The phenomenon of patients with advanced renal failure accepted for dialysis at a late stage in the disease process (late referral [LR]) is known almost from the beginning of dialysis therapy. It may also be associated with worse outcomes. The aim of the study was to assess the effect of referral time on the outcomes, such as number of hospitalizations, length of stay, kidney transplantation, and mortality. A study of 1303 patients with end-stage renal failure admitted for dialysis in the same period in Fresenius Nephrocare Poland dialysis centers was initiated. The type of vascular access during the first dialysis was accepted as the criterion differentiating LR ( n = 457 with acute catheter) from early referral (ER; n = 846). The primary endpoint was the occurrence of death during the 13-month observation. By the end of observation, 341 (26.2%) of patients died. The frequency of death was 18.1 for ER and 37.9 for LR per 1000 patient-months. It can be estimated that 52.1% (95% CI: 40.5–61.5%) of the 341 deaths were caused by belonging to the LR group. Patients from LR group had longer hospitalizations, more malignancies, lower rate of vascular access in the form of a–v fistula, higher comorbidity index. It seems that establishing a nephrological registry would help to improve the organization of care for patients with kidney disease, particularly in the pandemic era.

Introduction: Secondary hyperparathyroidism (sHPT) is a common hormonal complication of chronic kidney disease. There are several therapeutic options for sHPT management aiming at calcium-phosphorus balance normalization and decrease of parathormone secretion.Objectives: The aim of this retrospective, observational study was the outcome assessement of three most common therapeutic strategies of secondary hyperparathyroidism treatment with vitamin D receptor activator-paricalcitol, calcimimetic-cinacalcet or both agents administered together during in 12-months period.Methods: One hundred and thirty-one haemodialysed patients with uncontrolled parathyroid hormone secretion have been treated with paricalcitol administered intravenously (group PAR−60 patients) or cinacalcet per os (group CIN−50 patients). The last group (group PAR+CIN−21 patients) received paricalcitol i.v. and oral cinacalcet administered simultaneously.Results: In all groups, the iPTH level decreased significantly, however in group 1 treated with paricalcitol administered intravenously iPTH level decrease was greater than in group 2 treated with cinacalcet and in group 3 treated with paricalcitol and cinacalcet in parallel. The most substantial change of iPTH level was noticed after 3-months of observation. After this period the iPTH level was stabilized and maintained till the end of observation. Safety level of all strategies was comparable. No severe hypercalcemia or hypocalcemia was observed during the whole period of observation.Conclusions: The results of observation show significant advantage of intravenous paricalcitol treatment. Complementing cinacalcet therapy with paricalcitol does not improve treatment outcomes. In case of unsatisfactory results after 3-months treatment, potential continuation should be considered carefully. Among three available therapeutic options, the treatment with paricalcitol i.v. should be considered in all haemodialysed patients with inadequate control of serum PTH level. The second option—with cinacalced administered orally should be considered in PD patients and when severe hypercalcemia occurs.

No abstract

No abstract

Introduction. The patients in situations of "being ill" have to face not only pain and disabilities, but also problems in their social relationships. Perceptions of illness are results of reactions to the changes in the existential situations, and that these correspond to determined illness coping strategies.Aim. The aim of the research was to determine the relationships between perception of illness and social support, with the indicators of the adequacy of the renal replacement treatment and the level of urea as a biomarker of disease offset.Material and methods. The study was conducted on a group of 150 patients who were on chronic hemodialysis, and who were suffering from end stage renal disease. The patients were treated at on of the several Fresenius Medical centres. As a group, average Kt/V value was 1.45 (SD=0.22) and the URR ratio 71.78 (SD=5.95). Moreover, average urea concentration before HD equaled to 133.78mg% (SD=39.68) and after hemodialysis -38.22mg% (SD=14.60). The research procedure was based on a questionnaire study. This applied three standardized scales: the Imagination and Perception of Illness Scale (IPIS), the brief Illness Perception Questionnaire (IPQ-Brief) and the Berlin Social Support Scale (BSSS).Results. Patients who exhibited higher values of urea concentration in the blood serum measured before HD, perceived their disease (IPIS scale) as causing more motivation loss to carrying out specific activities, as well as mental and physical sphere destruction, pessimism and lost control over the disease. What is more, higher values of urea reduction ratio (URR) positively correlate with the loss of control over the disease (r=-0.20, p=0.024). Moreover, patients characterized by higher values of urea concentration in the blood serum before hemodialysis, evinced greater need for social support (BSSS).Conclusions. The need for social support among ESRD patients treated by hemodialysis does not correlate with dialysis adequacy indicators. Furthermore, the level of urea marked before hemodialysis exhibits an interdependence with psychological determinants of illness perception and social support.

secondary hyperparathyroidism (SHPT), bone abnormalities, and vascular calcification in patients with chronic kidney disease (CKD) are the components of chronic kidney disease-mineral bone disorder (CKD -MBD).1-3 This systemic disorder significantly contributes to the morbidity and mortality of patients with CKD. [4][5][6] SHPT (intact parathyroid hormone [iPTH] level >300 pg/ml) is diagnosed in 30% to 49% of dialyzed patients in Europe and even in 54% of those in the United States and Canada). 7 The diagnosis IntroductIon With progressive renal impairment and worsening of renal excretory function, the disorders of calcium and phosphorus metabolism become more severe. The increasing reduction of glomerular filtration results in lower phosphate excretion and, consequently, hyperphosphatemia. Phosphorus anions bond serum calcium cations, which leads to a reduction of ionized calcium levels. At the same time, a sustained high phosphate level inhibits vitamin D 3 synthesis. AbstrActIntroductIon Secondary hyperparathyroidism (SHPT) is a common hormonal disorder associated with chronic kidney disease (CKD). The treatment of SHPT should lead to a reduction in parathormone concentrations by calcimimetics or active vitamin D administration and stabilization of calcium and phosphate metabolism. In the event of failure of conservative treatment, complete or partial parathyroid resection should be considered.

No abstract

No abstract