Search

Background: Total antibodies to core antigen of hepatitis B virus (anti-HBc) are a marker for previous or current infection with hepatitis B virus (HBV). Our aim was to examine the prevalence and incidence of anti-HBc in relation to demographic, clinical and laboratory data of patients treated with intermittent hemodialysis (IHD). Methods: Predictors for anti-HBc positivity were evaluated in prevalence IHD patients with negative testing for surface antigen of HBV (HBsAg, n = 1,105) using the stepwise backward regression analysis. Patients starting IHD (n = 336) were introduced into the one-year prospective study evaluating seroconversion for anti-HBc. Results: Anti-HBc positivity (19.5% of all patients) was predicted by lack of vaccination against HBV with developed protective titer of antibodies to HBsAg (β = 0.592, p = 0.000), vintage of renal replacement therapy (RRT, β = 0.206, p = 0.000), history of hepatitis (β = 0.101, p = 0.000), and activity of alanine aminotransferase (β = 0.057, p = 0.037). In 85 prospective patients who finished first IHD year, seroconversion rate for anti-HBc was 1.23 episodes/100 patient-years. Conclusions: Lack of or not effective vaccination against HBV is the strongest predictor for prevalence of anti-HBc positivity in RRT patients. Periodical determination of anti-HBc, usually not required, may be helpful in evaluation of current epidemiological status and risk for further HBV infection in dialysis centers. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Patients undergoing renal replacement therapy have a higher risk of developing tuberculosis (TBC) in comparison with normal renal function population. The anergy to the tuberculin skin test, the lack of characteristic clinical symptoms of TBC and typical radiographic signs, and high prevalence of extrapulmonary TBC make the diagnosis in dialysis patients difficult and often delay the treatment. In contrast to the active TBC, latent TBC infection (LTBI) is asymptomatic and is not a direct epidemiological problem. However, in patients with end-stage renal disease prepared for renal transplantation, it is an obstacle to qualifying for immunosuppressive therapy. Treatment of LTBI patients with antimycobacterial medication decreases about 90% risk of developing active TB. Therefore, the possibility of a fast and easy identification of LTBI in this group of patients is extremely important. Test QuantiFERON-TB Gold In-Tube (QFT-G) is a new, simple and rapid diagnostic tool in LTBI and active tuberculosis infection (in conjunction with previously used clinical and microbiological methods). This test has been approved and is used in many European countries and in the USA. In a 65-year old patient, treated for 5 years with continuous ambulatory peritoneal dialysis, positive QFT-G results were shownin the course of diagnosis before reporting to the transplant program. After conducting an extensive diagnosis for tuberculosis infection (epidemiological interview, clinical examination, imaging studies, cultures by MB/BacT and the conventional method, consultations with a pulmonologist), latent form of tuberculosis was diagnosed with unspecified location. Due to the positive QFT-G and the need for future immunosuppressive treatment after kidney transplantation, a three-month prophylactic treatment with Rifamazyd 450 mg per day was included. After treatment, the patient entered the waiting list for a kidney transplant. Test QFT-G, in conjunction with other conventional methods is a good and rapid diagnostic tool in the identification of LTBI.

Introduction: Atherogenic dyslipidemia accelerates the development of cardiovascular complications and contributes to mortality of hemodialysis (HD) patients., Objectives: The aim of the study was to evaluate the effects of lifestyle changes followed by treatment with atorvastatin in dyslipidemic HD patients., Patients and Methods: Dyslipidemic HD patients (n = 49) were enrolled into the prospective study. Forty-two patients completed a 21-week lifestyle intervention. In 34 patients, who continued to be dyslipidemic, atorvastatin was used for 14 weeks. After 4 weeks, the initial dose of atorvastatin of 10 mg/d was increased to 20 mg/d in dyslipidemic patients., Results: The most pronounced effects of lifestyle changes were shown at 14 weeks and included significant differences in high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, salusin α, malondialdehyde-oxidized LDL, fructosamine, and monocyte CD36 expression. Immunoglobulin G anti-oxLDL showed the highest values at 21 weeks. Seven patients (16.7%) were nondyslipidemic at 21 weeks. In patients who continued to be dyslipidemic, LDL cholesterol and triglyceride levels significantly decreased, salusin α levels and CD36 expression increased, and dyslipidemia resolved in 59.4% of the patients following atorvastatin treatment., Conclusions: Lifestyle changes have selective efficacy in the treatment of dyslipidemia in HD patients, while atorvastatin (up to 20 mg/d) may be effective in about 60% of nonresponders to lifestyle changes. Lipid-lowering interventions affect plasma salusin α and monocyte CD36 expression.

This review is focused on results of application of calcimimetic drug--cinacalcet in the treatment of secondary hyperparathyroidism in patients in 3-5 stage chronic kidney disease (CKD), excluding dialysis patients (stage 5D CKD). Oral administration of cinacalcet (15-180 mg/day) significantly reduced plasma parathormone (PTH) concentrations (> or = 30% as compared to the baseline values), but simultaneously side effects occurred, among them hypocalcemia and hyperphosphatemia. Hypocalcemia was a reason for cinacalcet withdrawal in 2-15% of patients. There is a lack of studies showing the influence of advantages and disadvantages of long-term administration of cinacalcet on outcome of 3-5 stage CKD patients.

Objective: Epidemiological analysis of HBV infections in dialysis units of Wielkopolska., Methods: Studies were carried out in 19 dialysis units, in which patients were treated with intermittent hemodialysis (IHD). Data were collected from 18.04.2007 to 18.06.2007., Main Observations: There were 39 persons with HBsAg(+) among 1140 patients (3.42%). Positive results of HBcAb were shown in 114 from 349 examined patients with HBsAg(-) (32.7%). The group with HBsAg(+) consisted of 7 women (17.9%) and 32 men (82.1%). Documented duration of HBV infection was 9.7 +/- 6.0 years. Eight patients before detection of HBsAg(+) were vaccinated against hepatitis B; 21 patients (53.8%) underwent surgical interventions or invasive diagnostic procedures. Transfusions of blood or blood-related products were documented in 17 cases (43.6%). HBV infection in at least 32 patients (82.1%) was not connected with IHD treatment (p = 0.000). Four patients (10.3%) showed symptoms of acute hepatitis. Eleven patients (28.2%) with HBsAg(+) had renal transplantation. Patients with HBsAg(-) were vaccinated against hepatitis B. Vaccination was not effective (level of HBsAb < 10 IU/l) in 244 patients (22.2%)., Conclusions: HBV infection in patients with chronic kidney disease is most frequently detected before or due to initiation of IHD treatment. Over 20% IHD patients remains susceptible for HBV infection despite vaccination against hepatitis B.