Daniel Baczyński

Publications of Daniel Baczyński

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

  Authors: 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.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.

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

  Authors: 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 providesGiven 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.

  Authors: 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 failureThis 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.

• [Ambulatory or home peritoneal dialysis--time for changes?].

  Authors: Bozena Pietrzak, Daniel Baczyński, Monika Prokopiuk-Wierzbicka, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):338-9.

  Ambulatory peritoneal dialysis need to be adopted to the changing population of patients with irreversible renal failure who require more and more nursing support in normal performance of dialysisAmbulatory peritoneal dialysis need to be adopted to the changing population of patients with irreversible renal failure who require more and more nursing support in normal performance of dialysis procedure. Such possibility might be provided by introduction of supported or assisted by medical personal peritoneal dialysis in patient's home.

• [Cinacalcet in the therapy of secondary hyperparathyroidism--own experiences].

  Authors: Zbigniew Nowak, Maria Konieczna, Marek Saracyn, Daniel Baczyński, Piotr Wesolowski, Zofia Waińkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 04/2008; 24(142):303-6.

  Secondary hyperparathyroidism (sHPT) affects 20-25% dialysed patients and is related to the bone, mineral and cardiovascular complications. Cinacalcet, acts on the calcium-sensing receptor increasingSecondary hyperparathyroidism (sHPT) affects 20-25% dialysed patients and is related to the bone, mineral and cardiovascular complications. Cinacalcet, acts on the calcium-sensing receptor increasing its sensitivity to calcium, thereby reducing parathyroid hormone (PTH) secretion. The aim of this study was to evaluate the effect of cinacalcet in dialysed patients with sHPT Material and methods. We studied group of 12 patients on dialysis > 3 month with sHPT and baseline iPTH > 450 pg/ml (F = 6, M = 6; peritoneal dialysis 2 patients and HD 10 patients; mean age 56 +/- 14). Cinacalcet was titrated from 30 mg once daily during a 6 month period. The following parameters were determined in serum: iPTH, Ca, P, before onset of therapy and every 4 weeks during 6 months therapy. RESULTS: Serum iPTH significantly decreased after 4 weeks therapy compared to the start point (from 849 +/- 253 to 338 +/- 260 pg/ml) and after 24 weeks cinacalcet therapy to 298 +/- 153 pg/ml. (64% reduction). Serum calcium and phosphate decrease but not significantly 8.7 +/- 1.2 vs 8.6 +/- 1.1 mg/dl and 7.3 +/- 2.8 vs 6.3 +/- 1.7 mg/dl respectively. There weren't serious adverse events. CONCLUSIONS: Cinacalcet is effective and well tolerated nonsurgical management treatment of secondary hyperparathyroidism in dialysed patients.

• [Transperitoneal transport of water and substances--between theory and practice]

  Authors: Daniel Baczyński, Stefan Antosiewicz, Jacek Waniewski, Maria Marciniak, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 09/2006; 21(122):192-5; discussion 196.

  The practical use of the own method of prediction of peritoneal dialysis adequacy, based on direct assessment of transperitoneal transport, has been presented in this study.

• [Encapsulating peritoneal sclerosis as a serious complication of peritoneal dialysotherapy--current opinions on treatment and prevention]

  Authors: Daniel Baczyński, Stefan Antosiewicz, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 09/2004; 17(98):168-70.

  Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis program. It is characterised by high mortality. This article is a review of current knowledgeEncapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis program. It is characterised by high mortality. This article is a review of current knowledge concerning procedures in EPS. The views on change of renal replacement therapy--from peritoneal dialysis to hemodialysis were discussed. The possibilities of prevention and treatment of this complication were also presented.

• [Extended assessment of peritoneal transport kinetics of substances and water as an important element of integrated dialysis care]

  Authors: Daniel Baczyński, Stefan Antosiewicz, Jacek Waniewski, Maria Marciniak, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 09/2004; 17(98):110-3.

  The concept of integrated dialysis care is based on the choice of the most optimal method of renal replacement therapy for particular patient in particular period of disease. In many cases peritonealThe concept of integrated dialysis care is based on the choice of the most optimal method of renal replacement therapy for particular patient in particular period of disease. In many cases peritoneal dialysis (PD) is the initial therapy. PD modalities and regimens are modified according to values of parameters of ultrafiltration and adequacy. The routinely used methods of analysis of peritoneal transport are very useful for general assessment of properties of peritoneum as a dialysis membrane. However, the application of these methods do not guarantee the full assessment of peritoneal transport kinetics of water and substances. Therefore, the capabilities of the most adequate modification are limited. The tests based on mathematical models taking into account the kinetics of intraperitoneal dialysate volume seem to be the right supplement of standard methods. MATERIALS AND METHODS: To illustrate the problem mentioned above, the aim of this study was comparison of peritoneal transport of substances and water in two groups of patients: group I with negative ultrafiltration (UF) (n=14) and group II with positive UF (n=6). In the studied groups peritoneal equilibration test (PET) was done, then the assessment of peritoneal water transport was performed using 125I-HSA as dialysate volume marker, and finally the velocity of peritoneal transport of small molecules expressed by solute mass transport rate (SMTR) coefficient was measured. Patients from both groups belonged to the same category of high-average transporters according to PET criteria. RESULTS: On the base of broaden assessment of peritoneal transport of water and substances it was proved that different, "therapeutic approach" should be applied in studied groups to reach the adequate dialysis. Although in group II the minor modification of continuous ambulatory peritoneal dialysis (CAPD) regimen was desired, the radical change of CAPD schedule or transfer to automated peritoneal dialysis was necessary in cases of patients from group I. CONCLUSIONS: The results of the study indicate that the extended assessment of peritoneal transport kinetics of water and substances increases the capabilities of individualisation of PD program. Therefore, it should be treated as an important element of integrated dialysis care.

• Efficacy of automated peritoneal dialysis: from minimum to optimum.

  Authors: Daniel Baczyński, Stefan Antosiewicz, Jacek Waniewski, Maria Marciniak, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 11/2003; 15(88):319-21.

  The aim of the study was assessment of theoretical possibilities of the Automated Peritoneal Dialysis (APD) optimization. The analysis of influence of dwells number modification and peritonealThe aim of the study was assessment of theoretical possibilities of the Automated Peritoneal Dialysis (APD) optimization. The analysis of influence of dwells number modification and peritoneal transport character on Nightly Intermittent Peritoneal Dialysis (NIPD) efficacy and adequacy was performed. In the study the alternative method of theoretical foreseeing of peritoneal dialysis efficacy and adequacy was applied. This method was based on direct measurement of the velocity of solute peritoneal transport (SMTR). On the basis of SMTR, the dialysis efficacy expressed as total dialysed urea and dialysis adequacy expressed as Kt/V were estimated. The values of listed parameters were calculated for the different NIPD schedules (4-9 dwells during 8-hours session). It was revealed that the shortening of dwell time with simultaneous multiplying of dwell numbers resulted in increase of dialysis efficacy and adequacy. However, this improvement was non-proportional to the increase of dialysis solution volume and it did not provide the optimum of dialysis nor recommended level of adequacy even during the session consisting of 9 dwells. There were no statistically significant differences of Kt/V values between subgroups of patients with different character of peritoneal transport assessed according to PET test. The tendency to achieve the recommended values of Kt/V was observed in high transporters group. The results of the study indicate the large capabilities of APD optimization. The direct measurement of peritoneal transport velocity allows to provide better individualization of PD program. The prediction of APD efficacy and adequacy on the base of presented method seams to be an interesting alternative.

• [Mathematical analysis of the possibilities of automated peritoneal dialysis optimization]

  Authors: Daniel Baczyński, Stefan Antosiewicz, Jacek Waniewski, Maria Marciniak, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 12/2002; 13(77):384-8.

  The aim of the study was assessment of theoretical possibilities of the Automated Peritoneal Dialysis (APD) optimization. The analysis of influence of dwells number modification and peritonealThe aim of the study was assessment of theoretical possibilities of the Automated Peritoneal Dialysis (APD) optimization. The analysis of influence of dwells number modification and peritoneal transport character on Nightly Intermittent Peritoneal Dialysis (NIPD) efficacy and adequacy was performed. 20 patients were included in the study. The velocity of urea peritoneal transport expressed as SMTR (solute mass transport rate) was calculated according to the formula: SMTR = delta (CDVD)/delta t, where: delta (CDVD)--change of urea mass in dialysate during delta t time (CD-urea concentration in dialysate, VD-intraperitoneal volume of dialysate). VD was estimated from dilution of volume marker (RISA). On the basis of SMTR, the dialysis efficacy expressed as total dialysed urea and dialysis adequacy expressed as Kt/V were estimated. The values of listed parameters were calculated for the different NIPD schedules (4-9 dwells during 8-hours session). It was revealed that the shortening of dwell time with simultaneous multiplying of dwell numbers resulted in increase of dialysis efficacy and adequacy. However, this improvement was non-proportional to the increase of dialysis solution volume and it did not provide the optimum of dialysis nor recommended level of adequacy even during the session consisting of 9 dwells. There were no significant differences of Kt/V values between subgroups of patients with different character of peritoneal transport assessed according to PET test. The tendency to achieve the recommended values of Kt/V was observed in high transporters group. The results of the study indicate the large capabilities of APD optimization. The direct measurement of peritoneal transport velocity allows to provide better individualization of PD program. The prediction of APD efficacy and adequacy on the base of presented method seams to be an interesting alternative.

• [Empirical therapy of peritonitis in peritoneal dialysis patients--it is reasonable to use a new therapeutic schedule?]

  Authors: Daniel Baczyński, Stefan Antosiewicz, Bozena Pietrzak, Zofia Wańkowicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 12/2002; 13(77):396-8.

  The Ad Hoc Advisory Committee on Peritonitis Management recommended in the year 2000 a new protocol of empirical peritonitis therapy in patients on peritoneal dialysis with preserved residual renalThe Ad Hoc Advisory Committee on Peritonitis Management recommended in the year 2000 a new protocol of empirical peritonitis therapy in patients on peritoneal dialysis with preserved residual renal function (RRF). This protocol comprises 1st and 3rd generation cephalosporins. According to these recommendations the old protocol of therapy, comprising 1st generation cephalosporin and aminoglycoside may be used only in patients with diuresis lower than 100 ml/day. The aim of the study was a retrospective assessment of the efficacy and cost of peritonitis therapy using "old" and "new" protocols. The analysed episodes of peritonitis were divided into two groups. Group 1 included 22 episodes of peritonitis in 13 patients treated with the old protocol, in whom RRF was lower than 100 ml/day. Group 2 included 6 episodes of peritonitis in 4 patients with preserved RRF treated with the new protocol. The efficacy of the treatment according to the old protocol was 64% and according to the new protocol--33%. The average cost of 14-day therapy with the old and new schedule was 67.1 and 247.2 Euro, respectively. In our studied population a considerably lower efficacy and higher cost were revealed of the new empirical schedule of peritonitis treatment in comparison to the old schedule. The results of the study indicate the need of further estimation of the usefulness of the new peritonitis empirical treatment protocol.