Tomasz Stompór

Selenium status indices, laboratory data, and selected biochemical parameters in end-stage renal disease patients

We investigated the relations between selenium status (SeS) parameters, indexes of nutrition, erythropoiesis, and uremic toxemia, serum electrolytes, and other biochemical markers in end-stage renal disease (ESRD) patients, as no multivariate statistical analysis concerning all of these parameters was performed so far. SeS was evaluated by plasma Se concentration (plSe) and glutathione peroxidase (plGSHPx) activity in 69 uremic patients treated with hemodialysis (HD) and 40 healthy controls. The hierarchical multivariate partial least squares model (PLS2) was employed to establish data structure and correlations between parameters investigated. plSe and plGSHPx activity were significantly lower in patients when compared with controls (p=0.000). plSe was positively associated with indexes of erythropoiesis and nutritional status, as well as serum electrolytes and parameters of uremic toxemia. plGSHPx was inversely dependent on the pair of parameters: intact parathyroid hormone (iPTH) and aluminum plasma concentration (Al). We conclude that (1) ESRD strongly decreases selenium status and (2) the PLS2 approach revealed the existence of significant interactions among plSe, plGSHPx, and selected biochemical parameters or groups of such parameters; some of these associations need further studies to be clarified.

Timely referral to the nephrologist: Essential to optimizing patient outcomes

Annual mortality on renal replacement therapy is about 10% in Western Europe and reaches 20% in the United States. The reasons responsible for this excess mortality include among others advanced age, high prevalence of diabetes and comorbid conditions, susceptibility to infections, and cancer. An additional cause that should be considered is late referral to overall renal care and for renal replacement therapy. It has been demonstrated recently that early referral may provide many advantages for the patient, such as prevention of organ damage secondary to uremia and even delay the onset of end‐stage renal disease. These benefits prompted numerous recommendations for timely referral, both for dialysis and for long‐term renal follow‐up. Despite available guidelines for nephrology referral the current practice is still suboptimal, resulting in delayed initiation of dialysis and clinical outcomes that are not ideal. There is an urgent need in the renal community to change the current practice of referral. Beyond the benefits for patients, society may also expect potential cost effectiveness from early renal care.

Clinicopathologic correlations of renal pathology in the adult population of Poland

Background This is the first report on the epidemiology of biopsy‐proven kidney diseases in Poland. Methods The Polish Registry of Renal Biopsies has collected information on all (n = 9394) native renal biopsies performed in Poland from 2009 to 2014. Patients clinical data collected at the time of biopsy, and histopathological diagnoses were used for epidemiological and clinicopathologic analysis. Results There was a gradual increase in the number of native renal biopsies performed per million people (PMP) per year in Poland in 2009‐14, starting from 36 PMP in 2009 to 44 PMP in 2014. A considerable variability between provinces in the mean number of biopsies performed in the period covered was found, ranging from 5 to 77 PMP/year. The most common renal biopsy diagnoses in adults were immunoglobulin A nephropathy (IgAN) (20%), focal segmental glomerulosclerosis (FSGS) (15%) and membranous glomerulonephritis (MGN) (11%), whereas in children, minimal change disease (22%), IgAN (20%) and FSGS (10%) were dominant. Due to insufficient data on the paediatric population, the clinicopathologic analysis was limited to patients ≥18 years of age. At the time of renal biopsy, the majority of adult patients presented nephrotic‐range proteinuria (45.2%), followed by urinary abnormalities (38.3%), nephritic syndrome (13.8%) and isolated haematuria (1.7%). Among nephrotic patients, primary glomerulopathies dominated (67.6% in those 18‐64 years of age and 62.4% in elderly patients) with leading diagnoses being MGN (17.1%), FSGS (16.2%) and IgAN (13.0%) in the younger cohort and MGN (23.5%), amyloidosis (18.8%) and FSGS (16.8%) in the elderly cohort. Among nephritic patients 18‐64 years of age, the majority (55.9%) suffered from primary glomerulopathies, with a predominance of IgAN (31.3%), FSGS (12.7%) and crescentic GN (CGN) (11.1%). Among elderly nephritic patients, primary and secondary glomerulopathies were equally common (41.9% each) and pauci‐immune GN (24.7%), CGN (20.4%) and IgAN (14.0%) were predominant. In both adult cohorts, urinary abnormalities were mostly related to primary glomerulopathies (66.8% in younger and 50% in elderly patients) and the leading diagnoses were IgAN (31.4%), FSGS (15.9%), lupus nephritis (10.7%) and FSGS (19.2%), MGN (15.1%) and pauci‐immune GN (12.3%), respectively. There were significant differences in clinical characteristics and renal biopsy findings between male and female adult patients. Conclusions The registry data focused new light on the epidemiology of kidney diseases in Poland. These data should be used in future follow‐up and prospective studies.

Trends and dynamics of changes in aortic pulse wave velocity over one-year observation period in patients treated with peritoneal dialysis.

important co-morbid condition affecting patients with chronic renal failure (1). There is an increasing body of evidence suggesting that mortality on dialysis largely depends upon initial and follow-up serum levels of proinflammatory cytokines and acute phase proteins (2, 3). Chronic inflammation is closely associated with atherosclerosis, which to a cer tain extent may be considered an inflammatory disease (4). Aortic pulse wave velocity (AoPWV) assessment proved its cl inical usefulness in patients with chronic renal disease, including those on maintenance hemodialysis (5-9). For uncertain reasons this problem was seldom studied in peritoneal dialysis (PD) patients. The aim of the present study was to assess the trends and dynamics of changes in AoPWV in the group of stable PD patients over one year and to search for possible correlations between these changes and one-year profile of selected cytokines, acute phase proteins and other variables that may be considered as risk factors for atherosclerosis progression. Forty seven patients (25M, 22F, aged mean 52.7 ± 12.8 years and on dialysis for 19.1 ± 21.6 months) were analyzed. AoPWV was measured using an automatic device with two pressure transducers (TY-306; Fukuda Denshi) placed on the carotid and femoral arteries and connected to an automatic processor (Complior® Colson). AoPWV was assessed at baseline and after 12 months. In each patient an absolute difference in PWV between two mentioned time-points was calculated (∆AoPWV). Serum Interleukin 6 (IL-6) and Tumor Necrosis Factor alpha (TNFα) were analyzed as proinflammatory cytokines (ELISA; Quantikine, R&D Systems), and C-reactive protein (high sensitive assay), lipoprotein (a) and fibrinogen – as acute phase reactants (immuno-nephelometry; Dade Boehring). In all patients total, LDL-, HDL-cholesterol and triglyceride serum levels, as well as serum calcium and phosphate were measured (Hitachi 917). All biochemical and inflammatory parameters were assessed at baseline, and after 6 and 12 months. At the end of the study mean concentrations of all analyzed biochemical parameters from three assessments was calculated. Blood pressure was measured at baseline, after 6 and 12 months, and mean arterial pressure (MAP) as well as pulse pressure (PP) were calculated. Mean AoPWV did not change significantly for the whole study group after one year (from 11.2 ± 2.26 to 11.7 ± 2.4 m/s, p= 0.07; ∆AoPWV +0.48 ± 1.77 m/s). However, in the population studied two categories of patients might be distinguished: subjects who progressed in AoPWV (29 patients, 61.7%, from 10.6 ± 2.3 to 12.3 ± 2.65 m/s; p< 0.05; ∆AoPWV +1.6 ± 1.14) and those with regression after 12 months (18 patients, 38%, from 12.2 ± 1.89 to 10.8 ± 1.67 m/s; p< 0.05; ∆AoPWV -1.31 ± 0.89). The entire group ‘averaged’ in terms of AoPWV value after 12 months, as the differences between “Pregressors” and “Regressors” were significant at the study commencement (p< 0.01) and only borderline significant (p= 0.08) at its completion. Patients who progressed were character ized by significantly higher values of mean serum phosphates, TNFα and Lp (a) levels as well as mean PP calculated from three assessments in comparison to “Regressors” (p< 0.05 for all differences). No significant difference was found between groups in terms of age, PD duration, and Short Communication The International Journal of Artificial Organs / Vol. 27 / no. 10, 2004/ pp. 904-906