Third edition of "Kidney diseases" is improved monography on all aspects of kidney diseases and related disorders, written in slovenian language and dedicated to slovenian nephrologists, internists and family practitioners.
C.02 Editorial board of a national monograph
COBISS.SI-ID: 77338881Proceedings book was published and symposium was organized celebrating 30. anniversary of peritoneal dialysis in Slovenia.
C.07 Other editorial board
COBISS.SI-ID: 276545280Background: By comparing ultrasound - Doppler measurements with biopsy results in a retrospective study, we found that a bigger value of resistive index (RI) was associated with acute tubular necrosis (ATN) and that a bigger ratio of parenchyma thickness and kidney length, named parenchyma size index - PSI, was associated with ATN and acute rejection in a transplanted kidney. We wanted to test these results in a prospective study on a different population of patients. Hypotheses: 1. The ratio parenchyma thickness/ kidney length (PSI) is bigger in patients with acute rejection and acute tubular necrosis (ATN). 2. The value of resistance index (RI) is bigger in patients with ATN but does not differ in patients with acute rejection. 3. The ratio parenchyma thickness/ kidney length (PSI) is smaller in patients with chronic damage of transplanted kidney. 4. The value of resistance index (RI) and the ratio parenchyma thickness/ kidney length (PSI) is bigger in patients with ATN in a short period after the kidney transplantation. Methods: We tested the hypotheses with a comparison of patho-histologic results of transplanted kidney biopsies with ultrasound - Doppler measurements of PSI and RI. First the analysis was made in the whole group of patients, which was then divided on two subgroups. In one were patients who had a biopsy immediately after transplantation and in the other were those who had the biopsy later after transplantation. Results: 83 cases of kidney biopsy were included in the study. There were 20 cases in the group immediately and 63 later after transplantation. In the whole group the average value of PSI in acute rejection / ATN was 1.51 (±0.28) / 1.58 (±0.34) and in the absence of acute rejection / ATN it was 1.30 (±0.22) / 1.34 (±0.22); p ( 0.001. The average value of RI in acute rejection / ATN was 0.75(±0.10) / 0.93 (±0.08) and in the absence of acute rejection / ATN it was 0.77 (±0.10) / 0.74 (±0.09); p = 0.73 / p ( 0.001. The average value of PSI in chronic changes was 1.29 (±0.19) and in the absence of chronic changes it was 1.59 (±0.27); p ( 0.001. In the group immediately after transplantation the average value of RI / PSI in ATN was 0.93 (±0.08) / 1.57 (±0.33) and in the absence of ATN it was 0.68 (±0.03) / 1.44 (±0.19); p ( 0.01 / p = 0.74. Conclusion: In transplanted kidneys the average value of PSI is statistically significantly bigger in acute rejection and ATN and smaller in chronic changes. The average value of RI is bigger in ATN and not different in acute rejection. In the group immediately after transplantation the average value of RI is statistically significantly bigger in ATN. In this group the value of PSI is bigger but not statistically significantly.
D.09 Tutoring for postgraduate students
COBISS.SI-ID: 275627776Purpose: To evaluate platelet-related hemostasis during hemodialysis performed with five different anticoagulation methods. Methods: 31 chronic hemodialysis patients, 71% men, aged 57,5 ± 17,4 years, participated in our prospective study. Platelet function analyzer PFA-100 closure time (collagen/epinephrine – CEPI, collagen/adenosine diphosphate – CADP) was measured before and after hemodialysis, which was performed consecutively with five different anticoagulation methods: full-dose unfractionated heparin (UFH) and low-molecular weight heparin (LMWH) 31 patients; regional citrate anticoagulation (RCA) 28 patients; low-dose heparin 25 patients and ''heparin-free'' dialysis 9 patients. In addition, activated partial thromboplastin time (aPTT) and prothrombin time (PT) were measured before and after HD. The degree of clotting in the dialysis system was graded on a 5-point scale (1 – the worst outcome, 5 – the best outcome). Post-hemodialysis hemostasis was assessed by vascular compression time. Results: CEPI (mean ± SD, reference range 80–160 sec) before vs. after hemodialysis: UFH: 171,7 ± 62,1 vs. 170,8 ± 67,3; LMWH: 167,4 ± 56,9 vs. 159,4 ± 56,4; RCA: 172,6 ± 57,4 vs. 161,6 ± 57,0; low-dose heparin: 175,3 ± 69,0 vs. 183,1 ± 60,5; ''heparin-free'': 181,7 ± 56,8 vs. 209,0 ± 66,5; all differences were nonsignificant. CADP (mean ± SD, reference range: 68–121 sec) before vs. after hemodialysis: UFH: 132,0 ± 56,6 vs.146,3 ± 68,4; LMWH: 132,4 ± 57,0 vs. 123,1 ± 50,8; RCA: 140,7 ± 48,2 vs. 132,9 ± 48,1; low-dose heparin: 137,2 ± 64,2 vs. 143,8 ± 55,5; ''heparin-free'': 137,1 ± 68,0 vs.139,2 ± 29,7; all differences were nonsignificant. Before hemodialysis procedure CEPI was increased in 51,2% and CADP in 48,4% of the patients. The degree of clotting in the dialyzer and drip chambers (mean±SD): UFH: 4,3 ± 0,8/4,8 ± 0,5; LMWH:4,2 ± 0,8/4,5 ± 0,8; RCA: 4,3 ± 0,7/4,8 ± 0,5; low-dose heparin: 3,4 ± 1,2/3,8 ± 1,1; ''heparin-free'': 2,6 ± 0,5/3,0 ± 0,8. aPTT was significantly increased after dialysis with UFH (p=0,000), LWWH (p=0,000) and low-dose heparin (p=0,002). There was no significant difference in PT. There was a significant difference between the five methods considering the degree of clotting in the dialyzer (p = 0,0148) and the drip chambers (p = 0,0006). When comparing vascular compression time after dialysis no statistically significant difference was found between the five methods. Conclusions: Platelet dysfunction was demonstrated in approximately half of the chronic hemodialysis patients and was not improved after hemodialysis, regardless of the anticoagulation regimen used. Activated partial thromboplastin time was significantly increased after dialysis with anticoagulation methods that contained heparin. There was no significant difference in prothrombin time. We showed a tendency of platelet dysfunction improvement with RCA and LMWH. The best dialysis system clotting outcome was found with UFH, LMWH and RCA, but none of the three methods turned out to be significantly better. No correlation was found between coagulation times (aPTT, PT) after dialysis and dialysis system clotting outcome. What is more, no correlation was found between closure times (CADP/CEPI) before and after dialysis and dialysis system clotting outcome.
D.09 Tutoring for postgraduate students
COBISS.SI-ID: 271759872Introduction. Native arteriovenous fistula (AVF) remains the best vascular access for chronic hemodialysis patients due to its high patency rates with the lowest number of interventions and complications. Placement and maintenance of a permanent vascular access is particularly challenging in patients aged ≥ 65 years and those with risk factors (e.g. female gender, diabetes) because of their poor quality of the vessels. Preoperative ultrasonographic (US) examination of veins and arteries is an useful and non-invasive method for identifying suitable veins and arteries and therefore increasing the number of placed and matured AVFs. The aim of this study was to test the hypothesis that based on preoperative US examination of vessels on both arms and forearms and regardless of sex or the presence of diabetes, elderly patients have suitable vessels for construction of a usable AVF (hypothesis 1). The secondary aim of the study was to evaluate the following hypotheses: there is no significant difference in survival of a native AVF in relation to patient gender or diabetic status (hypothesis 2), that arterial calcifications in the forearm and arm are present in the majority of elderly patients (hypothesis 3) and they are an independent predictor of an abandoned AVF (hypothesis 4). Methods. Patients with advanced or end-stage kidney disease, aged ≥ 65 years were enrolled in this retrospective study with prospective follow-up. Before the first conduit was created, preoperative duplex US imaging of vessels of arms and forearms was performed. The following clinical and demographic parameters were recorded: age at the time of US examination, gender, diabetes status and inclusion in the chronic dialysis programme. AVFs were constructed by an interventional nephrologist. US examination, performed by a nephrologist between January 1, 2005, and June 1, 2011 using a linear 7 MHz probe and an Acuson 128 XP/10 or Siemens Acuson Sequoia 512 ultrasonography monitor, were analyzed. US parameters of vessels and possibility of construction of AVF were compared in terms of gender and diabetes status. Primary failure rate was calculated. Kaplan–Meier survival analysis was used to estimate primary and secondary (functional) patency rates. Patency rates were compared by log-rank test in relation to patient gender or diabetic status. Univariate and multivariate Cox proportional hazard models were used to determine the effect of factors considered relevant to AVF loss (female gender, diabetes, age ≥ 75 years, start of chronic hemodialysis, US documented atherosclerotic changes and arterial calcifications). Results. 214 incident patients participated in the study (89 females, 125 males, aged 75.5 ± 6.0 years), 89 (41.6%) were diabetics, 106 (49.5%) were already treated by chronic hemodialysis. Potentially usable vessels were noted in the majority of patients regardless of their diabetic status, in 88.0% of men and in 79.8% of women (P ) 0.05). Internal diameter of arteries (IDA) was significantly greater in men than in women, but no such difference was observed between diabetics and non-diabetics. Cubital and radial artery calcifications were detected in 33.1% and 41.8% of patients, respectively. Atherosclerotic changes were detected even more frequently (cubital artery 38.9%, radial artery 59.8%). In 84.6% patients, placement of at least one native AVF was possible based on preoperative US; no difference in number of possible AVFs was noticed in relation to gender (p = 0.10) or presence of diabetes (p = 0.51). In 74.3% (159/214) of patients a native AVF was placed. 11 patients were in predialysis period, 4 patients were lost to follow-up and from the remaining 144 patients, primary failure of AVF was observed in 24 patients (16.7 %). Primary (primary functional) patency rate of native AVF at 12 months was 68% (81%) and secondary (secondary functional) patency rate was 76% (89%). No differences in patencies in terms of gender were confirmed. Primary functio
D.09 Tutoring for postgraduate students
COBISS.SI-ID: 276048384