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The available evidence suggests that nutritional status in the HD patients is an extremely important predictive and causative factor for the good clinical outcome. Nutritional deficits and PEW are frequent problems in the dialysis population and implies an increased risk of negative health outcomes such as mortality risk and quality of life deterioration. There is no single specific measurement that provides complete assessment of the nutritional status in the HD patients, and the results should be analysed in the clinical context of each individual patients. As malnutrition is potentially reversible with appropriate nutritional support, early identification of patients at high nutritional risk may facilitate effective treatment and improve prognosis in the HD patients. .

Background/Aim. Inflammation is the most important factor in the genesis of vascular complication in the endstage renal disease. The serum C-reactive protein (CRP) level is a sensitive marker of systemic inflammation as well as a predisposing factor for cardiovascular and all cause mortality in patients on hemodialysis. Albumin is the negative acute phase protein and its synthesis declines during the inflammation. The patients undergoing hemodialysis have a high prevalence of protein-energy malnutrition, due to reduced protein synthesis and increased degradation. The low serum albumin levels in these patients originate from the complex setting of conditions with systemic inflammatory response as a major cause, malnutrition and overhydratation. The aim of this study was to determine the prevalence of elevated CRP levels in the dialysis patients and to analyse its correlation with serum albumin levels and other parameters of nutritional status. Methods. The study included 49 patients on maintenance hemodialysis at the Department of Hemodialysis, Clinic of Nephrology, Military Medical Academy, Belgrade, Serbia. In order to analyse the parameters, the blood samples were taken during the arteriovenous fistula (AVF) puncture and before the second weekly dialyse. The following parameters were determined: serum levels of urea and creatinine before and after the dialysis procedure, CRP, hemoglobin, fasting glycemia, total cholesterol, triglycerides, albumins, iron, glycosylated hemoglobin (HbA1c), fasting insulinemia and C-peptide only before the dialysis. Results. Out of 49 patients on maintenance hemodialysis, 37 (75.5%) were males and 12 (24.5%) females with the average age of 56.04 ± 13.93 years. The average duration of the dialysis treatment was 7.37 ± 5 years. The high serum CRP levels (more than 3 mg/L) was found in 65.3% of patients. Singificantly more diabetic patients were observed in the group with the higher CRP levels (n = 12) compared to the group with the norm, Uvod/Cilj. Inflamacija je jedan od glavnih faktora odgovornih za nastanak vaskularnih komplikacija kod bolesnika sa terminalnom bubrežnom insuficijencijom. C reaktivni protein (CRP) se smatra senzitivnim markerom sistemske inflamacije, kao i faktorom koji doprinosi povećanom riziku od opšteg i kardiovaskularnog mortaliteta. Albumin je negativni protein akutne faze zapaljenja i njegova sinteza opada sa napredovanjem sistemske inflamacije. Za bolesnike na hemodijalizi poznato je da pate od visokog stepena proteinske malnutricije usled smanjene sinteze proteina i njihove pojačane razgradnje. Nizak nivo serumskog albumina kod tih bolesnika je posledica kompleksnog stanja koje podrazumeva sistemsku inflamaciju, malnutriciju i prekomernu hidrataciju. Cilj naše studije bio je da se ispita učestalost povišenog serumskog CRP-a u našoj populaciji dijaliznih bolesnika i da se utvrdi stepen njegove korelacije sa serumskim albuminom i drugim parametrima nutritivnog statusa. Metode. Ispitivanjem je obuhvaćeno 49 bolesnika na hroničnom programu hemodijalize u Centru za hemodijalizu Klinike za nefrologiju Vojnomedicinske akademije u Beogradu. Uzorci krvi za analizu uzimani su tokom punkcije arteriovenske fistule, a pre druge nedeljne hemodijalize. Određivanu su sledeći parametri: serumski nivo uree i kreatinina pre i posle procedure, CRP, hemoglobin, glikemija, ukupni holesterol, trigliceridi, glikozilirani hemoglobin (HbA1c), insulinemija i C-peptid pre hemodijalize. Rezultati. Od ukupno 49 dijaliznih bolesnika, bilo je 37 (75,5%) muškaraca i 12 (24,5%) žena, prosečne starosti 56,04 ± 13,93 godine. Dužina lečenja hemodijalizom je prosečno iznosila 7,37 ± 5 godina. Povišene vrednosti serumskog CRP-a (više od 3 mg/L) imalo je 65,3% bolesnika. U grupi bolesnika sa povišenim nivoom CRP-a u serumu, bilo je značajno više dijabetičara (n=12) u odnosu na grupu sa normalnim nivoom CRP-a u serumu (n = 3) (p ≤ 0,05). Uočili smo postojanje značajne pozitivne korelacije između serumskog CRP-a

Background/Aim. Obesity is an established risk factor for numerous chronic diseases. The aim of this study was to investigate the effect of well-balanced different caloric restriction (CR) diets on anthropometric parameters and standard biochemical cardiovascular risk markers [lipid profile, glucose homeostasis and high sensitivity C-reactive protein (hs-CRP)] in overweight/obese females. Methods. Participants (age 20-40 years) were randomized into 3 different CR diet groups: the group I - restriction of 20% calories from baseline energy requirements, the group II - restriction of 50% calories from baseline energy requirements and the group III - alternating daily diets with 70%/30% restriction. The study lasted 42 weeks. Anthropometric parameters were measured at the start and after 4, 8, 20 and 42 weeks after dietary intervention beginning. Biochemical markers were determined at baseline and after 20 and 42 weeks from dietary restriction start. Results. Body weight, body mass index (BMI), waist circumference (WC) and body fat (in %), in the different CR diet groups significantly decreased after 42 weeks. Body weight was less 11 kg in the group I and 12 kg in the groups II and III. WC was reduced by 11 cm in the groups I and III and by 10 cm in the group II. Different CR diets had the same effects on body fat (a reduction of 15% of body fat). Total cholesterol decreased by 7% in the group I and by 8% in the group III. Low density lipoprotein (LDL) cholesterol decreased by 14% in the group I and by 13% in group III. There were no significant changes in total and LDL-cholesterol levels in the group II. The atherogenic index presented as trigliceride/high density lipoprotein (TG/HDL) ratio decreased by 0.22 in the group I, by 0.25 in the group II and by 0.32 in the group III. Various CR diets had the same effects on reducing the hs-CRP levels. Conclusion. Different CR diets with the same macronutrient content are equally effective in reducing body weight, WC and body, Uvod/Cilj. Gojaznost je faktor rizika od nastanka mnogih hroničnih bolesti. Cilj istraživanja bio je da se ispita efekat dobro izbalansirane ishrane različitih kalorijskih ograničenja na antropometrijske parametare i standardne biohemijske kardiovaskularne markere rizika [(lipidni profil, homeostazu glukoze, visoko senzitivni C-reaktivni protein - high-sensitivity C-reactive protein (hs-CRP)] kod predgojaznih/gojaznih žena. Metode. Ukupno 97 žena, između 20 i 40 godina starosti, konzumirale su uravnotežene, kalorijski različite restriktivne dijete, na sledeći način: I grupa (n = 37) - ograničenje 20% kalorija od osnovnih energetskih potreba; II grupa (n = 30) - ograničenje od 50% kalorija od osnovnih energetskih potreba i III grupa (n = 30) - naizmenična dnevna restrikcija od 70% i 30% kalorija od osnovnih energetskih potreba. Stepen uhranjenosti je određivan antropometrijskim merenjima na početku i nakon 4, 8, 20 i 42 nedelje od uvođenja dijeta. Biohemijski markeri analizirani su na početku i nakon 4, 8, 20 i 42 nedelje. Rezultati. Kalorijski različite restriktivne dijete dovele su do značajnog smanjena telesne mase, indeksa telesne mase (body mass index - BMI), obima struka (OS) i % telesne masti nakon tretmana od 42 nedelje. Telesna masa snižena je za 11 kg u grupi I, a za 12 kg u grupama II i III. Za 11 cm je smanjen OS u grupama I i III i za 10 cm u grupi II. Gubitak 15% ukupne telesne masti ostvaren je za sve vrste dijeta nezavisno od različitog kalorijskog unosa. Koncentracija ukupnog i (low density lipoprotein) holesterola (LDL-holesterola) snižena je za 7% i 14% u grupi I i za 8% i 13% u grupi III. Dijeta sa redukcijom kalorijskog unosa od 50% nije imala efekta na nivo ukupnog i lipoprotein niske gustine LDL-holesterola. Aterogeni indeks predstavljen kao odnos trigliceridi/lipoprotein visoke gustine (high density lipoprotein) - TG/HDL bio je manji za 0,22 u grupi I, za 0,25 u grupi II i za 0,32 u grupi III. Kalorijski različite restriktivne dijete dovele s

Background/Aim. Overweight/obesity has become important health problem in developed countries. It may be related to a presence of low-grade inflammation in white adipose tissue. The aim of this study was to investigate the levels of inflammatory marker C-reactive protein (CRP) and its relation to anthropometric parameters in overweight and obese females. Methods. This study included 200 apparently healthy, overweight and obese women (18-45 years). Their standard and alternative anthropometric parameters [body mass index (BMI), percentage of fat (%F), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI)] were determined and correlated to serum CRP concentration. Results. Average CRP level was 5.56 ± 2.43 mg/L, and it significantly positively correlated to all investigated anthropometric parameters. There was significant difference between overweight and obese group in all investigated anthropometric parameters, as well as in CRP values. When investigated separately, according to BMI, values regarding obese females showed significant correlation between CRP and every investigated anthropometric parameter. In overweight subjects, no such correlation was recorded. In the obese group, all investigated parameters were significantly related to F. In overweight subjects, body weight (BW), BMI, WC and WHtR showed significant relation to F. Conclusion. The significant difference between the overweight and obese group in all parameters of central obesity was found as well as in the CRP levels. In the obese group, we found strong correlation between adiposity measured by fat percentage and parameters of central obesity, while in the overweight group WHR and BAI did not correlate to fat percentage. Our results confirmed that CRP is a valuable marker of metabolic risk in obese females, and BMI, although not so new, is still reliable parameter of adiposity., Uvod/Cilj. Prekomerna telesna masa i gojaznost postali su značajan zdravstveni problem u razvijenim zemljama, a mogu biti povezani sa prisustvom hronične inflamacije niskog intenziteta u belom masnom tkivu. Cilj rada bio je da se ispitaju nivoi markera inflamacije, C-reaktivnog proteina (CRP), i njegova povezanost sa standardnim antropometrijskim parametrima kod predgojaznih i gojaznih žena. Metode. Studijom je bilo obuhvaćeno 200 zdravih žena (18-45 god) kojima su određeni standardni i alternativni antropometrijski parametari [indeks telesne mase (BMI), procenat masti (%F), obim struka (WC), odnos obima struka i kukova (WHR), odnos obima struka i visine (WHtR), kao i indeks telesne masnoće (BAI)] koji su zatim korelisani sa koncentracijama CRP u serumu. Rezultati. Prosečna vrednost nivoa CRP u serumu u celoj grupi iznosila je 5,56 ± 2,43 mg/L i utvrđena je njegova značajna pozitivna korelacija sa svim ispitivanim antropometrijskim parametrima. Uočena je statistički značajna razlika između grupa predgojaznih i gojaznih žena u svim ispitivanim antropometrijskim parametrima, kao i u pogledu koncentracije CRP. U grupi gojaznih ispitanica utvrđena je značajna povezanost između CRP i svih antropometrijskih parametara, dok u predgojaznoj grupi nije zabeležena statistička značajnost. U grupi gojaznih, svi antropometrijski pokazatelji pokazali su značajnu korelaciju sa procentom telesne masti, a kod predgojaznih žena, korelacija je bila značajna samo za telesnu masu, BMI, WC i WHtR. Zaključak. Između predgojaznih i gojaznih ispitanica postoji značajna razlika u pogledu svih pokazatelja centralne gojaznosti, kao i u pogledu koncentacije CRP u serumu. U grupi gojaznih, pokazana je značajna korelacija između sadržaja masti, izraženog kao procenat masnoće, i svih pokazatelja visceralne distribucije masti, dok u grupi predgojaznih značajna povezanost nije urađena za WHR i BAI. Naši rezultati potvrđuju da CRP može predstavljati značajan marker metaboličkog rizika kod gojaznih žen

Background/Aim. Morbidity and mortality of continous ambulatory peritoneal dialysis (CAPD) patients is still very high. The aim of the study was to evaluate the effects of peritoneal dialysis (PD) solutions (standard vs biocompatible) on long-term patients' and the techique survival. Methods. A total of 42 stable patients on CAPD participated in this crosssectional study. They were prospectively followed-up during the twelve years. Patients with severe anemia (Hb lt 10 g/L) and malignant disease ware excluded. Twenty one (50%) patients were treated with the standard PD solutions (CAPDP- 1) while the other 21 (50%) were treated with biocompatible PD solutions [(lower level of glucose degradation products, lower concentration of Ca2+ and neutral pH (CAPDP-2)]. All patients were analyzed for a presence of vascular calcification, nutrition status, and parameters of inflammation after 2.5 ± 0.6 years of starting CAPD, and these variables considered in the analysis as risk factors. Results. The patients from the group CAPDP-2 compared to those from the group CAPDP-1 had lower level of high-sensitivity C-reactive protein (hs-CRP) (p = 0.003), and better nutritional status as confirmed by the mid-arm circumference (p = 0.015), and midarm muscle circumference (p = 0.002) and subjective global assessment (p = 0.000). Also, they had lower vascular calcifications as confirmed by intima media thickness (IMT) (p = 0.003), degree of carotid narrowing (p = 0.001) and calcified plaques of common carotid arteries (CCA) (p = 0.008). Kaplan- Meier analysis confirmed better survival of patients from the group CAPDP-2 than those from the group CAPDP-1 (1-, 5-, and 10-year patients survival rate was: 100%, 61.9% and 14.3% for the group CAPDP-1, and 100%, 85.7%, and 52.4% for the group CAPDP-2, respectively; p = 0.0345). The 1-, 5-, and 10-year technique survival rate was: 100%, 71.4%, and 38.1% for the group CAPDP-1, and 100%, 85.7%, and 76.2% for the group CAPDP-2, respectively; (p = 0.0, Uvod/Cilj. Morbiditet i mortalitet bolesnika na kontinuiranoj ambulantnoj peritoneumskoj dijalizi (KAPD) i dalje je neprihvatljivo visok. Cilj rada bio je da se proceni uticaj vrste dijaliznih rasvora (bioinkompatibilni vs biokompatibilni) na višegodišnje preživljavanje bolesnika i same tehnike KAPD. Metode. Ovom studijom preseka sa delimično prospektivnim praćenjem ishoda lečenja obuhvaćeno je ukupno 42 nasumice izabrana, stabilna bolesnika (26 muškaraca i 16 žena) lečena primenom metode KAPD tokom poslednjih 12 godina. Isključeni su bolesnici sa teškom anemijom (Hb lt 10 g/L) i malignom bolešću. Pri tome, 21 (50%) bolesnika kontinuirano je lečeno bioinkompatibilnim rastvorom za KAPD (kiseli standardni rastvor - ANDY-disc; grupa KAPDB-1), dok je preostalih 21 bolesnik sve vreme bilo na biokompatibilnijem rastvoru za KAPD (neutralni rastvor sa znatno manjom koncentracijom degradacionih produkata glukoze, 1.25 mmol/L Ca i 40 mmol/L laktata - Gambrosol Trio; grupa KAPDB-2). Svim bolesnicima određeni su odabrani parametri hronične inflamacije, malnutricije i ateroskleroze zajedno sa transportnim karakteristikama peritoneumske membrane i rezidualnom bubrežnom funkcijom nakon 2,5 ± 0,6 god od započinjanja KAPD. Svi dobijeni rezultati analizirani su kao potencijalni faktori rizika. Rezultati. Grupa KAPDB-2 u odnosu na KAPDB-1 imala je statistički značajno niže vrednosti serumskog hs-CRP (p = 0,003) i bolje parametre nutritivnog statusa izražene kroz obim nadlaktice (p = 0,015), obim mišića nadlaktice (p = 0,002) i subjektivnu globalnu procenu (p = 0,000) kao i u manjoj meri prisutnu aterosklerozu potvrđeno debljinom intimomedijalnog kompleksa (IMT) (p = 0,003), stepenom suženja karotida (p = 0,001) i prisustvom kalcifikovanih ateromatoznih plakova na karotidnim arterijama (p = 0,008). Kaplan-Meier-ova kriva preživljavanja potvrdila je značajno duže preživljavanje bolesnika u grupi KAPD-2 u odnosu na KAPDB-1 (1-, 5-, i 10-godišnje preživljavanje bolesnika iznosilo je redom