BACKGROUND AND AIMS The development of vascular calcifications is accelerated in dialysis patients and is associated with an increased risk of cardiovascular morbidity and mortality. Studies have shown that magnesium (Mg) reduces mineral deposit formation, thus potentially abating the process of vascular calcification. Therefore, the use of higher dialysate-Mg might present a promising tool to reduce vascular calcification. Many in vitro studies have investigated effects of Mg on vascular calcification, but prospective clinical trials are lacking. This study evaluated the difference in coronary artery calcification progression over 12 months based on different concentrations of routinely used dialysate-Mg. METHOD This prospective randomized, multicentre study included 60 angina-free chronic haemodialysis (HD) patients distributed into two equal groups based on dialysate-Mg level (0.5 versus 1.0 mmol/L) used routinely before and throughout the study period. Laboratory measurements, including total serum Mg level and coronary artery calcium score (CACS) determined by cardiac computed tomography, were performed in all patients at baseline and after 12 months of follow-up. RESULTS Total serum Mg was significantly higher in patients on higher dialysate-Mg, both at baseline and after 12 months of follow-up (P < 0.001). Nevertheless, in both study groups, total serum Mg decreased after 12 months of follow-up; from 1.13 ± 0.15 mmol/L to 0.99 ± 0.14 mmol/L (P < 0.001) in the lower dialysate-Mg group and from 1.39 ± 0.22 mmol/L to 1.29 ± 0.21 mmol/L (P < 0.001) in the higher dialysate-Mg group. CACS increased significantly in both study groups after 12 months: from 361.90 ± 725.67 to 480.00 ± 783.53 (P <0.001) in the lower dialysate-Mg group and from 437.71 ± 573.77 to 589.07 ± 682.82 (P < 0.001) in the higher dialysate-Mg. Still, the mean change in CACS (ΔCACS) did not differ significantly between the study groups (109.29 ± 181.99 versus 151.86 ± 211.22; P = 0.321). In patients with CACS = 0 at the beginning of the study (4 in the lower and 5 in the higher dialysate-Mg group), the mean ΔCACS was 21.25 ± 3.96 and 0 (P = 0.180), respectively. CONCLUSION Routine use of higher dialysate-Mg (1.0 mmol/L) increases total serum Mg level compared with standard dialysate-Mg solutions (0.5 mmol/L). However, this was not associated with lower CACS progression over 12 months of follow-up. Further research is needed to assess if patients with CACS = 0 may benefit from higher dialysate-Mg in terms of reduced calcification progression compared with standard dialysate-Mg solutions.
Background and Aims The general significance of Balkan endemic nephropathy (BEN) is the association with upper tract urtohelial cancer (UTUC). In published papers studying these two entities, there is large difference between the obtained results. By UTUC research, obtained results are the most diverse in relation to the period and region of research. The aim of the research is to show the discrepancy between the results of the research of UTUC of Jablanica district in relation to the observation period and the type of settlement. Method The research period lasted from 1978-2017. During the analysis of the frequency of UTUC, we used the operative material of Urology Department, Health Care Center, Leskovac , and Urology Clinic, Clinical Center, Nis, Clinical Center, Nis. For practical reasons, this period was devided into two periods, the first (1978-1997) and the second (1998-2017). In order to make classification of settlements we used the data of the Institute of Nephrology and Hemodialysis in Nis (A-endemic regions, B-hypo-endemic, C-non-endemic urban, D-non-endemic rural regions). Data on the total number of Jablanica region population were obtained on the basis of the censuses from 1991 and 2011. The average annual incidence rate (AAIR) was calculated per 100 000 people. Finally, we jointly observed groups A and B (endemic areas) C and D (non-endemic areas) for UTUC. Results The average annual incidence rate (AAIR) in the period of 1978-2017 in endemic settlements of Jablanica region was (11.82), while in hypo-endemic was (4.49) and non-endemic (0.83). The data demonstrated that inhabitants of endemic settlements has 14.24 times higher UTUC frequency in comparison to non-endemic settlements in time span of research. Our research in Jablanica region also demonstrated unexpectedly high frequency of on UTUC not only in endemic settlements with BEN (Kutles village- 1 tumor per 99.63 and AAIR 40.15), but also in some of the non-endemic area (Brejanovac village-1 tumour per 98.75 people and AAIR of 40.50; Rudare village-1 tumour per 139.50 people and AAIR of 28.67; Bogojevce village-1 tumour per 187.63 people and AAIR 21.32). This occurrence of UTUC frequency in some non-endemic settlements refers to the first observed period until no occurrence was recorded in the second observed period. There is a higher UTUC frequency in endemic settlements of 11.37 in the first period (A- AAIR 21.95), while in hypo-endemic (B-AAIR 11.82) is 3.64 higher incedence. In non-endemic settlements (C,D-AAIR 1.09) there is 1.63 higher incidence in comparison to the second period. Observing the periods, there is a higher UTUC frequency of five times in endemic settlements (A, B) of Jablanica region in the first period comparing to the second. The linear trend of UTUC in the 40-year period demonstrates a slow decrease (y= -0.0797x + 4.2846; r2 = 0.2028) in Jablanica region. In the same observed period, linear trend of BEN is in corelation of decreased linear trend of UTUC (y= -0.164x+6.0669; r2 =0.748). Conclusion A forty-year study of UTUC in the Jablanica region showed a discrepancy between the results in relation to the observation period and the type of settlement, which coincides with the generally accepted view that epidemiology is the most fascinating part of BEN. In endemic settlements, in the second observed period, the frequency of UTUC was registered five times lower than in the first, which coincides with the decrease in the frequency of BEN in these settlements.
BACKGROUND AND AIMS An epidemic of coronavirus (COVID-19) has been reported in Serbia since March 2020. Patients requiring chronic haemodialysis (HD) are considered particularly vulnerable due to altered immune response. However, severe form of COVID-19 infection has also been associated with multiple organ disfunction that, in some patients, may lead to acute kidney injury (AKI) or acutisation of previously known chronic kidney disease (aCKD). This study aimed to evaluate mortality rates in dialysis dependent patients hospitalized due to COVID-19. METHOD This retrospective study included 189 patients hospitalized in Clinical Hospital Centre Zemun between March 2020 and March 2021 due to COVID-19. All patients underwent haemodialysis during hospitalization and have been distributed in three groups depending on their renal status: AKI, HD and aCKD. Clinical presentation of the COVID-19 was defined as asymptomatic, mild, moderate, severe or critical. Demographic data and laboratory analyses were derived from the patients’ electronic record. Statistical analysis of the acquired data was performed in SPSS program. RESULTS Out of 189 patients, majority (75.1%) were receiving chronic haemodialysis, while 14.8% had AKI and 10.1% aCKD. The oldest patients were in AKI group, with average age of 70 ± 15 years, although difference did not reach statistical significance. Bilateral pneumonia was a predominant radiography finding in all patients, independently of study group (P = 0.168). Clinical presentation was mostly defined as mild in CHD group, whereas critical in AKI and aCKD group. Regarding complications, AKI group of patients had significantly higher sepsis rate (21.4%, P = 0.027) and respiratory insufficiency (78.5%, P = 0.000) than other groups. Mortality rate among overall population was high, precisely occurred in 64 (34.6%) patients. Statistically significant difference was observed between study groups regarding outcomes (P = 0.000). The worst survival rate was observed in AKI, while the lowest in HD group of patients, 82.1% and 21.9%, respectively. CONCLUSION Among COVID-19 positive population, patients who develop AKI have higher mortality rate compared with patients with previously acknowledged CKD, irrespectively of pre-hospital initiation of dialysis.
We present a case of a 33-year-old man who complained of weakness, fever and decreased urination. A personal history revealed a consumption of creatine, protein supplements, soft-drinks containing caffeine and stevia, and extreme physical activity which included lifting of heavy weights. The patient developed anuria, uraemia, fatigue, rhabdomyolysis and paradoxical hypokalaemia. After the patient had seven successive dialysis treatments, normal kidney function was restored. The report presents the first case of acute renal injury followed by hypokalaemia due to the combined action of the excessive consumption of supplements, soft-drinks with stevia and caffeine, and extreme physical activity.
BACKGROUND AND AIMS All researchers dealing with Balkan endemic nephropathy (BEN) talk about the association of BEN with malignant tumours of the upper urothelium (UTUC). Long-term research of UTUC obtained various results depending on the period and region of observation, depending on the stage of renal failure, degree of malignancy, surgical or autopsy treatment. The aim of this paper is to monitor UTUC in certain parts of the Republic of Serbia in a long period of time and what is the frequency of tumours in relation to the observed endemic and non-endemic built-up areas for BEN. METHOD Occurrence of UTUC was analyzed for the period 1953–2017 on the basis of operational protocols of the Institute of Urology and Nephrology KCS Belgrade, Clinic of Urology Nis, Department of Urology and Haemodialysis Leskovac. The categorization of built-up areas into (A) endemic, (B) hypoendemic, (C) non-endemic rural and (D) non-endemic urban built-up areas was used. For practical reasons, the groups of built-up areas (A) and (B) united in the group of endemic and (C) and (D) in the group of non-endemic built-up areas. The average annual incidence rate (AAIR) is calculated/100 000 inhabitants. RESULTS In his summary series of UTUC, which included a large number of urological centres in Serbia, Petkovic found in a period of 20 years (1953–1973) that the frequency of tumours is 100 times higher in an endemic than in a non-endemic built-up area. In a 40-year study (1978–2017), Glogovac found that the incidence of tumours in Jablanica district was 14.24 times higher in endemic (AAIR-11.82) than in non-endemic built-up areas (AAIR-0.83) in the last 20 years (1998–2017). The frequency is 4.14 times higher. The linear trend of UTUC in the Jablanica district in the endemic built-up area for BEN in the observed 40-year period was in a statistically weak decline (y = –0.0276x + 55.691; r2 = 0.1718) while for BEN it was in a statistically significant decline (y = –0.2127x + 6.6966; r2 = 0.8529). CONCLUSION The high frequency of UTUC in regions with BEN may indicate a common nephropathogenic and carcinogenic etiological factor and confirms the existence of a positive correlation between BEN and UTUC. The reason for the decline in the frequency of UTUC in the observed built-up area in the observed period should be sought in the drastic decline in BEN, which is explained by changes in the course of the disease, better screening, water supply, health education, lower toxicity, micromigration and possibly misdiagnosis.
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