[show abstract][hide abstract] ABSTRACT: Malnutrition is a negative predictive factor for survival in end stage renal disease (ESRD) patients. Coincidence of malnutrition, inflammation and atherosclerosis (MIA syndrome) in the dialysis population is an exceptionally poor outcome event. Due to flexibility, ease of performance and reproducibility, clinical scales are of particular value in assessment of nutritional status in ESRD patients. The aim of the present study was to evaluate the clinical value of Mini Nutritional Assessment (MNA) in peritoneal dialysis (PD) patients.
Nutritional status was assessed in 41 peritoneal dialysis patients by means of the MNA scale and malnutrition inflammation score (MIS). Some other clinical and laboratory parameters associated with nutritional status were analyzed. Patients were followed up for 30 months.
In the analyzed group of patients a good nutritional state was diagnosed in 22 patients (54%), risk of malnutrition in 17 (41%) and malnutrition in 2 patients (5%) based on the MNA scale. A strong correlation between MNA based nutritional status and MIS was found (r = -0.85, p < 0.01, ANOVA, p < 0.01). Differences in time on dialysis, body mass index, concentration of albumin, cholesterol and triglycerides were noted between at risk/malnourished and well-nourished (according to MNA) patients. Statistically significant factors determining survival of patients by Cox proportional hazard analysis were age (HR 1.07), being at risk/malnourished according to MNA (HR 5.7), MIS (HR 1.2), and albumin (HR 0.13).
The MNA scale is a valuable, clinically suitable tool for assessment of nutritional status in peritoneal dialysis patients. Risk of malnutrition and malnutrition diagnosed by MNA identifies patients at high mortality risk.
Archives of Medical Science 08/2013; 9(4):669-76. · 1.07 Impact Factor
[show abstract][hide abstract] ABSTRACT: Abstract Purpose: The lifespan of maintenance hemodialysis patients is reduced mainly because of cardiovascular complications due to accelerated atherosclerosis and impaired angiogenesis. We aimed to compare the effect of unfractionated heparin (UFH) and enoxaparin used as anticoagulants during hemodialysis (HD) on circulating levels of heparin-binding, anti-angiogenic Endostatin, pro-inflammatory RANTES (Regulated upon Activation, Normal T cell Expressed and Secreted), and MCP-1 (Monocyte Chemoattractant Protein-1). Methods: We enrolled 22 chronic HD patients, who were randomly assigned to either enoxaparin (n=11) or UFH (n=11) anticoagulation, and followed prospectively for 12 weeks before crossing over to the alternate therapy for further 12 weeks. The factors were measured (ELISA) at the start, 10 and 180 min of HD, and compared to 20 healthy volunteers. Results: The baseline Endostatin, RANTES, and MCP-1 levels in patients were higher than in controls and comparable during enoxaparin and UFH treatment. RANTES significantly increased during both enoxaparin and UFH anticoagulated HD, while over-HD Endostatin and MCP-1 levels remained stable regardless of the heparin sort. About 25% RANTES increase after 10 min of HD positively correlated with the dose of both heparins and HD duration. The switch from enoxaparin to UFH treatment had no impact on the levels of parameters studied. Patients with ischemic heart disease had less RANTES increase after 180 min of HD especially during enoxaparin treatment. Conclusion: RANTES is dose-depended and transitory increased in response to both UFH and enoxaparin administration during HD. Cardiovascular disease status occurred to be the most important predictor of its over-HD level.
Advances in Medical Sciences 08/2013; · 0.80 Impact Factor
[show abstract][hide abstract] ABSTRACT: Abstract Purpose: Cardiovascular disease (CVD) is a major cause of death among chronic hemodialysis (HD) patients. Gender and age belong to its classical risk factors. OPG/RANK/sRANKL (Osteoprotegerin/ Receptor Activator of Nuclear Factor κB/ soluble Receptor Activator of Nuclear Factor κB Ligand) axis constitute a system connecting bone and vascular remodeling. Methods: We aimed to evaluate the plasma levels of OPG, sRANKL and OPG/sRANKL ratio in 21 HD patients and 16 healthy volunteers in relation to gender, age and the other clinical parameters. Results: OPG and OPG/sRANKL ratio were significantly higher in HD patients than in controls whereas sRANKL was similar in both groups. Adjusted for gender, in controls OPG were higher in women whereas sRANKL did not differ between men and women. In HD group OPG and sRANKL were higher in women whereas OPG/sRANKL ratio was similar in both genders. Female patients compared to healthy women revealed 56% higher OPG concentration and 54% higher OPG/ sRANKL ratio. Comparison of male patients and controls revealed 61% higher level of OPG and 75% higher OPG/sRANKL ratio in HD group. Interestingly, OPG and OPG/sRANKL ratio positively correlated with age only in male patients. Contrary, the association between OPG/sRANKL ratio and age was negative in HD women. Conclusion: Higher OPG levels in HD women comparing to age matched HD men indicate the necessity of more careful screening towards the presence of CVD and bone-mineral disorders. The negative association between age and OPG/ sRANKL ratio in HD women warrant in-depth study for thorough understanding of this complex interrelationship.
Advances in Medical Sciences 08/2013; · 0.80 Impact Factor
[show abstract][hide abstract] ABSTRACT: INTRODUCTION Low levels of vitamin D are linked to many unfavorable phenomena among hemodialyzed (HD) patients e.g. disturbances of mineral and bone metabolism and increased mortality. Klotho, a molecule involved among others in phosphate homeostasis, ageing, exists in two forms: a transmembrane protein acting as a co-receptor for fibroblast growth factor 23 (FGF-23) and soluble one, which is formed by cleavage of the extracellular domain. OBJECTIVES The aim of the study was to evaluate the effect of cholecalciferol supplementation on soluble Klotho in HD patients. PATIENTS AND METHODS Prospective, open label trial examining effects of cholecalciferol supplementation in HD patients on selected laboratory markers. Vitamin D stores were assessed by measurement of 25-hydroxyvitamin D level. Soluble Klotho, intact FGF-23, intact parathormone (iPTH) and markers of bone formation and resorption were measured at the beginning and after 12 weeks of cholecalciferol supplementation in 22 treated HD patients. RESULTS Levels of 25(OH)D increased, iPTH and cross-linked C-telopeptide of type 1 collagen decreased significantly among treated HD patients. Cholecalciferol treatment lowered median concentration of soluble Klotho (from 438.73 pg/ml; interquartile range 257.99-865.51 pg/ml to 370.94 pg/ml; 181.72-710.91 pg/ml, p<0.05). FGF-23 level was not affected by the treatment. CONCLUSIONS Supplementation with cholecalciferol in HD patients decreases soluble Klotho not influencing FGF-23 concentration. Replenishment of vitamin D stores results in iPTH decrease and is accompanied by decreased bone resorption.
Polskie archiwum medycyny wewnȩtrznej 05/2013; · 1.83 Impact Factor
[show abstract][hide abstract] ABSTRACT: Abstract Background: High levels of antibodies against Nε-homocysteinylated (Nε-Hcy) proteins have been observed in patients on long-term hemodialysis (HD). We sought to investigate whether these antibodies are present in patients on peritoneal dialysis (PD) in comparable titers and to characterize the factors that determine levels of those antibodies in both patient groups. Methods: The study involved 80 patients on HD and age- and sex-matched 75 subjects on PD. Serum IgG antibodies against Nε-Hcy-albumin and -hemoglobin were determined using in-house enzyme-linked immunosorbent assays. Total homocysteine (tHcy), folate, 8-isoprostaglandin F2α (8-iso-PGF2α) and paraoxonase-1 (PON-1) activity were also measured. Results: Patients on PD and those on HD had similar levels of anti-Nε-Hcy-albumin [absorbancy at 490 nm: 0.571 (0.519-0.609) vs. 0.583 (0.523-0.625), p=0.41, respectively] and anti-Nε-Hcy-hemoglobin antibodies [0.659 (0.597-0.705) vs. 0.664 (0.597-0.722), p=0.60, respectively]. In both groups levels of the antibodies correlated with tHcy (r from 0.54 to 0.77, p<0.0001), 8-iso-PGF2α (r from 0.57 to 0.77, p<0.0001), and folate (r from -0.59 to -0.74, p<0.0001) levels, but not with the cause of renal disease, dialysis vintage, a history of coronary artery disease or PON-1 activity. In the multivariate logistic regression, after adjustment for potential confounders, plasma tHcy was the independent predictor of antibodies against Nε-Hcy-proteins irrespective of the method of dialysis. Conclusions: Levels of antibodies against Nε-Hcy-proteins are similar in patients on long-term PD and HD. The level of tHcy is the only independent predictor of both antibodies irrespective of the dialysis method.
Clinical Chemistry and Laboratory Medicine 11/2012; · 3.01 Impact Factor
[show abstract][hide abstract] 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. · 1.83 Impact Factor
[show abstract][hide abstract] 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; · 1.83 Impact Factor
[show abstract][hide abstract] 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.
[show abstract][hide abstract] 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. · 1.83 Impact Factor
[show abstract][hide abstract] 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. · 0.82 Impact Factor
[show abstract][hide abstract] 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. · 1.83 Impact Factor
[show abstract][hide abstract] 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.
[show abstract][hide abstract] ABSTRACT: Disturbances in endothelial function, adipokines, and mineral metabolism due to secondary hyperparathyroidism (SHPT) shorten the lifespan in hemodialysis (HD) patients.
The aim of the study was to evaluate the effect of SHPT treatment with cinacalcet on selected adipokines and markers of endothelial injury in HD patients.
Soluble thrombomodulin (sTM), E-selectin, leptin, and adiponectin levels were measured in patients with SHPT at baseline and at 6 months of cinacalcet treatment.
A total of 18 patients completed the study. SHPT treatment with cinacalcet decreased calcium, phosphate, and intact parathormone (iPTH) levels; however, no significant changes in sTM, E-selectin, leptin, or adiponectin were observed. iPTH levels after treatment correlated with age (r = -0.51, P = 0.031), mean cinacalcet dose (r = 0.65, P = 0.004), as well as baseline calcium (r = 0.65 P = 0.003), iPTH (r = 0.59, P = 0.01), E-selectin (r = 0.56, P = 0.016), and leptin (r = -0.49, P = 0.039).
Cinacalcet treatment does not affect the markers of endothelial function and selected adipokines. Effectiveness of treatment may be modulated by E-selectin and leptin.
Polskie archiwum medycyny wewnȩtrznej 02/2012; 122(4):148-53. · 1.83 Impact Factor
[show abstract][hide abstract] 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. · 1.83 Impact Factor
[show abstract][hide abstract] 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.
[show abstract][hide abstract] ABSTRACT: Many factors affect long-term graft and patient survival. Compliance with lifestyle recommendation may be an important factor. Lifestyle modifications may play a therapeutic and protective role against graft failure and possible death.
The aim of this work was to assess compliance with lifestyle recommendations among 110 kidney allograft recipients. All patients were asked to complete a questionnaire regarding life style, frequency of outpatient visits, self-control, diet, physical activity and addictions.
The mean age of the population was 48.79±13.18 years, and their mean time after transplantation was 69±44.5 years with a mean serum creatinine value of 1.45±0.7 mg/dL. Physicians were the major source of information (40%) for patients while in the hospital; nurses informed patients in only 5.5% of cases. The majority of patients (97.5%) attended regular outpatient clinic visits. A similar percentage of subjects regularly measured their blood pressure at home. One-fifth of the patient wrote a self-control diary. Only 55.5% of patients knew the immunosuppressive regimen, including the doses of the medications. An overweight condition was diagnosed in 39%, with obesity in 22%; 16% of the patients were smokers; one-fourth of the patients drank alcohol at least several times a month; 85.3% of patients did not change their diet after kidney transplantation; and one-half of the patients (64.2%) were not aware of dietary recommendations after kidney transplantation.
The majority of patients regularly attended the outpatient clinic and ingested immunosuppressive medications. However, their knowledge regarding diet, cancer prophylaxis, and self-control was insufficient. Therefore, there is a need to introduce more intense organizational and educational activities to improve patient knowledge.
[show abstract][hide abstract] ABSTRACT: BK polyomavirus (BKV) infection and BKV-associated nephropathy (BKVAN) are among the most important problems in renal transplantation. We aimed to determine the incidence of BK viruria, viremia, and BKVAN in renal transplant recipients in the northeastern part of Poland.
Urine and blood samples from 126 cadaveric renal transplant recipients were analyzed for BK viruria and viremia using quantitative real-time polymerase chain reaction and the patients were followed prospectively. The diagnosis of BKVAN was established on the allograft biopsy.
Based on the BKV DNA analysis, the patients were divided into three groups: group 1 (n=89; 70.6%) without viruria or viremia, group 2 (n=24; 19.1%) with isolated viruria, and group 3 (n=13; 10.3%) with both viruria and viremia. The presence of BK viremia negatively correlated with time after the transplantation. BK viruria was associated with mycophenolate mofetil daily dose. In group 3 there were four patients (3.2%) with high viremia (>10(4) genome equivalents [gEq]/mL) and viruria (>10(7) gEq/mL) loads. Only one patient from this group developed clinical symptoms and had BKVAN in allograft biopsy. In all four cases, the maintenance immunosuppression therapy was based on tacrolimus and steroids.
Prevalence of BKV infection in renal transplant recipients in the northeastern part of Poland is similar to that reported by studies from other countries. We confirm that BK viremia could be predicted by the presence of intense viruria. Time after transplantation and the type of immunosuppression strategy are the most important predictors of BK viremia and viruria in patients after renal transplantation.
[show abstract][hide abstract] ABSTRACT: Low-molecular-weight heparins (LMWHs) are an alternative to unfractionated heparin (UFH) for anticoagulation during hemodialysis (HD). We performed a prospective randomized crossover study of the effect of enoxaparin, nadroparin, and dalteparin on some hemostatic factors, including tissue factor pathway inhibitor (TFPI), in patients with maintenance HD.
Plasma levels (immunoassays) of total TFPI, platelet-derived growth factor-AB (PDGF-AB), and prothrombin fragment 1 + 2 (PF 1 + 2) were evaluated pre-HD, after 10 (T10) and 180 (T180) minutes of HD in 21 patients, who completed a 3-period (for 2 months each) crossover study in 6 groups (Latin-square design).
The baseline TFPI, PDGF-AB, and PF 1 + 2 levels were comparable under all LMWH treatments. Tissue factor pathway inhibitor levels, compared with the baseline, significantly increased (all P < 10(-4)), whereas PDGF-AB levels remained stable at each interval during enoxaparin, nadroparin, and dalteparin anticoagulated HD. Interestingly, TFPI increment at T10 was the highest, dose-dependent, and accompanied by PF 1 + 2 decrease under enoxaparin administration.
The switch from enoxaparin to nadroparin and dalteparin used as anticoagulants had no long-term effect on the baseline total TFPI and PF 1 + 2 levels in chronically HD patients. Only short-term, overdialytic differences were noticed, indicating a single bolus of enoxaparin (0.75 mg/kg) as the most potent stimulus for endothelial TFPI.
Clinical and Applied Thrombosis/Hemostasis 10/2011; 17(5):480-6. · 1.02 Impact Factor