Nefrologia kliniczna

Calcimimetics provide a potential therapeutic benefit through suppressing parathyroid hormone (PTH) release without increasing calcium and phosphorus concentrations in patients with secondary hyperparathyroidism. In this report we present one center experience with cinacalcet given to six peritoneal dialysis (PD) patients. We observed 60–80% decrease of the baseline PTH concentration. In four patients we noticed very low PTH level which resulted in discontinuation of cinacalcet. There are only a few studies concerning calcimimetics application in PD patients. We would indicate that long-term cinacalcet therapy requires a regular PTH monitoring and very strict sequential dose titration especially in PD patients because of the increased risk of low-turnover bone disease.

In Poland, over 21,000 patients are treated with renal replacement therapy by hemodialysis. On average, half of them have impaired nutritional status. The state of nutrition of hemodialysis is influenced by a number of factors, both the cause of chronic kidney disease, the effect of the disease itself, and the result of its treatment. Regularly conducted assessment of nutritional status and response to disorders would reduce the risk of complications and deaths in this group of patients. The paper presents the most important factors affecting the nutritional status of hemodialyzed patients.

Many patients undergoing hemodialysis are at risk of developing malnutrition. A case study of dialyzed elderly patient with diagnosed malnutrition, suggests how to assess nutritional status and implement a nutritional intervention in practice. It presents the prognostic importance of early action taken to prevent and treat malnutrition in hemodialyzed patients.

HMG-CoA reductase inhibitors (statins) have proven their efficacy in improving the prognosis of patients with increased cardio-vascular risk. This risk is specif­ically high in end-stage renal failure patients undergo­ing peritoneal dialysis (PD). Moreover, these patients are characterized by atherogenic lipid disturbances, caused by the kidney disease itself as well as the glu­cose load from dialysis fluids. Therefore, stains ought to constitute a perfect group of drugs in reducing the cardio-vascular risk in PD subjects. However, results of the hitherto studies are far from being unequivocal in this respect. Moreover, the current guidelines do not recommend initializing statins in PD patients. This ar­ticle aims at presenting the current knowledge on the use of these drugs in the course of PD.

A transplant physician often has under his care a kid­ney recipient with end-stage kidney disease due to diabetes mellitus (DM) or DM developed after trans­plantation (posttransplantation diabetes mellitus — PTDM). The presence of DM is associated with a de­terioration in quality of life and worse prognosis both for the transplanted kidney and the patient survival. Such patients should be provided with combined and coordinated nephrology/diabetes care. The diagnostic procedures for PTDM do not differ from those gen­erally accepted, the basic one being an oral glucose load test. An important role in the control of treatment is played by glycated haemoglobin, sometimes used as a diagnostic support tool. Until now, no unambigu­ous standards of therapeutic treatment in PTDM have been established and both in the diagnosis and the therapeutic regimens apply the guidelines established for diabetic patients without a transplanted organ. The basis of treatment should be a diet combined with ap­propriate physical exercise. There are many hypogly­cemic medications available, including new ones with wide spectrum pharmacokinetic and pharmacody­namic properties that vary in efficacy and safety pro­file. Graft function and also possible interactions with other medications, especially immunosuppressants, should be taken into account before implementing hy­poglycemic treatment in transplanted patients.

Acute kidney injury is a frequent complication in hospitalized patients and is associated with high mortality. The management of acute kidney injury is supportive with renal replacement therapy but whether to provide continuous renal replacement therapies or intermittent hemodialysis and when to initiate it are unclear. This article reviews the current literature presenting optimal method and timing to start of renal replacement therapy in acute kidney injury.

Cholemic nephropathy (bile cast nephropathy) is an underestimated but important cause of renal dysfunction in cholestasis or advanced liver disease with jaundice in most cases > 20 mg/dl (342 μmol/l) of serum bilirubin level. It is a common complication of hepatorenal syndrome AKI and acute on chronic liver failure, increasing morbidity and mortality. This review summarizes the present knowledge on definition, morphological characteristics, patomechanisms as well as diagnostic and therapeutical strategies of cholemic nephropathy.

Skin cancers are the most common malignancies diagnosed in the population of patients after solid
organ transplantation. It is estimated that 10 years after transplantation up to 35% of the patients develop this type of tumor. The more risk factors for skin cancer development we recognize, the better preventive actions we will be able to undertake. Therefore, many studies are still being conducted to explain the mechanisms of etiopathogenesis of this disease. The following paper describes the pathogenesis of skin cancers that specifically focuses on genetic and immunological factors.

Obesity is a well-known factor of the progression of Chronic Kidney Disease. Recommended range of BMI (Body Mass Index) among patients with CKD is 23,0–24,9. Obesity causes serious difficulties for the technical aspects of kidney transplant procedure. According to local transplant centers BMI over 35 is a contraindication for kidney transplantation. Obesity in kidney transplant recipients may lead to the occurrence of complications such as Delayed Graft Function or even increased risk of renal transplant rejection, in particular in the short-term posttransplant period. Excessive body mass noted before KTx but also body weight gain noted after the surgery may determine the appearance of future posttransplant complications. Significant body weight gain occurs commonly especially during first 6–12 months after successful kidney transplantation and may result approximately in over 5 to 10% of body mass increasing. Continually, poor outcomes more affect patients remaining at transplant waiting list than obese renal transplant recipients at the time of transplantation.

This article describes the own experience of the Dialysis Center at the Nephrology and Transplantology Department in Białystok, which was the first in Poland to implement in September 2017 remote monitoring of peritoneal dialysis patients. The system implementation process is described and four clinical cases are presented, in which the possibility of remote supervision over the patients turned out to be particularly useful.