Background The European Renal Association (ERA) Registry collects data on kidney replacement ther... more Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with ESKD. This paper is a summary of the ERA Registry Annual Report 2020, also including comparisons among primary renal disease (PRD) groups. Methods Data were collected from 52 national and regional registries from 34 European countries and countries bordering the Mediterranean Sea: 35 registries from 18 countries providing individual level data and 17 registries from 17 countries providing aggregated data. Using this data, KRT incidence and prevalence, kidney transplantation rates, expected remaining lifetimes and survival probabilities were calculated. Results A general population of 654.9 million people was covered by the ERA Registry in 2020. The overall incidence of KRT was 128 per million population (p.m.p.). In incident KRT patients, 54% were older than 65 years, 63% were men and the most common PRD was diabetes mellitus (21%). Regarding initial treatment ...
Introduction: Mycophenolate mofetil and its active metabolite mycophenolic acid are routinely use... more Introduction: Mycophenolate mofetil and its active metabolite mycophenolic acid are routinely used as immunosuppressant drugs in solid organ transplantation in a fixed daily dose regimen in association with cyclosporine, tacrolimus and steroids. Therapeutic drug monitoring for mycophenolic acid concentration has been suggested to optimize outcomes by reducing rejection and drug related toxicities in clinical renal transplantation. Aim: To determine the predose concentration of mycophenolic acid in renal transplanted patients by a validated proposed high-performance liquid chromatography (HPLC) method and to estimate the interindividual variability based on the therapeutic target. Materials and methods: An HPLC method combined with protein precipitation has been validated for mycophenolic acid determination in the human plasma obtained from 21 renal transplant recipients. HPLC analysis was carried out using the chromatographic system Agilent Technologies 1200 DAD. Samples were inject...
Background Data on renal replacement therapy (RRT) for end-stage renal disease were collected by ... more Background Data on renal replacement therapy (RRT) for end-stage renal disease were collected by the European Renal Association (ERA) Registry via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article provides a summary of the 2019 ERA Registry Annual Report, including data from 34 countries and additional age comparisons. Methods Individual patient data for 2019 were provided by 35 registries and aggregated data by 17 registries. Using these data, the incidence and prevalence of RRT, the kidney transplantation activity and the survival probabilities were calculated. Results In 2019, a general population of 680.8 million people was covered by the ERA Registry. Overall, the incidence of RRT was 132 per million population (p.m.p.). Of these patients, 62% were men, 54% were ≥65 years of age and 21% had diabetes mellitus as primary renal disease (PRD), and 84% had haemodialysis (HD), 11% had peritoneal dialysis (PD) and 5% had pre-e...
Membranous Nephropathy (MN) also known as membranous glomerulonephritis is a slowly progressive k... more Membranous Nephropathy (MN) also known as membranous glomerulonephritis is a slowly progressive kidney disease characterized of subepithelial immune complex deposits and subsequent thickening of glomerular basement membrane. MN is a common cause of proteinuria that may progress to ERDS. The decision to treat MN with immunosuppressive medications is complicated by the well-known natural history of disease and it depends on patient presentation and disease progression. Herein, we present a case of a 48-year-old male patient with weight gain, lower extremity edema, arterial hypertension, and nephrotic range proteinuria (13.5 gr). The patient was diagnosed with MN 14 years ago with relapses and remission of disease over the years. First immunotherapy was stared with cyclosporine and methylprednisolone, but the patient occurred to have cyclosporine-induced toxicity. Second immunotherapy was stared with methylprednisolone and cyclophosphamide that resulted in complete remission for 4 year...
Background Recent studies have provided evidence for an important contribution of the immune syst... more Background Recent studies have provided evidence for an important contribution of the immune system in the pathophysiology of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). In this report, we investigated whether the inflammatory profile of pulmonary hypertension patients changes over time and correlates with patient WHO subgroups or survival. Methods 50 PAH patients (16 idiopathic (I)PAH, 24 Connective Tissue Disease (CTD)-PAH and 10 Congenital Heart Disease (CHD)-PAH), 37 CTEPH patients and 18 healthy controls (HCs) were included in the study. Plasma inflammatory markers at baseline and after 1-year follow-up were measured using ELISAs. Subsequently, correlations with hemodynamic parameters and survival were explored and data sets were subjected to unbiased multivariate analyses. Results At diagnosis, we found that plasma levels of interleukin-6 (IL-6) and the chemokines (C-X3-C) motif legend CXCL9 and CXCL13 in CTD-PAH patients we...
Background and Aims Diabetes mellitus was prevalent in nearly 0.8 % of the adult population and a... more Background and Aims Diabetes mellitus was prevalent in nearly 0.8 % of the adult population and assent in our modest hemodialytic population in 1990. Changing of lifestyle and nutrition, increase in longevity, aging population, and stress have brought to increase of this morbid condition. Nowadays, with a galloping rise, we have a prevalence of 11,1 % of DM in the adult population and nearly 22% of hemodialysis patients whose primary diagnosis is diabetes. Despite this, data of EUROSTAT put us in the first place for mortality due to diabetes. It's time to act! Method We analyzed the number of diabetic patients in Albania second the IDF data and the number of diabetic nephropathy patients hospitalized during this decade in our Departement of Nephrology according the Statistical Department of UHC "Mother Theresa". Results In 2010 there were 4.5% diabetics in the adult population in Albania and in 2019 there were 9%, so doubling of numbers. Diabetic nephropathy is increas...
Background The European Renal Association – European Dialysis and Transplant Association (ERA-EDT... more Background The European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry collects data on kidney replacement therapy (KRT) via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article summarizes the 2018 ERA-EDTA Registry Annual Report, and describes the epidemiology of KRT for kidney failure in 34 countries. Methods Individual patient data on patients undergoing KRT in 2018 were provided by 34 national or regional renal registries and aggregated data by 17 registries. The incidence and prevalence of KRT, the kidney transplantation activity and the survival probabilities of these patients were calculated. Results In 2018, the ERA-EDTA Registry covered a general population of 636 million people. Overall, the incidence of KRT for kidney failure was 129 per million population (p.m.p.), 62% of patients were men, 51% were ≥65 years of age and 20% had diabetes mellitus as cause of kidney failure. Treat...
Linezolid has been successfully used for treatment of multidrug-resistant tuberculosis (MDR-TB). ... more Linezolid has been successfully used for treatment of multidrug-resistant tuberculosis (MDR-TB). However, dose- and duration-related toxicity limit its use. Here, our aim was to search relevant pharmacokinetics (PK)/pharmacodynamics (PD) literature to identify the effective PK/PD index and to define the optimal daily dose and dosing frequency of linezolid in MDR-TB regimens. The systematic search resulted in 8 studies that met inclusion criteria. A significant PK variability was observed. Efficacy of linezolid seems to be driven by area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC). Literature is inconclusive about the preferred administration of a daily dose of 600 mg. To prevent development of drug resistance, an AUC/MIC ratio of 100 in the presence of a companion drug at relevant exposure is required. A daily dose of 600 mg seems appropriate to balance between efficacy and toxicity. Being a drug with a very narrow therapeutic window, linezolid treatment may benefit from a more personalized approach, that is, measuring actual MIC values and therapeutic drug monitoring.
9.964.1 mmol/l), HbA1c (9.2%61.5 vs. 6.8%61.9%) and s.creatinin (5686106 vs. 3586118 mmol/l) were... more 9.964.1 mmol/l), HbA1c (9.2%61.5 vs. 6.8%61.9%) and s.creatinin (5686106 vs. 3586118 mmol/l) were higher in non-survivors, whereas LVĂ°F (28614 vs. 38611%), SBP (108629 vs. 151632mmHg), DBP (54623 vs.73613) were lower (all p<0.01). High coefficient of variation and standard deviation values were significantly associated with increased mortality, increasing death risk by 19% (OR 1.13, 95% CI 1.01-1.31; P = 0.03) and 9% (OR 1.09, 95% CI 1.02-1.16; P = 0.03), respectively. Finally, only MGI10.5mmol/l and BNP> 1014 pg/ml were independently associated with inhospital mortality. CONCLUSIONS: Parameters of glycemic variability in addition to plasma BNP levels are associated with in-hospital mortality in diabetic patients hospitalized because of AKI.
In diabetic patients with TCC infection, there are significantly more pronounced inflammatory res... more In diabetic patients with TCC infection, there are significantly more pronounced inflammatory response-C reactive protein (p=0,05) than in non-diabetic patients who have infection (table 1.) The presence of DM increases the risk of infection by 1.25 times (OR 1.25; CI 0.53 to 2.90, p = 0.606). Although without statistical significance, binary logistic regression analysis confirmed that right jugular position of TCC had protective effect on the occurrence of infections (OR 0.71; CI 0.13 to 3.76: p = 0.689). CONCLUSIONS: In presented group of patients TCC infection rate is high, and diabetics have a 25 percent higher risk.TCC into the right jugular vein stands out as protective.
Development of eosinophilic inflammation is independent of B-T cell interaction in a chronic hous... more Development of eosinophilic inflammation is independent of B-T cell interaction in a chronic house dust mite-driven asthma model
The aim of this study was to evaluate ventricular geometry, its relationship with the inflammator... more The aim of this study was to evaluate ventricular geometry, its relationship with the inflammatory markers, and mortality of patients with end-stage renal disease on peritoneal and hemodialysis treatment. We enrolled adult patients on long-term dialysis (hemodialysis and peritoneal dialysis) for more than 3 months. Two-dimensional echocardiography was performed by an experienced cardiologist who was blinded to all clinical details of patients. Cardiovascular mortality was assessed during a 2-year follow-up period. There were 129 participants, of whom 86 (66%) were on hemodialysis. Left ventricular hypertrophy was present in 86.7%; concentric hypertrophy was found in 64 (49.1%) and eccentric hypertrophy in 48 patients (37.2%). Patients with left ventricular hypertrophy were further divided into tertiles according to their left ventricular mass index. Logistic regression found pulse pressure as an independent risk factor associated with left ventricular mass index (odds ratio [OR], 1....
Renal stones, urinary tract infections (UTI) and gross hematuria (GH) are the most important rena... more Renal stones, urinary tract infections (UTI) and gross hematuria (GH) are the most important renal manifestations of autosomal dominant polycystic kidney disease (ADPKD). They are not only common, but are also frequent cause of morbidity, influencing renal dysfunction. The aim of this study was to evaluate the frequency of these manifestations in our patients with ADPKD and their impact on renal function. One hundred eighty ADPKD patients were included in the study. Subjects were studied for the presence of UTI, gross hematuria frequency and responsible factors of nephrolithiasis. Survival times were calculated as the time to renal replacement therapy or time of serum creatinine value up to 10 mg/dl. Kaplan-Meier product-limit survival curves were constructed, and log rank test was used to compare the survival curves. Kidney stones were present in 76/180 (42% of pts). The stones were composed of urate (47%) calcium oxalate (39%), and other compounds 14%. UTI was observed in 60% (108...
Background The European Renal Association (ERA) Registry collects data on kidney replacement ther... more Background The European Renal Association (ERA) Registry collects data on kidney replacement therapy (KRT) in patients with ESKD. This paper is a summary of the ERA Registry Annual Report 2020, also including comparisons among primary renal disease (PRD) groups. Methods Data were collected from 52 national and regional registries from 34 European countries and countries bordering the Mediterranean Sea: 35 registries from 18 countries providing individual level data and 17 registries from 17 countries providing aggregated data. Using this data, KRT incidence and prevalence, kidney transplantation rates, expected remaining lifetimes and survival probabilities were calculated. Results A general population of 654.9 million people was covered by the ERA Registry in 2020. The overall incidence of KRT was 128 per million population (p.m.p.). In incident KRT patients, 54% were older than 65 years, 63% were men and the most common PRD was diabetes mellitus (21%). Regarding initial treatment ...
Introduction: Mycophenolate mofetil and its active metabolite mycophenolic acid are routinely use... more Introduction: Mycophenolate mofetil and its active metabolite mycophenolic acid are routinely used as immunosuppressant drugs in solid organ transplantation in a fixed daily dose regimen in association with cyclosporine, tacrolimus and steroids. Therapeutic drug monitoring for mycophenolic acid concentration has been suggested to optimize outcomes by reducing rejection and drug related toxicities in clinical renal transplantation. Aim: To determine the predose concentration of mycophenolic acid in renal transplanted patients by a validated proposed high-performance liquid chromatography (HPLC) method and to estimate the interindividual variability based on the therapeutic target. Materials and methods: An HPLC method combined with protein precipitation has been validated for mycophenolic acid determination in the human plasma obtained from 21 renal transplant recipients. HPLC analysis was carried out using the chromatographic system Agilent Technologies 1200 DAD. Samples were inject...
Background Data on renal replacement therapy (RRT) for end-stage renal disease were collected by ... more Background Data on renal replacement therapy (RRT) for end-stage renal disease were collected by the European Renal Association (ERA) Registry via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article provides a summary of the 2019 ERA Registry Annual Report, including data from 34 countries and additional age comparisons. Methods Individual patient data for 2019 were provided by 35 registries and aggregated data by 17 registries. Using these data, the incidence and prevalence of RRT, the kidney transplantation activity and the survival probabilities were calculated. Results In 2019, a general population of 680.8 million people was covered by the ERA Registry. Overall, the incidence of RRT was 132 per million population (p.m.p.). Of these patients, 62% were men, 54% were ≥65 years of age and 21% had diabetes mellitus as primary renal disease (PRD), and 84% had haemodialysis (HD), 11% had peritoneal dialysis (PD) and 5% had pre-e...
Membranous Nephropathy (MN) also known as membranous glomerulonephritis is a slowly progressive k... more Membranous Nephropathy (MN) also known as membranous glomerulonephritis is a slowly progressive kidney disease characterized of subepithelial immune complex deposits and subsequent thickening of glomerular basement membrane. MN is a common cause of proteinuria that may progress to ERDS. The decision to treat MN with immunosuppressive medications is complicated by the well-known natural history of disease and it depends on patient presentation and disease progression. Herein, we present a case of a 48-year-old male patient with weight gain, lower extremity edema, arterial hypertension, and nephrotic range proteinuria (13.5 gr). The patient was diagnosed with MN 14 years ago with relapses and remission of disease over the years. First immunotherapy was stared with cyclosporine and methylprednisolone, but the patient occurred to have cyclosporine-induced toxicity. Second immunotherapy was stared with methylprednisolone and cyclophosphamide that resulted in complete remission for 4 year...
Background Recent studies have provided evidence for an important contribution of the immune syst... more Background Recent studies have provided evidence for an important contribution of the immune system in the pathophysiology of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). In this report, we investigated whether the inflammatory profile of pulmonary hypertension patients changes over time and correlates with patient WHO subgroups or survival. Methods 50 PAH patients (16 idiopathic (I)PAH, 24 Connective Tissue Disease (CTD)-PAH and 10 Congenital Heart Disease (CHD)-PAH), 37 CTEPH patients and 18 healthy controls (HCs) were included in the study. Plasma inflammatory markers at baseline and after 1-year follow-up were measured using ELISAs. Subsequently, correlations with hemodynamic parameters and survival were explored and data sets were subjected to unbiased multivariate analyses. Results At diagnosis, we found that plasma levels of interleukin-6 (IL-6) and the chemokines (C-X3-C) motif legend CXCL9 and CXCL13 in CTD-PAH patients we...
Background and Aims Diabetes mellitus was prevalent in nearly 0.8 % of the adult population and a... more Background and Aims Diabetes mellitus was prevalent in nearly 0.8 % of the adult population and assent in our modest hemodialytic population in 1990. Changing of lifestyle and nutrition, increase in longevity, aging population, and stress have brought to increase of this morbid condition. Nowadays, with a galloping rise, we have a prevalence of 11,1 % of DM in the adult population and nearly 22% of hemodialysis patients whose primary diagnosis is diabetes. Despite this, data of EUROSTAT put us in the first place for mortality due to diabetes. It's time to act! Method We analyzed the number of diabetic patients in Albania second the IDF data and the number of diabetic nephropathy patients hospitalized during this decade in our Departement of Nephrology according the Statistical Department of UHC "Mother Theresa". Results In 2010 there were 4.5% diabetics in the adult population in Albania and in 2019 there were 9%, so doubling of numbers. Diabetic nephropathy is increas...
Background The European Renal Association – European Dialysis and Transplant Association (ERA-EDT... more Background The European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry collects data on kidney replacement therapy (KRT) via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article summarizes the 2018 ERA-EDTA Registry Annual Report, and describes the epidemiology of KRT for kidney failure in 34 countries. Methods Individual patient data on patients undergoing KRT in 2018 were provided by 34 national or regional renal registries and aggregated data by 17 registries. The incidence and prevalence of KRT, the kidney transplantation activity and the survival probabilities of these patients were calculated. Results In 2018, the ERA-EDTA Registry covered a general population of 636 million people. Overall, the incidence of KRT for kidney failure was 129 per million population (p.m.p.), 62% of patients were men, 51% were ≥65 years of age and 20% had diabetes mellitus as cause of kidney failure. Treat...
Linezolid has been successfully used for treatment of multidrug-resistant tuberculosis (MDR-TB). ... more Linezolid has been successfully used for treatment of multidrug-resistant tuberculosis (MDR-TB). However, dose- and duration-related toxicity limit its use. Here, our aim was to search relevant pharmacokinetics (PK)/pharmacodynamics (PD) literature to identify the effective PK/PD index and to define the optimal daily dose and dosing frequency of linezolid in MDR-TB regimens. The systematic search resulted in 8 studies that met inclusion criteria. A significant PK variability was observed. Efficacy of linezolid seems to be driven by area under the concentration-time curve (AUC)/minimum inhibitory concentration (MIC). Literature is inconclusive about the preferred administration of a daily dose of 600 mg. To prevent development of drug resistance, an AUC/MIC ratio of 100 in the presence of a companion drug at relevant exposure is required. A daily dose of 600 mg seems appropriate to balance between efficacy and toxicity. Being a drug with a very narrow therapeutic window, linezolid treatment may benefit from a more personalized approach, that is, measuring actual MIC values and therapeutic drug monitoring.
9.964.1 mmol/l), HbA1c (9.2%61.5 vs. 6.8%61.9%) and s.creatinin (5686106 vs. 3586118 mmol/l) were... more 9.964.1 mmol/l), HbA1c (9.2%61.5 vs. 6.8%61.9%) and s.creatinin (5686106 vs. 3586118 mmol/l) were higher in non-survivors, whereas LVĂ°F (28614 vs. 38611%), SBP (108629 vs. 151632mmHg), DBP (54623 vs.73613) were lower (all p<0.01). High coefficient of variation and standard deviation values were significantly associated with increased mortality, increasing death risk by 19% (OR 1.13, 95% CI 1.01-1.31; P = 0.03) and 9% (OR 1.09, 95% CI 1.02-1.16; P = 0.03), respectively. Finally, only MGI10.5mmol/l and BNP> 1014 pg/ml were independently associated with inhospital mortality. CONCLUSIONS: Parameters of glycemic variability in addition to plasma BNP levels are associated with in-hospital mortality in diabetic patients hospitalized because of AKI.
In diabetic patients with TCC infection, there are significantly more pronounced inflammatory res... more In diabetic patients with TCC infection, there are significantly more pronounced inflammatory response-C reactive protein (p=0,05) than in non-diabetic patients who have infection (table 1.) The presence of DM increases the risk of infection by 1.25 times (OR 1.25; CI 0.53 to 2.90, p = 0.606). Although without statistical significance, binary logistic regression analysis confirmed that right jugular position of TCC had protective effect on the occurrence of infections (OR 0.71; CI 0.13 to 3.76: p = 0.689). CONCLUSIONS: In presented group of patients TCC infection rate is high, and diabetics have a 25 percent higher risk.TCC into the right jugular vein stands out as protective.
Development of eosinophilic inflammation is independent of B-T cell interaction in a chronic hous... more Development of eosinophilic inflammation is independent of B-T cell interaction in a chronic house dust mite-driven asthma model
The aim of this study was to evaluate ventricular geometry, its relationship with the inflammator... more The aim of this study was to evaluate ventricular geometry, its relationship with the inflammatory markers, and mortality of patients with end-stage renal disease on peritoneal and hemodialysis treatment. We enrolled adult patients on long-term dialysis (hemodialysis and peritoneal dialysis) for more than 3 months. Two-dimensional echocardiography was performed by an experienced cardiologist who was blinded to all clinical details of patients. Cardiovascular mortality was assessed during a 2-year follow-up period. There were 129 participants, of whom 86 (66%) were on hemodialysis. Left ventricular hypertrophy was present in 86.7%; concentric hypertrophy was found in 64 (49.1%) and eccentric hypertrophy in 48 patients (37.2%). Patients with left ventricular hypertrophy were further divided into tertiles according to their left ventricular mass index. Logistic regression found pulse pressure as an independent risk factor associated with left ventricular mass index (odds ratio [OR], 1....
Renal stones, urinary tract infections (UTI) and gross hematuria (GH) are the most important rena... more Renal stones, urinary tract infections (UTI) and gross hematuria (GH) are the most important renal manifestations of autosomal dominant polycystic kidney disease (ADPKD). They are not only common, but are also frequent cause of morbidity, influencing renal dysfunction. The aim of this study was to evaluate the frequency of these manifestations in our patients with ADPKD and their impact on renal function. One hundred eighty ADPKD patients were included in the study. Subjects were studied for the presence of UTI, gross hematuria frequency and responsible factors of nephrolithiasis. Survival times were calculated as the time to renal replacement therapy or time of serum creatinine value up to 10 mg/dl. Kaplan-Meier product-limit survival curves were constructed, and log rank test was used to compare the survival curves. Kidney stones were present in 76/180 (42% of pts). The stones were composed of urate (47%) calcium oxalate (39%), and other compounds 14%. UTI was observed in 60% (108...
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