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Abnormalities in blood bicarbonates (HCOWe enrolled 75 stable hemodialysis patients (mean age 65.5 years, 34 women), from a single Department of Nephrology. We assessed blood pressure, and acid-base balance parameters before and after mid-week hemodialysis session.We found significant differences in pH, HCODespite the improvement in hemodialysis techniques, acid-base balance still remains a challenge. The individual selection of bicarbonate in bath, based on previous single tests, does not improve permanently the acid-base balance in the population of hemodialysis patients. New guidelines how to correct acid-base disorders in hemodialysis patients are needed to have less 'acidotic' patients before hemodialysis and less 'alkalotic' patients after the session.

Kidney transplant is the preferred treatment for most patients with end-stage renal disease. Because dialyzed patients often have significant comorbidities or multimorbidities, they should be carefully evaluated before being waitlisted for transplant. The COVID-19 pandemic presents a major challenge for surgery, including transplant surgery. Owing to a fear of COVID-19 symptoms occurring in lungs, thin-section computed tomography (TSCT) became a standard evaluation technique in potential kidney transplant recipients before surgery.The aim of the study was to evaluate the rationale and usefulness of TSCT in deceased donor kidney transplant during the COVID-19 pandemic. All adult patients who underwent deceased donor kidney transplant between May 1, 2020, and December 15, 2021, were included in the study. Potential kidney transplant recipients who were admitted to the Department of General, Vascular, and Transplant Surgery at the Medical University of Warsaw in Warsaw, Poland, were tested for COVID-19 (CovGenX rapid test); blood chemistries were performed; dialysis was performed (if needed); and, on a negative reverse transcriptase polymerase chain reaction test, HRCT was performed.From May 2020 until the end of December 2021, 54 patients were transplanted; however, 7 patients were disqualified after TSCT and consulted with a pulmonary specialist. Disqualification from kidney transplant accounted for 13% of the potential kidney allograft recipients.Despite the possibility of overdiagnosis by TSCT, TSCT should be considered a standard evaluation technique in potential kidney transplant recipients. Potential kidney transplant recipients must be periodically reassessed given the prolonged wait time for a donor kidney and the significant number of comorbid conditions in this patient population. However, more data with longer follow-ups are needed to prove or disprove the rationale to use TSCT in transplant surgery.

It is widely accepted that patients with chronic kidney disease (CKD) should play an active role in the selection of renal replacement therapy (RRT) option. However, patients' knowledge about CKD and treatment options is limited. The implementation of structured education program and shared decision-making may result in a better preparation to RRT, more balanced choice of dialysis modalities and better access to kidney transplantation (TX).The aim of this long-term study was to assess the impact of formalized Predialysis Education Program (fPEP) on knowlege on RRT options, as well as on selected and definitive therapy.The study included 435 patients (53% men, mean age 60 years) with CKD stage 4 and 5, participating in fPEP at our center. The program included at least 3 visits, during which balanced information about all RRT options was presented and self-care and informed decision-making were encouraged. The knowledge about RRT options before and after fPEP attendance, and selected and definitive RRT options were assessed.Ninety-two percent of patients received prior nephrology care. After fPEP completion, in most patients, the knowledge about CKD and RRT options and selected preferred modality improved - 40% of participants chose hemodialysis (HD), 32% peritoneal dialysis (PD) and 18% TX. During the observation period, 4% of patients died before commencement of dialysis, 2.7% received preemptive kidney transplant, 8.6% were placed on transplant waiting list, and 94% started dialysis (30% PD and 70% HD). Among those who chose PD, 69% started PD and 24% started HD; the leading causes of the discrepancy between choosing and receiving PD was the deterioration in clinical condition (50%) and change of decision (32%).The fPEP increases CKD patients' knowledge on RRT methods. The implementation of a decision-making process based on fPEP leads to a satisfying distribution between modalities, with a good concordance between chosen and definitive modality.

Peritoneal dialysis (PD)-associated peritonitis is a serious complication of PD and prevention and treatment of such is important in reducing patient morbidity and mortality. The ISPD 2022 updated recommendations have revised and clarified definitions for refractory peritonitis, relapsing peritonitis, peritonitis-associated catheter removal, PD-associated haemodialysis transfer, peritonitis-associated death and peritonitis-associated hospitalisation. New peritonitis categories and outcomes including pre-PD peritonitis, enteric peritonitis, catheter-related peritonitis and medical cure are defined. The new targets recommended for overall peritonitis rate should be no more than 0.40 episodes per year at risk and the percentage of patients free of peritonitis per unit time should be targeted at >80% per year. Revised recommendations regarding management of contamination of PD systems, antibiotic prophylaxis for invasive procedures and PD training and reassessment are included. New recommendations regarding management of modifiable peritonitis risk factors like domestic pets, hypokalaemia and histamine-2 receptor antagonists are highlighted. Updated recommendations regarding empirical antibiotic selection and dosage of antibiotics and also treatment of peritonitis due to specific microorganisms are made with new recommendation regarding adjunctive oral N-acetylcysteine therapy for mitigating aminoglycoside ototoxicity. Areas for future research in prevention and treatment of PD-related peritonitis are suggested.

The aim of the review is to present the most common renal complications after HSCT such as acute kidney injury, chronic kidney disease glomerulopathies. HSCT is a critical therapy for many cancer patients with cancer, as well as patients with some other nonmalignant hematologic disorders and certain congenital immune deficiencies. Kidney complications after HSCT in a form of acute kidney injury is associated with significant morbidity and worse patient outcome. In addition, risk of chronic kidney disease is also increased following HSCT. It is very important to be aware, prevent, early recognize and treat renal damage to improve kidney and patient survival.

Acute kidney injury (AKI), formerly called acute renal failure (ARF), is clinically manifested as a reversible acute increase in nitrogen waste products, as measured by blood urea nitrogen (BUN) and serum creatinine levels. Contrast induced acute kidney injury (CIAKI) is a potentially fatal complication of angiographic procedures caused by the use of contrast media (CM). It is the third most prevalent cause of hospital acquired acute renal damage, accounting for around up to 30% of cases. Contrast induced nephropathy (CIN) is defined as a greater than 25% or 0.5 mg/dl (44 μmol/l) increase in serum creatinine (Scr) from baseline within 3 days. More sensitive indicators of renal damage are sought, hence numerous tubular injury biomarkers are being studied. Multiple risk factors may lead to the development of CIN; these risk factors are classified as patient-related and procedure-related. Treatment of CIN Is primarily symptomatic and consist firstly of careful fluid and electrolyte management, although dialysis may be necessary in some cases. With available treatment options, prevention is the cornerstone of management.

Background: Anemia and vitamin D deficiency are common factors in chronic heart failure (CHF). The aim of this study was to assess vitamin D levels as well as its binding protein and anemia in relation to a cause of CHF: coronary heart disease, valvular disease and cardiomyopathy. Methods: One hundred and sixteen consecutive patients (36 females and 80 males) with CHF were admitted for percutaneous coronary interventions (PCI). Hemoglobin concentration, serum creatinine, B-type natriuretic peptide (BNP), 25-hydroxyvitamin D [25(OH)D] and its binding protein-VDBP were measured. Results: The prevalence of anemia was 22%. BNP was the highest in the group with coronary artery disease. Ejection fraction was the lowest in cardiomyopathy group. 25(OH)D was lowest in valvular disease group, significantly lower than in the coronary artery group. A similar pattern of change showed vitamin D binding protein. The prevalence of vitamin D deficiency (level below 20 ng/mL) in the whole group was 95%, in 49% of the patients 25(OH)D was below 10 ng/mL. In univariate analysis 25(OH)D correlated with hemoglobin, red blood cell count, hematocrit, mean corpuscular volume and BNP in patients with CHF in the whole group. In multiple regression analysis, predictors of 25(OH)D were estimated, glomerular filtration rate, BNP and valvular disease. Conclusions: 25(OH)D deficiency is common in CHF patients. Valvular disease is associated the most severe vitamin D deficiency and worsened kidney function. A higher prevalence of anemia in CHF due to coronary heart disease may be associated with wider use of angiotensin converting enzyme inhibitors and acetylsalicylic acid. Heart and kidney function are predictors of 25(OH)D level in the patients of this study.

Nowadays, the high prevalence of kidney diseases and their related complications, including endothelial dysfunction and cardiovascular disease, represents one of the leading causes of death in patients with chronic kidney diseases. Renal failure leads to accumulation of uremic toxins, which are the main cause of oxidative stress development. The renal replacement therapy appears to be the best way to lower uremic toxin levels in patients with end-stage renal disease and reduce oxidative stress. At this moment, despite the increasing number of recognized toxins and their mechanisms of action, it is impossible to determine which of them are the most important and which cause the greatest complications. There are many different types of renal replacement therapy, but the best treatment has not been identified yet. Patients treated with diffusion methods have satisfactory clearance of small molecules, but the clearance of medium molecules appears to be insufficient, but treatment with convection methods cleans medium molecules better than small molecules. Hence, there is an urgent need of new more validated, appropriate, and reliable information not only on toxins and their role in metabolic disorders, including oxidative stress, but also on the best artificial renal replacement therapy to reduce complications and prolong the life of patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) are at a high risk for cardiovascular disease (CVD), and approximately half of all deaths among patients with CKD are a direct result of CVD. The premature cardiovascular disease extends from mild to moderate CKD stages, and the severity of CVD and the risk of death increase with a decline in kidney function. Successful kidney transplantation significantly decreases the risk of death relative to long-term dialysis treatment; nevertheless, the prevalence of CVD remains high and is responsible for approximately 20-35% of mortality in renal transplant recipients. The prevalence of traditional and nontraditional risk factors for CVD is higher in patients with CKD and transplant recipients compared with the general population; however, it can only partly explain the highly increased cardiovascular burden in CKD patients. Nontraditional risk factors, unique to CKD patients, include proteinuria, disturbed calcium, and phosphate metabolism, anemia, fluid overload, and accumulation of uremic toxins. This accumulation of uremic toxins is associated with systemic alterations including inflammation and oxidative stress which are considered crucial in CKD progression and CKD-related CVD. Kidney transplantation can mitigate the impact of some of these nontraditional factors, but they typically persist to some degree following transplantation. Taking into consideration the scarcity of data on uremic waste products, oxidative stress, and their relation to atherosclerosis in renal transplantation, in the review, we discussed the impact of uremic toxins on vascular dysfunction in CKD patients and kidney transplant recipients. Special attention was paid to the role of native and transplanted kidney function.

Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. Methods In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR 2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). Results In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p Conclusion Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

The pandemic crisis of COVID-19 has caused anxiety and depressive symptoms to increase in many people worldwide. Yet, difficult situations may not only lead to various types of disorders, fears, anxieties and feelings of loss. They can also lead to positive changes, even to development or growth after experienced trauma, to positive adaptation, to changes in self-perception, changes in interpersonal relations or philosophy of life. Patients with chronic kidney disease, especially those on renal replacement therapy, often experience severe psychological problems such as anxiety disorders, depressive disorders, or difficulties related to coping with excessive stress. The aim of our review is to disscus the appropriatness of mental health screening tools in patients with chronic kidney disease, including those on dialyses, during COVID-19 pandemic. Recently published studies indicate the limited available data evaluating the diagnostic accuracy of screening tools for mental status in patients with chronic kidney disease. This, it seems reasonable to stress the mental health associations with situational stress in this group of patients during the SARS-CoV-2 pandemic. It is also worth pointing out the need to research the impact of the mental disorders in this population on morbidity and mortality, taking into account other organ complications and the quality of life of patients not only during the SARS-CoV-2 pandemic. It is worth to to make every effort to reduce the severity of the anxiety and feelings of hopelessness in dialysis patients, to cope with the pandemic.

BACKGROUND AND AIMS Use of a high dialysate bicarbonate (HCO3) concentration during haemodialysis (HD) is associated with higher patient mortality, potentially due to post-dialytic metabolic alkalosis [1]; it remains unclear how to optimize dialysate HCO3 concentration ([HCO3]) to both neutralize interdialytic acid generation and minimize post-dialytic alkalosis. We compared the effects of an intradialytic increasing or decreasing dialysate [HCO3] during HD on blood bicarbonate kinetics. METHOD Blood [HCO3] was measured in 11 chronic, thrice-weekly HD patients (5 male, 6 female) during 4-h treatments with i) constant dialysate [HCO3] of 35 mEq/L; ii) dialysate [HCO3] of 35 mEq/L for the first 2-h and 30 mEq/L for the second 2-h; and iii) dialysate [HCO3] of 30 mEq/L for the first 2-h and 35 mEq/L for the second 2-h. Treatment interventions were fixed during a given week, and arterial blood samples were obtained at the start of treatment, every hour during the treatment and 1-h after the treatment during the second and third treatments of the week; a total of 66 HD treatments were monitored. Blood acid-base composition was determined using a blood gas analyzer; [HCO3] was calculated from measured pH and partial pressure of carbon dioxide using the Henderson–Hasselbalch equation. Blood [HCO3] for each patient was averaged over the second and third treatment of the week. HCO3 transfer from dialysate to blood was calculated by numerical integration of the time-dependence of the blood bicarbonate profile assuming a constant dialyzer dialysate of 198 mL/min. Blood flow rates were 250–350 mL/min and were relatively constant for each patient; dialysate flow rates were always 500 mL/min. RESULTS Pre- and post-dialytic body weights were 71.1 ± 12.6 kg and 69.5 ± 12.1 kg [mean ± standard deviation (SD)], respectively, during the first study treatment. Mean values of blood [HCO3] are shown in the Figure; certain statistics are tabulated. Blood pH at the start of treatment was not different (P = 0.12) between Treatments A and B (7.41 versus 7.40, respectively) but was lower (P CONCLUSION HD treatments with a dialysate [HCO3] of 35 mEq/L for only the first 2-h led to a reduction in HCO3 transfer to the patient and lower post-dialytic blood [HCO3] and pH. Lowering dialysate [HCO3] after 2-h of a 4-h HD treatment can reduce post-dialytic metabolic alkalosis. Further, long-term studies with such a strategy are needed to evaluate its effect on patient outcomes.

BACKGROUND AND AIMS The hydrogen ion (H+) mobilization model has been previously shown to describe blood bicarbonate (HCO3) kinetics during haemodialysis (HD), but this model has only been evaluated when the dialysate HCO3 concentration ([HCO3]) was constant throughout the treatment [1]. To further assess the H+ mobilization model, we tested its ability to describe blood HCO3 kinetics during HD treatments with a time-dependent dialysate [HCO3]. METHOD The H+ mobilization model describes the time dependence of blood [HCO3] assuming HCO3 is distributed in the extracellular fluid volume and removed from that space by mobilization of H+ from buffers and other sources as previously described [1]. HCO3 transfer across the haemodialyzer during HD is assumed governed primarily by diffusion and the difference between dialysate and blood [HCO3]. In this work, we evaluated this model by comparing its predictions with data from a recent clinical study where blood [HCO3] was measured in 11 chronic, thrice-weekly HD patients (5 male, 6 female) during 4-h treatments with i) constant dialysate [HCO3] of 35 mEq/L; ii) dialysate [HCO3] of 35 mEq/L for the first 2-h and 30 mEq/L for the second 2-h; and iii) dialysate [HCO3] of 30 mEq/L for the first 2-h and 35 mEq/L for the second 2-h. Treatment interventions were fixed during a given week, and arterial blood samples were obtained at the start of treatment and every hour during the first, second and third treatments of the week. Blood acid-base composition was determined using a blood gas analyzer; [HCO3] was calculated from measured pH and partial pressure of carbon dioxide using the Henderson–Hasselbalch equation. The H+ mobilization model was used to determine the H+ mobilization parameter (mH+) by comparing the time dependence of the measured blood [HCO3] with that predicted by the model using nonlinear regression; a total of 66 HD treatments were monitored. Determination of similar mH+ values for each patient, independent of the time-dependent dialysate [HCO3], would demonstrate model validity. RESULTS Example fits of model predictions to blood HCO3 kinetic data from one patient for all three treatment types are shown in the Figure. For all patients, mH+ values during treatments A, B and C were 139 ± 68 (mean ± standard deviation) mL/min, 178 ± 96 mL/min and 156 ± 55 mL/min; they were not statistically different from each other (P = 0.43). The sum of the squared differences between the measured [HCO3] and that predicted by the model (mEq2/L2) was similar during treatments A, B and C (1.48 versus 1.85 versus 1.61), indicating a similar degree of model fit to the data. CONCLUSION This work supports the validity of the H+ mobilization model to describe intradialytic blood HCO3 kinetics with a time-dependent dialysate [HCO3]. Further work is needed to validate the model during post-dialytic and interdialytic periods.

BACKGROUND AND AIMS Chemerin is an adipokine and novel biomarker of cardiovascular disease in patients with chronic kidney disease, which has been associated with renal, metabolic and inflammatory parameters. Data on chemerin in transplant patients are scarce. METHOD One hundred twenty-seven kidney transplant recipients were enrolled in the present study. Biochemical testing of serum samples was performed at baseline, and subsequent follow-up of kidney function was performed. Subjects were followed for a median of 58 months (Q1, Q3; 32, 63) during which a composite primary endpoint of hemodialysis or all-cause death was assessed. RESULTS Patients were stratified according to low or high chemerin concentrations based on median values of 94.43 ng/mL (Q1, Q3; 83.4, 122.2). In patients with high chemerin, estimated mean glomerular filtration (eGFR) was significantly reduced (50.7 versus 62.7, P = 0.004), while mean hemoglobin concentrations were significantly lower (12.63 versus 14.78, P CONCLUSION The findings of the present study are in line with earlier reports in chronic kidney disease cohorts. Serum chemerin concentrations remain significantly tied not only to kidney function but also, surprisingly, hemoglobin levels. It remains to be established whether pathogenic pathways that lead to anemia are tied to chemerin concentrations and may translate into poor outcome following kidney transplant.

Background Orthotopic liver transplantation (LT) is a technically complex surgical procedure associated with a major risk of hemodynamic instability and metabolic derangement, especially in patients with coexisting renal dysfunction. Some centers have applied intraoperative renal replacement therapy (ioRRT) to support patients with preoperative renal failure and prevent critical complications. Although there is a strong theoretical rationale for this treatment, there remains a paucity of definite data demonstrating its benefits. Methods This was a retrospective observational study of all adult patients undergoing intraoperative dialysis in our center from January 2010 till December 2016. Results The study group consisted of 88 patients with a mean MELD score of 31.4. Six patients underwent simultaneous liver and kidney transplantation. Forty-four (50%) recipients were admitted to the intensive care unit before transplantation, and 19 (21.6%) needed mechanical ventilation. Twenty-eight (31.8%) of the procedures were retransplantations, and 40 (45.4%) patients had been undergoing renal replacement therapy before LT. The mean preoperative serum creatinine was 2.82 ± 1.13 mg/dL. The majority of patients (54.5%) was operated on using the veno-venous bypass technique. The mean arterial blood pH and potassium levels after reperfusion were 7.2 ± 0.12 and 4.04 ± 0.95 mmol/L, respectively. Postreperfusion syndrome (PRS) occurred in 11 (13.9%) patients in whom dialysis started at least 15 minutes before reperfusion. Dialysis circuit clotting occurred in 9.1% of cases. There were no other adverse events of ioRRT. Conclusion Our data suggests that intraoperative dialysis in severely ill patients with a high MELD score is safe and effective. Lower than expected PRS occurrence needs to be confirmed in a study with a control group.

Kidney transplantation improves quality of life, prolongs survival, and is cost-effective, but bears some serious complications including malignancy. The aim of this study was to assess the prevalence of malignancy in dialyzed patients on the waiting list and in kidney allograft recipients. The cross-sectional study was conducted in 50 prevalent patients on the waiting list and 300 kidney allograft recipients. Patients who had been registered in the cadaver kidney waiting list and kidney allograft recipients did not differ in regard to age, sex, dialysis vintage, and causes of end-stage renal failure. In waitlisted patients, only 3 had a history of malignancy. In kidney allograft recipients, 52 patients developed malignancy. The leading malignancy was skin cancer with 9 cases, followed by post-transplant lymphoproliferative disorder in 5 cases, Kaposi sarcoma in 2 cases, brain cancer in 2 cases, Merkel carcinoma in 2 cases, lung cancer (small cell and non--small cell), unknown origin in 2 cases, and the other 22 malignancies were in single patients (including 1 leukemia and 1 multiple myeloma). Seventeen deaths were recorded in kidney allograft recipients with malignancy mainly in post-transplant lymphoproliferative disorder, Kaposi sarcoma, Merkel carcinoma, sarcoma, and brain cancer. Concluding, waitlisted patients represent a very selected and healthier dialyzed population. Guidelines for cancer screening in both potential transplant recipients and kidney allograft recipients should be developed as nowadays a scarcity of data exists in this matter. Minimization of immunosuppressive regimen should be considered, in particular, in high-risk patients.

Atrial fibrillation (AF) is common in patients with chronic kidney disease (CKD), affecting 10–25% of patients requiring dialysis. Compared with the general population, patients requiring dialysis are also at increased risk of stroke, the major thromboembolic complication of AF. The evidence base for management strategies of AF specific to patients with advanced CKD is limited and not informed by randomized controlled trials. These gaps in evidence encompass rate and rhythm control strategies as well as a paucity of data informing which patients should receive anticoagulation. The European Renal Association–European Dialysis and Transplant Association and European Heart Rhythm Association undertook a survey of nephrologists and cardiologists exploring management strategies in patients with AF and CKD. We review the results of this survey, highlighting the differences in clinical approaches from cardiologists and nephrologists to these conditions. Closer collaboration between these specialties should lead to improved outcomes for patients with advanced CKD and AF. Specific issues that will need to be addressed may include healthcare burden to patients, location of clinics compared with dialysis sites and awareness of complications of treatments specific to CKD, such as calciphylaxis associated with vitamin K antagonism.

The progress of transplantation in Poland is influenced not only by medical staff, but also by the legislative organ, which approves amendments to the Act of the Collection, Storage and Transplantation of Cells, Tissues and Organs. This is why young lawyers should be aware of the scale of the problem and have current statistics on transplant issues. Aim To assess the awareness of existing problems in the field of transplantation in Poland among law students. Materials and Methods A survey (with 11 questions) of 209 law students at the University of Bialystok (64% women and 36% men). Results Of respondents, 32% do not see the difference between dialysis treatment and transplantation, and 47% are convinced that the 5-year survival of dialysis patients is as much as 70% (in fact this number is twice as low). Still, 13% of people consider the stereotype of family consent for organ procurement is necessary. Of law students, 5% indicated that organ trafficking is allowed in Poland, and 41% believe that as many as 5% of people in Poland stated in writing opposition to removal of their organs after death. Fortunately, this number is much smaller (2%). The respondents have current knowledge about the place of Poland in the world in terms of the number of donors. Relatively good results were recorded in questions about medical knowledge. Conclusions In most questions, the correct answer obtained the highest score, but it was not an absolute majority. There is a trend among law students for an optimistic approach to statistics and the real problems in transplantology.

Renal impairment (RI) is one of the multiple myeloma (MM)-defining events for initiating therapy. After induction therapy, high-dose chemotherapy followed by autologous peripheral blood stem cell transplant (ASCT) remains the standard of care for transplant-eligible patients with MM. According to the International Myeloma Working Group (IMWG), the organ criterion for kidney damage is defined by a serum creatinine concentration (CrC)2 mg/dL or estimated glomerular filtration rate (eGFR) 40 mL/min. In this long-term study, we evaluated the impact of CrC and eGFR calculated by the Modification of Diet in Renal Disease equation on progression-free and overall survival using a lower threshold than the IMWG criteria.We studied the longitudinal outcomes as measured by progression-free survival and overall survival in 59 transplant-eligible patients with MM: 38 patients with normal renal function and 21 patients with RI defined as a CrC higher than upper limit of normal (≥ 1.1 mg/dL), eGFR 60 mL/min, treated with ASCT from 1998 to 2004.The risk of disease progression and death following ASCT increased by 16.5% (P = .005) and 19% (P .0009) per 1 mg/dL of CrC, respectively. The thresholds for the association of renal insufficiency and negative outcomes were CrC1.4 mg/dL and eGFR 55mL/min.We observed a negative correlation between minimal renal insufficiency and long-term outcomes. Management of patients with even marginally increased CrC and/or decreased eGFR not fulfilling IMWG RI criteria requires more concentrated effort to reverse even minimal renal insufficiency.

Acute kidney injury (AKI) is a very common condition with high morbidity and mortality, which can be seen in 5-7% of all hospitalized patients and in up to 57% of all intensive care unit admissions. Despite recent advances in clinical care, the prevalence of AKI has been shown to increase with virtually no change in mortality. AKI is a complex syndrome occurring in a variety of clinical settings. Early detection is crucial to prevent irreversible loss of renal function. The pathogenesis of AKI is highly multifactorial and complex, including vasoconstriction, reactive oxygen species formation, cell death, abnormal immune modulators and growth factors. Emerging evidence from both human and animal studies suggests that dysregulation of iron metabolism may play a potentially important role in AKI. Therefore, targeting the iron homeostasis may provide a new therapeutic intervention for AKI. New therapeutic strategies including iron chelation therapy, targeting iron metabolism related proteins and direct inhibitors of ferroptosis are imperative to improve the outcomes of patients. Taking into consideration the complexity of AKI, one intervention may not be enough for therapeutic success. Future preclinical studies in animal disease models followed by well-designed clinical trials should be conducted to extend findings from animal AKI models to humans.

Introduction Valvular heart diseases (VHD) are becoming a significant problem in the Polish population. Coexistence of chronic kidney disease (CKD) in patients with VHD increases the risk of death and affects further therapeutic strategy. Aim Analysis impact of CKD on long-term prognosis in patients with VHD. Material and methods The inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ± 1454 days. Results The average age of the studied population was 66.75 (SD = 10.34), male gender was dominant 56% (N = 579). Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CKD occurred in 37.1% (N = 380) patients mostly with mitral stenosis (50%, N = 16) and those with severe MVI (44.8%, N = 94). During the observational period, 52.7% (N = 540) deaths were noted. Increased risk of mortality was associated mostly with age (OR: 1.02, 95% CI: 1.00–1.03, p p p p = 0.01) and coexisting of AVS (OR: 1.19, 95% CI: 1.04–1.35, p = 0.01). Conclusions Mitral valve defects more often than aortic valve defects coexist with chronic kidney disease. Regardless of the stage, chronic kidney disease is an additional factor affecting the prognosis in patients with heart defects. Factors increasing the risk of death were age, creatinine concentration and reduced EF. The monitoring of renal function in patients with VHD should be crucial as well as the implementation of treatment at an early stage.

International audience; Hyperkalemia is a common electrolyte disorder observed in the emergency department. It is often associated with underlying predisposing conditions, such as moderate or severe kidney disease, heart failure, diabetes mellitus, or significant tissue trauma. Additionally, medications, such as inhibitors of the renin-angiotensin-aldosterone system, potassium-sparing diuretics, nonsteroidal anti-inflammatory drugs, succinylcholine, and digitalis, are associated with hyperkalemia. To this end, Kidney Disease: Improving Global Outcomes (KDIGO) convened a conference in 2018 to identify evidence and address controversies on potassium management in kidney disease. This review summarizes the deliberations and clinical guidance for the evaluation and management of acute hyperkalemia in this setting. The toxic effects of hyperkalemia on the cardiac conduction system are potentially lethal. The ECG is a mainstay in managing hyperkalemia. Membrane stabilization by calcium salts and potassium-shifting agents, such as insulin and salbutamol, is the cornerstone in the acute management of hyperkalemia. However, only dialysis, potassiumbinding agents, and loop diuretics remove potassium from the body. Frequent reevaluation of potassium concentrations is recommended to assess treatment success and to monitor for recurrence of hyperkalemia.

Introduction Sirtuin1 (SIRT1) acts as an anti-aging protein due to anti-apoptotic, anti-oxidative and anti-inflammatory effect and is implicated in several diseases including diabetes or cardiovascular problems. SIRT1 renal overexpression indicates oxidative stress. Similarly, αKlotho was primarily exposed as anti-aging factor. It is primary produced in kidney. It's deficiency is associated with progression of chronic kidney disease and heart disorders. Purpose The aim of the study was to assess the serum concentration of sirtuin1 and αKlotho in hemodialysis (HD) patients compared to healthy volunteers in regard to age, blood pressure control, residual kidney function (RKF), diabetes, cardiovascular disease, dialysis vintage and type of dialyzer. Patients and Methods The serum level of SIRT1 and αKlotho was evaluated using ELISA tests in 103 HD patients, median age 67 years and in 21 volunteers. Blood pressure, RRF, echocardiography and dialysis parameters were assessed. HD group was divided according to the presence/absence of RKF. Results The serum SIRT1 level was higher (28.4 vs 2.71ng/mL, p

Background: Tumor lysis syndrome (TLS) is an oncologic emergency due to a rapid break down of malignant cells usually induced by cytotoxic therapy, with hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and serious clinical consequences such as acute renal injury, cardiac arrhythmia, hypotension, and death. Rapidly expanding knowledge of cancer immune evasion mechanisms and host-tumor interactions has significantly changed our therapeutic strategies in hemato-oncology what resulted in the expanding spectrum of neoplasms with a risk of TLS. Summary: Since clinical TLS is a life-threatening condition, identifying patients with risk factors for TLS development and implementation of adequate preventive measures remains the most critical component of its medical management. In general, these consist of vigilant laboratory and clinical monitoring, vigorous IV hydration, urate-lowering therapy, avoidance of exogenous potassium, use of phosphate binders, and – in high-risk cases – considering cytoreduction before the start of the aggressive agent or a gradual escalation of its dose. Key Messages: In patients with a high risk of TLS, cytotoxic chemotherapy should be given in the facility with ready access to dialysis and a treatment plan discussed with the nephrology team. In the case of hyperkalemia, severe hyperphosphatemia or acidosis, and fluid overload unresponsive to diuretic therapy, the early renal replacement therapy (RRT) should be considered. One must remember that in TLS, the threshold for RRT initiation may be lower than in other clinical situations since the process of cell breakdown is ongoing, and rapid increases in serum electrolytes cannot be predicted.

Potassium disorders are common in patients with kidney disease, particularly in patients with tubular disorders and low glomerular filtration rate. A multidisciplinary group of researchers and clinicians met in October 2018 to identify evidence and address controversies in potassium management. The issues discussed encompassed our latest understanding of the regulation of tubular potassium excretion in health and disease; the relationship of potassium intake to cardiovascular and kidney outcomes, with increasing evidence showing beneficial associations with plant-based diet and data to suggest a paradigm shift from the idea of dietary restriction toward fostering patterns of eating that are associated with better outcomes; the paucity of data on the effect of dietary modification in restoring abnormal serum potassium to the normal range; a novel diagnostic algorithm for hypokalemia that takes into account the ascendency of the clinical context in determining cause, aligning the educational strategy with a practical approach to diagnosis; and therapeutic approaches in managing hyperkalemia when chronic and in the emergency or hospital ward. In sum, we provide here our conference deliberations on potassium homeostasis in health and disease, guidance for evaluation and management of dyskalemias in the context of kidney diseases, and research priorities in each of the above areas.

Objective Introduction: A novel coronavirus SARS-CoV-2 RNA, detected by reverse-transcription polymerase chain reaction (RT-PCR) was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread, at first in China, then resulting in an epidemic in other countries throughout the world. One of such controversial topics is the issue of diagnostics and interpretation of test for COVID-19. According to Polish and global guidelines, the basis for diagnosis is molecular testing - real-time reverse transcriptasepolymerase chain reaction (RT-PCR). Taking all these data into consideration, the aim of the study was to compare RT-PCR with serological test in our employees post-exposure. According to Polish and global guidelines, the basis for diagnosis is molecular testing, real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The aim: To compare RT-PCR with serological test in our employees post-exposure. Patients and methods Material and methods: 79 employees of the Clinic, 19 men and 60 women in the age range 27-69 years were evaluated. Tests were begun four days after information about the positive test in our "Employee 0" and lasted for 7 days. At first, we made RT-PCR tests on the specimen from nasopharyngeal swab. Then, we accomplished rapid antibodies tests. This test is based on the qualitative assessment of the presence of IgM and IgG antibodies by immunochromatography using a sample of capillary blood from the fingertip. Results Results: All the tests were negative. No employee developed symptoms during the 7-day follow-up after the end of the tests. Conclusion Conclusions: As routine tests for patients have been implemented widely, but similar solutions for employees have not gained popularity. Use of personal protective equipment (PPE) e.g. facemask and shields, transparent screens, disposable medical uniforms, minimalization the contact time, increasing distance from both colleagues and patients (if possible), and strictly follow sanitary procedures largely contributed to the absence of illness in the surveyed group of employees.

Introduction Coexistence of chronic kidney disease (CKD) in the case of acute coronary syndromes (ACS) significantly worsens the outcomes. Aim The aim of our study was to assess renal function impact on mortality among patients with ACS. Materials and methods The study was based on records of 21,985 patients hospitalized in the Medical University of Bialystok in 2009–2015. Inclusion criteria were ACS. Exclusion criteria were: death within 24 h of admission, eGFR

CKD is one of the fastest growing causes of death in the world and in 2040, it is estimated that it will be in the top five causes of death. In order to slow down this process, it is necessary to improve prevention, inhibit development and treat complications including anemia. Anemia is one of the common complication of chronic kidney disease (CKD), which is a significant clinical problem. It is most often the result of decreased renal production of erythropoietin and / or iron deficiency. Iron deficiency anemia is one of the most common problems in CKD that increases mortality. In order to successfully treat anemia in CKD with erythropoiesis-stimulating agentsand (ESA) and iron substitution, it is necessary to determine iron iron level. The diagnosis of iron deficiency anemia in patients with CKD is complicated due to the relatively low predictive ability of routine serum iron markers (e.g., ferritin and transferrin saturation) and more invasive measurements such as bone marrow iron stores. In the review novel biomarkers of iron metabolism are discussed such as hypoxia-inducible factor, erythroferon, growth differentiation factor 15 etc. with their possible clinical relevance.