Žiginskienė, Edita

Lėtinė inkstų liga (LIL) yra viena iš dažniausių lėtinių ligų pasaulyje, su ja susiduria milijonai žmonių. LIL apibūdinama kaip inkstų struktūros ar funkcijos sutrikimai, trunkantys mažiausiai 3 mėnesius ir turintys įtakos sveikatai. Yra įrodyta, kad LIL susijusi su padidėjusia rizika sirgti širdies ir kraujagyslių ligomis, dėl jos didėja hospitalizacijų skaičius, sveikatos priežiūros ištekliai. Dar viena problema, susijusi su LIL - pažintinių funkcijų sutrikimas. Moksliniais tyrimais įrodyta, jog LIL sukelia tiek centrinės, tiek periferinės nervų sistemos disfunkciją. Ilgainiui sutrinka pažintinės funkcijos, blogėja gyvenimo kokybė, atsiranda neįgalumas ir didėja šių pacientų gydymo ir priežiūros išlaidos. LIL dažnai vadinama tyliąja liga, nes ankstyvosiose stadijose jos simptomai būna neryškūs arba visai nepasireiškia, todėl svarbu šią ligą įtarti kuo anksčiau ir pradėti gydymą dar prieš atsirandant rimtų simptomų.

Introduction Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. Muscle pain, general weakness and dark urine are predominant symptoms. Laboratory findings include elevated creatine kinase levels and myoglobinuria [1]. Rhabdomyolysis is likely multifactorial, with statin therapy being one of the contributing factors [2]. Case Presentation A 52-year-old female presented with anuria, generalized weakness and oedema. Her past medical history included a two-year history of arterial hypertension, dyslipidemia, treated with valsartan/ rosuvastatin (160/10 mg), as well as hypophyseal nanism, diagnosed in childhood. Laboratory findings revealed elevated serum creatinine (556 µmol/L), urea (38.8 mmol/L), severe hyperkalemia (8.3 mmol/L), and increased liver enzymes levels, with no evidence of anemia. Renal imaging demonstrated kidneys of normal size. Severe acute kidney injury was diagnosed based on a serum creatinine level of 66 µmol/L measured one month earlier, and hemodialysis treatment was initiated. Renal biopsy showed acute focal tubular necrosis with interstitial nephritis and evidence of myoglobinuria. Subsequent laboratory testing showed markedly elevated creatine kinase (9804 IU/L) and myoglobin levels (11647 μg/L). A diagnosis of statin-associated acute rhabdomyolysis complicated by acute kidney injury was established. Rosuvastatin therapy was initiated two months before the onset of symptoms and subsequently discontinued. After 25 days of hospitalization, kidney function improved, and the patient was transferred to the rheumatology department for further management of myopathy. Discussion Statin-induced rhabdomyolysis is a rare but life-threatening condition and untreated it may lead to acute kidney injury and death [3]. Accurate diagnosis is often challenging because the presenting symptoms are frequently nonspecific and the potential role of statins may be overlooked. Conclusions This clinical case illustrates that, although statins play a beneficial role in clinical practice, they may be associated with adverse effects such as muscle injury. Even when nonspecific symptoms occur in patients receiving statin therapy, close monitoring and timely modification of treatment are required to prevent irreversible kidney and muscle damage.

Kidney replacement therapy (KRT) practices in Europe are heterogeneous, with apparent differences between Western and Central/Eastern Europe. However, time trends in KRT incidence and prevalence in Central and Eastern Europe are not previously reported. Therefore, we aimed to describe trends in incidence and prevalence of KRT in Central and Eastern Europe from 2010 to 2021.

The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper summarizes the ERA Registry Annual Report 2022, with a special focus on comparisons by sex. The supplement of this paper contains the complete ERA Registry Annual Report 2022. Data was collected from 53 national and regional KRT registries from 35 countries. Using this data, incidence, and prevalence of KRT, kidney transplantation rates, survival probabilities, and expected remaining lifetimes were calculated. In 2022, 530 million people of the European general population were covered by the ERA Registry. The incidence of KRT was 152 per million population (pmp). In incident patients, 54% were 65 years or older, 64% were male, and the most common primary renal disease (PRD) was diabetes mellitus (22%). At KRT initiation, 83% of patients received haemodialysis, 12% received peritoneal dialysis, and 5% underwent pre-emptive kidney transplantation. On 31 December 2022, the prevalence of KRT was 1074 pmp. In prevalent patients, 48% were 65 years or older, 62% were male, the most common PRD was of miscellaneous origin (18%), 56% of patients received haemodialysis, 5% received peritoneal dialysis, and 39% were living with a functioning graft. In 2022, the kidney transplantation rate was 40 pmp, with most kidneys coming from deceased donors (66%). For patients starting KRT between 2013 to 2017, 5-year survival probability was 52%. Compared with the general population, the expected remaining lifetime was 66% and 68% shorter for males and females, respectively, receiving dialysis, and 46% and 49% shorter for males and females, respectively, living with a functioning graft.

Aim of the study. To analyze the rate of frailty syndrome among chronic hemodialysis (HD) patients (pts.) and it's association with outcomes. Objectives: 1. To evaluate the rate of frailty in chronic HD pts. 2. To assess relation of frailty to hospitalisation and mortality in chronic HD pts. Methods. A retrospective analysis of clinical data (evaluation of the Edmonton Frail Scale) was performed. Results. In total, 60 HD pts. (70% male and 30% female) participated in our study. The mean age of pts. was 60.1 ± 13.6 years and the median duration of HD was 69 mo (52.5-90). Rate of frailty was 46.7% (n = 28) Older age directly correlated with frailty ( p = 0.01 R = 0.305 ) . The hospitalization rate > 2 times per year directly correlated with the total score of the Edmonton Frail Scale higher results were observed in comparison with non-hospitalized pts. (6 (5-9) vs 5 (3-6); P = 0.037 ) During follow-up period of 45 mo, 18 (30%) patients died, more than a half of them (n = 10; 55.6%) had frailty, but there was no significant correlation between frailty and mortality (p > 0.05) . Conclusions. 1. Rate of frailty prevalence was 46.7% of patients: slight - 31.7%, moderate - 8.3% and severe 6.7%. 2. The significant direct correlation between higher total frailty score and higher hospitalisation rate was found (p = 0.037) but there was no association between frailty and mortality (p = 0.534) .

In the global threat of SARS-CoV-2, individuals undergoing maintenance dialysis represent a vulnerable population with an increased risk of severe COVID-19 outcomes. Therefore, immunization against SARS-CoV-2 is an essential component of healthcare strategy for these patients. Existing data indicate that they tend to exhibit a reduced immune response to vaccines compared to the general population. Our study aimed to assess both humoral and cellular immune responses following two doses of an anti-SARS-CoV-2 mRNA vaccine, an ability to maintain adequate antibody titers over time, and potential relations with vitamin D, comorbidities and other factors in hemodialysis patients based on a single center experience. A total of 41/45 patients (91.1%) responded to the second dose of the anti-SARS-CoV-2 mRNA vaccine. The titer of anti-SARS-CoV-2 IgG class antibodies and levels of T cells three to four weeks after vaccination were lower in dialysis patients than in healthy controls. Antibodies titer in dialysis patients had a positive correlation with B lymphocytes and was related to cardiovascular diseases. The level of CD4+ cells had a negative correlation with hemodialysis vintage, as did the vitamin D level with post-vaccination seroconversion and decline in anti-SARS-CoV-2 antibodies titer during six months after vaccination. Hemodialysis patients had decreased amounts of CD4+ and CD8+ cells and lower levels of anti-SARS-CoV-2 antibodies than healthy controls. Therefore, chronic hemodialysis could lead to diminished cellular immunity and humoral immune response to the anti-SARS-CoV-2 mRNA vaccination and reduced protection from COVID-19. Comorbidity in cardiovascular diseases was associated with a lower level of specific anti-SARS-CoV-2 antibody titer. Vitamin D may be important in maintaining stable levels of anti-SARS-CoV-2 antibodies, while the duration of dialysis treatment could be one of the factors decreasing anti-SARS-CoV-2 antibody titer and determining lower CD4+ cell counts.

The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD). This paper is a summary of the ERA Registry Annual Report 2021, including a comparison across treatment modalities.

Algoritmas (lot. algorismus

BACKGROUND: The aim of this study was to identify trends in total, deceased donor and living donor kidney transplantation (KT) rates in European countries. METHODS: The European Renal Association (ERA) Registry and the Global Observatory on Donation and Transplantation (GODT) databases were used to obtain the number of KTs in individual European countries between 2010 and 2018. General population counts were obtained from Eurostat or the national bureaus of statistics. The KT rate per million population (pmp) and the average annual percentage change (APC) were calculated. RESULTS: The total KT rate in the 40 participating countries increased with 1.9% annually (95% confidence interval (CI): 1.5, 2.2) from 29.6 pmp in 2010 to 34.7 pmp in 2018, reflecting an increase of 3.4 pmp in the deceased donor KT rate (from 21.6 pmp to 25.0 pmp, APC: 1.9% [95%CI: 1.3, 2.4]) and of 1.5 pmp in the living donor KT rate (from 8.1 pmp to 9.6 pmp, APC: 1.6% [95%CI: 1.0, 2.3]). The trends in KT rate varied widely across European countries. An East-West gradient was observed for deceased donor KT rate with Western European countries performing more KTs. In addition, most countries performed less living donor KTs. In 2018, Spain had the highest deceased donor KT rate (64.6 pmp) and Turkey the highest living donor KT rate (37.0 pmp). CONCLUSIONS: The total KT rate increased due to a rise in the KT rate from deceased donors and to a lesser extent from living donors, with large differences between individual European countries.

The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with ESKD. This paper is a summary of the ERA Registry Annual Report 2020, also including comparisons among primary renal disease (PRD) groups.