Background Recent research has closely linked adipocytokines to liver inflammation and fibrosis progression in patients with non-alcoholic liver disease. This study aimed to determine the relationship of serum adiponectin and resistin levels with the severity of liver fibrosis in patients with chronic hepatitis B (CHB), depending on the duration of antiviral therapy. Methods The cross-sectional study included 75 patients with CHB divided into two groups: the T1 group (undergoing antiviral therapy for up to 2 years) and the T2 group (undergoing antiviral therapy over 2 years). The control group consisted of 40 healthy people. Serum concentrations of adiponectin and resistin were estimated with the ELISA method, while the degree of liver fibrosis was determined using FIB-4 and APRI score. Results There were no statistically significant differences in the mean serum adiponectin levels in relation to the duration of antiviral therapy. Higher values of serum resistin concentration were confirmed in patients of the T1 group compared to healthy controls (p=0.001) and to the T2 group (p=0.031). The mean level of serum resistin concentration was significantly higher in the group of patients with a higher FIB-4 score (9.12±3.39 vs 5.58±3.36 ng/mL, p=0.001) and higher APRI score (17.45±3.96 ng/mL vs 4.82±1.11 ng/mL, p=0.001). A positive correlation was found between serum resistin levels and the degree of liver fibrosis (p<0.001). There was no significant difference between mean serum adiponectin levels according to the values of FIB-4 and APRI scores. Conclusions Progression of liver fibrosis estimated by FIB4 and APRI scores as well as the length of antiviral treatment had a significant effect on serum resistin values in CHB patients on antiviral therapy.

Aim To evaluate the relationship between cardiovascular remodelling and glomerular filtration rate (eGFR) in pre-dialysis chronic kidney disease (CKD) patients without cardiovascular diseases (CVD) and in renal transplant recipients (RTR). Methods The cross-sectional study included 83 patients with eGFR<60 mL/min/1.73m2 (45 with CKD 3 stage and 38 with CKD 4 stage). Thirty six RTR had eGFR 67.8 (57.3-73.7) mL/ min/1.73m2 and control group consisted of 44 patients with eGFR>60 mL/min/1.73m2 . All patients were evaluated by echocardiography and X-ray. Results Left ventricular hypertrophy (LVH) was present in 74.7% CKD patients, most frequently in CKD 4 stage and in RTR. Calcifications of abdominal aorta (CAA) were present in 87% CKD 4, 60% RTR and in 44% CKD 3 patients. Calcifications of the mitral valve were found in 34.2% CKD 4, 25.0% RTR and in 6.7% CKD 3 stage patients. Aortic valve calcifications were most frequently present in CKD 4 stage (26.3%). The LV mass index negatively correlated with eGFR (p<0.001), and positively with parathyroid hormone (p<0.001), phosphorus (p=0.043), age (p<0.001) and diabetes (p=0.043). In multivariate regression analysis the risk factor for calcifications of the mitral and aortic valve, as well as for CAA was the decline in eGFR (p<0.001). Conclusion Renal transplant recipients have a higher incidence of CV remodelling than patients with CKD 3 and less than patients with CKD 4 stage, indicating incomplete regression of CV calcifications and LVH after kidney transplantation. A decrease of renal function represents a significant risk factor for valvular and vascular calcifications occurrence in CKD patients.

Aim To investigate the association of parameters of lipid profile and estimated glomerular filtration rate (eGFR) p<60 ml/min/1.73m2 calculated by the Modification of Diet in Renal Disease (MDRD) in non-dialysis kidney patients. Methods The observational, case-control study enrolled patients (n=117) recruited from the Nephrological Counselling Centre of the University Clinical Centre Sarajevo and divided into two groups: group 1 eGFR (15-59 mL/min/1.73 m2 ), and group 2 (control) eGFR ≥ 60 mL/min/1.73 m2 . Concentration of lipids, lipoproteins and apolipoproteins was measured, and atherogenic index of plasma (AIP; log(TG/HDLc)) was calculated. Results High density lipoprotein cholesterol (HDLc) and apolipoprotein E (APOE) concentrations in serum were reduced [(1.02 (0.94-1.29) vs 1.15 (1.1-1.4) mmol/L; p=0.009 and 0.035 (0.026-0.04) vs 0.041 (0.034-0.05) g/L; p=0.002, respectively)], while AIP was higher in group 1 than in group 2 (0.19±0.03 vs 0.09±0.04; p=0.013). Values less than 1.09 mmol/L and 0.038 g/L for HDLc and APOE, or higher than 0.165 for AIP (p< 0.05) were associated with the eGFR below 60 ml/min/1.73 m2. The age [OR = 1.1; 95% CI (1.05-1.17)] and AIP [OR = 8.7; 95% CI (1.18- 65.0)] were independent positive predictors, while APOE was a negative predictor of eGFR reduction rate (OR=0.01; 95% CI (0.001-0.033; p<0.001). Conclusion Changes in parameters such as HDLc, APOE and AIP are associated with CKD. The study results imply the need of the AIP calculation as routine laboratory work due to its role along with the age and APOE in the prediction of renal function decline.

The r enal damage is an emerging complication of excess weight.  Aim of this study was to determine the occurrence of chronic kidney disease (CKD) in subjects depending on their weight and the influence of body mass index (BMI) on glomerular filtration (GF) rate decline in outpatients with hypertension and/or diabetes mellitus type 2. Methods: This observational, cross sectional, pilot study included 200 adult patients suffering from hypertension and/or diabetes mellitus type 2 from March 2012. to March 2013. in the Institute for Occupational Medicine of Canton Sarajevo. Renal function was evaluated by using MDRD equation and measurement of microalbuminuria and proteinuria in 24 - hour urine, using nefelometric method at the Institute of Clinical Biochemistry of the University Clinical Center in Sarajevo K/DOQI classification  was used to define the stages of CKD. Results: Of the total 200 patients (62.5% male; mean age of 52.46 ± 8.2 years) most of them had a BMI of 25 - 30 (n=99; 49.5%). Most patients with a body mass index above 30 suffered from hypertension associated with diabetes mellitus type 2 (n=23; 34.3%,  p<0.05). The average values of BMI were statistically higher in men than in women (29.16±4.4 vs. 27.76±3.7). Early CKD was found in 118 patients (59.0%), mostly those with a BMI above 30 (63.8%). Conclusion: Early detection of CKD in primary care should definitely be a priority, especially in high - risk patients. It is also necessary to increase work on the prevention of obesity in order to prevent disease progression.

Aim: Identification of risk factors for adverse outcome in acute kidney injury (AKI) provides the knowledge necessary to make important medical decisions. Sepsis, as the most important cause of AKI, deserves special attention in evaluating AKI prognosis. The present study aimed to identify risk factors for renal function non-recovery and in-hospital death in AKI patients. Additionally, we evaluate baseline characteristics and clinical outcomes of patients with septic AKI compared to patients with non-septic AKI. Methods: This prospective study included one hundred hospitalized patients diagnosed with AKI. Baseline physiological and laboratory parameters, as well as renal function outcome and in-hospital death of AKI patients, were evaluated. Results: Patients with septic AKI had significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (p<0.001), erythrocyte sedimentation rate (ESR) (p<0.001) and white cell counts (p=0.017), higher levels of ferritin (p<0.001), C-reactive protein (CRP) and fibrinogen (p<0.001) as well as significantly lower serum albumin values (p<0.01) compared to patients with non-septic AKI. Risk factors for adverse renal outcome were increased APACHE II score (p<0.01) and ESR (p<0.05), higher values of CRP (p<0.01) and serum ferritin (p<0.05), as well as hypoalbuminemia (p<0.01). By multivariate analysis, APACHE II score was the independent risk factor for non-recovery of renal function (95% CI 0.788-0.956, p꞊0.004) and in-hospital mortality (95% CI 1.057-9.075, p꞊0.039), while sepsis (95% CI 0.128-0.967, p=0.043) was predictive of renal function non-recovery in AKI patients. Conclusion: Acute-phase reactants, APACHE II score, and sepsis are useful in predicting the adverse clinical outcome in AKI patients.

Introduction: Data regarding prognostic factors of post-discharge mortality and adverse renal function outcome in acute kidney injury (AKI) hospital survivors are scarce and controversial. Objectives: We aimed to identify predictors of post-discharge mortality and adverse renal function outcome in AKI hospital survivors. Patients and Methods: The study group consisted of 84 AKI hospital survivors admitted to the tertiary medical center during 2-year period. Baseline clinical parameters, with renal outcome 3 months after discharge and 6-month mortality were evaluated. According survival and renal function outcome, patients were divided into two groups. Results: Patients who did not recover renal function were statistically significantly older (P < 0.007) with higher Charlson comorbidity index (CCI) score (P < 0.000) and more likely to have anuria and oliguria (P = 0.008) compared to those with recovery. Deceased AKI patients were statistically significantly older (P < 0.000), with higher CCI score (P < 0.000), greater prevalence of sepsis (P =0.004), higher levels of C-reactive protein (CRP) (P < 0.017) and ferritin (P < 0.051) and lower concentrations of albumin (P<0.01) compared to survivors. By multivariate analysis, independent predictors of adverse renal outcome were female gender (P =0.033), increasing CCI (P =0.000), presence of pre-existing chronic kidney disease (P =0.000) and diabetes mellitus (P =0.019) as well as acute decompensated heart failure (ADHF) (P =0.032), while protective factor for renal function outcome was higher urine output (P =0.009). Independent predictors of post-discharge mortality were female gender (P =0.04), higher CCI score (P =0.001) and sepsis (P =0.034). Conclusion: Female AKI hospital survivors with increasing burden of comorbidities, diagnosis of sepsis and ADHF seem to be at high-risk for poor post-discharge outcome.

Peritoneal transport characteristics and residual renal function require regular control and subsequent adjustment of the peritoneal dialysis (PD) prescription. Prescription models shall facilitate the prediction of the outcome of such adaptations for a given patient. In the present study, the prescription model implemented in the PatientOnLine software was validated in patients requiring a prescription change. This multicenter, international prospective cohort study with the aim to validate a PD prescription model included patients treated with continuous ambulatory peritoneal dialysis. Patients were examined with the peritoneal function test (PFT) to determine the outcome of their current prescription and the necessity for a prescription change. For these patients, a new prescription was modeled using the PatientOnLine software (Fresenius Medical Care, Bad Homburg, Germany). Two to four weeks after implementation of the new PD regimen, a second PFT was performed. The validation of the prescription model included 54 patients. Predicted and measured peritoneal Kt/V were 1.52 ± 0.31 and 1.66 ± 0.35, and total (peritoneal + renal) Kt/V values were 1.96 ± 0.48 and 2.06 ± 0.44, respectively. Predicted and measured peritoneal creatinine clearances were 42.9 ± 8.6 and 43.0 ± 8.8 L/1.73 m(2)/week and total creatinine clearances were 65.3 ± 26.0 and 63.3 ± 21.8 L/1.73 m(2) /week, respectively. The analysis revealed a Pearson's correlation coefficient for peritoneal Kt/V of 0.911 and Lin's concordance coefficient of 0.829. The value of both coefficients was 0.853 for peritoneal creatinine clearance. Predicted and measured daily net ultrafiltration was 0.77 ± 0.49 and 1.16 ± 0.63 L/24 h, respectively. Pearson's correlation and Lin's concordance coefficient were 0.518 and 0.402, respectively. Predicted and measured peritoneal glucose absorption was 125.8 ± 38.8 and 79.9 ± 30.7 g/24 h, respectively, and Pearson's correlation and Lin's concordance coefficient were 0.914 and 0.477, respectively. With good predictability of peritoneal Kt/V and creatinine clearance, the present model provides support for individual dialysis prescription in clinical practice. Peritoneal glucose absorption and ultrafiltration are less predictable and are likely to be influenced by additional clinical factors to be taken into consideration.

The most common influenza A (H1N1)-associated complications are pulmonary, but other organ systems, such as kidneys and nervous system can be affected too. There are no sufficient data about the development of acute kidney injury (AKI) related to A (H1N1) infection. Neurological complications, especially encephalitis with or without seizures, have been documented among pediatric patients, but data of influenza A (H1N1) related focal neurological deficits in adults are scarce. Here we describe a previously fit 46-year-old male patient with influenza A (H1N1) infection presenting with multi-organ failure (acute respiratory distress syndrome and AKI) accompanied by muscular and unusual neurological complications. We found hypoglossal nerve paralysis and unilateral peroneal nerve paralysis in the course of the influenza A (H1N1) infection, but with no permanent neurological sequelae. Renal function was fully recovered one month after patient’s discharge. Keywords : influenza A (H1N1), pulmonary complications, acute kidney injury, hypoglossal nerve paralysis

Objective was to assess whether the concentration of malondialdehyde (MDA) as a marker of lipid peroxidation and serum concentration of matrix metalloproteinase-9 (MMP-9) are involved in the process of atherosclerosis in chronic kidney disease (CKD) patients nondialysis-dependent and those on peritoneal dialysis (PD), both with signs of cardiometabolic syndrome (CMS). Thirty CKD and 22 PD patients were included in a study. All observed patients were divided into three subgroups depending on the degree of atherosclerotic changes in the carotid arteries (CA). Severity of atherosclerotic changes in the CA was evaluated by ultrasonography. We confirmed significantly lower level of serum MDA throughout all the stages of atherosclerosis in PD patients compared with observed CKD patients (P < 0.05) and increased serum concentration of MDA and MMP-9 with the progression of severity atherosclerotic changes in both groups of patients. The multiple regression analysis revealed that MDA and MMP-9 are significant predictors of changes in IMT-CA CKD patients (P < 0.05) and plaque score on CA in these patients (P < 0.05). The results suggest that MDA and MMP-9 could be mediators of CKD-related vascular remodeling in CMS.

Introduction: Starting from the point that the chronic kidney disease (CKD) is chronic, inflammatory and hypercoagulable state characterized by an increase in procoagulant and inflammatory markers high cardiovascular morbidity and mortality in these patients could be explained. Aim: The aim of the research was to monitor inflammatory markers and procoagulants in various stages of kidney disease (stage 1-4). Materials and Methods: The research included 120 subjects older than 18 years with CKD stages 1-4 examined and monitored in Clinic of Nephrology, University Clinical Centre Sarajevo over a period of 24 months. The research included determining the following laboratory parameters: serum creatinine, serum albumin, C-reactive protein, leukocytes in the blood, plasma fibrinogen, D-dimer, antithrombin III, coagulation factors VII (FC VII) and coagulation factor VIII (FC VIII). Results: With the progression of kidney disease (CKD stages 1-4), there was a significant increase of inflammatory and procoagulant markers: CRP, fibrinogen and coagulation factor VIII, and an increase in the average values of leukocytes and a reduction in the value of antithrombin III, but without statistical significance. Also, there were no significant differences in the values of D-dimer and coagulation factor VII. Conclusion: The progression of kidney disease is significantly associated with inflammation, which could in the future be useful in prognostic and therapeutic purposes. Connection of CKD with inflammation and proven connection of inflammation with cardiovascular risk indicates the potential value of some biomarkers, which could in the future identify as predictors of outcome and could have the benefit in the early diagnosis and treatment of cardiovascular disease in CKD.

Background/Aims: Residual renal function (RRF) has been shown to influence survival of peritoneal dialysis (PD) patients. This study examined the relations between RRF and left ventricular hypertrophy (LVH) before switching on dialysis treatment and observed during 18 months on PD treatment. Methods: A prospective longitudinal study was performed in 50 non-anuric (defined as >200 mL urine output in a 24-hour period) PD patients. Echocardiography, RRF and other known risk factors for the increase of LV mass index (LVMi) were determined at study baseline and the end of follow-up. Results: There was 78% patients with LVH in end-stage renal disease (ESRD) baseline and 60% at the end of follow-up. RRF at the start of the study showed no significant difference between patients with normal and increased LVMi, as well as in daily collection of urine. After 18 months, patients with decreased LVMi had better RRF, lower CRP and better Kt/V compared to patients with increased LVMi (p < 0.001). Patients with better preserved RRF not only had significantly higher total Kt/V, but were less anemic and hypoproteinemic and lesser presence of LVH. Conclusions: PD in non-anuric ESRD patients the first 18 months has a positive effect on the preservation of RRF and partial regression of left ventricular remodeling.

Aim: This study sought to assess whether the volume and osmolarity of contrast media (CM) influences the occurrence of contrast induced nephropathy (CIN) following coronarography procedure. CIN can be defined as an increase in the serum concentration of creatinine greater than a 25% from baseline during the period of 12 to 48 hours after the administration of radiocontrast media. Material and methods: We examined 100 patients without diabetes with serum creatinine concentration from 45 mmol/l to 141 mmol/l and 100 patients with diabetes with serum creatinine concentration from 46 mmol/l to 161 mmol/l who underwent coronary angiography. During procedure they received iso-osmolar contrast medium, Visipaque 320 (iodixanol-320), for group without diabetes from 40 to 340 ml and for group with diabetes from 49 to 310 ml. Results: CIN occurred in 27 (13,5%) of the 200 study patients. There was a trend toward higher prevalence of CIN (16% vs.11%, p = 0.086) in the diabetic group compared with the non-diabetic group. Patient with diabetes received less contrast media, they are younger but number patients with CIN are higher. Conclusion: Increasing contrast media dose is associated with the occurrence of CIN following coronarography. But, another risk factors like diabetes mellitus, old age, male sex and preexisting kidney disease have influence of developing CIN after coronarography.

Abstract Background: Cardiac valve calcification (CVC) and left ventricular (LV) alterations are frequent complication in end-stage renal disease (ESRD). We determined the prevalence of CVC and LV hypertrophy (LVH) in ESRD patients before renal replacement therapy and 12 months after peritoneal dialysis (PD). Methods: A prospective longitudinal of 50 incident PD patients was studied. Demographic and clinical data were recorded and blood assayed at baseline and after 1-year of follow-up. CVC and LVH were evaluated by M-mode two-dimensional echocardiography. Results: CVC of the mitral and aortic valves and of both valves were noted in 30, 18 and 10% of patients, respectively. After 12 months of PD regimen, 20% patients had aortic, 24% mitral and 8% had calcification of both valves. After one year of PD, LVH was 62 and 36% in patients with and without CVC, respectively (p < 0.05). Endothelin-1 is an independent predictor of CVC at the baseline, while nitric oxide is inversely an independent predictor at the end of follow-up. Conclusions: CVC is associated with LVH in PD patients. These findings identified a potential role for monitored markers to be incorporated into therapeutic strategies aimed at detection and treatment of cardiovascular complications and prevention strategies.