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Abstract Background SARS-CoV-2 viral infection is associated with a rapid and vigorous systemic inflammatory response syndrome. Soluble urokinase-type plasminogen activator receptor (suPAR) is a novel biomarker, both indicative of inflammation and propagating it. Hemoadsorption has been proposed as a potential therapy in COVID-19 patients, therefore the aim of this study is to determine suPAR kinetics during hemoadsoprtion. Methods This was a prospective observational study of critical COVID-19 patients, enrolled when hemoperfusion therapy was initiated. Hemoadsorber was integrated into the continuous renal replacement therapy circuit. The first series of suPAR measurements was performed 10 minutes after the start of the session, sampling both incoming and outgoing lines of the adsorber. A second series of the measurements was performed beforefinishing the session with the same adsorber. Statistical significance level was set

Abstract The population of patients with end‐stage renal disease is rapidly growing and hemodialysis remains the most common treatment option. We present a case of a young patient with arteriovenous fistula (AVF)‐related heart failure, and a review of the main hemodynamic changes after AVF formation and ligation procedures.

BackgroundThis study was designed to verify whether early posttransplant standardized phase angle (SPhA) determines nutrition status of hemodialysis patients in regard to different nutritional markers and predicts handgrip strength (HGS) 6 months after kidney transplantation.MethodsA total of 82 kidney transplant recipients on maintenance hemodialysis treatment entered the study. Nutritional status was evaluated before kidney transplantation, at the hospital discharge date, and 6 months after. We used bioelectrical impedance analysis (BIA), three different malnutrition screening tools, HGS, and anthropometric measurements. Demographic profiles and biochemical nutritional markers were collected. SPhA values, adjusted for age and BMI, were used in our study.ResultsIn the early posttransplant period, kidney transplant recipients lost muscle mass, gained fat mass, and developed mostly negative SPhA, accompanied by significantly lower albumin levels. The subjects with lower than median (

Purpose: The study was designed to evaluate clinical and laboratory determinants pulse wave velocity (PWV) ratio in women at the age of 50–65 years without overt cardiovascular disease but having elevated cardiovascular risk, such as hypertension, obesity, diabetes and hypercholesterolemia. Materials and methods: We analyzed data from 1170 women enrolled in the national-wide primary prevention program. Univariate and multivariate linear regression analysis was used to establish independent risk factors in groups based on clinical data, laboratory values, and comorbidities. Arterial stiffness was evaluated using applanation tonometry technique (SphygmoCor). The PWV ratio was calculated by dividing cfPWV to crPWV. Results: In multivariate logistic regression analysis, age (OR = 1.109, p

Vascular calcification (VC) is linked to post-transplant cardiovascular events and hypercalcemia which may influence kidney graft function in the long term. We aimed to evaluate whether pretransplant aortic arch calcification (AoAC) can predict post-transplant cardiovascular or cerebrovascular events (CVEs), and to assess its association with post-transplant plasma calcium levels and renal function in one-year follow-up. Our single-center observational prospective study enrolled 37 kidney transplant recipients (KTR) without previous history of vascular events. Two radiologists evaluated pretransplant AoAC on chest X-ray as suggested by Ogawa et al. in 2009. Cohen’s kappa coefficient was 0.71. The mismatching results were repeatedly reviewed and resulted in consensus. Carotid-femoral (cfPWV) and carotid-radial pulse wave velocity (crPWV) was measured using applanation tonometry before and one year after transplantation. Patient clinical, biochemical data, and cardiovascular/CVE rate were monitored within 1 year. We found out that eGFR1year correlated with eGFRdischarge and calcium based on hospital discharge data (β = 0.563, p = .004 and β = 51.360, p = .026, respectively). Multivariate linear regression revealed that donor age, donor gender, and recipient eGFRdischarge (R-squared 0.65, p = .002) better predict eGFR1year than AoAC combined with recipient eGFRdischarge (R-squared 0.35, p = .006). During 1-year follow-up, four (10.81%) patients experienced cardiovascular events, which were predicted by PWV ratio (HR 7.549, p = .045), but not related to AoAC score (HR 1.044, p = .158). In conclusion, KTR without previous vascular events have quite low cardiovascular/CVE rate within 1-year follow-up. VC evaluated as AoAC on pretransplant chest X-ray together with recipient eGFRdischarge could be related to kidney function in one-year follow-up.

Aim: To assess a time-dependent change of arterial stiffness gradient (PWVratio calculated by dividing carotid-femoral to carotid-radialPWV), a marker of vascular aging, in high cardiovascular risk cohort. Methods: This cohort study (n = 689) was conducted during the period 2010–2019 at Vilnius University Hospital Santaros Klinikos. Participants were referred by the primary health care institutions according to Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program which recruited men at the age of 40–55 years and women at the age of 50–65 years without overt cardiovascular disease; they underwent a detailed cardiovascular risk assessment and arterial stiffness evaluation and were repeatedly examined after the mean follow-up of 965.63 ± 511.98 days. Results: The cohort was comprised of 40.2% male participants. Cardiovascular risk factors were distributed as follows: 19.5% subjects had diabetes mellitus, 52.69% left ventricular hypertrophy, 95.21% hypertension, 99.13% dyslipidemia. During the follow-up period 52.1% of patients presented PWV ratio increase. In spite of the difference in age between men and women, PWV ratio progression adjusted for follow-up time and age was more pronounced in males (OR 1.72, p = 0.032). In the subanalysis, we found that in men, as compared to women, there was a more pronounced decrease in carotid-radialPWV (p < 0.001). The carotid-femoralPWV increased both in men and in women. Glucose level, abdominal obesity, mean arterial blood pressure, menopause was related to the change of the PWV ratio. Conclusion: In this high cardiovascular risk cohort, the change in arterial stiffness gradient is related to abdominal obesity, mean arterial blood pressure, and menopause.

Background and Objectives: Kidney transplant recipients represent a unique population with metabolic abnormalities, altered nutritional and immune status, as well as an imbalanced regulation of adipocytokine metabolism. Leptin is a hormonally active protein mainly produced by fat tissue that modulates appetite, satiety, and influences growth, energy, and bone metabolism. There has been great interest in the role of this hormone in chronic kidney disease-related protein energy wasting; thus, a positive leptin correlation with body mass index and fat mass was confirmed. This study was designed to determine the association of pre and post-kidney transplant leptin concentration with nutritional status and body composition. Materials and Methods: We studied 65 kidney transplant recipients. Nutritional status was evaluated before kidney transplantation and 6 months later using three different malnutrition screening tools (Subjective Global Assessment Scale (SGA), Malnutrition Inflammation Score (MIS), and Geriatric Nutritional Risk Index (GNRI)), anthropometric measurements, and body composition (bioelectrical impedance analysis (BIA)). Demographic profile, serum leptin levels, and other biochemical nutritional markers were collected. Statistical analysis was performed with R software. Results: Median age of the studied patients was 45 years, 42% were females, and 12% had diabetes. Leptin change was associated with body weight (p < 0.001), waist circumference (p < 0.001), fat mass (p < 0.001) and body fat percentage (p < 0.001), decrease in parathyroid hormone (PTH) (p < 0.001) transferrin (p < 0.001), diabetes mellitus (p = 0.010), and residual renal function (p = 0.039), but not dependent on dialysis vintage, estimated glomerular filtration rate (eGFR), or delayed graft function at any time during the study. After adjustment for age and sex, body mass index (BMI) (p < 0.001), fat mass (p < 0.001), and body fat percentage (p < 0.001) were independent variables significantly associated with post-transplant leptin change. Lower leptin values were found both before and after kidney transplantation in the SGA B group. GNRI as a nutritional status tool was strongly positively related to changes in leptin within the 6-month follow-up period. Conclusions: Kidney transplant recipients experience change in leptin concentration mainly due to an increase in fat mass and loss of muscle mass. GNRI score as compared to SGA or MIS score identifies patients in whom leptin concentration is increasing alongside an accumulation of fat and decreasing muscle mass. Leptin concentration evaluation in combination with BIA, handgrip strength measurement, and GNRI assessment are tools of importance in defining nutrition status in the early post-kidney transplant period.

Thermally reduced graphene oxide (TRGO) is a graphene-based nanomaterial that has been identified as promising for the development of amperometric biosensors. Urease, in combination with TRGO, allowed us to create a mediator-free amperometric biosensor with the intention of precise detection of urea in clinical trials. Beyond simplicity of the technology, the biosensor exhibited high sensitivity (2.3 ± 0.1 µA cm−2 mM−1), great operational and storage stabilities (up to seven months), and appropriate reproducibility (relative standard deviation (RSD) about 2%). The analytical recovery of the TRGO-based biosensor in urine of 101 ÷ 104% with RSD of 1.2 ÷ 1.7% and in blood of 92.7 ÷ 96.4%, RSD of 1.0 ÷ 2.5%, confirmed that the biosensor is acceptable and reliable. These properties allowed us to apply the biosensor in the monitoring of urea levels in samples of urine, blood, and spent dialysate collected during hemodialysis. Accuracy of the biosensor was validated by good correlation (R = 0.9898 and R = 0.9982) for dialysate and blood, utilizing approved methods. The advantages of the proposed biosensing technology could benefit the development of point-of-care and non-invasive medical instruments.

Vascular calcification (VC) is linked to post-transplant cardiovascular events in the long term. We aimed to evaluate whether pretransplant chest X-ray based aortic arch calcification (AoAC) or pulse wave velocity measurement can better predict post- transplant cardiovascular or cerebrovascular events, and to assess the progression of calcification within 2 years. Methods: Our single-center observational longitudinal study enrolled 40 kidney transplant recipients (KTR) without previous history of vascular events (no cardiovascular, cerebrovascular events, no peripheral artery disease). Two radiologists evaluated pretransplant and postransplant (after 2 years) AoAC on chest X-ray by using two different AoAC scales: AoAC grade evaluation [1] and AoAC score as suggested by Ogawa et al. in 2009 [2]. Cohen’s kappa coefficient was 0.75. The mismatching results were repeatedly reviewed and resulted in consensus. Carotid-femoral (cfPWV) and carotid-radial pulse wave velocity (crPWV) was measured using applanation tonometry and the PWV ratio (cfPWV/rPWV) was calculated. Patient clinical, biochemical data and cardiovascular/cerebrovascular event rate were monitored within 2 years. Results: During 2-year follow-up 5 patients experienced cardiovascular events, which were predicted by PWV ratio, but not related to AoAC. In 3 patients, we observed progression of AoAC, in others – AoAC was less evident or remained unchanged in 2-years follow-up. AoAC score [2] could better describe the extent of vascular calcification in KTR. Conclusions: KTR without previous vascular events have quite low cardiovascular/ cerebrovascular event rate within 2-year follow-up, which are better predicted by pretransplant PWV ratio. AoAC postransplant regression is evident even when using simplified chest X- ray scales.

Background: Arterial stiffness (AS) is a highly prognostic risk factor of cardiovascular diseases. The aim of this study was to investigate the relationships between cardio-ankle vascular index (CAVI) and eGFR in patients under the risk of cardiovascular disease. Methods: This was a retrospective study of Lithuania High cardiovascular risk patients’ database. Demographic, renal function and AS data was gathered. Patients were divided into groups by gender and age by intervals of 5 years. Mean values of CAVI were further investigated according to the patients’ eGFR. ANOVA was used to compare mean values of CAVI. Results: This study included data of 2070 patients aged from 40 to 65 years. The mean eGFR of the patients was 100.13 ml/min/1.73m2, 58.7% were women. The increase in CAVI was observed with age in overall population, with mean values in different age groups of 6.55±1.28, 7.13±1.84, 7.71±1.92, 7.79±1.95, 7.73±1.98, 8.06±1.79, p < 0.001. Calculation of the mean CAVI in different age and gender groups of eGFR are presented in Table 1. Further comparison of mean values of CAVI did not yield statistically significant results. eGFR Men Women 40–5 p 45–0 p 50–5 p 50–5 p 55–0 P 60–5 p 90 7,17 7,67 8,32 7,49 7,78 7,92 Table 1.Mean values of CAVI. Conclusions: Arterial stiffness increases with age in overall population. There was no statistically significant difference between mean values of CAVI in groups divided by age and gender according to eGFR.

Background and Objectives: Kidney transplant recipients are at risk of developing more severe forms of COVID-19 infection. The aim of this study was to compare the clinical course of COVID-19 infection among kidney transplant patients and a control group. Materials and Methods: We examined 150 patients hospitalized with COVID-19 infection. Patients were divided into study (kidney transplant recipients, n = 53) and control (without a history of kidney transplantation, n = 97) groups. Demographics, clinical characteristics, treatment data, and clinical outcomes were assessed. Results: The median patient age was 56.0 (46.0–64.0) years, and seventy-seven patients (51.3%) were men. The median Charlson comorbidity index was higher in the study group (3.0 vs. 2.0, p < 0.001). There was a higher incidence of hypoxemia in the control group upon arrival (52.6% vs. 22.6%, p = 0.001) and a higher NEWS index median (2.0 vs. 1.0 points, p = 0.009) and incidence of pneumonia during hospitalization (88.7% vs. 73.6%, p = 0.023). In the study group, there were more cases of mild (26.4% vs. 11.3%, p = 0.023) and critically severe forms of COVID-19 infection (26.4% vs. 3.1%, p < 0.001), kidney failure was more prevalent (34.0% vs. 1.0%, p < 0.001), and a greater number of patients were transferred to the intensive care unit (22.6% vs. 3.1%, p < 0.001) and died (18.9% vs. 1.0%, p < 0.001). Multivariable analysis revealed that treatment in the intensive care unit correlated with a higher mortality rate than transplantation itself (HR = 20.71, 95% CI 2.01–213.33, p = 0.011). Conclusions: The course of the COVID-19 disease in kidney transplant recipients is heterogeneous and can be more severe than in the general population. Even though patients may be hospitalized with fewer symptoms, complications and death are more likely to occur.

Abstract Our case series showed that eculizumab is efficacious and safe in treating thrombotic microangiopathy, as well as it has positive effects on quality of life. Further extensive studies are required to develop unified treatment guidelines.

Background and Objectives: Kidneys are one of the main targets for SARS-CoV-2. Early recognition and precautionary management are essential in COVID-19 patients due to the multiple origins of acute kidney injury and the complexity of chronic kidney disease management. The aims of this research were to investigate the association between COVID-19 infection and renal injury in a regional hospital. Materials and Methods: The data of 601 patients from the Vilnius regional university hospital between 1 January 2020 and 31 March 2021 were collected for this cross-sectional study. Demographic data (gender, age), clinical outcomes (discharge, transfer to another hospital, death), length of stay, diagnoses (chronic kidney disease, acute kidney injury), and laboratory test data (creatinine, urea, C-reactive protein, potassium concentrations) were collected and analyzed statistically. Results: Patients discharged from the hospital were younger (63.18 ± 16.02) than those from the emergency room (75.35 ± 12.41, p < 0.001), transferred to another hospital (72.89 ± 12.06, p = 0.002), or who died (70.87 ± 12.83, p < 0.001). Subsequently, patients who died had lower creatinine levels on the first day than those who survived (185.00 vs. 311.17 µmol/L, p < 0.001), and their hospital stay was longer (Spearman’s correlation coefficient = −0.304, p < 0.001). Patients with chronic kidney disease had higher first-day creatinine concentration than patients with acute kidney injury (365.72 ± 311.93 vs. 137.58 ± 93.75, p < 0.001). Patients with acute kidney injury and chronic kidney disease complicated by acute kidney injury died 7.81 and 3.66 times (p < 0.001) more often than patients with chronic kidney disease alone. The mortality rate among patients with acute kidney injury was 7.79 (p < 0.001) times higher than among patients without these diseases. Conclusions: COVID-19 patients who developed acute kidney injury and whose chronic kidney disease was complicated by acute kidney injury had a longer hospital stay and were more likely to die.

Background. Gastric antral vascular ectasia (GAVE) is currently recognized as an important cause of upper gastrointestinal (GI) haemorrhage, being responsible for about 4% of non-variceal upper GI haemorrhages and typically presents in middle-aged females. GAVE, also called “watermelon stomach”, is diagnosed through esophagogastroduodenoscopy and is characterized by the presence of visible columns of red tortuous enlarged vessels along the longitudinal folds of the antrum. The pathogenesis is still obscure and many hypotheses have been proposed such as mechanical stress, humoral and autoimmune factors. In the last two decades, numerous therapeutic strategies have been proposed, including surgical, endoscopic, and medical choices, yet successful treatment of GAVE continues to be a challenge. Currently, given the rapid response, safety, and efficacy, endoscopic ablative modalities have largely usurped medical treatments as first-line therapy, particularly using argon plasma coagulation. The actual GAVE prevalence in patients with end-stage renal disease (ESRD) is not clear, yet in difficult cases it should be considered as a cause of erythropoietin resistance. Case presentation. We report four clinical cases of GAVE syndrome patients diagnosed with stage 4 to 5 chronic kidney disease. All patients presented with anaemia and GI haemorrhage, the origin of which turned out to be GAVE syndrome. Conclusions. GAVE syndrome is a serious condition in ESRD patients, especially in those presenting with treatment-refractory anaemia. Realization of its aetiology and characteristics is essential to suspect, diagnose, and treat gastric ectasia. Only proper diagnosis and well-timed disease treatment can significantly improve a patient’s medical condition and future prognosis.