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Polskie archiwum medycyny wewnȩtrznej 01/2013; 123(1-2):69-70. · 1.37 Impact Factor
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ABSTRACT: Iron is the most abundant transition metal in the human body and an essential element required for growth and survival. Our understanding of the molecular control of iron metabolism has increased dramatically over the past 10 years due to the discovery of hepcidin, which regulates the uptake of dietary iron and its mobilization from macrophages and hepatic stores. Although general practitioners and internists encounter iron deficiency and anemia in their everyday practice, little is known about iron metabolism in patients after solid‑organ transplantation. The aim of this review was to summarize the current knowledge on iron metabolism in kidney, heart, and liver transplant recipients. Iron deficiency and/or anemia, as well as iron overload, are frequently observed but the precise mechanism of these disturbances have not been fully elucidated. Iron deficiency is more prevalent in kidney and heart transplant patients, while iron overload in liver transplant recipients. Secondary and potentially reversible causes of these disturbances should be considered such as inflammation, graft failure, and type of immunosuppression. Iron status check‑up should be a part of long term follow‑up because disturbances in iron metabolism are a possible risk factor of infections and mortality in solid transplant recipients. Internists and general practitioners are often the first doctors to take care of organ transplant recipients (before they will present at outpatient transplant clinics or hospital transplant units); therefore, knowledge about the disturbances in iron metabolism in this specific population would be useful for better diagnosis and treatment both before and after transplantation.
Polskie archiwum medycyny wewnȩtrznej 10/2012; 122(10):504-11. · 1.37 Impact Factor
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ABSTRACT: INTRODUCTION In the recent years new parameters in iron metabolism were described as well as the problem of functional iron deficiency. Functional iron deficiency is characterised by the presence of adequate iron stores as defined by conventional criteria, but with insufficient iron mobilisation to adequately support erythropoiesis with the administration of erythropoiesis stimulating agents. OBJECTIVES The aim of this study was to test the hypothesis whether new parameters of iron metabolism are related to functional iron deficiency in stable hemodialysis patients. PATIENTS AND METHODS Iron status, complete blood count, creatinine, calcium, phosphorus, albumin, iPTH and serum lipids were assessed using standard laboratory methods. High sensitivity C-Reactive Protein (hsCRP), IL-6 (interleukin-6), NT-proBNP (N-terminal-proBrain Natriuretic Peptide), hepcidin, BMP-6 (bone morphogenic protein) and GDF15 (growth differentiation factor 15) were measured using commercially available kits. RESULTS BMP-6, GDF15 were similar in patients with and without functional iron deficiency. Functional iron deficiency was present in 23% of the studied hemodialysis patients and associated with significantly higher serum ferritin, IL-6, hsCRP and hepcidin levels, higher NT-proBNP levels, lower Kt/V (kinetic of urea modeling), increased prevalence of hypertension and diabetes and higher erythropoietin doses. It was predicted by serum iron and residual renal function. Left ventricular hypertrophy and left ventricular internal end-systolic dimension were also significantly more severe in hemodialysis patients with functional iron deficiency. CONCLUSIONS New parameters in iron metabolism were unrelated to functional iron deficiency, present in considerable group of hemodialysis patients. This population should be carefully screened for possible reversible causes of inflammation and then adequately treated.
Polskie archiwum medycyny wewnȩtrznej 10/2012; · 1.37 Impact Factor
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ABSTRACT: Hepatocyte growth factor (HGF), endogenous cytokine with pleiotropic repairing and regeneration properties in relation to most tissues and organs, contributes to the progression of periodontal disease (PD). Furthermore, PD is a significant health problem in patients with chronic renal failure (CRF). The role of HGF in the development of PD in this specific population was not a subject of research so far.
The following groups were enrolled in the study: (1) 26 chronic hemodialysis (HD) subjects, (2) 26 patients treated by continuous ambulatory peritoneal dialysis (CAPD), (3) 28 predialysis CRF patients, (4) 26 subjects with advanced PD (without coexisting diseases), and (5) 20 healthy subjects without PDs. HGF level in saliva was measured using the immunoenzymatic method. Gingival index, papillary bleeding index, plaque index, and the loss of clinical attachment level were evaluated.
The HGF level in saliva of HD patients was twice higher than in that of subjects with healthy periodontium. Direct relationships between proper HGF level in saliva and the indices GI, PBI, and PI in CAPD-treated patients and with more severe PD were shown. It was found that PD is most advanced in HD patients, moderately in CAPD-treated patients and to the smallest extent in predialysis CRF patients.
The HGF level in mixed saliva is the index of PD progression in subjects without renal failure and in CAPD-treated patients. PD is common in renal failure patients and is a significant problem concerning general health status.
Renal Failure 07/2012; 34(8):942-51. · 0.82 Impact Factor
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ABSTRACT: Anemia is not only a feature of chronic kidney disease of native or grafted kidneys, but also is frequently found in liver and heart transplant recipients. End-stage organ failure requiring transplantation is usually associated with failure or impaired function of other organs. Chronic kidney disease developing after non-renal solid organ transplantation is a significant issue, as reviewed previously. The degree of functional impairment in kidney function after non-solid organ transplantation and the rate of progression of CKD post-transplant depend to a large extent on pretransplant kidney function (ie, stage of preexisting CKD), the type of the transplanted organ, and the immunosuppressive protocol (use of calcineurin inhibitors), presence of comorbid conditions such as diabetes, hypertension, HCV infection, older age, surgical issues, and individual clinical features determining susceptibility to renal injury, even nephropathy resulting from BK virus infection, is presented.
Annals of transplantation: quarterly of the Polish Transplantation Society 06/2012; 17(2):86-100. · 2.02 Impact Factor
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ABSTRACT: Arteriovenous fistulas are a preferred access for hemodialysis. Subsequent hemodynamic changes in systemic circulation may cause heart failure. The general conclusions that can be drawn from the few available studies are that high‑flow fistulas causing symptomatic heart failure should be subjected either to reconstruction or ligation. However, it is still unclear whether a well‑functioning fistula should be ligated after successful kidney transplantation.
The aim of our study was to assess the effect of the fistula on heart function in patients after kidney transplantation.
The study included 18 patients after kidney transplantation. Five patients underwent fistula ligation for esthetic reasons; 4 fistulas thrombosed shortly after transplantation. A group of 9 patients with a patent fistula was matched for age and sex. Heart function was assessed by physical examination and echocardiography.
The study group consisted of 6 women and 3 men, aged 32 to 64 years, with 6 forearm and 3 arm fistulas, and with hemoglobin levels ranging from 6.95 to 9.63 mmol/l. The control group consisted of 6 women and 3 men, aged 38 to 66 years, with 5 forearm fistulas and hemoglobin levels ranging from 7.32 to 9.25 mmol/l. Control echocardiography was performed in each patient 3 months after fistula closure and did not reveal any significant differences compared with baseline examination.
Fistula ligation performed in a stable kidney allograft recipient does not seem to have a beneficial effect on cardiac function during short-term follow-up. Decision making should be cautious and balanced, because the creation of a new access may be extremely difficult and not always feasible.
Polskie archiwum medycyny wewnȩtrznej 06/2012; 122(7-8):348-52. · 1.37 Impact Factor
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ABSTRACT: Hypertension (HT) is one of the most frequent complications of solid organ transplantation; about 70-90% of this population have high blood pressure or require antihypertensive therapy. Abnormal blood pressure is a potent non-immunological risk factor directly related to patient and graft survival. The etiology of hypertension after orthotopic heart transplantation is multifactorial and varies depending on the time following transplantation. In the early period after transplantation, hypertension is generally related to intravascular volume expansion and persistently increased systemic vascular resistance. Other factors predominant in kidney allograft recipients include: donor age, donor familial history of hypertension, transplant renal artery stenosis, graft function, the recurrence or de novo appearance of glomerulonephritis in transplanted kidney, and post-biopsy arteriovenous fistula. In liver and heart transplantation, hypertension is mainly due to impaired kidney function, with all its consequences. Another contributing factor is immunosuppressive regimen based on calcineurin inhibitors and steroids. The management of post-transplant hypertension usually requests non-pharmacological and pharmacological treatment. In this review, the pathogenesis and treatment of post-transplant hypertension in solid organ transplantation is presented.
Annals of transplantation: quarterly of the Polish Transplantation Society 03/2012; 17(1):100-7. · 2.02 Impact Factor
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ABSTRACT: Chronic kidney disease (CKD) is associated with a considerably higher risk of cardiovascular disease due to the presence of traditional and nontraditional risk factors. Hypertension occurs in approximately 80% to 85% of the patients with CKD and its etiology is multifactorial. The sympathetic nervous system activity is enhanced in patients witch CKD resulting in increased vascular resistance and systemic blood pressure. This enhanced activity is the result of overspill and reduced catecholamine clearance. Recently, a new protein was discovered, named renalase. Experimental in vitro studies showed that renalase degrades catecholamines and thus may have a significant hemodynamic effect in vivo, for example may decrease cardiac contractility, heart rate, and blood pressure. Studies conducted in CKD and hemodialysis patients demonstrated lower serum renalase levels compared with healthy individuals. Other studies revealed increased serum renalase levels in dialysis population and kidney transplant recipients. There are no data concerning the association between renalase gene expression and activity/concentration and function of renalase; thus, it has to be proved in further studies that renalase is not an innocent bystander but is involved in the pathogenesis of hypertension.
Polskie archiwum medycyny wewnȩtrznej 03/2012; 122(4):174-9. · 1.37 Impact Factor
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ABSTRACT: Premature loss of permanent teeth leads to stomatognathic system disability. It is a very serious but underrated problem for patients with chronic renal failure. The aim of study was analyse the degree of loss of masticatory function and number of teeth present for haemodialysis patients, and to define patients' needs for prosthetic treatment, which could restore correct occlusal condition.
Sixty-nine haemodialysis patients treated at the Nephrology and Transplantology Clinic with the Dialysis Centre at the Medical University of Bialystok, Poland. We checked: 1) the total number of teeth and number of teeth separately for upper and lower jaws, 2) the existing prosthetic restorations and 3) the preserved masticatory function.
More male than female patients were in possession of full dentition.All patients with at least 28 natural teeth with retained occlusal contacts whilst chewing were males (4; 10% males; 5.7% of the whole group). There were 15 edentulous patients: 7 males (10%) and 8 females (11.5%). Hundered percent of female patients presented with various degrees of tooth loss and needed prosthetic treatment. Nearly 70% of tested haemodialysis patients did not have a reconstructed masticatory function.
The population of haemodialysis patients from the North East part of Poland are patients with severe stomatognathic system dysfunctions. It is of importance for dentists, as well as nephrologists, to understand the essence of the problem, as the general health of a patient cannot be improved without ensuring functional comfort of such as important system as the masticatory one.
Archives of medical science : AMS. 02/2012; 8(1):81-7.
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ABSTRACT: Renalase is an enzyme released by the kidneys, which breaks down catecholamines in the blood and thus may regulate blood pressure. In kidney transplant recipients, endothelial dysfunction is often present.
The aim of the study was to assess associations between renalase, blood pressure, and kidney function in kidney allograft recipients.
We studied 62 kidney allograft recipients. Complete blood count, urea and creatinine levels, serum lipids, and fasting glucose were measured by standard laboratory methods. We also assessed markers of coagulation: prothrombin fragments 1+2; fibrinolysis: tissue plasminogen activator (tPA), plasminogen activator inhibitor, plasmin-antiplasmin complexes; endothelial function/injury: von Willebrand factor (vWF), thrombomodulin, intercellular adhesion molecule, vascular cell adhesion molecule (VCAM); and inflammation: high‑sensitivity C‑reactive protein and interleukin 6. Renalase levels were assessed using a commercially available kit.
Mean serum renalase levels in kidney allograft recipients correlated with age, time after transplantation, soluble CD44 (sCD44), VCAM, serum creatinine, estimated glomerular filtration rate (eGFR; measured by CKD-EPI, MDRD, and Cockcroft‑Gault formulas), serum phosphate, urea, sCD146, vWF, and thrombomodulin and tended to correlate with tPA. In patients with eGFR above 60 ml/min, renalase was lower than in those with lower eGFR. In hypertensive allograft recipients, renalase was significantly higher than in normotensives. A multiple regression analysis showed that renalase was predicted in 58% by serum creatinine.
Renalase, which is highly elevated in kidney transplant recipients, is dependent primarily on kidney function, which deteriorates with age and time after transplantation. Further studies are needed to establish the putative role of renalase in the pathogenesis of hypertension after transplantation and its possible use in novel targeted therapies.
Polskie archiwum medycyny wewnȩtrznej 02/2012; 122(1-2):40-4. · 1.37 Impact Factor
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ABSTRACT: Stress hyperglycaemia on admission is a predictor of mortality in patients with acute myocardial infarction (MI).
To establish what level of hyperglycaemia on admission indicates a significantly poorer long-term prognosis in patients with MI treated invasively.
Glycaemia on admission was measured in patients with both ST-segment elevation MI (STEMI) and non-ST- -segment elevation MI (NSTEMI) treated with percutaneous coronary intervention (PCI). In-hospital and late mortality were evaluated during a 679.3 ± 202 day follow-up.
We enrolled 794 patients (564 men; 71%), mean age 63.8 ± 11.3 years. One per cent of the patients died during initial hospitalisation, and 10% during the two-year follow-up. The mean value of glycaemia in the whole population was 115 ± 36 mg/dL (6.32 ± 1.98 mmol/L). Admission glycaemia in patients who died in hospital was 194 ± 71 mg/dL (10.67 ± 3.91 mmol/L), while in the patients discharged home it was 114 ± 35 mg/dL (6.27 ± 1.93 mmol/L) (p 〈 0.0001). In terms of two-year mortality, the patients who died had also significantly higher glycaemia on admission (145 ± 48 mg/dL; 7.98 ± 2.64 mmol/L) vs 112 ± 31 mg/dL (6.16 ± 1.71 mmol/L, p 〈 0.0001). Apart from admission hyperglycaemia, we found the following risk factors of late mortality in univariate analysis: age, heart rate (HR), left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), creatinine level, number of significantly narrowed coronary vessels other than the infarct related artery (IRA), and unsuccessful PCI. In multivariate analysis, the following parameters correlated with death in the two-year follow-up: glycaemia on admission, age, HR, LVEF, GFR, creatinine level, total cholesterol, number of significantly narrowed coronary vessels other than the IRA, and unsuccessful PCI. Hyperglycaemia on admission was an independent risk factor of death even after adjustment for confounding variables such as age, sex and LVEF. We compared the areas under ROC curve for in-hospital mortality and the areas under ROC curve for late mortality according to glycaemia on admission. Both were significantly different from those of a random model (p 〈 0.001 and p 〈 0.001, respectively). A glycaemia value of 205 mg/dL (11.28 mmol/L) calculated from ROC curve had the highest sensitivity and specificity for late mortality. Apart from these findings, we observed a linear correlation between glycaemia and mortality.
The best cut-off value for stress hyperglycaemia determined by ROC curve in patients with acute MI treated invasively is 205 mg/dL (11.28 mmol/L). Patients with glucose levels 〉 205 mg/dL (11.28 mmol/L) on admission have significantly higher late mortality compared to those with glucose levels 〈 205 mg/dL (11.28 mmol/L). Our results suggest that hyperglycaemia is a reliable marker of poor outcome in acute MI patients with and without previously diagnosed diabetes mellitus. This level of glucose may be used in risk stratification in patients with acute MI.
Kardiologia polska 01/2012; 70(6):564-72. · 0.51 Impact Factor
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ABSTRACT: Obesity and overweight alone may confer a survival benefit after myocardial infarction, independent of age, medical care or therapy.
To evaluate the impact of body mass index (BMI) on long-term mortality in ST-segment elevation acute myocardial infarction (STEMI) patients treated by primary angioplasty (PCI).
We prospectively studied a homogenous group of 131 patients who had suffered STEMI, and subsequently exhibited a TIMI 3 flow after primary PCI. The patients (41 women, 90 men, mean age 58.3 ± 10.8 years) were analysed in two groups: Group 1 - 30 (23%) patients with BMI 〈 25 kg/m(2) and Group 2 - 101 (77%) patients with BMI ≥ 25 kg/m(2).
Altogether, 19 (14.5%) patients died during the five-year follow-up period - nine out of 30 (30%) were patients with BMI 〈 25 kg/m(2), and ten out of 101 (10%) were patients with BMI ≥ 25 kg/m(2) (p 〈 0.001). Individuals with BMI ≥ 25 kg/m(2) had lower five-year mortality, and this was independent of other potentially confounding variables. Area under the receiver-operating characteristic (ROC) curves for death with respect to weight on ROC analysis was significantly different than for a random model (p 〈 0.05). There were no significant differences in 30-day mortality and one-year mortality (p = 0.6517 and p = 0.3573, respectively).
Patients after primary angioplasty for STEMI with BMI 〈 25 kg/m(2) and patients with BMI ≥ 25 kg/m(2) have no difference in 30-day or one-year mortality, but individuals with BMI ≥ 25 kg/m(2) have a better five year prognosis, and this is independent of other potentially confounding variables.
Kardiologia polska 01/2012; 70(7):686-93. · 0.51 Impact Factor
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ABSTRACT: The year 2011 was very interesting regarding new studies, trials and guidelines in the field of lipidology, hypertensiology and nephrology. Suffice it to mention the new European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias, American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines on hypertension in the elderly, and many important trials presented among others during the American Society of Nephrology (ASN) Annual Congress in Philadelphia and the AHA Annual Congress in Orlando. The paper is an attempt to summarize the most important events and reports in the mentioned areas in the passing year.
Archives of medical science : AMS. 12/2011; 7(6):1055-66.
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ABSTRACT: INTRODUCTION: The blood pressure (BP) J-curve debate has lasted for over 30 years and we still cannot definitively answer all the questions. However, recent studies suggest that BP should be reduced carefully in patients with hypertension and coronary artery disease. BP should not fall below 110 - 115/70 - 75 mmHg, because this may be associated with more cardiovascular events. AREAS COVERED: A retrospective analysis of the INVEST Trial and the results of the BP arm of the ACCORD Trial shows that care is needed in patients with hypertension and diabetes. Although the ACCORD BP Trial suggests important benefits connected with the significant reduction of stroke in patients being treated intensively, it also shows the lack of advantage of such therapy on each main and other additional endpoints. The ACCORD Trial also confirmed the increased risk of adverse events that might appear when intensive treatment was used in this group of patients. EXPERT OPINION: Most available studies were observational and randomized trials (BBB, HOT, ACCORD BP), do not have or have lost their statistical power and were inconclusive. Further studies are therefore needed to provide definitive conclusions on the subject. In the meantime, it seems that in high-risk patients with hypertension, it is necessary to carefully select those who might suffer adverse events and those who may benefit from intensive BP lowering.
Expert Opinion on Pharmacotherapy 04/2011; 12(12):1835-44. · 3.20 Impact Factor
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Archives of Medical Science 01/2011; 7:1055-1066. · 1.21 Impact Factor
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ABSTRACT: The aim of the study was to assess whether neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C could reflect kidney function in pregnant healthy women.
The studies were performed on 130 healthy pregnant women (n = 63, 3(rd) trimester; n = 21, 2(nd) trimester; n = 46, 1(st) trimester) and 30 healthy female volunteers. Serum NGAL, cystatin C, IL-6, and hs-CRP were assayed using commercially available kits.
Serum cystatin C rose steadily during the pregnancy, whereas NGAL rose in the 2(nd) trimester, then decreased in the 3(rd) trimester. In univariate analysis, NGAL correlated with serum cystatin C, number of pregnancies, white blood cell count, total iron-binding capacity (TIBC), ferritin, and IL-6, and tended to correlate with eGFR. In multiple regression analysis the only predictor of serum NGAL was cystatin C.
Serum NGAL in pregnancy might reflect subclinical inflammation rather than kidney function. It seems that NGAL, similarly to cystatin C, is not useful to monitor renal function in pregnancy.
Archives of medical science : AMS. 10/2010; 6(5):744-7.
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ABSTRACT: Heart disease and renal failure occurring together, constitute a potential threat to life, especially in the elderly. Diseases of the cardiovascular system are the main factor in morbidity and mortality in patients with chronic kidney disease. On the other hand, chronic kidney disease is considered a risk factor for cardiovascular diseases. Identified major nephrological problems, especially chronic renal disease and acute kidney damage, as the most aggravating cardiac patients. Stressed the importance of clinical, preventive measures and prognosis in contrast nephropathy
Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego 02/2010; 28(164):152-7.
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ABSTRACT: Cardiovascular disease (CVD) is leading cause of death in patients on renal replacement therapy. Increased concentration of fibrinogen, dyslipidemia, and impaired fibrinolysis are regarded as important risk factors for CVD. Intima media thickness (IMT) of the common carotid artery is related to coronary and cerebrovascular arterial disease. Thrombin-activatable fibrinolysis inhibitor (TAFI) is a recently discovered inhibitor of the fibrinolytic system. The aim of study was to evaluate whether IMT is related to the hemostatic factors prothrombin fragments 1+2 (F 1+2), thrombin-antithrombin (TAT) complexes, plasmin-antiplasmin (PAP) complexes, fibrinogen, euglobulin clot lysis time (ECLT), TAFI, and thrombomodulin in peritoneally dialyzed (PD) and hemodialyzed (HD) patients.
The study included 80 chronically dialyzed patients (27 on PD, 53 on HD). The hemostatic parameters were measured with commercially available kits.
Significant positive correlations were found between fibrinogen or triglycerides and TAFI activity only in the PD patients. In univariate analysis, IMT correlated significantly with age, cholesterol, CRP, fibrinogen, hemoglobin, prothrombin time, activated partial thromboplastin time, and iron in the PD patients. In multiple regression analysis, IMT was only independently related to age and cholesterol in PD patients. In HD patients, IMT correlated with age, prothrombin time, and iron and in multiple regression analysis IMT was only independently related to age.
The correlations between IMT and Hb may imply a role of these rheological factors in the progression and acceleration of arterial remodeling in the PD population. Age remains the most significant predictor of IMT in both dialyzed populations
Medical science monitor: international medical journal of experimental and clinical research 12/2009; 15(12):CR644-9. · 1.70 Impact Factor
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ABSTRACT: Inflammation and disturbances of the hemostatic system may play a role in pathogenesis and complications of ischemic heart disease. More and more reports indicate that apart from their cholesterol-lowering effect statins also exert other beneficial effects in cardiovascular diseases. Taking this into consideration, the aim of the study was to assess the influence of simvastatin (20 mg per day) on a marker of inflammation - CRP and some parameters of coagulation and fibrinolysis in 22 patients with ischaemic heart disease. Serum lipids, levels of hsCRP, thrombomodulin (TM), vWF, prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), thrombin activatable fibrinolysis inhibitor (TAFI), t-PA, plasmin-antiplasmin complex (PAP) and TAFI activity were assessed before and after one, three and six months simvastatin treatment. After one month therapy of simvastatin, there have been significant reduction of levels of total cholesterol, LDL-cholesterol and triglycerides and these values have remained until the end of the study. No influence on the level of HDL-cholesterol has been observed. After 6 months of treatment significant decrease in the level of hsCRP and increase of the levels TM and vWF with reference to baselines results have been observed. After a 1-and 6-month therapy, the level of TAFI have been significantly increased. Other hemostatic parameters, i.e. levels of F1+2, TAT, t-PA, PAP and TAFI activity have not changed significantly. This prospective study has confirmed high efficacy of lipid-lowering effect and anti-inflammatory properties of simvastatin. Simvastatin influenced some hemo-static parameters, however, these effects were not, in majority, significant.
Przegla̧d lekarski 02/2008; 65(2):68-72.
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ABSTRACT: There is an increasing number of patients with end-stage renal disease all over the world, mainly in the population of patients with diabetic nephropathy and in the elderly. One of the most important issues in nephrology care is the vascular access. The closest to the ideal vascular access is the native arterio-venous fistula. On the other hand, patients with end-stage renal failure are prone to cardiovascular complications, including left ventricular hypertrophy, cardiomyopathy, accelerated arterio- and atherosclerosis, vascular remodeling. Congestive heart failure is 20-fold more common than in the general population, and is found in about 30% of dialyzed patients, whereas left ventricular hypertrophy in 75%. Creating vascular access in patients with already established cardiovascular complications, may enhance the risk of exacerbation of cardiovascular complications with a negative effect on the patients' survival. The novel cardiovascular problems following vascular access creation may include: decompensation of congestive heart failure, pulmonary hypertension, inadequately low blood flow in the fistula with subsequent inadequate dialysis and fistula thrombosis, fistula infection (with local and systemic symptoms), and micro-inflammation (particularly in the politetrafluoroethylene grafts). The data concerning mutual relationship between vascular access and cardiovascular system in hemodialyzed patients are very scarce, mainly casual. In the review the updated status concerning the effects of vascular access creation on the cardiovascular system is presented.
Przegla̧d lekarski 02/2008; 65(12):858-61.
