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Background Women of all ages and elderly patients of both genders comprise an increasing proportion of the haemodialysis population. Worldwide, significant differences in practice patterns and treatment results exist between genders and among younger versus older patients. Although efforts to mitigate sex-based differences have been attempted, significant disparities still exist. Methods This retrospective cohort study included all 1247 prevalent haemodialysis patients in DaVita units in Portugal (five dialysis centres, n  = 730) and Poland (seven centres, n  = 517). Demographic data, dialysis practice patterns, vascular access prevalence and the achievement of a variety of Kidney Disease: Improving Global Outcomes (KDIGO) treatment targets were evaluated in relation to gender and age groups. Results Body weight and the prescribed dialysis blood flow rate were lower in women (P < 0.001), whereas treated blood volume per kilogram per session was higher (P < 0.01), resulting in higher single-pool Kt/V in women than in men (P < 0.001). Haemoglobin was significantly higher in men (P = 0.01), but the proportion of patients within target range (10–12 g/dL) was similar. Men more often had an arteriovenous fistula than women (80% versus 73%; P < 0.01) with a similar percentage of central venous catheters. There were no gender-specific differences in terms of dialysis adequacy, anaemia parameters or mineral and bone disorder parameters, or in the attainment of KDIGO targets between women and men >80 years of age. Conclusions This large, multicentre real-world analysis indicates that haemodialysis practices and treatment targets are similar for women and men, including the most elderly, in DaVita haemodialysis clinics in Europe. [ABSTRACT FROM AUTHOR]

Most mitochondrial mRNAs are edited in Trypanosoma brucei by a series of steps that are catalyzed by a multienzyme complex that is in its initial stages of characterization. RNA interference (RNAi)-mediated repression of the expression of TbMP81, a zinc finger protein component of the complex, inhibited growth of bloodstream and insect forms, and blocked in vivo RNA editing. This repression preferentially inhibited insertion editing compared with deletion editing in vitro. It resulted in reduced specific endoribonucleolytic cleavage and a greater reduction of U addition and associated RNA ligation activities than U removal and associated RNA ligation activities. The repressed cells retained 20S editing complexes with several demonstrable proteins and adenylatable TbMP52 RNA ligase, but adenlyatable TbMP48 was not detected. Elimination of TbMP48 by RNAi repression did not inhibit cell growth or in vivo editing in either bloodstream or procyclic forms. These results indicate that TbMP81 is required for RNA editing and suggest that the editing complex is functionally partitioned. [ABSTRACT FROM AUTHOR]

Unlabelled: The aim of the study was to evaluate the influence of elevated homocystein (Hcy) level and selected lipid parameters on the progression of atherosclerotic changes in patients after kidney transplantation (KTx)., Patients and Methods: The study included 51 pts (17 F, 34 M) aged 15-62 years (median 38.1) after cadaver KTx. The mean observation period equaled 21.2 months (6-24 months); while total observation period was 90 patients/ years. Hcy levels was measured using HPLC, Lp(a) and Apo-B levels using the nephelometric method and total cholesterol with its' HDL and LDL fractions, triglycerides and creatinine based on the Hitachi 917 analyzer. Patients' blood was drawn before renal transplantation and 3, 6, 9, 12, 15, 18, 21 and 24 months after KTx. Common carotid artery intima media thickness (CCA-IMT) was evaluated by ultrasound on 14 days, 12 and 24 months after KTx., Results: CCA-IMT correlated significantly with Hcy levels after 12 months (R=0.53; p=0.0009) and 24 months (R=0.38; p=0.0356) after KTx. Significant differences were found 12 and 24 months after KTx in CCA-IMT between patients with normal (<15 micromol/l) and increased (>15 micromol/ l) mean Hcy concentrations: p=0.0035 and p= 0.015, respectively. Analyzing changes in CCA-IMT, significant differences were noted when comparing the CCA-IMT increment after 12 and 24 months post KTx in patients with normal (< or =15 micromol/l) and increased (>15 micromol/l) homocystein concentrations: p=0.049 and p=0.0039, respectively. Increment of CCA-IMT 12 months after KTx, significantly correlated with mean total cholesterol level (R=0.35; p=0.0333), whereas 24 months after procedure correlated significantly with 0.0315)., Conclusions: Hcy level is an independent risk factor for atherosclerosis development in patients after KTx. Elevated Hcy level as well as increased cholesterol and Lp(a) levels enhance the progression of atherosclerotic changes evaluated by CCA-IMT in KTx patients.

The very high cardiovascular mortality and morbidity in hemodialyzed patients (HD) is strongly associated with cardiovascular calcification. The aim of the study was to find the predictors of mortality in HD patients during 5-years observation period. The study group was composed of 64 patients (35 F, 29 M) aged 25-75 years (mean 48.9) hemodialyzed three times a week for 12-275 months (mean 77.8). The levels of hemoglobin, total protein, albumin, Ca, P, Ca x P, iPTH, cholesterol, triglycerides, fibrinogen, insulin, homocysteine, leptin, procalcitonin, CRP, IL-6, TGF-beta, PDGF were assessed and all patients underwent Calcium Score (CS) of coronary arteries (CACS) calculation using MSCT and B-mode ultrasound of carotid arteries for intima-media thickness (CCA-IMT), as well as echocardiographic assessment with LVMI calculation and heart valves evaluation at the start of observation. The self-elaborated Cumulative Calcification Index (CCl) was calculated as a sum of CACS Index according to Rumberger et al. (CS<10-0, 10400 - 3 points); number of calcified plaques in carotid arteries (0-0, 1 - 1, 2 - 2, 3 and more - 3 points) and the number of calcified heart valves. At the start of the study the median value of CCl was 4 and interquartile range 4. Only 2 (3%) patients were free of any type of cardiovascular calcification (CCl =0), 15 (23%) patients had minimal calcification (CCl 1 to 2 points), 33 (52%) average (2 - 6 points) and 14 (22%) patients had severe calcification (CCl>6). 21 (32,8%) patients died during observation period. Patients who died were older (56.9 vs. 45.3 yrs.) and had higher CS at the start (1275 vs. 356), higher CCA-IMT (0.948 vs. 0.687 mm) and CCl (6.15 vs. 3.63) values. Those patients had also higher CRP (0.645 vs. 0.245 mg/dl) and IL-6 (10.16 vs. 4.15 pg/ml) levels (p<0.05). LVMI and mean: hemoglobin, total protein, albumin, Ca, P, Ca x P, iPTH, cholesterol, triglycerides, fibrinogen, insulin, homocysteine, leptin, procalcitonin, TGF-beta as well as PDGF levels did not differ between the groups. In logistic regression model (p<0.00002), among tested parameters only CCl was an independent and statistically significant factor of mortality with OR=1.82 per every point of CCl (p<0.0003). Cardiovascular calcification expressed as CCl confirmed to be a strong predictor of mortality in HD patients.

The Aim of the Study: The echocardiography evaluation of cardiac function in children with CKD., Patients and Methods: 30 children (17 males, 13 females), aged 2-20 yrs with CKD 2-5. Left ventricular (LV) dimensions, LV ejection fraction (EF) and LV mass index (LVMI), as well mitral inflow velocity (E/A waves) and isovolumetric relaxation time (IRT) were evaluated., Results: Impaired diastolic heart function were ascertained in 12 patients (in 2 from 5 with CKD 3, in 3 from 10 with 4 and 7 from 14 with 5). Left ventricular hypertrophy was observed in 13 children with CDD 3-5 (4, 4, 5), and decreased ejection fraction in 2., Conclusions: The vast majority of children with chronic kidney disease demonstrate an impairment of diastolic cardiac function.

Background: Atherosclerosis and vascular calcifications are common causes of morbidity and mortality in maintenance haemodialysis patients. In addition to the well-known traditional risk factors, uraemia-specific factors appear to enhance dramatically the progression of the pathological processes involved. The aim of the present study was to evaluate the degree of atherosclerosis and vascular calcifications in chronic haemodialysis patients using non-invasive imaging methods, and to identify potentially involved factors., Methods: The study included 73 patients (36 females, 37 males), aged 25-75 years, who were on haemodialysis treatment for 12-275 months (mean dialysis vintage 73.8 months). We assessed the following circulating parameters: calcium (Ca), phosphorus, 'intact' parathyroid hormone (iPTH), 25OH vitamin D, lipids, oxidized LDL (ox-LDL), Lp(a), homocysteine, leptin, IL-1-beta, IL-6, CRP, TGF-beta, TNF-alpha, (PDGF), advanced oxidation protein products (AOPP) and myeloperoxidase activity (MPO). Coronary artery calcification score (CACS) was assessed using multi-row spiral CT (MSCT). Intima-media thickness index of the common carotid artery (CCA-IMT) and presence of cervical artery atherosclerotic plaques were evaluated by ultrasonography., Results: Coronary artery calcifications were observed in 79.5% of the patients, with CACS ranging from 0 to 4987. In univariate analysis, a positive correlation was observed between CACS and age, BMI, iPTH, CRP, IL-6 and CCA-IMT, whereas an inverse correlation existed with 25OH vitamin D, TGF-beta and PDGF. CCA-IMT ranged from 0.4 to 1.1 mm. It was positively correlated, in univariate analysis, with age, CACS, CRP and Il-6, and negatively with 25OH vitamin D, TGF-beta and PDGF. Only CACS remained as independent predictive factor of CCA-IMT in multivariate analysis. Atherosclerotic plaques were found in the carotid arteries of 53 patients (72%). The number of plaques was positively correlated with age, CACS, phosphorus, MPO, CRP and IL-6, and inversely with 25OH vitamin D in univariate analysis. In multivariate regression analysis, only age and CACS remained as independent variables., Conclusion: In addition to classic risk factors, the degree of atherosclerosis and vascular calcification in our dialysis patient population were associated with several factors that are frequently abnormal in advanced chronic renal failure, but except age, all of them were interdependent. Notably, as in the general population, CACS was an independent predictor of the degree of atherosclerosis in haemodialysis patients.

An accurate evaluation of water content in the body of hemodialyzed patients seems to be an important problem in chronic dialysotherapy. Acute intradialytic hypotension observed in 20-33% of hemodialysis patients is a very common complication of this kind of renal replacement therapy. The study was performed in 40 uremic patients, treated with hemodialysis at the Nephrology Clinic of the University Hospital in Cracow. In every patient, 3 model dialysis sessions were carried out. Total fluid removal was the same during every hemodialysis. The first model hemodialysis (HD1) was performed with constant dialysate sodium concentration (140 mmol/L), the second (HD2) with linear and the third (HD3) with expotential decrease of dialysate sodium concentration (from 144 to 136 mmol/L). Every hemodialysis was also monitored continuously with Crit-Line 2 R system (In-Line Diagnostics, Riverdale, UT). Before and after the first model hemodialysis (HD1), ultrasound examination of abdominal cavity was performed. The measurement of inferior vena cava diameter (mm), circumference (mm), area (mm2), at hepatic veins orifice-level, on expiration was performed. The fluid removal during the first model hemodialysis resulted in significant reduction of the vena cava inferior diameter, circumference and area, measured with ultrasound on expiration. The statistically significant lower fall of blood volume after the first and second hour of the second model hemodialysis session (HD2) was observed when compared to the first hemodialysis (HD1) - p<0.05 was observed. The statistically significant lower frequency of hypotension during the second hemo-dialysis session (HD2) as compared to HD1 (chi2=5.25 p<0.05). Differences among HD1 and HD3 and HD2 and HD3 did not reach statistical significance. The monitoring of hemodialysis with the Crit-Line instrument permits for optimalization of dry weight of dialyzed patients and allows reaching higher ultrafiltration rates during dialysis without hypotensive episodes. The changes in the blood volume, approximately 5% per one hour of dialysis session are an optimal value for these patients.

Hepatitis B is a serious epidemiological problem in uremic patients treated with renal replacement therapy. A high proportion of hemodialyzed patients do not respond to the standard method of intramuscular (i.m.) hepatitis B vaccination. Low-dose intradermal (i.d.) inoculations and supplementary i.m. injections have been reported to improve the responsiveness in formerly non responding uremic patients. We applied a inoculation schedule of 10 microg Engerix B i.d. in 49 pts and i.m. (control group) in 13 pts once a week during 12 consecutive weeks in order to compare the effectiveness of the various ways of immunization in maintenance dialyzed patients not responding to standard vaccination. Serum anti-HBs antibody level, as well as biochemical and immunological parameters were examined. Already one month after initiation of the cycle, 57.1% of patients in the i.d. group responded by achieving the minimum protective anti-HBs antibody level (>10 IU/I.); while 14.3% reached full adequate anti-HBs antibody level (>100 IU/I.). After the full therapy period, anti-HBs antibody level >100 IU/I. was achieved in 42.9% of the patients, while a total of 81.7% of patients reached the anti-HBs antibody level >10 IU/I. In 18.4% of patients no response was observed. Surprisingly similar results were achieved in the i.m. group. Twelve months after termination of the inoculation cycle we noted decrease of anti-HBs antibody level; the values >100 IU/ I. was observed only in 18.4% of the study group, while 87.8% reached a titre >10 IU/I. We found a relationship between the effectiveness of immunization and RBC count, total serum protein and albumin levels and GGTP activity. Mitogen stimulation indexes in both groups were 4-5 times lower in comparison to reference values in the general population. In the study group that did not respond to vaccination, mitogen stimulation indexes were 2 times lower as compared to the group characterized as having a good response. In conclusion, the route of injection seems to be less important than the frequency and number of doses of the vaccine. Anemia and malnutrition may be responsible for the worse response to vaccination against hepatitis B virus.

A comparison of accuracy between electrical bioimpedance analysis (BIA) and body mass index (BMI) for fat mass evaluation in children was the aim of the study. One-hundred and ninety three healthy children (90 females, 103 males) were enrolled. The mean age of the studied population was 11.8 years (+/- 2.2), mean weight equalled to 42.6 (+/- 12.8) kg and mean height-151.1 (+/- 13.5) cm. BIA measurments were performed by multifrequency (1; 5; 50; 100 kHz) BIA 2000M analyzer using BIANOSTIC electrods. Calculations of free fat mass and fat mass were performed using Nutri 4 Data Input Software (Germany). The LMS method for percentile charts of FFM and FM acording to height has been applied and results for boys and girls were drawn separatelly. Percentile charts of FM and BMI were compared. Different shape of curves of FM content and BMI for boys during puberty was noticed. BIA allows for precise fat mass content evaluation in children and its use should be disseminated.

Unlabelled: The aim of the study was to assess severity of injury of the peripheral nervous system of chronic renal failure patients on continuous ambulatory peritoneal dialysis (CAPD) or on maintenance hemodialysis (HD) diagnosed based on the electrophysiological testing as well as to establish the effect of adequate dialysis dose on peripheral nerve functioning. The study was performed in 53 patients (21 males, 32 females) on CAPD for mean 16.9 +/- 14.4 months and 68 patients (46 males, 22 females) on HD for mean 47.5 +/- 46.5 months. Both groups were age matched (48.9 +/- 12.4 vs. 50.6 +/- 11.9 yrs; p= NS). Patients with co-existing diseases that could lead to disturbances in nerve conduction were excluded from the study group., Methods: Electrophysiological testing was performed using Medelec Shaphire 2ME equipment. Nerve conductivity testing was performed in motor and sensory fibres of right ulnar nerve, motor fibres of right fibular nerve and left tibial nerve as well as in sensory fibres of right calf nerve. In the sensory nerves there were assessed: amplitude of the evoked sensory response, latency of the response and conduction velocity. In the motor nerves there were analyzed amplitude of the compound muscle action potential, latency of the evoked response, F-wave minimal latency and conduction velocity. Polyneuropathy was diagnosed if abnormal results obtained in electrophysiological examination were found in at least two out of four tested nerves. To assess dialysis adequacy in the CAPD group weekly Kt/V (wKt/ V) and weekly creatinine clearance (WCrCI) were used and in the HD patients the following indices were measured: Kt/V, PRU, TAC and TAD., Results: Polyneuropathy diagnosed based on the above described criteria, was found in 59 (86.8%) HD patients and in 41 (77.4%) CAPD patients (p= NS). The results of motor conductivity testing showed significantly longer distal latency in HD patients in comparison to the CAPD patients in fibular nerve (4.9 +/- 0.9 vs. 4.5 +/- 0.8 ms; p< 0.05) and F-wave latency in ulnar nerve (29.3 +/- 3.1 vs. 27.3 +/- 2.5 ms; p< 0.05), in fibular nerve (52.4 +/- 6.4 vs. 48.5 +/- 7.94 ms; p< 0.05), in tibial nerve (54.8 +/- 7.8 vs. 50.6 +/- 7.12 ms; p< 0.05) and also significantly lower conduction velocity in ulnar nerve (51.9 +/- 5.9 vs. 55.6 +/- 6.99 m/s; p< 0.05), in fibular nerve (41.2 +/- 5.9 vs. 44.5 +/- 5.5 m/s; p< 0.05), in tibial nerve (40.1 +/- 5.81 vs. 42.7 +/- 4.6 m/s; p< 0.05). Mean value of sensory response amplitude evoked in ulnar nerve was significantly higher in the CAPD treated patients than in HD patients (21.2 +/- 14.8 vs. 15.1 +/- 11.4 microV; p< 0.05) and distal latency in calf nerve was significantly shorter (2.1 +/- 1.0 vs. 2.4 +/- 0.6 ms; p< 0.05). Analysing the effect of dialysis on peripheral nerve functioning in the group of CAPD patients a statistically significant relationship between the severity of peripheral nerve injury and WCrCl was demonstrated. Mean value of WCrCl in patients without features of neuropathy was significantly higher (83.3 +/- 28.98 l/week/ 1.73m2) in comparison with those with diagnosed polyneuropathy (59.9 +/- 15.9 l/week/1.73m2) (p< 0.01). Analyzing effect of WCrCl on conduction velocity in the tested nerves there was demonstrated that in patients with WCrCl value at least 60 l/week/1.73m2, mean velocity values were higher, and the statistically significant difference was found for sensory (p< 0.05) and motor (p< 0.01) fibers of ulnar nerve. Mean value of residual renal clearance in the CAPD treated patients without features of sensory and motor nerve injury was significantly higher (2.9 +/- 1.8 ml/min) when compared to the patients with diagnosed polyneuropathy (1.4 +/- 1.3 ml/min) (p= 0.006). In the hemodialyzed group no statistically significant relationship was found between conduction velocity in the tested nerves and indices of dialysis efficiency (Kt/V, PRU) as well as degree of exposure to uremic toxemia described by TAC and TAD., Conclusions: Polyneuropathy is a common complication in patients with chronic renal failure independently of a kind of the therapy. Well preserved residual renal function in CAPD patients plays an important role in improving effectiveness of the dialytic treatment, in consequence influencing preservation of proper peripheral nerve function.

Atherosclerosis and calcifications in the cardio-vascular system are the most frequent causes of increased morbidity and mortality in patients with end-stage renal disease treated with hemodialyses. The aim of this study was to estimate the atherosclerosis progression and presence of calcifications in the circulatory system in patients treated with hemodialyses using, non-invasive imaging diagnostic techniques and to search for the relationships between these changes and microinflammation and oxidative stress during two years. The study was performed in 73 patients (36 female and 37 male), aged 25 to 75 years (mean -49.5), treated with hemodialyses, 3 times/week for 12 to 275 months (mean -73.8). In each patient before starting hemodialysis levels of: ox-LDL, Lp (a), procalcitonin, IL-1beta, IL-6, CRP, TGFbeta, TNFalpha, PDGF, AOPP and MPO were determined. Presence of artery calcifications was detected by Multi-Row Spiral Computed Tomography (MSCT) and expressed as coronary artery calcification score (CACS). Ultrasonography was used to evaluate CCA-IMT. During the study CACS increased significantly after 12 and 24 months (p < 0.00001) as compare with baseline. After 12 months, CACS increase significantly correlated with procalcitonin level (r = 0.30 p = 0.01) and after 24 months with CRP (r = 0.46; p = 0.0002) and IL-6 (r = 0.36; p = 0.005). Independent factor of coronary artery calcification progression after 24 months of observation was only CRP (beta = 0.569). CCA-IMT increased during the study and this increase was statistically significant (p < 0.00001). CCA-IMT increase correlated with CACS growth after 12 (r = 0.36; p = 0.003) and 24 months (r = 0.39; p = 0.002). After 12 months significant relationship was noted with procalcitonin (r = 0.29; p = 0.022). After 24 months CCA-IMT correlated with AOPP (r = -0.30; p = 0.017). The independent factor of CCA-IMT progression after 24 months of observation was only CACS (delta CACS beta = 0.49). From the performed study, we can conclude that exacerbation of atherosclerosis and calcification in the circulatory system of patients treated with maintenance hemodialyses depends on microinflammation and oxidative stress. Reasonable tools for diagnostic algorithm estimation of atherosclerosis advancement in this group of patients are non-invasive, visual diagnostic techniques such as MSCT and ultrasonography.

Unlabelled: Renal replacement therapy has become a recognized treatment modality of children with chronic renal failure (CRF). Despite of unquestionable progress in heamodialysis treatment quite high morbidity and mortality still remain a serious problem among pediatric patients. The most common cause of death in haemodialyzed and transplanted patients are cardiovascular complications. The main aim of the study was an echocardiographic (ECHO) assessment of selected cardiac parameters in heamodialyzed children., Methodology: 16 chronically dialyzed (6 HD, 10 PD) children participated in the study (10 M, 6 F), aged 5-18,5 yrs (x=12.2 +/- 3.8 yrs). Echocardiography examinations were carried out with HP 5500 device and S4 ultrasound probe of variable frequency. Diastolic and systolic LV dimension, ejection fraction (EF) and LV mass index (LVMI) were evaluated. By means of pulsating Doppler method mitral flow peak E and A velocity and isovolumetric relaxation time (IRT) were assessed., Results: On the basis of ECHO examinations 3 groups were singled out: A (n=3) of normal heart function, B (n=3) of impaired systolic and diastolic heart function and C (n=10) of normal systolic and impaired diastolic heart function. In group of children with severe cardiac lesion (B group) a higher LV mass (A vs B vs C: 74.7 vs 119.9 vs 73.5 g/m2) and statistically significant lower ejection fraction (68.1 vs. 33.7 vs. 65.9%) were ascertained. These children were anuric (996 vs. 0 vs. 1112 mild), their systolic (102.1 vs. 118.4 vs. 117,9) and diastolic (64,4 vs. 84.8 vs. 77.9) blood pressure were significantly higher, so was the number or hipotensive medications (0.33 vs. 1.72 vs. 1,44)., Conclusions: The great majority of chronically dialyzed children demonstrates an impairment of cardiac function mainly of diastolic parameters. Anuria and hypertension stand for a significant risk factor of cardiac lesion.

Intradialytic anticoagulation is an essential element of the dialysis procedure. Patients with end stage renal failure, due to the repetitive nature of dialysis sessions are exposed in a chronic manner to side effects of drugs applied during the procedure. Popular administration of unfractionated heparin, concerning its unstable pharmacokinetic profile may cause thrombocytopenia, enhance hyperkalemia, osteoporosis, and lipid disturbances. In the past years, a clinical alternative to unfractionated heparin have become, as well as in dialysis therapy, low molecular weight heparins. Beside the beneficial pharmacokinetic aspect, these heparins are characterized by decreasing number and less intensified side effects associated with their administration.

Unlabelled: Acetaminophen is found to be potentially hepatotoxic drug. Both, acute acetaminophen intoxication (dose >10 g) and therapeutic dose administration in the case of glutathion depletion (chronic alcohol abuse) hepatotoxic effect may occur. Late N-acetylcysteine (NAC) administration does not prevent liver injury. Molecular Adsorbents Recirculating System (MARS) is useful liver support device based on albumin dialysis for saving time for spontaneous liver regeneration or bridging technique to liver transplantation., Case Series: Two cases admitted to the Department in 19 and 20 hour post-ingestion of hepatotoxic paracetamol doses as confirmed by toxiocological examination (serum paracetamol concentration). Despite of NAC administration the signs of the liver injury (progressive encephalopathy and jaundice, decreased prothrombin activity) developed. On day four post exposure according to King's College of Medicine London criteria both cases were qualified to MARS therapy. Albumin dialysis of 8 hour duration was performed in both cases and a full recovery with normalization of the liver function was noted. Patient three: patient with the liver and the kidney insufficiency due to alcohol-paracetamol syndrome admitted to the Department of Clinical Toxicology for MARS therapy. Five performed dialysis resulted in the liver function improvement. The patient was disqualified from the liver transplant because of heart failure, pneumonia, hyperthyroidism and alcoholism. Patient died because of heart failure.

The main cause of increased morbidity and mortality in patients on maintenance hemodialysis are cardiovascular complications due to accelerated atherosclerosis. Lipid profile disturbances, increased levels of homocysteine (HC), fibrinogen, iPTH as and Ca-P abnormalities seem to be the important factors in atherosclerosis progression. The aim of the study was to evaluate the advancement of atherosclerosis in patients on maintenance hemodialysis and to assess levels of pro-atherosclerotic factors. The study included 50 patients (30 M, 20 F) aged 21-75 years (mean 48.6 y) hemodialyzed three times a week for 12 to 282 months (mean 114.5 m). The homocysteine, fibrinogen, iPTH, calcium, phosphate and indices of lipid metabolism such as total cholesterol, HDL, LDL, triglicerides, Lp (a) and Apo B were measured before hemodialysis. To evaluate the advancement of atherosclerosis, all patients underwent MSCT using Somatom plus 4 apparatus with calcium scoring (CS) calculation and B-mode ultrasound for IMT using Acuson 128 XP 10 apparatus. The above applied methods helped to evaluate changes in central and peripheral arteries. In CS testing, coronary artery calcifications were present in 36 patients (72%). The CS ranged from 0 to 4345, with the mean CS being 584 (SD = 1012). The CS correlated significantly with age (r = 0.39; p < 0.005), P (r = 0.33; p < 0.05), CaxP product (r = 0.39; p < 0.05), iPTH (r = 0.43; p < 0.001) and with IMT (r = 0.56; p < 0.0001). The IMT ranged from 0.5 to 1.5, with mean of 0.89 (SD = 0.28). The IMT correlated significantly with age (r = 0.54; p < 0.0001), time on dialysis (r = 0.40; p < 0.01), fibrinogen (r = 0.43; p < 0.02), LDL (r = 0.30; p < 0.05), P (r = 0.29; p < 0.05), and CaxP product (r = 0.3; p < 0.05). Based on our study, we conclude that age, time on dialysis, increased levels of homocysteine, LDL cholesterol, fibrinogen, P, and iPTH as well as Ca-P disturbances are strong predictors of atherosclerosis in HD patients.

Cardiovascular diseases connected with atherosclerosis are the main factor of morbidity and mortality in patients with end-stage renal failure. Hyperhomocysteinemia is a known and independent risk factor of atherosclerosis, occurring in 85-95% patients treated with hemodialysis. The aim of this study was to analyse relation between plasma level of homocysteine and chosen indicators of atherosclerosis development and also examined retrospectively cardiovascular complications in these patients. The study was carried out in 100 patients on hemodialysis who were divided into two groups: 72 patients with mild (20.74 mumol/l +/- 3.75) and 28 patients with moderate hyperhomocysteinemia (38.81 mumol/l +/- 9.81). Ultrasonographic examinations of Carotid Communis Artery Intima-Media Thickness (IMT), Ankle-Arm Blood Pressure Index (AABPI), echocardiographic parameters and biochemical examinations such as: PTH, folic acid and Vitamin B12, total protein, albumin, fibrinogen, glucose, total, LDL and HDL cholesterol, transferring, apolipoprotein B, lipoprotein (a), sodium potassium, calcium, phosphate, magnesium, iron, ferritin, urea, creatinine, uric acid and value of Hb, Ht, total iron binding capacity and transferring saturation, were performed. Patients with hypertension were divided into groups according to the number of taken anti-hypertensive drugs. Hyperhomocysteinemia was confirmed in 96% of patients. Frequency and type of acute cardiovascular complications were not related with the level of hyperhomocysteinemia. Statistically significant difference between IMT and level of hyperhomocysteinemia was observed. In patients with mild hyperhomocysteinemia IMT was 0.68 mm +/- 0.24 whereas in patients with moderate hyperhomocysteinemia 0.80 mm +/- 0.25, p < 0.036). Positive correlation between level of homocysteine and IMT (r = 0.22, p < 0.03) was noted. Based on this study, we concluded, that measurement of intima-media thickness is a good indicator of atherosclerosis development and correlates with hyperhomocysteinemia in patients on maintenance hemodialysis. It clearly confirms the role of hyperhomocysteinemia as significant risk factor of atherosclerosis in those patients.