Occupational exposure to cytostatic fumes during hyperthermic intraperitoneal chemotherapy.

Hyperthermic intraperitoneal chemotherapy (HIPEC)-heated, intra-abdominal chemotherapy-has become the treatment of choice for treating peritoneal metastases from ovarian, stomach or colorectal cancers. HIPEC has several advantages and disadvantages. The major benefit is minimal systemic toxicity for the patient, but there is a risk of occupational exposure for operating room staff. We have not found any reports of workers with chronic aplastic anaemia as a result of exposure to cytostatic fumes during HIPEC. The aim of this case report is to raise the awareness of potential negative health effects of inhalation exposure to cytostatic drugs. We present a rare case of a 43-year-old woman, suffering from aplastic anaemia as a long-term consequence of exposure to cytostatics. During the HIPEC procedure, surgical revision of the peritoneal cavity was undertaken which resulted in release of cytostatic fumes. Despite awareness of the health effects of occupational exposure to cytostatic drugs and well-developed procedures for safely handling them, unexpected exposure may occur causing serious medical conditions. These may develop in sensitive subjects although accidental high-level exposure may lead to unexpected long-term consequences in all workers. Medical staff need to be informed of the risks of HIPEC and safety guidelines to reduce the risk of exposure.

Painful crural ulcerations and proteinuria as complications after several years of therapy with mTOR inhibitors in the renal allograft recipient: a case report.

BACKGROUND: Proliferation signal inhibitors (mammalian target of rapamycin [mTOR]) are a class of immunosuppressive drugs with a new mechanism of action and safety profile, different form calcineurin inhibitors. However, their use is limited because of an high incidence of adverse reactions, the majority of which occur within the first 6 months after commencing treatment. In this paper, we report a patient with substantial proteinuria and painful crural ulcerations that appeared after a few years of mTOR inhibitor therapy and necessitated their withdrawal. CASE REPORT: A 43-year-old man who received a cadaveric kidney was converted to sirolimus from cyclosporine after being diagnosed with adenocarcinoma and carcinoma clarocellulare of his own removed cystic kidney. After 5.5 years of fairly good tolerance of the treatment, proteinuria and painful crural ulcerations appeared. Because of the progressive character of the adverse reactions and no satisfactory results of the applied treatment, mTOR therapy was discontinued. Proteinuria was reduced, pain improved, and the ulcerations healed. CONCLUSIONS: This case report indicates that adverse reactions may develop as a result of mTOR inhibitor use even after many years of good tolerance of the drug and they may necessitate its withdrawal.

The relationship between serum level of N-terminal pro-B-type natriuretic peptide and nutritional status, and inflammation in chronic hemodialysis patients.

BACKGROUND: N-terminal pro-B-type natriuretic peptide (NT-pro BNP), a biomarker of heart failure, is involved in regulation of the body fluid homeostasis and vascular tone. The purpose of this study was to investigate the relationship between serum level of NT-pro BNP and nutritional status, inflammation and hydration in patients on maintenance hemodialysis (HD). MATERIALS AND METHODS: The study involved 97 HD patients (mean age: 65.3 +/- 13.9 years, HD duration: 36.3 +/- 43.5 months). Blood tests comprised the measurements of serum levels of NT-pro BNP, interleukin-6 (IL-6), human soluble tumor necrosis factor receptor I (s TNF RI), hemoglobin (Hb), albumin (alb) and urea. Furthermore, normalized protein catabolic rate (n PCR), body mass index (BMI), mean arterial blood pressure (MAP), adequacy of HD (Kt/V), and interdialytic body weight gain (IBWG) were calculated. In addition, NT-pro BNP was measured in a healthy control group (CG; n = 24, mean age 49.5 +/- 15.0 years). Hydration status was determined by bioimpedance analysis (BIA). RESULTS: Irrespective of gender, NT-pro BNP levels were markedly elevated in HD patients compared with CG (15879.2 +/- 14033.3 pg/ml vs. 73.45 +/- 23.56 pg/ml; p < 0.00001). NT-pro BNP was unrelated to any measures of body fluid compartments. Multivariate regression analysis revealed that only four parameters (nPCR, Hb, MAP, and total time on HD) influenced serum NT-pro BNP levels. CONCLUSION: While there was only moderate direct association of NT-pro BNP with hydration status, it was elevated in patients with intensive catabolism, severe anemia, higher MAP and longer total duration of HD.

Successful pregnancy in a chronically hemodialyzed patient with end-stage renal failure.

A 36 year-old female with chronic kidney failure due to hypertension and who was being treated with hemodialysis for eight months, was admitted to the hospital on the suspicion of being pregnant. Gynecological examination and ultrasound scan confirmed the pregnancy. Gestation was diagnosed in the 29(th) week after the patient felt fetal movements. Intensification of the dialysis treatment was started immediately after the diagnosis was made.

Diurnal rhythm of blood pressure, heart rate and adrenergic activity in patients with normotension treated with continuous ambulatory peritoneal dialysis and haemodialysis.

PURPOSE: People with normotension and with essential hypertension are subjected to the diurnal rhythm of blood pressure (BP) with higher values during the day than during the night. Among dialysed patients nocturnal reduction of BP is blunted. The aim of the study was to evaluate diurnal BP rhythm and adrenergic activity measured as values of catecholamines. MATERIAL AND METHODS: Study was performed among dialysed patients with normotension: 13 haemodialysed patients (HD), 8 patients treated by continuous ambulatory peritoneal dialysis (CAPD) and 10 controls (C). Ambulatory BP monitoring (ABPM) was done by using Micro SJ7400 AMP device. Catecholamines concentrations were measured by HPLC-ED method before and after cold pressure test. RESULTS: There was no significant difference between manual measurements of BP done by dialysis nurses and mean values of 24-hours ABPM in CAPD group and C group and 48-hours ABPM among HD patients. Diurnal BP was blunted in 80% of HD patients during the day of haemodialysis, 70% during the day without haemodialysis and in CAPD group in 50%. Heart rate (HR) variability was comparable in HD and CAPD groups and significant lower than in C group. Baseline noradrenaline (NA) as well as NA (ng/ml) post cold pressure test levels were significantly higher among HD patients (463 +/- 21, 546 +/- 31) and CAPD patients (452 +/- 76, 527 +/- 92) as compared with C (206 +/- 53*, 315 +/- 61*). (x +/- SD), *p<0.001 CONCLUSIONS: Despite increased adrenergic activity and altered diurnal rhythmof BP and HR exist in dialysed patients we didn't find directly relationship. Another or composed factors couldaffect diurnal rhythm of BP and HR.

Chlamydia trachomatis infection in chronically hemodialyzed patients.

PURPOSE: In the general population there is association between Chlamydia trachomatis (Ch. trachomatis) infection and reactive arthritis (RA). RA is a systemic illness characterized by inflammatory synovitis. Arthritis tends to be oligoarticular and involves mainly the lower limbs. The aim of this study is to assess the age and sex specific prevalence of Ch. trachomatis infection in dialysis population and to find possible relationship between manifestation of infection and renal osteodystrophy. MATERIAL AND METHODS: The study was conducted in 53 patients: 22 women (W) and 31 men (M), with a mean age of 58.1 +/- 15 years, treated with HD for 28.5 +/- 28.2 months. The Ch. trachomatis infection was assessed by the detection IgG antibodies for Ch. trachomatis. Also some other biochemical parameters of osteodystrophy, inflammation and malnutrition were measured. RESULTS: The presence of a high titre of anti-Ch. trachomatis antibodies was found in 22 patients--41% [G IgG (+)]. Mean level of anti-Ch. trachomatis antibodies was significantly higher in G IgG (+) than in seronegative patients [G IgG (-)]: 19.0 +/- 8.6 vs 4.0 +/- 2.1 U/ml, p<0.001. There was no difference in mean age of seropositive and seronegative patients for Ch. trachomatis (62.4 +/- 13.1 vs 56.2 +/- 15.9 years). We did not observe in both groups of patients any differences in mean level of C-reactive protein (CRP): 12106.2 +/- 10791.0 vs 14015.3 +/- 11194.3 ng/ml. The mean ferritin level was significantly higher in G IgG (+): 624.3 +/- 375.7 vs 418.3 +/- 341.4 ng/ml, p<0.05. Significant negative correlations were found in G IgG (+) between IgG antibodies and transferrin saturation (r=-0.645719, p<0.001) and between CRP and calcium (r=-0.4526, p<0.05). IgG antibodies were detected frequently in W (60%) than in M (29%). Mean level of IgG was significantly higher in seropositive W than in seropositive M (23.3 +/- 7.8 vs 12.1 +/- 4.2 U/ml, p<0.0001). The seropositive W were older (67.9 +/- 11.8 vs. 53.8 +/- 11.0 years, p<0.02) and seropositive W were shorter treated with HD (18.1 +/- 16.6 vs 43.7 +/- 30.6 months, p<0.02). The mean serum calcium conc. and phosphorus were significantly lower in seropositive W (2.1 +/- 0.1 vs 2.3 +/- 0.2 mmol/l, p<0.05 and respectively 1.3 +/- 0.3 vs 1.8 +/- 0.2 mmol/l, p<0.005). Likewise the mean transferrin saturation (TS) was significantly lower in that group (25.7 +/- 7.3 vs 38.0 +/- 11.3%, p<0.01). There were no differences between seropositive men and women in mean serum concentrations of CRP, iPTH, albumin and hemoglobin. We found in seropositive W significant negative correlation between IgG antibodies and age (r=-0.633, p<0.02). CONCLUSIONS: The patients treated with HD were quite frequently shown significantly elevated level of IgG antibodies for Ch. trachomatis. It could have be connected with past infection. The antibodies were more commonly detected in women, particularly in younger patients. No relationship between osteodystrophy and Ch. trachomatis infection was found.

Low-T3 syndrome and signal-averaged ECG in haemodialysed patients.

The study was designed to evaluate the potential link between low-T3 syndrome and signal-averaged ECG parameters (SAECG) in a group of hemodialyzed patients (HD-pts). 52 selected HD-pts (without relevant thyroid and cardiac diseases) were included. SAECGs were performed postdialysis together with evaluating free triiodothyronine (fT3), free thyroxine (fT4), reverse triiodothyronine (rT3), thyroid stimulating hormone levels and echocardiography. For each SAECG, QRS duration (QRSd), root-mean-square voltage of the terminal 40 ms of the QRS (RMS40), and low-amplitude signal duration (LAS40) were measured. Abnormal SAECGs were found in 30.8 % of HD-pt. HD-pts with decreased fT3 and increased rT3 values (low-T3 positive) revealed higher QRSd and LAS40 values in comparison with low-T3 negative HD-pts (p = 0.019, p < 0.001 respectively). Low-T3 positive HD-pts had lower RMS40 values than low-T3 negative patients (p < 0.001). The Pearson test showed significant correlations between QRSd and fT3 (r = -0.592, p < 0.001); QRSd and rT3 (r = 0.562, p < 0.001); RMS40 and fT3 (r = 0.432, p = 0.009); RMS40 and rT3 (r = -0.325, p = 0.025). On multivariate analysis, both fT3 and rT3 levels were found to be independent predictors of QRSd and RMS40 values. Our study showed that decreased fT3 and increased rT3 concentrations due to low-T3 syndrome influence SAECG parameters in HD-pt.

Effect of vitamin E modified cellulose membrane on human lymphocyte, monocyte, and granulocyte CD11b/CD18 adhesion molecule expression during hemodialysis.

Chronic renal failure induces a clinical state of immunodefi ciency that also depends upon a wide spectrum of dialysis membranes used during hemodialysis. Previous studies have shown that cellular immunodeficiency is caused by malfunc tion of the antigen presenting cells (monocytes or granulocytes). Subsequent activation of rolling mononuclear leuko cytes results in up-regulated expression of CD11b/CD18 (Mac-1) on endothelial cells. It is postulated that a VitE coated dialysis membrane might minimize the membrane biocompatibility, thereby generating a smaller amount of re active oxygen species (ROS). The purpose of this study was to evaluate the expression of the CD11b/CD18 adhesion mole cule on lymphocytes, monocytes, and granulocytes during HD in 10 patients, using flow cytometric analysis. The study protocol included the measurement of molecule expression using cellulose membrane (Clirans RS15, TERUMO Corp. Japan), and the same membrane coated by vitamin E (Exce brane, Clirans E15, TERUMO Corp., Japan) during 20 dialysi sessions each. Lymphocyte CD11 b/CD1 8 (Mac-1) expression did not change with either dialyzer type. However, monocyt (p = 0.046) and granulocyte (p = 0.018) CD11b/CD18 ex pression in the post HD period was significantly lower using the vitamin E coated membrane compared with the contro cellulose membrane. Our findings suggest a significant de crease in activation and migration of monocytes and granu locytes when using a vitamin E coated cellulose membrane.

Searching for a genetic risk profile in end-stage renal disease.

There is a strong evidence that both, genetic factors and environment, affect the development of end-stage renal disease (ESRD). The factors that initiate renal failure are probably different from those contributing to its progression. Some factors involved in the progression of nephropathy are already identified, like elevated blood pressure, hypercholesterolemia or hyperparathyroidism. Molecular genetic techniques are extensively applied to developing strategies for detection of human renal failure genes. The candidate gene approach for finding an association between polymorphic DNA markers and disease was successfully used in studying genes of the renin-angiotensin system, especially those coding angiotensin I-converting enzyme, angiotensinogen and angiotensin type 1 receptor. Several other genes, for example growth factors and cytokine genes, nitric oxide synthase or genes of the kallikrein-kinin system are being evaluated using this approach. Identification of candidate genes associated with end-stage renal disease will create a need for testing several disease loci simultaneously. Subsets of predictive genetic markers will be developed for routine use in clinical practice. Recognizing genetic changes affecting the initiation and progression of renal failure will have important clinical implications, involving testing individuals who are genetically susceptible but yet unaffected. It will make possible identification of individuals at a higher risk for renal failure and help in the choice of diagnostic tests as well as in planning therapeutic interventions.

[Relationships between hyperparathyroidism and Helicobacter pylori infection in long-term hemodialysis patients]. / Zaleznosci miedzy wtórna nadczynnoscia przytarczyc u chorych hemodializowanych a zakazeniem Helicobacter pylori.

UNLABELLED: In the accessible literature we did not find data about the connection between Helicobacter pylori (H. pylori) infection and parathyroid hormone (PTH) abnormalities in patients on hemodialysis (HD pts). It is known that hyperparathyroidism is connected with stimulation of gastrin synthesis as well with increased acidity of gastric juice. We speculate that it should be connected with susceptibility to H. pylori infection in HD pts. The aim of our study was the assessment of relationships between PTH abnormalities and parameters of H. pylori infection expressed by concentration of IgG antibodies against H. pylori and histologically performed urease test. The study was conducted in 65 (37 M, 28 F) stable HD pts. They were dialyzed for 6 to 288 months (102.9 +/- 84.5). Simultaneously in 25 HD pts qualified for renal transplantation biopsy specimens taken during gastroscopy were examined by a histological test and urease test (CLO-test). According to the PTH concentration HD pts were divided into 3 groups with PTH < 100 pg/ml; with PTH 100-350 pg/ml and with > 350 pg/ml. Positive IgG H. pylori test > 24 U/ml was found in 60 (92%) HD pts. Mean IgG H. pylori concentration was similar in tree groups of HD pts. (82 vs 91 vs 88 U/ml) and did not differ significantly from control group. We found significant negative correlation between IgG H. pylori concentration and time on dialysis therapy (r = -0.50067, p = < 0.0001). Positive test in biopsy specimen was found in 14 HD pts (56%). PTH level in this group of HD pts not differ significantly from PTH level in pts with negative test (426 vs 398 pg/ml) and IgG H. pylori concentration was significantly higher in positive pts than in negative pts (104 vs 48 U/ml). CONCLUSION: We did not find significant relationship between PTH abnormalities and H. pylori infection in HD pts. Longer period of dialysis therapy is connected with decreased ability to produce antibodies againts H. pylori.

Effect of recombinant human erythropoietin on adrenergic activity in normotensive hemodialysis patients.

Ten normotensive hemodialysis patients with severe anemia participated in the study. Human recombinant erythropoietin (rHuEpo) was administered i.v. 3 times a week in doses of 50 U/kg of body weight. During 12 weeks of observation, the mean hematocrit value increased from 19%, before start of therapy, to 32%. Simultaneous monitoring of serum plasma noradrenaline (NA) concentration showed an elevation from 202 to 281 pg/ml. An increase of NA concentration after a cold pressure stimulating test (CP) was not statistically significant after as compared to before treatment, but became statistically significant after 12 weeks of rHuEpo therapy (281 pg/ml before to 441 pg/ml after CP test, p < 0.01). The mean arterial blood pressure increased from 92 - 109 mmHg after 12 weeks of rHuEpo therapy (p < 0.001). We have demonstrated significantly increased NA blood concentrations after 12 weeks of rHuEPO therapy in normotensive patients, which correlated with increased MAP. This may suggest that the observed increase of noradrenaline concentration as a vasoactive substance after the CP test may contribute to hypertension during rHuEPO therapy.

Rate of Staphylococcus aureus nasal carriage in immunocompromised patients receiving haemodialysis treatment.

Specimens from the nose and throat were collected from 28 long-term haemodialysed patients. Staphylococcus aureus strains were isolated from sixteen patients who been on haemodialysis for over 113 months. Cytokine levels, as well as full blood cell differential counts and cell surface antigens were determined in these patients. The serum concentration of TGF-beta was significantly higher in patients carrying Staphylococcus aureus. CD14 and HLA-DR molecule expression on monocytes, as well as NK cell percentage was significantly different in S. aureus carriers. Our preliminary results suggest that immune status imbalance in haemodialysed patients could be related to the high incidence of S. aureus nasal carriage and infections.

Changes of endogenous erythropoietin level and iron status during a 30-month hemodialysis treatment of a group of patients.

In our earlier paper we found that among 50 hemodialysis patients (HD pts) 48% (24 pts) control anemia with hemoglobin (Hb) concentration >9.5 g/dl and hematocrit (Hct) >30% without recombinant human erythropoietin (rHuEpo) therapy. These HD pts had significantly higher mean endogenous erythropoietin (eEpo) level and lower iron reserves (IR) than HD pts who need rHuEpo therapy. The aim of this study was to judge whether the possibility to control anemia in pts not requiring rHuEpo therapy changes during a 30-month HD treatment. Serum eEpo and ferritin were measured every 6 months. After 30 months of HD treatment 18 pts remained in this group--5 pts died, 1 underwent transplantation. During the study period 4/18 pts permanently had a very low level of eEpo (under detection limit), 7/18 had the level of eEpo within normal range for healthy control, 7/18 pts had a high level of eEpo (up to 3 times higher than the mean for healthy control). Pts who had the highest level of eEpo had the lowest IR. After 30 months IR were significantly lower than at the beginning of observation (292 +/- 87 vs 143 +/- 127 mg). Important negative correlation between eEpo and IR was observed throughout the whole period of study: r = -0.4820, p < 0.02 at the start of the study, and r = -0.6126, p < 0.007 after 30 months of treatment. The study shows that the possibility to control anemia in pts not treated with rHuEpo did not change significantly during 30 months of HD treatment. Endogenous Epo level in HD pts not treated with rHuEpo varied between different pts: it was permanently low in some pts, permanently high in others and stayed normal in remaining pts.

[Late abdominal wall leaks of dialysis fluid--own experience in conservative treatment]. / Pózny przeciek plynu dializacyjnego do powlok--doswiadczenia wlasne w leczeniu zachowawczym.

The late abdominal wall leaks (LAWL) of dialysis fluid is a serious technical complication of continuous ambulatory peritoneal dialysis (CAPD). Manifestation of LAWL is a significant diagnostic and therapeutic problem. The aim of our study was to establish of diagnostic procedure and the methods of treatment of LAWL. The group of 80 patients treated with CAPD was observed during one-year-period. LAWL appeared in 8 patients from this group. LAWL was diagnosed by: physical examination, abdominal circumference measurement, ultrasound examination of abdominal wall. Patients with LAWL were temporary transferred from CAPD to automated peritoneal dialysis (APD). After applied treatment the remission of leakage was observed. Basing on performed observation we concluded, that physical examination, abdominal circumference measurement and ultrasound examination of abdominal wall are the basal diagnostic methods of LAWL and that temporary change of dialysis method from CAPD to APD is an effective method of LAWL treatment.

[Renin-angiotensin system genes in chronic glomerulonephritis]. / Geny ukladu renina-angiotensyna w przewleklych klebuszkowych zapaleniach nerek.

Glomerulonephritis is a group of diseases with complex etiology, pathogenesis, morphological features and clinical course. The renin-angiotensin system genes are important group of candidate genes involved in pathogenesis of chronic renal diseases. The purpose of our study was to analyze the association of genetic polymorphisms of these genes with glomerular kidney diseases. The study population consisted of 52 patients with immunological glomerular kidney diseases and 50 hemodialyzed patients with end-stage renal failure with glomerulonephritis as primary disease. The control group consisted of 200 healthy subjects. By means of the polymerase chain reaction (PCR) the following polymorphisms were evaluated: insertion/deletion (I/D) polymorphism in intron 16 of the angiotensin-converting enzyme gene (ACE), M235T polymorphism of the angiotensinogen gene (AGT) and A1166C polymorphism of the angiotensin II type 1 receptor gene (AT1R). No significant association was found between the ACE allele and genotype frequencies and the disease. The allele frequency of the M235T polymorphism was different from that observed in the control group, but differences in the genotype distribution were not statistically significant. The CC genotype of the AT1R gene polymorphism was significantly more frequent in patients than controls. This suggests an increased susceptibility to renal diseases in individuals carrying the CC genotype. This relationship is not associated with hypertension. Our results suggest that in the Polish population the AT1R gene polymorphism might be associated with increased susceptibility to chronic renal diseases.

[Effect of vitamin E-modified membrane on expression of coreceptors CD4, CD8 on lymphocytes in chronic hemodialysis patients]. / Wplyw celulozowej blony dializacyjnej pokrytej witamina E na ekspresje koreceptorów CD4, CD8 na limfocytach u pacjentów z przewlekla niewydolnoscia nerek leczonych hemodializami.

Chronic renal failure induces a clinical state of cellular and humoral immunodeficiency that also depends on the time duration of blood contact with the wide spectrum of dialysis membranes use during long-term hemodialysis treatments. In end stage renal failure (ESRD) patients it is possible to induct state of chronic inflammation mostly caused by leukocytes and complement activation. It is postulated that the vitamin E-coated dialysis membrane minimalizes unbiocompatible reactions that generate smaller amounts of reactive oxygen species (ROS). The purpose of this study was to analyze the effect of classical and vitamin E coated cellulose membranes on the expression of CD 4 and CD 8 adhesion molecules on lymphocytes during HD in 10 patients using flow cytometric analysis. The study protocol included the measurement of molecules expression using cellulose membrane (Clirans RS15, TERUMO Corp., Japan), and the same membrane coated by vitamin E (Excebrane, Clirans E15, TERUMO Corp., Japan) during 20 dialysis sessions with each kind of membrane. During dialysis with classical cellulose membrane, significant decrease of lymphocyte serum level and increase of lymphocyte CD4 expression was observed. During the session with vitamin E coated membranes we did not observe any significant changes in serum CD4, CD8, CD4+8+ lymphocyte level, and also lymphocyte CD4, and CD8 expression on lymphocytes. Our findings suggest the potential role of vitamin E-coated cellulose membrane to minimalize negative reaction of the T lymphocyte subpopulation in ESRD patients treated on long-term dialysis.

[Use of bioimpedance spectroscopy techniques for monitoring fluid balance in patients with end stage renal failure]. / Zastosowanie techniki bioimpedancji elektrycznej w ocenie stanu nawodnienia u pacjentów ze schylkowa niewydolnoscia nerek.

Adequate body hydration is considered the key element of fluid management in critically ill patients including group with end stage renal failure. Bioimpedance technique is widely used as a non-invasive, simple and accurate method to measure body composition. The purpose of the paper was to prescribe the using of single, and multifrequency bioimpedance spectroscopy technique for estimation of fluid balance in end-stage renal patients. We also discussed some measurements and data modelling problems, including postural change effect, and intercompartmental fluid shift during dynamic monitoring of fluid balance.

[Effect of arterio-venous fistula blood flow dynamics on ECG abnormalities in chronic hemodialysis patients]. / Wplyw dynamiki przeplywu przetoki tetniczo-zylnej na zmiany elektrokardiograficzne u chorych hemodializowanych z powodu krancowej niewydolnosci nerek.

UNLABELLED: The dialysis doses is mostly dependent on well functional permanent vascular access. From the other hand high vascular access blood flow (Qva) may induce cardiac problems in HD patients. The purpose of this study was to investigate the effect of vascular access dynamics on electrocardiographic abnormalities in hemodialysis patients. Therefore, forty non-diabetic, HD patients, with native vascular access (VA) were divided into two equal groups; with Qva > 1500 ml/min (group A), and also Qva < 1500 ml/min (group B). The average of VA survival period was 28 +/- 18 (mean +/- SE) (group A), and 29 +/- 15 (months) (group B). The Qva measurements monitoring by color Doppler sonography included also: maximal velocity (Vmax), time average of maximal velocity (TAMX), pulsate index (PI), and resistive index (RI). Kt/V index was calculated, as classical parameter of adequacy, and also shunt recirculation using 3 urea samples was measured. For estimation of cardiac function we used M-mode echocardiography, and 24-hours ECG (Holter) monitoring. The occurrence of ventricular (VE), and supraventricular extrasystoles (SVE), ST-T, and ST characteristic as well were monitored by 24-hours Holter. CONCLUSIONS: 1. In the group with high Qva (A) we observed significantly higher number of VE, and also of SVE recorded by Holter monitoring compared with the low Qva group (B). 2. The mean number of patients with ST-T changes was higher in group A (12 vs. 7), but number of patients with recorded by Holter ST depression, and ST elevation between investigated groups were similar. 3. The mean number of ventricular arrhythmias of Lown classified as 4A, and 4B of Lown grading was significantly higher in the group with high Qva (A).