A Wiecek

Medical University of Silesia in Katowice, Catowice, Silesian Voivodeship, Poland

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Publications (457)1363.78 Total impact

  • Piotr Kuczera · Marcin Adamczak · Andrzej Wiecek
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    ABSTRACT: Background/aims: Calcium sensing receptor (CaSR) is expressed, among others also in testis. Cinacalcet binds to the CaSR, increases sensitivity of CaSR to serum calcium and is used in the treatment of secondary hyperparathyroidism (sHPT) in chronic hemodialysis patients (HDP). In most of male HDP, serum testosterone concentration is lower than in healthy males. The aim of this study was to assess the influence of six-month treatment with cinacalcet on the serum total and free testosterone concentration in male HDP with sHPT. Methods: 38 male, hemodialysed CKD patients with sHPT (PTH>300 pg/ml) were enrolled into the study. In each patient serum PTH, total testosterone (TT) and free testosterone (FT) concentrations were assessed before the first dose of cinacalcet and then after 3 and 6 months of treatment. The results are presented as means with 95% confidence interval. Results: In 33 patients who completed the study cinacalcet treatment caused significant decrease of serum PTH from 1143 pg/ml (828 - 1458 pg/ml) at the baseline, to 809 pg/ml (487 - 1132pg/ml) after 3 month of treatment (p = 0.002), and to 607 pg/ml (281 - 934pg/ml; p < 0.0001) after 6 months of treatment. Serum TT concentration also decreased from 4.95ng/ml (4.23 - 5.67 ng/ml) to 4.45 ng/ml (3.85 - 5.06ng/ml) and to 4.39 ng/ml (3.75 - 5.03ng/ml), respectively (p for trend = 0.009). Moreover, serum FT concentration decreased from 6.95 pg/ml (5.54 - 8.36pg/ml) to 5.98 pg/ml (5.00-6.94 pg/ml); p = 0.14 and to 5.60 pg/ml (4.63 - 6.57 pg/ml); p = 0.034, respectively (p for trend = 0.012). Conclusion: Treatment with cinacalcet decreases serum total and free testosterone concentration in male hemodialysed patients with chronic kidney disease and secondary hyperparathyroidism.
    No preview · Article · Jan 2016 · Kidney and Blood Pressure Research
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    Piotr Kuczera · Marcin Adamczak · Andrzej Wiecek
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    ABSTRACT: In patients with chronic kidney disease the alterations of the endocrine system may arise from several causes. The kidney is the site of degradation as well as synthesis of many different hormones. Moreover, a number of concomitant pathological conditions such as inflammation, metabolic acidosis and malnutrition may participate in the pathogenesis of endocrine abnormalities in this group of patients. The most pronounced endocrine abnormalities in patients with chronic kidney disease are the deficiencies of: calcitriol, testosterone, insulin-like growth factor and, erythropoietin (EPO). Additionally accumulation of several hormones, such as: prolactin, growth hormone and insulin frequently also occur. The clinical consequences of the abovementioned endocrine abnormalities are among others: anemia, infertility and bone diseases.
    Full-text · Article · Dec 2015
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    ABSTRACT: Background: Tonsillectomy has been considered a treatment for IgA nephropathy (IgAN). It is aimed at removing a source of pathogens, reducing mucosa-associated lymphoid tissue and decreasing polymeric IgA synthesis. However, its beneficial effect is still controversial. In Asia, favorable outcomes have been claimed mostly in association with corticosteroids. In Europe, small, single-center uncontrolled studies have failed to show benefits. Methods: The European validation study of the Oxford classification of IgAN (VALIGA) collected data from 1,147 patients with IgAN over a follow-up of 4.7 years. We investigated the outcome of progression to end-stage renal disease (ESRD) and/or 50% loss of estimated glomerular filtration rate (eGFR) and the annual loss of eGFR in 61 patients who had had tonsillectomy. Results: Using the propensity score, which is a logistic regression model, we paired 41 patients with tonsillectomy and 41 without tonsillectomy with similar risk of progression (gender, age, race, mean blood pressure, proteinuria, eGFR at renal biopsy, previous treatments and Oxford MEST scores). No significant difference was found in the outcome. Moreover, we performed an additional propensity score pairing 17 patients who underwent tonsillectomy after the diagnosis of IgAN and 51 without tonsillectomy with similar risk of progression at renal biopsy and subsequent treatments. No significant difference was found in changes in proteinuria, or in the renal end point of 50% reduction in GFR and/or ESRD, or in the annual loss of eGFR. Conclusion: In the large VALIGA cohort of European subjects with IgAN, no significant correlation was found between tonsillectomy and renal function decline. © 2015 S. Karger AG, Basel.
    No preview · Article · Nov 2015 · Nephron - Physiology
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    ABSTRACT: Resistant hypertension is defi ned as blood pressure above goal despite adherence to a combination of at least three optimally dosed antihypertensive medications, one of which is a diuretic. Chronic kidney disease is the most frequent of several patient factors or comorbidities associated with resistant hypertension. The prevalence of resistant hypertension is increased in patients with chronic kidney disease, while chronic kidney disease is associated with an impaired prognosis in patients with resistant hypertension. Recommended low-salt diet and triple antihypertensive drug regimens that include a diuretic, should be complemented by the sequential addition of other antihypertensive drugs. New therapeutic innovations for resistant hypertension, such as renal denervation and carotid barostimulation, are under investigation especially in patients with advanced chronic kidney disease. We discuss resistant hypertension in chronic kidney disease stages 3–5 (ie, patients with an estimated glomerular fi ltration rate below 60 mL/min per 1·73 m² and not on dialysis), in terms of worldwide epidemiology, outcomes, causes and pathophysiology, evidence-based treatment, and a call for action.
    Full-text · Article · Nov 2015 · The Lancet
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    ABSTRACT: Hypertension is a very common disease, and office measurements of blood pressure are frequently inaccurate. Ambulatory Blood Pressure Monitoring (ABPM) offers a more accurate diagnosis, more detailed readings of average blood pressures, better blood pressure measurement during sleep, fewer false positives by detecting more white-coat hypertension, and fewer false negatives by detecting more masked hypertension. ABPM offers better management of clinical outcomes. For example, based on more accurate measurements of blood pressure variability, ABPM demonstrates that taking antihypertensive medication at night leads to better controlled nocturnal blood pressure, which translates into less end organ damage and fewer clinical complications of hypertension. For these reasons, albeit some shortcomings which were discussed, ABPM should be considered as a first-line tool for diagnosing and managing hypertension.
    Full-text · Article · Oct 2015 · Clinical and Experimental Nephrology
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    ABSTRACT: Cyclosporine A (CsA) is a commonly used immunosuppressive agent. In some patients treatment with CsA has to be continued during pregnancy. The aim of the study was to assess in an experimental model whether the exposure to CsA during fetal life influences the number and volume of glomeruli, kidney function and blood pressure in the offspring. Eight pregnant female Sprague-Dawley rats were allocated to 2 treatment regimens: with CsA or solvent. Blood pressure was measured in the offspring at 7 and 11 weeks of age and albuminuria was determined at 11 weeks of age. In the kidney the number and mean volume of glomeruli was assessed using stereological methods. In the offspring of pregnant rats treated with CsA the number of glomeruli was significantly lower and the mean volume of glomeruli was higher when compared to the offspring of pregnant rats receiving solvent. Systolic and diastolic blood pressures as well as albuminuria were significantly higher in the offspring of mothers treated with CsA during gestation compared to the offspring from the control group. Exposure of rats to CsA during fetal life impairs kidney development, thus potentially predisposing to chronic kidney disease and hypertension in the adult life. © 2015 S. Karger AG, Basel.
    No preview · Article · Jul 2015 · Kidney and Blood Pressure Research
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    Full-text · Dataset · Jul 2015
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    ABSTRACT: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA(1c). We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA(1c) (HbA(1c) >= 6 . 5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG >= 7 . 0 mmol/L or 2hOGTT >= 11 . 1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG- or-2hOGTT was correlated with prevalence based on FPG alone (r= 0 . 98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA(1c) was lower than prevalence based on FPG in 42 . 8% of age-sex-survey groups and higher in another 41 . 6%; in the other 15 . 6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA(1c)-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA(1c) 6 . 5% or more had a pooled sensitivity of 52 . 8% (95% CI 51 . 3-54 . 3%) and a pooled specificity of 99 . 74% (99 . 71-99 . 78%) compared with FPG 7 . 0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30 . 5% (28 . 7-32 . 3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA(1c) versus FPG. Interpretation: Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA(1c)-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.
    Full-text · Article · Jun 2015 · The Lancet Diabetes & Endocrinology
  • M Adamczak · M Gazda · D Gojowy · S Dudzicz · H Karkoszka · A Wiecek
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    ABSTRACT: A cardiovascular diseases are a frequent cause of death of patients after liver transplantation. The aim of the study is to estimate the prevalence of arterial hypertension among patients who underwent liver transplantation and the role of immunosuppressive drugs in the pathogenesis of hypertension in these patients. 91 patients (age 47 ± 12; 33 women, 58 men) after liver transplantation who survived 12 months were analyzed retrospectively. 84 of them completed 24 months follow-up. The statistical analysis was performed using the following tests: χ, Spearman's correlation, Mann-Whitney U and multiple regression analysis. The results are presented as means with standard deviation. One, 12 and 24 months after liver transplantation the prevalence of hypertension were 46%, 56% and 63%, respectively (the difference between 1 and 24 months: p = 0.02). Systolic blood pressure (SBP) and eGFR in above mentioned months were 126 ± 18; 134 ± 20; 136 ± 18 and were 78 ± 34; 75 ± 31; 76 ± 29 respectively. 24 months after transplantation 60 (78%) patients were treated with tacrolimus, 10 (13%) cyclosporine A, 10 (13%) everolimus and 70 (91%) prednisone. Hypertension was found significantly more frequently in patients treated with cyclosporine A than with tacrolimus (p = 0.008) and everolimus (p = 0.02) (100% vs 56% vs 60%, respectively). There were significant correlations between tacrolimus blood concentration and SBP after 24 months (R = 0.29; p = 0.04). Multiple regression analysis performed in the group of patients treated with tacrolimus, with SBP as the dependent variable and eGFR, tacrolimus blood concentration as independent 24 months after liver transplantation showed that SBP significantly depends both on eGFR (p = 0.02) and tacrolimus blood concentration (p = 0.01). 1. Arterial hypertension occurs in more than 50% of patients after liver transplantation. 2. Calcineurin inhibitors may participate in the high incidence of arterial hypertension in these patients 3. Clinical importance of these findings and the influence on cardiovascular outcome of the liver transplant patients need to be elucidated.
    No preview · Article · Jun 2015 · Journal of Hypertension
  • Article: PP.39.14
    M. Adamczak · P. Kuczera · A. Wiecek

    No preview · Article · Jun 2015 · Journal of Hypertension

  • No preview · Conference Paper · Jun 2015
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    Full-text · Article · May 2015 · Hypertension

  • No preview · Conference Paper · May 2015

  • No preview · Conference Paper · May 2015

  • No preview · Conference Paper · May 2015
  • Aureliusz Kolonko · Jerzy Chudek · Andrzej Wiecek
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    ABSTRACT: Cardiovascular complications remain the most frequent cause of death in kidney transplant recipients. We analysed the prognostic value of early measured resistance index (RI) in the aspect of long-term cardiovascular mortality. In order to eliminate potential donor-related confounders, we analysed the mortality of recipients, transplanted with organs procured from the same donor, in whom the initial RI values substantially differed. Doppler sonography was performed in 725 consecutive kidney graft recipients early after transplantation. We identified 133 pairs (266 patients) who received their kidney grafts from the same donor and their initial RI values differed by >0.1. During 109 ± 37 months of follow-up after transplantation, 84 patients lost their graft and 29 died, 14 of them due to cardiovascular causes. Two groups of paired patients with higher RI and lower RI did not differ significantly with respect to their age, BMI, HLA mismatch and cold ischaemia time. There were more patients with diabetes in the higher RI group (14.3 versus 6.8%). Survival analysis revealed a higher mortality for cardiovascular (8.3 versus 2.3%, P = 0.02) and all causes (14.3 versus 7.5%, P = 0.06) among patients with higher initial RI values. In the Cox regression model, not including age, a higher RI value was a strong predictor of cardiovascular death (HR = 4.88), independent of previous cardiovascular episodes (HR = 6.78). Both these variables lost its significance as a predictors after inclusion of age in the regression model. Increased intrarenal resistance index in the early posttransplant period may help to identify the recipients with increased cardiovascular risk. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
    No preview · Article · Apr 2015 · Nephrology Dialysis Transplantation
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    ABSTRACT: Cinacalcet increases the sensitivity of calcium receptor (CaSR) to the serum calcium. CaSR is expressed among others in adipocytes. Adiponectin is an adipokine with antiatherogenic and insulin-sensitizing properties. The aim of this study was to assess the influence of 3-months therapy with cinacalcet on plasma adiponectin concentration in hemodialysed patients with chronic kidney disease (HDP) and secondary hyperparathyroidism (sHPT). In 65 HDP with sHPT treated with cinacalcet (30-120 mg/day) plasma adiponectin, advanced oxidation protein products (AOPP), serum interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations were assessed before the first dose of cinacalcet and after 3 months of treatment. There was a significant decrease in serum parathormone concentration: from 1089 (891-1286)pg/ml to 775 (574-976)pg/ml after 3 months of treatment (p<0.0001). The treatment was associated with a significant (p=0.048) increase in plasma adiponectin concentration from 16.9 (14.4-19.5)μg/ml to 17.8 (15.0-20.6) μg/ml, respectively. Significant (p=0.03) reduction of plasma AOPP concentration was observed: from 186.7 (156.7-216.7)pg/ml to 162.6 (141.2-183.9)pg/ml, respectively. 1. Three months treatment with cinacalcet in haemodialysed patients with sHPT is associated with the increase of plasma adiponectin concentration. 2. Such an increase of adiponectinemia in these patients may be related to the reduction of oxidative stress.
    No preview · Article · Mar 2015 · Endocrine Practice
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    ABSTRACT: Until the discovery of calcimimetics, the management of secondary hyperparathyroidism (SHPT) relied exclusively on treatment with phosphate binders, vitamin D derivatives or surgical parathyroidectomy with limited success. The therapeutic use of calcimimetic agents, together with a better understanding of the pivotal role of the calcium-sensing receptor (CaSR) in the physiological regulation of parathyroid gland function, substantially advanced the management of hyperparathyroidism in dialysis practice. Calcimimetics bind selectively to the CaSR receptor in parathyroid tissue and enhance the inhibitory effect of extracellular calcium ions on parathyroid hormone (PTH) secretion, thereby reducing PTH levels even when serum calcium concentrations are normal or low. The availability of calcimimetic agents for clinical use has opened a new era in the management of patients with SHPT. Indeed, calcimimetic compounds have been shown to reduce PTH levels and to lower serum calcium concentrations in all forms of hyperparathyroidism, including primary hyperparathyroidism (PHPT) and parathyroid carcinoma. Such findings underscore the critical importance of the CaSR as a therapeutic target in this family of clinical disorders. New calcimimetic agents are being developed that have the potential to offer improved efficacy and safety compared with currently available calcimimetic compounds. © 2015 Wiley Periodicals, Inc.
    Full-text · Article · Mar 2015 · Seminars in Dialysis
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    ABSTRACT: Studies assessing plasma visfatin/nicotinamide phosphoribosyltransferase (NAMPT) concentrations in chronic kidney disease with the ELISA method are restricted mainly to subjects with end-stage kidney disease. Therefore, little is known about to what extent glomerular filtration rate (GFR) affects the plasma levels of visfatin/NAMPT. The aim of this study was to assess the relations between circulating visfatin/NAMPT levels and estimated GFR (eGFR), independently of potential confounders such as inflammation, nutritional status, and insulin resistance in the elderly population. The analysis included 3023 elderly subjects (1076 with impaired kidney excretory function – eGFR
    No preview · Article · Oct 2014 · Clinical Chemistry and Laboratory Medicine
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    ABSTRACT: Patients with chronic kidney failure—defined as a glomerular filtration rate persistently below 15 mL/min per 1·73 m2—have an unacceptably high mortality rate. In developing countries, mortality results primarily from an absence of access to renal replacement therapy. Additionally, cardiovascular and non-cardiovascular mortality are several times higher in patients on dialysis or post-renal transplantation than in the general population. Mortality of patients on renal replacement therapy is affected by a combination of socioeconomic factors, pre-existing medical disorders, renal replacement treatment modalities, and kidney failure itself. Characterisation of the key pathophysiological contributors to increased mortality and cardiorenal risk staging systems are needed for the rational design of clinical trials aimed at decreasing mortality. Policy changes to improve access to renal replacement therapy should be combined with research into low-cost renal replacement therapy and optimum clinical care, which should include multifaceted approaches simultaneously targeting several of the putative contributors to increased mortality.
    Full-text · Article · May 2014 · The Lancet

Publication Stats

6k Citations
1,363.78 Total Impact Points

Institutions

  • 2003-2016
    • Medical University of Silesia in Katowice
      • Department of Nephrology, Endocrinology and Metabolic Diseases
      Catowice, Silesian Voivodeship, Poland
    • Gracie Square Hospital, New York, NY
      New York, New York, United States
  • 2009
    • Polish Academy of Sciences
      Warszawa, Masovian Voivodeship, Poland
  • 1994-2009
    • Silesian University of Technology
      Gleiwitz, Silesian Voivodeship, Poland
  • 2007
    • Universität Basel
      Bâle, Basel-City, Switzerland
  • 1995-2005
    • University of Silesia in Katowice
      Catowice, Silesian Voivodeship, Poland
  • 1989-2001
    • Universität Heidelberg
      Heidelburg, Baden-Württemberg, Germany