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COVID-19 patients and survivors quite often experience depressive symptoms, which can increase risk for lower immune system response and poorer recovery. Vulnerability to depressive symptoms may be elevated in those patients who have the most severe COVID-19 course of illness, that is, patients who require supplementary oxygen therapy or even intubation. The current study involved a unique sample of patients who were hospitalized due to COVID-19 and who required respiratory support (N = 34, 10 women) in which we investigated depressive symptoms as well as psychopathological personality traits (PID5) as predictors. The majority of patients (76.5%) presented some degree of depressive symptoms. Although we expected severe levels of depressive symptoms to be most prevalent, more patients showed rather moderate levels. At the same time, Negative Affectivity was most predictive of depressive symptoms. We suggest that medical care for patients with greater emotional sensitivity and vulnerability to stress be supplemented with psychological support in order to address depressive symptoms and foster recovery.

(1) Background: It was examined whether glucose-induced changes in the relative blood volume are suitable to identify subjects with and without type-2 diabetes mellitus (T2D) during hemodialysis. (2) Methods: The relative blood volume was continuously recorded during hemodialysis and perturbed by the infusion of glucose comparable to the dose used for intravenous glucose tolerance tests. Indices of glucose metabolism were determined by the homeostatic model assessment (HOMA). Body composition was measured by a bioimpedance analysis. The magnitude and the time course of hemodilution were described by a modified gamma variate model and five model parameters. (3) Results: A total of 34 subjects were studied, 14 with and 20 without T2D. The magnitude of the hemodilution and the selected model parameters correlated with measures of anthropometry, body mass index, absolute and relative fat mass, volume excess, baseline insulin concentration, and HOMA indices such as insulin resistance and glucose disposition in a continuous analysis, but were not different in a dichotomous analysis of patients with and without T2D. (4) Conclusions: Even though the parameters of the hemodilution curve were correlated with measures of impaired glucose metabolism and body composition, the distinction between subjects with and without T2D was not possible using glucose-induced changes in the relative blood volume during hemodialysis.

Background: Intradialytic hypotension (IDH) is a frequent complication of hemodialysis (HD). Current methods of IDH prevention are insufficient., Methods: We analyzed the intradialytic time course of systolic (SBP), diastolic (DBP), mean arterial (MAP), pulse pressure (PP), and heart rate (HR) in a group of chronic kidney disease (CKD) patients. First, 30 min into HD, a 40% glucose solution was injected into the venous line of the extracorporeal circulation at a dose of 0.5 g/kg of dry weight. Pressures and HR were measured in frequent intervals. Relative volume overload was determined by bioimpedance spectroscopy., Results: Thirty-five participants were studied. SBP increased after 5, 10, and 20 min of glucose infusion. DBP increased after 2 and 3 h and also at the end of HD. PP increased after 5, 10, and 20 min of glucose infusion and fell after the 2nd and 3rd hour and also at the end of HD. MAP increased after 2 and 3 h of glucose injection and at the end of HD. Significant interactions of the time course of SBP, DBP, MAP, with HR at baseline and of the time course of PP with fluid overload were observed. Symptomatic hypotensive episodes were absent., Conclusions: Glucose infusions during HD prevent symptomatic IDH and do not cause severe hypertensive episodes.

Background: The quality of autonomic blood pressure (BP) control can be assessed by the entropy of serial BP data. The aim of this study was to evaluate the effect of hemodialysis (HD) and glucose infusion (GI) on amplitude aware permutation entropy (AAPE) of hemodynamic variables during HD in chronic kidney disease patients with and without type-2 diabetes mellitus (DM)., Methods: Twenty-one patients without DM (NDO) and ten with DM were studied. Thirty minutes after the start of HD, a 40% glucose solution was administered. Hemodynamic data were extracted from continuous recordings using the Portapres ® system., Results: AAPE decreased during HD in all patients and all hemodynamic signals with the exception of AAPE of mean and diastolic BP in DM patients. GI led to an increase in AAPE for cardiac output in all patients, while AAPE for heart rate and ejection time increased only in DM studies, and AAPE for systolic, diastolic, and mean arterial pressure, as well as total peripheral resistance, increased only in NDO patients., Conclusions: The reduction in entropy during HD indicates impaired autonomic control in response to external perturbations. This state is partially reversed by the infusion of glucose with differences in central and peripheral responsiveness in DM and NDO patients., Competing Interests: Within the past 12 months, DS has served as a consultant to American Renal Clinical Research Services, LLC and CHF Solutions, Inc. The other authors declare no conflicts of interest.

Background: The genetic backgrounds of diabetic kidney disease (DKD) and end-stage kidney disease (ESKD) have not been fully elucidated., Aim: To examine the individual and cumulative effects of single-nucleotide polymorphisms (SNPs) previously associated with DKD on the risk for ESKD of diabetic etiology and to determine if any associations observed were specific for DKD., Methods: Fourteen SNPs were genotyped in hemodialyzed 136 patients with diabetic ESKD (DKD group) and 121 patients with non-diabetic ESKD (NDKD group). Patients were also re-classified on the basis of the primary cause of chronic kidney disease (CKD). The distribution of alleles was compared between diabetic and non-diabetic groups as well as between different sub-phenotypes. The weighted multilocus genetic risk score (GRS) was calculated to estimate the cumulative risk conferred by all SNPs. The GRS distribution was then compared between the DKD and NDKD groups as well as in the groups according to the primary cause of CKD., Results: One SNP (rs841853; SLC2A1) showed a nominal association with DKD ( P = 0.048; P > 0.05 after Bonferroni correction). The GRS was higher in the DKD group (0.615 ± 0.260) than in the NDKD group (0.590 ± 0.253), but the difference was not significant ( P = 0.46). The analysis of associations between GRS and individual factors did not show any significant correlation. However, the GRS was significantly higher in patients with glomerular disease than in those with tubulointerstitial disease ( P = 0.014) and in those with a combined group (tubulointerstitial, vascular, and cystic and congenital disease) ( P = 0.018)., Conclusion: Our results suggest that selected SNPs that were previously associated with DKD may not be specific for DKD and may confer risk for CKD of different etiology, particularly those affecting renal glomeruli., Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing financial interests. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article., (©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.)

Aims: The disposal of a glucose bolus was studied to identify glucose metabolism in patients with and without type 2 diabetes mellitus (T2DM) during their regular hemodialysis (HD) treatment., Methods: Plasma glucose, insulin, and c-peptide concentrations were measured during a 60 min observation phase following a rapid glucose infusion (0.5 g/kg dry weight). Glucose disposition and elimination rates were determined from kinetic analysis, and insulinogenic index was calculated. Insulin resistance (R HOMA ) was determined by homeostatic model assessment (HOMA)., Results: 35 HD patients (14 with T2DM) distinguished by a higher age (median: 70 vs. 55 y, p < 0.01) in T2DM patients were studied. Glucose kinetic data showed only small differences between patients with or without T2DM, but as R HOMA measured in all patients increased, a larger fraction of glucose was removed by the extracorporeal system (r = 0.430, p = 0.01). One hour after glucose bolus injection the glucose level was not different from that before HD also in patients with T2DM (p = 0.115)., Conclusions: The larger glucose amount recovered in dialysate in patients with increasing R HOMA indicates that impaired glucose disposal could be measured during HD using a non-invasive dialysis quantification approach without blood sampling. Glucose infusion during HD is safe also in patients with T2DM., Competing Interests: Declaration of Competing Interest In the past 12 months, DS has served as a consultant to American Renal Clinical Research Services, LLC and CHF Solutions, Inc. LN, AW, KSz, JS, and SN declare no conflict of interest., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

This study was designed to investigate the biocompatibility of hemodialysis procedures, largely depending on the contact of patient's blood with the dialysis membranes. We addressed the issue by comparing the content of the proteolytic enzymes collagenase and cathepsin B and that of neutrophil myeloperoxidase (MPO) and C-reactive protein (CRP) in the blood before and after a single session treatment and a full course of successive 8-week-long therapies with three types of hemodialysis: low-flux (lfHD), high-flux (hfHD), and post-dilution hemodiafiltration (HDF). The study included 19 patients with chronic nephropathy. We found that collagenase significantly increased after a single session of each type of hemodialysis. Cathepsin B tended to decrease after single sessions; the decrease reached significance only after hfHD. CRP increased significantly after single hfHD and HDF treatments. These changes were meager, with no differences depending on the dialysis type, and their significance was lost after 8-week-long therapy, except the persisting increase in CRP after HDF. Neutrophil MPO apparently was not activated during any type of dialysis, as its content was below the detection threshold. We conclude that all three types of hemodialysis are compatible with the biological system, so that they would rather unlikely lead to clinically harmful effects in chronically hemodialyzed patients. Nonetheless, proteolytic enzymes and myeloperoxidase seem hardly appropriable estimators of hemodialysis biocompatibility due to meager and variable changes. Upregulation of C-reactive protein, on the other hand, expresses a general pro-inflammatory propensity of hemodialysis and is not a suitable estimator of biocompatibility either.

Indoxyl sulfate (IS) and p-cresol sulfate (p-CS) are protein-bound solutes that accumulate in the blood serum in chronic kidney disease and have a detrimental effect on the kidney and other organs' function. This study seeks to define the effectiveness of IS and p-CS clearance after single dialysis sessions and after 8-week-long cycles of hemodialysis using the following different dialysis modalities in succession: low-flux hemodialysis (lfHD), high-flux hemodialysis (hfHD), and post-dilution hemodiafiltration (HDF). We also investigated to what extent IS and p-CS serum content would associate with some other biochemical indices in patients with chronic kidney diseases. The study included 21 uremic patients. We found that a single session of each modality effectively decreased the content of both IS and p-CS, with the predominance of p-CS decrease. There were no appreciable differences depending on the modality of hemodialysis chosen. However, the leaching effect tended to wear off with the weeks' long dialysis cycles. We further found that a greater inflammation-prone level of hsCRP evoked by dialysis led to a greater removal of solutes, and thus their decrease in the serum, during a single dialysis session. Reversely, a greater protein level might result in a greater solute binding and a decrease in removal. We conclude that there are no major differences in the serum clearance of IS and p-CS depending on the dialysis modality. These protein-bound toxins are significantly cleared from the serum already during the first dialysis session, but their level tends to revert during weeks' long dialysis sessions.

Renal perfusion, which depends on cardiac function, is a factor conditioning the work of kidneys. The objective of the study was to assess the influence of cardiac function, including left ventricular contractility and relaxation, on renal cortical perfusion in patients with hypertension and chronic kidney disease treated pharmacologically. There were 63 patients (7 F and 56 M; aged 56 ± 14) with hypertension and stable chronic kidney disease enrolled into the study. Serum cystatin C, with estimated glomerular filtration rate (eGFR), ambulatory blood pressure monitoring, carotid intima-media thickness (cIMT), echocardiography with speckle tracking imaging and the calculation of global longitudinal strain (GLS), diameter of vena cava inferior (VCI), and an ultrasound dynamic tissue perfusion measurement of the renal cortex were performed. We found that the renal cortical perfusion correlated significantly with age, renal function, cIMT, GLS, left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), diastolic peak values of early (E) and late (A) mitral inflow velocities ratio (E/A) and E to early diastolic mitral annular tissue velocity (E/E'), but not with VCI, or the right ventricle echocardiographic parameters. In multivariable regression analysis adjusted to age, only eGFR, E/E', and GLS were independently related to renal cortical perfusion (r 2  = 0.44; p < 0.001). In conclusion, the intensity of left ventricular strain and relaxation independently influence renal cortical perfusion in hypertensive patients with chronic kidney disease. A reduction in left ventricular global longitudinal strain is superior to left ventricular ejection fraction in the prediction of a decline in renal cortical perfusion.

Introduction: The increasing number of patients with end-stage renal disease (ESRD) requires seeking new opportunities to improve their quality of life, not only because of kidney disease but also due to other disturbances, such as thyroid hormone disorders. The objective of the study was to evaluate the influence of coexisting hypothyroidism and thyroid hormone therapy in patients with ESRD on thyroid hormone conversion ratios and rT3 concentration., Material and Methods: The study involved 85 patients aged 26 to 87 years, with a mean age of 59.62 ± 15.45 years. Four groups of patients were examined: G1 group - 25 persons without RF and hypothyroidism, G2 - 26 patients with ESRD treated with haemodialysis (HD), G3 - 12 patients with ESRD treated with HD and newly diagnosed hypothyroidism, and G4 - 22 HD patients with hypothyroidism treated with thyroid hormones substitution. The concentrations of TSH, T4, T3, fT4, fT3, and rT3 were measured and the fT3/fT4, T3/T4, and rT3/T4 conversion ratios and rT3/T3 ratio were calculated. Concentrations of protein, hsCRP, Hg, and blood gases were also checked; the anion gap was calculated., Results: Patients from group G1 through G2 to G3 were older (ptrend = 0.002), with lower Hb level (ptrend < 0.001), with lower pH (ptrend < 0.001), with increased anion gap (ptrend < 0.013) and CRP concentrations (ptrend < 0.001), and decreased total protein level (ptrend < 0.001). There were increased TSH values (ptrend < 0.001) and lower T4 (ptrend = 0.024), fT3 (ptrend < 0.001), T3 (ptrend < 0.001), and rT3 (ptrend = 0.008) levels. rT3/T3 ratio did not change, the rT3/T4 ratio tended to decrease (ptrend = 0.065) similarly to T3/T4 ratio (ptrend = 0.063), and the fT3/fT4 ratio also decreased (ptrend = 0.005). It seems that the treatment of thyroid disease in patients with renal failure, treated with haemodialysis, is not associated with change of rT3 and conversion factor levels., Conclusions: The concentration of rT3 in HD patients in relation to healthy persons tends to decrease, and hypothyroidism increases this tendency in these patients. Hormone substitution treatment does not eliminate the influence of RF on inhibition of rT3 production. In patients with ESRD, hypothyroidism additionally reduces the conversion of thyroid hormones examined by fT3/fT4 and to a lesser extent T3/T4 ratios.

Kidney dysfunction is a common complication of hematopoietic cell transplantation (HCT) with proven negative impact on early and long-term mortality. Causes of this complication are diverse, usually overlapping, and poorly understood. Therefore, management implicates multidirectional investigations and simultaneous treatment of suspected causes. The etiology is frequently unconfirmed due to a lack of specific markers and prevalence of contraindications to renal biopsy among HCT recipients. Herein, we provide a summary of etiology and propose an algorithm for evaluation of kidney injury after HCT. We also map out the most urgent areas for research that aim to identify patients at risk of severe renal injury and develop nephroprotective strategies., (Copyright © 2018 King Faisal Specialist Hospital & Research Centre. Published by Elsevier Ltd. All rights reserved.)

Genetic factors play a key role in the pathogenesis of atrial fibrillation (AF). We would like to establish an association between previously described single-nucleotide polymorphisms (SNPs) and AF in haemodialysed patients with end-stage kidney disease (ESKD-HD) as well as to assess the cumulative effect of all genotyped SNPs on AF risk. Sixteen SNPs were genotyped in 113 patients with AF-ESKD-HD and in 157 controls: without AF (NAF) and with ESKD-HD. The distribution of the risk alleles was compared in both groups and between different sub-phenotypes. The multilocus genetic risk score (GRS) was calculated to estimate the cumulative risk conferred by all SNPs. Several loci showed a trend toward an association with permanent AF (perm-AF): CAV1, Cx40 and PITX2. However, GRS was significantly higher in the AF and perm-AF groups, as compared to NAF. Three of the tested variables were independently associated with AF: male sex, history of myocardial infarction (MI) and GRS. The GRS, which combined 13 previously described SNPs, showed a significant and independent association with AF in a Polish population of patients with ESKD-HD and concomitant AF. Further studies on larger groups of patients are needed to confirm the associations.

It is believed that the vasopressinergic system plays an important role in the pathogenesis of chronic kidney disease (CKD). The aim of this study was to evaluate the effect of CKD on changes in vasopressin system expression in the kidney cortex in rats with nephrectomy. The study was performed on 4 groups of Sprague Dawley (SPRD) rats: a control group ( CN ), 1/2 nephrectomy ( N1/2 ), 2/3 nephrectomy ( N2/3 ), and 5/6 nephrectomy ( N5/6 ). Blood and the kidney cortex were collected to evaluate plasma copeptin concentrations and mRNA expressions of V1a vasopressin receptors (V1aR) and V2 vasopressin receptors (V2R) and V1aR, V2R, and aquaporin 2 (AQP2) protein levels. V1aR and V2R mRNA expression in the kidney cortex was significantly lower in the CN group compared with the other groups. In contrast, the V1aR, V2R, and AQP2 protein levels were significantly higher in the CN group compared with all of the nephrectomized groups. Plasma copeptin concentration was significantly lower in the CN group than in the nephrectomized groups. CKD caused significant changes in the expression of the vasopressinergic system. Further research is needed to explain the mechanisms of the impact of the vasopressinergic system on the kidney in CKD.

Plasma content of copeptin increases with the advancement of chronic kidney disease (CKD). The purpose of this study was to evaluate copeptin content as a potential marker of CKD, as a single pathology or with coexisting heart failure. Seventy-six patients were divided into the following groups: Group 1 (control), without CKD and heart failure; Group 2, CKD stage 3a; Group 3, CKD stage 3b; Group 4, CKD stage 4; Group 5, CKD stage 5; and Group 6, CKD stage 3b and heart failure. For all patients, plasma concentrations of copeptin, creatinine, urea, cystatin C, sodium, C-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and blood pH were assessed. We found that plasma content of creatinine, urea, CRP, cystatin, NT-proBNP, and copeptin increased with CKD progression. Heart failure in CKD patients was not the cause of an appreciable increase of copeptin level. Copeptin/creatinine, copeptin/cystatin C ratios, and especially copeptin/eGFR ratio enhanced copeptin prognostic sensitivity concerning renal failure in CKD, compared with copeptin alone. The copeptin×NT-proBNP ratio decreased along CKD progression, reaching a nadir in the accompanying heart failure. In contradistinction, copeptin×NT-proBNP/creatinine ratio increased along CKD progression, reaching a peak in the accompanying heart failure. We conclude that copeptin is an important marker in CKD, but not so concerning heart failure in the disease. A decrease in copeptin×NT-proBNP and an increase in copeptin×NT-proBNP/creatinine ratio are useful markers of cardiac function decline in CKD.

Hypothyroidism in patients with renal failure (RF) causes many metabolic and clinical problems, and both these diseases can mutually exacerbate their disturbances., Aim: The aim of this study was to evaluate the effect of hypothyroidism, and end-stage renal disease (ESRD) on conversion of thyroid hormones (TH) in patients with ESRD treated with chronic hemodialysis (HD)., Materials and Methods: The study was performed in 74 patients, including 41 women (K) and 33 men (M) aged 28-83 y.o. in 4 groups: G1 - 12 people with ESRD treated with HD and with newly diagnosed hypothyroidism without substitution (6 K and M 6) aged 66,83±12,90 y.o., G2 - 26 patients with ESRD treated with HD without hypothyroidism (10 F, 16 M) aged 58,85±15,52 y.o., G3 - 11 hypothyroid patients without RF (9 K, 2 M) aged 54,73±21,26 y.o., G4 - 25-persons from control group of healthy subjects (16 M, 9 M) aged 51,24±12,58 y.o. In all subjects the concentration of TSH and TH (T4, T3, fT4, TSH, FT3, rT3) were measured and values of conversion factors (T3/T4, FT3/ fT4, rT3/fT4 and rT3/fT3) and binding TH to protein factors (fT4/T4 and fT3/T3) were calculated., Results: Lower concentration of T3 (p=0.012), fT3 (p<0.001) i fT4 (p=0.014) was found in patients without hypothyroidism than in healthy subjects. Renal failure with concomitant hypothyroidism intensify the disturbances of T4 to T3 conversion (p=0.034) and hypothyroidism with concomitant renal failure disrupts binding of T3 to proteins (p=0.001). FT3 to fT4 ratio in renal failure with concomitant hypothyroidism group was significantly lower than in each other group. rT3 concentrations were the highest in healthy subjects., Conclusions: Concomitance of hypothyroidism and end-stage renal disease reduces the conversion of thyroxine to triiodothyronine, but does not increase the production of rT3. Hypothyroidism significantly increases the disorders of thyroid hormones in end-stage renal disease. There is decreased tendency to bind of thyroid hormone to protein in hypothyroidism in patients with end-stage renal disease.

In the article, the authors discuss proliferation signal inhibitors (PSI), a group of medicines used in immunosuppressive therapy after renal transplantation. They present the mechanism of action of this class, side effects and drug interactions important in clinical practice. In addition, they present the available drugs and their practical application.

Acute tubule-interstitial nephritis is a heterogeneous group of inflammatory diseases which affect renal parenchyma and tubules, mostly as a result of the immune-mediated injury. They are the important cause of acute kidney injury accounting for 5-15% of all its causes. In subsequent years, with the development of pharmacotherapy, the incidence of drug-induced nephrotoxicity has been increasing. The other causes of the acute tubule-interstitial nephritis are autoimmune and inflammatory diseases, infections, neoplasms and electrolyte abnormalities. The diagnostics are complex and treatment of the disease is not always easy. The following overview provides a summary of causes of acute tubule-interstitial nephritis, clinical picture of the disease, the diagnosis and treatment.

Background: Lowered testosterone level in CRF patients is associated with elevated risk of death due to cardiovascular reasons, and is influenced by many factors, including acid-base balance disorders., Aims: evaluation of testoste-rone concentration (TT) and free testosterone concentration (fT) in pre-dialysis and dialysis patients; assessment of TT and fT relationships with biochemical parameters; evaluation of prognostic importance of TT and fT in predicting patient survival., Material and Methods: 4 groups of men: 14 - on hemodialysis (HD), 13 - on peritoneal dialysis (PD), 9 - with chronic renal failure (CRF) and 8 - healthy (CG), aged 56±17, 53±15, 68±12, 43±10 years, respectively. TT and biochemical para-meters were measured; fT was calculated., Results: The lowest TT and fT were observed in HD and CRF, the highest - in CG (p=0.035 for TT; p=0.007 for fT). fT in CRF and CG were different (p=0.031). TT and age was associated in HD (p=0.026). Age and fT was strongly associated in PD (p<0.001). After adjustment for age, TT was negatively associated with BMI (p=0.013) and fT was positively associated with HCO3 level (p=0.007). fT was lower in those who died during 5 years of observation than in survivors (p=0.009). We have found that, opposite to TT, fT appeared to be a better predictor of 5-year survival than age. After combining pH and HCO3 levels into a single variable - no acidosis, acidosis with HCO3 normal serum level, acidosis with low concentrations of HCO3 and adjustment for age and the study group - a trend toward the lowest values of free testosterone in decompensated acidosis was observed (ptrend=0.027). Such a trend was not seen for testosterone concentrations (ptrend=0.107)., Conclusions: Total and free testosterone levels were lower in HD and pre-dialysis than in healthy patients. Free testost-erone level may predict long-term survival better than age. Total and free testosterone levels are lower in metabolic acidosis and total and free testosterone levels were positively associated with HCO3 level.

Acute renal graft failure or delayed graft function (DGF) is defined as a necessity at least one hemodialysis during first week after transplantation. Approximately 20% of patients require temporary dialysis after kidney transplantation. There are many different factors, donor, recipient and transplant-related, that can trigger DGF. In the article a pathophysiology, clinical picture, treatment and prevention of the disorder have been shortly summarized.

Anemia is one of the most common problems of patients with advanced chronic kidney disease (CKD). Its main causes in this population are: iron deficiency and a decreased renal synthesis of erythropoietin. Up to the 80's of the twentieth century, treatment of anemia in CKD was limited to blood and red blood cells transfusions. However during last three decades there has been a huge progress in the field, starting with introduction into clinical practice of human recombinant erythropoietin (rHuEPO), followed by an appearance of agents with a longer duration of action, darbepoetin alfa and methoxy polyethylene glycol-epoetin beta, all of which are shortly reviewed in this paper.

Metabolic acidosis is defined as a decrease of bicarbonates in the blood, below normal range, with a reduction of blood pH. It is a common disorder in chronic kidney disease (CKD). Clinically apparent fairly late (GFR < 30 ml/min/m2), although usually mild, it can have adverse effects on important functions of the human body. In the article the pathomechanism of metabolic acidosis in CKD, its influence on human body and treatment is shortly reviewed.

Recent epidemiological studies show significant prevalence of chronic kidney disease (CKD) in the general population. Diuretics are critical in therapy ofvolume overload and hypertension commonly encountered in these patients. However, they frequently demonstrate relevant diuretic resistance, and from the other hand diuretic overdose may lead to dehydratation and worsening of kidney function. In this paper the main principles of diuretic treatment in CKD are described, including the diuretic agent and its dose selection, as well as adverse effects of the therapy.

Introduction: Thyroid hormone disorders in patients with chronic kidney disease (CKD) are a result of impaired conversion of T4 to T3. The importance of kidneys in thyroid hormones conversion is not fully understood. The activities of different types of iodothyronine deiodinases in the kidney structures have not been determined yet. The aim of this study was to determine the activity of deiodinase type 1 (D1) and type 2 (D2) in renal cortex and medulla in renal cancer patients., Material and Methods: Samples of renal cortex and medulla (ten patients) or renal cortex alone (13 patients) were taken from kidneys resected because of malignant cancer, from a site opposite to the cancer. Resections were performed in the 23 patients (seven female and 16 male) who were 52-82 years old. The material was stored at -72 oC., Results: Activity of D1 in renal cortex was 3.785 ± 2.041 fmol 125I/mg protein/minute and activity of D2 was 0.236 ± 0.125 fmol 125I/mg protein/minute. There was a strong positive correlation between D1 and D2 activities in renal cortex (r = 0.890, p 〈 0.001). Activity of D1 in renal medulla was 2.157 ± 2.176 fmol 125I/mg protein/minute, and activity of D2 was 0.168 ± 0.095 fmol 125I/mg protein/minute. A positive correlation between D1 and D2 in renal medulla (r = 0.661, p = 0.038) was observed as well. Activities of D1 in cortex and medulla were strongly and positively associated (r = 0.794, p = 0.006), whereas there was no correlation between the activities of D2 in cortex and medulla (r = 0.224, p = 0.553)., Conclusions: Results presented in this study suggest that both cortical and medullary D1 and D2 may be involved in thyroid hormone metabolism. This finding could be of clinical relevance in patients with impaired renal function.

The authors discussed disorders in adipocytokines' function in chronic renal failure (CRF) and their clinical implications. Adipocytokines' concentrations in CRF are in most cases elevated, which is associated with decreased level of their excretion. This may cause number of clinical implications such as inflammation, loss of appetite, development of protein energy wasting (PEW) syndrome and the progress of artherosclerosis, what leads to increased mortality in a group of patients with end-stage renal disease (ESRD). Disturbances in sexual hormones function are also characteristic for CRF. Disorders in fertility, sexual life and decreased quality of life are observed in patients with CRF. Therapeutic procedure is complicated and not fully effective.

The aim of this study was to look at basic endocrinological disorders in chronic kidney disease, acquainting endocrinologists with information about the definition and classification of kidney diseases and basic metabolic disorders in uraemia. Secondary hyperparathyroidism, insulin resistance and hyperinsulinism, growth hormone disorders and the possibility of growth hormone treatment, the reasons for and the consequences of hyperprolactinaemia are presented in a practical way. Thyroid hormones management, a problem which requires further study, is portrayed extensively. Hypothalamic-pituitary-adrenal axis disorders are equally complex and not yet fully examined. We have largely concentrated on the practical aspects of diagnostics of the presented disorders.

Unlabelled: Determination of circadian of prolactine (PRL) profile and its relationship to selected clinical and laboratory indices in end-stage renal disease (ESRD) patients undergoing hemodialysis, peritoneal dialysis as well as those in predialysis period was the aim of the study. Investigations were carried out in 38 patients with ESRD aged 36 to 79 yr. (medium 59 +/- 11 yr.), (20 male, 18 female, 7 treated with peritoneal dialysis, 25 undergoing hemodialysis, 6 in predialysis period) and the control group consisting of 7 healthy volunteers (4 male and 3 female). Serum concentration of PRL was evaluated at 3:00, 7:00, 12:00, 18:00, 22:00. The influence of different dialysis methods, blood concentration of parathormone, hemoglobin, total protein, erytropoietin (EPO), C-reactive protein, EPO therapy and duration of dialysis therapy on the PRL profile was analyzed. Results were analyzed according to medium obtained values of daily PRL profiles and individual indexes of variation of the daily concentration. Impaired circadian PRL profile was found in the all of followed groups comparing to the control, which was based on flatting of the curve and decreasing of the nightly pick of secretion PRL. None of analyzed factors had normalized the PRL profile curve., Conclusions: The PRL profile in ESRD patients treated with hemodialysis, peritoneal dialysis and in predialysis period is changed. The PRL profile curve is flatted and there was no night pick of PRL secretion in the patients. PRL level was shown to increase with progress of the disease, and the highest levels were in hemodialysed patients. EPO treatment, general appearance improvement, increased hemoglobin level and any of studied different dialysis method did not normalize the altered PRL profile.

Unlabelled: Evaluation of metoclopramide (MTC) test values in end-stage renal disease patients undergoing hemodialysis with different level of hyperprolactinemia was aim of the study. Clinical value of application of the MTC test and influence of different laboratory and clinical factors including erytropoietin treatment were examined. Sixty-eight hemodialysed patients (31 male and 37 female) aged 20-74 yr. (medium 48 +/- 13 yr.) underwent the MTC test, the control group consisted of 8 healthy volunteers (4 male and 4 female). 10mg of MTC was given i.v. and serum level of PRL was determined in 0, 30 and 60 min. after injection. Significant suppression of PRL stimulation in the patients was shown as compared with the controls after 30 min and delayed decrease of the curve values was found. An increase in the PRL level after 60 min in investigated group was lower than in control. Lower relative enhance of PRL level in 30 min was found and slower decrease after 60 min. Despite the slower decrease PRL level was lower in the patients than in the controls after 60 min. The highest relative increase in PRL level after 30 min was observed in the patients with lowest initial level of PRL (r=-0.471; p<0.001). Erytropoietin administration improved the response in the test (p=0.005) without relationship to the duration of erytropoietin treatment. There was influence of hemoglobin level on the results of the test., Conclusions: Results of the MTC test in end-stage renal disease patients is inadequate and the PRL response is diminished. Diagnostic value of the test in end-stage renal disease patients is low. Erytropoietin administration improves although not to the normal values the results of the MTC test.

We analysed medical documentation of 65 patients with alcoholic cirrhosis admitted to the Internal Diseases Department with Dialysis Ward in the hospital in Wolomin between 2002 and 2004 year. Patients were divided into 3 groups according to renal disfunction: patients with HRS-1, patients with HRS-2 and patients with cirrhosis without renal failure. Each diagnosis was established basing on criteria of International Ascites Club. Different factors, which may influence a development of HRS, such as large--volume paracentesis without plasma expansion, bacterial infections, gastrointestinal bleeding and nephrotoxic drugs were analysed. Patients were treated with terlipressin and intravenous albumin infusions, antibiotics, diuretics, dopamine, haemodialysis and paracentesis. 10 patients (3 with HRS-1.5 with HRS-2 and 2 without renal failure) died, which is 15.4% of the all group. The mortality in the group of patients with HRS is high but complex treatment may be effective. Nowadays liver transplantation is the most effective method.

Due to a high frequency of autoimmune diseases in patients with ESRF we observed for 4 years 8 patients treated with HD with high level of TPOAb and 8 patients without TPOAb. Aim of the study was to estimate the role of TPOAb as a prognostic factor of hypothyreosis. We observed in a 4-years follow-up significant increase of TSH (p<0.05) in patients with high TPOAb level. fT3 and fT4 did't change in this time. In the group without TPOAb we observed significant (p<0.01) decrease of fT3 probably due to the disturbances in T4 to T3 conversion. Our results don't permit us to draw a final conclusions but induce us to further observation of hypothyreosis development in patients with ESRF.

Unlabelled: Left ventricular hypertrophy (LVH) in course of the systemic hypertension (HT) is found as independent risk factor for ventricular arrhythmia and sudden cardiac death., Objects: The aim of the study was to evaluate the relationship between occurrence of LVH and electrical instability. Study group included 64 patients (pts) with mild to moderate HT, without clinical signs of coronary artery disease. Pts were divided into two group: with and without LVH (LVH was diagnosed by echocardiography (ECHO) when left ventricular mass index (LVMI) was > 106 g/m2 for women, and > 111 g/m2 for men). By 12-lead ECG QTc, dispersion QT (QTd) were calculated. From SAECG the QRS duration (tQRS), the root mean square of the last 40 ms of the filtered QRS complex (RMS40) and the duration of the terminal low amplitude QRS signal < 40 microV (LAS 40) were calculated. Ventricular arrhythmias were recorded during 24 hour Holter monitoring and classified into the Lown classification., Results: No difference in QTd between two groups was observed. Nobody has nonsustained ventricular tachycardia in 24-hour Holter monitoring. In group with LVH tQRS was longer and RMS higher in SAECG than in group without LVH., Conclusion: LVH in hypertensive pts influences the increase of electrical instability that is evaluated by SAECG.