Abstract Introduction. BNP plasma levels are significantly increased in heart failure and have an excellent negative predictive value for left ventricular dysfunction. Measurement of BNP level is useful for “screening” in high-risk populations. It is suitable for detection of left ventricular hypertrophy (LVH) and/or dysfunction and risk assessment in the sub-acute phase of acute myocardial infarction in hypertensive patients. The aim of our study was to find whether BNP may correlate with the left ventricular systolic function, i.e. its echocardiographic parameters in chronic kidney disease (CKD) patients. Methods. In a prospective study performed at the Department of Nephrology and Clinic for hemodialysis at the Clinical Center in Sarajevo we followed-up 80 patients stratified in three separate groups according to CKD stage (Stage III, IV and V) for two years, regardless of their cardiovascular symptoms. We analyzed levels of BNP before and after diuretic therapy or hemodialysis and echocardiographic characteristics of the left ventricle. Results. There was a strong negative correlation between BNP values and the size of the EF before (rho=−0.692, p<0.0001) and after diuretic therapy (rho=−0.683, p<0.0001) for patients in CKD stage III, stage IV (rho=−0.314, p>0.05) and after diuretic therapy (rho=−495, p<0.05) Similarly, a negative correlation was found for BNP and EF values before (rho=−0.432, p<0.05) and after hemodialysis (rho=−0.556, p<0.01) for stage V CKD. Conclusions. Our study confirmed that the value of BNP in CKD patients may represent a measure of left ventricular systolic function with a strong negative correlation with ejection fraction. BNP measurement is a reliable parameter for further follow-up and prognosis in patients with established left ventricular dysfunction, acute coronary syndrome and for estimation of the left ventricular dysfunction.

Kronicna bubrežna bolest (HBB) je važan javno-zdravstveni problem (1). Prema definiciji KDIGO (Kidney Disease: Improving Global Outcomes) HBB je definirana kao strukturno ili funkcionalno ostecenje bubrega, koje traje >3 mjeseca, s posljedicama za zdravlje i klasificirana je na osnovi uzroka, kategorije glomerularne filtracije i kategorije albuminurije (2). HBB ima nekoliko stadija, a posljednji, terminalni stadij ili end-stage of renal disease (ESRD) odgovara uremiji s glomerularnom filtracijom 90 dana se također povecala i u 2011. godini iznosila 123,1 (3). Također, i u drugim zemljama koje vode renalni registar, zabilježen je porast incidencije i prevalencije pacijenata s ESRD. U svijetu je, u odnosu na modalitet tretmana zamjene bubrežne funkcije u razdoblju 2001.-2010. godina, bila najzastupljenija HD (68,5-69,2 %), zatim transplantacija bubrega (22,5-23,1 %), te peritonejska dijaliza (8,3-8,5 %) (4). U Bosni i Hercegovini u razdoblju 2006.-2011., HD je najucestalija metoda zamjene bubrežne funkcije s ucestaloscu UCINAK INTRADIJALIZNOG PROGRAMA VJEŽBANJA NA KVALITETU ŽIVOTA I FIZICKE MOGUCNOSTI U HEMODIJALIZIRANIH PACIJENATA

AIM In hemodialysis patients renal disease may cause an impairment of central and peripheral nervous system. In most cases of the peripheral nervous system polyneuropathy is reported. The aim of this study was to evaluate the function of small A-delta nerve fibres, whose function is often overlooked. METHODS The function of large diameter nerve fibers was performed by standard routine neurophysiological examination. Cutaneous silent period (CSP) was elicited by single electrical stimulations at the tip of digit II by the bipolar electrodes. The superficial electrodes were placed on the muscle belly of m. abductor pollicis brevis. The onset latency (L1) was recorded at the beginning of voluntary muscle activity suppression, the late latency (L2) at the start of new muscle activity. The difference between two latencies indicates the duration of CSP. RESULTS The study included 38 consecutive patients (male/female - 21/17, median age 56.6±10.9 years) treated with hemodialysis (one month to 30 years) and 35 healthy subjects (male/female 23/17, age 47.4±10.1 years). The results of the conduction study demonstrated a significant prolongation of F-waves of the median and ulnar nerves, decreased motor and sensory velocities of both nervesin patients on hemodialysis (p less than 0.001). In patients with A-V fistulas a significant prolongation of the onset CSP latency L1 was obtained (p less than 0.001), whereas duration of CSP was not changed. CONCLUSION In hemodialysis patients the significant impairment of small nerve fibers was recorded. The evaluation of small nerve fibers contributes to the assessment of the whole peripheral nerve function.

Introduction: Regulatory T cells (Treg) play a central role in the immunopathogenesis of psoriasis. Immunoregulatory T cells (Tregs) are involved in important homeostatic mechanism for maintaining tolerance and preventing autoimmunity, and autoimmune diseases. The aim of this study was to examine the role of Tregs cells in the pathogenesis of psoriasis, and determine the range value for Treg cells (CD4+ CD25+) in the peripheral blood of patients with psoriasis compared to the severity of disease. Material and methods: The study included 51 patients diagnosed with psoriasis and 25 healthy individuals. Phenotype profile of peripheral blood lymphocytes was determined by flow cytometry, and assessment of severity of disease was determined on the basis of PASI score (e.g. Psoriasis Area and Severity Index). Results: Proportion of CD4+CD25+T cells in the control group was significantly higher than in the patients with psoriasis [6,4% ±(5,4-7,6) vs. 4,1% (3,1 -5,8)–Mann–Whitney U test, p <0.001]. In the present study we did not find a statistically significant correlation between the levels of CD4+CD25+cells, in patients with psoriasis, compared to the severity of disease–PASI. (i.e. Pearson correlation, r = 0.197, p = 0.194). Conclusion: The stratification of patients, according to the severity of the clinical course was not possible on the basis of Treg cells’ level. ROC curve analysis of the optimal cutoff (PASI=10) and the CD4+CD25+, which distinguishes between patients and healthy individuals was 5% of CD4+CD25+ of the total number of CD4+ lymphocytes with specificity of 69% and sensitivity of 84%.

AIM To determine the effect of a 16-week intradialytic exercise program consisting of 30 minutes of exercise during the first two hours of dialysis with three times a week frequency, on the quality of life (QoL), level of depression/anxiety and physical perfor- mance in hemodialysis (HD) patients. METHODS The clinical, longitudinal, prospective study with one-group repeated measures design was conducted during a 16-week period. A convenience sample of 52 HD patients, who had been on HD for a minimum of 6 months, were included. QoL, level of depression and anxiety (questionnaires: SF-36, Back Depression Inventory (BDI) and Back Anxiety Inventory (BAI)) and physical performance (modifying Visual Analogue Scale (VAS) and Manual Muscle Testing (MMT)) were assessed at baseline and after 4-month exercise program. RESULTS The following scales of SF-36 questionnaire were improved after 16-week exercise program: role functioning/emotional (P=0.01 8), energy/fatigue (P = 0.002) and social functi- oning (P = 0.030). Level of depression and anxiety were significantly decreased in males (P = 0.007 and P = 0.022, respectively) and females (P = 0.001 and P = 0.000, respectively). VAS scale and MMT were significantly increased in males (P = 0.000 and P = 0.001, respectively) and females (P = 0.01 9 and P = 0.001, respectively) after 16-week exercise program. CONCLUSION Exercise program improves some aspects of QoL and physical performance, and decreases the level of depression and anxiety in HD patients.

Background This article provides a summary of the 2011 ERA–EDTA Registry Annual Report (available at www.era-edta-reg.org). Methods Data on renal replacement therapy (RRT) for end-stage renal disease (ESRD) from national and regional renal registries in 30 countries in Europe and bordering the Mediterranean Sea were used. From 27 registries, individual patient data were received, whereas 17 registries contributed data in aggregated form. We present the incidence and prevalence of RRT, and renal transplant rates in 2011. In addition, survival probabilities and expected remaining lifetimes were calculated for those registries providing individual patient data. Results The overall unadjusted incidence rate of RRT in 2011 among all registries reporting to the ERA–EDTA Registry was 117 per million population (pmp) (n = 71.631). Incidence rates varied from 24 pmp in Ukraine to 238 pmp in Turkey. The overall unadjusted prevalence of RRT for ESRD on 31 December 2011 was 692 pmp (n = 425 824). The highest prevalence was reported by Portugal (1662 pmp) and the lowest by Ukraine (131 pmp). Among all registries, a total of 22 814 renal transplantations were performed (37 pmp). The highest overall transplant rate was reported from Spain, Cantabria (81 pmp), whereas the highest rate of living donor transplants was reported from Turkey (39 pmp). For patients who started RRT between 2002 and 2006, the unadjusted 5-year patient survival on RRT was 46.8% [95% confidence interval (CI) 46.6–47.0], and on dialysis 39.3% (95% CI 39.2–39.4). The unadjusted 5-year patient survival after the first renal transplantation performed between 2002 and 2006 was 86.7% (95% CI 86.2–87.2) for kidneys from deceased donors and 94.3% (95% CI 93.6–95.0) for kidneys from living donors.

1. Brenner BM, Chertow GM. Congenital oligonephropathy and the etiology of adult hypertension and progressive renal injury. Am J Kidney Dis 1994;23:171–5. 2. Vikse BE, Irgens LM, Leivestad T et al. Low birth weight increases risk for end-stage renal disease. J Am Soc Nephrol 2008;19:151–7. 3. Lackland DT, Bendall HE, Osmond C et al. Low birth weights contribute to high rates of early-onset chronic renal failure in the Southeastern United States. Arch Intern Med 2000;160: 1472–6. 4. Ichikawa T, Fukuda M, Wakamatsu-Yamanaka T et al. Low birth weight and end-stage renal disease: demographic analysis by region in Japan. Clin Exp Nephrol 2012;16:596–603.

Background This study provides a summary of the 2010 European Renal Association–European Dialysis and Transplant Association (ERA–EDTA) Registry Annual Report (available at www.era-edta-reg.org). Methods This report includes data on renal replacement therapy (RRT) using data from the national and regional renal registries in 29 countries in Europe and bordering the Mediterranean Sea. Individual patient data were received from 27 registries, whereas 18 registries contributed data in aggregated form. We present incidence and prevalence of RRT, transplant rates, survival probabilities and expected remaining lifetimes. The latter two are solely based on individual patient records. Results In 2010, the overall incidence rate of RRT for end-stage renal disease (ESRD) among all registries reporting to the ERA–EDTA Registry was 123 per million population (pmp) (n = 91 798). The highest incidence rate was reported by Turkey (252pmp) and the lowest reported by Montenegro (21 pmp). The overall prevalence of RRT for ESRD at 31 December 2010 among all registries reporting to the ERA–EDTA Registry was 741 pmp (n = 551 005). The prevalence varied from 124 pmp in Ukraine to 1580 pmp in Portugal. The overall number of renal transplantations performed in 2010 among all registries was 29.2 pmp (n = 21 740). The highest overall transplant rate was reported from Spain, Cantabria (73 pmp), whereas the highest transplant rate for living donor kidneys was reported from the Netherlands (28 pmp). For patients who started RRT between 2001 and 2005, the unadjusted 5-year patient survival on RRT was 46.2% [95% confidence interval (CI) 46.0–46.3], and on dialysis 38.6% (95% CI 38.5–38.8). The unadjusted 5-year patient survival after the first renal transplantation performed between 2001 and 2005 was 86.6% (95% CI 86.1–87.1) for deceased donor kidneys and 94.1% (95% CI 93.4–94.8) for living donor kidneys.

INTRODUCTION Mortality after hip fracture remains high in spite of the progress of medicine. Due to the trend toward longer life, the problem of hip fracture is getting more significant. The aim of this study is to determine the effects of surgical treatment in patients with high risk of hip fracture on mortality reduction. METHODS In the retrospective-prospective study, 66 patients aged 65-92 with a hip fracture and a high cardiac risk have been analyzed. The risk estimation was based on the Lee index. The patients with three or more risk factors were considered high-risk. The first group consisted of surgically treated patients with a hip fracture and at high cardiac risk, and in the second group were conservatively treated patients with a hip fracture and high cardiac risk. RESULTS In the group of conservatively treated patients, 75% were women and in operatively treated group 67.6%. Patient in both group are similar in relation to the participation of risk factor. A difference has been noticed in terms of renal insufficiency (RI). There was 18.8% conservatively treated patient with RI and 2.9% in operatively treated group. CONCLUSION Patients with hip fracture and at high cardiac risk have lower mortality when treated surgically.

This issue of the International Journal of Nephrology focused on kidney diseases within a devil's triangle, oxidative stress (OS), mediators, inflammation, specifically relating to the clinical significance of identification, and prevention. Every creature in need of oxygen faces OS. It has a critical role in the molecular mechanisms of renal injury in several kidney diseases, and many complications of these diseases are mediated by OS, mediators, and inflammation. There is a complex relationship between these three; mostly they induce each other. While some of the diseases themselves can contribute to OS, reactive oxygen species (ROS) produced by activated leukocytes and endothelial cells in sites of inflammation cause tissue damage. Although inflammation looks dangerous for the organism, it is a normal reaction of organs and tissues to protect themselves against several invasion(s). It enables the immune system to remove the injurious stimuli and initiate the healing process of tissues. However, the interactions between OS, mediators, and inflammation may result in glomerular damage, proteinuria, electrolyte, and volume instabilities which cause nephron loss, on the long view. Detailed studies on this topic are included in this issue. The kidney can easily be damaged by ROS, due to the rich structure of long-chain polyunsaturated fatty acids. The article by E. Ozbek summarizes the induction of OS within kidney in several conditions, including diabetes, hypertension, hypercholesterolemia, obesity, aging, urinary obstruction, environmental toxins, and molecular mechanisms of these inductions in the light of existing literature data. Diabetic nephropathy is one of the most common microvascular complications of type 1 and type 2 diabetes mellitus and the leading cause of end-stage renal disease worldwide [1]. Rojas-Rivera et al. reviewed the biological bases of oxidative stress and its role especially on diabetic nephropathy, as well as the role of the Keap1-Nrf2 pathway, and recent clinical trials targeting this pathway with bardoxolone methyl, a novel synthetic triterpenoid with antioxidant and anti-inflammatory properties. Obesity continues to be a public health problem throughout the world. Epidemiologic studies have shown that 66% of adults and 16% of children and adolescents are overweight or obese [2]. Obesity-related glomerulopathy is an increasing cause of end-stage renal diseases. J. Tang et al. stressed the chronic low-grade systemic inflammation in obesity and discussed the roles of inflammation and oxidative stress in the progression of obesity-related glomerulopathy and possible treatment modalities to prevent kidney injury in obesity, such as the usage of anti-IL-6 receptor antibody, TNF-α antagonist, adiponectin, nutritional and surgical interventions to reduce OS. Hypertension is an another important global health issue both in adults and children. It is one of the major risk factors for the progression of kidney diseases. The relationship between blood pressure and dietary sodium and salt sensitivity has been well known, and renal sodium handling is a key determinant of long-term blood pressure regulation [3]. There is a limited knowledge in the literature regarding the role of ROS-mediated fibrosis and renal proximal tubule sodium reabsorption through the Na/K-ATPase. S. Liu et al. reviewed the possible role of ROS in the regulation of Na/K-ATPase activity. The authors emphasized the importance of further researches whether ROS signaling is a link between the Na/K-ATPase/c-Src cascade and NHE3 regulation and how OS, stimulated by high salt and cardiotonic steroids, regulates Na/K-ATPase/c-Src signaling in renal sodium handling and fibrosis. Urotensin-II is the most potent mammalian vasoconstrictor identified to date, almost tenfold more potent than endothelin-I [4]. A. Balat and M. Buyukcelik discussed the role of urotensin-II on renal hemodynamics and its possible role on several kidney diseases, such as the minimal change nephrotic syndrome. The article includes a detailed discussion of urotensin-II immunoreactivity in renal biopsy specimens of children with membranoproliferative glomerulonephritis, membranous nephropathy, IgA nephropathy, Henoch-Schonlein nephritis, and focal segmental glomerulosclerosis. Because of its complex relation with OS and other mediators, authors describe it as “more than a mediator” in glomerular diseases. They briefly mention from the effectiveness of U-II antagonism, as a new promising pharmacological treatment target in some kidney diseases. Given the potential impact of OS, mediators, and inflammation trio, the importance of prevention has come into question. Strong evidence indicates the importance of new molecules that are able to diminish them which in turn may help to decrease the prevalence and/or progression of several kidney diseases. Therefore, further researches are needed to the better understanding of the molecular and clinical mechanisms of this triad. They may help to provide new therapeutical strategies to control several complications in patients with kidney diseases. Ayse Balat Halima Resic Guido Bellinghieri Ali Anarat

Pacijenti s kroničnom bubrežnom bolešću (HBB) imaju smanjeni odgovor na vakcinaciju zbog općeg slabljenja imunološkog sustava povezanog s uremijom. U odnosu na vakcinaciju u pacijenata bez HBB-a, na primjer, dijalizni pacijenti imaju niži titar antitijela i nemogućnost održavanja adekvatnog titra antitijela tijeNovi protokol vakciNacije pacijeNata Na hemodijalizi protiv hepatitisa B iskustvo jedNog ceNtra

INTRODUCTION Central venous catheters in hemodialysis patients can be used as vascular access for hemodialysis. At our clinic, our doctors use temporary and tunneled catheters for hemodialysis treatment. The presence of the catheter, increases the risk of bacteremia in hemodialysis patients. Risk factors are nasal colonization with Staphylococcus aureus, prolonged use of catheters, previous bacteremia, anover dose of iron, low hemoglobin, low albumins, diabetes mellitus, and surgical procedures. The aim of this study was prevention of catheter sepsis and timely disclosures of existing and effective cures. PATIENTS AND METHODS Thirty-eight patients with tunnelled catheters as vascular access for hemodialysis were included into the study. The study was conducted between January 1, 2011 and January 3, 2012. Outof 38 patients, 60% (23) were male and 40% (15) were female, while the average age was 67.48 +/- 13.9 years. The duration of hemodialysis treatment was 108.9 +/- 16.54 months. RESULTS Over the study period, 9 patients developed bacteriemia associated with the use of catheter as a vascular approach. The incidence of infection in our study was 3.5 cases per 1000 catheter days. Two patients (5.2%) developed an infection in the first three months after the day of catheter placement, and the remaining 6 (15.8%) patients after one year of the use of catheter as a vascular approach. Regarding the causes of infection, in 3 (33%) patients these were gram-positive pathogens, in 5 (56%) patients gram-negative pathogens, and in one (11%) patient it was polimicrobe flora. According to the protocol and pending the outcome of susceptibility testing (antibiogram), all the patients were prescribed with antibiotic treatment therapy. In 7 (75%) patients tunnelled catheter was removed and replaced with temporary catheters for hemodialysis treatment. In 2 (25%) patients, was antibiotic-lock solution was injected into the catheter. There were no significant differences (p<0.05) in age, duration of dialysis treatment, hemoglobin levels, iron, transferrin saturation, ferritin and albumin in patients without infection and those who developed an infection. Only one patient has had a nasal colonization with Staphylococcus aureus. One patient developed severe thrombocytopenia, followed by sepsis anda lethal outcome due to heavy gastrointestinal bleeding. CONCLUSION tunneled venous catheter is the increasingly common vascular access with the hemodialytic patients, but it is also a common cause of infection. Proper care and use of catheters, making the unique protocols of care and treatment algorithm occupy a significant place in each hemodialysis center. Our goal is to prevent the catheter sepsis, and to promptly detect the existing and a fast treatment of the same.

INTRODUCTION Hepatitis C virus infection (HCV) is an important cause of morbidity and mortality in patients with end-stage renal disease (ESRD). PATIENTS AND METHODS In this prospective, observational study, 205 patients, 37 (18%) of them with chronic HCV infection, were followed up for a one-year period at Department of Hemodialysis, Sarajevo Clinical Center, University of Sarajevo. The following parameters were analyzed: dialysis duration, sex, PCR RNA, HCV genotypes and biochemical parameters. Thirteen anti-HCV PCR RNA positive patients were treated with pegylated interferon alpha (Pegasys, Hoffman-La Roche). The goal of therapy was to reach sustained virologic response. The presence of anti-HCV antibodies in serum was detected by enzyme linked immunosorbent assay (ELISA). RESULTS Of 37 anti-HCV positive patients, there were 20 (54%) males and 17 (45.9%) females with the mean hemodialysis duration of 143.67 +/- 57.64 months and mean age of 54.45 +/- 8.93 years. Of 37 anti-HCV positive patients, 30 (81.08%) patients were HCV RNA PCR positive. Among HCV RNA PCR positive patients, two had up to twofold elevated ALT values, one had twofold elevated AST values, and one had sixfold elevated GGT values. Thirteen RNA PCR positive patients were treated with pegylated interferon alfa for 48 weeks. Only one patient had genotype 1 virus. Upon therapy completion, only three patients were negative by PCR RNA (genotype 1b, 23.07%) at six months and yearly follow ups remained PCR negative. CONCLUSION Sustained virologic response was achieved in three study patients. Monitoring guidelines for infection control, isolation of seropositive patients, and strict hygienic preventive measures can prevent HCV seroconversion in hemodialysis patients.