[Epidemiology of HBV infections and possibilities for therapeutic actions in children and adolescents with end-stage renal failure treated with dialysis]. / Epidemiologia zakazen HBV i mozliwosci dzialan terapeutycznych u dzieci i mlodziezy ze schylkowa niewydolnoscia nerek leczonych nerkozastepczo.

Wide spreading of prophylaxis principles of HBV infections in dialysis centers decreased the HBV infection rate in general population of dialyzed patients in Poland last years. There is neither data concerned with HBV infection epidemiology in children and adolescents, nor data about anti-viral treatment possibilities and effects in this group of dialyzed patients. The aim of the study was evaluating of HBV infection rate in patients of pediatric dialysis centers and analysis of causes of infection and efficacy of treatment. Study was based on data sent in a query-answer by 8 biggest pediatric dialysis centers, all of them treating 210 patients. HBV infection was found much more often (16.6%) than in population of all hemodialyzed patients in Poland. More than 75% non-vaccinated patients was infected before dialysis therapy, remaining were infected during vaccination, before the protecting level of antibodies was gained. Big differences in HBV infection rate among centers are observed. Nowadays HCV infections (more than 40% patients infected) are a bigger issue. Only 10 patients in 5 centers had anti-viral treatment (5 with isolated HBV infection, 5 with mixed HBV/HCV infection). In 9 patients interferon-alpha and in 1 patient lamivudine was administered. Efficacy of interferon-alpha treatment was similar to the population of non-uremic children (33.3% vs. 50% of HBeAg elimination). Majority of patients quite well tolerated the drug. Only in 1 case interferon-alpha treatment had to be ceased because of side effects. In a boy treated with lamivudine, after 3 months elimination of viremia and decrease of ALAT activity was observed. HBV infection in patients of pediatric dialysis centers is still a serious matter. More strict applying of vaccination against hepatitis B before dialysis treatment is needed. The possibility of HBV infections therapy is limited, mostly for economical reasons.

Patient survival and causes of death on hemodialysis and peritoneal dialysis--single-center study.

Survival and causes of death in children dialyzed in a single center were analyzed. During the last 12 years a chronic dialysis program was introduced in 146 children in our center and 125 of them, eligible for observation, were included in this analysis; 58 patients were on hemodialysis (HD) and 67 on peritoneal dialysis [continuous ambulatory peritoneal dialysis/automated peritoneal dialysis (CAPD/APD)]. Mean age at the start of dialysis was 13.1 years in HD and 9.8 years in CAPD/APD patients. Overall, 16 patients died (12.5%); 6 (10.3%) on HD and 10 (14.9%) on CAPD/APD; 4 HD patients died of hemorrhagic stroke and 2 were killed in road traffic accidents. Of 10 CAPD/APD patients, 7 died of heart failure, ischemic stroke, and/or disseminated thromboembolic disease. Another was killed in a road traffic accident and 2 died during the course of severe infections. The 1-year patient survival rate was 96.6% in HD patients and 95% in CAPD/APD patients, 2-year survival 94% and 93% and 5-year survival 91% and 78%, respectively (P=0.2, NS). In conclusion, the survival rate for HD and CAPD patients is similar, although after 2 years of therapy, it is lower in CAPD patients. The main causes of death are cardiovascular. However, in CAPD/APD patients, heart failure with low cardiac output and thromboembolic complications are major causes of death, and in HD patients the main cause is hemorrhagic stroke.

[Analysis of causes of death in children and adolescents on chronic peritoneal dialysis and hemodialysis in 10 year period: single center experience]. / Przyczyny zgonów u dzieci i mlodziezy przewlekle dializowanych otrzewnowo i hemodializowanych w okresie 10 lat.

Causes of death in children and adolescents treated with chronic peritoneal dialysis or hemodialysis in 1990-1999 in single centre were analysed. Overall 131 patients were treated, including 55 on peritoneal dialysis (PD) and 76 on hemodialysis (HD). Overall mortality in a 10-year period was 12% (16 patients). 10 patients in PD (18%) and 6 patients in HD group (7.8%) died. The main causes of death in PD patients were cardiac insufficiency, sudden cardiac arrest, ischemic stroke and atherothrombotic disease. In HD patients the main cause of death was hemorrhagic stroke.

Influence of some immune factors on the IL-6 and soluble IL-2 receptors in haemodialysed patients.

In respect to the immune deficiency state of long-term haemodialysed patients, both cytokines and their receptor disturbances have been taken into consideration. The purpose of our study was to evaluate the effect of uraemic and haemodialysis factors on the interleukin-6 and interleukin-2 soluble receptor levels and the reactivity after influenza vaccination. We have found that IL-6 and IL-2 receptor levels were statistically significantly elevated (98.8 +/- 39 pg/ml and 1557 +/- 544 U/ml, respectively) in serum of haemodialysed patients. The fact that increased immune complexes statistically correlated with soluble IL-2 receptor levels (p < 0.01) was very interesting for us. In order to study the immunological response after vaccination, 10 patients have been investigated after influenza vaccination. Plasma samples were collected before, as well as 1 and 4 weeks after vaccine administration. Antibody titres measured by haemagglutinin inhibition showed decreased antibody levels in haemodialysed patients. We conclude that the interleukin disturbance and the elevated interleukin-2 receptor levels together with the presence of circulating immune complexes can influence in some way the immune response of haemodialysed patients.

[Lipid disturbances in children after kidney transplantation]. / Zaburzenia lipidowe u dzieci po przeszczepieniu nerki.

We evaluated the lipid profile every 3 months in 49 children (mean age 14.6 +/- 4.4 years) after kidney transplantation. This included measuring the concentrations of cholesterol (TC), triglycerides (TG), phospholipids (PL), VLDL, LDL, HDL lipoproteins and apolipoprotein B(apo-B). The average values of TG and VLDL-C were above normal, while the remaining parameters were within the normal range. No statistically significant differences in these parameters were found between immunosuppressive and hypotensive regimens. There were statistically significant increases (above normal range) in TC, LDL-C, VLDL-C and apo-B in patients treated with prednisone (total yearly dose more than 10 mg/m2/day) in comparison to patients treated with smaller doses of prednisone. We observed a reduction in lipid disturbances, although TG and VLDL-C remained elevated in patients with good graft function. We believe that typical immunosuppressive therapy and low doses of hypotensive drugs do not exacerbate lipid disturbances, which occur in patients treated with high doses of prednisone.