Risk stratification for patients awaiting kidney transplantation: Role of bioimpedance derived edema index and nutrition status.

BACKGROUND: Recent studies demonstrate that the edema index (ECW/TBW) may be a significant predictor of poor outcomes as a composite of overhydration and protein-energy wasting. There is no consensus regarding ECW/TBW cut-off values. We aimed to determine the performance of ECW/TBW in all-cause mortality prediction and to establish certain cut-off values in patients on chronic hemodialysis. METHODS: Body composition of 158 hemodialysis patient was performed by using InBody S10 (Biospace, Seoul, Korea) analyzer. Demographic profile and laboratory data were collected. Subjective Global Assessment Scale (SGA) was used to assess nutrition status. In the mean follow up of 3.5 ± 1.15 years, two independent clinicians evaluated death cases and factors for all-cause mortality were established. Statistical analysis was performed with R software. RESULTS: 73 of 158 hemodialysis patients were on kidney transplant waiting list. Mean age of study subjects was 53.6 ± 15.1 years, 51.9% were females, and 13.9% had diabetes. During the follow-up period, 17.72% of patients died. They had significantly higher ECW/TBW values 0.393 vs 0.408, p < 0.001. Subjects with lower edema index had better nutrition according to SGA (SGA A 0.391; SGA B 0.400; SGA C 0.413; p < 0.001). The calculated ECW/TBW cut-off point for all-cause mortality was 0.4055, with sensitivity of 84.6%, specificity of 69.8%. On the other hand, the cut-off point for SGA scores B and C was 0.396 with sensitivity of 72.7% and specificity of 68.7%. CONCLUSION: The manufacturer provided ECW/TBW cut-off point of 0.400 should be addressed carefully, because it varies depending on the selected outcome and population studied. InBody ECW/TBW reference values from 0.390 to 0.410 are the most promising in hemodialysis population to assess all-cause mortality, nutrition status and body composition.

The incidence of possible causes of membranoproliferative glomerulonephritis: a single-center experience.

BACKGROUND: Diagnosis of membranoproliferative glomerulonephritis (MPGN) is based on kidney biopsy findings: unique glomerular injury pattern and characteristic changes on light, electron microscopy and immunohistochemical analysis. The purpose of this study was to identify possible etiology and incidence of glomerular injury among patients with a diagnosed MPGN. MATERIALS AND METHODS: A retrospective analysis (years 2000-2014) of 81 clinical cases with a diagnosis of MPGN based on biopsy results was performed. Records were examined, and data about viral, bacterial infections, autoimmune and hematological diseases was collected. Test results of blood C3 and C4 factors of the complement system, and results of kidney biopsy immunohistochemical analysis were investigated. Statistical analysis was performed using Statistical Package for the Social Sciences and p-value less than 0.05 was considered statistically significant. RESULTS: Study population consisted of 55 males (67.9%) and 26 females (32.1%). The average patients' age was 48.53 (standard deviation ± 16.67) years. The identified etiology of MPGN was: idiopathic in 26 cases (32.10%), bacterial infections in 20 cases (24.69%), viral hepatitis in 16 cases (19.75%), autoimmune diseases in 11 cases (13.58%), and hematological diseases in eight cases (9.88%). Changes of the concentration of complement component C3 as well as component C4 were found; their concentration was decreased in 26 (32.1%) and 17 (20.99%) patients' respectively while concentration was within the normal range in 11 (13.58%) and 19 (23.46%) patients respectively. Immunohistochemistry results revealed immunoglobulin (Ig) deposits: C3+/Ig+ was found in 47 (58.02%) cases, C3-/Ig+ was found in 16 (19.75%) cases and in six (7.41%) cases test was not performed. The total number of immunoglobulin positive biopsies (C3+/Ig+ and C3-/Ig+, also called immune-complex mediated MPGN) was 63 (77.78%). Complement-mediated MPGN (C3+/Ig-) was less common and was diagnosed only in seven cases (8.64%). C3-/Ig- was found in five cases (6.17%). CONCLUSIONS: The leading cause of MPGN was idiopathic as well as bacterial infections. Complement component C3 concentration was mostly decreased. The incidence of normal and decreased concentration of the complement component C4 was almost equal. Most immunohistochemical deposits in kidney biopsy appeared to be C3/Ig positive, and it was observed in more than half of the cases of each MPGN etiological group. Hippokratia 2015; 19 (4): 314-318.

Delayed graft function: risk factors and the effects of early function and graft survival.

INTRODUCTION: Delayed graft function (DGF), a well-known immediate postoperative complication is defined as the need for dialysis during the first week after deceased donor kidney transplantation. It affects 25% to 50% of recipients. In this study we identified risk factors for DGF and its impact on patient and graft survivals. METHODS: We retrospectively analyzed medical records from renal transplant recipients aged above 18 years who received a deceased donor kidney graft between November 2008 and December 2011, excluding kidney losses during the first week. RESULTS: Among 137 transplantations, 64 (46.5%) displayed DGF. Multivariate analysis showed secondary renal disease (OR 3.7, CI 1.36-10.30; P = .011), HLA mismatches > 3 (OR 4.4, CI 1.53-12.51; P = .006) and donor urine output ≤ 3000 ml/24h (OR 25.8, CI 3.60-185.70; P = .001) to be significant risk factors for DGF. The hospitalization time was longer in the DGF group (38,2 ± 20,75 vs. 25,6 ± 8,18; P < .001). At 1 month, DGF group showed worse graft function based upon serum creatinine: 207.7 ± 148.52 vs 118.1 ± 36.63 µmol/L (P < .001). At 1 year follow-up, incidence of biopsy-proven acute renal rejection episodes was higher in the DGF (28; 51,9%) vs. the non-DGF group (18; 33,3%; P = .05). The 1-year recipient survival in DGF and no DGF groups were 90% vs 97% respectively (P = .124). With 1-year death censored graft survivals of 92% vs 100% respectively (P = .062). CONCLUSION: Secondary renal disease, HLA mismatches and lower donor urinary output were associated with a greater incidence of DGF, leading to prolonged hospitalizations and an increased risk for an acute rejection episode.

Efficacy and tolerability of amlodipine/valsartan combination therapy in hypertensive patients not adequately controlled on valsartan monotherapy.

OBJECTIVE: To demonstrate additional BP-lowering effects of amlodipine/valsartan combination in patients whose BP was not adequately controlled on valsartan alone. METHODS: This was a multi-centre, randomised, double-blind, active-controlled study in patients with essential hypertension. After a washout period followed by a single-blind valsartan 160 mg run-in period, patients with mean sitting diastolic blood pressure (DBP) >or= 90 mmHg and < 110 mmHg were randomised to receive amlodipine/valsartan (10/160 mg or 5/160 mg o.d.) or valsartan (160 mg o.d.) for 8 weeks. TRIAL REGISTRATION: NCT00170963 MAIN OUTCOME MEASURES: Primary efficacy variable was change from baseline in mean DBP at study end. Secondary efficacy variables included change from baseline in mean sitting systolic blood pressure (SBP), responder rate (mean DBP < 90 mmHg or >or= 10 mmHg reduction from baseline), and DBP control rate (mean DBP < 90 mmHg). Safety was also assessed. RESULTS: Of 1136 patients enrolled in single-blind phase, 947 (mean age: 54.6 years) were randomised. Statistically significantly greater reductions in mean SBP/DBP were observed in both amlodipine/valsartan combinations (10/160 mg: 14.3/11.5 mmHg, 5/160 mg: 12.2/9.6 mmHg; both p < 0.0001) compared to valsartan 160 mg (8.3/6.7 mmHg). The 10/160 mg combination (p < 0.05) showed statistically significantly greater reductions in mean SBP/DBP compared to 5/160 mg (p < 0.001). Responder rates were higher in both combination therapy groups (10/160 mg: 81% [p < 0.0001]; 5/160 mg: 68% [p = 0.0018], respectively) compared to monotherapy (57%). Peripheral oedema was the most frequent adverse event, reported in amlodipine/valsartan 10/160 mg (9.1%), 5/160 mg (0.9%), and valsartan 160 mg (1.3%). CONCLUSIONS: The combination of amlodipine/valsartan in this 8-week double-blind study provided additional BP control and was well-tolerated in patients inadequately controlled with valsartan monotherapy.

The epidemiology of end-stage renal disease in the Baltic countries: an evolving picture.

INTRODUCTION: The epidemiology of end-stage renal disease (ESRD) and renal replacement therapy (RRT) is under continuous evolution all over the world. Of particular interest is the development of RRT in the countries of the former Soviet bloc which underwent great political and socio-economical changes in the last decade. We report here the epidemiological analysis of ESRD and RRT in the three Baltic countries: Lithuania, Estonia, Latvia. Subjects and methods. This epidemiological report is based on data from centre questionnaires which were collected from 1996 onwards, with a response rate of 98-99%. RESULTS: The prevalence/incidence of RRT patients in 1999 were 213/99.5 p.m.p. in Lithuania, 186/45.5 p.m.p. in Estonia and 172/55.8 p.m.p. in Latvia. Haemodialysis (HD) was the most common RRT modality in Lithuania (60% of prevalent patients), but not in Estonia (29%), while in Latvia it was nearly as common as renal transplantation (45 and 46%, respectively). Home HD was not performed. The proportion treated by peritoneal dialysis (PD) was very low in Lithuania (4% of RRT patients), while the percentage was higher in Latvia (9%) and Estonia (20.4%). The percentage of patients on RRT treated by renal transplantation was high throughout, representing the main modality of treatment in Estonia (50.5% of RRT prevalent patients, 94 p.m.p.) and in Latvia (46%, 79 p.m.p.) and being high in Lithuania (36%, 77 p.m.p.). The main renal diseases leading to ESRD were glomerulonephritis, pyelonephritis and diabetes. CONCLUSION: The epidemiology of RRT in the Baltic countries is undergoing rapid changes. Transplantation has reached an impressive level. A high percentage of RRT patients live with a functioning graft.