.6±21.8 mL/min/1.73 m2 for SPK and KTx, respectively. Normoglycemia in SPK recipients did not improve patient survival at 5 years. The worse HLA compatibility in the SPK group did not lead to impaired kidney graft survival compared to KTx. Better kidney graft function among SPK recipients probably resulted from a more restrictive donor selection.
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0.99Impact points
Intraoperative resistance index measured with transsonic flowmeter on kidney graft artery can predict early and long-term graft function.
Transplantation proceedings. 10/2011; 43(8):2926-9.
Resistive index (RI) measured by Doppler sonography in the early period after kidney transplantation is a well-known predictor of kidney transplant outcome. The purpose of this study was to analyze the impact of RI values calculated intraoperatively in renal allograft artery using transit time flowm... [more] Resistive index (RI) measured by Doppler sonography in the early period after kidney transplantation is a well-known predictor of kidney transplant outcome. The purpose of this study was to analyze the impact of RI values calculated intraoperatively in renal allograft artery using transit time flowmetry (TTF) on both early and long-term kidney graft function. TTF was performed on 72 patients who received kidney grafts fed by a single artery. TTF was performed before wound closure. We excluded patients with an early acute rejection (n=8), an early graft loss (n=2), or primary graft nonfunction (n=1). Recipients were divided into RI tertile groups. The initial kidney graft function was defined as immediate (IGF), slow or delayed. Kidney graft estimated glomerular filtration rate (eGFR) was analyzed upon long-term follow-up. Patients with a low RI (<0.57) showed the highest incidence of immediate graft function (65% versus 5.3%), whereas the high RI group (>0.70). Show the most frequent rate of delayed graft function (52.6% versus 15%). Recipients with low RI values displayed significantly better eGFR (by at least 12 mL/min/1.73 m2) than those with medium or high RI values at all analyzed times; subjects with medium or high RI showed similar eGFR at 48-months. An high RI value measured intraoperatively was a valuable predictor of inferior early and long-term kidney graft function.
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0.99Impact points
Impact of early lymph node procurement to facilitate histocompatibility testing on long-term cadaveric kidney graft survival.
Transplantation proceedings. 10/2011; 43(8):2875-8.
Prolonged cold ischemia time (CIT) is a clinically important causes of delayed graft function (DGF) after kidney transplantation. As DGF has been previously shown to have a deleterious influence on long-term graft survival, in the present study we analyzed the impact of early lymph node (LN) procure... [more] Prolonged cold ischemia time (CIT) is a clinically important causes of delayed graft function (DGF) after kidney transplantation. As DGF has been previously shown to have a deleterious influence on long-term graft survival, in the present study we analyzed the impact of early lymph node (LN) procurement on CIT, HLA mismatches, and long-term kidney graft outcome. We evaluated 394 consecutive cadaveric procedures performed from 2001 to 2006, including 289 recipients, in whom LN were obtained before kidney procurement seeking to shorten the total time for HLA typing and crossmatch procedures. During 58±6 months, 24 patients died (918 [8.3%] in the early and 6 [5.7%] in late procurement group, P=ns) and 52 lost their kidney grafts (31 [10.7%] vs 21 [20%]; P=.025). Early procurement of LN performed in 73.4% of all kidney graft recipients shortened CIT by almost 7 hours (22.9 vs 16.1 hours; P<.001), with a nonsignificantly lower incidence of DGF (32.2% vs 41.0%; P=.13). However, a Cox proportional hazards regression model revealed that early procurement reduced the risk of death-censored kidney graft loss by roughly 40% (log-rank, P=.013). Early LN procurement in significantly shorten CIT and subsequently reduced the risk of long-term kidney graft loss.
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0.99Impact points
Improved kidney graft function after conversion from twice daily tacrolimus to a once daily prolonged-release formulation.
Transplantation proceedings. 10/2011; 43(8):2950-3.
Tacrolimus once daily (Tac-QD) formulation has been recently introduced to improve patient adherence to immunosuppressive medications. To evaluate long-term effects of conversion from tacrolimus twice daily (Tac-BID) to Tac-QD on kidney graft excretory function, we retrospectively analyzed kidney gr... [more] Tacrolimus once daily (Tac-QD) formulation has been recently introduced to improve patient adherence to immunosuppressive medications. To evaluate long-term effects of conversion from tacrolimus twice daily (Tac-BID) to Tac-QD on kidney graft excretory function, we retrospectively analyzed kidney graft function after the conversion from Tac-BID to Tac-QD over 24 months. We enrolled 72 kidney transplant recipients, including 19 simultaneous pancreas-kidney cases, who were at least 9 months posttransplantation and showed stable graft function for 6 months. We analyzed kidney graft function (glomerular filtration rate [eGFR] by the Modification of Diet in Renal of Disease equation), tacrolimus daily dose and tacrolimus blood trough level changes over 24 months after conversion. All patients completed the 12 months and 56 patients, 24 months observation. At 3 months, the eGFR increased significantly after conversion from 57.1 to 60.0 mL/min/1.73 m2 (P=.004) and at 24 months to 66.0 mL/min/1.73 m2 (P<.001). Tacrolimus daily dose diminished over time by almost 10%, a difference that reached statistical significance at 18 months. Tacrolimus blood trough levels did not change significantly until 24 months. There was no correlation between eGFR changes during the first 12 months after conversion and changes in tacrolimus blood trough levels (r=-0.118; P=.33). Conversion from Tac-BID to Tac-QD formulation was followed by a clinically significant improvement in kidney graft function upon long-term observation. The improvement seemed to not be related to changes in tacrolimus blood trough levels.
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0.99Impact points
Association between gene polymorphisms of the components of the renin-angiotensin-aldosteron system, graft function, and the prevalence of hypertension, anemia, and erythrocytosis after kidney transplantation.
Transplantation proceedings. 10/2011; 43(8):2957-63.
Genetic predisposition, including polymorphisms of the renin-angiotensin system (RAS) genes, are among the potential factors that may affect the occurrence of hypertension, anemia, or erythrocytosis as well as transplanted kidney function. However, the association of the RAS genes polymorphism and t... [more] Genetic predisposition, including polymorphisms of the renin-angiotensin system (RAS) genes, are among the potential factors that may affect the occurrence of hypertension, anemia, or erythrocytosis as well as transplanted kidney function. However, the association of the RAS genes polymorphism and the kidney transplant outcomes is controversial. The aim of this study was to analyze the association between polymorphic variants of the angiotensin-converting enzyme (insertion/deletion [I/D]), angiotensinogen (M235T), and angiotensin II receptor type 1 (A1166C) genes, and the early and long-term kidney graft outcomes, as well as the prevalence of hypertension, anemia and erythrocytosis after kidney transplantation. We included 331 consecutive kidney transplant patients performed between 1998 and 2003. Of the total, 87.9% of patients completed a 5-year follow-up. Subjects were genotyped for the I/D, M235T, and A1166C polymorphisms. None of the examined polymorphism affected early or long-term graft function or was associated with hypertension before or after kidney transplantation. There was no significant difference in genotype distribution between patients with and without posttransplant erythrocytosis. However, posttransplant anemia (PTA) seemed to be significantly more common among kidney recipients with TT and MT than MM angiotensinogen genotypes (35.7% vs 20.7%; P=.03). The T allele was associated with the risk of development of PTA (odds ratio, 2.12; 95% confidence interval, 1.12-3.99; P=.02). Our results do not support the hypothesis that polymorphism of the genes coding RAS components may by an independent risk factor for the development of interstitial fibrosis/tubular atrophy, posttransplant hypertension, or PTE. Further studies are necessary to investigate the association between angiotensinogen M235T genotypes and PTA.
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0.99Impact points
Acute kidney injury before organ procurement is associated with worse long-term kidney graft outcome.
Transplantation proceedings. 10/2011; 43(8):2871-4.
As the disparity between the numbers of available organ donors and patients awaiting transplantation increases, different strategies have been proposed to extend the donor pool. Patients with acute kidney injury (AKI) developing during an intensive care unit (ICU) stay are often considered to be don... [more] As the disparity between the numbers of available organ donors and patients awaiting transplantation increases, different strategies have been proposed to extend the donor pool. Patients with acute kidney injury (AKI) developing during an intensive care unit (ICU) stay are often considered to be donors, but the long-term outcomes of such high-risk kidney transplantations is unknown. We analyzed the renal function and outcomes over 5 years of kidney grafts recovered from deceased donors diagnosed with AKI. We collected data from 61 deceased kidney donors, identified in 1 ICU, and 120 kidney graft recipients who underwent transplantation between January 1999 and December 2006. Donors were stratified according to the RIFLE classification, based on their creatinine and urine output change from admission to the ICU and organ procurement. Recipient kidney graft function (eGFR) calculated according to the MDRD (Modification of Diet in Renal Disease) equation was estimated every 6 months. Among 61 donors, 10 (16.4%) developed AKI, including 7 classified as "risk", 2 as "injury," and 1 as "failure." The mean follow-up of kidney graft recipients was 49±18 months. The long-term risk for graft loss was significantly higher among the group of kidneys recovered from donors with AKI (27.8% vs 7.1%; P=.02; log-rank=0.07). Their excretory function was worse over the whole follow-up period. Patients with kidney grafts obtained from the donors with AKI showed a higher risk for graft loss and worse excretory function upon long-term follow-up.
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0.97Impact points
Apoptosis of tubular epithelial cells in preimplantation biopsies of kidney grafts with immediate, slow and delayed function.
Annals of transplantation : quarterly of the Polish Transplantation Society. 09/2011; 16(3):17-22.
Apoptosis is a form of cell death observed in kidney grafts as a result of ischemia/reperfusion injury. The aim of our prospective study was to analyze the intensity of apoptosis in kidney tubules after cold storage in respect to early and 12-month post-transplant graft function. The intensity of re... [more] Apoptosis is a form of cell death observed in kidney grafts as a result of ischemia/reperfusion injury. The aim of our prospective study was to analyze the intensity of apoptosis in kidney tubules after cold storage in respect to early and 12-month post-transplant graft function. The intensity of renal tubular apoptosis was estimated by TUNEL method in proximal and distal tubules in 72 pre-implantation kidney biopsies. Sixteen patients with biopsies that did not fulfill Banff 97 classification, with early acute rejection or early graft loss, were excluded. Early graft function was defined as IGF (N=17) when serum creatinine (sCr) was <264 µmol/l at 3(rd) postoperative day (POD); as SGF (N=20) when sCr >264 µmol/l and not more than 1 dialysis was performed; and as DGF (N=19) when more than 1 dialysis was done. The percentage of apoptotic cells was markedly higher in distal than in proximal tubules in all 3 groups. The percentage of apoptotic cells in distal tubules found was: 3.02% (1.03-5.00%) in IGF, 1.66% (0.92-2.39%) in SGF, and 1.76% (0.84-2.68%) in DGF; these differences were not significant. In the IGF group the mean percentage of apoptotic cells in distal tubule was higher than in the other groups (not statistically significant). The subgroups of patients with higher and lower than median (1.35%) apoptotic cell range in distal tubules had similar graft function at the 12-month follow-up. The enhancement of tubular epithelial cells apoptosis in kidney grafts after cold storage does not determine its early and later excretory function.
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0.97Impact points
Intra-abdominal infections after simultaneous pancreas - kidney transplantation.
Annals of transplantation : quarterly of the Polish Transplantation Society. 09/2011; 16(3):36-43.
Intra-abdominal infections (IAI) are among the most common causes of pancreatic graft loss and recipient death in the early period after simultaneous pancreas - kidney transplantation (SPK). The aim of the study was to analyze risk factors and clinical consequences of IAI in SPK patients. Forty-six ... [more] Intra-abdominal infections (IAI) are among the most common causes of pancreatic graft loss and recipient death in the early period after simultaneous pancreas - kidney transplantation (SPK). The aim of the study was to analyze risk factors and clinical consequences of IAI in SPK patients. Forty-six consecutive SPK performed from 2004 to 2010 were subjected to analysis. IAI developed in 10 recipients (21.7%). The group of recipients with IAI had a higher rate of patients that required transfusion of more than 2 blood units (90% vs. 47%, p=0.028) or relaparotomy (80% vs. 14%, p<0.001), in comparison with patients without IAI. Additionally, in patients with IAI, both delayed kidney graft function or primary kidney graft nonfunction (40% vs. 11%, p=0.001) and recipient death (40% vs. 3%, p=0.006) were more frequently observed. Logistic regression analysis revealed an increased risk of IAI development in patients who required early relaparotomy (OR=24.8, p<0.001), transfusion of more than 2 blood units (OR=12.6, p=0.02), or postoperative dialysis therapy (OR=14.1, p=0.003). Perioperative blood loss requiring transfusion and necessity of relaparotomy increase the risk of IAI after SPK. Development of IAI after SPK may result in impaired kidney graft function and increases patient mortality in the early postoperative period.
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3.31Impact points
Impact of early kidney resistance index on kidney graft and patient survival during a 5-year follow-up.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 08/2011; 27(3):1225-31.
Resistance index (RI) measured by Doppler sonography during the early post-transplant period reflects interstitial oedema within the transplanted kidney. We have prospectively analysed the relationship between RI measured shortly after kidney transplantation (KTx), patient and graft survival, as wel... [more] Resistance index (RI) measured by Doppler sonography during the early post-transplant period reflects interstitial oedema within the transplanted kidney. We have prospectively analysed the relationship between RI measured shortly after kidney transplantation (KTx), patient and graft survival, as well as kidney graft function during a 5-year follow-up. RI was measured at the second to fourth day after KTx in 364 consecutive patients, who were divided into tertiles, according to baseline RI value (Group 1: RI < 0.73, Group 2: RI between 0.73 and 0.85 and Group 3: RI > 0.85). The kidney graft function [estimated glomerular filtration rate (eGFR)] during the follow-up period was calculated according to the Modification of Diet in Renal Disease formula. During the 5-year follow-up period, 23 patients died (2.6 versus 6.5 versus 9.6% in RI tertiles, respectively) and 59 lost their kidney graft (12.1 versus 17.7 versus 18.4%, respectively). Survival analyses showed that the effect of RI was significant for a combined outcome [graft loss or death; hazard ratio (HR) = 10.88] and in relation to death, it was of borderline significance (HR = 45.3, P = 0.09). The effect of delayed graft function (DGF) was only significant on graft loss (HR = 1.73). eGFR in the highest tertile was lower than in the lowest tertile during the entire follow-up period. High RI values measured in segmental arteries in the very early post-transplant period predict worse kidney graft function and increased risk of all-cause graft loss, including patient death in the 5-year follow-up period. (ii) The predictive value of RI is not completely independent from the adverse influence of DGF on the premature graft loss.
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0.38Impact points
Compliance with compression stockings in patients with chronic venous disorders.
Phlebology / Venous Forum of the Royal Society of Medicine. 08/2011; 26(8):353-60.
The aim of this large survey was to evaluate non-compliance with compression stockings in chronic venous disorder (CVD) patients. A total of 16,770 CVD patients participated in this study. Compression stockings were used by 25.6% of CVD patients and 46.6% of the patients were never prescribed compre... [more] The aim of this large survey was to evaluate non-compliance with compression stockings in chronic venous disorder (CVD) patients. A total of 16,770 CVD patients participated in this study. Compression stockings were used by 25.6% of CVD patients and 46.6% of the patients were never prescribed compression therapy. Compression stocking use was found to increase with the clinical stage of CVD. The percentage of patients using compression stockings during control visits increased to 37.4%. Furthermore, 5.3% of the patients coming to control visits discontinued the use of compression stockings owing to high cost, sweating, itching, cosmetic reason, oedema exacerbation, exudation lesions of lower legs and application difficulty. Past episodes of vein thrombosis (OR = 0.80), of stroke (OR = 0.28) and of varicose veins surgery (OR = 0.28) were decreasing, while the management by a general practitioner was increasing the risk (OR = 1.36) of compression therapy cessation. (1) Compression stockings are too rarely prescribed and often unaccepted at early stages of CVD; (2) The common reason for discontinuation of compression therapy is its high cost.
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[Pregnancy in a woman with chronic renal failure--the case of two successfully completed pregnancies and the review of the literature].
Ginekologia polska. 08/2011; 82(8):623-6.
Together with the prolongation and improving the quality of life of young women with chronic renal failure (CRF), procreation becomes an important issue. Pregnancies in women on renal replacement therapy are associated with an increased risk of health complications, both for mothers and for fetuses.... [more] Together with the prolongation and improving the quality of life of young women with chronic renal failure (CRF), procreation becomes an important issue. Pregnancies in women on renal replacement therapy are associated with an increased risk of health complications, both for mothers and for fetuses. Medical management of pregnant women with CRF is a great challenge and requires a close co-operation of nephrologists, transplantologists, gynecologists and neonatologists. The complexity of problems in these particular pregnancies has urged us to describe the case of a woman with CRF who successfully delivered two babies. We also review the current state of knowledge on the topic. The first pregnancy five years after renal transplantation, was completed with the delivery of term newborn with Tetralogy of Fallot. Also the second pregnancy on hemodialysis therapy was finished by the birth of a healthy neonate at term. The described case indicates that the gynecologists should be prepared for the challenge of the care for pregnancies in women suffering from chronic renal failure on renal replacement therapy.
Following (10)
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Marek Gierlotka
Śląskie Centrum Chorób Serca -
Paweł Madej
Slaski Uniwersytet Medyczny w Katowicach -
Olga Trojnarska
Uniwersytet im. Adama Mickiewicza w Poznaniu -
Tomasz Grodzicki
Uniwersytet Jagielloński -
Marcin Osuch
Śląskie Centrum Chorób Serca
Topics (2)
