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Background: Histocompatibility testing (HT) which includes donor-recipient human leukocyte antigen (HLA) matching, cross-match testing (XMT) and anti-HLA antibody searching are crucial examinations in solid organ transplantation aiming to avoid the hyperacute graft rejection and also to predict the immunological outcome of the graft. Aims: The aim of this study was to analyse the tissue typing data collected at the Laboratory of Immunology and Histocompatibility of the University Hospital Center of Tirana, Albania, in order to define those actions that should be taken for improvements in the situation of kidney transplantation in Albania. Study Design: Descriptive study. Methods: The donor/recipient cross-match testing was performed through a standard complement-dependent cytotoxicity (CDC) assay using separated donor T and B cells that were tested in parallel with the recipient serum sample. All recipient sera were screened for anti-Class I and anti-Class II HLA antibodies using a bead based Luminex anti-HLA antibody screening test. In the case of detected positivity, an allele-specific anti-HLA antibody determination was conducted with the respective Luminex anti-Class I and Class II HLA antibody determination kits. Results: A total of 174 recipients and 202 donors were typed for the purpose of living donor kidney transplantation at our laboratory between January 2006 and December 2012. The mean age and female gender proportion of patients were 34.9 years and 34.5%, respectively, and 48.0 years and 65.3% for the donors, respectively. Here, 25.9% of the patients reported a positive complement-dependent cytotoxicity cross-match test and/or a positive anti-HLA antibody testing result. Eighteen patients that were negative for the complement-dependent cytotoxicity cross-match test were positive for anti-HLA antibodies. Conclusion: The predominant causes of end-stage renal disease (ESRD) in our patient population are chronic pyelonephritis and glo-merulonephritis. The female gender is significantly more frequent among donors, which emphasises the need for more gender equity as far as the altruistic willingness for organ donation is concerned. The significant number of patients with Luminex anti-HLA antibody positivity combined with complement-dependent cytotoxicity cross-match negative results underlines the necessity of using additional methods like cell-based flow cytometry or bead-based Luminex anti-HLA antibody assays for the detection of anti-donor-specific antibodies. We also suggest that the number of kidney transplantations in Albania needs to be increased significantly by expanding it with paired exchange living donation and also by implementing an efficient deceased donor kidney transplantation program. [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: Liver involvement is the most frequent extrarenal manifestation in autosomal dominant polycystic kidney disease (ADPKD). We studied the impact of liver cysts on renal function in our patients with ADPKD. Methods: a retrospective observational from January 2002 to January 2009 e divided 138 patients with ADPKD into two groups: one group of 68 patients without liver cysts and another group of 70 patients with liver cysts. Renal function was considered to be impaired when the creatinine clearance was less than 60 ml/min. Differences were considered significant at the P<0.05 level. Results: The liver cysts were more frequent in female patients. No renal failure survival difference was found between patients in both groups (P=0.05). Female patients with liver cysts and three or more pregnancies had a worse survival rate than female patients with liver cysts with fewer than three or no pregnancies (P<0.01). Conclusion: Our study showed that there was no renal failure survival difference between patients with liver cysts compared with those without liver cysts. Female patients with liver cysts and three or more pregnancies had a greater risk of developing end stage renal disease when compared with patients with liver cysts and fewer than three or no pregnancies. [ABSTRACT FROM AUTHOR]

We aim to define the prevalence of nephrolithiasis, the impact of anatomic and metabolic factors to stone formation and prognosis of patients with autosomal dominant polycystic kidney disease in Albania. We included 200 patients with autosomal dominant polycystic kidney from 2002 to 2009. The patients underwent X-ray, renal ultrasonography. We performed the metabolic evaluation of blood and urine. Survival times were calculated as the time to dialysis, transplantation, or death. Kaplan-Meier product-limit survival curves were constructed. Log rank test was used to compare the survival curves. Nephrolithiasis was present in 116 of our patients with autosomal dominant polycystic kidney disease (58%), with a mean age 46.4±5.7 years. Sixty five patients with kidney stones (56%) were women. The stones were composed primarily of urate (47%) and calcium oxalate (39%), and other compounds 14%. In 40% of patients the presence of stones was associated with a history of urinary tract infections and flank pain. In our study the prevalence of nephrolithiasis is 58%, higher than it reported in literature. Except anatomic and metabolic factors, there are other contributor factors to stone formation in our patients such socioeconomic status of patients, geographic zones and dietary habits. [ABSTRACT FROM AUTHOR]

Introduction: Infective endocarditis is a potentially life-threatening condition, more prevalent among chronic maintenance hemodialysis patients, as opposed to the general population. Aim: Combined involvement of both the right and left heart chambers is exceptionally rare. Case study: Herein, we present the case of a patient on long-term maintenance hemodialysis with right and left sided infective endocarditis. Results and discussion: We discuss potential risk factors leading to the widespread infection and emphasize the importance of an early diagnosis and prompt treatment in yielding better outcomes. Conclusions: The patient was treated successfully by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper is a summary of the ERA Registry Annual Report 2021, including a comparison across treatment modalities. Methods Data was collected from 54 national and regional registries from 36 countries, of which 35 registries from 18 countries contributed individual patient data and 19 registries from 19 countries contributed aggregated data. Using this data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities and expected remaining lifetimes were calculated. Result In 2021, 533.2 million people in the general population were covered by the ERA Registry. The incidence of KRT was 145 per million population (pmp). In incident patients, 55% were 65 years or older, 64% were male, and the most common primary renal disease (PRD) was diabetes (22%). The prevalence of KRT was 1040 pmp. In prevalent patients, 47% were 65 years or older, 62% were male, and the most common PRDs were diabetes and glomerulonephritis/sclerosis (both 16%). On 31 December 2021, 56% of patients received haemodialysis, 5% received peritoneal dialysis, and 39% were living with a functioning graft. The kidney transplantation rate in 2021 was 37 pmp, a majority coming from deceased donors (66%). For patients initiating KRT between 2012–2016, 5-year survival probability was 52%. Compared to the general population, life expectancy was 65% and 68% shorter for males and females receiving dialysis, and 40% and 43% shorter for males and females living with a functioning graft. [ABSTRACT FROM AUTHOR]

Polymyositis is a rare condition with an unknown etiology occurring more frequently in adult women. There is a lack of evidence on the coexistence of PM and CMV infection in a patient with hypothyroidism due to Hashimoto's Thyroiditis. However, the growing occurrence of both CMV infection and the simultaneous occurrence of autoimmune diseases points out a relationship, while the association direction remains unclear. Case outline: A 32-year-old woman recently treated for HT hypothyroidism was admitted to the hospital two weeks after being treated for common flu by the family doctor, complaining about a worsening condition with muscle pain, weakness, frequent falls, and fatigue. The first tests showed a normalized thyroid function, with elevated values of troponin and serum creatinine kinase (CK). The immunological tests revealed the presence of a high titer of CMV IgG antibodies and raised levels of CMV DNA. Pelvis MRI images demonstrated markedly elevated signals on the STIR sequences in the pelvis, thighs, and calves, indicating active and severe multifocal myositis. The diagnosis of PM was confirmed with the muscle biopsy on day 7 of hospitalization. The patient showed significant improvements within two weeks after the medical therapy and physiotherapy. [ABSTRACT FROM AUTHOR]

Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with ESKD. This paper is a summary of the ERA Registry Annual Report 2020, also including comparisons among primary renal disease (PRD) groups. Methods Data were collected from 52 national and regional registries from 34 European countries and countries bordering the Mediterranean Sea: 35 registries from 18 countries providing individual level data and 17 registries from 17 countries providing aggregated data. Using this data, KRT incidence and prevalence, kidney transplantation rates, expected remaining lifetimes and survival probabilities were calculated. Results A general population of 654.9 million people was covered by the ERA Registry in 2020. The overall incidence of KRT was 128 per million population (p.m.p.). In incident KRT patients, 54% were older than 65 years, 63% were men and the most common PRD was diabetes mellitus (21%). Regarding initial treatment modality in incident patients, 85% received haemodialysis (HD), 11% received peritoneal dialysis (PD) and 4% received a pre-emptive kidney transplant. On 31 December 2020, the prevalence of KRT was 931 p.m.p. In prevalent patients, 45% were older than 65 years, 60% were men and glomerulonephritis was the most common PRD (18%). Of these patients, 58% were on HD, 5% on PD and 37% were living with a kidney transplant. The overall kidney transplantation rate in 2020 was 28 p.m.p. with a majority of kidney grafts from deceased donors (71%). The unadjusted 5-year survival, based on incident dialysis patient from 2011–15, was 41.8%. For patients having received a deceased donor transplant, the unadjusted 5-year survival probability was 86.2% and for patients having received a living donor transplant it was 94.4%. When comparing data by PRD group, differences were found regarding the distribution of age groups, sex and treatment modality received. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to identify trends in total, deceased donor (DD) and living donor (LD) kidney transplantation (KT) rates in European countries. Methods The European Renal Association (ERA) Registry and the Global Observatory on Donation and Transplantation (GODT) databases were used to obtain the number of KTs in individual European countries between 2010 and 2018. General population counts were obtained from Eurostat or the national bureaus of statistics. The KT rate per million population (p.m.p.) and the average annual percentage change (APC) were calculated. Results The total KT rate in the 40 participating countries increased with 1.9% annually  [95%  confidence  interval  (CI) 1.5, 2.2] from 29.6 p.m.p. in 2010 to 34.7 p.m.p. in 2018, reflecting an increase of 3.4 p.m.p. in the DD-KT rate (from 21.6 p.m.p. to 25.0 p.m.p.; APC 1.9%; 95% CI 1.3, 2.4) and of 1.5 p.m.p. in the LD-KT rate (from 8.1 p.m.p. to 9.6 p.m.p.; APC 1.6%; 95% CI 1.0, 2.3). The trends in KT rate varied widely across European countries. An East–West gradient was observed for DD-KT rate, with Western European countries performing more KTs. In addition, most countries performed fewer LD-KTs. In 2018, Spain had the highest DD-KT rate (64.6 p.m.p.) and Turkey the highest LD-KT rate (37.0 p.m.p.). Conclusions The total KT rate increased due to a rise in the KT rate from DDs and to a lesser extent from LDs, with large differences between individual European countries. [ABSTRACT FROM AUTHOR]

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]

Introduction: The aim of this study was to evaluate ventricular geometry, its relationship with the inflammatory markers, and mortality of patients with end-stage renal disease on peritoneal and hemodialysis treatment.Materials and Methods: We enrolled adult patients on long-term dialysis (hemodialysis and peritoneal dialysis) for more than 3 months. Two-dimensional echocardiography was performed by an experienced cardiologist who was blinded to all clinical details of patients. Cardiovascular mortality was assessed during a 2-year follow-up period.Results: There were 129 participants, of whom 86 (66%) were on hemodialysis. Left ventricular hypertrophy was present in 86.7%; concentric hypertrophy was found in 64 (49.1%) and eccentric hypertrophy in 48 patients (37.2%). Patients with left ventricular hypertrophy were further divided into tertiles according to their left ventricular mass index. Logistic regression found pulse pressure as an independent risk factor associated with left ventricular mass index (odds ratio [OR], 1.04; 95% confidence interval (CI), 1.01 to 1.19; P = .047). Cardiovascular mortality rate was 15.5%. Multivariable analysis showed that C-reactive protein (OR, 1.06; 95% CI, 1.01 to 1.10; P = .01), pulse pressure (OR, 1.01; 95% CI, 1.0 to 1.26; P = .046), and left ventricular mass index (OR, 1.03; 95% CI, 1.01 to 1.21; P = .03) were independent risk factors for cardiovascular mortality.Conclusions: Concentric hypertrophy is the most frequent left ventricular geometry model in patients with chronic kidney disease. Inflammation, pulse pressure, and  left ventricular hypertrophy are interrelated and all contribute to mortality and cardiovascular death risk among dialysis patients. [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]