Lada Zibar

University of Osijek, Osik, Osječko-Baranjska, Croatia

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Publications (21)10.6 Total impact

  • Jelena Banjeglav, Lada Zibar
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    ABSTRACT: To determine the prevalence of anemia and risk factors that can affect on it six months after kidney transplantation (TX) at the University Hospital Osijek (KBCO) in period from 2007 to March 2012. The study included 55 patients, mean age 49 +/- 11 (27 - 70) years, after deceased donor kidney TX in KBCO from 2007 to March 2012. Two grafts did not survive a week (one for sudden death and another for the renal artery thrombosis, in the first 24 hours, respectively). The method of the survey comprised of taking data from the medical records and statistical analysis (SPSS). Posttransplantation anemia (PTA) and is defined by serum hemoglobin (Hb) concentration less than 110 g/l at 3 months after TX. The prevalence of PTA was 28.85%. PTA was more frequent among women (P=0,025). Patients with PTA were significantly longer hospitalized (P=0.002). PTA was more frequent in patients with sepsis after TX (P=0,03), in those with dehiscent postoperative wound (P=0,021) and in the patients with acute kidney transplant rejection (P=0.004). Although delayed graft function was not found significantly related to the PTA, decreased kidney function indicating feature, i.e. number of hemodialysis (HD) needed after TX (P=0.004) and after HD duration (P=0,008), were associated with the PTA significantly. Furthermore, serum creatinine concentration, at the time of hospital release, were significantly higher in those with PTA (P=0.035). There is statistically significant correlation between mean Hb and cratininemia at 3 months after TX. Immunosuppressive drugs and other studied medication, frequently used by kidney transplanted patients, were not related to the PTA. The anemia required crythropoietin substitution in 20 of 53 patients, while 20 patients received blood transfusions. PTA presents a great problem among the kidney transplanted patients with prevalence in our patients similar to that in previously published reports. This study had confirmed some of the well known risk factors for anemia in kidney transplant patients, like gender and graft function, but also there had been noticed few risk factors that can be prevented, like dehiscent postoperative wound and sepsis. PTA often requires erythropoietin substitution and blood transfusions, increasing the expenses of kidney transplantation and posttransplantation treatment. Therefore, prevention of PTA is, both medically and economically, justifide.
    Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 10/2012; 66 Suppl 2:4-11.
  • Petra Lukinac, Lada Zibar
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    ABSTRACT: To determine prevalence of delayed graft function (DGF) in renal transplant patients at the Clinical Hospital Center in Osijek (KBCO) and its association with graft function 6 months after transplantation (TX). The study included 55 patients, mean age 49 +/- 11 (27 - 70) years, after deceased donor kidney TX in KBCO from 2007 to March 2012. Two grafts did not survive a week (one for sudden death and another for the renal artery thrombosis, in the first 24 hours, respectively). The method of the survey comprised of taking data from the medical records and statistical analysis (SPSS). DGF, defined as the need for hemodialysis (HD) for more than 7 days after TX, was found in 28 of 53 recipients. DGF was more common in women (p=0.022). Patients with DGF had significantly higher creatininemia at discharge (p=0.003). Using multivariate analysis, none of the examined characteristics (recipient's gender, age at TX, basic renal illness, previous TX number, pretransplantation dialysis method and duration, donor's age and cause of death, number of HLA mismatches, cold ischemia duration and donor's creatininaemia, initial immunosuppressive therapy) showed significant impact on the occurrence of DGF. Patients with DGF did not differ from those without DGF in creatininemia 6 months after TX. The overall incidence of DGF was high and similar to that in previously published reports, but more common in women. In this study, previously known risk factors, like cold ischemia time and cause of death of the donor, were not associated with the development of DGF. Although DGF unfavorably impacts posttransplantation course, the study did not found its association with renal graft function 6 months after TX.
    Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 10/2012; 66 Suppl 2:12-6.
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    ABSTRACT: The aim of the study was to assess the frequency of SNP896A/G in the Toll-like receptor (TLR) 4 gene and SNP1350T/C in the TLR2 gene in patients with acute myocardial infarction (AMI) and to analyse the association of these SNPs with risk factors for atherosclerosis and clinical aspects of AMI in a sample of the Croatian population. We included 240 participants in the study: 120 AMI patients and 120 sex- and age-matched healthy blood donor controls. The SNP1350T/C variant in the TLR2 gene showed a lower frequency in the AMI patient group than in the control group (P = 0.033). The frequency of SNP896A/G variants in the TLR4 gene between the patients and the controls did not differ (P = 0.286). Significantly, fewer people had SNP1350T/C in the TLR2 gene (P = 0.003) among the participants with arterial hypertension than those without it. The frequency of SNP896A/G in TLR4 was the same in hypertensive patients compared with normotensive subjects (P = 0.088). SNP1350T/C in TLR2 was less frequent in the AMI patients and in those with hypertension. Thus, SNP1350T/C in TLR2 might play a protective role against AMI and arterial hypertension. The frequency of SNP896A/G in the TLR4 gene was not associated with AMI and arterial hypertension. Other risk factors for atherosclerosis and clinical aspects of myocardial infarction were not associated with the genotype distribution of the examined genes.
    Scandinavian Journal of Immunology 01/2012; 75(5):517-23. · 2.20 Impact Factor
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    ABSTRACT: The renin-angiotensin system (RAS) has been shown to have important role in blood pressure regulation. Inconsistent results have been reported regarding the association of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism (NCBI ref. SNP ID: rs1799752) and hypertension as well as a contributing factor in the development of diabetic nephropathy. Aim of the study was to investigate the significance of insertion/deletion polymorphism of angiotensin-converting enzyme as contributing factor to blood pressure regulation in type 2 diabetic patients with diabetic nephropathy and those with preserved renal function. Genomic DNA was extracted from whole blood of 100 patients with diabetic nephropathy and 102 diabetic patients with normal renal function (urinary protein excretion rate less than 300 mg/day and creatinin clearence level > or = 80 ml/min). Blood pressure measurement was done 3 times by a nurse in the supine position, in 15 minutes intervals. Mean arterial pressure (MAP) was calculated according to the standard equation- (systolic pressure + 2 x diastolic pressure)/3, for all measurements. Genotyping was carried out using primers and fluorescent probes in a Lyght Cycler System. Statistical analysis was performed using software package SPSS 16.0 (SPSS inc, Chicago, IL, USA). Genotype frequencies of the ACE I/D) polymorphysm were in accordance with the Hardy-Weinberg equilibrium. In all subjects, the frequencies of the DD. ID and II genotypes were 0.32; 0.45 and 0.23 respectively. The allelic frequency of the D allele in nephropatby group was 0.82 and 0.72 in the control group. The highest systolic blood pressure was in the subjects with DD genotype. Systolic and mean, arterial pressure were significantly higher in diabetic nephropathy patients compared to patients with preserved kidney function, only if D allele was present (systolic blood pressure: DD t=2,877, p=0,006; ID t=2.733, p=0,008; mean arterial pressure: DD t=2,687, p=0.009; ID t=2,843, p=0,006). Individuals with type 2 diabetes mellitus who carry the D allele appear to be susceptible to development of the end stage renal disease. D allele might be an additional risk factor for the uncontrolled hypertension in diabetic nephropathy patients.
    Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 10/2011; 65 Suppl 3:14-9.
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    ABSTRACT: Despite of routinely practised living kidney transplantation, data on consequences and impact of unilateral nephrectomy on the quality of life and health of donors are scarce. The aim of the present study was to examine long-term changes and function of the remnant kidney after unilateral nephrectomy in an animal model. Thirty six female Sprague - Dawley rats at 4 months of age were randomized into the three groups: unilaterally nephrectomized, sham operated and naïve rats. The nephrectomy was done at inclusion in the experiment and their blood was taken at inclusion and six months thereafter. There was a significant increase in serum creatinine concentrations six months after unilateral nephrectomy (39.7 ± 0.8 μmol/l) in comparison with the sham operated (30.1 ± 1.1 μmol/l) and the naïve rats (26.3 ± 3 μmol/l) (p ≤ 0.001). Serum sodium levels remained unchanged (p=0.116). Blood haemoglobin concentration did not differ between the three groups (p=0.115). Although it has been very well established that kidney possesses huge capacity to compensate severe loss of renal mass, our results implicate that renal function undergoes significant deterioration with time after unilateral nephrectomy. Fortunately, in everyday clinical practice we do not see severe renal dysfunction in patients with a single kidney. However, prolongation of the human life span in the future could face us with renal impairment in living kidney donors. Future examination of specific biomarkers in our rat model (e.g. growth factors) could support our findings.
    Medicinski glasnik 08/2011; 8(2):185-91. · 0.20 Impact Factor
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    ABSTRACT: Angiotensin converting enzyme (ACE) inhibitors provide well known cardiorenal-protective benefits added to antihypertensive effects in chronic renal disease. These agents are underused in management of patients receiving hemodialysis (HD) because of common concern of hyperkalemia. However, few studies have investigated effect of renin angiotensin aldosterone system (RAAS) blockade on serum potassium in hemodialysis patients. We assessed the safety of ramipril in patients on maintenance HD. We enrolled 28 adult end stage renal disease (ESRD) patients treated by maintenance HD and prescribed them ramipril in doses of 1.25 to 5 mg per day. They underwent serum potassium concentration measurements before ramipril introduction and in 1 to 3 months afterwards. No significant increase in kalemia was found. Results of our study encourage the use of ACE inhibitors in chronically hemodialyzed patients, but close potassium monitoring is mandatory.
    Collegium antropologicum 06/2011; 35(2):537-42. · 0.61 Impact Factor
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    ABSTRACT: The aim of the study was to examine a perfusion and integrity of small bowel in 60 subsequent patients during the major open abdominal surgery which lasted from 2 to 7 hours. Two samples of the intestinal mucosa were removed: at the beginning, and at the end of the surgical procedure in general anaesthesia. A mucosal injury was classified into 4 grades. pH, PCO2 and lactate level were measured in the blood samples from the arterial and mesenteric vein in one hour time intervals. The changes of intestinal mucosa were found in 31 patients (51.7%): in 19 patients (31.7%) grade 1 changes were recorded, in 10 patients (16.7%) grade 2, and in 2 patients (3.3%) grade 3. Grade 4 lesions were not recorded. There was a statistically significant correlation between grades of the mucosal damage and the surgery duration (p = 0.001). Analysis during the one hour intervals showed that there was no exact time point when the significant aggravation of the pathohistological changes in intestinal mucosa occurred. However, when patients were allocated into two subgroups with surgical procedures lasting less than 4 hours and more than 4 hours, there was a statistically significant difference in the grades of mucosal damage between subgroups (p < 0.05). More biopsies without pathohistological changes were observed in the patients whose procedure duration was < 4 hours. A significantly higher lactate concentrations in arterial and mesenteric venous blood were observed in the patients with pathohistological changes at 6 hours time point as compared to 2 hour time point in the patients without pathohistological changes (p < 0.05). During the open abdominal surgery in general anaesthesia, the length of the procedure influences the grade of the intestinal mucosa injury. Deterioration of the pathohistological findings in the intestinal mucosa correlates with high lactate blood level, suggesting that the cause of these changes may result from tissue hypoxia.
    Collegium antropologicum 06/2011; 35(2):445-51. · 0.61 Impact Factor
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    ABSTRACT: Cytokine gene polymorphisms have been associated with modified gene expression and cytokine production. Gamma interferon (IFN-γ) plays an important role in the pathogenesis of kidney transplant rejection. This study evaluated the association between IFN-γ gene polymorphisms and the history of acute allograft rejection in 53 adult first-transplant recipients receiving cadaveric kidney grafts. They were followed up in a single centre until 2006, for a median time of 4 years after transplantation (1-22 years). IFN-γ gene polymorphisms +874 T/A (rs2430561) were determined by polymerase chain reaction (PCR). T/T high IFN-γ genotype was found in 12, intermediate T/A in 29 and low A/A in 12 patients. Twenty-six acute kidney rejection episodes were evidenced in 20 patients, of which none occurred in the 12 patients with low IFN-γ genotype A/A. Age, gender, number of HLA (human leukocyte antigen) mismatches, ABO blood groups, HLA, time after transplantation, creatinine clearance and immunosuppressive regimens were excluded as confounding factors associated with IFN-γ genotype distribution between rejectors and non-rejectors. IFN-γ gene polymorphisms could be an important risk factor for acute kidney transplant rejection, whereas the low A/A IFN-γ genotype could be protective against rejection.
    Scandinavian Journal of Immunology 01/2011; 73(4):319-24. · 2.20 Impact Factor
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    ABSTRACT: Chronically hemodialyzed (HD) patients frequently suffer from quantitative and even more often qualitative serum lipids disorders. Mostly they have increased triglycerides and VLDL-cholesterol, slightly increased or normal total and LDL-cholesterol and decreased HDL-cholesterol concentrations. The study compared lipid profile between two groups of chronic HD patients coming from regionally distinct areas, the continental and the maritime one. The aim was to examine the hypothetic influence of their different dietary habits on lipid profile. The study included 72 patients from continental region (39 men) and 50 from maritime part of the country (30 men). Patients suffering from diabetes mellitus, hypothyroidism, liver disease, alcoholics as well as sevelamer treated patients were not included. Prior to a HD session the patients were determined fasting total cholesterol, triglycerides, HDL- and LDL-cholesterol, total proteins, albumins and C-reactive protein serum concentrations. All patients were undergoing bicarbonate hemodialysis with polysulphone dialysers of low permeability. The continental group of patients were somewhat older, undergoing HD for longer period of time, of lower height, greater weight, greater body mass index, higher total (4.70 +/- 0.91:4.42 +/- 1.02 mmol/L), and LDL-cholesterol (2.78 +/- 0.74:2.66 +/- 0.75 mmol/L) concentrations, while lower triglycerides (1.72 +/- 0.84:1.81 +/- 0.83 mmol/L) and HDL-cholesterol (1.13 +/- 0.42:1.16 +/- 0.54 mmol/L). However all the differences were without statistical significance. Chi-square test showed that the continental group of patients consumed more often pork, bacon, smoked and cured meats, margarine, butter, walnuts, almonds, garlic, cream and full-fat cheese than fish. They prepare food more often with lard and sunflower oil. Almost every fourth continental patient received statins, while only every 25th in the maritime group of patients. There were not any statistically significant Chi-square values for differences in frequencies of patients with total cholesterol greater than 5.2 mmol/L, triglycerides above 1.6 mmol/L, HDL-cholesterol less than 1.1 mmol/L, LDL-cholesterol greater than 2.6 mmol/L, obesity and malnutrition between the two groups. Based on the results of this study we have concluded that diet has significant influence on lipid profile of HD patients. Even though the continental and the maritime groups of patients differed significantly in diet, they were similar in plasmatic lipoprotein concentrations. However, this similarity was ascribed only to statin treatment, which was more frequent in the continental group of patients. The influence of ESRD and HD as a method of renal replacement therapy on lipid profile was not more dominant than diet.
    Collegium antropologicum 03/2010; 34 Suppl 1:181-8. · 0.61 Impact Factor
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    ABSTRACT: Chronic renal failure affects all organ systems. Senses are not exception and hearing impairment is common, particularly sensorineural hearing loss (SNHL). The term SNOS of unknown origin or uremic deafness is related to only a smaller part of the cases with unclear etiology of the impairment. The study searched for SNOS in 66 chronic hemodialysis (HD) patients, mean age 51.50 +/- 12.70 years. They were treated by HD for 69.70 +/- 53.80 months. The relation between the severity of the impairment and the patients' age, duration of HD treatment (months) and a set of laboratory parameters typical for chronic HD patients was examined. The aim of the study was to detect potential causes of the impairment. The increased hearing threshold (HT) of above 20 dB for all frequencies was found in 42 patients (mean HT 26 +/- 10.50 dB), for speaking area frequencies in 22 patients (mean HT 19.70 +/- 8.80 dB), and in 56 patients for high frequencies (mean HT 41.70 +/- 19.70 dB). The significant positive correlation of HT was found only with the patients' age (r = 0.49, p < 0.01). The patients older than 45 years had higher mean HT than those younger, and those older than 65 also had higher HT than the younger ones. Patients with pathological value of HT were significantly more common among the older subgroup of patients, when divided according to the age at both cutoff values of 45 and of 60 years. Mean HT did not differ significantly according to the duration of HD treatment (subgroups A- no longer than 60 months, B- from 61 to 120 months, and C- longer than 120 months). The patients with pathological HT did not differ significantly in frequency among those subgroups, and the subgroups were not different according to the mean age (A--50.30 +/- 13.20 years; B--51.40 +/- 12.75 years; C--55.80 +/- 10.55 years). In conclusion, our results along with other authors'published data report on SNHL as very frequent finding among chronic HD patients and suggest multifactorial etiology. Accurate proportion of those with SNHL of unknown origin is not possible to determine. Those cases are probably not caused by uremic polyneuropathy and/or preterm vascular aging only, although those factors are likely to play crucial roles.
    Collegium antropologicum 03/2010; 34 Suppl 1:165-71. · 0.61 Impact Factor
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    ABSTRACT: There is an ongoing trend of a rapid increment in the frequency of diabetes mellitus, expecially the non-insulin dependent form. By the end of the 2nd millenium 150 million cases were recorded worldwide, while the estimations predicted doubling the number by the year 2030. Numerous chronic complications accompany the disease, among them micro-, as well as macrovascular prevail, affecting small and large blood vessels. This paper provides a literature review on the topic of diabetic nephropathy, the main microvascular complication of diabetic disease. Microalbuminuria is the earliest sign of the diabetic renal involvement, with more than 30 mg and less than 300 mg of albumins in 24 h urine sample. The reduction of renal function begins with albuminuria leaving microalbuminuria level and entering the pathologic proteinuria range. Renal failure advances through the 5 stages, the final fifth occurring fortunately only in a minor proportion of the patients. The final stage ensues in 232 of 100 000 diabetic patients, according to the US data. However, in many developed countries there are 30-40% of new patients entering chronic dialysis treatment for diabetic nephropathy. Pathogenesis of diabetic nephropathy is based on hyperglycemia and distinct hemodynamic changes, glomerular hyperfiltration and high intraglomerular pressure. The important role have oxidative stress, advanced glycation end products, some cytokines, growth factors and sorbitol pathway. Nevertheless, genetic influence is considered by far the most important risk factor for diabetic nephropathy. Heritage determines the susceptibility in one and the protection in another diabetic patient. At the moment of pathologic proteinuria occurrence, glomerular filtration rate begins to decline for 1.2 ml/min/monthly in some patients, making the annual reduction of 7-14 ml/min/1.73 m2 of body surface area. Improving glycemia, blood pressure control, renal anemia correction with rHu-Epo, dyslipidemia control, reduction in protein intake, i.e. management of the nongenetic factors, could slower the renal function loss in some of the patients. Hence, these measures could reduce the proportion of the patients reaching end-stage renal disease, having in mind that morphological and functional changes are reversible only within certain limits. Therefore, the success of kidney protection is better if commenced earlier.
    Lijec̆nic̆ki vjesnik 01/2009; 131(7-8):218-25.
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    ABSTRACT: The aim of this study was to determine the association of bleeding as a complication of warfarin therapy with polymorphism of CYP2C9 gene (alleles 1, 2 and 3). The CYP2C9 is the main enzyme for warfarin metabolism. Study included 181 patients receiving warfarin for at least one month. Allele 1 of CYP2C9 gene (in 94.5%) and genotype *1/*1 (57.5%) prevailed. Allele 3 was found in 12.7% patients. Bleeding side-effects occurred in 18 patients (10%). Patients with allele *1 needed significantly higher maintenance warfarin dose (p=0.011). Those with allele *3 had significantly lower maintenance warfarin dose (p=0.005) and higher prothrombin time (PT) at induction (p=0.034). Bleeding occurred significantly more often in those with lower maintenance warfarin dose (p=0.017). Patients with allele *3 had increased risk of bleeding, with marginal significance (p=0.05). Polymorphism of CYP2C9 could determine dose of warfarin therapy and thus it could be related to the risk of bleeding complications. Allele *3 carriers need lower warfarin dose. Therefore, initially reduced warfarin induction dose in allele *3 carriers could avoid more prolonged PT and decrease the risk of bleeding complication.
    Collegium antropologicum 07/2008; 32(2):557-64. · 0.61 Impact Factor
  • Blood Reviews - BLOOD REV. 01/2007; 21.
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    ABSTRACT: Duplex sonography was used to assess functional features of arteriovenous fistula (AVF) for hemodialysis (HD). Internal diameter (ID), resistance index (RI) and blood flow (BF) velocity in feeding artery and in vein ofAVF, and venous BF volume were analyzed with purpose to determine the normal values. Presumed normal BF velocities are those of clinically well functioning shunts, allowing BF through HD lines of minimally 250 ml/min. Study included 66 nondiabetic HDpatients (30 women, 36 men), mean age 52-13 years, treated by HD for median 61 (4-252) months. Measurements in 47patients with clinically well functioning AVF were as followed: mean arterial ID 5.2 +/- 1.4 mm, median arterial RI 0.3 (0.3-0.9), median arterial BF velocity 1.5 (0.6-3.6) m/s, mean venous ID 7.6 +/- 2.2 mm, median venous RI 0.3 (0.3-0.9), mean venous BF velocity 1.6 +/- 0.7 m/s, and median venous BF volume 530 (120-1890) ml/min. Patients with poor functioning AVF had significantly less arterial ID, higher arterial RI, less venous ID, less venous BF velocity and volume. Duplex sonography findings obtained for clinically estimated well functioning shunt should be considered as normal Doppler values. Blood vessels' morphologic features depend upon age, and older patients have more pronounced changes.
    Collegium antropologicum 10/2006; 30(3):535-41. · 0.61 Impact Factor
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    ABSTRACT: This survey presents epidemiological, serological and clinical features of 270 patients (85% males, 18% children) treated for leptospirosis from 1969 to 2003 at the Clinic for Infective Diseases, University Hospital Osijek, Osijek, eastern Croatia. 75% of the admissions were between July and October. The route of transmission was mostly by indirect contact with domestic animals, less frequently by direct contact with urine or tissue of infected animals. Clinical presentation included signs and symptoms with expected and common frequency, with the exception of jaundice (62%) and aseptic meningitis (60%), which occurred with higher incidence than previously reported. Acute renal failure ensued in 53% of patients, 7% of whom required haemodialysis. No deaths were observed. Therapy consisted of antimicrobials (penicillin and doxycycline) and symptomatic measures. Diagnosis was confirmed by microscopic agglutination test (MAT). There were in total 18 serological types of Leptospira detected, and types L. sejroe, L.pomona, L. australis and L. icterohaemorrhagiae prevailed. During the last 10 y some new types were observed. Leptospirosis was not rare in the region of eastern Croatia, and its course could be life-threatening if not recognized and adequately treated.
    Scandinavian Journal of Infectious Diseases 02/2005; 37(10):738-41. · 1.71 Impact Factor
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    ABSTRACT: A proportion of peritoneal dialysis (PD) patients experience substantial body weight (BW) gain with time. It is caused by fat tissue accumulation or fluid retention. It is believed that fat tissue accumulates due to caloric contribution of glucose absorbed from dialysis solution or to the mitochondrial fat regulatory uncoupling protein (UCP) gene polymorphism. This study examined BW fluctuations in 40 patients (24 females, 16 males), treated by PD at least 36 months (initial mean age 54.50+/-9.00 years, mean BW 68.00+/-8.50 kg and mean height 164.00+/-8.50 cm), relation of the BW fluctuation and caloric contribution of glucose absorbed from dialysis solution and characteristics of the patients with BW gain. Initial BW increased after 6, 12, 24 and 36 months by 5.90+/-3.50 kg, 7.90+/-4.90 kg, 9.50+/-5.00 and 11.00+/-5.00 kg, or for 8.68, 11.62, 13.97 and 16.18% of the initial value, respectively. After the first 6 and 12 months 38 patients gained weight, 39 after 24 and all 40 patients after 36 months. There was not significant correlation between BW gain and caloric contribution of glucose absorbed from dialysis solution. Female patients had initially lower BW, but for the first 12 months period significantly increased BW more than males, and not for the other observed periods. High transporters (patients with higher transport, higher transmission of glucose from peritoneal solution into the blood, and urea and creatinine in the opposite direction, with rapid decrement of osmolality gradient between dialysate and blood that is necessary for excessive fluid elimination), had lower initial BW and, although without statistical significance, only within the first period increased BW more than low transporters. In conclusion, with time BW gain was found in all the PD dialysis patients, it was not related to caloric contribution of glucose absorbed from dialysis solution, and women and high transporters increased BW weight more than men and low transporters in the first year of treatment. The BW gain is at least in part caused by fluid retention.
    Lijec̆nic̆ki vjesnik 01/2005; 127(5-6):116-20.
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    ABSTRACT: Red blood cell osmotic resistance (RBCOR) is defined as resistance to osmotic changes in cell integrity after their exposure to hypotonic saline solution. The investigation examined the effect of rHuEPO on RBCOR in hemodialysed patients. The study included 58 patients aged 49 +/- 14 years, treated by hemodialysis for 59 +/- 43 months on average. Half of the patients received rHuEPO for anemia correction. RBCOR was determined in all patients as 3 values: hemolysis start point (HSP), hemolysis end point (HEP) and middle osmotic resistance (MOR). The patients underwent laboratory checkup for parameters characteristically changed in the uremic syndrome. In the control group of healthy subjects (n = 16) RBCOR was only determined. No differences were found in the average values of HSP, HEP and MOR between the rHuEPO treated group of patinets and the untreated group. Compared to healthy individuals, the hemodialysed patients displayed significantly higher values of HSP, HEP and MOR. The only one significant correlation of RBCOR and routine laboratory features was found between MOR and predialytic serum concentrations of calcium (r = 0.28, p < 0.05) and hydrogen ions (r = 0.37, p < 0.05). Our results suggest that the administration of rHuEPO does not affect RBCOR in hemodialysed patients, that RBCOR is not always reduced in this population and that it correlates with a small number of laboratory parameters characteristic for the uremic syndrome.
    Collegium antropologicum 01/2005; 28(2):639-46. · 0.61 Impact Factor
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    ABSTRACT: Peritoneal dialysis adequacy is usually estimated using the ratio of total weekly urea clearance (Kt) and urea distribution volume (V), the later being identical to total body water volume. It is observed that even patients with acceptable Kt/V values sometimes show signs and symptoms of dialysis inadequacy. A question arose whether the discrepancy came from a falsely assessed urea distribution volume, because the less the urea distribution volume measured the higher the Kt/V gained. The survey included 32 patients (15 women, 17 men) in whom 62 total weekly urea clearances were calculated during a 2-year period. Each Kt was used in 4 different equations (A-Watson's method, B-Hume's method, C-58% of body mass for urea distribution volume, D-for urea distribution volume: 58% of body mass reduced by 2 kg, and then augmented by 2 kg added for dialysate volume assumed). It resulted in 4 different Kt/V for each Kt, i.e. a total of 248 Kt/V values. At the moment of the examination the patients were aged 57.66 +/- 8.66 years, weighted 75.54 +/- 11.04 kg (with dialysate intraperitoneally), and were treated with peritoneal dialysis for a mean of 23.28 +/- 27.55 months. Their mean total weekly urea clearance was 79.94 +/- 12.53 L. Depending on the method used, the mean urea distribution volumes were as follows: A = 37.24 +/- 5.27 L, B = 37.89 +/- 5.22 L, C = 43.81 +/- 6.40 L and D = 44.65 +/- 6.47 L, and mean Kt/V 2.15 +/- 0.32 (A), 2.11 +/- 0.32 (B), 1.82 +/- 0.33 (C) and 1.79 +/- 0.34 (D). The highest mean urea distribution volume (D) was higher than the lowest value (A) by 19.90%, and the difference between those values was statistically significant (tV D: A = 6.99, p < 0.01). The highest mean total weekly Kt/V (A) was higher than the lowest value (D) by 20.11%, and the difference was also significant ((tKt/V A: D = 6.08, p < 0.01). The estimation of urea distribution volume has a direct impact on calculation results of total weekly Kt/V in peritoneal dialysis patients. Urea distribution volumes as assessed by the anthropometrical methods or by a certain percentage of body mass were approximate values. We suggest replacing "nondeuterial methods" by deuterial, in order to get more comparable results.
    Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 02/2004; 58(1):25-30.
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    ABSTRACT: The patients treated with hemodialysis have marked cardiovascular morbidity and mortality. Furthermore, lipid and lipoprotein disorders in these patients are well known. Since lipid and lipoprotein disorders are undoubtedly associated with cardiovascular morbidity and mortality, treatment of this group of patients should aim also at the correction of these disorders. The effect of hemodialysis with cellulose diacetate membranes on plasma lipids and lipoproteins was studied in 13 female patients followed-up for 4.5 months. Total cholesterol, triglycerides, HDL and LDL cholesterol, and apolipoproteins (a), AI and B were determined in each patient at the beginning and at the end of the study. Significant increases in HDL cholesterol (0.95 +/- 0.30-1.09 +/- 0.32 mmol/l), apolipoprotein B (1.14 +/- 0.35-1.35 +/- 0.36 g/l), and apolipoprotein (a) (272.38 +/- 281.66-357.36 +/- 400.30 U/l), nonsignificant increases in total cholesterol (5.61 +/- 1.18-5.63 +/- 1.23 mmol/l), LDL cholesterol (3.30 +/- 1.05-3.69 +/- 1.32 mmol/l) and apolipoprotein AI (1.03 +/- 0.25-1.11 +/- 0.19 g/l), and nonsignificant decrease in triglycerides (3.07 +/- 1.49-2.74 +/- 1.37 mmol/l) were found in the study. In conclusion, only some of the observed changes in plasma proteins and lipoproteins are beneficial for the patients.
    Lijec̆nic̆ki vjesnik 03/1997; 119(2):56-9.
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    ABSTRACT: Physical growth is permanently influenced by genetic and environmental factors. Their impacts are overlapping, and therefore it is difficult to separate the contribution particularly ascribable to one or another kind of the factors. The study investigated the relation between body weight and height in 397 children (195 girls and 202 boys) enrolling primary school and their birth growth features on the one side, and their parents' heights on the other. The correlations between children's weight and height on enrolling primary school and their birth growth features were also studied. The aim was to examine the proportion of genetic determinacy of children's growth. Mean birth weight and length were 3440 +/- 413 g and 50.50 +/- 2.00 cm, respectively, and mean head circumference was 34.50 +/- 1.20 cm. On entering the primary school, the children were 6.70 +/- 0.30 years of age in average, and had mean body weight and height of 24.60 +/- 5.00 kg and 122.70 +/- 6.15 cm, respectively. Majority of children had both parents with middle or low education level, 285 (71.79%) of them. Majority of children also had both parents employed. 266 (67.00%) of them. Children's height on enrolling the school was in significant positive correlation with birth weight, length and head circumference, and with parents' heights. The correlation coefficient was the highest with father's height (r=0.473, p<0.01), and the lowest with birth weight (r=0.158, p<0.05). Children's weight on enrolling the school significantly positively correlated with the three birth growth features and with father's height, but not with mother's height (r=0.091, p>0.05). The correlation coefficient was the highest for father's height (r=0.288, p<0.01) again. All the birth parameters correlated stronger with mother's than with father's height. In the subgroup of children whose mothers were of equal or greater height than fathers (n=28), correlation coefficient between children's and fathers' heights (r=0.295, p<0.01) was lower than between children's and mothers' heights (r=0.474, p<0.01). In conclusion, children's weight and height at the time of enrolling primary school significantly positively correlates with their parents' heights. The correlations are stronger with father's height. Though, it is not the matter of gender, but of the higher parent. The birth growth parameters are only in part related to parents' heights (all three with mother's and only one with father's height). It is obvious that mothers' influence is dominant for children's growth at that time. There was no significant difference in any examined parameter between subgroups of children divided according to their parents education level and employment status.
    Lijec̆nic̆ki vjesnik 128(1-2):13-9.