Is Peritoneal Dialysis a Suitable Method of Renal Replacement Therapy in Acute Kidney Injury?

Research focus: The role of peritoneal dialysis (PD) in the management of acute kidney injury (AKI) is not well defined, although it remains frequently used, especially in low-resource settings. A review was performed to ascertain its suitability as the “first choice” in AKI patient treatment and to compare PD with extracorporeal blood purification (EBP), such as hemodialysis (HD). Research methods used: Design, setting, participants, and measurements of MEDLINE, CINAHL, and Central Register of Controlled Trials were searched. The review selected eligible adult population studies on PD in the setting of AKI. Results/findings of the research: This paper suggests that PD should be considered as a valuable method for AKI since it offers several advantages over HD, such as technical simplicity, no extracorporeal circuit, and no bleeding risk. It offers good cardiovascular tolerance and less cardiovascular instability, thus reducing kidney aggression by ischemia and hydroelectrolytic imbalance. Main conclusions and recommendations: Finally, not only in developing countries but also in developed countries, PD is relatively simple and inexpensive and is more widely used. Various techniques of PD have been developed, and these have been adapted for use in AKI. There is currently no evidence to suggest significant differences in mortality between PD and HD in AKI. There is a need for further good-quality evidence in this important area

Traditional, Nontraditional, and Uremia-Related Threats for Cardiovascular Disease in Chronic Kidney Disease

As many as 40–50% of all patients suffering from chronic kidney disease (CKD) die from reasons related to cardiovascular disease (CVD). The severity of the illness is directly connected to higher mortality caused by cardiovascular factors, with the cause of the CKD not as significant for the relationship. This risk of high cardiovascular mortality and morbidity is actually so high that it surpasses the risk of the patients reaching end-stage renal disease. Within the context of CKD, CVD has certain distinct characteristics. Left ventricular hypertrophy (LVH) is commonly used as a predictor of cardiovascular (CV) mortality. The striking cardiac interstitial fibrosis, a crucial part of uremic cardiomyopathy, and nonobstructive vascular diseases are highly prevalent CV pathology in CKD patients. Traditional risk factors appear to be of less importance in the CKD population compared to the general population but have been hypothesized as uremic toxins as a risk factor of cardiorenal syndrome. In this chapter, we discuss the importance of renal function in the pathophysiology of heart failure. We also elaborate on the novel understanding of chronic kidney disease and its role in cardiovascular disease progression

Distribution and Molecular Detection of Methicilin-Resistant <em>Staphylococcus aureus</em>

Isolation of Staphylococcus aureus is quite common in both the general population and hospital environment. The heterogeneity of the disease and the unique ability of S. aureus to develop resistance to the most recently discovered antibacterial drugs points to its ability to adapt and survive in different conditions. CA-MRSA is different from hospital strains of MRSA by its epidemiological, phenotypic and genotypic characteristics. The emergence of MRSA in the community suggests the need for a new approach to managing the indications and the certification of staphylococcal infections, with special emphasis on the selection of empiric antibiotic therapy. In the study, we analised of MRSA from 4341 samples taken from patients from the general population of Sarajevo Canton in the six-month period of follow-up processed at the Public Health Institute of Sarajevo Canton. We determined the epidemiological characteristics of the isolated strains. Methicillin resistance was determined by phenotypic methods. The following molecular methods were used for the confirmation of methicillin resistance: determination of the mecA gene, PFGE profile, genetic type of MRSA being determined by spa typing, the distribution of SCCmec types being examined, and the detected gene for PVL. The study stresses the need for national monitoring of spreading of the existing epidemic strains, as well as the monitoring of emergence of new strains which would enable the inclusion of our country in the international network of monitoring bacterial resistance

Kvantificiranje mikrovaskularnih promjena u kroničnih bubrežnih bolesnika

Introduction. Ocular microvascular changes can be related to kidney deterioration in chronic kidney disease (CKD). We aimed to identify the association between retino-choroidal parameters and kidney deterioration in diabetics and non-diabetics. Methods. The study group consisted of CKD patients (cross-sectional study) with arterial hypertension with different stages of CKD. Complete eye examination was completed with optical coherence tomography angiography (OCTA) scans of the macular region. According to the value of glomerular filtration rate (GFR) and albuminuria, patients were divided into groups: low GFR (60ml/min) and CKD patients without albuminuria and CKD with micro or macroalbuminuria. Results. One hundred and six eyes of 106 chronic kidney disease patients were evaluated. The mean retinal thickness in GFR 60 ml/min group was 274,36±10,77 μ. OCTA showed lower deep vascular density (DVD ) in CKD with albuminuria versus CKD without albuminuria group (p < 0.001). Albuminuria was inversely related to choroidal and retinal thickness measures of superficial (SVD) and DVD . Conclusions. CKD is associated with retinal diluting and decreasing kidney function with reduction of retinal and choroidal vascular density.Uvod. Korioretinalne mikrovaskualrne promjene mogu biti povezane s bubrežnim oštećenjem u kroničnoj bubrežnoj bolesti (KBB). Rad istažuje udruženost korioretinalnih parametara i bubrežnog oštećenja u hipertoničara, dijabetičara i nedijabetičara s KBB. Metode. Presječna studija KBB pacijenata s arterijskom hipertenzijom različitog stupnja oštećenja funkcije u KBB. Skeniranje makularne regije na očima je izvedeno pomoću optičke koherentne tomografije angiografije (OCTA). Pacijenti su podijeljeni na grupe prema stopi glomerularne filtracije na GFR60ml/min, kao i na KBB pacijenti s albuminurijom i KBB pacijenti bez albuminurije. Rezultati. Evaluirano je 106 očiju KBB pacijenata. Srednja vrijednost retinalnog zadebljanja u grupi s GFR <60ml/min je 275,73±9,65 mikrona (μ), dok je u grupi s GFR>60ml/min 274,36±10,77μ. Pomoću OCTA skena prikazana je značajno niža duboka vaskularna gustoća (DVD ) retine u grupi KBB s albuminurijom u odnosu na grupu KBB bez albuminurije (p<0.001). Albuminurija je bila u negativnom odnosu s mjerama debljine koroida i retine, kao i indeksima površne vaskularne gustoće (SVD) i DVD -a. Zaključak. KBB je povezan s retinalnim zadebljanjima, a opadajuća funkcija bubrega s progresivnom redukcijom korioretinalnom vaskularnom gustoćom

The Influence of Risk Factors in Remodelling Carotid Arteries in Patients Undergoing Peritoneal Dialysis

Accelerated atherosclerosis and vascular calcification, with oxidative stress, endothelial dysfunction, and other factors causing the arterial stiffness, increases cardiovascular morbidity and mortality in patients on peritoneal dialysis. The aim of this paper is to assess changes in intima media thickness (IMT) at common carotid arteries (CCA) in patients with stable continuous ambulatory peritoneal dialysis (PD) and examine the relationship of these changes and other risk factors on the occurrence of atherosclerosis. The study was conducted on 35 stable PD patients (25 type 2 diabetic patients), aged 58,6 ± 10’6 years. CCA-IMT was assessed using ultrasound B-mode technique, bilaterally. Other risk factors for the occurrence of atherosclerosis were monitored through regular laboratory control. One atheromatous plaque was found in 19 patients (54,3%). Among 25 type 2 diabetic patients, vascular calcifications were found in 80% patients. In all PD patients, CCA-IMT is 0,77 ± 0,23, in PD patients with vascular calcifications CCA-IMT is 1,05 ± 0,2 mm, while in group without vascular calcifications the value of this parameter is 0,56 ± 0,09 (p<0,01). Significant differences were found between PD patients with and without vascular calcifications on CCA in patients age (p<0,001), as well as values of systolic blood pressure (p=0,001), serum phosphorus (p=0,017), product calcium and phosphorus (p=0,021), CRP (p=0,039), triglycerides (p<0,05) and lipoprotein (a) values (p=0,044). Our results suggest an important determination of common carotid arteries intima media thickness and its relation to other risk factors for the occurrence and progression of atherosclerosis in patients undergoing peritoneal dialysis

Risk factors for cardiovascular disease in patients on continuous ambulatory peritoneal dialysis

Bolesti srčanožilnoga sustava su vodeći uzrok smrtnosti u bolesnika u terminalnom bubrežnom zatajenju (TBZ). Svrha rada bila je ispitati morfološke i funkcijske značajke lijeve srčane klijetke i karotidnih arterija (CCA) u bolesnika s TBZ prije uključenja u program liječenja bubrežnom nadomjesnom terapijom te nakon 18 mjeseci liječenja kontinuiranom ambulantnom peritonejskom dijalizom, sa ciljem evaluiranja doprinosa tradicionalnih čimbenika srčanožilnog rizika, čimbenika rizika vezanih za uremiju kao i čimbenika rizika specifičnih za peritonejsku dijalizu na zapažene značajke lijeve srčane klijetke i karotidnih arterija. U prospektivnom, longitudinalnom istraživanju obuhvaćeno je 50 bolesnika tretiranih CAPD-om, svaki praćen kroz jednoipolgodišnji period od momenta uključivanja na dijalizni tretman, sa laboratorijskom i ehokardiografskom evaluacijom, te ehosonografijom CCA bazalno i nakon 18 mjeseci dijaliznog tretmana. Hipertrofija lijeve srčane klijetke je zastupljena kod bolesnika sa krajnjom bubrežnom slabošću prije početka dijaliznog tretmana u 78% ispitanika, a nakon 18 mjeseci obavljanja tretmana peritonejskom dijalizom 60%. Aterosklerotske promjene na karotidnim arterijama u bolesnika prije početka dijalizne terapije su zabilježene u 44%, a nakon 18 mjeseci PD tretmana kod 26% ispitanika. Utvrđeno je da su neovisni čimbenici rizika razvoja hipertrofije lijeve klijetke nakon 18 mjeseci dijaliznog liječenja sa signifikantnom pozitivnom udruženošću lipoproteini male gustoće, troponin i C reaktivni protein, dok je inverzni odnos sa HLK pokazala ostatna bubrežna funkcija, 24h proteinurija i dušični oksid. Razina NO u serumu bolesnika je značajno porasla tijekom 18 mjeseci praćenja (p<0.001), dok je razina ET-1 u serumu u istom periodu signifikantno pala (p<0.001). Neovisni prediktori debljine intime medije (IMT CCA) kod PD bolesnika su bili homocistein, C-reaktivni protein, lipoprotein male gustoće, lipoprotein(a), produkt CaxP, endotelin-1 i proteinurija. Teški oblik ateroskleroze karotidnih arterija u CAPD bolesnika je udružen sa povećanom koncentracijom ET-1, CRP-a i B-tipa natriuretskog peptida. Bolesnici sa hipertrofijom lijeve klijetke i aterosklerotskim promjenama na karotidnim arterijama su imali slabiju adekvatnost dijalize, dok su transportna obilježja potrbušnice u najvećem broju bila u rangu umjereno visokih i visokih transportera. Prisutnost srčanožilnog preoblikovanja u TBZ naglašava značaj identificiranja i modificiranja srčanožilnih čimbenika rizika, prisutnih u visokom postotku kod bolesnika u TBZ, kao i tijekom dijalizne terapije. Vrlo velika učestalost HLK i aterosklerotskih promjena na krvnim žilama u bolesnika s TZB te dinamika njihovih promjena tijekom liječenja peritonejskom dijalizom, naglašavaju značenje njihovog pravovremenog prepoznavanja i potrebu modificiranja onih tradicionalnih čimbenika srčanožilnog rizika, čimbenika vezanih za uremiju, kao i za peritonejsku dijalizu, koji se mogu mijenjati sa ciljem smanjenja ukupnog srčanožilnog pobola i smrtnosti u bolesnika s TBZ.Cardiovascular diseases are the leading cause of mortality in patients with end stage renal diseaese (ESRD). The aim of study was to evaluate left ventricular and carotid arteries (CCA) abnormalities in patients with ESRD at baseline and 18 months after starting the peritoneal dialysis (PD) treatment in order to investigate the contribution of traditional cardiovascular risk factors as well as uremia-related factors and risk factors specific for peritoneal dialysis. Fifty PD patients were included in prospective longitudinal study, with laboratory, echocardiography and CCA ultrasound parameters evaluation at the start of peritoneal dialysis and after the follow-up period of 18 months. Left ventricular hypertrophy (LVH) was present at baseline in 78 %, and after 18 months in 60% PD patients. Atherosclerosis in the CCA was observed in 44% at baseline and after 18 months of PD treatment in 26 % patients. It was confirmed that low-density lipoproteins (LDL), troponin and C reactive protein (CRP) were independent risk factors for the development of LVH. Residual renal function, proteinuria, and nitric oxide (NO) were inversly related with LVH The level of NO in serum was significantly increased during the 18 months of follow-up (p<0.001), while the level of endothelin-1 (ET-1) in the same period fell significantly (p<0.001). Independent predictors of intima media thickness CCA in PD patients were homocystein, CRP, LDL, lipoprotein (a), product CaxP, ET-1 and proteinuria. Patients with LVH and atherosclerotic changes in the CCA had a lower dialysis adequacy, while the transport characteristics of the peritoneum in most patients were in the range of high-average and high transporters. The presence of cardiovascular remodeling in ESRD highlights the importance of identifying and correcting changes in cardiovascular risk factors present in ESRD, as well as during the renal replacement therapy

Risk factors for cardiovascular disease in patients on continuous ambulatory peritoneal dialysis

Bolesti srčanožilnoga sustava su vodeći uzrok smrtnosti u bolesnika u terminalnom bubrežnom zatajenju (TBZ). Svrha rada bila je ispitati morfološke i funkcijske značajke lijeve srčane klijetke i karotidnih arterija (CCA) u bolesnika s TBZ prije uključenja u program liječenja bubrežnom nadomjesnom terapijom te nakon 18 mjeseci liječenja kontinuiranom ambulantnom peritonejskom dijalizom, sa ciljem evaluiranja doprinosa tradicionalnih čimbenika srčanožilnog rizika, čimbenika rizika vezanih za uremiju kao i čimbenika rizika specifičnih za peritonejsku dijalizu na zapažene značajke lijeve srčane klijetke i karotidnih arterija. U prospektivnom, longitudinalnom istraživanju obuhvaćeno je 50 bolesnika tretiranih CAPD-om, svaki praćen kroz jednoipolgodišnji period od momenta uključivanja na dijalizni tretman, sa laboratorijskom i ehokardiografskom evaluacijom, te ehosonografijom CCA bazalno i nakon 18 mjeseci dijaliznog tretmana. Hipertrofija lijeve srčane klijetke je zastupljena kod bolesnika sa krajnjom bubrežnom slabošću prije početka dijaliznog tretmana u 78% ispitanika, a nakon 18 mjeseci obavljanja tretmana peritonejskom dijalizom 60%. Aterosklerotske promjene na karotidnim arterijama u bolesnika prije početka dijalizne terapije su zabilježene u 44%, a nakon 18 mjeseci PD tretmana kod 26% ispitanika. Utvrđeno je da su neovisni čimbenici rizika razvoja hipertrofije lijeve klijetke nakon 18 mjeseci dijaliznog liječenja sa signifikantnom pozitivnom udruženošću lipoproteini male gustoće, troponin i C reaktivni protein, dok je inverzni odnos sa HLK pokazala ostatna bubrežna funkcija, 24h proteinurija i dušični oksid. Razina NO u serumu bolesnika je značajno porasla tijekom 18 mjeseci praćenja (p<0.001), dok je razina ET-1 u serumu u istom periodu signifikantno pala (p<0.001). Neovisni prediktori debljine intime medije (IMT CCA) kod PD bolesnika su bili homocistein, C-reaktivni protein, lipoprotein male gustoće, lipoprotein(a), produkt CaxP, endotelin-1 i proteinurija. Teški oblik ateroskleroze karotidnih arterija u CAPD bolesnika je udružen sa povećanom koncentracijom ET-1, CRP-a i B-tipa natriuretskog peptida. Bolesnici sa hipertrofijom lijeve klijetke i aterosklerotskim promjenama na karotidnim arterijama su imali slabiju adekvatnost dijalize, dok su transportna obilježja potrbušnice u najvećem broju bila u rangu umjereno visokih i visokih transportera. Prisutnost srčanožilnog preoblikovanja u TBZ naglašava značaj identificiranja i modificiranja srčanožilnih čimbenika rizika, prisutnih u visokom postotku kod bolesnika u TBZ, kao i tijekom dijalizne terapije. Vrlo velika učestalost HLK i aterosklerotskih promjena na krvnim žilama u bolesnika s TZB te dinamika njihovih promjena tijekom liječenja peritonejskom dijalizom, naglašavaju značenje njihovog pravovremenog prepoznavanja i potrebu modificiranja onih tradicionalnih čimbenika srčanožilnog rizika, čimbenika vezanih za uremiju, kao i za peritonejsku dijalizu, koji se mogu mijenjati sa ciljem smanjenja ukupnog srčanožilnog pobola i smrtnosti u bolesnika s TBZ.Cardiovascular diseases are the leading cause of mortality in patients with end stage renal diseaese (ESRD). The aim of study was to evaluate left ventricular and carotid arteries (CCA) abnormalities in patients with ESRD at baseline and 18 months after starting the peritoneal dialysis (PD) treatment in order to investigate the contribution of traditional cardiovascular risk factors as well as uremia-related factors and risk factors specific for peritoneal dialysis. Fifty PD patients were included in prospective longitudinal study, with laboratory, echocardiography and CCA ultrasound parameters evaluation at the start of peritoneal dialysis and after the follow-up period of 18 months. Left ventricular hypertrophy (LVH) was present at baseline in 78 %, and after 18 months in 60% PD patients. Atherosclerosis in the CCA was observed in 44% at baseline and after 18 months of PD treatment in 26 % patients. It was confirmed that low-density lipoproteins (LDL), troponin and C reactive protein (CRP) were independent risk factors for the development of LVH. Residual renal function, proteinuria, and nitric oxide (NO) were inversly related with LVH The level of NO in serum was significantly increased during the 18 months of follow-up (p<0.001), while the level of endothelin-1 (ET-1) in the same period fell significantly (p<0.001). Independent predictors of intima media thickness CCA in PD patients were homocystein, CRP, LDL, lipoprotein (a), product CaxP, ET-1 and proteinuria. Patients with LVH and atherosclerotic changes in the CCA had a lower dialysis adequacy, while the transport characteristics of the peritoneum in most patients were in the range of high-average and high transporters. The presence of cardiovascular remodeling in ESRD highlights the importance of identifying and correcting changes in cardiovascular risk factors present in ESRD, as well as during the renal replacement therapy

Čimbenici rizika oboljenja srčanožilnoga sustava kod bolesnika na kontinuiranoj ambulatornoj peritonejskoj dijalizi [Risk factors for cardiovascular disease in patients on continuous ambulatory peritoneal dialysis]

Cardiovascular diseases are the leading cause of mortality in patients with end stage renal diseaese (ESRD). The aim of study was to evaluate left ventricular and carotid arteries (CCA) abnormalities in patients with ESRD at baseline and 18 months after starting the peritoneal dialysis (PD) treatment in order to investigate the contribution of traditional cardiovascular risk factors as well as uremia-related factors and risk factors specific for peritoneal dialysis. Fifty PD patients were included in prospective longitudinal study, with laboratory, echocardiography and CCA ultrasound parameters evaluation at the start of peritoneal dialysis and after the follow-up period of 18 months. Left ventricular hypertrophy (LVH) was present at baseline in 78 %, and after 18 months in 60% PD patients. Atherosclerosis in the CCA was observed in 44% at baseline and after 18 months of PD treatment in 26 % patients. It was confirmed that low-density lipoproteins (LDL), troponin and C reactive protein (CRP) were independent risk factors for the development of LVH. Residual renal function, proteinuria, and nitric oxide (NO) were inversly related with LVH The level of NO in serum was significantly increased during the 18 months of follow-up (p<0.001), while the level of endothelin-1 (ET-1) in the same period fell significantly (p<0.001). Independent predictors of intima media thickness CCA in PD patients were homocystein, CRP, LDL, lipoprotein (a), product CaxP, ET-1 and proteinuria. Patients with LVH and atherosclerotic changes in the CCA had a lower dialysis adequacy, while the transport characteristics of the peritoneum in most patients were in the range of high-average and high transporters. The presence of cardiovascular remodeling in ESRD highlights the importance of identifying and correcting changes in cardiovascular risk factors present in ESRD, as well as during the renal replacement therapy

Risk factors for cardiovascular disease in patients on continuous ambulatory peritoneal dialysis

Bolesti srčanožilnoga sustava su vodeći uzrok smrtnosti u bolesnika u terminalnom bubrežnom zatajenju (TBZ). Svrha rada bila je ispitati morfološke i funkcijske značajke lijeve srčane klijetke i karotidnih arterija (CCA) u bolesnika s TBZ prije uključenja u program liječenja bubrežnom nadomjesnom terapijom te nakon 18 mjeseci liječenja kontinuiranom ambulantnom peritonejskom dijalizom, sa ciljem evaluiranja doprinosa tradicionalnih čimbenika srčanožilnog rizika, čimbenika rizika vezanih za uremiju kao i čimbenika rizika specifičnih za peritonejsku dijalizu na zapažene značajke lijeve srčane klijetke i karotidnih arterija. U prospektivnom, longitudinalnom istraživanju obuhvaćeno je 50 bolesnika tretiranih CAPD-om, svaki praćen kroz jednoipolgodišnji period od momenta uključivanja na dijalizni tretman, sa laboratorijskom i ehokardiografskom evaluacijom, te ehosonografijom CCA bazalno i nakon 18 mjeseci dijaliznog tretmana. Hipertrofija lijeve srčane klijetke je zastupljena kod bolesnika sa krajnjom bubrežnom slabošću prije početka dijaliznog tretmana u 78% ispitanika, a nakon 18 mjeseci obavljanja tretmana peritonejskom dijalizom 60%. Aterosklerotske promjene na karotidnim arterijama u bolesnika prije početka dijalizne terapije su zabilježene u 44%, a nakon 18 mjeseci PD tretmana kod 26% ispitanika. Utvrđeno je da su neovisni čimbenici rizika razvoja hipertrofije lijeve klijetke nakon 18 mjeseci dijaliznog liječenja sa signifikantnom pozitivnom udruženošću lipoproteini male gustoće, troponin i C reaktivni protein, dok je inverzni odnos sa HLK pokazala ostatna bubrežna funkcija, 24h proteinurija i dušični oksid. Razina NO u serumu bolesnika je značajno porasla tijekom 18 mjeseci praćenja (p<0.001), dok je razina ET-1 u serumu u istom periodu signifikantno pala (p<0.001). Neovisni prediktori debljine intime medije (IMT CCA) kod PD bolesnika su bili homocistein, C-reaktivni protein, lipoprotein male gustoće, lipoprotein(a), produkt CaxP, endotelin-1 i proteinurija. Teški oblik ateroskleroze karotidnih arterija u CAPD bolesnika je udružen sa povećanom koncentracijom ET-1, CRP-a i B-tipa natriuretskog peptida. Bolesnici sa hipertrofijom lijeve klijetke i aterosklerotskim promjenama na karotidnim arterijama su imali slabiju adekvatnost dijalize, dok su transportna obilježja potrbušnice u najvećem broju bila u rangu umjereno visokih i visokih transportera. Prisutnost srčanožilnog preoblikovanja u TBZ naglašava značaj identificiranja i modificiranja srčanožilnih čimbenika rizika, prisutnih u visokom postotku kod bolesnika u TBZ, kao i tijekom dijalizne terapije. Vrlo velika učestalost HLK i aterosklerotskih promjena na krvnim žilama u bolesnika s TZB te dinamika njihovih promjena tijekom liječenja peritonejskom dijalizom, naglašavaju značenje njihovog pravovremenog prepoznavanja i potrebu modificiranja onih tradicionalnih čimbenika srčanožilnog rizika, čimbenika vezanih za uremiju, kao i za peritonejsku dijalizu, koji se mogu mijenjati sa ciljem smanjenja ukupnog srčanožilnog pobola i smrtnosti u bolesnika s TBZ.Cardiovascular diseases are the leading cause of mortality in patients with end stage renal diseaese (ESRD). The aim of study was to evaluate left ventricular and carotid arteries (CCA) abnormalities in patients with ESRD at baseline and 18 months after starting the peritoneal dialysis (PD) treatment in order to investigate the contribution of traditional cardiovascular risk factors as well as uremia-related factors and risk factors specific for peritoneal dialysis. Fifty PD patients were included in prospective longitudinal study, with laboratory, echocardiography and CCA ultrasound parameters evaluation at the start of peritoneal dialysis and after the follow-up period of 18 months. Left ventricular hypertrophy (LVH) was present at baseline in 78 %, and after 18 months in 60% PD patients. Atherosclerosis in the CCA was observed in 44% at baseline and after 18 months of PD treatment in 26 % patients. It was confirmed that low-density lipoproteins (LDL), troponin and C reactive protein (CRP) were independent risk factors for the development of LVH. Residual renal function, proteinuria, and nitric oxide (NO) were inversly related with LVH The level of NO in serum was significantly increased during the 18 months of follow-up (p<0.001), while the level of endothelin-1 (ET-1) in the same period fell significantly (p<0.001). Independent predictors of intima media thickness CCA in PD patients were homocystein, CRP, LDL, lipoprotein (a), product CaxP, ET-1 and proteinuria. Patients with LVH and atherosclerotic changes in the CCA had a lower dialysis adequacy, while the transport characteristics of the peritoneum in most patients were in the range of high-average and high transporters. The presence of cardiovascular remodeling in ESRD highlights the importance of identifying and correcting changes in cardiovascular risk factors present in ESRD, as well as during the renal replacement therapy

Typing of methicillin resistant Staphylococcus aureus using DNA fingerprints by pulsed-field gel electrophoresis

BACKGROUND: Methicillin resistant Staphylococcus aureus (MRSA) is responsible for a wide spectrum of nosocomial and community associated infections worldwide. The aim of this study was to analyze MRSA strains from the general population in Canton Sarajevo, B&H. ----- METHODS: Our investigation including either phenotypic and genotypic markers such as antimicrobial resistance, pulsed-field gel electrophoresis (PFGE), SCC typing, and Panton-Valentine leukocidin (PVL) detection. ----- RESULTS: Antimicrobial susceptibility: all MRSA isolates were resistant to the β-lactam antibiotics tested, and all isolates were susceptible trimethoprim sulphamethoxazole, rifampicin, fusidic acid, linezolid and vancomycin. Sixty-eight per cent of the MRSA isolates were resistant to erythromycin, 5% to clindamycin, 5% to gentamicin and 4% to ciprofloxacin. After the PFGE analysis, the isolates were grouped into five similarity groups: A-E. The largest number of isolates belonged to one of two groups: C: 60 (60%) and D: 27 (27%). In both groups C and D, SCCmec type IV was predominant (60% and 88, 8%, respectively). A total of 24% of the isolates had positive expression of PVL genes, while 76% showed a statistically significantly greater negative expression of PVL genes. ----- CONCLUSION: SCCmec type IV, together with the susceptibility profile and PFGE grouping, is considered to be typical of CA-MRSA