Leading figures in polish nephrology. Part I — Zbigniew Fałda, MD PhD

For over eight years now Forum Nefrologiczne has been filling some of its pages with the depictions of the figures of honorary members of the Polish Society of Nephrology. Having published 33 biographies to date, the authors wish to launch a new series presenting those who have received the title of the Leading Figures in Polish Nephrology. We begin with Dr. Zbigniew Fałda, who sadly passed away earlier this year. One of the pioneers of dialysis treatment in Poland, Dr. Fałda was a member of the Warsaw-based team taking initial steps into the field of hemodialysis in 1959, as the second one in the country. His merits for the development of Polish nephrology, notably dialysis treatment, are unique and well-known to more mature nephrologists, yet may be completely unknown to the younger generation of doctors. This is especially true about the first 20 years of the development of dialysis treatment in Poland. Although his career coincided with the historically difficult moments for the country and the nation, it abounded in fascinating and important moments that, we feel, are worth bringing to light. The most prominent of those moments must be his participation and input into the development of hemodialysis and peritoneal dialysis, along with their modalities, based on solid training foundation Dr. Fałda had received in the world’s leading centers like Lund (Sweden) or Seattle (USA)

Zasłużeni dla polskiej nefrologii. Część I — dr n. med. Zbigniew Fałda

Autorzy opracowania od ponad ośmiu lat publikująna łamach „Forum Nefrologicznego” życiorysyczłonków honorowych Polskiego TowarzystwaNefrologicznego. Dotychczas zaprezentowano33 biografie. Obecnie rozpoczynamy serię publikacjipoświęconych osobom, które otrzymały odPTN tytuł „zasłużony dla polskiej nefrologii”. Pierwsząosobą, której sylwetka zostanie przedstawionaw ramach tego cyklu, jest zmarły w tym roku dr n.med. Zbigniew Fałda — jeden z pionierów dializoterapiiw Polsce, członek zespołu rozpoczynającegoleczenie za pomocą hemodializ w 1959 roku w Warszawie,w drugim ośrodku dializ w Polsce. ZasługiDoktora dla rozwoju polskiej nefrologii, zwłaszczadializoterapii, są wyjątkowe, dobrze znane bardziejdojrzałym nefrologom, mogą być natomiast zupełnieobce młodszemu pokoleniu polskich lekarzy tej specjalizacji.Dotyczą one w głównej mierze pierwszych20 lat rozwoju dializoterapii w Polsce. Z tego właśniepowodu niezwykła postać Doktora Zbigniewa Fałdy,którego kariera zawodowa jako lekarza obfitowaław ciekawe i ważne wydarzenia w trudnym dla krajuczasie, jest godna przypomnienia bądź poznania.Najistotniejsze elementy tej kariery to współuczestnictwow rozwoju hemodializy i dializy otrzewnowejw Polsce, a także szkolenie w wiodących ośrodkachdializ na świecie, w Lund w Szwecji i Seattle w StanachZjednoczonych

Rapid resolution of EPO-induced pure red cell aplasia after a course of immunoadsorption therapy using protein a columns

Pure red cell aplasia (PRCA) is a rare, but important, complication of erythropoietin (EPO) replacement therapy in patients with renal disease. There is no consensus about the best way to treat this condition; however, recent reports indicated that immunosuppressive therapy is beneficial. We report a patient with EPO-induced PRCA treated with a regimen initially designed for antifactor VIII antibodies in patients with hemophilia. This regimen consists of immunoadsorption therapy using protein A columns, followed by oral prednisolone and single bolus infusions of intravenous immunoglobulin G and cyclophosphamide. Shortly after the course, a swift and rapid increase in reticulocyte count was evident; the patient became transfusion independent and has remained so during 2 years of follow-up. By means of this report, we wish to encourage others to consider this option when first-line treatments fail

Thirty-five years of hemodialysis: two case reports as a tribute to Nils Alwall.

Two patients with long-term (35 years) survival on hemodialysis are described. Kidney replacement therapy for these patients was initiated by a pioneer in hemodialysis, Nils Alwall, in 1968 and 1971, respectively. Kidney transplantation was attempted twice in both patients; however, the dialysis-free interval was less than 18 months in both patients. These patients represent two of the longest known survivors on hemodialysis worldwide. Factors that may have influenced their survival are discussed, and the complications that have occurred over the years are presented

Low Plasma Activated Protein C-Protein C Inhibitor Complex Concentration Is Associated with Vascular Access Failure in Hemodialysis Patients.

Background: Vascular access failure is a common cause of morbidity in patients with end-stage renal failure on hemodialysis (HD). Activation of the coagulation system and formation of a thrombus play important roles in recurrent arteriovenous fistula/graft (AVFG) failure. Thrombin in complex with thrombomodulin (TM) activates the anticoagulant protein C and creates activated protein C (APC), which is subsequently inactivated by the protein C inhibitor (PCI). The plasma concentration of the complex between APC and PCI (P-APC-PCI complex) is increased in hypercoagulable states and is therefore a sensitive indicator of the degree of activation of blood coagulation. Methods: Thirty-five HD patients dialyzed through a functioning AVFG were studied. The period of patency of AVFGs was recorded. Blood was drawn before and after the HD session for the analysis of the APC-PCI complex, soluble TM concentration and activity, von Willebrand factor antigen and homocysteine. Results: Patients with frequent AVFG failures (n = 8) had a significantly lower level of P-APC-PCI complex (median 0.09 mug/l) than those with less frequent AVFG failures (median 0.18 mug/l; n = 27; p = 0.04). No other significant differences were found between the groups. Conclusion: Thus, a low level of P-APC-PCI complex may be associated with an increased risk of AVFG failure in HD patients. Further prospective studies are needed to confirm these results and to evaluate the possibility of prophylactic measures

Biocompatibility of a novel avidin-agarose adsorbent for extracorporeal removal of redundant radiopharmaceutical from the blood.

The use of monoclonal antibodies (MAbs) in cytotoxic conjugates (radionuclides, toxins, or drugs) for targeting tumor cells is restricted due to toxicity in vital organs. Through improved tumor targeting, it is possible to administer larger amounts of such labeled MAbs, thus improving the ability to eradicate tumor cells without increased normal organ toxicity. Extracorporeal affinity adsorption treatment (ECAT) has therefore been developed using an avidin-agarose (AA) adsorbent with high binding affinity for the biotinylated radiolabeled MAb, rituximab. During ECAT, excess radioimmunoconjugates, not bound to the tumor cells, can be removed improving tumor targeting. The present study was performed to estimate the biocompatibility of the AA adsorber. Seven patients with B-cell lymphoma not responding to conventional treatment were studied. During the ECAT procedure, blood (B) components, plasma (P) complement fragments C3a, C5a, and P-bradykinin were analyzed, and other laboratory tests were carried out. Slight decreases in B-hemoglobin (8.3%), B-thrombocytes (11.4%), and P-albumin (14.3%) were observed, and could be explained by the dilution of the blood with normal saline and acid citrate dextrose. The AA adsorbent had no effect on the blood cells, immunological status or P-bradykinin level. The AA adsorber demonstrated good hemocompatibility and biocompatibility, without any side effects in the patients

The efficacy of once weekly compared with two or three times weekly subcutaneous epoetin β : Results from a randomized controlled multicentre trial

Background. Anaemia in haemodialysis patients can be effectively treated with erythropoietin. We investigated whether subcutaneous (SC) epoetin β administered once weekly was as effective as the same weekly dosage given in two to three divided doses. Methods. One hundred and fifty-eight patients (delivered Kt/V >1.0, where K=dialyser-renal urea clearance, t=dialysis time and V=filtration volume, obtained by urea kinetic modelling) were randomized to treatment with SC epoetin β either once weekly (n=118), or to their original dosage two or three times weekly (control group, n=40) for 24 weeks. All patients received intravenous iron supplementation when necessary. Results. Eight-eight patients in the once weekly group and 30 patients in the control group were treated for at least 16 weeks and are included in the analysis. Stable haemoglobin levels were maintained without epoetin dose increases in 73% of patients in both groups. Mean haemoglobin levels at randomization and after 16 and 24 weeks were 11.4, 11.1 and 11.1 g/dl, respectively, in the once weekly group compared with 11.2, 11.3 and 11.2 g/dl, respectively, in the control group. The mean weekly epoetin β dosages at randomization and after 16 and 24 weeks were 102, 103 and 106 IU/kg bodyweight, respectively, in the once weekly group compared with 109, 109 and 115 IU/kg bodyweight, respectively, in the control group. No statistically significant between-group differences were apparent for changes in haemoglobin levels or epoetin β dosages at week 24. Conclusions. Once weekly SC administration of epoetin β is as safe and effective in maintaining haemoglobin levels in stable haemodialysis patients as two or three times weekly administration of the same total dose. By using the once weekly regimen, patients can avoid up to 104 injections per year. This would reduce clinic time for patients who do not self administer, and may also encourage self-administration and improve overall compliance

Genotyping of hepatitis C virus isolates by a modified polymerase chain reaction assay using type specific primers: epidemiological applications

A polymerase chain reaction (PCR)-based assay using primers against the hepatitis C core gene has been described [Okamoto et al. (1992a): Journal of General Virology 73:673-679]. Within the two major HCV genotypes 1 and 2, the Okamoto system identifies two subtypes each (1a, 1b and 2a, 2b, respectively). Typing is achieved by a primary PCR with consensus primers followed by a nested PCR with type specific primers. The original assay was modified by addition of a parallel second PCR identifying the recently described major genotype 3. The assay also identifies in duplicate subtype 1b (type II by Okamoto), suggested to respond poorly to interferon. Reaction conditions were reviewed and melting temperatures of all typing primers equalised to increase strigency. The modified system functioned well and typing results were supported by partial core sequencing. The following distribution of genotypes was found in 53 hepatitis C virus (HCV) infected Swedish blood donors: genotype 1a (57%), 3 (19%), 1b (13%), and 2b (11%). In six recipients of HCV infected blood identified in a retrospective study, the recipient HCV genotype was identical to donor HCV genotype. Furthermore, in HCV positive couples identical genotype was observed when only one partner had an external risk factor; whereas genotypes were often diverse if both sex partners had parenteral risk factors. Finally, a cluster of hepatitis C cases in a haemodialysis unit was evaluated retrospectively. Eight patients had genotype 1b, two had mixed 1a and 1b, and one had type 1a. The modified HCV genotyping assay was of value in examining different epidemiological situations and can be expanded presumably to include future genotypes