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Objectives: Dialysis patients suffer from xerostomia based on hyposalivation even in stimulated saliva testing. Therefore, the aim of this study was (i) to evaluate an optimized oral hygiene system with an oral care gel reducing oral dryness, supporting dental plaque control and reducing the number of gingivitis affected teeth; (ii) to document the efficacy in a randomized controlled trial with dental indices; and (iii) to record the individual’s oral health related quality of life. Methods: After ethical approval (EC-UWH 103/2019), 44 dialysis patients provided signed informed consent and were divided into two groups followed up for four weeks. Subjects of the verum group (A) received daily oral care gel OROFAN® based on biopolymers with a mild antibacterial and saliva stimulating action. They were compared to the control group (B) who executed routine oral hygiene with conventional dentifrice and toothbrushes. At baseline (T0), the medical report and all dental indices (sialometry, DMF/S, plaque index, periodontal index, tongue coating and denture hygiene index) were assessed. After 2 weeks and 4 weeks, T1 and T2 dry mouth frequency and all dental indices were assessed. An Oral Health Impact Profile was documented at baseline (T0) and at the end of the study (T2). Results: Twenty-two subjects were allocated to group A and to group B. At baseline, there were no statistical differences concerning renal insufficiency (years on dialysis and complications), systemic diseases and dental background (caries experience, periodontal diseases, plaque index and number of gingivitis affected teeth). All subjects exhibited hyposalivation (p < 0.001) decrease in xerostomia frequency, in the number of gingivitis affected teeth and in their plaque index. Furthermore, their Oral Health Impact Profile improved considerably (p < 0.01). Significance of Results: Terminally ill patients may gain better oral health and, consequently, an improved quality of life by rather simple oral care using long-lasting, edible anti-inflammatory oral hygiene gel and a dentist’s devotion.

Aim. This study aims to compare efficacy and safety of direct oral anticoagulants (DOAC) with vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) and chronic kidney disease (CKD) stages IV and V.Material and methods. We systematically searched the PubMed, Google Scholar, Web of Science databases from 1990 to 2022 and included all published studies that compared DOACs with VKA in patients with atrial fibrillation and chronic kidney disease stages IV and V. To search the articles, we used the PICO strategy: Patient, Intervention, Comparison, Outcome of Interest. Data extraction was undertaken by five independent researches, and then a meta-analysis was performed.Results. Out of all, 6 studies were included in the meta-analysis: 3 randomized controlled trials (n=353) and 3 retrospective analyses (n=37470). The efficacy of DOACs was comparable with VKA. In terms of safety, DOACs and VKA also showed no statistical differences: hemorrhagic stroke, major/minor/gastrointestinal bleeding, general mortality.Conclusion. In terms of efficacy and safety, the indicators of DOACs and VKA were generally comparable.

Aim of the study was to investigate glomerular filtration rate in population of 25–45 years old young people of Novosibirsk city. Material and methods. A survey of Novosibirsk typical district’s population has been carried out by the Institute of Internal and Preventive Medicine since 2013 to 2016. 1074 people (467 males and 607 females of 25–45 years old) have been included into the survey. The levels of glomerular filtration rate (GFR) were chosen according to KDIGO (2012) recommendation, such as: GFR more than 90 ml/min/1.73 cm2 – high or optimal, 60–89 ml/min/1.73 cm2 – slightly reduced, 45–59 ml/min/1.73 cm2 – moderately reduced, 30–44 ml/min/1.73 cm2 – vastly reduced, 1529 ml/min/1.73 cm2 – highly reduced, lower than 15 ml/min/1.73 cm2 – terminal renal failure. Results and discussion. Average GFR(CKD-EPI) level in all age groups was 99,9 ml/min/1.73 cm2 . Average GFR(CKD-EPI) was 104.41 ml/min/1.73 cm2 in 25–34 age group. Male average GFR(CKD-EPI) levels in appropriate age groups were reliably higher comparing to female levels. Both male and female analyzed indicators turned out to be reliably lower in older group than in the younger one. 95.1 % of male participants at the age from 25 to 34 years old had GFR ≥ 90 ml/min/1.73 cm2 , while female indicator was 76.9 %. The indicators in the age group from 35–45 years old were: for males – 86.4 %, for females – 58.3 %. Both male and female groups at the age from 35 to 45 contained people with GFR < 60.ml/min/1.73 cm2 (2 men – 0,8 %; 1 woman – 0.4 %). While GFR calculating according to MDRD and CKD-EPI formulas two dissimilar results were revealed. The advantages of CKD-EPI formulas calculating for higher GFR indicators have been evidenced.

Achievement of stabilization of carbohydrate metabolism in patients with diabetes mellitus, receiving renal replacement therapy with hemodialysis, is a significant problem in endocrinology. It has to do with multiple factors of this cohort of patients, which affect the level of glycemia, pharmacokinetic of drugs, the efficiency of glycemic control. At the moment, the most efficiency method of glycemic control in patients with type 2 diabetes mellitus on hemodialysis is insulin therapy in the basis - bolus regime by analogues of human insulin. The use of oral hypoglycemic agents is significantly limited. The hemoglobin A1c (HbA1c) remains the main parameter of glycemic control. The simultaneous use of continuous glucose monitoring allows to reveal the true level of glucose of the blood and to carry out the timely correction of therapy in order to achieve targets for glycemic control and to decrease the risk of hypoglycemic episodes. At the moment other glycemic control markers such as glycated albumin and fructosamine are described. However, in routine practice at the moment these indicators are not used due to the lack of sufficient evidentiary base of their use in this cohort of patients.

Urgency. Chronic renal failure poses medical, social and organizational problem because of high mortality, disability and complexity of modern treating methods technical support. The objective: to evaluate the effectiveness of febuxostat in controlling hyperuricemia in patients with end-stage chronic renal failure. Material and methods. 90 patients were divided into three groups in accordance with the use of febuxostat at a dose of 40 mg to reduce uric acid level: group 1 (n=30) - terminal chronic renal failure patients who are not yet receiving renal replacement therapy; Group 2 (n=30) peritoneal dialysis patients; 3 group (n=30)- hemodialysis patients. Results and discussion. Febuxostat use led to uric acid level decrease in all groups under study, increase of the functional renal reserve level in the 1st and 2nd groups. In the 3rd group patients (hemodialysis patients), only uric acid level changes were studied in connection with the absence of in this cohort residual functional renal reserve. The use of febuxostat determines, with decrease in uric acid levels, increase in the residual functional renal reserve and improvement the patients’ quality of life according to the questionnaire data. These results are best reflected in pre-dialysis patients with terminal chronic renal failure. Conclusion: treatment with febuxostat leads to a marked decrease in the level of serum uric acid, increase of residual functional renal reserve and improvement of chronic renal failure patients quality of life, which indicates its good nephroprotective properties.

Introduction/Objective. Jeune syndrome (JS) is a rare hereditary ciliopathy characterized by asphyxiating thoracic dystrophy, shortened limbs and brachydactyly. Extraskeletal anomalies such as chronic renal failure (CRF), hepatic fibrosis, and retinitis pigmentosa may be a part of the JATD phenotype. The aim of this study is to present long-term follow-up of JS patients with early progressive kidney disease. Methods. This is a retrospective study of pediatric patients with JS and CRF who were treated at the University Children’s Hospital between January 1980 and December 2014. The patients’ data were retrospectively reviewed from the medical records. Results. There were thirteen patients from 11 families, five girls and eight boys mean aged 4.3 years at the time of diagnosis. All of the patients had characteristic skeletal findings, retinal degeneration and an early onset of CRF at age range from 1.5 to 7 years. Five patients had neonatal respiratory distress and congenital liver fibrosis was diagnosed in five patients. One patient died due to complications of CRF, while others survived during follow-up of mean 11 years. IFT140 mutations were found in four genetically tested patients. Conclusion. The average incidence rate of JS with renal phenotype in Serbia was about 0.2 per one million of child population. Long-term survival of JS patients depends on renal replacement therapy, while skeletal dysplasia, growth failure, respiratory and eyes problems have impact on the patients’ quality of life.

Introduction: Kidney transplant is the best method of terminal renal failure treatment. The transplanted organ can function properly only if the patients change their lifestyle. Preferred health behaviours are the basis. Aim: Defining the relation between preferred health behaviours and health locus of control, as a determinant of returning to opti‑ mal health. Material and research methods: The research was conducted in the Transplant and Surgery Clinic and Transplant Outpatients Clinic in the University Hospital number 1 in Bydgoszcz. It was carried out among 98 patients after kidney transplant. They were tested using Health Behaviour Inventory by Juczyński and Multidi‑ mensional Health Locus of Control scale. Results: Patients differ among each other regarding health behaviours, however, all of them present a high level of health behaviours. Preventive behaviours, health practices and positive attitude were assessed high, whereas eating habits got a small amount of points. People between 41 and 50 years of age who have children, those living in the countryside, women and those patients for whom it was the first trans‑ plant, manifested more health behaviours. The vast majority of patients were convinced about the influence of oth‑ ers on their health, however they also claimed that their health was dependent on chance. Conclusion: The obtained results may help to enable better understanding of the needs of the patients after kidney transplant. Additionally, they may assist in education planning which may raise the level of knowledge and therefore help patients in taking care of their own health. The research may also serve as educational material for the patients and their families.

The aim of this study was to analyse the demographic variables of chronic non-terminal (CRF) and terminal (TRF) renal failure patients (pts) younger than 19 years treated in Serbia in June 2001. The prevalence of CRF pts was registered as 4,7 per million total population (pmtp) or 14,1 per million child population (pmcp) while corresponding values for TRF pts were 4,5 pmtp or 13,5 pmcp. The incidence of TRF pts during the period Jan.2000-Jan.2002 was 4,35 pmcp. Boys dominated only among CRF pts (34:14); 60,4% beeing between the ages of 6 and 19 yrs while at the time of diagnosis of HBI, 33,3 % of boys were yanger than 2 yrs.The causes of CRF were: reflux nephropathy 58,3%, congenital kidney disease 16,7%, familial/hereditary 14,6% glomerulonephritis 6,2% and Willms tu 4,1%. Reflux nephropathy was also the most common underlying disease of TRF accounted for 36,9% of total cases while glomerulonephritis was responsible for 23,9 %. Reflux nephropathy was associated with neural tube defect in 53,3% and with congenital lower urinary tract obstruction in 66,7%. The most of CRF (81,25%) and TRF pts (95,6%) were from Serbia, the others were from Monte Negro and Republic Srpska. The most of CRF (65%) and TRF (80%) pts were treated in University Children’s Hospital in Belgrade. Of CRF pts 46% had serum sreatinine 100-200 μmol/l, in 11% of pts it was 400-600 μmol/l and 2% of pts were in pre-terminal CRF. One third of CRF pts had proteinuria 150-500 mg/l, and second third had proteinuria greater of 1000 mg/l. Anemia was present in 54% of CRf pts, and arterial hypertension in 56%. Hemodialysis was dominant treatment modality for TRF pts and only 23,9% had functioning transplant. Conclusion: This is the first national study of demographic characteristics of pediatric CRF in Serbia. Since its prevalence is considerably lower than that in Western and North European countries the true prevalence is some what higher. The increasing incidence of pediatric TRF from 2,85 pmcp to 4,35 pmcp reflect better diagnosis and treatment of these patients in the recent years.

Summary The diabetes and renal phenotype of patients with maturity-onset diabetes of the young (MODY) on a transplantation waiting list is not known; neither is their outcome after pancreas (PT) and/or kidney transplantation (KT). Between 2002 and 2009, we screened 50 of 150 patients referred for kidney and pancreas transplantation to the Kremlin-Bicêtre center for HNF1B and HNF1A mutations if one or more of the following criteria was present (i) an atypical history of diabetes (ii) diabetes with at least one affected parent or two affected relatives, (iii) an absence of auto-antibodies at diagnosis (iv) a persistent secretion of fasting C peptide (v) a personal or a family history of renal cysts or dysplasia. Their phenotype and their outcome were analyzed. Four HNF1A (MODY3) and eight HNF1B mutations [renal cysts and diabetes (RCAD)] were identified. All MODY3 patients had diabetic nephropathy, but only 50% of RCAD patients. Four patients underwent a kidney and pancreas transplantation and two a kidney transplant alone. After 4.1 ± 1.1 years of follow-up, 83% of patients still have a functioning kidney and 75% a functioning pancreas. PT can be proposed with good results for MODY3 and RCAD patients. [ABSTRACT FROM AUTHOR]

Thiol compounds such as glutathione, homocysteine, and cysteinyl-glycine are the natural reservoir of reductive capacity of the cells. Chronic renal failure is accompanied by disturbances in redox status of plasma thiols. The aim of the present study was to compare the changes in concentrations of different forms of thiols in plasma of terminal renal failure patients, nondialyzed and on peritoneal dialysis. Total concentrations of different redox forms of thiols were determined by high performance liquid chromatography. We observed that total concentration of glutathione in terminal renal failure patients decreased and total concentration of the remaining thiols in these patients significantly increased. Continuous ambulatory peritoneal dialysis had the following features in comparison with nondialyzed patients: (1) glutathione and cysteine concentration was restored and (2) free fraction of thiols rose, while protein-bound fraction dropped (except for homocysteine). Continuous ambulatory peritoneal dialysis corrects total concentration of glutathione and cysteine, in comparison with nondialyzed patients. [ABSTRACT FROM AUTHOR]

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Abstract: Background: The aim of the present studies was to investigate the changes in concentrations of different forms of thiols in plasma of terminal renal failure patients before and after hemodialysis. Methods: Total concentrations of thiols, their free forms and the level of their mixed disulfides with proteins were determined with HPLC. Results: In terminal renal failure patients before dialysis, total concentrations of cysteine, homocysteine and cysteinylglycine and their free and protein-bound fractions increased while level of all such forms of glutathione dropped. A single dialysis session caused short-lasting return of concentrations of all forms of thiols to the level equal or close to the control group. The changes observed in non-dialyzed patients were similar to those observed in dialyzed patients before single dialysis procedure. Conclusions: The obtained results showed severe disturbance of thiol homeostasis in plasma of terminal renal failure patients. The following changes have to be emphasized: (1) high level of free cysteine (cystine) fraction, (2) strong tendency of homocysteine to form mixed disulfides with proteins, (3) drop of glutathione level. These observations confirm a suggestion that atherogenic action of homocysteine can be a result of S-homocysteinylation and N-homocysteinylation reactions, whereas toxic action of cysteine can result from auto-oxidation reaction. [Copyright &y& Elsevier]

Abstract: Backround and objectives:: There are several potential endogenous digitalis-like factors (EDLF) in mammalian body fluids, and marinobufagenin (MBG) may be the most potent EDLF. Improved assays are needed to confirm the potency of these metabolites. In the present study, we have identified MBG and telocinobufagin (TCB) in human plasma by high-resolution mass spectrometry (MS) and nuclear magnetic resonance (NMR). Methods and results:: The high-resolution MS analysis revealed the molecular masses of TCB and MBG to be the same as their respective theoretical values. Using a tandem mass spectrometer, the mass–charge ratio for TCB was determined to be 403.2 for the parent ion and 349.2 for the daughter ion. The mass–charge ratio for MBG was m/z 383.2 and m/z 401.2. The NMR study revealed that the signals for MBG and TCB were the same as those obtained by MS analysis. In human blood, MBG and TCB were also identified by liquid chromatography (LC) as well as MS. In the LC/MS assay, proscillaridin A was used as an internal standard. The plasma was pretreated with Sep-Pak C18, and then 50 μL was applied to the C8 high-performance liquid chromatography (HPLC) column. The mean plasma concentration of MBG in healthy volunteers (0.94 ± 0.28 ng/mL) was significantly lower than that in patients undergoing regular hemodialysis (3.81 ± 1.92 ng/mL). The concentration of TCB in the healthy volunteers (1.80 ± 0.55 ng/mL) was also significantly lower than that in patients with terminal renal failure (6.86 ± 4.30 ng/mL). Conclusion:: These results indicate that the major EDLF is TCB because its plasma concentration is the highest among the reported endogenous digitalis candidates. [Copyright &y& Elsevier]

Background/Aim: Fasting hyperkalemia in patients with end-stage renal failure is a well-documented phenomenon. Both a decreased secretion of insulin and decreased β-adrenergic receptor sensitivity may take part in this effect. Methods: Twelve anuric, long-term (6.4 ± 2.7 years; mean ± SD) hemodialysis patients underwent three periods of 18-hour fasting (from 6 p.m. to 12 a.m.). At the beginning of each fasting period a single dose of the nonselective β-blocker, nadolol (80 mg), or the β[sub 1] -selective blocker, betaxolol (20 mg), or placebo were given in a random order and in blinded fashion. The wash-out period was 7 days. Results: The mean decrease in blood pressure was similar after nadolol and betaxolol (18 ± 10 vs. 19 ± 11 mm Hg) as was a decrease in heart rate (20 ± 3 and 19 ± 6, respectively). Serum potassium was not different before each of the fasting periods. The increase in serum potassium during fasting was highly significant in each case. The mean increase in serum potassium was 1.2 ± 0.4 mmol/l after nadolol, 0.9 ± 0.6 after betaxolol and 0.6 ± 0.6 after placebo. This effect was significantly larger after nadolol than after placebo (p = 0.01), but this relation was not significant with respect to betaxolol (p = 0.30). Serum insulin as well as glucose decreased significantly and to a similar extent during each fasting period. Plasma aldosterone was unchanged. Conclusion: Nonselective β-adrenergic blockade increases the hyperkalemic effect of fasting in hemodialysis patients.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We report on a patient with multiple myeloma and light-chain induced renal failure, diagnosed with hepatitis C and high viral load in the pre-transplant period. We show that the new hepatitis C virus directed drugs daclatasvir and sofosbuvir can be safely applied concomitantly to high-dose therapy with autologous hematopoietic stem cell transplantation. Liver enzymes remained in the normal range during the transplant and in the post-transplant period. [ABSTRACT FROM AUTHOR]

The pharmacokinetics of cefoperazone after i.p. and/or i.v. administration were studied in 12 CAPD patients. After i.v. injection, the plasma half-life was 2.65±0.4 h, the total clearance amounting to 70.1±19.2 ml/min. Peritoneal clearance was calculated to be 6.9±1 ml/min. After peritoneal instillation, the bioavailability was 63.9±5%. After repeated i.p. administration, no accumulation of the drug in the body was observed. Thus, cefoperazone can be safely administered for the treatment of peritonitis in CAPD patients. [ABSTRACT FROM AUTHOR]

We investigated the in vitro erythroid progenitor growth and the effects of sera on normal-marrow CFU-E (colony-forming units – erythroid) growth in 2 patients with renal failure on regular hemodialysis following a prior history of polycythemia vera (PV). PV was diagnosed 3 and 11 years, respectively, before the development of terminal renal failure. One of the patients had entered a spent phase of PV as characterized by diffuse extensive myelofibrosis and anemia; the other also had mild myelofibrosis. The serum erythropoietin (EPO) levels were low or normal on serial measurements by radioimmunoassay. There was no correlation between the hematocrit values and serum EPO levels. EPO-independent erythroid colonies were present in the cultures of bone marrow and peripheral blood cells from both patients after renal failure in the anemic state. With the addition of various concentrations of EPO, the number of erythroid colonies increased as the concentrations of EPO increased which was in accordance with the clinical observation that 1 patient with postpolycythemic myeloid metaplasia partially responded to recombinant human EPO therapy. In the EPO-dependent CFU-E assay, normal-marrow CFU-E numbers supported by 10% of the patient sera were less than those by normal sera. In the absence of EPO in cultures, no erythropoietic activity was found in the patients’ sera. Our study on uremic patients with underlying PV showed that the biologic characteristics of autonomous erythroid progenitor growth for PV persisted during the spent phase and after the development of terminal renal failure with anemia. The erythroid progenitors responded to EPO both in vitro and in vivo. Their sera exhibited an inhibiting effect on the growth of normal-marrow erythroid progenitors. [ABSTRACT FROM AUTHOR]

Achievement of stabilization of carbohydrate metabolism in patients with diabetes mellitus, receiving renal replacement therapy with hemodialysis, is a significant problem in endocrinology. It has to do with multiple factors of this cohort of patients, which affect the level of glycemia, pharmacokinetic of drugs, the efficiency of glycemic control. At the moment, the most efficiency method of glycemic control in patients with type 2 diabetes mellitus on hemodialysis is insulin therapy in the basis - bolus regime by analogues of human insulin. The use of oral hypoglycemic agents is significantly limited. The hemoglobin A1c (HbA1c) remains the main parameter of glycemic control. The simultaneous use of continuous glucose monitoring allows to reveal the true level of glucose of the blood and to carry out the timely correction of therapy in order to achieve targets for glycemic control and to decrease the risk of hypoglycemic episodes. At the moment other glycemic control markers such as glycated albumin and fructosamine are described. However, in routine practice at the moment these indicators are not used due to the lack of sufficient evidentiary base of their use in this cohort of patients.