Publications by authors named "Mariusz Kusztal"

81 Publications

Therapeutic dilemmas in dialysis patients hospitalized for COVID-19: balancing between nihilism, off-label treatment and side effects.

Clin Kidney J 2021 Apr 11;14(4):1039-1041. Epub 2021 Jan 11.

Center of Nephrology and Kidney Transplantation, Regional Hospital, Szczecin, Poland.

Avoiding the use of drugs in patients with a glomerular filtration rate (GFR) <30 mL/min/1.73 m is due to the exclusion of this group of patients from many clinical trials. However, in view of the widespread COVID-19 pandemic and the need to treat all patients, including those with renal failure, the World Health Organization points out in the Solidarity trial the need for the inclusion some patients with kidney failure and recognizes the urgent need for trials/studies in patients with coronavirus disease 2019 (COVID-19) with lower GFR. It is well known that the therapeutic goal to treat patients with renal failure, acute kidney injury or on maintenance dialysis is complicated by pharmacokinetics, drug interactions and extracorporeal therapies. In patients with COVID-19 and impaired kidney function, the role of nephrologists is crucial in order to draw a balance between nihilism and benefits or potentially harmful effects of current available treatments. The potential use of European Medicines Agency recommended remdesivir and dexamethasone for COVID-19 among dialysis patients are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ckj/sfaa274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929032PMC
April 2021

Overhydration: A cause or an effect of kidney damage and how to treat it.

Adv Clin Exp Med 2021 Feb;30(2):219-227

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland.

Volume overload can be both the cause and effect of chronic kidney disease (CKD). Overhydration often accompanies renal insufficiency. In cardiovascular disease (CVD), fluid overload can also be the cause of renal function impairment. Beside salt restriction, loop diuretics are the first-line therapy. Frequently developed resistance can be overcome by switching to intravenous administration, adding albumin alone or in combination with other diuretics. Transient factors like infection or contrast media can impair diuretic response and contribute to congestion. Apart from conservative management, ultrafiltration (UF) and peritoneal dialysis (PD) are used. In huge congestion with inadequate diuretic effect, hemodialysis with UF plays an important role as a temporary or permanent remedy. An increasing amount of data indicates that sodium-glucose co-transporter-2 inhibitors (SGLT2i) have allowed for a breakthrough in controlling fluid volume in diabetic and non-diabetic patients with CKD. Sodium-glucose cotransporter 2 inhibitors show cardioand renoprotective effects and have a positive impact on hard cardiovascular and renal endpoints.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17219/acem/132035DOI Listing
February 2021

Exhausted Capacity of Bicarbonate Buffer in Renal Failure Diagnosed Using Point of Care Analyzer.

Diagnostics (Basel) 2021 Feb 3;11(2). Epub 2021 Feb 3.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland.

Background: Metabolic acidosis in patients with chronic kidney disease (CKD) is a common complication. A bicarbonate concentration in venous blood (V-HCO) is a key index for diagnosis and treatment initiation. The aim of our study is to evaluate usability of acid-base balance parameters of in blood taken simultaneously from peripheral artery and the vein.

Methods: A total of 49 patients (median age 66 years [interquartile range IQR 45-75]), with CKD stage G4 or G5 were enrolled in this cross-sectional study. All patients were qualified for arteriovenous fistula creation in pre-dialysis period. The samples were taken during surgery, directly after dissection, and evaluated in a point of care testing analyzer. The arteriovenous difference in bicarbonate levels (Δ-HCO) was calculated. According to glomerular filtration rate (eGFR) the group was divided into Group A eGFR ≥ 10 mL/min/1.73 m) and Group B eGFR < 10 mL/min/1.73 m).

Results: In Group A Δ-HCO was significantly higher compared to Group B. No such differences were observed in the case of V-HCO. Δ-HCO positively correlated with eGFR. The discriminative power of Δ-HCO for predicting eGFR < 10 mL/min/1.73 m was 0.72 (95% confidence interval [CI] = 0.551-0.88; 0.01) which provided 67% sensitivity and 75% specificity. The best cut-off was 0.5 mmol/L.

Conclusions: The Δ-HCO lower than 0.5 mmol/L may be used as predictor of exhaust buffer capacity. The value of this tool should be tested in larger population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/diagnostics11020226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913213PMC
February 2021

ANCA-associated vasculitis patients treated in Polish intensive care units - retrospective characteristics based on the POLVAS registry.

Anaesthesiol Intensive Ther 2020 ;52(4):281-286

Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.

Introduction: ANCA-associated vasculitides (AAV) is a group of rare disorders where inflammation and damage of the small blood vessels lead to dysfunction of the supplied organs. In severe flares of the disease patients may require intensive care unit (ICU) admission and treatment. The study aims to characterize Polish patients with AAV who were admitted to the ICU and compare them to the others.

Material And Methods: An observational, retrospective study based on the POLVAS - registry of Polish adult patients with AAV was carried out. Patients admitted to the ICU (ICU group) were identified and compared with the patients who did not require ICU admission (non-ICU group). Characteristics and comparison between groups were made using standard statistic descriptive methods.

Results: 30 patients admitted to the ICU were identified among 573 cases included in the registry. All patients in the ICU group with available data were ANCA positive. The clinical manifestations related to the ICU admission were respiratory, renal and central nervous system involvement. The treatment regimen for remission induction was similar in both groups. Almost half of the patients in the ICU-group (48.3%) required dialysis, whereas in the non-ICU group it was 21.8% (P = 0.01). Infections were also more frequent in the ICU group (72.4% vs. 36.9% P < 0.001). The mortality rate among patients who needed ICU treatment was significantly higher when compared to the rest of the patients (53.6% vs. 7.8%; P < 0.001).

Conclusions: In the Polish AAV cohort one in twenty patients required ICU admission. This group was characterized by multiple organ involvement and high mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/ait.2020.100047DOI Listing
January 2020

Hemodialysis vascular access affects heart function and outcomes: Tips for choosing the right access for the individual patient.

J Vasc Access 2020 Nov 4:1129729820969314. Epub 2020 Nov 4.

Nephrology and Dialysis Unit - ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milano, Milano, Italy.

Chronic kidney disease is associated with increased cardiovascular morbidity and mortality. A well-functioning vascular access is associated with improved survival and among the available types of vascular access the arterio-venous (AV) fistula is the one associated with the best outcomes. However, AV access may affect heart function and, in some patients, could worsen the clinical status. This review article focuses on the specific cardiovascular hemodynamics of dialysis patients and how it is affected by the AV access; the effects of an excessive increase in AV access flow, leading to high-output heart failure; congestive heart failure in CKD patients and the contraindications to AV access; pulmonary hypertension. In severe heart failure, peritoneal dialysis (PD) might be the better choice for cardiac health, but if contraindicated suggestions for vascular access selection are provided based on the individual clinical presentation. Management of the AV access after kidney transplantation is also addressed, considering the cardiovascular benefit of AV access ligation compared to the advantage of having a functioning AVF as backup in case of allograft failure. In PD patients, who need to switch to hemodialysis, vascular access should be created timely. The influence of AV access in patients undergoing cardiac surgery for valvular or ischemic heart disease is also addressed. Cardiovascular implantable electronic devices are increasingly implanted in dialysis patients, but when doing so, the type and location of vascular access should be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1129729820969314DOI Listing
November 2020

Abnormal Nailfold Capillaries in Patients after Hand Transplantation.

J Clin Med 2020 Oct 25;9(11). Epub 2020 Oct 25.

Department of Pathophysiology, Poznan University of Medical Sciences, 60-806 Poznan, Poland.

Background: The development of graft vasculopathy may play a role in the long-term deterioration of hand grafts. The aim of study was to examine the patterns of the nailfold capillaries in hand transplant recipients.

Methods: the study was performed on six patients who received hand transplantation. To normalize for the effect of immunosuppression an age- and sex-matched group of 12 patients with active kidney transplant was selected. As an additional control group, 12 healthy volunteers were recruited. Nailfold videocapillaroscopy was performed in all participants. Additionally, serum concentrations of vascular endothelial growth factor (VEGF) were measured.

Results: Videocapillaroscopic examination of the hand allografts revealed significant abnormalities: including capillary disorganization and microhaemorrhages. The number of capillaries was reduced, the vessels were enlarged and branched. Surprisingly, similar, albeit slightly less pronounced, changes were seen in the nailfolds of healthy hands of the limb transplant recipients. In kidney transplant recipients the capillaroscopic pattern was general normal and comparable to healthy individuals. Moreover, serum concentrations of VEGF in all participants correlated with average capillary diameter in capillaroscopy.

Conclusions: in hand transplant recipients advanced microvascular abnormalities are found in nailfold capillaroscopic pattern in both transplanted and own extremities connected with elevated levels of VEGF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9113422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693261PMC
October 2020

Unintentional puncture of thyroid cyst during insertion of dialysis catheter.

J Vasc Access 2020 Sep 28:1129729820962232. Epub 2020 Sep 28.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.

Central venous catheter (CVC) for hemodialysis are frequently implanted to the internal jugular vein. Thyroid cysts are commonly shown in ultrasound examination and their recognition should not pose a problem. Herby we present an uncommon case of the thyroid cyst unintended puncture, during an attempt of CVC insertion. No further clinical consequences were observed. For all practitioners, involved in interventional nephrology, such complication may be of the utmost importance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1129729820962232DOI Listing
September 2020

Carotid artery tortuosity may pose a problem during insertion of the tunneled catheter for hemodialysis.

Artif Organs 2021 Mar 15;45(3):303-308. Epub 2020 Oct 15.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.

Tortuosity of the carotid artery is usually an asymptomatic vascular abnormality and is discovered accidentally during cerebral angiography. These vascular changes may aggravate surgical procedures in the neck region. We described a technique of permanent catheter insertion in patients with renal graft failure in whom renal replacement therapy was necessary. Severe tortuosity of cervical arteries may make this procedure more difficult, necessitating a special technique, that is, full image monitoring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aor.13817DOI Listing
March 2021

Subphenotypes of ANCA-associated vasculitis identified by latent class analysis.

Clin Exp Rheumatol 2020 Sep 1. Epub 2020 Sep 1.

2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland.

Objectives: ANCA-associated vasculitides (AAV) are a heterogeneous group of rare diseases with unknown aetiology and the clinical spectrum ranging from life-threatening systemic disease, through single organ involvement to minor isolated skin changes. Thus, there is an unmet need for phenotype identification, especially among patients with granulomatosis with polyangiitis (GPA). Patients with microscopic polyangiitis (MPA) seem to be clinically much more uniform. Recently, three subcategories of AAV have been proposed and described as non-severe AAV, severe PR3-AAV, and severe MPO-AAV.

Methods: In line with these attempts, we decided to use an unbiased approach offered by latent class analysis (LCA) to subcategorise GPA and MPA in a large cohort of Polish AAV patients included in a multicentre POLVAS registry.

Results: LCA of our AAV group identified a four-class model of AAV, including previously proposed three subphenotypes and revealing a fourth (previously not described) clinically relevant subphenotype. This new subphenotype includes only GPA patients, usually diagnosed at a younger age as compared to other groups, and characterised by multiorgan involvement, high relapse rate, relatively high risk of death, but no end-stage kidney disease.

Conclusions: Based on multiple clinical and serological variables, LCA methodology identified 4-class model of AAV. This newly described fourth class of AAV may be of clinical relevance and may require prompt diagnosis and aggressive treatment due to the multiorgan involvement, high risk of relapse and marked mortality among these relatively young GPA subjects.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2020

Hyponatremia in Infectious Diseases-A Literature Review.

Int J Environ Res Public Health 2020 07 23;17(15). Epub 2020 Jul 23.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland.

Hyponatremia is one of the most common water-electrolyte imbalances in the human organism. A serum sodium concentration threshold of less than 135 mmol/L is diagnostic for hyponatremia. The disorder is usually secondary to various diseases, including infections. Our review aims to summarize the diagnostic value and impact of hyponatremia on the prognosis, length of the hospitalization, and mortality among patients with active infection. The scientific literature regarding hyponatremia was reviewed using PubMed, ClinicalKey, and Web of Science databases. Studies published between 2011 and 2020 were screened and eligible studies were selected according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and specific inclusion criteria. The most common infections that were associated with hyponatremia were viral and bacterial infections, including COVID-19 (coronavirus disease 2019). The etiology varied according to the infection site, setting and patient cohort it concerned. In several studies, hyponatremia was associated with prolonged hospitalization, worse outcomes, and higher mortality rates. Hyponatremia can also play a diagnostic role in differentiating pathogens that cause a certain infection type, as it was observed in community-acquired pneumonia. Although many mechanisms leading to hyponatremia have already been described, it is impossible with any certainty to ascribe the etiology of hyponatremia to any of them.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijerph17155320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432506PMC
July 2020

The attitude of kidney transplant recipients towards elective arteriovenous fistula ligation.

PLoS One 2020 2;15(7):e0234931. Epub 2020 Jul 2.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland.

Background: Arteriovenous fistulas (AVF) are a source of various complications. Among previously hemodialyzed kidney transplant recipients (KTxR), the AVF may persist over time. The patients' decisions whether to ligate the functioning AVF may be prompted by many factors. Our knowledge of benefits concerning the procedure as well as patients' attitude towards it is scarce.

Aim: Evaluation of the patients' opinion on the persistent AVF ligation after a successful kidney transplantation.

Materials And Methods: An anonymous survey was carried out among 301 previously hemodialyzed KTxR. The patients were recruited during scheduled visits in the Transplantation Outpatient Unit. All subjects completed an anonymous questionnaire including questions about their attitude towards the matter in question.

Results: 69 patients (22.9%) have considered AVF closure. The most common causes for such attitude were esthetic reasons (n = 29) and concerns about heart health (n = 13). Among those 69 subjects, 18 have presented with symptomatic AVF due to multiple symptoms. Symptomatic AVFs were localized on the forearm in 14 out of 18 cases. As many as 116 (38.5%) cases have never wanted to ligate the AVF and 116 (38.5%) subjects did not have a clear opinion. In our study we report 158 (52.5%) cases of non-functioning AVFs. The main reason for the above was spontaneous AVF thrombosis (121 cases). Only 24 subjects reported to rely on the physician-provided information about the AVF management.

Conclusions: One fourth of KTRs have ever considered AVF ligation. There is a distinct need for educating patients on the possibilities of post-transplantation AVF management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234931PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332306PMC
September 2020

Disability of Dialysis Patients and the Condition of Blood Vessels.

J Clin Med 2020 Jun 10;9(6). Epub 2020 Jun 10.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland.

The number of elderly hemodialysis patients is constantly increasing worldwide. This population has a high burden of comorbid conditions, which impair daily activities. The aim of the study was to analyze problems of disability in hemodialysis patients in the context of cardiovascular (CV) complications and vascular condition. In this cross-sectional study, 129 patients (mean age 64.5) were enrolled. The degree of disability in Barthel index (Bi) and 10-year cardiovascular risk (QRISK3) were assessed. A Mobil-O-Graph monitor was used for measuring hemodynamic parameters. Only 6.2% of patients were professionally active, 19% used a wheelchair for transport, and 16% used crutches. More than half (51%) were independent in everyday activities reaching 80-100 points on Bi. The rest, with Bi < 80, were considered as dependent. The most common causes of disability were CV complications. The independent group (80-100 points) was characterized by significantly lower pulse wave velocity (PWV) and lower QRISK3 compared to dependent patients. The degree of disability negatively correlated with age, PWV, and QRISK3. Multivariate logistic regression revealed that disability (Bi < 80) was independently associated with CV events in the past adjusted odds ratio (adj.OR) 4.83 (95% confidence interval (95% CI): 1.74-13.41) and higher PWV adj.OR 1.45 (95% CI: 1.15-1.82). Our results indicate that CV diseases are the most important cause of functional impairment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9061806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356767PMC
June 2020

Arterial Stiffness Assessed by Oscillometric Method in Kidney Transplant, Predialysis, and Dialysis Patients.

Transplant Proc 2020 Oct 29;52(8):2337-2340. Epub 2020 Apr 29.

Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland. Electronic address:

Introduction: Chronic kidney disease (CKD) is strongly associated with a higher risk of cardiovascular disease (CV). An important nontraditional risk factor of cardiovascular disease in renal patients is vascular stiffness, which currently can be evaluated by oscillometric measuring of pulse wave velocity (PWV) and heart rate-corrected augmentation index (AIx@75).

Aim: The aim of our study was to compare vascular stiffness between kidney transplant (KTx) recipients, patients on dialysis maintenance, and those in the predialysis period.

Materials And Methods: A cross-sectional study of 140 patients (52 in CKD stage 3-4; 37 in CKD stage 5 on hemodialysis maintenance [HD]; and 51 KTx recipients) had their PWV and AIx@75 measured with Mobil-O-Graph (IEM Gmbh, Stolberg, Germany) blood and pulse pressure monitor.

Results: KTx, HD, and CKD G3-4 were comparable in term of age, sex, body mass index, and diagnoses of diabetes mellitus and hypertension. The PWV was higher in the HD group than in the KTx and CKD G3-4 (9.4 m/s vs 8.4 m/s vs 7.9 m/s respectively; P < .05 for HD vs other groups), while the difference between the KTx and CKD G3-4 was not significant. AIx@75 values were similar in the HD and KTx groups (27.1 and 25.6; P > .05) and significantly lower in CDK G3-4 (17.8; P < .05).

Conclusions: According to our results, the highest CV risk expressed by PWV (vascular stiffness) was found in hemodialysis patients. Although patients with CKD 3-4 and after KTx showed comparable large artery stiffness, transplant recipients additionally showed higher stiffness in smaller arteries as measured by heart rate-corrected AIx.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.transproceed.2020.01.132DOI Listing
October 2020

Simultaneous placement of leadless pacemaker and dialysis catheter in patient with exhausted vasculature.

J Vasc Access 2021 Jan 23;22(1):147-150. Epub 2019 Dec 23.

Medical University in Poznan, Poznan, Poland.

The problem with limited venous access may occur in patients receiving long-term hemodialysis treatment with no possibility of arteriovenous access or in patients with cardiac implantable electronic device-related infection leading to the removal of cardiac implantable electronic device. We present a case report where both situations occur simultaneously. Using recent development in cardiac pacing-leadless cardiac pacemaker-we manage to overcome the vascular access problem. The described case emphasizes the necessity of multispecialty collaboration and gains of new pacing technology in patients who need placement of vascular access for hemodialysis and cardiac implantable electronic device where vascular access is scarce.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1129729819894085DOI Listing
January 2021

Dialysis Catheter Insertion with Extended Ultrasound Monitoring.

Blood Purif 2020 24;49(1-2):102-106. Epub 2019 Sep 24.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.

Introduction: Dialysis catheter insertion is a routine procedure performed when there is necessity of urgent renal replacement therapy initiation. Due to limited access, higher costs, and long waiting times for fluoroscopy, alternative visualization methods are introduced into clinical practice. One of the most promising is transthoracic echocardiographic monitoring of guide-wire introduction.

Objective: The feasibility of the technique was verified by nephrologists inserting dialysis catheters.

Methods: A single center prospective trial was performed (NCT03727581). Introduction of guide-wire was monitored with ultrasound to confirm correct position of the wire in the inferior vena cava (IVC) or right atrium (RA). The study group included 30 patients, 19 males and 11 females, 25-83 years old.

Results: It was possible to obtain a good picture of IVC in the majority of patients. In 20 (66.7%) cases, IVC view was excellent; in 9 (30%) cases, was fair; and in 1 (3.3%) patient, we failed to visualize IVC. The guide-wire was identified in IVC in 12 (42.8%) patients, in another 9 (32.1%) patients guide-wire was visible in IVC after withdrawing and advancing it, and in RA in 6 (21.4%) patients. Catheters were successfully placed in 29 (96.7%) patients.

Conclusions: Detection of the guide-wire confirms correct course of the procedure and increases the safety of catheter insertion without fluoroscopy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000503057DOI Listing
December 2020

Quality assessment of vascular access procedures for hemodialysis: A position paper of the Vascular Access Society based on the analysis of existing guidelines.

J Vasc Access 2020 Mar 19;21(2):148-153. Epub 2019 May 19.

Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia.

Quality assessment in vascular access procedures for hemodialysis is not clearly defined. The aim of this article is to compare various guidelines regarding recommendation on quality control in angioaccess surgery. The overall population of end-stage renal disease patients and patients in need for hemodialysis treatment is growing every year. Chronic intermittent hemodialysis is still the main therapy. The formation of a functional angioaccess is the cornerstone in the management of those patients. Native (autologous) arteriovenous fistula is the best vascular access available. A relatively high percentage of primary failure and fistula abandonment increases the need for quality control in this field of surgery. There are very few recommendations of quality assessment on creation of a vascular access for hemodialysis in the searched guidelines. Some guidelines recommend the proportion of native arteriovenous fistula in incident and prevalent patients as well as the maximum tolerable percentage of central venous catheters and complications. According to some guidelines, surgeon's experience and expertise have a considerable influence on outcomes. There are no specific recommendations regarding surgeon's specialty, grade, level of skills, and experience. In conclusion, there is a weak recommendation in the guidelines on quality control in vascular access surgery. Quality assessment criteria should be defined in this field of surgery. According to these criteria, patients and nephrologists could choose the best vascular access center or surgeon. Centers with best results should be referral centers, and centers with poorer results should implement quality improvement programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1129729819848624DOI Listing
March 2020

Dialysis membranes: A 2018 update.

Polim Med 2018 Jan-Jun;48(1):57-63

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland.

Dialysis membranes are the basic element of a hemodialyzer. Synthetic and natural materials characterized by various fiber arrangements are used in their production. The most up-to-date ones are made of synthetic polymers such as polyamide, phosphatidylserine (PS), polyacrylonitrile-based fiber (PAN), polyarylethersulfone, polyethersulfone, or polymethylmethacrylate. Dialysis membranes are characterized by the ability to remove uremic molecules, which can be divided into small water-soluble compounds, protein-bound compounds and larger "middle molecules". Newer membranes such as medium cut off membranes (MCO) allow the removal of a wider spectrum of uremic molecules, which reduces the risk of late complications of dialysis. Dialysis membranes are used in therapy methods such as low flux, high flux or HDx therapy. An important aim in dialysis membrane development is to increase their biocompatibility. Insufficient biocompatibility can result in complement activation or platelet activation, which can lead to an increased risk of cardiovascular complications. The aim of the study is to discuss the latest reports on dialysis membranes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17219/pim/102974DOI Listing
May 2019

Nutritional assessment of patients with end-stage renal disease using the MNA scale.

Adv Clin Exp Med 2018 Aug;27(8):1117-1123

Department of Physiotherapy, University School of Physical Education, Wrocław, Poland.

Background: Patient malnutrition is a significant problem in the process of rehabilitation and treatment. One of the tools that can reveal the risk of malnutrition is a series of standardized nutritional questionnaires.

Objectives: The aim of the study was to assess the nutritional status of patients with end-stage renal disease (ESRD) by means of the minimal nutritional assessment (MNA) scale.

Material And Methods: The study group included respondents suffering from ESRD who were patients of the Dialysis Center at the Clinic of Nephrology and Transplantation Medicine at the University Clinical Hospital in Wrocław. The study was conducted in 47 dialysis patients (22 women and 25 men), mean age 69.68 ±8.95 years. A standardized MNA scale was used to evaluate the nutritional status of the patients.

Results: In the study group, women had a significantly lower score on the MNA scale than men (23.95 vs 25.26 points). Using the MNA scale, the risk of malnutrition was found in 13 patients, while malnutrition was found in 1 patient. Among females, the mean body mass index (BMI) was 27.28, and it was significantly correlated with the MNA score. In males, the mean BMI was 29.61, but it did not correlate with the MNA score. The time spent undergoing renal replacement therapy was 7.63 years for women and 7.24 years for men. This correlated significantly with the MNA score only in the case of men. Significant correlations were established between eating habits and MNA scores in both groups.

Conclusions: The results obtained using the MNA scale showed a significant risk of malnutrition in patients with ESRD. In women only, a low score on the MNA scale significantly correlated with the BMI. The time of renal replacement therapy had a significant impact on the MNA scale only in the case of men. An influence of comorbidities on the MNA scores recorded by men and women was not observed. Major health incidents and other stressful situations significantly affected the nutritional status in men.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17219/acem/75604DOI Listing
August 2018

Depressive symptoms but not chronic pain have an impact on the survival of patients undergoing maintenance hemodialysis.

Arch Med Sci 2018 Mar 9;14(2):265-275. Epub 2016 May 9.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.

Introduction: More than 1/3 of patients with end-stage renal disease who are in a chronic dialysis program suffer from chronic pain and depression/anxiety. The aim of the study was to determine the impacts of symptoms of depression/anxiety, chronic pain and quality of life (QoL) on 6-year patient survival.

Material And Methods: Observational study of end-stage renal disease patients on maintenance hemodialysis ( = 205) who met the inclusion criteria. Patients from three dialysis centers in Lower Silesia were asked to complete a battery of validated questionnaires: the Hospital Anxiety and Depression Scale (HADS), the 36-item Short Form Health Survey Questionnaire, the Verbal Rating Scale (VRS) and the Visual Analog Scale (VAS). Clinical and biochemical data (dialysis adequacy) were recorded.

Results: One hundred thirty from 205 enrolled hemodialysis patients (63.4%) suffered from chronic pain. Patients with pain were on maintenance dialysis for longer times and had higher levels of parathyroid hormone, more depressive symptoms and a lower QoL than those without pain. In the 6-year period, 96 (46.8%) patients died. The most common cause of death was cardiovascular disease in 44 (45.8%) patients. Highly depressed patients (HADS depression score > 8) exhibited higher mortality (< 8 vs. > 8 points; = 0.016) independent of age, diabetes, cardiovascular disease, C-reactive protein or albumin level.

Conclusions: Chronic pain, although common among hemodialysis patients, did not lower survival. Depressive symptoms are an important predictor for all-cause mortality in hemodialysis patients, with the relationship independent of nutritional or inflammatory status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5114/aoms.2016.59765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868660PMC
March 2018

Cardiac implantable electronic device and vascular access: Strategies to overcome problems.

J Vasc Access 2018 Nov 19;19(6):521-527. Epub 2018 Mar 19.

2 Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.

For arrhythmia treatment or sudden cardiac death prevention in hemodialysis patients, there is a frequent need for placement of a cardiac implantable electronic device (pacemaker, implantable cardioverter defibrillator, or cardiac resynchronization device). Leads from a cardiac implantable electronic device can cause central vein stenosis and carry the risk of tricuspid regurgitation or contribute to infective endocarditis. In patients with end-stage kidney disease requiring vascular access and cardiac implantable electronic device, the best strategy is to create an arteriovenous fistula on the contralateral upper limb for a cardiac implantable electronic device and avoidance of central vein catheter. Fortunately, cardiac electrotherapy is moving toward miniaturization and less transvenous wires. Whenever feasible, one should avoid transvenous leads and choose alternative options such as subcutaneous implantable cardioverter defibrillator, epicardial leads, and leadless pacemaker. Based on recent reports on the leadless pacemaker/implantable cardioverter defibrillator effectiveness, in patients with rapid progression of chronic kidney disease (high risk of renal failure) or glomerular filtration rate <20 mL/min/1.73 m, this option should be considered by the implanting cardiologist for future access protection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1129729818762981DOI Listing
November 2018

Difficulties with tunneling of the cuffed catheter: a single-centre experience.

Sci Rep 2018 02 20;8(1):3314. Epub 2018 Feb 20.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, ul.Borowska 213, 50-556, Wroclaw, Poland.

Tunneling of the cuffed catheter for hemodialysis is an important part of insertion procedure with faulty techniques being the cause of catheter dysfunctions. We retrospectively analyzed 737 double-lumen cuffed catheter procedures between 2008 and 2015 in patients aged 60 ± 15years, requiring renal replacement therapy. Complications of tunneling included kinking, bleeding and other problems. In 20 of 737 (2.7%) procedures, the catheter kinked, which was observed in 7.7% of silicone and 0.6% of polyurethane catheters. Repositioning was attempted in 4, but was successful in only 2 cases. Catheter exchange was necessary in 16 cases, but the function was adequate in 2 cases, despite radiological signs of kinking. In 6 cases (1 patient with diabetes, 2 with chest anatomy changes and medical devices, 2 with systemic sclerosis and 1 with greatly enlarged superficial jugular veins) we faced particular difficulties requiring an individual solution by tunneling; these are described in detail. The cumulative catheter patency rate were 69%, 52% and 37% at 3, 6 and 12 months, respectively. In conclusion, the most frequent complication of tunneling was kinking, usually necessitating catheter exchange. The silicon catheter kinked more often than the polyurethane one. An individual approach is sometimes needed by patients with diabetes and anatomical changes of the chest.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-018-21338-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820247PMC
February 2018

Type 1 diabetic patients have better endothelial function after simultaneous pancreas-kidney transplantation than after kidney transplantation with continued insulin therapy.

Diab Vasc Dis Res 2018 03 13;15(2):122-130. Epub 2017 Dec 13.

1 Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland.

The purpose of this study was to analyse the influence of simultaneous pancreas-kidney or kidney transplantation on endothelial function and systemic inflammation in type 1 diabetic patients with end-stage renal disease. In 39 simultaneous pancreas-kidney, 39 type 1 diabetic kidney and 52 non-diabetic kidney recipients, flow-mediated dilatation was measured. Additionally, blood glycated haemoglobin, serum creatinine and lipids, plasma nitrites [Formula: see text] and nitrates, asymmetric dimethylarginine, soluble vascular cell adhesion molecule-1, intercellular adhesion molecule-1, and E-selectin, high-sensitivity C-reactive protein, tumour necrosis factor-α, interleukin 1β and interleukin 6 concentrations were assessed. During 58 ± 31 months follow-up period, flow-mediated dilatation and [Formula: see text] were greater in simultaneous pancreas-kidney than in type 1 diabetic kidney recipients [10.4% ± 4.7% vs 7.7% ± 4.2%, p < 0.05 and 0.94 (0.74-1.34) vs 0.24 (0.20-0.43) μmol/L, p < 0.01, respectively]. In type 1 diabetic patients after simultaneous pancreas-kidney or kidney transplantation, [Formula: see text] correlated with flow-mediated dilatation (r = 0.306, p < 0.05) and with blood glycated haemoglobin (r = -0.570, p < 0.001). The difference in [Formula: see text] was linked to blood glycated haemoglobin and estimated glomerular filtration rate, whereas the difference in flow-mediated dilatation was linked to [Formula: see text]. The levels of inflammatory markers (except soluble vascular cell adhesion molecule-1) were similar in simultaneous pancreas-kidney and type 1 diabetic kidney recipients. Improved endothelial function in type 1 diabetic patients with end-stage renal disease after simultaneous pancreas-kidney compared to kidney transplantation is associated with normalisation of glucose metabolism but not with improvement in plasma pro-inflammatory cytokines.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1479164117744423DOI Listing
March 2018

Vascular access should be tailored to the patient.

Semin Vasc Surg 2016 Dec 5;29(4):146-152. Epub 2016 Nov 5.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.

A cornerstone of hemodialysis treatment is the creation of a functional and durable dialysis vascular access. Every patient with chronic kidney disease should have a plan of renal replacement therapy and access site protection. Factors having a crucial impact on vascular access selection include age, comorbidity, vessel quality, prognosis, dialysis urgency, and surgeon's preferences. Our medical group have reviewed these factors in our patients and, based on recently published data, developed a clinical decision tree for dialysis access in the chronic kidney disease patient. Vascular access care should be patient-centered with the aim to maximize patient survival without loss of vascular access options; and not focused only the primary patency rates of dialysis access procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.semvascsurg.2016.11.003DOI Listing
December 2016

The sleeve method for creation of radiocephalic arteriovenous fistulas in patients with calcified vessels.

J Vasc Access 2017 Sep 26;18(5):384-389. Epub 2017 Jul 26.

 Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw - Poland.

Introduction: Creation of an arteriovenous fistula (AVF) in patients with advanced atherosclerotic changes of the artery is often a challenge for the physician due to difficulties in suturing the vein to the side of the frangible artery. The sleeve technique relies on advancing the end of the artery into the lumen of the vein and protecting the anastomosis by adventitial sutures.

Material And Methods: The sleeve technique was performed in 23 patients with chronic kidney disease stage IV and V and included hemodialysis patients. Their mean age was 60.8 ± 14.8 years and hemodialysis treatment time 49.8 ± 40.2 months. The most frequent causes of chronic kidney disease are ischemic nephropathy (43%, n = 10) and type l diabetes (21%, n = 5). Only patients with extremely advanced atherosclerotic were recruited and analyzed.

Results: The primary patency rate was 67%, 59%, 44% and 28% at 6, 12, 24, and 36 months, respectively. The secondary patency rate was 67%, 61%, 50% and 37% at 6, 12, 24, and 36 months, respectively. In three patients the AVF failed directly after the operation. Delayed fistula failure occurred in seven patients. The overall success in the creation of a functioning fistula was achieved in 15 of the 23 patients (65%). No serious complications were observed.

Conclusions: In patients with calcified atherosclerotic plaques, which constitute a barrier or make it difficult to suture the vein to the side of the artery, the sleeve method may be considered as an alternative before abandoning the creation of a fistula on the forearm. The technique is much simpler than the standard end-to-side or side-to-side anastomosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/jva.5000761DOI Listing
September 2017

Dialysis-Related Parameters Influence Remodeling in the Venous Part of the Native Arteriovenous Fistula.

Ann Vasc Surg 2017 Nov 23;45:179-185. Epub 2017 Jun 23.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.

Background: The aim of this study was to evaluate the association of hemodynamic parameters related to hemodialysis and antropometric parameters of patients with changes in the venous part of the arteriovenous fistula (AVF) at points of needling.

Methods: Two hundred forty-two hemodialysis (HD) patients (60.3% men), with median age 65 (interquartile range [IQR] 56-75) years, on HD treatment for a median of 49 (IQR 20-88) months with functioning fistula were recruited for the study. The history of vascular access, comorbidity, antropometric (body mass index, body surface area, and body composition), and dialysis-related parameters were analyzed. The cross-sectional area of upper extremity vessels were measured using ultrasound and included 2 points: A (arterial point for blood aspiration) and V (venous point for returning the blood after purification). The difference between A and V (A-V) was calculated.

Results: The median cross-sectional area of A was larger than V (1.04 [IQR 0.58-1.7] vs. 0.74 cm [IQR: 0.41-1.39], P <0.0001). The median difference between A and V (A-V) was 0.17 cm and positively correlated with mean blood flow (Qb), effective Kt/V, and time of AVF use. Other analyzed factors had no influence on A-V. In the multivariate analysis, the independent factor increasing the difference (A-V) was mean blood flow measured during HD sessions.

Conclusions: The needling and utilization of AVF for hemodialysis may affect vein anatomy, namely causing dilatation at the arterial point and narrowing at venous point of AVF. We suggest that blood pump velocity of the dialysis machine may have an impact on these changes, but practical importance of these findings has to be elucidated. The significance of (A-V) factor in the prognosis of fistula complications should be further studied and confirmed in the prospective trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.avsg.2017.06.051DOI Listing
November 2017

Reduction of lung congestion following arteriovenous fistula flow reduction in renal graft recipient.

J Vasc Access 2018 03 19;19(2):207-208. Epub 2018 Feb 19.

1 Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław - Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/jva.5000735DOI Listing
March 2018

Over-catheter tract suture to prevent bleeding and air embolism after tunnelled catheter removal.

J Vasc Access 2017 Mar 8;18(2):170-172. Epub 2016 Nov 8.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw - Poland.

Introduction: Severe, life-threating, complications might occur on dialysis catheter removal.

Methods: We present a useful technique that may prevent vascular air embolism and severe bleeding.

Results: The suture is placed around the catheter and tied over previous tract just after device removal.

Conclusions: Applying a compressing suture to the tract left after removal of a tunnelled haemodialysis catheter is a simple manoeuvre that could prevent severe complication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5301/jva.5000620DOI Listing
March 2017

Evaluation of Exercise Tolerance in Dialysis Patients Performing Tai Chi Training: Preliminary Study.

Evid Based Complement Alternat Med 2016 28;2016:5672580. Epub 2016 Jul 28.

Department of Physiotherapy, University of Physical Education, Paderewskiego 35 Street, 51-612 Wroclaw, Poland.

Unlabelled: Introduction. Patients with end-stage renal disease (ESRD) have poor physical performance and exercise capacity due to frequent dialysis treatments. Tai Chi exercises can be very useful in the area of rehabilitation of people with ESRD.

Objectives: The aim of the study was to assess exercise capacity in ESRD patients participating in 6-month Tai Chi training. Patients and Methods. Twenty dialysis patients from Wroclaw took part in the training; at the end of the project, 14 patients remained (age 69.2 ± 8.6 years). A 6-minute walk test (6MWT) and spiroergometry were performed at the beginning and after 6 months of training.

Results: After 6 months of Tai Chi, significant improvements were recorded in mean distance in the 6MWT (387.89 versus 436.36 m), rate of perceived exertion (7.4 versus 4.7), and spiroergometry (8.71 versus 10.08 min). Conclusions. In the ESRD patients taking part in Tai Chi training, a definite improvement in exercise tolerance was recorded after the 6-month training. Tai Chi exercises conducted on days without dialysis can be an effective and interesting form of rehabilitation for patients, offering them a chance for a better quality of life and fewer falls and hospitalisations that are the result of it.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2016/5672580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980525PMC
August 2016

Check the guide wire after catheter placement.

Hemodial Int 2016 07;20(3):492

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/hdi.12449DOI Listing
July 2016

Treatment of renal ANCA-associated vasculitides.

Postepy Hig Med Dosw (Online) 2016 Jun 28;70(0):654-67. Epub 2016 Jun 28.

Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are a group of small vessel vasculitides which commonly affect the kidneys, manifesting as rapidly progressive glomerulonephritis. In this review, we present different treatment methods (e.g. cyclophosphamide, rituximab, plasma exchange) used for remission induction and maintenance in renal AAV. We also discuss treatment options in relapsing and refractory disease and for patients with end-stage renal disease due to AAV. In addition, we enumerate the various risk factors associated with relapsing and refractory disease, quality of life impairment and decreased renal and patient survival in AAV. Finally we present information on new, potentially applicable agents which can further help modify the disease course, thereby leading to increased patient survival.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5604/17322693.1207508DOI Listing
June 2016