11 research outputs found
How COVID-19 Outbreak Influenced Transplantation in Poland
No full textAnnounced by the World Health Organization in early 2020, the pandemic caused by SARS-CoV-2 infections has had a huge impact on healthcare systems around the world. Local and international authorities focused on implementing procedures to safeguard the health of the population. All regular daily activities were disrupted. Similar factors related to the global fight against the COVID-19 epidemic also had a large impact on transplantation activity. In this article, the authors present the number of patients qualified for transplantation, transplanted and waiting on the waiting list in Poland during the 2-year period of the pandemic. In the first year of the epidemic (2020), all transplantation figures dropped drastically, by as much as 20–30% compared with 2019. The most disturbing fact is that the number of transplants performed in 2022 is still lower than before the outbreak of the epidemic (2019 and earlier)
Cardiovascular disease in waitlisted hemodialyzed patients
No full textBackground Cardiovascular diseases are one of the major limitations in the evaluation of potential kidney transplantation. The study aimed to assess cardiovascular status, including cardiovascular risk factors in waitlisted hemodialyzed patients.Material and methods From the population of 5,068 hemodialyzed patients (60% men), we included 449 waitlisted and 4,619 not considered for potential kidney transplantation. We assessed demographic data, basal biochemical data, and cardiovascular disease prevalence.Results Waitlisted patients (262 males) were significantly younger when compared to non-listed patients (2,718 males); 53.2 ± 14.2 vs. 67.2 ± 3.3 years (p < 0.001), had lower Charlson comorbidity score (3.33 ± 1.52 vs. 4.42 ± 1.93, p < 0.001), lower BMI (26.3±.5.07 vs. 27.7 ± 6.15 kg/m2, p < 0.001), with lower prevalence of cardiovascular disease (46.5% vs. 66.8%, p < 0.001), diabetes (20.5% vs. 37,8%, p < 0.001). The prevalence of hypertension was similar in both groups (94.7% vs. 92.7%, NS). Blood pressure was significantly higher in waitlisted patients relative to non-waitlisted (143 ± 16 mmHg vs. 140 ± 17 mm Hg, p < 0.001 for systolic blood pressure and 80 ± 9 mmHg vs. 75 ± 9 mmHg, p < 0.001 for diastolic blood pressure). Ultrafiltration was also higher in waitlisted population over non-waitlisted (31.3 ± 12.7 mL/kg per HD session vs. 28.4 ± 12.6 mL/kg per HD session, p < 0.001). Mean dialysis vintage, the mean number of hypotensive medications (mean 2.5), the prevalence of apparent treatment-resistant hypertension, and eKt/V were similar, as well as sex distribution.Conclusion Waitlisted patients are a much healthier population, with fewer comorbidities but blood pressure control not meeting target ranges for the present guidelines. The low number of hypotensive medications should be reassessed and the treatment of hypertension may require further attention
MP696INTRAVENOUS PARICALCITOL, ORAL CINACALCET OR COMBINATION OF BOTH AGENTS - EFFECTIVENESS OF DIFFERENT STRATEGIES OF SECONDARY HYPERPARATHYROIDISM TREATMENT IN HEMODIALYZED PATIENTS
No full textDoes combination of paricalcitol with cinacalcet in secondary hyperparathyroidism in hemodialysis treatment make sense?
No full textGreen dialysis – let us talk about dialysis fluid.
No full textBackground: Hemodialysis is one of the most resources consuming medical intervention. Due to its concept, the proper amount of dialysis fluid passed through dialyser is crucial to obtain the expected outcomes. The most frequent source of dialysis fluid is production from liquid concentrate (delivered in containers or plastic bags) in dialysis machine. Alternatively, concentrates for dialysis may be produced in dialysis center by dilution in mixing devices dry or semi-dry pre-mixed compounds connected with system of central dialysis fluid delivery system. Dialysate consumption depends on various factors like type of hemodialysis machine,session duration,prescribed flow etc.
Summary: Modern hemodialysis machines are equipped with the modules which automatically reduce flow rate of dialysis fluid to the patient blood flow and minimize dialysate consumption during preparation and after reinfusion. Smart using of available options offered by manufacturers allows to save additional portion of acid concentrate and water. The weight of concentrates to be deliver to the dialysis center is the major factor influencing on the cost (financial and environmental) of transportation from the manufacturer to the final consumer. The crisis on the energy carriers market and extremely high fuel prices made the transportation cost the one of the significant cost of the treatment,which must be bear by supplier and finally influence on the price of goods.
Key messages: The careful choice of the concentrate delivery system can improve cost-effectiveness of dialysis. Such solutions implemented in dialysis unit helps to make significant savings and decrease the impact on natural environment by carbon footprint reduction
Three Therapeutic Strategies: Cinacalcet, Paricalcitol or Both in Secondary Hyperparathyroidism Treatment in Hemodialysed Patients During 1-Year Observational Study—A Comparison
No full textIntroduction: Secondary hyperparathyroidism (sHPT) is a common hormonal complication of chronic kidney disease. There are several therapeutic options for sHPT management aiming at calcium-phosphorus balance normalization and decrease of parathormone secretion.Objectives: The aim of this retrospective, observational study was the outcome assessement of three most common therapeutic strategies of secondary hyperparathyroidism treatment with vitamin D receptor activator-paricalcitol, calcimimetic-cinacalcet or both agents administered together during in 12-months period.Methods: One hundred and thirty-one haemodialysed patients with uncontrolled parathyroid hormone secretion have been treated with paricalcitol administered intravenously (group PAR−60 patients) or cinacalcet per os (group CIN−50 patients). The last group (group PAR+CIN−21 patients) received paricalcitol i.v. and oral cinacalcet administered simultaneously.Results: In all groups, the iPTH level decreased significantly, however in group 1 treated with paricalcitol administered intravenously iPTH level decrease was greater than in group 2 treated with cinacalcet and in group 3 treated with paricalcitol and cinacalcet in parallel. The most substantial change of iPTH level was noticed after 3-months of observation. After this period the iPTH level was stabilized and maintained till the end of observation. Safety level of all strategies was comparable. No severe hypercalcemia or hypocalcemia was observed during the whole period of observation.Conclusions: The results of observation show significant advantage of intravenous paricalcitol treatment. Complementing cinacalcet therapy with paricalcitol does not improve treatment outcomes. In case of unsatisfactory results after 3-months treatment, potential continuation should be considered carefully. Among three available therapeutic options, the treatment with paricalcitol i.v. should be considered in all haemodialysed patients with inadequate control of serum PTH level. The second option—with cinacalced administered orally should be considered in PD patients and when severe hypercalcemia occurs
Real-World Treatment of Hypertension on Hemodialyses Data from a Large Polish Database
No full textIntroduction: The prevalence of hypertension among patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD) ranges from 72 to 88% depending on applied diagnostic criteria and the chosen method of blood pressure measurement. Despite the guidelines recommending the widespread use of renin-angiotensin system blockers (RASBs) in patients with kidney disease, their utilization in patients on HD may be suboptimal, especially in patients with preserved diuresis. This hesitance that often steams from concern is often due to fear of a decrease in eGFR and a subsequent decrease in diuresis. The aim of this study was to compare clinical characteristics, blood pressure, safety, and HD adequacy indices in hypertensive HD patients on multiple antihypertensive drug regimens, including diuretic treated with RASB (RASB group) or without RASB (no-RASB) with preserved residual diuresis. We sought to examine the real-life use of RASB in HD patients in relation to their clinical characteristics, blood pressure, safety, and HD adequacy. Methods: From a database of 5,879 patients receiving HD (mean age 65.2 ± 14.2 years, 60% of males) of the largest provider of HD in the country, we selected the subgroup treated with at least three antihypertensive medications including diuretics. We compared patients treated with RASB to counterparts without RASB (no-RASB). Results: The RASB group has similar age and gender proportions as well as BMI and bioimpedance compared to counterparts. However, dry body mass was significantly lower in the RASB group (78.1 ± 18.3 kg vs. 80.0 ± 18.2 kg, p < 0.017). Prevalence of diabetes mellitus was similar in both groups, but RASB-treated patients have cardiovascular diseases more frequently (70.1 vs. 60.8%; p < 0.001). Systolic blood pressure and the number of antihypertensive drugs used were significantly higher in RASB patients than in counterparts (146 ± 16 mm Hg vs. 144 ± 15 mm Hg; p < 0.001 and 4.1 ± 0.9 vs. 3.5 ± 0.5; p < 0001, respectively). RASB-treated patients have significantly longer dialysis vintage (52.7 ± 44.4 months vs. 40.2 ± 40.9 months; p < 0.001) and dialysis time (722 ± 87.1 min/week vs. 713 ± 93.4 min/week; p < 0.017) than counterparts. Serum potassium was slightly but significantly higher in RASB (5.3 ± 0.8 mmol/L vs. 5.1 ± 0.7 mmol/L; p < 0.01). Conclusions: In the real world setting, RASB can be safely used in HD patients treated with diuretics with preserved residual diuresis. Given that many HD patients present numerous multimorbidities, RASB should not only be considered as an additional hypotensive drug in poorly controlled hypertension but also in other compelling indications in HD patients. The tendency toward hyperkalemia in HD patients could be effectively managed with appropriate diet and HD prescription adjustments
Vaccination and COVID-19 in Polish Dialysis Patients: Results from the European Clinical Dialysis Database
No full textBackground: Patients with end-stage kidney disease undergoing hemodialysis are particularly vulnerable to severe COVID-19 as a result of older age and multimorbidities. Objectives: Data are still limited and there are no published data on mortality in hemodialyzed patients in Poland, in particular when vaccines became available. We assessed the epidemiologic and clinical data of patients with laboratory-confirmed COVID-19 and assessed the mortality in 2019, 2020, and 2021, as well as the vaccination rate in 2021. Patients and Methods: Retrospectively collected data from 73 Fresenius Nephrocare Poland hemodialysis centers and one public unit were analyzed. Results: In 2021, the vaccination rate was 96%. The unadjusted mortality (number of deaths divided by number of patients) in 2019 was 18.8%, while the unadjusted (after exclusion of COVID-related deaths) mortality in 2020 was 20.8%, and mortality in 2021 was 16.22%. The prevalence of cardiovascular deaths in 2019 and 2020 was almost identical (41.4% vs. 41.2%, respectively), and in 2021, the figures increased slightly to 44.1%. The prevalence of sudden cardiac deaths in 2019 was higher than in 2020 (19.6% vs. 17.3%, respectively) and consequently decreased in 2021 (10.0%), as well as strokes (6.2% vs. 5.4%, and 3.31% in 2021), whereas deaths due to gastrointestinal tract diseases were lower (2.5% vs. 3.2%, and 2.25% in 2021), diabetes complications (0.5% vs. 1.3%, and 0.5% in 2021), sepsis (5.1% vs. 6.3%, and 8.79% in 2021), respiratory failure (1.2 vs. 1.6%, and 2.83% in 2021), and pneumonia (1.4% vs. 2.0%, and 0.82%). There were 1493 hemodialyzed COVID-19 positive patients, and among them, 191 died in 2020 (12.79%). In 2021, there were 1224 COVID-19 positive patients and 260 died (21.24%). The mortality of COVID-19 positive dialyzed patients contributed 13.39% in 2020 and 16.21% in 2021 of all recorded deaths. Conclusions: The mortality among HD patients was higher in 2021 than in 2020 and 2019, despite the very high vaccination rate of up to 96%. The higher non-COVID-19 mortality may be due to the limited possibility of hospitalization and dedicated care during the pandemic. This information is extremely important in order to develop methods to protect this highly vulnerable patient group. Prevention plays a key role; other measures are essential in the mitigation and spread of COVID-19 in HD centers
The prevalence of hepatitis C and B among patients on hemodialysis and on renal transplantation waiting list in Poland has significantly decreased during the last 10 years
No full textSARS-CoV-2 mRNA Vaccine-Induced Cellular and Humoral Immunity in Hemodialysis Patients
No full textBackground/Aims: Chronic kidney disease CKD patients on intermittent hemodialysis IHD are exposed to SARS-CoV-2 infection and carry a risk of developing severe symptoms. The aim of this study was to evaluate the humoral and cellular immunity induced by two doses of mRNA vaccines, the Pfizer-BioNTech (Comirnaty) COVID-19 Vaccine and the Moderna (mRNA-1273) COVID-19 vaccine. Patients and methods: The study included 281 patients from five dialysis centers in northern Poland. Within 2 weeks prior to the first dose of the vaccine, a blood sample was collected for an evaluation of SARS-CoV-2 antibodies. Thirty to forty-five days after the second dose of the vaccine, a blood sample was taken to evaluate humoral and cellular response. Results: Patients with stage 5 CKD on IHD were characterized by a considerable SARS-CoV-2 vaccine-induced seroconversion rate. The strongest factors influencing the antibodies AB level after vaccination were a pre-vaccination history of SARS-CoV-2 infection, age, the neutrophil-to-lymphocyte ratio NLR, neutrophil absolute count, and the hemoglobin level. Cellular immunity was higher in patients with a pre-vaccination history of SARS-CoV-2 infection. Cellular immunity depended on the albumin level. Positive cellular response to vaccination was a positive factor reducing all-cause mortality, except for COVID-19 mortality (no such deaths were reported during our follow-up). Cellular immunity and humoral immunity were positively mutually dependent. High levels of albumin and hemoglobin, low neutrophil count, and a reduced NLR, translated into better response to vaccination. Conclusions: Patients with stage 5 CKD on IHD were characterized by a considerable SARS-CoV-2 vaccine-induced seroconversion rate and a good rate of cellular immunity. The factors that change with exacerbating inflammation and malnutrition (albumin, hemoglobin, neutrophil count, the NLR) affected the efficacy of the vaccination
