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Periodontitis (PO), a chronic microbially-induced inflammation of the supporting tissues of the tooth, is linked to various systemic diseases. We analyze its bidirectional relationship to chronic kidney disease (CKD), a major health-care problem with impressive excess mortality. Overwhelming associative relationship between CKD and PO are analyzed. Major pathophysiologic mechanisms that link CKD to PO are then presented: systemic inflammation, endothelial dysfunction, and imbalance of oxidative stress characteristic of CKD have a role in PO development and might influence escape mechanisms of oral microbiota. Subclinical local and systemic inflammation induced by PO might influence in turn CKD outcomes. Homeostatic changes induced by CKD such as mineral bone disorders, acidosis, uremic milieu, or poor salivary flow are also relevant for the occurrence of PO. There is insufficient evidence to recommend a standardized diagnostic and therapeutic approach regarding association of PO to CKD.

The study goal was to assess the impact of each type of arterial intimal calcifications (AIC) and arterial medial calcifications (AMC) identified on ultrasound, of osteoprotegerin (OPG), mineral metabolism markers and other features on all-cause and cardiovascular mortality in chronic hemodialysis patients. Ultrasound was performed in 87 patients on the carotid and femoral arteries, and the severity of AIC and AMC was assessed calculating a score according to the extension of calcification. The cut-off value for OPG determined using ROC was 4.9 pmol/L for all-cause and cardiovascular mortality. Patients with higher serum OPG levels presented higher mortality rates. Our results revealed that AIC, high OPG, low ankle-arm index, presence of diabetes, smoking status, and lack of arteriovenous fistula are associated with all-cause and cardiovascular mortality in univariate regression analysis. Multivariate analysis identified AIC scoring based on the segmentation method as an independent predictor of all-cause and cardiovascular mortality, along with increased OPG levels. AMC scoring was not a predictor of mortality. Identifying and scoring AIC on ultrasound and measuring OPG levels, as a basis of the HD patient assessment may become valuable tools in clinical work, as these have an impact on death toll.

Background and aims. Cardiovascular (CV) disease is the leading cause of morbidity and mortality in hemodialysis (HD) patients. Kidney disease is associated with increased oxidative stress (OS), a nontraditional CV risk factor. Few studies evaluate the effect of OS markers on CV events (CVE) and survival in HD patients. The aim of this study is to examine potential determinants of OS markers and their predictive role on survival and CV morbidity and mortality in HD patients during a long-term follow-up (108 months). Methods. We conducted an analytical cross-sectional prospective observational study, carried on a cohort of randomly selected HD patients. We registered in 44 HD patients baseline characteristics, OS markers, mortality and CVE over a period of 108 months and we used statistical analysis (descriptive, Kaplan-Meier, univariate and multivariate Cox model) for interpretation.Results. Bound malondialdehyde (bMDA) was positively correlated with serum calcium, protein carbonyls (PC) were inversely correlated with diastolic blood pressure (DBP) and directly correlated with ferritin, NOx was directly correlated with ceruloplasmin) and serum albumin. Of the measured OS markers only bMDA was related to survival (HR=3.29 95% CI (1.28-8.44), p=0.01), and approached statistical significance in the effect on CV mortality (HR=2.85 95% CI (0.88-9.22), p=0.07). None of the measured OS markers was associated with CVE.Conclusions. bMDA has a strong predictive value on survival in HD patients in a long-term follow-up (9 years). Its value is correlated with CV mortality but is not a predictor of CV events. Regular assessment of MDA in HD patients and the development of strategies aimed at reducing oxidative stress in these patients might be beneficial.

We report the case of a sepsis-induced acute kidney injury accompanied by disseminated intravascular coagulation and thrombotic microangiopathy, responsible for subsequent renal microvascular thrombosis. Contrast-enhanced ultrasound was used to assess the thrombotic cortical kidney ischemia and its evolution over time.

Background and aim. In spite of numerous interventions, the control of mineral disturbances remains poor in end-stage renal failure (ESRF) patients. Chronic kidney disease - mineral and bone disorders (CKD-MBD) represent an important cause of mortality and morbidity. The aim of this study is to analyze the relationship between mineral and bone disorders (MBD) and their components impact on all-cause mortality and cardiovascular (CDV) mortality and morbidity in chronic dialysis patients. Methods. This prospective study was carried out in a cohort of 92 randomly selected patients with ESRF treated with hemodialysis (HD) and peritoneal dialysis (PD). The data regarding demographic and clinical characteristics were recorded, including vascular disease (coronary, cerebral, peripheral). The follow-up lasted 40 months and the final evaluation included the number and causes of deaths, CDV events and disease. Serum Ca, P, ALP, iPTH, albumin, cholesterol, urea and creatinine levels were measured. The plain radiographic films of hands and pelvis evaluated all bone abnormalities suggestive of renal osteodystrophy (ROD) and peripheral vascular calcification (VC). Results. All-cause annual mortality represented 9.25% in HD and 9.09% in PD patients. The CDV mortality represented almost 44% in HD patients and 66% in PD patients from all deaths. There was a high prevalence of CDV diseases and events. High and low serum P levels were associated with a worse survival rate. Hypercalcaemia was associated with high risk for CDV events in HD patients. In PD patients, the relationship between increased ALP levels and all-cause mortality was significant. Other mineral markers were not predictive of the outcome in the studied patients. In the HD patients the severity of VC was associated with all-cause and CDV mortality, and with CDV events. Male gender, hypercholesterolemia, decreased URR, albumin and creatinine were identified as risk factors for all-cause mortality. The diabetics had higher death rates. Low dialysis efficacy represented a risk factor for mortality and CDV diseases and events. In PD patients, low albumin induced a higher death rate. In PD patients the death rate was similar to HD patients. Conclusion. All-cause mortality was higher than in general population, but lower than the chronic dialysis patients’ mortality reported in other studies. The death rates in HD and PD patients were similar. VC and serum P levels influenced the outcome in the HD patients – increased the risk for all-cause and CDV mortality, but also for CDV events. ALP levels influenced outcome in PD patients. There were no significant differences between HD and PD patients regarding outcome.

CONTEXT: Angiotensin converting enzyme 2 (ACE2) is highly expressed in the kidney and cleaves angiotensin II to Angiotensin (1–7), annihilating the deleterious effects of angiotensin II which is known to be a strong activator of oxidative stress. OBJECTIVE: We aimed to evaluate the relationship of oxidative stress to urinary ACE2 (uACE2) in type 2 diabetes mellitus (T2DM) patients. DESIGN: We included consecutive normo or microalbuminuric T2DM patients in an observational transversal study. Routine laboratory investigations, plasma malondialdehyde (MDA, fluorimetric thiobarbituric method) as a marker of prooxidant capacity and superoxide dismutase (SOD, cytochrome reduction method) and catalase (CAT) activity (in erythrocyte lysate by the modification of absorbance method) as two measures of serum antioxidant capacity and uACE2 (ELISA method) were assessed. RESULTS: MDA showed a negative correlation with SOD (r=-0.44, p=0.001), CAT (r=-0.37, p=0.006), uACE2 (r=-0.33, p=0.016) and a positive correlation with glycated haemoglobin (HbA1c) (r=0.49, p

Aim: The aim of our study was to investigate the understanding of statistical terms commonly used in lectures presented at summer schools for residents and young specialists. Material and Method: A survey was distributed to all the participants at the “Diabetic neuropathy from theory to practice” Summer School, 2014. The program was addressed to residents or young specialists in diabetes, neurology, surgery, and orthopedic from Romania. The survey consists of 6 multiple-choice questions and the first four questions evaluate the understanding of statistical terms. Results: There were 51 (42.5%) participants who completed the questionnaires. From 204 total questions 81 (39.7%) had correct answers. At the question 1, where relative risk was evaluated, only 3 (5.9%) respondents answered correctly while at the question 2 (number need to treat) about 78.4% (40) of answers were correct. At the question 3 (sensitivity), 22 (43.1%) respondents answer correct while at the question 4 (Receiver Operating Characteristic curves) only 16 (31.4%) respondents provided a correct answer. The overall mean score of correct answers was 1.56±0.91. Conclusion: Our study showed that young specialists who participated to the survey were not familiarized with simple statistical terms commonly used in presentations.

Obiectiv. La pacienţii cu diabet zaharat de tip 2, natura progresivă a afectării renale reprezintă un risc crescut de mobiditate şi mortalitate. Scopul studiului nostru a fost acela de a evalua valoarea predictivă a molecului de adeziune intercelulară (ICAM 1) pentru creşterea albuminuriei în stadiile timpurii ale afectării renale la pacienţii cu diabet zaharat de tip 2. Metodă. S-au inclus în studiu pacienţi consecutivi cu diabet zaharat de tip 2, urmăriţi prospectiv timp de 1 an. Progresia bolii renale a fost evaluată prin modificarea în timp a raportului albumină urinară pe creatinină urinară (ΔuACR). Rezultate. 93 de pacienţi cu diabet zaharat tip 2 au fost incluşi în studiu, dintre aceştia 58 fiind normoalbuminurici, iar 35 albuminurici. Media excreţiei urinare de albumină a fost în stadiu microalbuminuric şi au avut a valoare a filtrării glomerulare aproape normală. ΔuACR a prezentat o corelaţie pozitivă cu nivelul seric iniţial al ICAM 1 (p=0.003, r= 0.31) şi cu creatinina serică. În regresie multiplă, ICAM 1 a rămas singurul determinant al ΔuACR (p= 0.002). La pacienţii albuminurici, ΔuACR a prezentat o corelaţie şi mai puternică cu nivelul seric iniţial al ICAM 1 (p=0.0003, r=0.57). Concluzii. La pacienţii noştri cu diabet zaharat tip 2, principalul predictor al creşterii albuminuriei pe parcusul unui an de urmărire a fost nivelul seric iniţial al ICAM 1, în special la pacienţii albuminurici. ICAM 1 ar putea fi un biomarker non-invaziv cu utilitate clinică în prezicerea progresiei albuminuriei la pacienţii cu diabet zaharat tip 2.

Background: Monocytes and granulocytes, activated by contact with hemodialysis membranes, generate increased cytokine secretion, an important key in pathogenesis of anemia and erythropoietin (rHuEPO) resistance. We aimed to examine the correlation of IL-17 and pro-hepcidin with anemia of chronic kidney disease (CKD) patients treated with hemodialysis(HD). Method: 69 HD patients were included. Exclusion criteria were: neoplasia, acute infections, blood loss, absolute iron deficiency. IL-17 and pro-hepcidin were determined. Hemoglobin, ferritin, transferrin and transferrin saturation were measured. rHuEPO responsiveness index was calculated. A poor response to rHuEPO was defined as rHuEPO responsiveness index>200. Results: Mean level of IL-17 was 33.3 ± 5.1 pg/ml and pro-hepcidin was 336.6 ± 23.7 pg/ml. IL-17 and pro-hepcidinnegatively correlated with hemoglobin (R0.503, p 200 had higher pro-hepcidin (432.5 ± 25 vs. 157.5 ± 12 pg/ml, p

Aims: Ultrasound (US) examination is an important tool in the diagnosis of arteriovenous (AVF) stenoses; different US measures are available for assessing the severity of stenoses. The aim of our study was to analyse risk factors and consequences of AVF stenosis and its severity and to compare the usefulness of different US measures of stenoses’ severity. Material and methods: Ninety-seven prevalent patients from a single dialysis centre with patent AVF were included. We recorded history of disease, clinical and laboratory data. US was used to diagnosis the stenosis and to measure blood flow in the brachial artery, resistivity index (RI), and the diameter of the vessels (arteries, anastomosis, venous outflow). Results: Stenosis was present in 54.64% of the patients (59.6% juxtaanastomotic). Stenosis patients had higher age, lower diameter of the brachial artery, lower anastomosis diameter, and lower diastolic blood pressure (DBP). Atherosclerosis, delayed maturation of AVF, and statin treatment were more prominent in the stenosis group. Logistic regression disclosed delayed maturation, cholesterol, atherosclerosis, and DBP as significant predictors of stenosis. When severe stenosis was measured by the diameter reduction, stenosis patients had higher age, lower HDL cholesterol, and poorer dialysis efficacy. Flow in the brachial artery and RI were less useful for identifying risk factors or differences in outcome. Conclusions: Prevalence of stenosis was high in our cohort, more than half of the patients having some degree of stenosis. Risk factors for stenosis were related to atherosclerosis, low DBP, and delayed maturation of AVF. Diameter of stenosis is the most useful marker of severity.