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Petrovic D.,Center for Nephrology and Dialysis | Jagic N.,Center for Radiology Diagnostics | Miloradovic V.,Clinical Center Kragujevac | Nikolic A.,Clinical Center Kragujevac | Stojimirovic B.,Institute for Urology and Nephrology
Serbian Journal of Experimental and Clinical Research | Year: 2010

Cardio-Renal Syndrome is defined as pathophysiological dysfunction of the heart and kidneys in which an acute or chronic abnormality of one organ favours either the acute or chronic disorder of the other one. Due to complex interactions between the heart and kidneys, Cardio-Renal Syndrome is divided into five types: Cardio-Renal Syndrome type 1 (Acute Cardio-Renal Syndrome) is defined as acute kidney dysfunction as a result of acute heart failure. Cardio-Renal Syndrome type 2 (Chronic Cardio-Renal Syndrome) is a progressive chronic kidney disorder as a result of chronic heart failure. Cardio-Renal Syndrome type 3 (Acute Reno-Cardial Syndrome) is defined as an acute heart abnormality due to acute kidney dysfunction. Cardio-Renal Syndrome type 4 (Chronic Reno-Cardial Syndrome) is defined as a chronic heart function disorder as a result of a chronic kidney disorder. Cardio-Renal Syndrome type 5 (Secondary Cardio-Renal Syndrome) is defined as either a permanent or temporary abnormality of both organs due to systemic disease. Early detection of kidney and heart disease and timely and adequate therapy can prevent the development of Cardio-Renal syndrome and reduce the overall expense of therapy. Source


Petrovic D.,Center for Nephrology and Dialysis | Jagic N.,Center for Radiology Diagnostics | Miloradovic V.,Clinical Center Kragujevac | Nikolic A.,Clinical Center Kragujevac | Stojimirovic B.,Institute for Urology and Nephrology
Serbian Journal of Experimental and Clinical Research | Year: 2011

Cardiovascular diseases present a leading cause of death in patients treated with haemodialysis. The rate of cardiovascular mortality in this population is approximately 9% on an annual basis, with left ventricular hypertrophy, ischemic heart diseases and heart failure having the highest rates of mortality. Left ventricular hypertrophy is present in 75-80% of haemodialysis- treated patients. The most important risk factors for the progression of left ventricular hypertrophy are: hypertension, arteriosclerosis, secondary aortic stenosis, anaemia, increased volume of extracellular fluid and increased blood flow through the vascular access for haemodialysis. Left ventricular hypertrophy is present when the left ventricular mass index on echocardiography exceeds 131 g/m2 in males and 100 g/m2 in females. Left ventricular hypertrophy is a risk factor of unfavourable outcome in patients treated with haemodialysis. The identification of patients with increased risk of progression of left ventricular hypertrophy, the timely implementation of adequate treatment, and the realisation and maintenance of targeted values of risk factors decelerates the progression of the hypertrophy and leads to the regression of existing left ventricular hypertrophy, the reduction of cardiovascular morbidity and mortality rates and the improvement of the quality of life of patients treated with haemodialysis. Source


Petrovic D.,Center for Nephrology and Dialysis | Obrenovic R.,University of Belgrade | Trbojevic-Stankovic J.,Clinical Hospital Center Dragisa Misovic | Majkic-Singh N.,University of Belgrade | Stojimirovic B.,Institute for Urology and Nephrology
Journal of Medical Biochemistry | Year: 2012

Hyperphosphatemia is a potent stimulator of vascular and valvular calcifications in hemodialysis patients. To determine the prevalence of hyperphosphatemia and assess its effect on the outcome of hemodialysis patients, a total of 115 chronic hemodialysis patients were studied. Laboratory parameters were determined at baseline, and after 12 and 24 months of follow-up. Valvular calcification was assessed with echocardiography. Laboratory parameters were statistically analyzed with ANOVA. Survival analysis was performed with the Kaplan-Meier test and Log-Rank test. Hyperphosphatemia was present in 31.30% of the patients, high calcium-phosphate (Ca × P) product in 36.52% and valvular calcifications in 48.70%. Patients with serum phosphate >2.10 mmol/L and Ca × P product >5.65 mmol2/L2 at baseline were at high risk for all-cause and cardiovascular mortality. Hyperphosphatemia is a risk factor for adverse outcome in patients on regular hemodialysis. Source


Cardiovascular diseases represent a considerable cause of death among patients with transplanted kidney. The study was aimed at defining risk factors, pathogenic progression mechanisms for cardiovascular diseases and pointing at clinical importance for early detection and timely treatment of cardiovascular diseases in patients with transplanted kidney. Expert papers and clinical studies dealing with etiopathogenesis, diagnosis and treatment of cardiovascular diseases in patients with transplanted kidney were analyzed. Increased incidence of cardiovascular diseases in patients with transplanted kidney is the consequence of high prevalence of traditional risk factors (obesity, cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus), risk factors due to status of transplantation and its treatment (immunosuppressive agents, graft rejection, viral infections (cytomegalovirus) and risk factors due to chronic reduction of allograft (anemia, volume strain stress, hyperhomocysteinemia, oxidative stress, secondary hyperparathyroidism, microinflammation). Left ventricular hypertrophy, ischemic heart disease and heart weakness bear the highest prevalence among cardiovascular diseases. Early detection of disease in patients with increased risk for progression of cardiovascular diseases enables optimization and individualization of immunosu-ppressive therapy, reaching aimed values for cardiovascular risk factors, all with the view to reduce cardiovascular morbidity and mortality, increase of allograft survival and better life quality of patients with transplanted kidney. Source


Reinke P.,University Hospital Charite | Budde K.,University Hospital Charite | Hugo C.,TU Dresden | Petersen P.,University Hospital of Tuebingen | And 8 more authors.
Transplantation Proceedings | Year: 2011

Gastrointestinal (GI) complications such as diarrhea or indigestion frequently occur in renal graft recipients treated with mycophenolate mofetil (MMF), requiring dose reductions to reduce side effects, thereby increasing the risk of rejection episodes and graft loss. In a prospective clinical trial, the immunosuppressive therapy of renal graft recipients was converted from MMF to enteric-coated mycophenolate sodium (EC-MPS) to identify a strategy to reduce GI symptoms without dose reduction. At baseline and 68 weeks later patients filled in 4 questionnaires related to GI symptoms and general and health-related quality of life. In 15 German study centers, 196 renal graft recipients (mean age 49.5 ± 13.5 years; male/female, 120/76) were included; 51.0% of patients suffered from GI complications at baseline. The Gastrointestinal Symptom Rating Scale score decreased significantly (P < .001) in patients with GI complications from 2.61 ± 0.86 at baseline to 2.14 ± 0.86 at visit 2. Health-related and general quality of life improved significantly. Fifty percent of patients with GI symptoms and 34% of the total per protocol population reported an improvement of their physical condition after converting the medication. In conclusion, conversion from MMF to EC-MPS reduces GI complications in renal graft recipients, reduces the patients' physical discomfort, and maintains their quality of life. (ClinicalTrials.gov number NCT00149968.) © 2011 Elsevier Inc. Source

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