Grażyna Kobus

Markers of kidney function in the elderly in relation to the new CKD-EPI formula for estimation of glomerular filtration rate

Introduction Neutrophil gelatinase-associated lipocalin (NGAL) has been recently proved useful in the quantitation of chronic kidney disease (CKD). The aim of the study was to assess prevalence of CKD according to the Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulae in 412 patients with normal serum creatinine and markers of kidney function/injury such as NGAL, cystatin C, and kidney injury molecule-1 (KIM-1) in these patients in relation to age (below and over 65 years). Material and methods We included in the study 1005 patients with coronary artery disease and normal serum creatinine. However, markers of kidney function/injury were assessed in 412 patients. The NGAL, cystatin C and KIM-1, were assessed using commercially available kits. Results Patients over 65 years had significantly lower estimated glomerular filtration rate (eGFR) than their younger counterparts despite identical creatinine. They also had significantly lower haematocrit, despite similar Hb, lower platelet count, higher serum fibrinogen, higher systolic (SBP) and lower diastolic blood pressure, higher serum NGAL and cystatin C, but similar urinary NGAL and KIM-1. Serum NGAL correlated with age, haematocrit, leukocyte, platelet and erythrocyte count, eGFR, creatinine, fasting glucose, HbA1c, fibrinogen, SBP, and diabetes duration. In multiple regression analysis kidney function (eGFR, creatinine clearance or creatinine), cystatin C and SBP were predictors of serum NGAL. Conclusions In our study we found a very high prevalence of CKD up to 61% in elderly patients with coronary artery disease and normal serum creatinine. Neutrophil gelatinase-associated lipocalin could be a sensitive marker of kidney function, particularly in elderly patients with another risk factor for kidney damage, i.e. hypertension.

Compliance with Lifestyle Recommendations in Kidney Allograft Recipients

BACKGROUND Many factors affect long-term graft and patient survival. Compliance with lifestyle recommendation may be an important factor. Lifestyle modifications may play a therapeutic and protective role against graft failure and possible death. METHODS The aim of this work was to assess compliance with lifestyle recommendations among 110 kidney allograft recipients. All patients were asked to complete a questionnaire regarding life style, frequency of outpatient visits, self-control, diet, physical activity and addictions. RESULTS The mean age of the population was 48.79±13.18 years, and their mean time after transplantation was 69±44.5 years with a mean serum creatinine value of 1.45±0.7 mg/dL. Physicians were the major source of information (40%) for patients while in the hospital; nurses informed patients in only 5.5% of cases. The majority of patients (97.5%) attended regular outpatient clinic visits. A similar percentage of subjects regularly measured their blood pressure at home. One-fifth of the patient wrote a self-control diary. Only 55.5% of patients knew the immunosuppressive regimen, including the doses of the medications. An overweight condition was diagnosed in 39%, with obesity in 22%; 16% of the patients were smokers; one-fourth of the patients drank alcohol at least several times a month; 85.3% of patients did not change their diet after kidney transplantation; and one-half of the patients (64.2%) were not aware of dietary recommendations after kidney transplantation. CONCLUSIONS The majority of patients regularly attended the outpatient clinic and ingested immunosuppressive medications. However, their knowledge regarding diet, cancer prophylaxis, and self-control was insufficient. Therefore, there is a need to introduce more intense organizational and educational activities to improve patient knowledge.

Midkine: A Novel and Early Biomarker of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions

We tested the hypothesis whether midkine could represent an early biomarker of contrast-induced acute kidney injury (CIAKI) in 89 patients with normal serum creatinine undergoing PCI. Midkine, serum and urinary NGAL, and cystatin C were evaluated before and 2, 4, 8, 24, and 48 hours after PCI using commercially available kits. Serum creatinine was assessed before and 24 and 48 hours after PCI. We found a significant rise in serum midkine as early as after 2 hours (P < 0.001) when compared to the baseline values. It was also significantly higher 4 hours after PCI and then returned to the baseline values after 24 hours and started to decrease after 48 hours. When contrast nephropathy was defined as an increase in serum creatinine by >25% of the baseline level 48 hours after PCI, the prevalence of CIN was 10%. Patients with CIN received significantly more contrast agent (P < 0.05), but durations of PCI were similar. Midkine was significantly higher 2, 4, and 8 hours after PCI in patients with CIN. Since the “window of opportunity” is narrow in CIAKI and time is limited to introduce proper treatment after initiating insult, particularly when patients are discharged within 24 hours after the procedure, midkine needs to be investigated as a potential early marker for renal ischemia and/or nephrotoxicity.

Opinions of Town Residents on Organ Transplantation

INTRODUCTION Organ transplantation is connected with many very difficult ethical and social issues that evoke a lot of emotion. The aim of this work was to determine the knowledge and opinions of the 612 residents of selected towns in Podlaskie voivodeship (in northeastern Poland) on organ transplantation. MATERIAL AND METHODS A diagnostic poll with the use of a survey questionnaire was implemented in the study. The respondents were divided into 2 groups (towns <100,000 and >100,000 residents). RESULTS Respondents from larger towns were more often willing to donate organs of close relatives for transplantation than those from small towns (67.1% vs 32.9%; P = .022). Respondents with higher education levels accepted organ donation from close relatives after their death significantly often than those with no more than a primary education (46.7% vs 22.2%; P < .001). Of the respondents, 83% would agree to donation after death and to donating their own organs (higher with primary education, 90.6% vs 63.5%; P < .001). Of respondents from big towns, 61.0% have informed their family of the decision for donation after death compared with 38.5% of respondents from small towns. Respondents with higher education significantly more often informed their family of such decision than persons with primary education (60.9% vs 42.9%; P < .007). CONCLUSIONS More emphasis should be on educating the communities living in small towns and people with primary and vocational education, because an adequate level of knowledge is a significant factor influencing the readiness to give ones organs for transplantation.

Angiographically-Derived SYNTAX Score and Its Prognostic Value in Dialysis Patients: Comparison With the Khan Index

BACKGROUND The aim of this study was to assess the value of the angiographically-derived Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score in predicting mortality and major adverse cardiac events (MACEs) during a 3-year follow-up of dialysis patients undergoing a percutaneous coronary intervention or coronary artery bypass graft operation. We compared the aforementioned results with the clinical Khan index. METHODS The SYNTAX score was calculated for 87 of 110 dialysis patients after coronary angiography. RESULTS The mean SYNTAX score was 12.75 ± 14.49. During the 3-year follow-up, 58% of the patients died, and 74% had at least 1 MACE. In a Kaplan-Meier survival analysis, the risk of death and MACEs increased in parallel with the SYNTAX score. A score greater than 12.75 was strongly associated with mortality and MACE (both Ps < 0.01). In receiver operating characteristic (ROC) curve analysis, the areas under the curves (AUCs) of the SYNTAX score and Khan index were significantly higher (both Ps < 0.001) than the area of diagnostic indifference. The predictive values for death as indicated by the SYNTAX score and the Khan index, respectively, were almost identical in the ROC analysis (AUC SYNTAX score, 0.6436; AUC Khan index, 0.6475; P = 0.9532). Areas under the ROC curves of both methods according to MACE were also significantly different from those for the random model (both Ps < 0.001). CONCLUSIONS The SYNTAX score is a powerful predictor of mortality and MACEs in dialysis patients undergoing percutaneous coronary intervention or coronary artery bypass graft during a 3-year follow-up. The score provides prognostic information similar to that provided by the Khan index.

Renal function after percutaneous coronary interventions depending on the type of hydration

PURPOSE The aim of our study was to evaluate renal function assessed by serum creatinine as well as novel biomarkers in 142 patients with stable coronary heart disease and normal serum creatinine undergoing percutaneous coronary interventions (PCI) depending on the type of hydration: physiological saline vs. sodium bicarbonate (1:1 randomization). MATERIALS AND METHODS Serum and urinary NGAL were evaluated before and after 8-12, and 24 hours after PCI. Serum cystatin C, serum creatinine, estimated glomerular filtration rate using different formulae were assessed before PCI, and 24 hours after the procedure. RESULTS Only 2 patients (2.8%) from the saline-hydrated group fulfilled the criteria for CI-AKI. In patients hydrated with sodium bicarbonate serum creatinine declined significantly (p<0.01). In patients hydrated with sodium bicarbonate a significant fall in serum NGAL after 8-12 hours was found. In sodium bicarbonate group cystatin C decreased non significantly after 8-12 hours, then returned to the baseline values. In patients hydrated with physiological saline serum NGAL before PCI and after 24 hours correlated positively with cystatin C and eGFR by CKD-EPI. In patients hydrated with sodium bicarbonate baseline serum NGAL correlated with NGAL baseline cystatin C and eGFR by CKD-EPI, similarly serum NGAL after 24 hours correlated with cystatin C. CONCLUSION We suggest to rather use sodium bicarbonate in a hydration protocol in patients undergoing PCI. However, the value of NGAL in this setting remains to be elucidated and volume expansion remain the unquestionable prevention methods of CI-AKI.

Organ transplantation – the view of healthcare employees

1Faculty of Clinical Medicine, Medical University, Bialystok Head of Department: prof. Hanna Bachorzewska-Gajewska, MD, PhD 2University Clinical Hospital, Bialystok Hospital Director: Boguslaw Poniatowski, MD, PhD 3Department of Nephrology with Dialysis Unit, Medical University, Bialystok Head of Department: prof. Beata Naumnik, MD, PhD 42nd Nephrology Department, Medical University, Bialystok Head of Department: prof. Jolanta Malyszko, MD, PhD