POVEZANOST IZMEĐU STAVOVA I NAVIKA U ISHRANI I SERUMSKOG FOSFORA U BOLESNIKA NA HEMODIJALIZI

Nutritional problems in hemodialysis (HD) patients are frequently associated with poor control of serum phosphorus what may lead to chronic kidney disease-metabolic bone disease. Hyperphosphatemia is an important risk factor for extraskeletal and vascular calcifications and is associated with cardiovascular morbidity and mortality. Increased ingestion of phosphorus is an important factor in development of hyperphosphatemia. We investigated nutritional habits and attitudes of HD patients and determined their correlation with serum phosphate levels in 57 patients treated in Clinical centre Montenegro. Twenty-two patients were male (38.6%), with average age 57 (range, 30-73 years). Statistically significant correlation was found between red meat or milk ingestion and serum phosphate, as well as between educational level and serum phosphate. In our population, socioeconomic level was directly correlated with serum phosphate. Conclusion: a serum phosphate level is determined by socioeconomic level, ingestion of red meat and milk, and depends on educational level in HD population of the capital of Montenegro.Poremećaj uhranjenosti bolesnika kojima se bubrežna funkcija nadomješta hemodijalizom (HD) često je povezan s lošom kontrolom serumskog fosfora, što može dovesti do poremećaja metabolizma kosti s posljedičnim razvojem sekundarnog hiperparatireoidizma i poremećajem mineralo-koštanog metabolizma. Hiperfosfatemija je značajan čimbenik rizika za razvoj kalcifikacija mekih tkiva, kao i za pobolijevanje i smrtnost od srčano-žilnih bolesti. Povećan unos hrane bogate fosforom značajan je čimbenik koji dovodi do hiperfosfatemije. Istraživanje ima za cilj ispitati prehrambene navike i stavove bolesnika liječenih HD i utvrditi njihovu povezanost s razinama serumskog fosfora. Istraživanje je provedeno u ožujku 2015. u Centru za hemodijalizu, Kliničkog centra Crne Gore. Istraživanje je provedeno na 57 bolesnika koji su na redovitom programu intermitentne hemodijalize. Muškaraca je bilo 22 (38,6 %). Prosječna dob bolesnika bila je 57 godina (raspon 30-73 godine). Pronađena je statistički značajna povezanost između vrste hrane, osobito crvenog mesa ili konzumiranja mlijeka i mliječnih proizvoda i serumske razine fosfora, kao i između razine obrazovanja ispitanika i razine serumskog fosfora. U našoj je populaciji serumska razina fosfora bila direktno povezana sa socioekonomskim statusom bolesnika. Zaključujemo da je: koncentracija fosfata u serumu određena socijalno–ekonomskom razinom društva, kao i običajem da se u prehrani koriste meso i mlijeko. Nadalje, u konkretnom slučaju vezana je uz prosvjećenost bolesnika koji se dijaliziraju u glavnom gradu Crne Gore

Estimated arterial stiffness and cardiovascular risk in chronic kidney disease – a study protocol

Introduction The prevalence of chronic kidney disease (CKD) in the general population is 9.1%. Cur- rent guidelines recommend a cut-off GFR value of 60 mL/min/1.73 m2 for diagnosis of CKD, without considering the physiological decline of GFR with aging, or the association with cardiovascular (CV), cerebrovascular or renal outcomes. There is also an increase in arterial stiffness with aging, which is es- timated by pulse wave velocity (PWV). Aim The aim of this study is to show how the ePWV predicts CV incidents independently of SCORE chart and traditional risk factors. Materials and Methods This prospective observational study will include 2058 subjects from the Endemic nephropathy in Croatia – epidemiology, diagnosis and etiopathogenesis scientific research project. Conclusion This will be the first study that could show how the estimated arterial stiffness, independently of CKD contributes to overall CV, cerebrovascular and renal risk. We could also, based on the results, propose an age-independent definition of CKD based on the association with CV disease and mortality

Cutaneous manifestations of tuberous sclerosis

No abstract availabl

Information systems in nephrology

The level of application of information technology in modern health systems is continuously growing throughout the world. Utilising new technology facilitates and speeds up the process of health care. The World Health Organisation has defined telemedicine 1997,, as the provision of health services in which distance represents a critical factor by health care professionals who use information and communication technologies for diagnosis, suggesting treatment and prevention of diseases, as well as the permanent training of health professionals in research and evaluation of health activities, in order to improve the health of people and the communities in which they live and work. Given,, tip of the iceberg ' which is now seen in terms of nephrology diseases in the future we can expect an increasing number of new information systems and technologies that will be applied in nephrology

Prooxidant-antioxidant balance, hsTnI and hsCRP: mortality prediction in haemodialysis patients, two-year follow-up

Oxidative stress and inflammation are highly intertwined pathophysiological processes. We analyzed the markers of these processes and high-sensitive troponin I (hsTnI) for mortality prediction in patients on haemodialysis. This study enrolled a total of 62 patients on regular haemodialysis. The patients were monitored for two years, and the observed outcomes were all-cause and cardiovascular mortality. Blood samples were taken before one dialysis session for analysis of the baseline concentrations of prooxidant-antioxidant balance (PAB), total antioxidant status (TAS), total oxidative status (TOS), hsTnI, hsCRP and resistin. The overall all-cause mortality was 37.1% and CVD mortality 16.1%. By univariate and multivariate logistic regression, our findings suggest that good predictors of all-cause mortality include hsCRP and PAB (p lt .05) and of CVD mortality hsCRP (p lt .05) and hsTnI (p lt .001). To evaluate the relationship between the combined parameter measurements and all-cause/CVD mortality risk, patients were divided into three groups according to their PAB, hsCRP and hsTnI concentrations. The cutoffs for hsCRP and hsTnI and the median for PAB were used. Kaplan-Meier survival curves pointed out that the highest mortality risk of all-cause mortality was in the group with hsCRP levels above the cutoff and PAB levels above the median (p lt .001). The highest risk of CVD mortality was found in the group with hsCRP and hsTnI levels above the cutoff levels (p =.001). Our data suggest that hsCRP and PAB are very good predictors of all-cause mortality. For CVD complications and mortality prediction in HD patients, the most sensitive parameters appear to be hsTnI and hsCRP

SAMOPROCIJENJENA SURADLJIVOST BOLESNIKA KORELIRA SA SERUMSKIM FOSFOROM, OSTATNOM DIUREZOM I STATUSOM UHRANJENOSTI BOLESNIKA NA HEMODIJALIZI: MEĐUNARODNO, MULTICENTRIČNO ISTRAŽIVANJE

Compliance is a major obstacle to achieving phosphorus control in the majority of patients with end-stage renal disease. We investigated self-reported medication adherence and its correlation with serum phosphate levels and nutritional status in hemodialysis patients. A total of 417 patients from Croatia, Montenegro and Bosnia and Herzegovina, mean age 63.82 (range, 21-92) years, were included in the study. There were 55.1% of male patients with the mean dialysis vintage of 68.67 (range, 3-456) months. A signifi cant positive correlation was found between self-reported adherence and serum phosphorus (0.192), and negative correlation with hemoglobin, prealbumin, albumin, Kt/V and residual diuresis (-0.187, -0.227, -0.100, 0.192, and -0.106, respectively). On the other hand, the number of pills taken daily correlated signifi cantly with residual diuresis, serum prealbumin, serum glucose, triglycerides, ferritin and ultrafi ltration volume (0.241, 0.154, 0.158, 0.112, 0.201 and 0.125, respectively). In conclusion, self-reported medication adherence correlates with serum phosphate levels, residual diuresis and nutritional status in hemodialysis patients.Suradljivost je glavna prepreka kontroli fosfora u većine bolesnika sa završnim stadijem kronične bubrežne bolesti. Istražili smo povezanost suradljivosti s uzimanjem lijekova, procijenjene od strane samih bolesnika, s koncentracijom fosfora u serumu i statusom uhranjenosti bolesnika na hemodijalizi. U istraživanje je uključeno 417 bolesnika iz Hrvatske, Crne Gore i Bosne i Hercegovine. Prosječna dob bila je 63,82 godine (raspon, 21-92), 55,1 % ih je bilo muškog spola, prosječno liječenih dijalizom 68,67 (raspon, 3-456) mjeseci. Nađena je statistički značajna pozitivna korelacija između suradljivosti i serumskog fosfora (0,192), a negativna s prealbuminom, albuminom, Kt/V i ostatnom diurezom (redom, -0,187, -0,227, -0,100, 0,192 i -0,106). S druge strane, broj dnevno unesenih tableta je statistički značajno korelirao s ostatnom diurezom, serumskim prealbuminom, glukozom, trigliceridima, feritinom i volumenom ultrafi ltracije (redom, 0,241, 0,154, 0,158, 0,112, 0,201 i 0,125). Zaključno, samoprocijenjena suradljivost bolesnika korelira sa serumskim fosforom, ostatnom diurezom i statusom uhranjenosti bolesnika na hemodijalizi

SAMOPROCIJENJENA SURADLJIVOST BOLESNIKA KORELIRA SA SERUMSKIM FOSFOROM, OSTATNOM DIUREZOM I STATUSOM UHRANJENOSTI BOLESNIKA NA HEMODIJALIZI: MEĐUNARODNO, MULTICENTRIČNO ISTRAŽIVANJE

Compliance is a major obstacle to achieving phosphorus control in the majority of patients with end-stage renal disease. We investigated self-reported medication adherence and its correlation with serum phosphate levels and nutritional status in hemodialysis patients. A total of 417 patients from Croatia, Montenegro and Bosnia and Herzegovina, mean age 63.82 (range, 21-92) years, were included in the study. There were 55.1% of male patients with the mean dialysis vintage of 68.67 (range, 3-456) months. A signifi cant positive correlation was found between self-reported adherence and serum phosphorus (0.192), and negative correlation with hemoglobin, prealbumin, albumin, Kt/V and residual diuresis (-0.187, -0.227, -0.100, 0.192, and -0.106, respectively). On the other hand, the number of pills taken daily correlated signifi cantly with residual diuresis, serum prealbumin, serum glucose, triglycerides, ferritin and ultrafi ltration volume (0.241, 0.154, 0.158, 0.112, 0.201 and 0.125, respectively). In conclusion, self-reported medication adherence correlates with serum phosphate levels, residual diuresis and nutritional status in hemodialysis patients.Suradljivost je glavna prepreka kontroli fosfora u većine bolesnika sa završnim stadijem kronične bubrežne bolesti. Istražili smo povezanost suradljivosti s uzimanjem lijekova, procijenjene od strane samih bolesnika, s koncentracijom fosfora u serumu i statusom uhranjenosti bolesnika na hemodijalizi. U istraživanje je uključeno 417 bolesnika iz Hrvatske, Crne Gore i Bosne i Hercegovine. Prosječna dob bila je 63,82 godine (raspon, 21-92), 55,1 % ih je bilo muškog spola, prosječno liječenih dijalizom 68,67 (raspon, 3-456) mjeseci. Nađena je statistički značajna pozitivna korelacija između suradljivosti i serumskog fosfora (0,192), a negativna s prealbuminom, albuminom, Kt/V i ostatnom diurezom (redom, -0,187, -0,227, -0,100, 0,192 i -0,106). S druge strane, broj dnevno unesenih tableta je statistički značajno korelirao s ostatnom diurezom, serumskim prealbuminom, glukozom, trigliceridima, feritinom i volumenom ultrafi ltracije (redom, 0,241, 0,154, 0,158, 0,112, 0,201 i 0,125). Zaključno, samoprocijenjena suradljivost bolesnika korelira sa serumskim fosforom, ostatnom diurezom i statusom uhranjenosti bolesnika na hemodijalizi

Association of multiple retinal nodular hamartomas and "confetti" skin lesions with end-stage renal disease in patients with tuberous sclerosis

Purpose: The main purpose of this study is to explore characteristics of patients with chronic kidney disease in tuberous sclerosis (TSC) and to underline differences in clinical characteristics between end-stage renal disease (ESRD) patients and patients in earlier stages of chronic kidney disease. Methods: This multicentric, retrospective study included data for 48 patients from seven South-Eastern European countries (Albania, Bosnia and Herzegovina, Croatia, Greece, Montenegro, Serbia, Slovenia) in the period from February to August 2020. Researchers collected data from local and national nephrological and neurological registries and offered clinical and laboratory results from medical histories in follow-up periods. Results: This study enrolled 48 patients with a median age of 32.3 years (range, 18-46 years), and predominant female gender (60.45%). The percentage of patients with chronic kidney disease (CKD) diagnosis of the total number of patients was 66.90%, with end-stage renal disease development in 39.6%. The most prevalent renal lesions leading to chronic kidney disease were angiomyolipomas (AMLs) in 76.6%, while multiple renal cysts were present in 42.6% of patients. Nephrectomy was performed in 43% of patients, while the mTOR inhibitors were used in 18 patients (37.5%). The majority of patients had cutaneous manifestations of tuberous sclerosis-83.30% had hypomelanotic cutaneous lesions, and 68.80% had angiofibromas. Multiple retinal nodular hamartomas and "confetti" skin lesions were more frequent in end-stage renal disease (ESRD) than in patients with earlier stages of chronic kidney disease (p-0.033 and 0.03, respectively). Conclusion: Our study has also shown that retinal hamartomas and "confetti" skin lesions are more frequent in end-stage renal diseases (ESRD) patients than in other chronic kidney disease (CKD) patients. Usage of mTOR inhibitors can also reduce the number of complications and associated with tuberous sclerosis, such as dermatological manifestations and retinal hamartoma, which are more common in the terminal stage of chronic kidney disease