MANAGEMENT OF HEMODIALYSIS PATIENTS USING SIMPLE INFORMATICS PROGRAM

Provođenje zdravstvene njege u bolnicama i dobra organizacija temelje se na dobro obrazovanoj i kompetentnoj medicinskoj sestri. Ona može bitno utjecati na uspješnost sveukupnog liječenja koje ima stručne i financijske učinke. Informatika u sestrinstvu kao specijalnost koja integrira sestrinsku, kompjutersku i informatičku znanost primijenjenu u menadžmentu sestrinstva i prijenosu podataka, informacija i znanja u sestrinskoj praksi olakšava njihovu integraciju kao potporu sudionicima u odlučivanju i provođenju zdravstvene njege. Informatika naglašava cjelokupnu sestrinsku praksu i sve medicinske sestre bi trebale imati osnovne informatičke vještine. U radu je prikazano korištenje jednostavnih tablica izrađenih u programima Microsoft Office: Excel i Word koje, više od desetljeća, olakšavaju organizaciju dnevnog rada, praćenja bolesnika i njihove propisane terapije. Educirana sestra-menadžer će znati i moći procijeniti potrebe bolesnika za zdravstvenom njegom i sukladno tome organizirati pružanje zdravstvene njege koristeći dostupne ljudske i tehničke resurse. Vizija nacionalnog zdravstvenog sustava još uvijek nije dostižna zbog nedostatne infrastrukture. Sestrinska informatička dokumentacija o kroničnom bubrežnom bolesniku može značajno doprinijeti kvaliteti zbrinjavanja i liječenja.Providing health care and good hospital organization are always based on a well-educated and competent nurse. Nurses can significantly affect the result of overall treatment, which has a professional and financial effect. Nursing Informatics is a specialty that integrates nursing, computer and information science applied to nursing management as well as transfer of data, information and knowledge in nursing practice. This facilitates nurses’ integration in supporting decision-making and implementation of health care. Informatics emphasizes overall nursing practice and nurses should have basic computer skills. In this article, we show how the use of simple tables, designed by using Microsoft Office programs (Word and Excel), has been employed for over a decade in facilitating the organization of daily work, monitoring of patients and their prescribed therapy. A trained nurse-manager will be able to evaluate patient care and to organize health care administration using all human and technical resources. The vision of the national health care system is still not achievable due to the lack of infrastructure. Nurses and computer documentation of patients with chronic kidney disease can significantly improve the quality of patient care and treatment

CHRONIC KIDNEY DISEASE AFTER ACUTE RENAL INJURY

Ciljevi Razvoj akutnog bubrežnog oštećenja (ABO) koje zahtijeva nadomjesno bubrežno liječenje (NBL) kod hospitaliziranih bolesnika povećava rizik smrtnosti za više od 50 %. Preživjeli bolesnici su pod povećanim rizikom dugoročnih komplikacija. Ovim istraživanjem željeli smo utvrditi razvoj kronične bubrežne bolesti (KBB) kod bolesnika liječenih NBL-om u KBC-u Rijeka tijekom praćenja dvije godine. Bolesnici i metode: Istraživanje je obuhvatilo 429 bolesnika (299 muškaraca i 130 žena) koji su u razdoblju od siječnja 2010. godine do lipnja 2016. godine liječeni metodama NBL-a u KBC-u Rijeka. Prosječna dob bila je 66,61 ± 16,26 godinu. Metodom CVVH liječen je 31 bolesnik, CVVHD 295 bolesnika, CVVHDF 99 bolesnika te HD 4 bolesnika. Indikacija za započinjanje je u 57 % bolesnika bila sepsa, u 31,7 % akutna epizoda kroničnog srčanog zatajivanja, a u 11,3 % kardiokirurški zahvat. Prosječna vrijednost serumskog kreatinina prije hospitalizacije u tih je bolesnika bila 101 ± 39,12 μmol/L. Rezultati: Ukupno 270 bolesnika preminulo je tijekom hospitalizacije, preživjelo je 159 bolesnika. Prosječna vrijednost serumskog kreatinina pri otpustu iznosila je 143,82 ± 45,96 μmol/L. Mjesec dana nakon otpusta prosječna vrijednost serumskog kreatinina iznosila je 177,38 ± 110,36 μmol/L, nakon 3 mjeseca 122,29 ± 64,26 μmol/L, nakon 6 mjeseci 126,63 ± 54,27 μmol/L, nakon godine dana 142,25 ± 133,02 μmol/L, nakon dvije godine 116,40 ± 39,57 μmol/L. Od navedenih bolesnika svega 32 bolesnika su upućena na kontrolu nefrologu mjesec dana poslije otpusta, 21 nakon tri mjeseca, 7 nakon 6 mjeseci, 19 nakon godinu dana i 14 nakon dvije godine. Zaključak: Naše istraživanje je pokazalo kako je u bolesnika koji su preživjeli epizodu ABO-a ili pogoršanja KBB-a zaostalo bubrežno oštećenje s prosječnim vrijednostima serumskog kreatinina višim od onih prije hospitalizacije. Većina bolesnika nije upućivana na redovite kontrole nefrologa.Development of acute renal injury (AKI) requiring renal replacement therapy (RRT) in hospitalized patients increases the risk of mortality by more than 50%. Surviving patients are at an increased risk of long-term complications. With this study, we wanted to determine development of chronic kidney disease (CKD) in patients treated with RRT at Rijeka UHC over a twoyear follow-up period. The study included 429 patients (299 men and 130 women) treated with RRT at Rijeka UHC during the period from January 2010 to June 2016. The mean age of patients was 66.61±16.26 years. Thirty-one patients were treated using CVVH, 295 by CVVHD, 99 by CVVHDF and 4 patients by HD. The indication for initiation was sepsis in 57%, worsening of chronic heart failure in 31.7% and cardiac surgery in 11.3% of patients. The mean serum creatinine value before hospitalization in these patients was 101±39.12 μmol/L. A total of 270 patients died during hospitalization and 159 survived. The mean serum creatinine at discharge was 143.82±45.96 μmol/L. One month after discharge, the mean serum creatinine value was 177.38±110.36 μmol/L, after 3 months 122.29±64.26 μmol/L, after 6 months 126.63±54.27 μmol/L, after one year 142.25±133.02 μmol/L, and after two years 116.40±39.57 μmol/L. Only 32 of these patients were referred for nephrologist check up one month after discharge, 21 after three months, 7 after 6 months, 19 after one year, and 14 after two years. Our study showed that patients surviving an episode of AKI or worsening of preexisting CKD during follow up had the mean serum creatinine values higher than those before hospitalization. Most patients were not referred for regular nephrologist check-ups

Kidney Complications Due to Hematopoietic Stem Cell Transplantation-A Disorder of an Increasing Incidence?

Abstract Hematopoietic stem cell transplantation (HSCT) is becoming an increasingly popular treatment considering that it is the only curative option for many malignant and non-malignant diseases. Many patients treated in this way have been followed for two or three decades post-transplant and are presumed to be cured. But, on the other hand, a great proportion of these patients are experiencing long-term side effects after HSCT, including non-malignant organ or tissue dysfunction, changes in quality of life, infections and secondary malignancy. Renal complications caused by HSCT are high and are associated with the development of both acute and chronic kidney failure. So, considering the increasing numbers of HSCT survivors many years after the transplantation, chronic kidney disease due to HSCT is becoming a growing problem and represents a new population of patients who are presented to nephrologists. The three most common forms of chronic kidney disease related to HSCT are: chronic calcineurin nephrotoxicity, glomerular disease after HSCT and HSCT associated thrombotic microangiopathy

OPATIJA STUDY: OBSERVATION OF HEMODIALYSIS PATIENTS AND TITRATION OF CERA DOSE JUST SWITCHED FROM ANOTHER ERYTHROPOIESIS STIMULATING AGENT

Anemija, posljedica kronične bubrežne bolesti, čija učestalost raste napredovanjem bubrežnog zatajenja, u završnom je stupnju kronične bubrežne bolesti zastupljena u čak do 95% bolesnika. Lijekovi izbora u liječenju bubrežne anemije su pripravci eritropoetina iz skupine lijekova za stimulaciju eritropoeze (LSE). Veliki napredak u liječenju je uporaba metoksipolietilenglikol-epoetina beta, kontinuiranog aktivatora receptora za eritropoetin (CERA). Cilj studije OPATIJA je usporediti postizanje ciljnih vrijednosti hemoglobina (Hb) kao i njegovu varijabilnost uz učinkovitost i sigurnost uporabe u dvije usporedne skupine bolesnika. U jednoj je skupini bolesnika učinjena konverzija s kratkodjelujućih stimulatora eritropoeze na doze CERA navedene na samom proizvodu, dok je druga skupina liječena alternativnim dozama prema individualnim potrebama bolesnika. U ispitivanju je sudjelovalo 79 bolesnika. Bolesnici su bili podijeljeni u dvije usporedne skupine ranije liječene kratkodjelujućim LSE, od kojih je 36 bolesnika bilo u skupini koja je izravno konvertirana na CERA prema preporučenom doziranju navedenom na samom proizvodu. Drugu su skupinu činila 43 bolesnika koji su konvertirani prema dozama prilagođenima prethodnom doziranju kratkodjelujućih LSE. Tijekom osamnaestomjesečnog razdoblja svakom bolesniku u razmacima od najdulje dva mjeseca evidentirani su laboratorijski parametri anemije – razine hemoglobina te parametara statusa željeza (serumsko željezo, TSAT, feritin). Prema navedenim vrijednostima, u slučaju potrebe, prilagođavana je doza CERA te primjenjivana supstitucijska terapija pripravcima željeza. Nakon završetka studije dvije je skupine činio ukupno 51 bolesnik, od kojih je 26 bilo u skupini koja je dobivala preporučenu dozu CERA-e, a 25 bolesnika u skupini koja je dobivala alternativnu dozu. U skupini bolesnika koji su primali preporučene doze CERA prosječna vrijednost hemoglobina tijekom studije iznosila je 104,41 g/L uz prosječne mjesečne doze CERA 104,33 mcg. U skupini bolesnika koji su primali alternativne doze CERA prosječna vrijednost hemoglobina iznosila je 105,33 g/L uz prosječne mjesečne doze CERA 113,08 mcg. U skupini bolesnika koja je dobivala alternativne doze CERA, u 33% slučajeva vrijednosti Hb bile su unutar uskog ciljnog raspona 110-120 g/L. U 30% slučajeva vrijednosti su bile 100-110 g/L, u 29% manje od 100 g/L, a u 8% slučajeva su prelazile 120 g/L. Prosječne vrijednosti Hb na početku i na kraju ispitivanja međusobno se nisu statistički razlikovale osim u skupini bolesnika s nepoželjnim vrijednostima Hb>120 g/L, gdje je 7% bolesnika u skupini s preporučenim doziranjem imalo takve vrijednosti, dok u skupini s alternativnim doziranjem nije bilo bolesnika sa Hb>120 g/L (P=0,017). Varijabilnost hemoglobina s odstupanjima ve im od 10 i 20 g/L zabilježena je u obje skupine uz trend manje pojavnosti u alternativnoj skupini doziranja CERA. U zaključku je preporučeno i alternativno doziranje ime se postižu i održavaju ciljne vrijednosti hemoglobina uz njegovu manju varijabilnost pri primjeni individualiziranog doziranja. Rezultati su potvrdili potrebu individualnog pristupa u liječenju anemije bolesnika koji boluju od završnog stupnja kroničnog bubrežnog zatajenja te se lije e postupcima hemodijalize sukladno najnovijim smjernicama nefrološke struke.Introduction: Anemia is a well-documented consequence of chronic kidney disease, its frequency increases with the progression of renal failure and occurs in up to 95% of patients with end stage renal disease (ESRD). Erythropoietin stimulating agents (ESAs) have become the standard of care in the treatment of renal anemia. The use of methoxy polyethylene glycol-epoetin beta, continuous erythropoietin receptor activator, represents an important beneit in clinical practice. Aim: The aim of the OPATIJA study was to compare the eficacy and safety of maintaining hemoglobin levels in dialysis patients and to assess its variability in a parallel-group design. Patients were randomly assigned to receive methoxy polyethylene glycolepoetin beta once monthly in “normal” dose conversion according to the label of record or “low” or “alternative” dose conversion widely spread according to previous ESA doses. Subjects and Methods: A total of 79 patients were included in the study. The patients who had undergone continuous maintenance intravenous ESA therapy were divided into two parallel groups: group 1 including 36 patients directly switched to CERA according to the manufacturer recommended dosage; and group 2 including 43 patients that were switched by using “low” or “alternative” dose conversion widely spread according to previous ESA doses. During the18-month period, each patient’s anemia parameters, i.e. hemoglobin level, serum iron concentration, TSAT and ferritin, were monitored at intervals not longer than two months. According to hemoglobin levels, the dosage of CERA was adjusted if needed along with oirn supplementation. Results: At the end of the study, the two groups consisted of 51 patients: 26 of those treated with the recommended dose of CERA and 25 treated with the alternative dose. In the normal conversion group, the mean hemoglobin level during the course of the study was 104.41 g/L with the mean monthly dose of 104.33 mcg CERA. In the alternative conversion group, the mean hemoglobin level during the course of the study was 105.33 g/L with the mean monthly dose of 113.08 mcg CERA. In the alternative conversion group, 33% of patients had Hb levels in the tight recommended range of 110-120 g/L. In 30% of patients, Hb levels were 100-110 g/L, in 29% less than 100 g/L, and in 8% more than 120 g/L. The mean Hb levels at the beginning and the end of the study did not differ signiicantly, except for the patient group with Hb levels >120 g/L, where 7% of patients with recommended dosing and none of the patients from the alternative dosing group had such levels (P=0.017). Hemoglobin variability higher than 10 and 20 g/L was recorded in both groups, but less frequently in the alternative CERA dosing group. Conclusion: Both treatments with the recommended and alternative conversion dosing achieved and maintained target hemoglobin level. Study results conirmed the need of individualized approach in the treatment of anemia in ESRD patients receiving hemodialysis, resulting in less potentially harmful hemoglobin variability

CLINICAL RELEVANCE OF ANEMIA TREATMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Anemija je dobro poznata posljedica kronične bubrežne bolesti, a učestalost joj raste s napredovanjem bubrežnog zatajenja, te se u završnom stadiju kronične bubrežne bolesti pojavljuje u čak do 95% bolesnika. Pripravci eritropoetina lijekovi su kojima se posljednjih godina postiže najveći napredak u liječenju bubrežne anemije. Cilj je istraživanja bio analizirati utječe li liječenje bubrežne anemije u bolesnika s kroničnom bubrežnom bolesti koji se još ne liječe dijalizom na ishode njihova liječenja, smanjuje li u učestalost srčanožilnih bolesti, odgađa li potrebu za liječenje dijalizom, smanjuje li pobol i smrtnost te smanjuje li učestalost neželjenih kardiovaskularnih događaja. Tijekom dvogodišnjeg razdoblja analizirali smo 62 bolesnika s kroničnom bubrežnom bolesti. Bolesnici su bili podijeljeni u dvije skupine. U prvoj su skupini (N=31) bolesnici u kojih je u liječenju bubrežne anemije primijenjen eritropoetin, a drugu skupinu (N=31) ine bolesnici u kojih su primijenjene druge mjere liječenja anemije kronične bubrežne bolesti, ali ne eritropoetin, zbog bilo kojeg razloga. Tijekom dvogodišnjega razdoblja u svakog su bolesnika u razmacima od najdulje 6 mjeseci praćeni laboratorijski parametri liječenja kronične bubrežne bolesti i bubrežne anemije. Evidentiran je broj hospitalizacija za svakog pojedinog ispitanika i uzet u obzir uzrok hospitalizacije te broj dana provedenih u bolnici. U dvogodišnjem razdoblju nije bilo statistički bitne razlike u promjenama biokemijskih pokazatelja (Fe, feritin, CRP, albumini, kalcij, fosfor), kao ni u vrijednostima glomerulske iltracije između ispitivanih skupina, ali je uočena tendencija sporije progresije bubrežnog zatajenja u bolesnika koji su primali eritropoetin u odnosu na bolesnike koji nisu primali taj pripravak. Uočeno je statistički bitno manje hospitalizacija zbog neželjenih kardiovaskularnih događaja u skupini bolesnika koja je primala eritropoetin. Zaključeno je da je bubrežna anemija povezana s povećanim morbiditetom i mortalitetom te sa smanjenom kvalitetom života bolesnika. Stoga je neophodno što ranije prepoznavanje i adekvatno liječenje tih bolesnika da bi im se produljio životni vijek i poboljšala kvaliteta života.Introduction: In the last ten years or so, there has been a steady increase in the number of patients with chronic kidney disease and those with end-stage renal failure who require some form of renal replacement therapy. Anemia is a well-known consequence of chronic kidney disease; its prevalence increases with the progression of renal failure and occurs in up to 95% of patients in the inal stages of chronic kidney disease. In recent years, the greatest advance in the treatment of renal anemia has been made by the introduction of erythropoietin preparations, the application of which has signiicantly improved the patients’ quality of life. The aim of this study was to analyze whether the treatment of renal anemia in chronic kidney disease patients not treated by dialysis affects the outcome of their treatment, reduces the incidence of cardiovascular diseases, delays the need of dialysis, reduces morbidity and mortality, and reduces the incidence of adverse cardiovascular events. Subjects and Methods: The study included patients with chronic kidney disease presenting for regular outpatient follow up at Department of Nephrology and Dialysis, Rijeka University Hospital Center. Patients were divided into two groups. Group 1 included patients whose renal anemia was treated with erythropoietin and group 2 patients whose anemia of chronic kidney disease was treated in any other way, regardless of the reason for the exclusion of erythropoietin. Each group included 31 patients with chronic kidney disease. During two years, each patient’s laboratory parameters of chronic renal disease and renal anemia treatment were monitored at intervals not longer than six months. In addition, each patient’s number of hospitalizations was recorded, taking into account the cause of hospitalization and the number of days spent in hospital. Results: During the two-year period, 62 patients with chronic kidney disease were analyzed (31 patients in the groups receiving and not receiving erythropoietin each). The mean age was 66±13.5 in the group receiving erythropoietin and 68±13.6 in the group not receiving erythropoietin. There were 70% of men and 30% of women in the former group, and 53% of men and 47% of women in the latter group. Examination for comorbid conditions (diabetes, hypertension, hyperlipoproteinemia and previous stroke) revealed no statistically signiicant differences between the two groups of patients. There were no statistically signiicant differences in changes of biochemical parameters (Fe, ferritin, CRP, albumin, calcium, phosphorus) between the two groups of patients during the two-year period either. There was no statistically signiicant between group-difference in the glomerular iltration rate after two years, but a tendency of slower progression of renal failure was observed in patients having received erythropoietin as compared to those who did not receive erythropoietin. Moreover, the number of hospitalizations due to adverse cardiovascular events was statistically signiicantly lower in patients that received erythropoietin, while there was no statistically signiicant difference in the total number of hospitalizations, hospitalizations for other indications (infection, bleeding, and worsening of renal failure), or total number of days spent in hospital, regardless of indication. Conclusion: The number of patients with chronic kidney disease and those with end-stage renal failure requiring renal replacement therapy is increasing. Renal anemia, which occurs as a consequence of chronic kidney disease, is associated with increased morbidity and mortality, and with a reduced quality of life in these patients. Consequently, it is necessary to recognize this condition and apply appropriate treatment early in order to prolong life and improve the quality of life of patients with chronic kidney disease

METABOLIC DISORDERS IN RENAL TRANSPLANT RECIPIENTS

Tradicionalni čimbenici rizika za razvoj srčanožilnih bolesti (SŽB) kao što su to arterijska hipertenzija (AH), novonastala šećerna bolest (NDDM) i poremećaj metabolizma masnoća (HLP) i do pedeset su puta učestaliji u primatelja bubrežnog presatka nego u općoj populaciji. Cilj istraživanja bio je analizirati učestalost navedenih metaboličkih poremećaja u primatelja bubrežnog presatka, analizirati utjecaj primijenjene imunosupresivne terapije na pojavnost spomenutih metaboličkih poremećaja te analizirati broj i vrstu primijenjene antihipertenzivne terapije. Tijekom dvogodišnjeg razdoblja analizirali smo 53 bolesnika kojima je u KBCu Rijeka zbog završnog stadija kroni ne bubrežne bolesti transplantiran bubreg. Nakon transplantacije 92,5% bolesnika imalo je evidentiranu AH. Bolesnici koji su primali ciklosporin imali su statistički značajno veću incidenciju AH u odnosu na bolesnike koji su primali takrolimus (p=0,025). Devet bolesnika (17%) postiglo je ciljnu vrijednost arterijskog tlaka (<130/80 mm Hg). Osam bolesnika je u terapiji imalo jedan antihipertenziv, 24 bolesnika dva, 15 bolesnika tri, dva bolesnika su uzimala više od tri lijeka, dok četvoro bolesnika nije primalo antihipertenziv. Najčešće upotrijebljeni antihipertenziv bio je inhibitor kalcijskih kanala (40,4% bolesnika), potom slijede β blokatori (26,6% bolesnika) i inhibitori RAS sustava (ACE inhibitore primalo je 9,2% bolesnika, blokatore angiotenzinskih receptora 16,5% bolesnika). U šest (11,3%) bolesnika dijagnosticirana je NDDM, a u 21 (39,62%) dijagnosticirana je HLP. Zaključeno je da je potrebno provoditi redovitu i stalnu provjeru zdravstvenog stanja bolesnika s bubrežnim presatkom. Uz kontrolu laboratorijskih parametara funkcije presatka vrlo je važna kontrola krvnog tlaka, metabolizma glukoze i masnoća sa svrhom sprječavanja razvoja SŽB, poboljšanja funkcije presatka i kvalitete života te smanjenja mortaliteta primatelja bubrežnog presatka.Introduction: Advancements in immunosuppressive treatment of renal transplant recipients have signiicantly increased the graft and patient survival and signiicantly lowered the incidence of rejection crises. Efforts to increase long term patient and graft survival are directed to the prevention and treatment of cardiovascular diseases because they are the leading cause of mortality in these patients. Traditional risk factors for the development of cardiovascular diseases (e.g., arterial hypertension, posttransplant diabetes mellitus and metabolic lipid disorder) are up to ifty times more frequent among renal transplant recipients than in the general population. The goal of this study was to analyze the prevalence of the above mentioned metabolic disorders in renal transplant recipients, to analyze the impact of immunosuppressive therapy on the manifestation of these mentioned metabolic disorders, and to analyze the antihypertensive therapy applied. Subjects and Methods: We analyzed 53 patients that underwent renal transplantation at Rijeka University Hospital Center during a two-year follow-up. Glomerulonephritis was the primary kidney disease in 14 (29.6%), polycystic kidney disease in 10 (18.87%), interstitial nephritis in 7 (13.21%), nephroangiosclerosis in 5 (18.5%), diabetic nephropathy in 4 (7.55%) and other diseases in 13 (24.53%) patients. Results: The study included 53 patients (58.5% male), mean age 49.8±11.3 (range 27-72) years and mean dialysis treatment before transplantation 56.0±41.9 months. All patients received triple immunosuppressive therapy including a calcineurin inhibitor/ MMF/corticosteroids and induction with IL-2 receptor blocker (daclizumab or basiliximab). Thirty-three (62%) patients were treated with tacrolimus and 20 (38%) with cyclosporine. The mean creatinine value was 144.92±46.49. Eighteen (34%) patients had creatinine lower than 120 mmol/L and 35 (66%) patients had a level higher than 120 mmol/L. After transplantation, 49 (92.5%) patients were treated for arterial hypertension (arterial hypertension was deined as systolic blood pressure greater than 140 mm Hg and diastolic pressure greater than 90 mm Hg or the routine use of antihypertensive therapy). Patients receiving cyclosporine had a signiicantly higher incidence of arterial hypertension as compared with patients on tacrolimus (P=0.025). Among patients with serum creatinine level higher than 120 mmol/L, 32 (65.3%) patients had hypertension, 9 (17%) achieved target blood pressure (<130/80 mm Hg), 8 (16.32%) were treated with one drug, 24 (48.98%) with two drugs, 15 (30.61%) with three drugs and 2 (4.09%) with more than three antihypertensives. Only four patients did not take any antihypertensive medication. The most often used antihypertensive drugs were calcium channel blockers (40.4% of patients), β-blockers (26.6%), and RAS inhibitors (9.2% of atients received ACE inhibitors and 16.5% ARB). In 6 (11.3%) patients, posttransplant diabetes mellitus developed and 21 (39.62%) patients were treated for metabolic lipid disorder. Conclusion: In order to identify patients at a higher risk of developing cardiovascular disease with time, it is essential that kidney transplant recipients undergo regular follow up of graft function, blood pressure, and metabolic parameters. Good graft function is important to improve the quality of life and decrease mortality of renal transplant recipients

INFLAMMATORY BOWEL DISEASE AND KIDNEY– IS THERE A CONNECTION?

Cilj ove studije bio je ispitati imaju li bolesnici s upalnom bolesti crijeva u nekoj mjeri promjene na bubregu. Štoviše, ispitivali smo odnosi li se ta povezanost na aktivnu bolest crijeva. U ovoj presječnoj studiji okupili smo od rujna 2012. do rujna 2013. godine 50 bolesnika srednje dobi od 47,1±16,5 godina s dijagnozom upalne bolesti crijeva postavljenom na osnovi anamneze, endoskopskih, histoloških i radioloških nalaza. Aktivnost bolesti procjenjivali smo indeksom aktivnosti ulceroznog kolitisa (UC activity index, UCAI) i indeksom za Crohnovu bolest (Crohn’s disease index, CDAI). Bilo je 38% bolesnika s ulcertivnim kolitisom (UK) i 62% bolesnika s Crohnovom bolešću (CB). Učestalost abnormalne albuminurije bila je 21,1% u bolesnika s UK i 29% u onih s CB. Nađena je visoka negativna korelacija između trajanja bolesti crijeva i 24-h albuminurije u bolesnika s UK, kao i visoka korelacija između odnosa albumin-kreatinin (ACR) i zbira UCAI u bolesnika s UK, ali te korelacije nisu bile statistički značajne, vjerojatno zbog malog broja bolesnika s UK. S druge strane, procijenjena stopa glomerularne filtracije (estimated glomerular filtration rate, eGFR) pokazala negativnu korelaciju s aktivnošću bolesti u bolesnika s CB (r=-0,569; p=0,05), dok nije bilo statistički značajne korelacije između UK i eGFR (r=0,343; p=NS). Zaključujemo da je abnormalna albuminurija dosta česta u bolesnika s upalnom bolesti crijeva. Čini se da bolesnici s tom bolešću imaju do neke mjere oštećenje glomerula, pretežito oni s CB. Da se istraži ta povezanost potrebne su zajedničke prospektivne studije gastroenterologa i nefrologa.The aim of the present study was to investigate whether patients with inflammatory bowel disease (IBD) have some degree of renal involvement. Furthermore, we investigated whether this connection is related to active bowel disease. In this cross-sectional study, 50 patients diagnosed with IBD, mean age 47.1±16.5 years, were recruited from September 2012 to September 2013. The diagnosis of IBD was based on clinical history, endoscopic, histological and radiological findings. Disease activity was assessed using the UC activity indeks (UCAI) for ulcerative colitis (UC) and Crohn’s disease activity index (CDAI) for Crohn’s disease (CD). There were 38% of UC patients and 62% of CD patients. The prevalence of abnormal albuminuria in UC and CD patients was 21.1% and 29%, respectively. There was a high negative correlation between duration of bowel disease and 24-h albuminuria in UC patients, as well as a high correlation between albumin-creatinine ratio (ACR) and UCAI score in UC patients, but these correlations were not statistically significant, probably due to the small number of UC patients. On the other hand, estimated glomerular filtration rate (eGFR) showed negative correlation with disease activity in CD patients (r=-0.569; p=0.05), while there was no statistically significant correlation between active UC and eGFR (r=0.343; p=NS). In conclusion, abnormal albuminuria is quite frequent in patients with IBD. It seems that patients with IBD have some degree of glomerular damage, mainly those with CD. Collaborative, prospective studies conducted by gastroenterologists and nephrologists are needed to investigate this association

Equivalent: Evaluation of kidney recipients and donors for transplantation

S obzirom na sve stariju populaciju pacijenata sa završnim stupnjem kronične bubrežne bolesti, a kako bi se na Listu čekanja uvrstilo što više pacijenata za presađivanje bubrega, potrebna je temeljitija i opširna obrada potencijalnih primatelja bubrežnog presatka. Nakon dijagnostičkih postupaka trebalo bi pokušati sa svim dostupnim terapijskim mogućnostima otklanjanja kontraindikacija. Nakon uvrštavanja na Listu čekanja, potencijalne primatelje potrebno je dalje pratiti i isključiti moguće kontraindikacije. U prilog ovome ide činjenica da je posljednjih godina sve manji broj apsolutnih kontraindikacija za presađivanje bubrega. Jednako važna je temeljita obrada potencijalnog darivatelja bubrežnog presatka jer omogućuje i olakšava samu odluku o presađivanju bubrega, kao i pripremu potencijalnog primatelja bubrega za operativni zahvat, odabir imunosupresivne terapije te daljnje postupke prije i nakon presađivanja bubrega. Cilj je što više pacijenata uvrstiti na Listu čekanja prije početka liječenja dijalizom (preemptivno presađivanje bubrega) te omogućiti presađivanje od živog darivatelja, jer dosadašnja istraživanja pokazuju kako se tada postižu najbolji rezultati.Considering the growing number of elderly patients with end-stage renal disease, and the simultaneous goal of including as many patients on the waiting list for kidney transplantation, potential kidney transplant recipients should undergo a rigorous selection and evaluation. For the same reason, after diagnostic procedures, we have to try all available therapeutic possibilities to eliminate contraindications. After putting patients on the waiting list, it is necessary to further monitor potential recipients and to treat all contraindications. The supporting fact is the declining number of absolute contraindications for kidney transplantation over the past few years. Equally the extensive evaluation of a potential kidney transplant donor is important because it enables easier decision about kidney transplantation, as well as the preparation of a potential kidney recipient for surgery, selection of immunosuppressive therapy and further procedures before and after the kidney transplantation. The goal is to place as many patients as possible on the wthe aiting list before starting dialysis treatment (preemptive kidney transplantation) and to enable living donor transplant, because existing research shows that the best results are achieved then

Equivalent: Evaluation of kidney recipients and donors for transplantation

S obzirom na sve stariju populaciju pacijenata sa završnim stupnjem kronične bubrežne bolesti, a kako bi se na Listu čekanja uvrstilo što više pacijenata za presađivanje bubrega, potrebna je temeljitija i opširna obrada potencijalnih primatelja bubrežnog presatka. Nakon dijagnostičkih postupaka trebalo bi pokušati sa svim dostupnim terapijskim mogućnostima otklanjanja kontraindikacija. Nakon uvrštavanja na Listu čekanja, potencijalne primatelje potrebno je dalje pratiti i isključiti moguće kontraindikacije. U prilog ovome ide činjenica da je posljednjih godina sve manji broj apsolutnih kontraindikacija za presađivanje bubrega. Jednako važna je temeljita obrada potencijalnog darivatelja bubrežnog presatka jer omogućuje i olakšava samu odluku o presađivanju bubrega, kao i pripremu potencijalnog primatelja bubrega za operativni zahvat, odabir imunosupresivne terapije te daljnje postupke prije i nakon presađivanja bubrega. Cilj je što više pacijenata uvrstiti na Listu čekanja prije početka liječenja dijalizom (preemptivno presađivanje bubrega) te omogućiti presađivanje od živog darivatelja, jer dosadašnja istraživanja pokazuju kako se tada postižu najbolji rezultati.Considering the growing number of elderly patients with end-stage renal disease, and the simultaneous goal of including as many patients on the waiting list for kidney transplantation, potential kidney transplant recipients should undergo a rigorous selection and evaluation. For the same reason, after diagnostic procedures, we have to try all available therapeutic possibilities to eliminate contraindications. After putting patients on the waiting list, it is necessary to further monitor potential recipients and to treat all contraindications. The supporting fact is the declining number of absolute contraindications for kidney transplantation over the past few years. Equally the extensive evaluation of a potential kidney transplant donor is important because it enables easier decision about kidney transplantation, as well as the preparation of a potential kidney recipient for surgery, selection of immunosuppressive therapy and further procedures before and after the kidney transplantation. The goal is to place as many patients as possible on the wthe aiting list before starting dialysis treatment (preemptive kidney transplantation) and to enable living donor transplant, because existing research shows that the best results are achieved then