Ukrainian Journal of Nephrology and Dialysis
ISSN / EISSN : 23040238 / 26167352
Current Publisher: State Institution "Institute of Nephrology NAMS of Ukraine" (10.31450)
Total articles ≅ 250
Latest articles in this journal
Published: 3 May 2020
Ukrainian Journal of Nephrology and Dialysis pp 52-61; doi:10.31450/ukrjnd.2(66).2020.08
Systemic chronic inflammation (SCI) is a common feature of chronic kidney disease (CKD) which is most pronounced in dialysis patients. SCI is associated with cardiovascular pathology, various comorbid conditions and high mortality risk in dialysis patients. The existing dialysis methods are ineffective for removing substances involved in SCI (medium molecular uremic toxins: cytokines, growth factors, adiponectin, hormones, and other substances). The dialysis technology development has always aimed to create the membranes that will be as close as possible to the natural glomerular membrane. Currently, Middle Cut-Off membranes have been created. The use of Middle Cut-Off membranes is implemented in a new method of dialysis therapy entitled expanded hemodialysis (HDx). Further studies will determine the expected perspective of these membranes and HDx in the treatment of dialysis patients.
Published: 16 April 2020
Ukrainian Journal of Nephrology and Dialysis pp 3-8; doi:10.31450/ukrjnd.2(66).2020.01
Rapid progression of chronic kidney disease (CKD) is seen in patients with hepatitis C virus (HCV) infection compared with uninfected patients. Despite the high efficacy of direct-acting antivirals (DAAVs), their cost represents a limiting factor to their use in developing countries. Aim. This study aimed to evaluate the efficacy of low dose Sofosbuvir along with Daclatasvir in the management of HCV infection in end-stage renal disease (ESRD) patients. Methods. A total of 82 HCV positive patients on ESRD were included in this study. The patients were observed for six months without antiviral drugs. Patients who remained seropositive were divided into two groups. The first group included 26 (37%) patients who were treated with half-dose Sofosbuvir 200 mg and Daclatasvir 60 mg and the second group consisted of 44 (63%) patients who have been treated with full-dose Sofosbuvir 400 mg and Velpatasvir 100 mg irrespective of HCV infection genotype for 12 weeks also. Results. 12 (14%) patients became seronegative spontaneously. All patients (100%) of both groups achieved sustained virological response with undetectable HCV RNA in 12 weeks of the treatment. There were nonsignificant gastrointestinal side effects in the full dose Sofosbuvir group. All patients tolerated the DAAs well. No patient discontinued antiviral therapy due to side effects Conclusion. In this study, the spontaneous seroconversion of HCV was 14%. Low-dose Sofosbuvir along with Daclatasvir was safe and as effective as full-dose Sofosbuvir and Velpatasvir in the treatment of HCV in ESRD patients. Low-dose Sofosbuvir regimen can be recommended for HCV infection treatment in ESRD patients.
Published: 24 March 2020
Ukrainian Journal of Nephrology and Dialysis pp 9-16; doi:10.31450/ukrjnd.2(66).2020.02
The risk of cardiovascular disease begins to increase from the early stages of chronic kidney disease (CKD). Abdominal aortic aneurysms are the most common arterial aneurysms of peripheral arterial diseases. The frequency of abdominal aortic aneurysm varies according to the population studied. This study aimed to determine the prevalence of abdominal aortic aneurysm in patients with stage 3-4 CKD and investigate CKD is a risk factor for abdominal aortic aneurysm formation. Methods. Patients aged 55 years and older who were followed up in the internal medicine outpatient clinics were enrolled. Two hundred CKD patients with glomerular filtration rates between 15-59 mL/min per 1.73 m2 were included in the study group, and 110 patients with glomerular filtration rates of 60 mL/min per 1.73 m2 or above were assigned to the control group. An ultrasonography device with a 3.5 MHz probe was used for screening. Abdominal aortic diameters of 3 cm and above were accepted as abdominal aortic aneurysms. Results. Eighteen patients in the study group (9%) and four in the control group (3.6%) had an abdominal aortic aneurysm. The prevalence of abdominal aortic aneurysms was higher in the CKD group. However, the difference was not statistically significant (p=0.078). Moreover, the median aortic diameter was 21.8 mm (14-44 mm) in the study group, compared to 21.0 mm (14-46 mm) in the control group. The prevalence of the abdominal aortic aneurysm was 14.9% in stage 4 CKD patients and 6% in stage 3 CKD patients (p=0.038). Conclusion. An abdominal aortic aneurysm is more common in patients with CKD although it does not reach statistical significance. The median aortic diameter was significantly wider in CKD patients compared to the control group . The prevalence of abdominal aortic aneurysm increased with an increase in the CKD stage .
Published: 22 March 2020
Ukrainian Journal of Nephrology and Dialysis pp 47-51; doi:10.31450/ukrjnd.2(66).2020.07
In the field of hemodialysis technologies, as in other fields of medicine, evolutionary changes are constantly taking place. The innovations are driven by unachieved clinical outcomes and desire to improve the quality of care of patients with CKD 5D. Recent advances in dialysis techniques resulted in the possibility to expand the permeability of dialysis membranes for a wider spectrum of uremic toxins that lead to the enhancement of long-term outcomes improving quality of life and reducing the mortality rate of dialysis patients. The inadequacy of existent dialysis techniques, at least in part, is due to the chronic accumulation of organic retention solutes of middle and large molecules, which are poorly or even not removed during dialysis. A gradual improvement in the elimination of uremic toxins is observed as a result of the development of new alternative approaches of hemodialysis therapy, such as high-flux hemodialysis, hemodiafiltration, expanded hemodialysis (HDx). However, some techniques have had limited success due to a host number of organizational, technological, financial and human factors. Expanded hemodialysis offers a novel blood purification technology in removal of the large spectrum of uremic toxins, in particular large medium molecules, due to the new structure of the dialysis membrane. There are a number of studies that prove the potential benefits of a new method of dialysis therapy over the previous ones, suggesting a reduction in cardiovascular mortality, vascular calcification and inflammation. In addition, there is evidence of a positive effect of HDx on the quality of life in dialysis patients. In particular, to minimize the manifestations of skin itching, restless legs syndrome, asthenic syndrome.
Published: 20 March 2020
Ukrainian Journal of Nephrology and Dialysis pp 17-23; doi:10.31450/ukrjnd.2(66).2020.03
The aim of the current study was to investigate the possible association of HOTAIR gene rs1899663 polymorphism with kidney cancer patients survival and clinicopathological characteristics of kidney cancer. Methods. The whole venous blood of 101 patients with clear cell renal cell carcinoma (CCRCC) (42 women and 59 men) was used in the study. Genotyping of rs1899663 HOTAIR gene polymorphic locus was performed by polymerase chain reaction followed by restriction fragment length polymorphism analysis (PCR-RFLP). Statistical analysis was performed using SPSS (version 17.0). The Kaplan-Meier test and the Cox regression were used to test the possible association between rs1899663 polymorphism of long non-coding RNA HOTAIR gene and the age of CCRCC onset. P values < 0.05 were considered as statistically significant. Results. The results of HOTAIR gene rs1899663 polymorphism genotyping showed that the ratio of GG-homozygotes, GT-heterozygotes and TT-homozygotes in CCRCC patients was 39.6%, 52.5%, and 7.9%, respectively. This distribution did not deviate from the expected by Hardy-Weinberg law (P = 0.143). Results of one-way ANOVA showed that rs1899663-locus of HOTAIR gene was not associated with tumor size of CCRCC patients (P > 0.05), was not related to body mass index, erythrocyte sedimentation rate, fasting glucose, hemoglobin, creatinine and leukocyte amount in the blood of CCRCC patients (P > 0.05). In addition, the results of the Kaplan-Meyer test showed that life expectancy until the CCRCC occurrence does not depend on rs1899663 SNP (log-rank P = 0.739). At the same time, the results of Cox regression analysis both before and after adjusting for covariates (sex, body mass index, metastases, smoking habits and alcohol abuse) showed that CCRCC risk development with age does not depend on HOTAIR gene rs1899663 polymorphism (P > 0.05). Conclusions. This is the first report about the possible link between HOTAIR gene polymorphism and survival of kidney cancer patients both in Ukraine and worldwide. The rs1899663 polymorphic site of HOTAIR gene is not associated with the age of CCRCC onset in the Ukrainian population. In addition, the rs1899663 SNP is also not related to tumor size and clinical фтв laboratory data in patients with kidney cancer.
Published: 20 March 2020
Ukrainian Journal of Nephrology and Dialysis pp 62-70; doi:10.31450/ukrjnd.2(66).2020.09
Hepatorenal syndrome (HRS) is a unique form of acute kidney injury (AKI) developing in patients with end‐stage liver disease. AKI is a frequent complication in advanced cirrhosis patients which is associated with increased hospital admissions and decreased survival. The definition of AKI in cirrhosis has been recently modified and the new diagnostic criteria are based on small changes in serum creatinine with respect to previous values, occurring within a short period of time. Systemic circulatory dysfunction and marked kidney vasoconstriction play a key role in the development of HRS. The modification of the AKI definition has also led to a change in the diagnostic criteria of HRS. The new diagnostic criteria are based on AKI stages and there is no need to reach a specific serum creatinine threshold. The use of the new HRS definition may lead to an earlier identification of renal impairment and better prognostic stratification. According to these new criteria, treatment with vasoconstrictors and albumin for the management of HRS will be started at lower serum creatinine values, with expected higher response rates. There are consistent data showing that some urine biomarkers, particularly NGAL (neutrophil gelatinase‐associated lipocalin), may be useful in daily clinical practice for the differential diagnosis of the cause of AKI in cirrhosis. Various HRS treatment regimens are available worldwide and all are designed to increase the mean arterial pressure by increasing the central blood volume and decreasing splanchnic vasodilation, and to serve as bridge to liver transplantation.
Published: 17 March 2020
Ukrainian Journal of Nephrology and Dialysis pp 24-31; doi:10.31450/ukrjnd.2(66).2020.04
Asymptomatic methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is a confirmed factor that affects the frequency of comorbid bacterial infections and mortality in patients with end-stage renal disease (ESRD). The aim was to study the frequency of comorbid conditions and their dynamics in ESRD patients depending on their MRSA status. Methods. To prospective cohort study included 265 ESRD patients, 204 of whom were treated by hemodialysis (HD) and 61 by peritoneal dialysis (PD). All recorded comorbidities, their frequency and the dynamics of change, polymorbidity indices, were analyzed depending on whom had MRSA nasal colonization (group 1, n = 92) and without it (group 2, n= 173). The most common cause of ESRD was glomerulonephritis - 161 patients (60.75%). The groups were representative according to gender, age, type of kidney injury and modality of renal replacement therapy (RRT). Results. According to the results of a 3-year study investigation, the patients with MRSA carriage had a statistically significant higher level of comorbid conditions frequencies compared to the patients who had opportunistic pathogenic bacteria carriage, namely: prevalence of coronary artery disease (55.4% vs 30.1%, р=0.0001), heart failure (44.6% vs 25.4%, р=0.0015), secondary hyperparathyroidism (61.9% vs 45.1%, р=0,009), chronic obstructive pulmonary disease (31.5% vs 17.3%, р=0.0082), peripheral vascular disease (39.15 vs 17.9%, р=0.0001). The increase in the modified polymorphism index in patients of Group 1 and Group 2 during the observation period, was 30 % and 5% respectively. One hundred thirty three hospitalization cases were detected during follow-up period: among patients from Group 1- 66 (71.34%) cases, Group 2 - 67 (38.73%); χ² = 26.180, р < 0.0001; RR – 1.8524, 95% ДІ: 1.4760 – 2.3247. Conclusions. Asymptomatic MRSA nasal colonization is a factor that can increase the incidence of coexisting diseases as well as the total number of comorbid conditions in dialysis patients.
Published: 2 March 2020
Ukrainian Journal of Nephrology and Dialysis pp 32-39; doi:10.31450/ukrjnd.2(66).2020.05
Hypertension is still the most prevalent non-communicable diseases in Indonesia. Renovascular hypertension is one type of secondary hypertension. It is commonly caused by the presence of renal artery stenosis (RAS). Whereas, atherosclerosis (ARAS) and fibromuscular disease (FMD) are the most common causes of RAS. Early diagnosis is necessary because it has the potential to be cured by eliminating stenosis of the renal artery. However, the signs and symptoms of renovascular hypertension are not specific. The supporting examination to diagnose RAS is also expensive. So, screening in the population at risk is needed. The examinations to prove the presence of RAS are arteriography, captopril renogram, renal ultrasonography, renal Doppler ultrasonography, magnetic resonance angiography (MRA), and computed angiographic tomography (CTA). Until now, three therapeutic modalities can be selected in the management of renovascular hypertension; pharmacological therapy, surgical intervention, percutaneous intervention angioplasty with and without stenting. This narrative review summarizes the literature focused on the diagnosis and therapy of RAS.
Published: 24 January 2020
Ukrainian Journal of Nephrology and Dialysis pp 36-47; doi:10.31450/ukrjnd.1(65).2020.06
Current scientific studies’ results have shown the relationship between the epiphysis functional state and the kidneys function. However, the impaired of the epiphysis melatonin-forming function (MFE) in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) is a poorly understood issue. Methods. 130 HD patients (50% of men) were examined in this study. Based on the melatonin level, the patients were allocated into 2 groups: group I included 110 HD patients with impaired MFE and group II consisted of 20 HD patients with preserved MFE. 20 healthy individuals were included in the control group. Results. The melatonin level was significantly lower in HD patients compared to the control group at daytime and night (p
Published: 24 January 2020
Ukrainian Journal of Nephrology and Dialysis pp 20-28; doi:10.31450/ukrjnd.1(65).2020.04
The gold standard method for prostate cancer diagnosis is a transrectal ultrasonography-guided prostate biopsy. The detection rate of prostate cancer using the biopsy is approximately 25-30%. A non-invasive method Technetium-99m methoxy-isobutyl-isonitrile single-photon emission computed tomography (technetium-99m-MIBI-SPECT) could be used in prostate cancer detected. The study aimed to try to show that Tc99m-MIBI-SPECT, which is performed as a non-invasive method before biopsy in patients with prostate biopsy indication, may prevent unnecessary biopsy among these patients. Methods. Fifty-six patients who were admitted to our clinic for any lower urinary tract symptoms or routine control and who had a digital rectal examination or PSA value indication for prostate biopsy were included in this retrospective study. Technetium-99m-MIBI-SPECT our patients before the biopsy was performed, radiopharmaceutical uptake by the intensity and localization of the prostate was detected. Technetium-99m-MIBI-SPECT localization and intensity of involvement by prostate biopsy results were evaluated by nuclear medicine specialists. Results. The patients’ age and PSA level were 62.8 (31-78) years and 11.3 (2.5-100) ng/ml, respectively. Prostate cancer was detected in 27/56 (48.2%) patients. The suspicious diagnosis in technetium-99m-MIBI-SPECT images was observed in 36/56 (64.3%) patients, but prostate cancer was detected in 20 of them only. The sensitivity and specificity of technetium-99m-MIBI-SPECT were 74% and 45%, respectively. The positive and negative predictive values were 55% and 45% respectively. The diagnostic value of technetium-99m-MIBI-SPECT methods was considered as 58%. Conclusıon: The technetium-99m-MIBI-SPECT method in this study had low sensitivity and specificity for prostate cancer diagnosis. Therefore, we came to the conclusion that technetium-99m-MIBI-SPECT cannot be an alternative diagnostic method.