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2 results on '"Marek Świtalski"'

1. FRAX prognostic and intervention thresholds in the management of major bone fractures in hemodialysis patients: A two-year prospective multicenter cohort study

Author

Jolanta Malyszko, Magdalena Durlik, Edyta Gieglis, Monika Wieliczko, Bartosz Fiderkiewicz, Jolanta Wściślak, Wojciech Klimm, Arkadiusz Piotrowski, Marek Stopiński, Andrzej Podgórzak, Wiesław Klatko, Roman Horbacz, Ryszard Gellert, Robert Małecki, Jacek Imiela, Dariusz Osuch, Paweł Żebrowski, Ewa Wojtaszek, Mirosław Piórecki, Małgorzata Kędzierska, Dorota Śliwicka, Zofia Sitkowska-Kurzec, Sewer Golebiewski, Janusz Grochowski, Jerzy Przedlacki, Bożenna Kaczanowska, Agnieszka Wyszyńska, Stanisław Niemczyk, Jakub Hartman, Marek Świtalski, Jolanta Buczyńska-Chyl, Dorota Daniewska, Mirosław Grzeszczyk, Ewa Niemczyk, Dariusz Stryjewski, Agnieszka Bolesta, Piotr Koźminski, Joanna Matuszkiewicz-Rowińska, Antoni Sokalski, Joanna Gorczyńska, Magdalena Wypych-Birecka, Andrzej Rydzewski, Piotr Kędzierski, Marek Papliński, and Przemysław Wierzbicki

Subjects
0301 basic medicine, medicine.medical_specialty, Histology, FRAX, Physiology, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Risk Assessment, 03 medical and health sciences, Fractures, Bone, 0302 clinical medicine, Bone Density, Renal Dialysis, Risk Factors, Intervention (counseling), Internal medicine, medicine, Humans, In patient, Prospective Studies, Dialysis, business.industry, Bone fracture, medicine.disease, Prognosis, 030104 developmental biology, Hemodialysis, business, Osteoporotic Fractures, Cohort study, Kidney disease
Abstract

Purpose The usefulness of FRAX in predicting major bone fractures in patients with end-stage kidney disease on maintenance hemodialysis treatment has been confirmed in previous studies. For meaningful clinical use, the prognostic and intervention FRAX thresholds need to be established. Methods The primary aim of our study was to calculate the optimal cut-off point of FRAX for the best prediction of an increased bone fracture risk in dialysis patients and additionally, to propose its intervention threshold, indicating the need for antifracture pharmacological treatment. The study included 718 hemodialysis patients, who were followed up for two years. Thirty low-energy major bone fractures were diagnosed during the study period. We used the Polish version of FRAX (without the DXA examination) and some particular variables of the FRAX calculator. The optimal cut-off point for prediction of an increased major bone fracture risk was based on the analysis of the sensitivity and specificity curves of FRAX. Results The analysis revealed FRAX >5% (sensitivity of 70.0%, specificity of 69.8%) as the prognostic threshold for major bone fractures. Its sensitivity for bone fracture prediction was significantly higher, but specificity lower than those of FRAX ≥10%, used in general Polish population. The reason for this can be an underestimation of bone fracture risk with FRAX in dialysis patients. Conclusions We conclude that the FRAX prognostic threshold for identification of an increased risk of major bone fractures in hemodialysis patients is >5%. We propose to use this specific value of FRAX as an intervention threshold for pharmacological antifracture treatment in hemodialysis patients.

Published
2019

2. Endometrial morphology and pituitary-gonadal axis dysfunction in women of reproductive age undergoing chronic haemodialysis—a multicentre study.

Author

Joanna Matuszkiewicz-Rowińska, Katarzyna Skórzewska, Stanisław Radowicki, Stanisław Niemczyk, Antoni Sokalski, Jerzy Przedlacki, Janusz Puka, Marek Świtalski, Kazimierz Wardyn, Janusz Grochowski, and Kazimierz Ostrowski

Abstract

Background. Although disorders of the reproductive system are very common in women undergoing chronic haemodialysis, this issue remains a neglected area. The aim of the study was to evaluate the endometrial morphology and its relationship with pituitary-gonadal axis dysfunction in uraemic women of reproductive age undergoing haemodialysis.Methods. The baseline survey with determination of the sex hormones concentrations was performed in 75 haemodialysed women aged 18–45 years. The control group consisted of 33 healthy premenopausal women, aged 18–45 years, with normal menstruation. Then, 40 haemodialysis women, who met the inclusion criteria and gave their informed consent, underwent endometrium suction biopsy.Results. The pathological endometrial morphology was observed in 80% of biopsied subjects. Atrophia or subatrophia was recognized in almost half of the cases, and proliferative changes in one-third of them. Full atrophia with no mitotic figures was found in all but one non-menstruating woman. In one case, adenocarcinoma in situ was diagnosed and successfully treated. The analysis of the relationship between hormonal status and endometrial morphology revealed the substantial influence of oestradiol on endometrium as a target organ. In women with atrophic changes, oestradiol concentrations were significantly decreased, whereas in the remaining subjects, the increase of serum oestradiol seemed to be accompanied by a shift in endometrium morphology from secretional pattern, through proliferative changes to glandular hyperplasia. Mean serum 17-β oestradiol was decreased in women with amenorrhoea, and increased in those with eumenorrhoea (P<0.001). Except women with regular menses, mean serum progesterone concentrations were in the lower normal range. Seventy-five percent of the studied population had menstrual disorders, and amenorrhoea constituted almost a half of them.Conclusions. Pathological endometrium morphology is very common in uraemic women of reproductive age undergoing haemodialysis, with proliferative changes in one-third and atrophia in almost a quarter of them. The results of the study suggest a preserved normal reactivity of endometrium on circulating oestrogens. [ABSTRACT FROM AUTHOR]

Published
2004
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