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Introduction: during the infant development, the organ growth is influenced by genetic factors, diet, hormones and many neuropeptides. The secondary ossification center in the hip joint begins to form around the 4th month of life. Primary dentition begins at the age of 5-6 months with the emergence of the central incisor in the maxilla. At birth, 6 fontanelles are present between the plate bones of the cranium. The largest is the anterior or large fontanelle. Objective of our research is to analyze the development of the secondary ossification center in the femoral head in relation to dentition and closure of the anterior fontanelle closure as well as influence of childrens' birth weight and current weight on these processes. Methodology: The study included 284 infants, male and female, aged 3 to 8 months. Clinical examination of the musculoskeletal system, anthropomentric measurements and ultrasonographic findings of the hip joint were performed at the Pediatric Clinic of the Clinical Hospital Center Pristina in Gracanica. Results: The development of secondary ossification centre correlated with child's age, dentition, anterior fontanelle closure, birth weight and delivery method, as well as actual body weight. Anterior fontanelle size was inversely related to age, body weight and secondary ossification. Conclusions: According to regression analysis, body weight is the only factor that has a direct and independent impact on the onset and progression of ossification process. Every additional kilogram of a child's body weight accelerates secondary ossification by 1.3-3.77 times.

Introduction. At the very beginning of the Corona virus epidemic there was not enough data on whether hemodialysis patients have a higher risk for Corona virus infection and which factors may affect the severity of clinical picture. Objective. The aim of the study was to determine the significance of the Modified Early Warning Assessment (MEWS) score for the assessment of coronavirus disease exacerbation. Methods. The research was conducted in COVID dialysis, as a retrospective, descriptive-analytical study, at the University Clinical Center Kragujevac, Serbia, which was organized ad-hoc for treatment of SARS-Cov-2 infection positive patients, which are transfered from Center for Hemodialysis "Ćuprija". They were evaluated routine laboratory findings, demographic and gender structure, arterial blood pressure, presence of comorbidities and residual diuresis, duration of dialysis, radiological evaluation of lungs, determination of MEWS score were the parameters that were monitored. The results were monitored on admission and and in the end of treatment. Results. A statistically significant difference was registered in serum lactate dehydrogenase concentration (486 ± 107.62 vs. 423.7 ± 92.4 U/L); p = 0.022 and absolute monocyte count (0.46 ± 0.15 vs. 0.67 ± 0.34 x 103; p = 0.008). The significant increase in MEWS score was also found (b = 0.017; p = 0.030). There was a positive correlation between increase of MEWS score and age (b = 0.027; p = 0.002) and arterial hypertension as a concomitant comorbidity (b = 0.700; p = 0.033). Conclusion. In the observed period, there was a significant increase in the degree of MEWS score of dialysis patients who had SARS-Cov-2 infection.

Objective: In the available literature data, there is not much information about problems of patients with end stage kidney disease in relation to oral health. Our objective was to show the importance of oral diseases for patients on hemodialysis. Data sources: In this review article, the sources of data are review articles and scientific articles in the English language published in MEDLINE database. The choice of studies was based on keywords: Chronic kidney disease, Hemodialysis, Oral health, Periodontal diseases. Results: It is assumed that almost 90% patients with chronic kidney disease manifest some symptoms of oral disease. Therefore, it is important to determine the impact of periodontal disease on the progression of kidney failure in these individuals, to evaluate inflammatory parameters in this patient population, to assess the degree of bone loss and periodontal disease index, to determine the presence of bacterial strains, paradontopathy of gingival fluid and antibody titers, to examine correlations of proinflammatory cytokines in the gingival sulcus and serum, as well as to determine the relationship between periodontal tissue and inflammatory mediators. Periodontal diseases can increase the possibility of developing chronic kidney disease by 1.5 to 2 times. These oral diseases include gingival hyperplasia, periodontitis, xerostomia, unpleasant breath, changes in the oral mucosa, malignancies, oral infections, dental abnormalities and bone lesions. Conclusion: This requires serious cooperation between nephrologists and dentists to make proper communication possible, in order to provide quality dental care for this growing patient population in accordance with new treatment strategies.

Background/Aim. The metabolism and effects of the abuse of psychoactive substances are not yet fully understood, but it is evident that they represent a tremendous risk to the health of individuals. This paper aims to present a review of published results on the impact of psychoactive substance abuse on kidney function. Methodology. PubMed and MEDLINE databases were used to search the literature related to drug abuse and its effects on renal function. Results. For this study, we found 79 human studies that aimed to present a summary of published results on the impact of psychoactive substance abuse on kidney function. Renal manifestations of specific illicit drug abuse were included in this review. Conclusion. Understanding the nephrotoxicological profile caused by the use of psychoactive substances is the basis for adequate risk assessment and improvement of the treatment of consequential kidney disorders. [ABSTRACT FROM AUTHOR]

One of the main problems related to inadequate planning of vascular access is dysfunction during maturation. Arteriovenous fistula dysfunction is most often a consequence of neointimal hyperplasia. Important causes for initial dysfunction of the fistula include narrow lumens of the arteries and veins used for anastomosis, damage to the vascular endothelium during fistula creation, previous venipuncture, postoperative development of venous collaterals, the impact force of friction on the arteriovenous anastomosis, a genetic predisposition for development of vascular stenosis, neointimal hyperplasia and previously persistent venous neointimal hyperplasia. Any damage to the endothelium is a stimulus for neointimal hyperplasia. During surgery for creating the fistula, endothelial cells separate on the intima, edema appears, fibrin is deposited, leukocytes and platelets infiltrate. Spotted edema and necrosis of smooth muscle cells appear in the media. In order to determine an adequate therapeutic strategy, the pathogenesis of intimal hyperplasia has been widely considered from different aspects. It is currently based on preoperative preservation of veins and careful selection of blood vessels, percutaneous transluminal angioplasty or surgical revision. Nevertheless, no current therapeutic strategies provide appropriate recommendations to improve maturation of the arteriovenous fistula. Notwithstanding considerable knowledge about the pathogenesis of venous neointimal hyperplasia, currently no prophylactic treatments would reduce its progression.

Introduction. Spontaneous splenic rupture is a rare but potentially fatal complication of infectious mononucleosis (IM). It occurs in only 0.1–0.5% of cases of this disease. The aim of this paper was to present a case with spontaneous splenic rupture after IM. Case outline. A 22-year-old female patient was feeling better one month after she was treated for infectious mononucleosis, and started training volleyball. Two weeks after starting the training, she felt severe abdominal pain. The diagnosis of rupture was confirmed with computer tomography. Splenectomy was successfully performed. The postoperative course was uneventful and the patient recovered with no need for blood transfusion. Conclusion. Timely diagnosis and setting indications for surgical treatment are crucial in healing. Patients should wait to start with sport activities at least two months if the size of the spleen is within normal range.

Introduction. Pseudomonas aeruginosa is a common cause of serious infections in hospitalized patients and is associated with high rates of hospital morbidity and mortality. Objective. The aim of this study was to identify the risk factors of nosocomial infections caused by piperacillin­tazobactam­ resistant P. aeruginosa (PT­RPA). Methods. A case­control study was conducted in the Clinical Centre Kragujevac from January 2010 to December 2011. Results. In the observed period, 79 (38.16%) patients had PT­ RPA infections, while 128 (61.84%) patients had infections caused by piperacillin­tazobactam­sensitive P. aeruginosa (PT­SPA). Pneumonia was more frequently found in the PT­RPA group (55.70%) (p

Introduction. Plasmacytomas are malignant tumors characterized by abnormal monoclonal proliferation of plasma cells. They originate in either bone - solitary osseous plasmacytoma, or in soft tissue - extramedullary plasmacytoma (EMP). EMP represents less than 1% of all head and neck malignancies. Case report. We presented a case of EMP of the nasal septum in a 44-year-old male who had progressive difficulty in breathing through the nose and frequent heavy epistaxis on the right side. Nasal endoscopy showed dark red, soft, polypoid tumor in the last third of the right nasal cavity arising from the nasal septum. The biopsy showed that it was plasmacytoma. Bence Jones protein in the urine, serum electrophoresis, bone marrow biopsy, skeletal survey and other screening tests failed to detect multiple myeloma. This confirmed the diagnosis of EMP. The mass was completely removed via an endoscopic approach, and then, 4 week later, radiotherapy was conducted with a radiation dose of 50 Gray. No recurrence was noted in a 3-year follow- up period. Conclusion. EMP of the nasal cavity, being rare and having long natural history, represents a diagnostic and therapeutic challenge for any ear, nose and throat surgeon. Depending on the resectability of the lesion, a combined therapy is the accepted treatment.

Introduction. Acute respiratory distress syndrome (ARDS) is a significant complication in patients with type A influenza (H1N1) due to the severity of the disease and adverse outcome. Objective. The aim of the study was to identify risk factors for the development of ARDS in patients with type A influenza (H1N1) and outcome of ARDS. Methods. The research was conducted as a case series study, and included patients admitted at the Clinical Center in Kragujevac during the 2009 and 2010 flu season. Data for the study were obtained from patients’ medical records, inclusion criteria having been determined in accordance with recommendations of the Expert Methodological Guide for Controlling Spread of Pandemic Influenza in the Republic of Serbia. Primary data analysis was performed using descriptive statistics and a statistical method for testing hypotheses. Dependence analysis was performed using simple logistic regression. The statistical hypotheses were tested at the 0.05 level of significance. Results. The case group consisted of 14 patients who developed ARDS, while the control group was composed of 34 patients with influenza but without ARDS (group alignment performed by age). Simple logistic regression analysis identified the following risk factors for the development of ARDS: diabetes mellitus type 1 or 2 (p=0.028), high levels of C-reactive protein (p=0.004), aspartate-aminotransferase (p=0.006), urea (p=0.028), creatine kinase (p=0.001), lactate-dehydrogenase (p=0.005) and longer time elapsed from disease symptoms onset to the administration of specific antiviral therapy administration (p=0.021). Conclusion. The research showed that diabetes, late initiation of antiviral therapy and some laboratory tests are risk factors for ARDS development in patients with type A influenza (H1N1).

Background/Aim. Adipose tissue secrets a number of hormonal active substances that play an important role in the development of various metabolic diseases. The aim of this study was to determine the resistin significance in patients with various forms of metabolic diseases. Methods. The survey was conducted in a hospital in Laplje Selo, and included 102 patients suffering from diabetes mellitus, cardiovascular disease and renal insufficiency. All patients were verified and anthropometric characteristics and the basic hematological and biochemical analysis and resistin level were controlled. Results. The average age of the patients, 69 (67.6%) men and 33 (32.4%) women, was 55 ± 9.3 years. It was about two-thirds of smokers. The values of mean arterial blood pressure suggested that our patients had expressed hypertension, body mass index (28.5 ± 3.4 kg/m2) pointed to excessive well-fed, the circumference of hips (100 ± 10.8 cm), waist circumference (110 ± 17.4 cm) and the ratio of hip/waist circumference (1.05 ± 0.14) indicated a significant intra-abdominal distribution of fat tissue. More than one third of our patients had a certain form of cardiovascular diseases, renal failure was present almost in a fifth of patients, while diabetes mellitus was verified in 44.1% of the studied population. Significantly higher values of resistin concentrations were determined in patients with renal insufficiency and diabetes mellitus. In relation to the level of resistin, according to the number of metabolic diseases per patient, a statistically significant difference was achieved (F = 11.80, DF = 4.61, p < 0.001). Spearman correlation (r = 0.66, p < 0.001) found a statistically significant correlation between the number of diseases in one subject and the levels of resistin. Conclusion. In patients with diabetes mellitus and renal failure higher concentrations of resistin were recorded.

Background. In hemodialysis patients the most common cause of vascular access failure is neointimal hyperplasia of vascular smooth muscle cells at the venous anastomosis of arteriovenous fistulas. Case report. We presented a 76-year old patient who had developed fistula thrombosis without the presence of known risk factors the eighth day after the initial function. A histopathological finding pointed to a significant rate of neointimal proliferation, as an initial reasons for the fistula stenosis and trombosis. Conclusion. Early pathohistological changes observed in ateriovenous fistula dysfunction are response to hemodynamic changed conditions.

Background/Aim. Vascular endothelium plays an important role in atherogenesis. The aim of this study was to estimate the correlation of endothelium malfunction and arteriosclerosis in patients on hemodialysis. Methods. The investigation was designed as a clinical, non-randomized, fiveyear study in the 'Kragujevac' Clinical Center and included 146 patients. We evaluated demographic characteristics, smoking, duration of dialysis, existence of tissue calcification and duplex ultrasound parameters of the carotid artery. All lethal outcomes, including the cause and time of death were recorded. Results. The cumulative survival rate was 57.5%. Survival was short in patients with wider lumen diameter of the carotid arteries. Carotid artery lumen diameter in men was wider than in women. The area cross section was closely correlated with intima media thickness (r = 0.913; p < 0.0001), as well as with the lumen diameter of the carotid arteries (r = 0.527; p < 0.0001). Carotid artery lumen diameter was negatively associated with serum cholesterol (r = - 0.278; p = 0.019), while serum triglycerides correlated negatively with the cross section of intima media (r = -0.261; p = 0.028). Positive correlations were found between the serum total protein level and carotid artery lumen diameter (r = 0.235; p = 0.047), cross section intima media (r = 0.269; p = 0.022) and cholesterol (r = 0.248; p = 0.037). Time on dialysis showed a negative correlation with carotid artery cross section (r = -0.241; p = 0.04), while age was positively correlated with intima media (r = 0.295; p = 0.013), lumen diameter (r = 0.296; p = 0.012) and intima media cross section (r = 0.347; p = 0.003). Regression analysis pointed to predictive importance of carotid artery lumen diameter for survival (Beta = 0.437; p = 0.011) of the examined patients. The cumulative rate of survival was 57%. Conclusion. In our study patient age correlated positively with all parameters of arteriosclerosis. The average duration of dialysis was negatively associated with carotid artery diameter, which was significantly higher in males. Regression correlation analyses indicated that the survival rate of the patients on hemodialysis was lower if the carotid artery diameter was larger.

Background/Aim. Metabolic syndrome and malnutrition represent metabolic abnormalities which significantly characterize patients on haemodialysis. The aim of the study was to determine the incidence and find characteristics of metabolic disbalance in patients on haemodialysis. Methods. The study involved 124 patients on chronic haemodialysis at the Clinical Centre Kragujevac. There were analyzed demographic and anthropometric characteristics of the examined patients. Of clinical characteristics, there were determined smoking habit, time on dialysis, arterial pressure; of comorbide states there were recorded heart diseases and diabetes mellitus. Routine biochemical analyses were carried out by a standard laboratory procedure. Results. Metabolic syndrome was found in 29.8% of the examined patients. The patients with metabolic syndrome were older as compared to the patients without metabolic syndrome (58.45±12.91 vs 52.25±11.63 years). The values of systolic pressure (143.88±19.75 vs 133.01±22.93 mmHg; p = 0.014), body mass index (21.2±3.71 vs 19.4±2.88 kg/m2; p = 0.001), fat body mass (19.57±8.47 vs 16.45±5.82%; p = 0.0002) and waist scope (89±12.54 vs 96±12.34 cm; p = 0.0001) were significantly higher in the patients with metabolic syndrome as compared to those without metabolic syndrome. The values of erythrocytes (3.4±0.45 vs 19±0.53 × 1012; p = 0.04) and hemoglobin (107±15.76 vs 101±13.87 g/l; p = 0.009), glycaemia (9.5±8.15 vs 5.6±1.4 mmol/l; p = 0.04) triglycerides (2.44±1.8 vs 1.41±0.64 mmol/l; p = 0.007), HDL cholesterol (1.11±0.19 vs 0.82±0.25 mmol/l; p = 0.005) and albumins (32.5±5.6 vs 29.5±3.7 g/l; p = 0.007) were statistically higher in the patients with metabolic syndrome than in patients without disturbance. Diabetes mellitus was a significant etiological factor of renal insufficiency in the patients with metabolic syndrome (p = 0.008). Conclusion. In our study approximately 30% of patients on haemodialysis had pronounced metabolic syndrome. The older, more obese men with increased levels of triglycireds and glucose in the serum dominated among them. Diabetes mellitus was a leading etiological factor of renal insufficiency in these patients.

Backgraund/Aim. Hemodialysis catheter, as an integral part of hemodialysis, is a catheter placed into the jugular, subclavian and femoral vein. The most common catheter-related complications are infections and thrombosis. The aim of the study was to analyze the prevalence of complications associated with differently inserted central-vein catheters for hemodialysis. Methods. The study was organized as a prospective examination during the period from December 2003 to November 2006, and included all patients who needed an active depuration by hemodialysis, hospitalized at the Clinical Center Kragujevac. The subject of the study were 464 centralvein catheters inserted during the mentioned period and there were recorded all complications related to the placement and usage of catheters. Results. The largest percent of inserted catheters was into the femoral vein − 403 (86.8%), significantly less into the jugular vein − 42 (9.2%), while into the subclavian vein there were placed only 19 catheters (4%). The average of femoral catheter functioning was 17 catheter days, in jugular catheters it was 17.3 days while the subclavian catheters had an average rate of functioning of 25.9 catheter days; there was found a statistically significant difference regarding the duration of functioning (p = 0.03). By microbe colonization of smear culture of the skin at the catheter insertion site, in clinically present suspicion of catheter infection, there was obtained a positive finding in 5.5% of catheters placed into the femoral vein and 7.1% of catheters instilled into the jugular vein, of which Staphylococcus aureus was the most important bacterial type, without statistically significant difference (p = 0.51). Haemoculture, done when there was a suspicion of bacteriemia, was positive in 3.7% of the patients with femoral and 4.8% with jugular catheters; Staphylococcus aureus was the most common bacteria type, but there was no statistically significant difference (p = 0.65). Colonizing the smears of the cut catheter tops, there was found a positive finding in 8.9% of femoral and 4.7% of jugular catheters in which the mentioned type of staphylococcal bacteria was prevalent, without statistically significant difference (p = 0.82). In 77% of femoral, 71.4% of jugular and 68.4% of subclavian catheters, there were no complications associated with insertion and manipulation of catheters for hemodialysis and the difference was at the limits of statistical significance (p = 0.06). Conclusion. Unconvincing rate of infections and a smaller percent of serious complications associated with the placement and use of central vein catheters instilled into the femoral vein, indicate that personal experience is sufficient recommendation to convince us that femoral vein does not represent a region with an increased risk for insertion of hemodialysis catheters.

Introduction/Aim. Gastric acid is a key factor in the pathophysiology of gastroesophageal reflux disease. A plausible mechanism by which the Helicobacter pylori infection might protect against reflux disease is by its propensity to produce atrophic gastritis. The aim of the study was to establish the influence of Helicobacter pylori infection on the occurrence of gastroesophageal reflux in patients with different stages of renal insufficiency. Methods. The examination was organized as a prospective, clinical study and involved 68 patients − 33 patients with preterminal stage of renal failure and 35 patients with terminal renal insufficiency. Due to dyspeptic difficulties, in all the patients there was preformed upper esophagogastroscopy and Helicobacter pylori infection was found by ureasa test. Results. The patients with preterminal renal insufficiency were significantly younger than patients with terminal renal failure (53.4±11.1 vs. 65.4±12.3 years; p = 0.014). There was found a statistically significant difference between the groups in Helicobacter pylori infection (p = 0.03), hiatal hernia (p = 0.008), gastroesophageal reflux disease (p = 0.007), and duodenal ulcer (p = 0.002). Using the multiple non-parametric correlative analysis there was confirmed a negative correlation between Helicobacter pylori infection and gastro-esophageal reflux disease (Kendal τB = -0.523; p = 0.003) and hiatal hernia (Kendal τB = 0.403; p = 0.021), while there was found a positive correlation between gastro-esophageal reflux disease and hiatal hernia (Kendal τB = 0.350; p = 0.044). Conclusion. Helicobacter pylori infection is a significant protective parameter of the incidence of gastro-esophageal reflux disease in patients with both pre-terminal and terminal renal insufficiency.

Background/Aim. Numerous clinical studies have shown that the incidence of artheriosclerosis is higher in patients with progressive renal insufficiency. The aim of this study was to examine the incidence of artheriosclerosis in patients on chronic hemodialysis and its influence on survival and functioning of vascular access. Methods. The study was organized as one-year prospective study. All the patients had arteriovenous fistulas native as a vascular access. The study analyzed demographic, biochemical, clinical and Doppler echomorphological characteristics of the patients in order to make an evidence of artheriosclerotic incidences as compared to functioning arteriovenous fistulas for hemodialysis. Results. The examined patients were of the mean age 55.7±12.68 years. Of them, 53.8% were males and 46.2% females. Functioning arteriovenous fistulas for haemodialysis were found in 56.8% of the examined patients. Concentration of hemoglobin was a significant parameter of functioning fistula (group with complications - 89±14.034 vs. group with no complications - 96.6±17.71; p = 0.0489. An amount of urea removed (URR) was a statistically more significant parameter among the patients without fistula complications: (group with complications - 58.67±7.92% vs. group with no complications - 62.80±7.53%; p = 0.037). A Cox regressive analysis of an index of Doppler parameters of the carotid arteries found no statistical significance between the examined groups. There was a positive correlation between artheriosclerosis and the age, as well as the time on dialysis. In multiple regression, where intima media is a dependent and the age and time on dialysis independent variables, the regressive model was statistically significant (F = 8.22, p = 0.001). Both independent variables had statistically significant inclinations, p < 0.01. Conclusion. Anemia and the level of urea elimination, as a statistically significant indicator of hemodialysis adequacy, were in correlation with the risk for fistula complications. B-mode ultrasonography of the carotid arteries is a significant non-invasive method for detecting artheriosclerosis. Intima- media thickness of the carotid arteries was an important marker of artheriosclerosis correlating significantly with the age and time on dialysis, but not with the traditional risk factors.

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Objective: Many studies have reported insufficient support from surgical services, resulting in nephrologists creating arteriovenous fistulas in many centers. The aim of this study was to compare risk factors of arteriovenous fistula dysfunction in patients whose fistulas were created by nephrologists versus vascular surgeons.Methods: This was a retrospective, analytical study of interventions by nephrologists and vascular surgeons during a period of 15 years. Out of a total of 1,048 fistulas, 764 (72.9%) were created by nephrologists patients, while vascular surgeons were responsible for 284 (27.1%) fistulae. Laboratory, demographic, and clinical parameters which might affect functioning of these arteriovenous fistulae were analyzed.Results: Patients whose arteriovenous fistula was formed by nephrologists differed significantly from those created by vascular surgeons in relation to the preventive character of the arteriovenous fistula (p = 0.011), lumen of the vein (p < 0.001) and systolic blood pressure (p = 0.047). Multivariate logistic regression of arteriovenous fistula dysfunction showed that risk factors were female gender (odds ratio [OR] = 1.56, 95% CI 1.16-2.07), whether the fistulae were created by vascular surgeons or nephrologists (OR = 1.38; 95% CI 1.01-1.89) and the site of the arteriovenous fistula (OR = 0.64; 95% CI 0.48-0.85).Conclusions: Arteriovenous fistulae created by vascular surgeons, female gender, and the location are risk factors of dysfunction. [ABSTRACT FROM AUTHOR]

Background. In hemodialysis patients the most common cause of vascular access failure is neointimal hyperplasia of vascular smooth muscle cells at the venous anastomosis of arteriovenous fistulas. Case report. We presented a 76-year old patient who had developed fistula thrombosis without the presence of known risk factors the eighth day after the initial function. A histopathological finding pointed to a significant rate of neointimal proliferation, as an initial reasons for the fistula stenosis and trombosis. Conclusion. Early pathohistological changes observed in ateriovenous fistula dysfunction are response to hemodynamic changed conditions. [ABSTRACT FROM AUTHOR]

Introduction Malnutrition in patients on haemodialysis represents an important factor of mortality. The aim of the study was to estimate the influence and predictive significance of malnutrition on mortality of patients on haemodialysis. Material and methods There were analyzed the outcomes of treatment of patients on outpatient program of haemodialysis who were hospitalized in Clinical Centre "Kragujevac" for different reasons. The study included the analysis of demographic characteristics, duration of dialysis, body mass index, indications for hospitalization, result oj the treatment and biochemical parameters. Results 39.2% of the examined patients had the elements of protein-energetic malnutrition; 36.8% of patients with malnutrition died; the difference between the groups was statistically significant (p<-0.0006) regarding the results of treatment. Statistically significant difference(p<0.0001) was also obtained concerning the body mass index with its value of 17.1±1.55 kg/m2 in patients with malnutrition. Cardiovascular diseases were statistically more common in patients with malnutrition (p-0.037). In correlation of the group of patients with and the group without malnutrition a statistically significant difference in number of erythrocytes was found (2.87±0.71 vs. 3.26±0.5 x 1012; p-=0.04), concentration of hemoglobin (85±15.7 vs. 104±15.7; p<0.0001), level of creatinin (874±229.3 vs. 998±237.8 ĕmol/L; p=0.04), total proteins (66.5±5.4 vs. 70±4.47 g/L; p=0.001), albumin (30±3.7 vs. 38±4.38; p<0.0001), total cholesterol (3.05±1.14 vs. 4.31±1.2 mmol/L; p<0.0001). C-reactive protein (9.5±6.8 vs. 2.9±5.09 mg/L; p<0.0001) and concentration of fibrinogen (4.96±0.91 vs. 4.22±0.91 μmol/L p=0.00l). Survival time in patients with malnutrition was statistically shorter - 18 months (p<0.0001). Conclusions A third of the examined patients in our study were malnourished with lower survival rate. More than two thirds of patients with malnutrition died. [ABSTRACT FROM AUTHOR]

Background/Aim. Metabolic syndrome and malnutrition represent metabolic abnormalities which significantly characterize patients on haemodialysis. The aim of the study was to determine the incidence and find characteristics of metabolic disbalance in patients on haemodialysis. Methods. The study involved 124 patients on chronic haemodialysis at the Clinical Centre Kragujevac. There were analyzed demographic and anthropometric characteristics of the examined patients. Of clinical characteristics, there were determined smoking habit, time on dialysis, arterial pressure; of comorbide states there were recorded heart diseases and diabetes mellitus. Routine biochemical analyses were carried out by a standard laboratory procedure. Results. Metabolic syndrome was found in 29.8% of the examined patients. The patients with metabolic syndrome were older as compared to the patients without metabolic syndrome (58.45±12.91 vs 52.25±11.63 years). The values of systolic pressure (143.88±19.75 vs 133.01±22.93 mmHg; p = 0.014), body mass index (21.2±3.71 vs 19.4±2.88 kg/m²; p = 0.001), fat body mass (19.57±8.47 vs 16.45±5.82%; p = 0.0002) and waist scope (89±12.54 vs 96±12.34 cm; p = 0.0001) were significantly higher in the patients with metabolic syndrome as compared to those without metabolic syndrome. The values of erythrocytes (3.4±0.45 vs 19±0.53 x 1012; p = 0.04) and hemoglobin (107±15.76 vs 101±13.87 g/l; p = 0.009), glycaemia (9.5±8.15 vs 5.6±1.4 mmol/l; p = 0.04) triglycerides (2.44±1.8 vs 1.41±0.64 mmol/l; p = 0.007), HDL cholesterol (1.11±0.19 vs 0.82±0.25 mmol/l; p = 0.005) and albumins (32.5±5.6 vs 29.5±3.7 g/l; p = 0.007) were statistically higher in the patients with metabolic syndrome than in patients without disturbance. Diabetes mellitus was a significant etiological factor of renal insufficiency in the patients with metabolic syndrome (p = 0.008). Conclusion. In our study approximately 30% of patients on haemodialysis had pronounced metabolic syndrome. The older, more obese men with increased levels of triglycireds and glucose in the serum dominated among them. Diabetes mellitus was a leading etiological factor of renal insufficiency in these patients. [ABSTRACT FROM AUTHOR]

Introduction/Aim. Gastric acid is a key factor in the pathophysiology of gastroesophageal reflux disease. A plausible mechanism by which the Helicobacter pylori infection might protect against reflux disease is by its propensity to produce atrophic gastritis. The aim of the study was to establish the influence of Helicobacter pylori infection on the occurrence of gastroesophageal reflux in patients with different stages of renal insufficiency. Methods. The examination was organized as a prospective, clinical study and involved 68 patients -- 33 patients with preterminal stage of renal failure and 35 patients with terminal renal insufficiency. Due to dyspeptic difficulties, in all the patients there was preformed upper esophagogastroscopy and Helicobacter pylori infection was found by ureasa test. Results. The patients with preterminal renal insufficiency were significantly younger than patients with terminal renal failure (53.4±11.1 vs. 65.4±12.3 years; p = 0.014). There was found a statistically significant difference between the groups in Helicobacter pylori infection (p = 0.03), hiatal hernia (p = 0.008), gastroesophageal reflux disease (p = 0.007), and duodenal ulcer (p = 0.002). Using the multiple non-parametric correlative analysis there was confirmed a negative correlation between Helicobacter pylori infection and gastro-esophageal reflux disease (Kendal τB = -0.523; p = 0.003) and hiatal hernia (Kendal τB = 0.403; p = 0.021), while there was found a positive correlation between gastro-esophageal reflux disease and hiatal hernia (Kendal τB = 0.350; p = 0.044). Conclusion. Helicobacter pylori infection is a significant protective parameter of the incidence of gastro-esophageal reflux disease in patients with both pre-terminal and terminal renal insufficiency. [ABSTRACT FROM AUTHOR]

Background/Aim. Numerous clinical studies have shown that the incidence of artheriosclerosis is higher in patients with progressive renal insufficiency. The aim of this study was to examine the incidence of artheriosclerosis in patients on chronic hemodialysis and its influence on survival and functioning of vascular access. Methods. The study was organized as one-year prospective study. All the patients had arteriovenous fistulas native as a vascular access. The study analyzed demographic, biochemical, clinical and Doppler echomorphological characteristics of the patients in order to make an evidence of artheriosclerotic incidences as compared to functioning arteriovenous fistulas for hemodialysis. Results. The examined patients were of the mean age 55.7±12.68 years. Of them, 53.8% were males and 46.2% females. Functioning arteriovenous fistulas for haemodialysis were found in 56.8% of the examined patients. Concentration of hemoglobin was a significant parameter of functioning fistula (group with complications - 89±14.034 vs. group with no complications - 96.6±17.71; p = 0.0489. An amount of urea removed (URR) was a statistically more significant parameter among the patients without fistula complications: (group with complications - 58.67±7.92% vs. group with no complications - 62.80±7.53%; p = 0.037). A Cox regressive analysis of an index of Doppler parameters of the carotid arteries found no statistical significance between the examined groups. There was a positive correlation between artheriosclerosis and the age, as well as the time on dialysis. In multiple regression, where intima media is a dependent and the age and time on dialysis independent variables, the regressive model was statistically significant (F = 8.22, p = 0.001). Both independent variables had statistically significant inclinations, p < 0.01. Conclusion. Anemia and the level of urea elimination, as a statistically significant indicator of hemodialysis adequacy, were in correlation with the risk for fistula complications. B-mode ultrasonography of the carotid arteries is a significant non-invasive method for detecting artheriosclerosis. Intima-media thickness of the carotid arteries was an important marker of artheriosclerosis correlating significantly with the age and time on dialysis, but not with the traditional risk factors. [ABSTRACT FROM AUTHOR]

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Introduction The analysis of frequency of kidney diseases, causes of terminal renal failure in patients subjected to repeated dialysis in major dialysis centers in the region of Kosovo and Metohija as well as mortality rate in these patients showed a stable number of patients with kidney diseases, evidencing that the populations of Vitina and Gnjilane were the most commonly affected. These towns are designated as regions with the highest incidence of Balkan endemic nephropathy. The present analysis was aimed at: 1. establishing the incidence rate of hypertension and renal function impairment by using clinical and laboratory analyses in individuals from Vitina and neighboring villages, and 2. investigating the correlation between creatinine clearance, age and arterial blood pressure in the studied group. Material and methods The analysis included 510 individuals (excluding diabetics) over the one-month period during 2004 (201 males with their age ranging from 18 to 90 years). Blood pressure measurements were performed in all the individuals, while renal function was determined by glomerular filtration rate (GFR) , as calculated according to Cockcroft-Gault formula. Results Creatinine clearance was lower than 100 ml/min in 237 (46.5%) individuals, out of whom 62 (12%) had GFR below 60 ml/min. Among the remaining 273 (53.5%) individuals with GFR above 100 ml/min, 68 individuals had GFR above 140 ml/min. The distribution of patients depending on their systolic blood pressure values revealed that systolic blood pressure was lower in 44 subjects and higher in 302 subjects (59%). The correlation test revealed significant association between the studied parameters. The positive correlation between patients' age and kidney function means the higher the age of subjects the lower creatinine clearance value (r=-0.622, p<0.001). The negative correlation of the systolic blood pressure value and kidney function was found. meaning that higher the systolic blood pressure is accompanied by lower creatinine clearance (r=-0.204, p<0.001). Moreover, patients' age was significantly correlated with the systolic blood pressure level (r=0.511. p<0.001), as well as with the diastolic blood pressure level (r=0.299, p<0.001). The former means that higher values 0.(both systolic and the diastolic pressures were found in older subjects. No correlation was found between the diastolic blood pressure level and kidney function (the results are not presented). Conclusion The results obtained in the study confirm significant incidence of renal function impairment measured according to creatinine clearance values in patients from the endemic nephropathy region. Reduced kidney function is found in both elderly individuals and those with high systolic blood pressure. In order to establish the correlation with the incidence and presence of BEN or other kidney diseases additional population screening is necessary. [ABSTRACT FROM AUTHOR]

Background: Doppler ultrasound examination of blood vessels has a significant role in planning and identifying parameters that affect the functioning and maturation of arteriovenous fistula (AVF). Our goal was to determine the predictive parameters of Doppler ultrasound, measured at different time distances, which affect the maturation of AVF for hemodialysis., Materials and Methods: The research was a retrospective cohort study. The criteria for selecting patients in our study was the existence of information on ultrasound examinations of the lumen of blood vessels before the creation of AVF, as well as lumens of fistula conduits and blood flow measurements, at time intervals of 6-8 weeks and 2-4 months, after the creation of AVF, which we recorded in 105 patients. The respondents were divided into two groups: a group of patients with immature, and mature fistulas. Basic demographic data, clinical characteristics of the responders and laboratory parameters were analyzed., Results: By comparing clinical and laboratory parameters between the group of subjects with and without AVF maturation, a statistically significant difference was determined between the lumen of the proximal radial vein (p = 0.008) and the lumen of the distal radial vein (p = 0.001). The diameter of the fistulous veins (p = 0.037), and the blood flow through the AVF 6-8 weeks (p = 0.001) and 2-4 months (p = 0.001) after its creation were statistically significantly higher in subjects with mature fistulas. By univariate regression analysis, brachial vein (p = 0.04), proximal (p = 0.011) and distal radial artery (p = 0.001), fistula vein, after 6-8 weeks (p = 0.002), blood flow through AVF 6-8 weeks (p = 0.001) and 2-4 months (p = 0.001) after AVF creation, are statistically significant parameters. Predictive parameters of AVF maturation are AVF blood flow after 6-8 weeks (p = 0.010) and AVF blood flow after 2-4 months (p = 0.001)., Conclusion: Our research confirmed that greater the blood flow through AVF, at time intervals of 6-8 weeks and 2-4 months after creation, the better the maturation., Competing Interests: There are no conflicts of interest., (© 2024 Indian Journal of Nephrology | Published by Scientific Scholar.)

Atherosclerosis - the pathophysiological mechanism shared by most cardiovascular diseases - can be directly or indirectly assessed by a variety of clinical tests including measurement of carotid intima-media thickness, carotid plaque, -ankle-brachial index, pulse wave velocity, and coronary -artery calcium. The Prospective Studies of Atherosclerosis -(Proof-ATHERO) consortium (https://clinicalepi.i-med.ac.at/research/proof-athero/) collates de-identified individual-participant data of studies with information on atherosclerosis measures, risk factors for cardiovascular disease, and incidence of cardiovascular diseases. It currently comprises 74 studies that involve 106,846 participants from 25 countries and over 40 cities. In summary, 21 studies recruited participants from the general population (n = 67,784), 16 from high-risk populations (n = 22,677), and 37 as part of clinical trials (n = 16,385). Baseline years of contributing studies range from April 1980 to July 2014; the latest follow-up was until June 2019. Mean age at baseline was 59 years (standard deviation: 10) and 50% were female. Over a total of 830,619 person-years of follow-up, 17,270 incident cardiovascular events (including coronary heart disease and stroke) and 13,270 deaths were recorded, corresponding to cumulative incidences of 2.1% and 1.6% per annum, respectively. The consortium is coordinated by the Clinical Epidemiology Team at the Medical University of Innsbruck, Austria. Contributing studies undergo a detailed data cleaning and harmonisation procedure before being incorporated in the Proof-ATHERO central database. Statistical analyses are being conducted according to pre-defined analysis plans and use established methods for individual-participant data meta-analysis. Capitalising on its large sample size, the multi-institutional collaborative Proof-ATHERO consortium aims to better characterise, understand, and predict the development of atherosclerosis and its clinical consequences., (© 2020 S. Karger AG, Basel.)

Introduction: The analysis of frequency of kidney diseases, causes of terminal renal failure in patients subjected to repeated dialysis in major dialysis centers in the region of Kosovo and Metohija as well as mortality rate in these patients showed a stable number of patients with kidney diseases, evidencing that the populations of Vitina and Gnjilane were the most commonly affected These towns are designated as regions with the highest incidence of Balkan endemic nephropathy. The present analysis was aimed at: (1) establishing the incidence rate of hypertension and renal function impairment by using clinical and laboratory analyses in individuals from Vitina and neighboring villages, and (2) investigating the correlation between creatinine clearance, age and arterial blood pressure in the studied group., Material and Methods: The analysis included 510 individuals (excluding diabetics) over the one-month period during 2004 (201 males with their age ranging from 18 to 90 years). Blood pressure measurements were performed in all the individuals, while renal function was determined by glomerular filtration rate (GFR), as calculated according to Cockcroft-Gault formula., Results: Creatinine clearance was lower than 100 ml/min in 237 (46.5%) individuals, out of whom 62 (12%) had GFR below 60 ml/min. Among the remaining 273 (53.5%) individuals with GFR above 100 ml/min, 68 individuals had GFR above 140 ml/min. The distribution of patients depending on their systolic blood pressure values revealed that systolic blood pressure was lower in 44 subjects and higher in 302 subjects (59%). The correlation test revealed significant association between the studied parameters. The positive correlation between patients' age and kidney function means the higher the age of subjects the lower creatinine clearance value (r = --0.622, p < 0.001). The negative correlation of the systolic blood pressure value and kidney function was found, meaning that higher the systolic blood pressure is accompanied by lower creatinine clearance (r = --0.204, p < 0.001). Moreover, patients' age was significantly correlated with the systolic blood pressure level (r = 0.511, p < 0.001), as well as with the diastolic blood pressure level (r = 0.299, p < 0.001). The former means that higher values of both systolic and the diastolic pressures were found in older subjects. No correlation was found between the diastolic blood pressure level and kidney function (the results are not presented). Conclusion The results obtained in the study confirm significant incidence of renal function impairment measured according to creatinine clearance values in patients from the endemic nephropathy region. Reduced kidney function is found in both elderly individuals and those with high systolic blood pressure. In order to establish the correlation with the incidence and presence of BEN or other kidney diseases additional population screening is necessary.

Introduction: A few small-scale studies have shown that high levels of various parameters of inflammation were associated with a less efficient response to erythropoetin. The responsiveness to EPO in haemodialysis (HD) patients with relative risk of cardiovascular disease (CVD) remains undetermined. In a retrospective study of HD patients, we compared causes of CV morbidity and mortality in relation to various weekly EPO doses needed for stable hemoglobin (Hb) levels, according to the definition currently suggested by international guidelines., Material and Methods: On the basis of distribution of the weekly EPO doses (lower or higher than the minimally recommended), eighteen HD patients, aged 55.8+/-14.8 years, were divided into two groups with higher (A) and lower (B) EPO doses. We correlated EPO doses with positive (C reactive protein-CRP, fibrinogen, feritin) and negative (albumin, LDL, TIBC) acute phase reactans, BMI, the quality (Kt/V) and duration of HD., Results: We also found a significantly positive corelation between CRP levels on the start of EPO therapy and weekly EPO dose in the univariate linear regression analysis (p-0.290). Higher EPO doses were associated with a lower levels of Kt/V, BMI, residual diuresis and higher levels of CRP, LDL, feritin, age and duration of HD. CRP levels were decreasing in the group with higher EPO doses. This important result can be explained the know EPO effect of endothelial cells apoptosis and inhibiting inflammation induced by HD., Conclusion: Chronic inflammation is a common cause of CVD, hyporesponsiveness to EPO and endothelial dysfuncton in HD patients. Our results suggest a new protective function of EPO.

Pruritus is one of the commonest symptoms of dermatologic appearances in uraemic syndrome and it occurs in 90% of patients on dialysis with different etiology and pathophysiology. The aim of the study was to estimate the frequency of uraemic pruritus and the comparison with clinical and biochemical parameters in 124 patients treated by chronic haemodialysis at Department of Haemodialysis, Clinical Centre in Kragujevac. The routine laboratory analyses were carried out in the examined patients and the concentration of parathyroid hormone was determined. The study was based on data from history of disease and questionnaire taken out in all patients. Of 124 patients 46.8% had symptoms of uraemic pruritus. Concentration of urea, albumin concentration, iron, parameters UIBC, as well as hyperglycemia and time on dialysis are the significant are significantly correlated with uraemic pruritus. 27.6% of the examined patients had itching of all the body. Between the patients with localized itching and patients with generalized itching, there are statistically significant differences in the following parameters: erythrocyte count, hemoglobin concentration, hematocrit and TIBC, as well as glycemia concentration.

Introduction: Atherosclerosis is more frequent in patients with chronic renal insufficiency than in general population. The aim of this study was to investigate the frequency of atherosclerosis and risk factors in hemodialysis patients., Material and Methods: We studied 62 patients (36 male and 26 female; mean age, 56 +/- 13 years). The mean time on HD was 65.7 +/- 46.7 months. These patient underwent the following examinations: assessments of risk factors, body mass index, soft tissue calcification biochemical analyses and Duplex ultrasonography of carotid arteries;, Results: In two thirds of patients older than fifty years, thickening of the intima-media complex was found. No statistically significant difference was found in the frequency of atherosclerosis regarding sex, tissue calcification, plaque, smoking and Diabetes Mellitus. There was no correlation between the thickness of the intima-media complex and traditional risk factors for atherosclerosis. However, there was a statistically significant correlation among atherosclerosis, age and time on dialysis. Atherosclerosis was found in 68% of patients between the age of fifty and seventy years. Duration of dialysis and age are statistically significant factors for atherosclerosis.