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Introduction. Dose adjustment for certain drugs is required in patients with reduced renal function to avoid toxicity as many drugs are eliminated by the kidneys. The aim of this study was to assess whether appropriate dosage adjustments were made in hospitalized patients with renal failure. Methods. A prospective study was carried out in the ward Service of Nephrology, University Hospital Center "Mother Teresa", Tirana. The patients admitted to hospital between October and December 2019 were included in the analysis. Data regarding serum creatinine level, age, gender, prescribed drugs and their dosage was collected from the patients' medical records. The estimated creatinine clearance was calculated using the Cockcroft-Gault equation. Guideline for Drug prescribing in renal failure provided by the British National Formulary was used as the standard for dose adjustment. Results. There were 589 prescription entries for 74 patients with renal impairment. Dose adjustment was required in 56% (331/589) of prescription entries and 49.8% (165/331) prescription entries requiring dose adjustment were found to be inappropriate. Eleven (14.9%) patients had all of their drugs appropriately adjusted while 53 (71.6%) patients had some drugs appropriately adjusted, and 10 (13.5%) of patients had no drugs appropriately adjusted. Conclusion. The findings indicate that dosing errors were common among hospitalized patients with renal failure. Improving the quality of drug prescription in patients with renal impairment could be of importance for improving the quality of care. [ABSTRACT FROM AUTHOR]

Glomerular disease is the most common cause of endstage renal disease (ESRD), accounting for almost two thirds of cases. In glomerular disease, alterations of podocytes are of particular importance. Podocyte loss represents a central mediator of glomerular sclerosis. Toxic, genetic, immune, infectious, oxidant, metabolic, hemodynamic, and other mechanisms can all target the podocytes. These mechanisms provide new insight into the unique dynamic microenvironment that each individual podocyte inhabits and how it can turn hostile to survival. At the same time, they raise new therapeutic challenges to preserve glomerular function by containing podocyte injury and limiting its spread, both in podocytopathies and in other progressive glomerular diseases. Treatment strategies should aim at enhancing podocyte survival. The renin-angiotensin axis blockade, apart from its antifibrotic and intraglomerular hemodynamic effects, has an important role in preventing podocyte loss. However, only long-term observational studies can clarify if many patients will benefit from podocyte-targeted treatment such as abatacept or similar agents. [ABSTRACT FROM AUTHOR]

Introduction. The hemodialysis treatment in Albania was firstly applied in 1985. Over the 20 years the number of patients was very limited and only 45 were treated in Tirana. Since 2005 due to the positive health policies, the number of patients in HD has been increasing rapidly. Unfortunately, these patients are mostly late referral, resulting in other subsequent serious problems with the vascular access complications: catheter infections, arteriovenous fistula failures due to little experience of surgeons, and then inadequate hemodialysis, repeated interventions, increasing hospitalizations, morbidity and mortality, and in the end, higher costs. The aim of this study was to evaluate the present situation of vascular access and to plan the future with a multidisciplinary team. Methods. We conducted a cross-sectional study in 6 centers which offer hemodialysis in Albania. There were 484 patients enrolled in the study: 300(63%) males, 18(37%) females that were asked for the actual and past history of vascular access since the beginning of HD treatment. The age ranged from 19-78 years (mean 49.9). Diabetes was encountered in 13.8% of them. Duration of HD treatment ranged from 1 month to 22 years (mean 3.8 years). Results. At the time of the study 83.5% of patients had an A-V native fistula, 2.25% an A-V graft and 14.25% a catheter. The probability of fistula failure seen by chi square test was statistically higher in diabetics (p<0.05) and older age (>50 years) (p<0.05), starting hemodialysis without a fistula (p<0.01), previous subclavian catheter use (p<0.001), non use of antiplatelet drugs (p<0.01) and if they had hypotension pre or during hemodialysis session (p<0.02). Conclusions. Arteriovenous fistula is the predominant form of vascular access in majority of patients in Albania. The main characteristics of our HD population are the low percentage of diabetics and their younger age, which may prolong the use of their vascular access and render HD treatment more effective. Thus, we are satisfied and proud of our results achieved in the majority of HD patients, but we do have a lot of work to do with the incident ones. [ABSTRACT FROM AUTHOR]

Introduction. Valve calcification is highly prevalent and an important predictor for all cause mortality in haemodialysis (HD) patients. Abdominal fat deposition is linked to inflammation and protein-energy wasting and it is also associated with increased mortality risk. An association of inflammation and malnutrition with cardiac VC is reported, similar to that of atherosclerosis. We evaluated the possible relationship between abdominal fat deposition, inflammation markers and valve calcification (VC) in patients on maintenance haemodialysis (HD). Methods. The data of 69 haemodialysis patients were analysed. There were 41 (59.4%) males, mean age 51.39± 12.72 yrs and mean time on therapy 54.3±39.9 months. The presence of cardiac valve calcification was assessed by standard bi-dimensional echocardiography. Abdominal fat deposition was assessed by conicity index (Ci). Fibrinogen and C-reactive protein (CRP) were measured to assess the presence of inflammation. Results. The prevalence of valve calcification was 58%. Significantly higher fibrinogen level [446±100.84 vs 356 ±109.01 (p=0.037)], conicity index [1.45±0.13 vs 1.33±0.08 (p= 0.002)] and lower s-albumin (3.8±0.32 vs 4.04±0.29 (p=0.045)] were observed in the group with valve calcification compared to the group without valve calcification. Patients were divided into groups according to tertiles of Ci distribution. There were statistically significant differences in fibrinogen, VC and BMI between Ci groups, with significantly higher fibrinogen (p= 0.001), valve calcification (p=0.01) and BMI (p=0.043) in high Ci group. Significant difference between Ci groups was found for CRP. A significant relationship between presence of valve calcification with Ci and fibrinogen and inversely with serum albumin was found [(r= 0.414, p= 0.002); (r=0.224, p= 0.043); (r= -0.274, p= 0.045) respectively]. Conclusions. We found that abdominal adiposity was frequent in HD patients, and it was associated with inflammatory markers, both being risk factors for heart valve calcification. HD patients must be encouraged to decrease the abdominal fat, even when they are not overweight. [ABSTRACT FROM AUTHOR]