DANUBE SYMPOSIUM OF NEPHROLOGY and ERA-EDTA CME-Literature-Update-Course Krems - AustriaAugust 28. – 30. 2008

XIXth Danube Symposium of Nephrology Dear colleagues, dear friends, dear participants of the XIXth Danube Symposium of Nephrology in Krems, On behalf of the Danube Society of Nephrology (DSN), it is my great pleasure and It is a great pleasure and honour for me to welcome you all here in Krems – a very nice honour to welcome you to the 19th Danube Symposium of Nephrology in Krems, Austria.
city in one of the most impressive areas in Austria.
Krems is very well suited to be the host city for the 19th Danube Symposium of The Danube Symposium of Nephrology originally was created by the famous Austrian Nephrology, as the city is located in the centre of Europe being famous for its archi- Nephrologist Bruno Watschinger and now has a real excellent tradition. This Meeting tecture, culture and art. It has a history of more than 1000 years and is one of the is a very good opportunity for nephrologists from the regions along the river of Danube capitals of wine culture. The blue water of the river Danube emphasizes the beauty to meet each other and we are very proud that Krems and especially the Danube Uni- of this region, which was selected by the UNESCO as a „World Heritage Site".
versity Krems was selected to be the host of this wonderful event. Because of this special atmosphere, Krems became the capital for education and science in Lower Austria. The new campus involving two universities will ack- The Danube-University Krems was founded in 1995 as the first postgraduate State-Uni- nowledge your participation at the DSN 2008 Symposium.
versity in Europe and has many activities in teaching and research. Medicine takes animportant rule in this University and especially in research we are following the routes You will enjoy „state of the art" presentations and lectures in Nephrology-Dialysis of Bruno Watschinger, who was the inventor of the artificial kidney based on the coil and Transplantation. The Danube Symposium in Nephrology 2008 will bring principle. Our R&D activities are focused mainly on intelligent blood purification de- together distinguished clinicians with experts in the field from all over central Europe, vices based on combined membrane and adsorption technologies making blood detoxi- who will discuss new scientific results.
fication more specific than the very genius invention made by Bruno Watschiger 1956. We promise to anyone participating in the DSN 2008 in Krems a well-organized Today thanks to the initiative of the country of Lower Austria – the Danube University scientific and social programme at the highest level. We, the local organizing commit- Krems has one of the most beautiful University Campus in Europe. Small but beautiful tee and the International Scientific Advisory Board, welcome you to Krems, Austria.
is our slogan! Nearly 4 500 students contribute to the success of the Danube UniversityKrems attending nearly 200 Master-Courses in different fields. Additionally many con-ferences and meetings organised in our University Campus are part of our success. We also consider the Danube-Symposium of Nephrology as an important activity of our Uni- President of DSN 2008 versity and we will do our best to support this meeting as much as we can! On behalf of my team I wish you a successful meeting and especially also a lot of fundrinking the first class wine of our region.
Dieter Falkenhagen Head of the Department of Clinical Medicine and Biotechnology, Danube-University Krems Board of the Danube Association of Nephrology (DAN) Secretary General: Bruno Watschinger jun. Vienna, Austria Honorary Secretary General: Bruno Watschinger sen. Linz, Austria President of the Symposium: Reinhard Kramar Wels, Austria Committee Members of the Danube Association of Nephrology (DAN) Sandor Sonkodi Szeged, Hungary Ljubica Djukanovic Belgrade, Serbia and Montenegro Rastislav Dzurik Bratislava, Slovakia Ovidiu-Sorin Golea Timisoara, Romania Volkmar Heinze Durbach, Germany Gyorgy Kakuk Debrecen, Hungary Petar Kes Zagreb, Croatia Radoslav Kveder Ljubljana, Slovenia Bohdan Kovaliv Lviv, Ukraine Slobodan Curic Novi Sad, Serbia and Montenegro Bernd Osten Halle-Saale, Germany Iancu Sabo Timiosara, Romania Momir Polenakovic Skopje, Rep Macedonia Vladimir Teplan Prague, Czech Republic Walter Schulz Bamberg, Germany Wladyslaw Sulowicz Krakow, Poland Bruno Watschinger jun. Vienna, Austria Valentin Ikonomov Varna, Bulgaria Boriana Kiperova Sofia, Bulgaria

08.30 – 08.45
NDT educational: The transition to electronic Journals • C. Zoccali, Italy
Update in Nephrology and Transplantation 08.45 – 09.10
Epidemiology & outcome research • K. Jager, The Netherlands
09.10 – 09.35
Acute Renal Failure • M. Joannidis, Austria
09.35 – 10.00
A Review of the latest literature Chronic Renal Failure • A. Wiecek, Poland (Course Organizer: B. Watschinger) 10.00 – 10.25
Clinical Nephrology • R. Coppo, Italy
10.25 – 11.00 Break
11.00 – 11.25
Hypertension/Cardiovascular disease • F. Mallamaci, Italy
At the occasion of the 11.25 – 11.50
Peritoneal Dialysis • A. Vychytil, Austria
XIXth Danube Symposium of Nephrology 11.50 – 12.15
HD/HF/Plasmapheresis • R. Vanholder, Belgium
12.15 – 12.50
Transplantation • B. Watschinger, Austria
Thursday l August 28th 2008 l 14.00 – 15.00
THE HISTORY OF ORGAN TRANSPLANTATION Raimund Margreiter (Innsbruck, Austria) Thursday l August 28th, 2008 l 15.00 – 17.00
Chair: Kitty Jager (Amsterdam, The Netherlands), Martin Auinger (Vienna, Austria)
R e g i s t r y S e s s i o n
XIXth DANUBE SYMPOSIUM 15.00 – 15.20
David Ansell (Bristol, Great Britain) 15.25 – 15.45
Kitty Jager (Amsterdam, The Netherlands)
15.50 – 16.10
Carmine Zoccali (Reggio Calabria, Italy) 16.15 – 16.35
Rychlik Ivan, Lopot F, Potucek J, on behalf of the CNS (Prague, Czech Republic)
16.40 – 16.50
NEW CONTRIBUTIONS TO THE MULTIFACTOR CHARACTER OF BALKAN ENDEMIC NEPHROPATHY ETIOLOGYNikola M. Pavlovic, William H. Orem, Calin A. Tatu, Harry E. Lerch, Vuk Maksimo-vic, Jelena Maksimovic, Joseph E. Bunnell and Emina N. Kostic 16.50 – 17.00
G e n e r a l A s s e m b l y o f D A N ,
Building C, 3rd Floor, Room 3.07
Friday l August 29th 2008 l 8.30 – 10.00
Friday l August 29th 2008 l 10.30 – 12.40
Chair: Radoslav Kveder (Ljubljana, Slovenia), Peter Balcke (St. Pölten, Austria)
Chair: Walter Schulz (Bamberg, Germany), Manfred Wallner (Wels, Austria)
C a r d i o v a s c u l a r R i s k i n C K D
8.30 – 8.50
10.30 – 10.50
PATIENTS: DIAGNOSTIC AND THERAPEUTIC TOOLS KIDNEY DISEASE, A CARDIOVASCULAR RISK FACTOR? Yurii B Kovaliv (Lviv, Ukraine) Francesca Mallamaci (Reggio Calabria, Italy) 8.50 – 9.00
10.50 – 11.10
9.00 – 9.20
Dialysis, Clinic of Urology, Radiology Department University Hospital „St. Marina", ADVANCED SECONDARY HYPERPARATHYREOIDISMUS, A „CARDIOVAS- Medical University „Prof. Dr. Paraskev Stojanov" CULAR RISK FACTOR"Walter Schulz (Bamberg, Germany) 9.20 – 9.40
11.50 – 12.00
CVD RISK IN A GROUP OF END STAGE RENAL DISEASE PATIENTS ON METABOLIC DISORDERS AND NUTRITION AFTER RENAL TRANS- Zorica Rasic-Milutinovic, Perunicic-Pekovic G, Sobajic S, Djuricic I (Belgrade, Serbia) Teplan V, Stollová M, Mengerova O (Prague, Czech Republic) Department of Ne-phrology, Transplant Centre, Institute for Clinical and Experimental Medicine and 12.00 – 12.20
PROTEIN-ENERGY WASTING, CHRONIC INFLAMMATION AND Peter Kotanko, Len Usvyat, Stephan Thijssen, Adam Tashman, Nathan W Levin PUFAs: MARKERS OF ATHEROSCLEROSIS IN ESRD Renal Research Institute New York, USA Perunicic-Pekovic G, Rasic-Milutinovic Z, Sobajic S, Djuricic I and Maletic R(Belgrade, Serbia) 12.20 – 12.40
10.00 - 10.30 B r e a k
Raymond Vanholder (Ghent, Belgium) 12.40 - 14.00 L u n c h b r e a k
Friday l August 29th 2008 l 13.00 – 14.00
Friday l August 29th 2008 l 16.15 – 18.00
Chair: Josef Kovarik (Vienna, Austria), Helmut Graf (Vienna, Austria)
Friday l August 29th 2008 l 14.00 – 15.45
Chair: Dieter Falkenhagen (Krems, Austria), Friedrich Prischl (Wels, Austria)
16.15 – 16.35
Gere Sunder-Plassman (Vienna, Austria) 14.00 – 14.20
16.35 – 16.55
16.55 – 17.05
Andreas Vychytil (Vienna, Austria) WHAT IS THE REAL RATIO OF CONVERSION FROM EPOETIN BETA TO DARBEPOETIN ALPHA? Veresová J, Nehézová K, Slavícková R, Rychlík I (Prague, Czech Republic) 14.40 – 15.00
17.05 – 17.15
Ammer, R. for the HX575 study group (PI Haag-Weber, 50 centers in Germany, CITRAT ANTICOAGULATION IN ACUTE RENAL FAILURE 9 centers in Austria), Iserlohn & Hallein, Münster, Germany Michael Joannidis (Innsbruck, Austria) 15.20 – 15.35
17.20 – 17.40
Dieter Falkenhagen (Krems, Austria) IMMUNOADSORPTION - PRINCIPLES AND INDICATIONSSabine Schmaldienst (Vienna, Austria) 15.35 – 15.45
POINT OF VIEWGeorg Stummvoll (Vienna, Austria) 19.00
G a l a N i g h t

Saturday l August 30th 2008 l 9.00 – 12.00
S AT Chair: Sandor Sonkodi (Szeged, Hungary), Bruno Watschinger (Vienna, Austria)
30 9.00 – 9.20
NANOMEDICINEWolfgang Schütt (Krems, Austria) 9.20 – 9.40
Sandor Sonkodi1, Bela Ivanyi2, Laszlo Puskas3 (Szeged, Hungary)
1 Nephrology and Hypertension Center, University of Szeged, Szeged, Hungary
2 Dept. of Pathology, Szeged Scientific University, Medical Faculty, Szeged, Hungary 3 Laboratory of Functional Genomics, Biological Research Center of the Hungarian Academy of Sciences, 9.40 – 10.00
Thomas Roy (FMC- Bad Homburg, Germany)
10.00 – 10.30 B r e a k
10.30 – 10.50
Gert Mayer (Innsbruck, Austria)
10.50 – 11.10
Bruno Watschinger (Vienna, Austria)
11.10 – 11.30
Q U O VA D I S M E D I C I N A Iancu Sabo (Timisoara, Romania) C L O S I N G R E M A R K S Reinhard Kramar (Wels, Austria) PO02POSSIBILITIES OF RADIONUCLIDIC RESEARCHES IN DIAGNOSTICS OF AD-JACENT DEFEATS OF KIDNEYS AND VERTEBRAL COLUMN IN PATIENTSWITH CHRONIC KIDNEY DISEASES AND ARTERIAL HYPERTENSIONNykula T., Trunova S., Kundin V., Moyseyenko V (Kyiv, Ukraine)Propedeutical Medicine N 2, National Medical University Balzak str., 16A, ap 21, Friday August 29th 2008 13.00 – 14.00
02225, Kyiv, Ukraine PO04INDUCED DRUG RESISTANCE OF THE ORGANISMS INVOLVED IN UTIs INCHILDREN Gafencu M, Doros G, Golea O, Sabo I, Sandru R (Timisoara, Romania)3rd Pediatric Clinic /UMF Timisoara Romania /Str. I. Nemoianu Nr. 3 PO05CORRELATION OF SERUM CREATINE KINASE, CREATINE KINASE-MB, ANDTROPONIN I WITH CARDIAC PATHOLOGY IN HEMODIALYSIS PATIENTSGîju S1, Flangea C2, Craciun I3, Dumitrascu V1, Ursoniu S4, Vlad D1, Ostafe V5, Golea O3 and Chiriac A5 (Timisoara, Romania)1 Clinical County Emergency Hospital Timisoara, Central Laboratory 2 Victor Babes University of Medicine and Pharmacy Timisoara, Department of Biochemistry 3 Clinical County Emergency Hospital Timifloara, Hemodialysis Department 4 Victor Babefl University of Medicine and Pharmacy Timifloara, Department of Public Health 5 West University of Timifloara, Faculty of Chemistry – Biology PO06CARDIOVASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS IS AHIGH RISK FACTOR FOR MORTALITYAncuta Mates, Nicoara S.M, Totolici C, Mihailescu D, Craciun I, Golea O (Timisoara,Romania) Dialysis and renal transplant center, Districtual hospital Timisoara PO07AN ANALYSIS OF RISK FACTORS FOR PERITONITIS AND AD VITAM PRO-GNOSIS IN PATIENTS TREATED WITH CAPDNicoara S.M, Mihailescu D, Totolici C, Mates A, Craciun I, Golea O (Timisoara, Romania) Dialysis and renal transplant center, Districtual hospital Timisoara RELATIONSHIP BETWEEN A HISTOLOGICAL SCORING SYSTEM AND BIO- FACTORS INVOLVED IN VASCULAR CALCIFICATION AND ATHEROSCLERO- LOGICAL DATA IN ASSESSING PATIENTS WITH GLOMERULONEPHRITIS SIS IN CHRONIC HAEMODIALYSIS PATIENTS Flaviu B, Gluhovschi Gh, Herman D, Potencz E, Gluhovschi C, Petrica L, Bozdog Vaduva C, Cana Ruiu D,Toader D, Mota E (Craiova, Romania) Gh, Velciov S, Trandafirescu V (Timisoara, Romania) Nephrology Dept. Univ. of Nephrology Clinic, County Emergency Hospital Craiova, Romania Medicine and Pharmacy „Victor Babes" Timisoara, Romania 2 Chopin Str. Timisoara, Romania PO18IS THE SF-SACRAH ABLE TO SCREEN A NEPHROLOGIC PATIENT COHORT FOR HAND DISORDERS? PREGNANCY IN RENAL TRANSPLANT RECIPIENT (RTR) – FAVOURABLE Sautner J1,2, Kramar R1, Leeb BF2 (Wels, Stockerau, Austria) OUTCOME: 12 YEARS OF OBSERVATION 1 Klinikum Wels-Grieskirchen, 3. Med.Department 2 Landesklinikum Weinviertel Stockerau, 2. Med. Department Kovaliv Y.B1, Sozanskyi O1, Tychka I1, Zazgornik J2 (Lviv, Ukraine; Linz, Austria) 1 Danylo Halytskyi National Medical University, Lviv, Ukraine 2 Allgemeines Krankenhaus, Linz, Austria HYPERPHOSPHATEMIA - COMPARISON OF TWO ESTABLISHED PHOSPHATEBINDERS (ALUMINUMHYDROCHLORIDE VS. ALUMINUMHYDROXIDE) ON THE PLASMA PHOSPHATE-LOWERING EFFECT THE INFLUENCE ON LIPID SPECTRUM OF CONSECUTIVE PATHOGENETIC Ammer R., for the Jahn study group (PI Friedrich Jahn) (Münster, Deutschland) TREATMENT OF PATIENTS WITH NEPHROTIC SYNDROME (NS) USING LOW Universitätsklinikum Münster Med D - Nephrologie Albert-Schweitzer-Strasse 3, MOLECULAR WEIGHT (LMWH)/CONVENTIONAL (CH) HEPARINS D - 48149 Münster and MEDICE Arzneimittel, 58638 Iserlohn & 5400 Hallein Yurii B.Kovaliv, Danylo Halytskyi National Medical University, Lviv, Ukraine Pekarska Str. 27 / 5, 79008 Lviv, Ukraine PO23NOCTURNAL POLYURIA IN CHILDREN WITH CHRONIC GLOMERULOPATHY Peco-Antic A1, Marinkovi J2, Krus i D 1, Kosti M1, Paripovi D1, Spasojevi B1, AGREEMENT BETWEEN CLEARANCE OF CREATININE AND ESTIMATING Stani M1, Milosevska G1 GLOMERULAR FILTRATION RATE IN PATIENTS WITH CHRONIC RENAL 1 University Children's Hospital, Belgrade, Serbia 2 Institute for Medical Statistics and Informatics, School of Medicine, Belgrade, Serbia Lezaic V1, Ristic S1, Stosovic M1, Dajak M2, Dokic Z1, Obradovic I (Belgrade, Serbia)1 Institutes for Urology and Nephrology, 2 Medical Biochemistry, Clinical Center of Serbia PO14NT-PRO-BNP BUT NOT BNP IS A PROGNOSTIC MARKER FOR CARDIACEVENTS IN PATIENTS ON HEMODIALYSISDapra M, Kogler R, Lechleitner P (Lienz, Austria)Abteilung für Innere Medizin A.ö. Krankenhaus Lienz E.v. Hiblerstr. 5, A-9900 Lienz, Austria Speakers and Chairs in alphabetical order Pavlovic Nikola M.
Bratusch-Marrain Paul Prischl Friedrich Rasic-Milutinovic Zorica Falkenhagen Dieter Golea Ovidio-Sorin Schmaldienst Sabine Ikonomov Valentin Joannidis Michael Sunder-Plassman Gere Vanholder Raymond Mallamaci Francesca Margreiter Raimund Watschinger Bruno free communication BICARBONATE HAEMODIALYSIS USING A-CONCENTRATE WITH CITRIC ACID Lopot F, Svara F, Polakovic V (Prague, Czech Republic)General University Hospital and 1st Medical Faculty of the Charles University, Depart-ment of Medicine, Sermirska 5, 16900 Prague 6 - Strahov, Czech Republic Background:Recently, use of citric acid (CA) instead of traditional acetic acid (AA) in A-concentratefor bicarbonate dialysis (BHD) was suggested to reduce blood clotting in the extracorpo-real circuit and also amount of heparin administered. The work reports results of tho- rough in vitro testing of CA-based concentrate in conventional HD machines and first re-sults of its use in in vivo BHD.
Methods:As most current HD machines have only AA as the acidifying agent in their memory, wefirst checked in vitro by paired measurement final dialysate composition (Na+, K+,Ca2+, pH, and HCO3+) with AA- and CA-containing A-concentrate on B.Braun, Frese- XIXth DANUBE SYMPOSIUM nius, Gambro, and Nikkiso HD machines. Functionality of sodium and bicarbonate con-trol was verified at 4 different Na / HCO3 settings (134/24, 134/38, 148/24, and 148/38 mmol/l). Following the in vitro tests, in vivo HD with CA-containing A-concentrate wasstarted in five patients. Evaluation period was 4 weeks, one week with standard A-con-centrate with AA, followed by 3 weeks with CA-containing A-concentrate. Data on pre-HD trends and intra-dialytic changes in plasma levels of total and ionised calcium and bi-carbonate, intradialytic behaviour of activated clotting time (ACT) and spKt/V are beingcollected for subsequent statistical analysis.
28th – 30th August 2008 The in vitro tests documented safe use of CA-containing concentrate on conventionalHD machines with no conductivity alarms and fully functional Na / HCO3 control. Withequal amount of CaCl2 and the same B-concentrate, significantly lower concentrationof ionised calcium (difference of 0,35-0,5 mmol/l) and slightly higher bicarbonate con-centration was seen in final dialysate mixed from CA-containing A-concentrate as com-pared to standard type with AA. The former finding corresponds with tendency to aslight decrease in pre-HD plasma level of both total and ionised calcium (the differenceagainst conventional BHD is below 0,1 mmol/l) and slight increase in pre-HD plasma bi-carbonate. Data on ACT and spKt/V are still being collected to see whether the obser-ved increasing tendency would prove to be statistically significant.
Conclusions:The A-concentrate with CA can be safely used instead of the AA-based one without anychange in pre-setting of the HD machines. Current preliminary results of in vivo use ofCA-based concentrate reveal slight decrease in pre-HD plasma Ca-level, prolonged ef-fect of administered heparin and a tendency towards increasing Kt/V.
POSSIBILITIES OF RADIONUCLIDIC RESEARCHES IN DIAGNOSTICS WHAT IS THE REAL RATIO OF CONVERSION FROM EPOETIN BETA OF ADJACENT DEFEATS OF KIDNEYS AND VERTEBRAL COLUMN TO DARBEPOETIN ALPHA? IN PATIENTS WITH CHRONIC KIDNEY DISEASES AND ARTERIAL Veresová J1, Nehézová K1, Slavícková R2, Rychlík I1 (Prague, Czech Republic) 1 Dialysis center FMC Vinohrady, Prague 10 Nykula T., Trunova S., Kundin V., Moyseyenko V (Kyiv, Ukraine) 2 1st Dept. Medicine, 3rd Fac. Medicine, Charles University Prague, Czech Republic Propedeutical Medicine N 2, National Medical University Balzak str., 16A, ap 21, 02225,Kyiv, Ukraine Background:Recommended conversion ratio from epoetin beta (EB) to darbepoetin alpha (DA) in the treatment of renal anemia of patients receiving maintenance hemodialysis is given as The data of our previous researches have shown that in arterial hypertension (AH) pa- 200:1. Some authors had critical notes concerning this ratio and other doses were re- thogenesis in nephrological patients an important role can be played by reflexogenic in- commended. Experience in the Czech Republic is lacking. The aim of study was to as- fluence of selective neurovegetative ganglions (NVG) induced by vertebral osteochon- sess a final EB:DA ratio after switching patients from EB to DA. drosis (VO), innervating blood supply basins of kidneys. The aim of the research was toestimate the possibilities of radionuclidic researches in diagnostics of adjacent defeats of kidneys and vertebral column in nephrological patients with AH All patients (pts) receiving maintenance post-dilution hemodiafiltration on-line treatment(>90-d) and with administration of once a week EB intravenously (iv) were included.
Conversion from EB to DA was performed in ratio 200:1. During the 9-month follow-up In 12 (7 males and 5 females) nephrological patients aged 36 – 76 years (6 chronic glo- DA was adjusted to achieve the Hb target 110-130 g/l and transferrin saturation (TSAT) rumelonephritis and 6 chronic pyelonephritis with moderate AH on the background of 25-45% (monitored twice a month). Statistical significance test was performed using VO) the complex research is made. All patients in conditions of nephrologic hospital ra- pair t-test.
diographic examination of vertebral column, clinical neurovegetative examination swit-ching clinical-neurovegetative researches, roentgenography, neurometameric tensoal- gesimetry and osteoscintigraphy (ÎSG) before and during of treatment is carried out.
27 pts were enrolled, M/F 66/34%, mean age 67.2-y (37-87), diabetics 48%, causes ofESRD: 52% vascular nephrosclerosis, 33% diabetic, 15% others. Mean time on HDF was 23-months (4-113), mean treatment time was 13.6-h/week. The processing of the received data consist of qualitative and quantitative parameters.
Baseline and end-study mean Hb values were 112 vs.120 g/l (p=0.006), doses of ESA In result of radionuclidic researches were differensed attributes of inherent displasia 33 vs. 26 μg/week (p=0.002) and 92 vs. 65 IU/kg BW/week (p=0.005), respectively, and and osteohondroses of vertebral column. The received ÎSG results correlated with le- number of pts with Hb>130g/l was 3 vs.11%, Hb 110-130g/l 63 vs.67%, and Hb vels of a threshold pain sensitivity increasing in zones of autonomic innervation afferent <110g/l 34 vs.22%. and efferent systems of small abdominal nerves, which innervate kidney and they also Following baseline vs. end-study values were found as non-significant: blood pressure can normalizate the arterial pressure.
138/70 vs. 137/66 mmHg, serum albumin 36.0 vs.36.9g/l, CRP 6.9 vs 9.3 mg/l, eKt/V1.65 vs 1.72, serum phosphate 1.50 vs.1.46 mmol/l. Iron consumption (Na-gluconan) was 60.1 vs. 48.6 mg iv/week.
Our results have shown the possibilities of radionuclidic researches in diagnostics of ad-jacent defeats of kidneys and vertebral column in patients with chronic kidney diseases and arterial hypertension, presence of selective NVG irritation in many nephrological pa- 1/ equivalent effective dose in our study (end-study conversion ratio) was found as 292 tients, what should be taken into account in pathogenesis of AH formation in these pa- IU EB to1.0 μg DA; tients with the aim of selection of an adequate AH correction and prophylactics at com- 2/ following guidelines, decrease of ESA consumption (given in IU/kg/week) was 29% bination of nephrological pathology with the background of VO.
during 9-month therapy, while Hb levels increased of 7% and efficacy of HD therapy re-mained unchanged. 3/ observed higher monthly Hb levels variation during DA therapy was found probablydue to low experience with DA pharmacokinetic.
We assume that the current conversion factor of 200 is too low. A new EP:DA ratio of300:1 seems to be more realistic for a proper adjustment of Hb levels after changingpatients to DA.
INDUCED DRUG RESISTANCE OF THE ORGANISMS INVOLVED IN CORRELATION OF SERUM CREATINE KINASE, CREATINE KINASE-MB, AND TROPONIN I WITH CARDIAC PATHOLOGY IN HEMODIALYSIS Gafencu M, Doros G, Golea O, Sabo I, Sandru R (Timisoara, Romania) 3rd Pediatric Clinic /UMF Timisoara Romania /Str. I. Nemoianu Nr. 3 Gîju S1, Flangea C2, Craciun I3, Dumitrascu V1, Ursoniu S4, Vlad D1, Ostafe V5, Golea O3 and Chiriac A5 (Timisoara, Romania) 1 Clinical County Emergency Hospital Timisoara, Central Laboratory In Romania UTIs represent a major health issue, because of the severe renal function 2 Victor Babes University of Medicine and Pharmacy Timisoara, Department of Biochemistry impairment that recurrent infections can lead to.
3 Clinical County Emergency Hospital Timifloara, Hemodialysis Department4 Victor Babefl University of Medicine and Pharmacy Timifloara, Department of Public Health The objective of this study is to analyze the types of organisms that produce UTI and 5 West University of Timifloara, Faculty of Chemistry - Biology their sensibility to routine therapy. Over the last 10 years, increases in cardiac troponin I (cTnI) have been studied in hemo- We studied a total number of 81 patients, 59 admitted in 2006 and 22 hospitalized in the dialysis patients and the prevalence of increased troponins is correlated with increased first six months of 2007. The distribution according to sex and age was: 0 – 3 years, 41 risk of coronary artery disease.
patients (27 boys, 13 girls); 3 – 6 years, 12 patients (8 boys, 4 girls), >6 years, 28 patients(7 boys, 21 girls); urban and rural distribution was 38 and 43 patients respectively. We studied: the types of germs, their sensibility to antibiotics, the therapy and the possible In the present study, we investigated 51 hemodialysis patients with increased cTnI with association with other factors.
or without clinical myocardial infarction and the results were correlated with serum crea-tine kinase (CK), its MB isoenzyme (CK-MB). Patients in whom no suitable plasma sam- ples were available were excluded from the study. 51% of samples (from 26 patients) The organisms were identified in 66,67% of the patients. For the rest of the patients, were obtained within 8 days before the death. The rest of the samples were obtained the organism remained unknown, although they had bacteriuria, and the antibiotics were more than 6 months before death. All samples were frozen at -70 °C within 72 h. Serum administered without any knowledge of the organism sensibility.
markers were analyzed for clinical reasons.
The most frequent organism responsible for UTIs was Escherichia Coli (40,74%), follo-wed by Proteus spp. (12,31%), Klebsiella spp. (2,46), Pseudomonas Aeruginosa (2,46 %), Citrobacter Koseri (1,23%), Enterobacter spp. (1,23%) and fungus (1,23%). Serum cTnI appears to be a valuable predictive marker of cardiovascular events in asym- Infections with more than one organism were found in 4,93% of the cases.
ptomatic dialysis patients. There was no myocardial pathology in 11patients. Cardiac pa- 54,5 % of the E. Coli strains presented resistance to 2 or 3 antibiotics (ampicillin, trime- thologies were in five groups: scarring from previous MI or patchy ventricular fibrosis thoprim-sulfomethoxazole). The high resistant strains represented 30,33% and were (n = 5), recent MI (n = 8), recent microinfarct (n = 8), healing MI (n = 5), degenerative resistant to ampicillin, gentamicin, trimethoprim-sulfomethoxazole, colistin and ciproflo- myocyte changes consistent with congestive heart failure CHF; (n = 8), and other cardiac xacin. Proteus spp. was resistant to: ampicillin, aminoglycozides (gentamicin, amikacin, pathologies (n = 6). The median concentrations in the five groups were not significantly netilmicin), kanamicin, trimethoprim-sulfomethoxazole, colistin, and ciprofloxacin alterna- different for either CK or CK-MB. Compared with the no-pathology group, only the MI ting with nalidixic acid.
group was significantly different for cTnI. For patients with recent MI, 37.5 %, 25 % and Klebsiella spp. was proven to be resistant to ampicillin, gentamicin, amikacin, trimetho- 75 %, had increased CK, CK-MB and cTnI, respectively; for CHF the percentages were prim sulphamethoxazole, kanamicin and nalidixic acid.
62.5 %, 25 % and 25 % respectively. Only one patient without myocardial pathology hadincreases in CK-MB, cTnI.
Conclusions:1. Male patients were most frequently affected (65,85 %) in the age group of 0 – 3 years; female patients were most frequently affected (75%) in the above 6 years group.
All patients with increased serum CK-MB, and cTnI, had significant cardiac changes. cTnI 2. The strains responsible for the community acquired infections were initially sensible to assay appears to be a more sensitive indicator of MI and other myocardial pathologies the first choice antibiotics (ciprofloxacin, gentamicin, colistin and ampicillin), but most of than the CK-MB assay used in this study.
the strains developed resistance to these antibiotics; thus the percentage of successfulempiric treatment is reduced (< 30 %).
3. The antibiotics should be used according to the guidelines, on the basis of the sensibi-lity/resistance and frequency of the organisms.
5. In case of infections due to more than one microorganism, it is essential to use multi-drug therapy, because the organisms are usually high-resistant and they have a selectivesensibility.
CARDIOVASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS AN ANALYSIS OF RISK FACTORS FOR PERITONITIS AND AD VITAM IS A HIGH RISK FACTOR FOR MORTALITY PROGNOSIS IN PATIENTS TREATED WITH CAPD Ancuta Mates, Nicoara S.M, Totolici C, Mihailescu D, Craciun I, Golea O Nicoara S.M, Mihailescu D, Totolici C, Mates A, Craciun I, Golea O (Timisoara, Romania) (Timisoara, Romania) Dialysis and renal transplant center, Districtual hospital Timisoara Dialysis and renal transplant center, Districtual hospital Timisoara The aim of this study was to evaluate risk factors associated to peritonitis and ad vitam Cardiovascular mortality is the leading cause of death in patients treated in dialysis, with prognosis of patients treated with CAPD. There have been followed up the effects of mortality 10 – 30 times higher than the general population despite stratification for other diabetes mellitus(DM), malnutrition (i.e. serum albumin), residual renal function (i.e. diu- factors well established. Vascular calcification can occur as a normal consequence of resis), on the ad vitam prognosis of CAPD patients as well as on the rate of peritonitis. aging. In patients with ESRD it is a manifestation of ectopic calcification and is at leastpartiality driven by occurrence of hyperparathyroidism and has been variably associated with age, dialysis vintage. HLP, HTA, marker of inflammation. Calcification in ESRD oc- We have investigated 67 CAPD patients treated in Timisoara Dialysis and Renal Trans- curs with or without association atherosclerosis plaques. plant Center between 2000 and 2006 – 34 female, 33 male, average age 58.43 +/-14.62years. The etiology of end stage renal failure (ESRF) was: DM 26.85 % of the cases, chronic glomerulonephritis in 25.37%, chronic pyelonephritis in 23,88 %, hypertension We studied prospectively 60 stable ESRD patients in hemodialysis, during a follow up in 10.44 %, ADPKD in 4.47%, other causes in 8,95 %.
of 30+/- 5 months, involving following parameters: aortic diameter, presence of arterialcalcification, myocardial calcification and valvular calcification, For these purpose of de- tecting calcification we performed echocardiography, radiography, CT.
During the followed up period 12% of the patients died and 37.31% developed peritoni-tis (0.15/ patient / year). We found no difference concerning the prevalence of peritoni- tis (38.88% vs. 40.81%) or the peritonitis rate (0.12 vs. 0.16) between DM and non DM 50 of the 60 patients investigated were found with calcification(83,3%). 18,36 % have patients but the DM patients had a significantly poorer ad vitam prognosis (22.22% died died because of coronary heart diseases (miocardial ischemia or arythmias). 3,6 % pa- vs. 8.16 % p<0,0005).
tients have been aorto-coronarian by-passed, 4,8 % have aputations for 3th stage arteri- The prevalence of peritonitis was significantly higher in patients with poor residual renal tis, 2,4% have died from other diseases (infections), the rest survive without any impor- function (i.e diuresis < 500 ml/d) : r=-0.2693, p=0.028. Serum albumin was found to be tant clinical symptomes although the calcifications have extended .Risk of death positively correlated to diuresis (r=0.3251, p=0.007) and negatively to ad vitam progno- increased with number of vascular sites involved by calcification.
sis of the patients (r=-0.3508, p=0.004).
Both atherosclerosis and arteriosclerosis have been shown to contribute to cardiovas- In conclusion DM was not a risk for peritonitis in our patients. The prevalence of perito- cular disease in patients with ESRD in hemodialysis.Vascular change is typified by calci- nitis increased as diuresis decreased and it imposed the change of type of the RRT. The fication of both intimae and media. Once mineralization is initiated, increased CaxP pro- presence of hypoalbuminemia and DM was associated with poor ad vitam prognosis in duct from abnormal bone, secondary hyperparathyroidism or excessive calcium intake our CAPD patients may accelerate the process. Further understanding of the mechanism by which vascu-lar calcification occurs should offer the potential hope of developing therapeutic strate-gies to arrest this process and reduced mortality.
RELATIONSHIP BETWEEN A HISTOLOGICAL SCORING SYSTEM METABOLIC DISORDERS AND NUTRITION AFTER RENAL AND BIOLOGICAL DATA IN ASSESSING PATIENTS WITH GLOME Teplan V, Stollová M, Mengerova O (Prague, Czech Republic) Flaviu B, Gluhovschi Gh, Herman D, Potencz E, Gluhovschi C, Petrica L, Bozdog Gh, Velciov Department of Nephrology, Transplant Centre, Institute for Clinical and Experimental S, Trandafirescu V (Timisoara, Romania) Medicine and Institute for Postgraduate Education,Prague, Czech Republic Nephrology Dept. Univ. of Medicine and Pharmacy „Victor Babes" Timisoara, Romania 2Chopin Str. Timisoara, Romania Kidney transplantation is the most common solid organ transplant procedure in theworld. Successful kidney transplantation leads to restoration of renal function, but some Background: Both glomerular and tubulo-interstitial lesions are involved in determining the metabolic disorders may persist and new metabolit abnormalities can develop. Additio- degree of renal function impairment and also of the outcome of the disease in patients with naly, immunosuppressive drugs (corticosteroids, cyclosporine A, tacrolimus and rapa- primary or secondary glomerulonephritis. The histological lesions at these levels can be divi- mycin) may agravate course of diabetes, hypertension and dyslipidemia.
ded into active- inflammatory lesions and chronic- sclerotic/fibrotic lesions.
Metabolic role of the kidney is associted with the quality of the removed kidney graft,ischemia-reperfusion damage, early posttransplant hydratation (hyper-or hypovolemia) Methods: We studied a group of 41 patients with primary and secondary glomerulonephri- and early posttransplant mineral disorders (iKs, iMgs, iNas, Cas, iPs).
tis [M-24p, F-17p, mean age 45.5 +/- 12.9y], which underwent kidney biopsies, processed in Nutrition management of renal transplantation can be divided on pretransplant period, light microscopy. In order to quantify the histological changes and to assess the extent of ac- transplant surgery, early posttransplant period and late posttransplant period. tive-inflammatory and chronic- sclerotic/fibrotic lesions, we adapted a scoring system initially Nutrition management in early posttransplant period with functioning kidney graft used only for lupus nephritis, and ANCA-associated vasculitis. The scores obtained from the needs fluid and electrolyte balance control with protein intake of 1.2g–1.4g/kgBW/day retrospective evaluation of the renal biopsies where correlated to biological data: serum crea- and energy of 35kcal/kgBW/day. In non functioning kidney graft continues dialysis treat- tinine (SC), glomerular filtration rate (GFR). In order to perform statistical analysis we used ment with adjustment of immunosuppression. Main complications in late posttrans- WinStat for Microsoft Excel.
plant period are obesity,diabetes, dyslipidemia, hypertension, malnutrition, Ca-P disor- Results: We observed a strong correlation between the interstitial scores for activity, such ders and renal bone disease.All of these possible complications may be prevented or as interstitial edema, interstitial infiltrate, and also of the total activity index with renal treated through early nutritional intervention and follow up. function at the moment of the renal biopsy: interstitial edema with SC (R=0.42, P=0.002), Nutrional status is an important determinant of clinical outcome in patients with chronic and with GFR (R= -0.41, P=0.003); interstitial infiltrate with SC (R=0.55, P<0.0001), and with renal disease. Malnutrition, altered protein and lipid metabolism, and obesity are asso- GFR (R=-0.62, P<0.0001); total activity index with SC (R=0.54, P=0.0001) and with GFR (R= - ciated with a variety of factors related to renal function and forms of renal replacement 0.49, P= 0.003). We found also a strong correlation of the renal function with tubulo-intersti- therapy. Changes in body composition after renal transplantation are due to increased tial scores for chronicity (interstitial fibrosis, tubular atrophies, hyalinosis/ fibrosis of interstitial appetite and reversal of the uremic state, as well as to the immunosuppressive treat- vessels) and also with the total chronicity score: interstitial fibrosis with SC (R=0.49, ment, in particular immediately after surgery.
P=0.0006), and with GFR (R=-0.59, P<0.0001); tubular atrophies with SC (R=0.41, P= 0.003)and with GFR (R= -0.59, P<0.0001); vascular hyalinosis/ fibrosis with SC (R=0.42, P=0.002), Conclusion: Frequent nutritional evaluation and intensive nutritional education are of and with GFR (R= -0.59, P<0.0001); total chronicity index with SC (R=0.50, P=0.0003), and great importance in all renal transplant phases, including the pretransplant period. In with GFR (R= -0.65, P<0.0001). We also could find a correlation betweeen the glomerular case of previous severe obesity, fat loss is recommended prior to surgery. During the segmental sclerosis score and SC (R=0.3, P=0.02) and with GFR (R=-0.42, P=0.003). Howe- first year, the major nutritional goal is to treat preexisting malnutrition and prevent ex- ver we could not find any statistically significant correlation of the renal function with mesan- cessive weight gain.
gial cell proliferation and mesangial matrix increase. For the 10 patients followed up in time Repeated nutritional interventions are needed to facilitate improvement in dietary habits for a mean period of 22.9+/- 11.9 months we found out a mean renal function decline of 5.2 and development of a more produc¬tive and healthy lifestyle.
+/- 12.11 ml/min/year. We observed that the renal function decline in these patients correla-ted with active lesions: interstitial edema (R=0.45, P= 0.09), interstitial infiltrate (R=0.50,P=0.06), total activity index (R=0.58, P=0.03); and also with chronic lesions: glomerular seg- mental sclerosis (R=0.50, P=0.06).
1. Kasiske BL, Vazquez MA, Harmon WE, et al: Recommen¬dations for the outpatientsurveillance of renal transplant recipi¬ents. American Society of Transplantation. Conclusions: Interstitial lesions were more important then the glomerular ones in determi- J Am Soc Nephrol ll (Suppl):Sl, 2000 ning the degree of renal function impairment in our patients. Both glomerular and interstitial, 2. Martins C, Pecoits-Filho R, Riella MC. Nutrition for the post-renal transplant active and chronic histological lesions seem to be involved in assessing the outcome of the recipients. Transpl Proc 36:1650-1654,2004 glomerular disease. A scoring of histological changes is important in the assessment of ac- 3. Teplan V, Schueck O, Racek J, et al. Asymmetric dimethylarginine and adiponectin tive and chronic glomerular changes in patients with different primary or secondary glomeru- after renal transplantation: role of obesity. J Ren Nutr 18 (1) :154-157, 2008 This study was supported by Research Project 978 of the Ministry of Health of the Czech Republic - MZO 00023001 THE ROLE OF URINARY C5B-9 (MAC) AS A PROGNOSTIC FACTOR PREGNANCY IN RENAL TRANSPLANT RECIPIENT (RTR) – IN MAJOR PRIMARY GLOMERULONEPHRITIDIES FAVOURABLE OUTCOME: 12 YEARS OF OBSERVATION Skoberne A1, Lindic J1, Kovac D1, Ales A1, Pajek J1, Kveder A3, Kotnik V2, Kveder R1 Kovaliv Yurii. B1, Sozanskyi O1, Tychka I1, Zazgornik J2 (Lviv, Ukraine; Linz, Austria) 1 Univerity Medical Center, Dept. of Nephrology, Zaloska 7, 1000 Ljubljana, SLOVENIA 1 Danylo Halytskyi National Medical University, Lviv, Ukraine 2 Institute of Microbiology and Immunology, University of Ljubljana 2 Allgemeines Krankenhaus, Linz, Austria 3 UNECE - United Nations Economic Commission for Europe, Population Activities Unit Background: Current prognostic factors in different primary glomerulonephritides „Glomerulopathiae et graviditas" seem to be an everlasting problem of medicine alto- (PGN), such as gender, age, renal function, degree of proteinuria and the extent of glo- merular sclerosis and tubulointerstitial fibrosis are rather rude and behind time to followtimely guided start of specific immunosuppressive treatment. Searching for novel and valid urinary biomarkers could be helpful in this regard but is rather scanty when one A pregnancy (P) of patient suffering from chronic renal failure and resulting in the be- performs a literature search. aring of living child still remains an unusual phenomenon: frequency of uncomplicated P Among possible urinary markers, urinary C5b-9 or membrane attacking complex (MAC) outcomes generally does not exceed 50%.
is well established in membranous nephropathy as an index of disease activity and pos-sibly of prognosis. The aim of our retrospective study was to estimate the prognostic value of urinary MAC in patients with major PGN, i.e. membranous nephropathy (MN), All known criteria (Kidney Int., 1985, 27, 74) of safe P in RTR don't exclude fetal hypo- IgA nephropathy (IgAN) and focal segmental glomerulosclerosis (FSGS).
trophy – intrauterine growth retardation (IUGR) or premature delivery (PD). Twenty twoyears ago there were 1600 renal transplant women with 2309 pregnancies. Hence, we Methods: Seventy-two patients with biopsy confirmed primary glomerulonephritis and describe a very rare case of a young (27-year old in partu) RTR woman with first P (1997 persistent proteinuria were included in the present study. Among them, there were 28 - 5 years after kidney transplantation), PD: child birth (per vias naturales) at 36th P week with MN, 25 with IgAN, 10 with FSGS, 4 with minimal change disease and 5 with with IUGR of II grade (1,95 kg b.w., 44 cm body height). Fetal ultrasonography parame- membranoproliferative GN. Patients with non glomerular diseases or non-proteinuric ters corresponded to postnatal body weight and height data. Blood loss – 0,2 l. Urine glomerular diseases served as controls. The concentration of urinary MAC was deter- protein loss (directly before delivery) – 0,6 g/24 h; after it – 0,08 g/24 h. Blood pressure mined by the modified enzyme-linked immunosorbent assay (ELISA) described by Ac- – 170/100 mm Hg (in partu) and 130/80 mm Hg post partum. Bcr – normal. P and post- cardo-Palumbo et al. Urinary MAC measurements were performed at the time of natal course were without complications. Cathamnesis (12 years later): immunosup- biopsy or at the start of follow up and at the last visit or at the last estimation of disease pression is continued (methipred, imuran, neoral), the common state of mother is nor- status (remission, persistent disease or worsening of renal function (doubling of the se- mal (only reflux gastritis erosive, confirmed by fibroscopy), her daughter at today rum creatinine or ESRD). The values of urinary C5b-9 have to be logarithmically transfor- develops corresponding to the age and goes to school. The graft is painless, firmly-ela- med for the statistical analysis due to a great disparity in measured values.
stic and not enlarged (USG-11,0 x 4,0 cm).
Results: Lower levels of proteinuria at the time of urinary C5b-9 determination (ANOVA, F 10,39, p < 0.0001) as well as the lower levels of urinary C5b-9 itself (ANOVA Our data show – RTR may have a successful P even by moderate IUGR and PD, esp. in of log transformed variable, F 11,05 p< 0.00007) were significantly associated with the women with normal graft function prior to conception and by pre-, intra- and post- likelihood of partial or complete remission of glomerular disease regardless of its type.
partum careful obstetrical/nephrological counceiling of these casuistically observed wo- To test the validity of urinary C5b-9 measurement logistic regression with determination men. Pregnancy in RTR does not bring excessive risk of graft function deterioration.
of the area under the ROC curve was used. The area under the curve (0,831) has confir-med good to excellent test. Due to rather small numbers of patients in different diagno-stic groups, we could not test the prognostic validity of urinary MAC in each type of glo-merular disease. The same reason as well as a short observational time prevented us totest the validity of urinary MAC determinations in progression of glomerular diseases.
Conclusions: Urinary C5b-9 determination proved to be a promising tool to predictmore favourable course of major PGN, mainly partial or complete remission. Its validityto predict a progressive course of different primary glomerulonephritides has yet to beconfirmed THE INFLUENCE ON LIPID SPECTRUM OF CONSECUTIVE PATHO- AGREEMENT BETWEEN CLEARANCE OF CREATININE AND ESTI GENETIC TREATMENT OF PATIENTS WITH NEPHROTIC SYNDROME MATING GLOMERULAR FILTRATION RATE IN PATIENTS WITH (NS) USING LOW MOLECULAR WEIGHT (LMWH)/CONVENTIONAL CHRONIC RENAL FAILURE Lezaic V1, Ristic S1, Stosovic M1, Dajak M2, Dokic Z1, Obradovic I (Belgrade, Serbia) 1 Institutes for Urology and Nephrology Danylo Halytskyi National Medical University, Lviv, Ukraine Pekarska Str. 27 / 5, 2 Medical Biochemistry, Clinical Center of Serbia 79008 Lviv, Ukraine Background: A great number of mathematical equations have been developed over the years in order to provide physicians with the best glomerular filtration rate GFR esti- Hyperlipidemia (HL) of NS pts is considered to be a risk factor for atherosclerosis deve- mate (eGFR) possible. The present study analyzes whether the classic clearance of lopment and kidney injury progression.
creatinine (Ccr) could be replaced by simple prediction equations based on sCr or cysta-tin C plasma concentration.
Methods:Today, we summarize the 15-year experience of the nephrology clinic of our university Methods: The study involved 404 adult patients (185 men, mean age 59.83±14.89 ye- in the pathogenetic treatment of the named pts with LMWH/CH. Observed NS pts ars, range 19 to 85 years), referred to Outpatient Department during one month to per- were treated with 2 consecutive 10-day monotherapy (MT) courses: first LMWH (90 form renal function or regular nephrology control. Each routine visit includes complete IU/kg b.w. s/c twice a day), then CH (2,5-3 mg/kg b.w. s/c 4 times a day) [group I] or CH- blood (serum creatinin concentration-sCr and cystatin C-cyst C), and urine analysis, with MT alone [group II].
24 h urine collection. Ccr was additionally estimated using Cockcroft–Gault (C-G) equa-tion, and the abbreviated MDRD study equation (both based on sCr), and GFR based on Cyst C. Based on GFR MDRD values, patients were classified into subgroups in accor- Lipid-lowering influence of LMWH-MT was observed in 50,5 %, while such an effect of dance with the chronic kidney disease (CKD) classification of the NKF. The urinary pro- CH-MT – in 43% and 42,8% in groups I and II, respectively. In NS pts by acute glomeru- tein/creatinine ratio on the random spot urine specimen was used for estimation of total lonephritis, LMWH-MT more frequently decreased the elevated TG (69 %), LDL daily protein excretion. The following variables were considered for analysis: age, gen- (56,6 %) and Chol. (60 %) levels, than CH-MT „per se" (in 50 %, 52% and 43% of pts, der, underlying kidney disease, and all laboratory analyses and calculations.
resp.). The hypocholesterinemic effect of LMWH-MT was confirmed even in pts withprimary high Chol. (up to 2-3fold) content, while the decrease or normalization of TG Results: 16 studied patients have stage 1 CKD, 118 patients stage 2, 188 patients was observed predominantly (86,6%) in pts with the latter parameter not exceeding 4,2 stage 3, 57 patients stage 4, and 25 patients stage 5. The agreement between sCr and mmol/l. LMWH-MT induced normalization (58,9 %) or positive dynamics (41,1%) of HL cyst C (ICC 0.781), and between proteinuria for 24 h and urinary protein/creatinine ratio type (predom. from IIb type) almost twice as frequently (64,7%), than CH-MT. On the expressed in mg/g of urinary creatinine (ICC 0.931) was excellent. Furthermore, accep- other hand, CH-MT twice as frequently as LMWH-MT increased the HDL content in table agreement between CCr and C-G eGFR (ICC 0.630), CCr and MDRD eGFR (ICC groups I and II (p<0,02; p<0,05, resp.) and lowered the coefficient of atherogenicity. In- 0.739), and CCr and Cyst C eGFR (ICC 0.468) was found out. Multivariate analysis iden- dividual TG and HDL levels (the decrease of the former and elevation of the latter) prove tified CKD group, patient's age and gender, which independently correlated with the dif- to be predictors of the beneficial effect of mentioned treatment mode. These anticoa- ference between eGFR and CCr, sCr and Cyst C and 24 h PRT and PRT/uCr. No sy- gulants have also a positive influence on lipid peroxidation.
stemic bias was disclosed between sCr and cystatin C (mean difference 0.0794, 95%CI 0.0561 /0.215, p=0.249) and between MDRD-GFR estimation and Ccr (mean diffe- rence –0.684 ml/min, 95% CI –2.715 / 1.478, p= 0.562). Paired t-test disclosed sy- Hence, LMWH in mentioned therapeutic doses has obvious advantages over CH in stemic overestimation between Ccr by C-G eGFR estimation (mean difference –9.115 such pts, whereas the relative high price of various LMWHs limits their wide application ml/min, 95% CI –11.82 / -6.41, p< 0.0001), Ccr by Cyst C based eGFR (mean difference in the management of NS pts in contemporary nephrology.
–7.89 ml/min, 95% CI –13.66 / -2.12, p= 0.008). Additionally, paired t test disclosed mar-ked systematic overestimation of proteinuria by urinary protein/creatinine ratio (meandifference 0.138, 95% CI 0.032 / 0.245, p= 0.011). From these results adequate formu-las were derived. Conclusions: Obtained results showed that serum Cyst C and all eGFR equation couldbe used in everyday practice for measurement of kidney function. Further analyses arenecessary to check accurate of the obtained formulas.
NT-pro-BNP BUT NOT BNP IS A PROGNOSTIC MARKER FOR LEGAL VERSUS MEDICAL-ETHICAL ISSUES IN TERMINATION OF CARDIAC EVENTS IN PATIENTS ON HEMODIALYSIS CHRONIC HEMODIALYSIS DUE TO PATIENT'S REFUSAL AND Dapra M, Kogler R, Lechleitner P (Lienz, Austria) PARANOID PSYCHOSIS (A CASE OF TRIAL) Abteilung für Innere Medizin A.ö. Krankenhaus Lienz E.v. Hiblerstr. 5 Bratusch-Marrain P A-9900 Lienz, Austria Landesklinikum Waldviertel Horn Spitalgasse 10, A-3580 Horn, Austria The aim of the study was to compare the diagnostic and prognostic performance of Case history: A 72 year old woman with endstage kidney disease on hemodialysis for BNP with that of NT-pro-BNP in respect of systolic and diastolic left ventricular function 1,5 years and multiorgan dysfunction (intermittent paranoid phases, sever cardial insuf- as well as cardiovascular complications in patients at a dialysis center.
ficiency, sever general physical weakness and total dependency on 24 hour home care)convincingly and repeatedly expressed her desire for withdrawal of further dialysis. The- reafter cerebral and physical status deteriorated and dialysis was withdrawn for legal BNP and NT-pro-BNP were measured in blood samples taken from 28 patients before (patient's will) and medico-ethical (final stage of life) reasons. However, despite of prior and after hemodialysis at the time of study entry as well as after 3 and 12 months.
acceptance, the patient's son applied for custodianship, demanded further dialysis Changes in these parameters were followed and compared with systolic and diastolic (which was continued after 4 weeks of cessation until the patients death after another left ventricular function (by echocardiography) and cardiovascular events (hospitalization month of dialysis) and accused the nephrologist in charge of being responsible for his due to left ventricular decompensation or acute coronary syndrome and cardiovascular mother's early death due to interruption of hemodialysis.
death). The duration of follow-up was 2 years.
In the pre-trial proceedings, the case was taken up by the state prosecutor, who orde- BNP (mean value 863 pg/ml) and NT-pro-BNP (12892 pg/ml) levels were markedly ele- red an expert opinion by a forensic pathologist who suspected damage to inner organs vated in our patients. The dialysis procedure significantly reduced BNP (p<0.001) but by interruption of dialysis (i.e. grievous bodily harm). At present, judicial inquiries are not NT-pro-BNP levels. Whereas patients with systolic dysfunction had significantly hig- her BNP (mean, 1935 vs. 608 pg/ml) and NT-pro-BNP levels (25819 vs. 7961 pg/ml) thandid patients with normal systolic function, with regard to diastolic dysfunction this was only true for NT-pro-BNP (15959 vs. 5359 pg/ml). At study entry NT-pro-BNP values This case exemplifies the enormous challange of clinical-medical decision making in he- were significantly higher in patients who subsequently experienced complications modialysed patients in critical condition. Management guidelines, although scrupulously (n=12) compared with the event-free group (20585 vs. 9134 pg/ml mean; p=0.019).
describing technical details and management of patients, only vaguely elaborate on et- This was not true for BNP (1147 vs. 863 pg/ml; p= 0.155).
hical and practical issues in terminal situations as to initiation or withholding/withdra-wing dialysis.
Conclusions:Both BNP and NT-pro-BNP levels were markedly elevated in hemodialysis patients; those with systolic dysfunction had significantly higher levels. Hemodialysis reduced Beyond question, nephrologists at the bed-side should be backed up by clear decision BNP but not NT-pro-BNP. NT-pro-BNP, but not BNP levels were significantly higher in guidelines published by distinguished competent Associations and accepted by the me- patients with diastolic dysfunction and in those who subsequently experienced compli- dical and judicial community, e.g. withdrawal of dialysis in previously mentally compe- cations. In hemodialysis patients, the prognostic performance of NT-pro-BNP with re- tent patients, or in patients suffering from irreversible profound neurological and psych- spect to cardiovascular events appears to be better than that of BNP.
iatric impairment such as dementia and psychosis.
FACTORS INVOLVED IN VASCULAR CALCIFICATION AND NEW CONTRIBUTIONS TO THE MULTIFACTOR CHARACTER OF ATHEROSCLEROSIS IN CHRONIC HAEMODIALYSIS PATIENTS BALKAN ENDEMIC NEPHROPATHY ETIOLOGY Vaduva C, Cana Ruiu D,Toader D, Mota E (Craiova, Romania) Nikola M. Pavlovic3, William H. Orem1, Calin A. Tatu2, Harry E. Lerch1, Vuk Maksimovic4, Nephrology Clinic, County Emergency Hospital Craiova, Romania Jelena Maksimovic4, Joseph E. Bunnell1 and Emina N. Kostic5 (Nis, Serbia)1 US Geological Survey, 956 National Center, Reston, VA, 22092 USA 2 University of Medicine and Pharmacy „Victor Babes", Timisoara, Romania Atherosclerosis and vascular calcifications are common causes of morbidity and morta- 3 Institute of Biomedical Research, Medical Faculty, University of Nis, Nis, Serbia4 Institute for Multidisciplinary Research, Belgrade, Serbia lity in chronic haemodialysis patients.Aim of study is to evaluate the degree of athe- 5 Clinic of Nephrology, Medical Faculty, University of Nis, Serbia rosclerosis and vascular calcifications in chronic haemodialysis patients using non-inva-sive methods.
Background: Balkan endemic nephropathy (BEN) occurs in Serbia, Bulgaria, Romania, Bos-nia and Herzegovina, and Croatia. BEN has been characterized as a chronic, slowly progressive renal disease of unknown etiology. The first cases described in Serbia and Bulgaria date to the The study included 40 patients (28 males,12 females), aged 25 – 75 years, who were late 1950's. The etiology of BEN has been the extensively studied ever since which resulted in on haemodialysis treatment for 10 – 192 months (mean dialysis vintage 81,8 months).
publication of numerous hypotheses. The concepts presented within these hypotheses indica- We assessed the following circulating parameters: Calcium, Phosphorus, Ca x Phos- ted to various extents their relevance to the etiology of BEN, but none of them has provided phorus product, CRP, Cholesterol LDL, HDL, Triglycerides. Intima - media tickness index conclusive evidences related to BEN etiology and its clinical characteristics. Due to these in- of common carotid arthery (CCA-IMT) and the presence of cervical artery atherosclero- consistencies and various features of the disease, most researchers favor the idea of a multi- tic plaques were evaluated by ultrasonography. We excluded the patients with acute factorial etiology for BEN. On the ground of all these previously published hypotheses we cardiovascular episode or arrhythmias, diabetes mellitus and active infection or non-in- think that idea about the multifactor etiology is the hall-mark of BEN. Accepting the concept of fectious overt inflammation. 64% of patients received calcium carbonate as phosphate multifactor hypothesis seems rational, as this would help explain why BEN etiology has been binder and 77 % of patients received active vitamin D3 (alphacalcidol).
so difficult to define for the last 50 years.
Methods: In our study we tested the possible simultaneous role of coal-derived toxic organic compounds and decreased enzyme LCAT activity in the etiology of BEN. In order to examine Atherosclerotic plaques were found in 28 patients (69 %).The number of atherosclero- the possible bifactorial character of BEN etiology, we examined the influence of soluble or- tic plaques was significantly correlated with age, CRP and serum phosphorus. CCA-IMT ganic compounds in drinking water supplies on plasma LCAT activity, using organic matter of entire patients group ranged from 0.3 – 1.0 mm.CCA-IMT was directly correlated concentrates from drinking water collected from BEN villages and control sites. Controlplasma samples were prepared from human blood. LCAT activity kits (Roar Biomedical, New with inflammatory status (CRP > 6 mg/dl) and dialysis vintage and no correlations were York, NY, USA) were used for the measurement of LCAT activity with fluorescence detection.
found for the following parameters: Cholesterol LDL, HDL, Triglycerides, Ca, P, CaxP.
Fluorescence was recorded using a Fluorolog-3 spectrofluorometer (HORIBA, Jobin Yvon,France) in a 1 ml quartz cuvette, at a 90 angle.
Conclusions:In addition to classic risk factors the degree of atherosclerosis and vascular calcificati- Results: We found that changes for all samples were the most prominent for the dilution ca- ons were associated with some factors that are frequently abnormal in advanced chro- tegory containing 90% plasma and 10% of diluting media. Water samples from BEN villages nic renal failure.CCA-IMT remain a predictive factor for early atherosclerosis develop- from Serbia and Romania showed higher LCAT inhibiting activity (p = 0.02) and (p = 0.003), re- ment in uraemia.The presence of inflammatory status in uremic patients appears to spectively, compared to deionised water and non-endemic water. A secondary LCAT defi- predispose of the acceleration of atherosclerosis and cardiovascular complications in ciency could result from this inhibitory effect of the organic compounds found in endemic wa- dialysis patients.
ter supplies and provide an ethiopathogenic basis for the development of BEN in thesusceptible population.
Conclusions: On the basis of these results we hypothesize that organic compounds in drin-king water from BEN villages, inhibit LCAT activity and thus may cause plasma lipid abnormali-ties and consequent changes of cellular membrane lipid composition that can trigger the patho-genic mechanisms responsible for the development of BEN. The extent and characteristics ofcellular membrane lipid alterations caused by this factor's LCAT inhibiting activity and their role inthe etiology of BEN and associated urothelial cancer remains to be elucidated. Our ongoingwork is exploring the contribution of factors mentioned in this study to multifactor etiology andoccurrence of BEN as a global issue in order to determine the role of environment in human pa-thology. BEN and associated urothelial tumors linked to these factors may be widespread.
IS THE SF-SACRAH ABLE TO SCREEN A NEPHROLOGIC PATIENT PROTEIN-ENERGY WASTING, CHRONIC INFLAMMATION AND COHORT FOR HAND DISORDERS? PUFAs: MARKERS OF ATHEROSCLEROSIS IN ESRD Sautner J1,2, Kramar R1, Leeb BF2 (Wels, Stockerau, Austria) Perunicic-Pekovic G1, Rasic-Milutinovic Z1, Sobajic S2, Djuricic I2 and Maletic R3 1 Klinikum Wels-Grieskirchen, 3. Med.Department (Belgrade, Serbia) 2 Landesklinikum Weinviertel Stockerau, 2. Med. Department 1 Department of Nephrology and Endocrinology, University Hospital Zemun2 Faculty of Pharmacy, 3 Faculty of Agriculture,Belgrade, Serbia The SF-SACRAH is a score for the assessment of rheumatologic hand disorders andhas already been applied and validated in patients suffering from Hand Background: The patients with end-stage renal disease (ESRD) include significant per- Osteoarthritis(HOA) and Rheumatoid Arthritis (RA). Aim of this study was to test its ca- centage of malnourished patients together with other risk factors: dyslipoproteinaemia, pability as a screening instrument for rheumatologic and other hand affections in a pri- insulin resistance, increased oxidative stress, inflammation, and they all together impair marily non-rheumatologic patient cohort.
endothelial function. Nutrition, glycoregulation disorders and insulin resistance as etiolo-gic factors participate a great deal in premature atherosclerosis. Basic mechanism of these disorders are connected with changes in cell functions on the membrane level.
Between November and December 2006 a total of 182 patients (104 renal transplant These basic discoveries help us in understanding the damage process of endothelial recipients (RTR), 78 hemo- or peritoneal dialysis patients (DP)) filled in the and appearance of its dysfunction by inflammation process and by lipid peroxidation questionnaire. Mean age of the overall patient cohort was 55.3 years (DP: 60.3, RTR: 52 process. We examine association between atherosclerotic risk factors and nutritional years), 78 were female, 104 male.
status in hemodialysis patients.
The mean SF-SACRAH value in an earlier study of 247 RA and HOA patients was 2.1.
This value was taken as an arbitrary cut-off. A score exceeding 2.1 should identify pa- Methods: Forty three hemodialysis patients were examined (20 males, 23 females, tients with hand disorders. Subsequently all patients were clinically examined and divi- 55±12 years). Nutritional and inflammatory markers were measured. All blood samples ded into rheumatologically asymptomatic patients (ASY), patients with HOA or RA,and were obtained immediately before the dialysis session. Plasma albumin, transferrin, patients with other disabling conditions of the hands (MISC).
and lipids were measured by routine laboratory methods. Plasma hs-CRP level, TNF-al-pha, and IL-6 were measured by enzyme-linked immunosorbent assay (ELISA). Body mass index was recorded. We examined plasma phospholipids content by gas chroma- According to the clinical examination 101 (55 %) patients were assigned ASY, 65 tography. We used the Kaplan-Meier method to estimate the crude probability of cardio- (36%) patients showed a rheumatologic hand disorder (63 HOA and 2 RA). In 16 vascular mortality, associated with tertiles of CRP level. We used standard Doppler (9%)patients MISC (Dupuytren-contracture, Carpal tunnel syndrome etc.) were found.
echo examinations to determine plaque on carotid arteries.
Total SF-SACRAH amounted to 0.6 (1.6) (Median (IQR)).
While there was no significant difference between the SF-SACRAH in ASY (0.8 (1.2)) Results: Significant negative correlation between serum level of CRP and macroangio- and HOA patients (1.3 (2.5)), it differed significantly between ASY and RA patients(3.8 pathy was found. There was a negative correlations between serum albumin concen- (2.8)); (p=0.04 Mann Whitney U-Test).
tration and inflammatory markers (r= -0.31; p=0.05). There was significant positive cor- With the chosen cut-off of 2.1, the sensitivity of the SF-SACRAH to predict relation between arachidonic acid (AA) and high sensitivity C-reactive protein (hs-CRP).
rheumatic hand disorders was 0.44. When adding MISC patients, it amounted to 0.52.
Significant correlation was found between body mass index (BMI) and n-3 fatty acids.
The specificity for the respective cohorts of patients was 0.89.
The probability of death increased significantly in the upper tertile of CRP levels (test for The positive predictive value of the SF-SACRAH amounted to 0.72 for rheumatic trend: p < 0.01).
patients, when adding MISC patients it increased to 0.8.
The respective figures for the negative predictive value were 0.71 and 0.69.
Conclusions: The main findings of this study were that the decrease of nutritionalparameters in HD pts were related to degree of inflammation. Increasing inflam- mation and endothelial dysfunction predict the development of vascular disease.
The SF-SACRAH proved its capability as a screening tool for rheumatic hand disorders We report the relationship between inflammatory markers and nutritional parame- in a primarily non-rheumatologic patient cohort for the first time. This study revealed a ters indices of atherosclerosis and other cardiovascular risk factors in patients on number of persons affected with different disorders of the hand.
Therefore the potential use of the SF-SACRAH to screen other non-rheumatologicpatient cohorts is worth being considered.
HYPERPHOSPHATEMIA - COMPARISON OF TWO ESTABLISHED BIOSIMILAR EPOETIN: EVIDENCE-BASE AND IMPLICATIONS OF A PHOSPHATE BINDERS (ALUMINUMHYDROCHLORIDE VS. RANDOMIZED TRIAL IN 568 PATIENTS ON HEMODIALYSIS WITH ALUMINUMHYDROXIDE) ON THE PLASMA PHOSPHATE- Ammer R., for the HX575 study group (PI Haag-Weber, 50 centers in Germany, 9 cen- Ammer R., for the Jahn study group (PI Friedrich Jahn) (Münster, Germany) ters in Austria) (Münster, Germany) Universitätsklinikum Münster Med D - Nephrologie Universitätsklinikum Münster Med D - Nephrologie Albert-Schweitzer-Strasse 3 Albert-Schweitzer-Strasse 3 D - 48149 Münster and MEDICE Arzneimittel, 58638 Iser- D - 48149 Münster and MEDICE Arzneimittel, 58638 Iserlohn & 5400 Hallein lohn & 5400 Hallein Aluminumhydrochloride and aluminumhydroxide are well-established phosphate bin- Biosimilar epoetin approved by EMEA and EU commission broadens the therapeutic ders for the treatment of hyperphosphatemia in patients with chronic renal insuffi- options in renal anemia. To judge on their relevance scientific discussions require awa- ciency. Little has been known on the pharmacological difference of both substances.
reness of the evidence base collected in the trials for marketing authorization.
30 hemodialysis patients were randomized to treatment of either 2.7 g aluminumhydro- The multi-center trial (50 German, 9 Austrian centers) on A BioSsimilar Epoetin Alfa chloride (= 518 mg aluminium) or 2.0 g aluminumhydroxide (= 565 mg aluminium) for 4 (Abseamed®, MEDICE) enrolled 568 patients on hemodiaysis with hemoglobin (Hb) le- weeks in a single cross-over design study. Serum phosphate was assessed once per vels 10.0-13.0 g/dl; 478 eligible patients were randomized 2:1 to Abseamed® (i.v.) or week pre- and post-dialysis 4 weeks prior to control and during the treatment phase. Erypo® (i.v.) based on a 1:1 dose conversion. After 28 weeks both regimens were as-sessed for therapeutic equivalence defined as mean absolute change in Hb levels < 0.5 g/dl between baseline and evaluation period. The objective was to maintain stable Hb Treatment of the patients with Aluminumhydrochloride was followed by a marked de- levels (maintenance phase). crease of pre-dialytic plasma phosphate. Within 4 weeks, values significantly decreased After week 28 all patients were switched to the biosimilar epoetin to collect further effi- by 17%. The subsequent replacement of aluminumhydrochloride with aluminumhydro- cacy and safety data for 1 year.
xide resulted in a significant increase of plasma phosphate to a value 2% above the va-lue during the control period.
In the other regime, treatment of the patients with aluminumhydroxide first was follo- After 28 weeks the mean absolute change in Hb levels were 0.147 ± 0.092 g/dl in pa- wed by a significant decrease of the pre-dialytic plasma phosphate by 12% within 4 tients on Abseamed® and 0.063 ± 0.117 g/dl for patients on Erypo® resulting in a diffe- weeks. The subsequent replacement of aluminumhydroxide with aluminumhydrochlo- rence of 0.084 g/dl and meeting the criteria for therapeutic equivalence of both treat- ride resulted in a further significant decrease of plasma phosphate to a value 24% be- ment regimes (95% confidence interval [0.170; 0.338]). Hb levels remained stable low value obtained in the control period.
between 11.7 (9.5 – 14.9) g/dl and 12.0 (10.0-15.3) g/dl over the 28 weeks course in The effects of aluminumhydrochloride and aluminumhydroxide on post-dialytic plasma both groups with a cumulative dosage of 6800 to 7000 IE per week (i.v.).
phosphate were qualitatively similar to those on pre-dialytic values.
Safety data collected from patients on Abseamed® over 52 weeks and confirmed byELISA Assay, Radio-immun-prezipitation-test (RIP) and Neutralising Antibody Assay (NAB) revealed no difference to the reference product.
Both phosphate binders demonstrate a significant, but variable effect on both pre- andpost-dialytic plasma phosphate concentrations: in this cross-overs study aluminumhy- drochloride revealed to be more effective than aluminumhydroxide. The explanation is Despite the fact that biochemical analysis, pre-clinical investigations, pharmacokinetic not the difference in dosage as the relevant component is aluminum, which is actually and pharmaco-dynamic profile underline the close similarity of Abseamed® to the refe- lower in aluminumhydrochloride than in aluminumhydroxide. rence, further long-term clinical safety data need to be collected in post-marketing sur- In contrast to aluminumhydroxide, aluminumhydrochloride does not require the activa- veillance programs to judge on the safety profile of biosimilar epoetin. tion of the ion by gastric acid and can be taken during meals. In consequence, alumi- Subcutaneous (s.c.) administration in renal patients is not approved yet as the trials numhydrochloride binds phosphate ions more effectively.
were conducted at a time when the reference product was not eligible for s.c. use.
Subcutaneous administration is approved for the treatment of chemotherapy associa-ted anemia proven by the trial in cancer patients addressing the correction phase.
THE IMPACT OF LONG CHAIN N-3 POLYUNSATURATED FATTY ACID NOCTURNAL POLYURIA IN CHILDREN WITH CHRONIC SUPPLEMENTATION ON INFLAMMATION, INSULIN SENSITIVITY AND CVD RISK IN A GROUP OF END STAGE RENAL DISEASE Peco-Antiç A1, Marinkoviç J2, Krusciç D1, Kostiç M1, Paripoviç D1, Spasojeviç B1, PATIENTS ON HEMODIALYSIS Staniç M1, Milosevska G1 (Belgrade, Serbia) Zorica Rasic-Milutinovic1, Perunicic-Pekovic G2, Sobajic S3, Djuricic I (Belgrade, Serbia) 1 University Children's Hospital, Belgrade, Serbia 1 Dep. of Endocrinology, University Hospital Zemun-Belgrade, Serbia 2 Institute for Medical Statistics and Informatics, School of Medicine, Belgrade, Serbia 2 Dep. Of nephrology and dialysis, University hospital Zemun-Belgrade, Serbia3 Faculty of Farmacy, Belgrade, Serbia Background:Similar to blood pressure, urinary flow rate (UFR) express circadian rhythm, being hig- her in the active phase during the day, than in the resting phase during the night. A non- Chronic inflammation and reduced insulin sensivity are strongly related to the risk of dipping pattern of nocturnal diuresis has been recognized as an early sign of progres- cardiovascular disease (CVD) in end stage renal disease (ESRD) patients maintenance sive chronic kidney disease.
on hemodialysis (HD). The metabolic benefits of long chain (LC) n-3 polyunsaturated The aim of this study was to assess the prevalence of nocturnal polyuria and its relati- fatty acid (n-3 PUFA) may be attributable to its anti-inflammatory properties. To investi- onship with urinary excretion rates of protein (UPRT), sodium (UNa)and creatinine (UCr) gate whether an individual's inflammatory status influences the impact of a LC n-3 in children with chronic glomerulopathy and normal (CKD1), or decreased glomerular fil- PUFA intervention on insulin resistance as CVD risk .
tration rate (CKD2-4).
Thirty five HD patients (group 1 with higher level of hs-CRP and group 2 with lower In 54 pts (19 boys) aged 11.63±4.29 years with chronic glomerulopathy confirmed by level of hs-CRP) were randomized to received LC n-3 PUFA capsules (2.4g per day, renal biopsy, urinary samples for UFR, UNa, UPRT and UCr were collected during day- EPA:DHA 2:1) for 8 weeks, and 15 health subjects were control group time (6:00 to 22:00) and nighttime (22:00 to 6:00) and were expressed as hourly excre-tion per body surface area. Patients with massive edema or those under diuretics were not included, as well as the patients with nocturnal enuresis. Nocturnal polyuria was de- Baseline data were analysed using one-way anova, differences between treatment fined as nighttime UFR > 35% of whole 24 h UFR. According to creatinine clearance groups and controls were calculated and analysed using a random effects model. RE- the patients were divided in CKD1 group (n 44; CrCl 131 ±3.62 ml/min/1.73 m2) and SULTS: At baseline, the raised inflammatory status group had significantly higher insulin CKD 2-4 group (n=10, CrCl 51.68 ±7.23ml/min/1.73 m2).
resistance level (HOMA-IR) than the other two groups. With LC n-3 PUFA supplementa-tion, both groups of patients showed significantly higher plasma eicosapentaenoic acid and docosahexaenoic acid (p < 0.01 and p < 0, 05) and lower arachidonic acid (p < Age, gender, body mass index of the patients as well as daytime and 24 h UFR and UCr 0.001 and p < 0.05), with reduced SFA/n-3 PUFA ratio(p < 0.04, and p < 0.06), after 8 and daytime UNa were similar in CKD1 and CKD 2-4. Significant nocturnal decline of weeks of supplementation. The difference in HOMA-IR between the two treatment UFR, UPRT, UCr, and UNa were found only in CKD1, while, the excretion rates of these groups at 8 weeks was significantly greater in the raised inflammatory status group parameters in CKD2-4 showed reversed circadian rhythm, being higher at night than du- compared to the reference group (p < 0.05). Inflammatory markers were significantly lo- ring the day. Nocturnal polyuria was more prevalent in CKD 2-4. Urinary excretion rates wer after 8 weeks LC n-3 PUFA supplementation compared to baseline (hs-CRP p < of UCr, UPRT and UNa clearly increased with urinary flow only in overnight samples, but 0.01 and TNFalpha p < 0.05), but there was no significant group effect.
not in over daytime samples. Night/day ratios of UFR, UPRT, UCr and UNa had signifi-cant negative relationship with creatinine clearance.
Conclusions:Chronic inflammatory status influences the impact of LC n-3 PUFA supplementation, but it is not clear whether the effect of LC n-3 PUFA on HOMA-IR is mediated through Nocturnal poliuria and increased nocturnal natriuresis, creatinuria and proteinuria may be markers of progressive chronic glomerular disease.
OMINOUS SIGNS 52 WEEKS PRIOR TO DEATH: EVOLUTION OF SYSTOLIC BLOOD PRESSURE, SERUM ALBUMIN AND BODY WEIGHT IN HEMODIALYSIS PATIENTS Peter Kotanko, Len Usvyat, Stephan Thijssen, Adam Tashman, Nathan W LevinRenal Research Institute, 207 East 94th Street, Suite 303, New York, N.Y. 10128, USA Background:Low and declining pre-dialysis sitting systolic blood pressure (preSBP) has been linkedto increased mortality in chronic hemodialysis (HD) patients. This study aimed to inve-stigate the dynamics of preSBP, serum albumin, and body weight in the 52 weeks pre-ceding death.
Methods:The temporal evolution of preSBP, serum albumin level and body weight was followedin prevalent chronic HD patients in Renal Research Institute and New York Dialysis Ser-vice units until death. Minimum observation time was one year. preSBP and postdialyticbody weight were recorded at each dialysis session, serum albumin once a month. Indi-vidual temporal trends were modeled by linear splines fitted over 2 time periods, na-mely between death and week -12 before death and between weeks -12 and -52, re-spectively. The slopes of the regression lines were compared by paired t-test.
Results:We studied 1,799 chronic HD patients, mean age (±SD) 69±14 years, 55% males, 52%whites, 40% blacks, dialysis vintage 44.4±40.4 months, 50% had diabetes mellitus,39% arterio-venous fistulae, 32% catheters, and 29% grafts. A fall of preSBP and serum albumin in the 12 weeks prior to death was observed in 65% of patients and was independent of race, gender, dialysis vintage and diabetesstatus. A fall in preSBP was less frequently observed in patients dying of cerebrovascu-lar disease. Between weeks -52 and -12 preSBP fell on average 0.16 mmHg per week(95% CI: 0.09-0.23); in the 12 weeks prior to death preSBP fell an average 0.56 mmHgper week (95% CI: 0.46-0.66). The difference between these 2 slopes was significant(P<0.0001; paired t-test). Serum albumin concentration decreased on average by 0.09g/L per week (95%CI: 0.05-0.13) between weeks -52 and -12 and by 0.5 g/L per week(95%CI: 0.42-0.57) between week -12 and death (P<0.0001; paired t-test). Post-dialysisbody weight changes did not differ between the two time periods.
Conclusions:Two out of 3 chronic HD patients experience a fall of pre-dialysis sitting SBP and serumalbumin 12 weeks prior to death. This is a robust finding independent of race, gender,age, vintage and diabetes. Serum albumin and preSBP may represent common termi-nal pathways of pathological processes such as inflammation, cardiovascular diseaseand malnutrition. Identification of patients with deteriorating preSBP and albumin mayresult in timely diagnostic and therapeutic interventions preventing premature demise.
Danube University Krems A trade exhibition will be held during the Symposium and is located Dr.-Karl-Dorrek Str. 30, 3500 Krems, Austria in the exhibition area.
The exhibition will follow this schedule:Thursday, August 28th 13 – 18 hours Friday, August 29th Krems is located about 80 kilometers west of Vienna and can easily be reached Saturday, August 30th 09 – 12 hours from Vienna by bus, car or train in 50 to 60 minutes. Authors are encouraged to submit their final manuscript for peer reviewed Registration & Information desk open at the following times: publication in Nephrology Dialysis & Transplantation.
Thursday, August 28th 7.30 – 18 hours Friday, August 29th 7.30 – 18 hours Certificate of attendance Saturday, August 30th 8.00 – 12 hours All registered participants will receive a certificate of attendance.
Hotel reservation Only MS Power Point projection will be available during the Symposium. Hotel reservation can be made by e-mail or fax, using the form available The Auditorium Maximum is equipped with a notebook. The use of personal on the website. Reservations received after June 30th 2008 will be booked notebooks will not be possible as we cannot guarantee proper connections. on a „space available basis".
Files must be prepared in Power Point 2000/2003 format on a CD-ROM or USBstick. Zip disks will not be possible. Speakers are advised to hand in the presentati- ons in due time to guarantee a smooth running.
PRIM.DR. REINHARD KRAMARKlinikum Wels-Grieskirchen / Nephrology & DialysisGrieskirchnerstr. 42, A-4600 Wels, Austria Phone: +43 7242 415 - 2174, Fax: +43 7242 415 - 3993 e-mail: info@dsn2008.at Posters will be displayed in the Poster Area located on the 1st floor of building B.
Authors should mount their posters on Thursday and leave them on display the en- tire symposium. They should dismount them on Saturday within 12.00. The poster panel measures 130 x 90 (height: 130cm, width: 90cm). Suitable fixing material Donau-Universität Krems will be provided.
Zentrum für Biomedizinische Technologie DAN cannot be deemed responsible for lost or stolen posters. Posters which are Dr. Karl Dorrek Str. 30 not dismounted within due time will be disposed off.
A-3500 KremsPhone: +43 2732 893 - 2633 Fax: +43 2732 893 - 4600 The official language is English. No simultaneous translation will be provided.
e-mail: info@dsn2008.at

The Danube Association of Nephrology and the ECO Plus NÖFRESENIUS Medical Care Austria GmbH Local Organizing Commit- MEDICE Arzneimittel GmbH tee for the 19th Danube NOVARTIS Pharma GmbHTECHNOPOL Krems Symposium of Nephro- logy wish to acknowledge the following Companies for their generous support AMGEN GmbHASTELLAS Pharma GmbH by unrestricted grants.
BRAUN B-Austria GmbHCENAVIT Nahrungsmittel GmbHGAMBRO Hospal Austria GmbHGENZYME Austria GmbHJANSSEN-CILAG Pharma GmbHROCHE Austria GmbHSANOVA Pharma GmbHTAKEDA Pharma GmbHWYETH Lederle Pharma GmbH Cardioprotective Haemodialysis –
more than dialysis Best Therapy for your PatientsBest Handling for all UsersOptimal Use of Resources The 5008 Therapy System allows you todeliver premium therapy to the patient with an optimal use of resources and with maximum comfort for all its usersand operators. 5008 – The Sustainable Haemodialysis Therapy System.
Fresenius Medical Care Deutschland GmbH · 61346 Bad Homburg v. d. H. · Germany · Phone: +49 (0) 6172-609-0 · Fax: +49 (0) 6172-609-2191

Source: http://dsn2008.at/download/dsn2008_FinProg_complete.pdf

Perearsti võimalused parandada oma 300 suitsetaja tervist

NICOTINE AND DRUG INTERACTIONS lung physician Tartu University Lung Clinic ABRUPT SMOKING CESSATION CAN AFFECT THE METABOLISM OF DRUGS.  When patients enter hospital they may have to stop smoking abruptly if the hospital has a ‘no smoking' policy.  Cigarette smoking induces the activity of human cytochromes P450 (CYP) 1A2 and 2B6.  Decreased CYP1A2 activity after smoking cessation

Pcrm dietary guidelines 2010 02 02_mk_2

Dietary Guidelines Goals and Recommendations Physicians Committee for Responsible Medicine Authors: Susan Levin, M.S., R.D. Neal Barnard, M.D. Preamble The U.S. Government has promulgated dietary guidance in various forms throughout much of the last century. In recent decades, two major trends have occurred: First, the dietary problem of undernutrition has been eclipsed by an epidemic of overnutrition. More Americans are now overweight or obese than at any time in history. Diabetes, cardiovascular disease, and cancer are now commonplace, exacting costs that are both personal and financial. Abundant scientific information has established the role of nutrition in health, but much of this information has yet to be incorporated into practical dietary guidance for the benefit of the public. Although scientific knowledge has moved swiftly forward, nutritional guidelines have progressed only sluggishly. We therefore sought to establish a set of dietary guidance materials that serve the current needs of the public, based on current scientific knowledge. We first established eight general objectives for the guidance document. We then sought evidence-based materials that quantify nutritional needs and examined the most healthful sources of the essential nutrients.