Incremental dialysis for preserving residual kidney function-Does one size fit all when initiating dialysis?

While many patients have substantial residual kidney function (RKF) when initiating hemodialysis (HD), most patients with end stage renal disease in the United States are initiated on 3-times per week conventional HD regimen, with little regard to RKF or patient preference. RKF is associated with many benefits including survival, volume control, solute clearance, and reduced inflammation. Several strategies have been recommended to preserve RKF after HD initiation, including an incremental approach to HD initiation. Incremental HD prescriptions are personalized to achieve adequate volume control and solute clearance with consideration to a patient's endogenous renal function. This allows the initial use of less frequent and/or shorter HD treatment sessions. Regular measurement of RKF is important because HD frequency needs to be increased as RKF inevitably declines. We narratively review the results of 12 observational cohort studies of twice-weekly compared to thrice-weekly HD. Incremental HD is associated with several benefits including preservation of RKF as well as extending the event-free life of arteriovenous fistulas and grafts. Patient survival and quality of life, however, has been variably associated with incremental HD. Serious risks must also be considered, including increased hospitalization and mortality perhaps related to fluid and electrolyte shifts after a long interdialytic interval. On the basis of the above literature review, and our clinical experience, we suggest patient characteristics which may predict favorable outcomes with an incremental approach to HD. These include substantial RKF, adequate volume control, lack of significant anemia/electrolyte imbalance, satisfactory health-related quality of life, low comorbid disease burden, and good nutritional status without evidence of hypercatabolism. Clinicians should engage patients in on-going conversations to prepare for incremental HD initiation and to ensure a smooth transition to thrice-weekly HD when needed

The search for new pathogenesis of cardiorenal syndrome: the effect of local Schumann resonance on the occurrence of episodes of kidney disease and myocardial infarction

Background. The pandemic of noncommunicable chronic diseases and the high prevalence of combined damage to the cardiovascular system and kidneys determine the relevance of continuing scientific research to solve these medical problems. Therefore, the aim of this study was to compare the influence of the Earth’s electromagnetic field on the occurrence of episodes of kidney disease and myocardial infarction in order to search for new pathogenetic components of cardiorenal syndrome and deepen fundamental knowledge. According to the Lithuanian magnetometer GCI003, a number of stu­dies in 2014–2018 found that changes in the Earth’s electromagnetic field may play an important role in the pathogenesis of cardiovascular diseases as well as their incidence. Since the functioning of the cardiovascular system and kidneys are closely connected through the metabolic processes of the cardiorenal metabolic axis, this study tested the hypothesis that changes in the Earth’s electromagnetic field may also affect the pathogenesis of kidney disease as the changes of local magnetic field have been shown to influence the functioning of the cardiovascular system. Materials and methods. This was a search retrospective study on the relationship between the influence of local Schumann resonances and the occurrence of hospitalizations in 1340 patients with kidney disease. It also examined the relationship between local Schumann resonances and heart attacks in patients admitted to the University Hospital of the Lithuanian University of Health Sciences (703 patients). Mean power of local magnetic field fluctuations in Lithuania was measured in pT2 s2 in five different frequency ranges, which overlaps the Schumann resonance and electroencephalogram’s frequency ranges: SDelta (0–3.5 Hz), STheta (3.5–7 Hz), SAlpha (7–15 Hz), SBeta (15–32 Hz), SGamma (32–66 Hz). The data of hospitalizations to the Nephrology Department of University Hospital and the dynamics of Schumann resonances were analyzed from January 1, 2021 to December 31, 2021. The data of hospitalizations for myocardial infarction to the Cardiology Department of University Hospital and the dynamics of Schumann resonances were studied from January 1, 2016 to December 31, 2016. Results. It was found that changes in the strength of the Earth’s local magnetic field in 2016 and 2021 were comparable and corresponded to the characteristic annual dynamics of the Earth’s local electromagnetic fields. This made it possible to conduct a comparative analysis of annual correlation graphs and establish general trends in the dynamics of indicators and graphical similarities. It confirmed the pre­sence of a general dependence of reactions to the external electromagnetic field of the Earth in female and male patients both with nephrological pathology and myocardial infarction. In nephrological patients of both sexes, all correlation coefficients in all ranges of Schumann resonances were positive. The only negative correlation coefficient P5 (SGamma) [32; 65] Hz (r = –0.069; p = 0.313) was in the female group. This fact as well as the presence of a significant dynamics of the correlation coefficient P5 (SGamma) [32; 65] Hz (r = 0.009; p = 0.475) in the male group indicate that higher magnetic field strength in this frequency range may be associated with a reduced incidence of kidney disease. We obtained data that a higher magnetic field intensity in the gamma range from 32 to 65 Hz as a pathogenetic component can contribute to the destabilization of the cardiovascular system, but at the same time it is associated with a positive effect on the state of nephrological pathology. Based on this, we can tentatively assume the opposite direction of the Earth’s electromagnetic field influence on the pathogenetic mechanisms of renal and cardiovascular diseases. This is clearly demonstrated by comparing the correlation coefficients between the incidence of kidney disease and the occurrence of myocardial infarction in men and women. The Earth’s stronger magnetic field in the gamma range contributes to an increase in the incidence of myocardial infarction, which is confirmed by the large number of patients during this period. Under these same conditions, a decrease in the incidence of kidney disease has been detected. This opposite direction is observed in both sexes. But in women the reaction is stronger, which is confirmed by a larger difference in correlation coefficients. Conclusions. 1. Changes in the Earth’s electromagnetic field are related to the functional state of the cardiovascular system and the condition of the kidneys. 2. It can be assumed that the effect of the Earth’s electromagnetic field on the pathogenetic mechanisms of kidney disease is in the opposite direction of that on the cardiovascular one. 3. Reliable gender differences in correlations between the influence of changes in the local Schumann resonance on the functional state of the cardiovascular system and kidneys were not found. 4. The connection of the Earth’s local geomagnetic field with kidney function may be another new unexplored pathogenetic mechanism in cardiorenal syndrome and noncommunicable chronic diseases

Molecular characterization and seroprevalence of hepatitis E virus in inflammatory bowel disease patients and solid organ transplant recipients

16 p.-3 fig.-5 tab.Seroprevalence rates and molecular characterization of hepatitis E virus (HEV) prevalent in the Lithuanian human population has not yet been evaluated. Immunosuppressed individuals have been recognized as a risk group for chronic hepatitis due to HEV genotype 3 (HEV-3) infections. The objectives of the present study were to determine prevalence rates of anti-HEV antibodies among inflammatory bowel disease (IBD) patients and solid organ transplant (SOT) recipients, to isolate and characterize HEV strain present in the Lithuanian human population, and to investigate its capacity to infect non-human primate (MARC-145 and Vero), swine (PK-15) and murine (Neuro-2a) cells in vitro. In the present study, the significant difference of anti-HEV IgG prevalence between healthy (3.0% (95% CI 0–6.3)) and immunosuppressed individuals (12.0% [95% CI 8.1–15.9]) was described. Moreover, our findings showed that anti-HEV IgG seropositivity can be significantly predicted by increasing age (OR = 1.032, p < 0.01), diagnosis of IBD (OR = 4.541, p < 0.01) and reception of SOT (OR = 4.042, <0.05). Locally isolated HEV strain clustered within genotype 3i subtype of genotype 3 and was capable of infecting MARC-145 cells. This study demonstrates higher HEV seroprevalence in the risk group compared to healthy control individuals without confidence interval overlap. The high level of genetic homology between human and animal strains in Lithuania and the capacity of locally isolated strains to infect cells of non-human origin suggests its potential for zoonotic transmission.This research was partly funded by the Lithuanian University of Health Sciences Science Foundation (LSMUSF), grant number 119-05 and COST Action CA15116 ASF-STOP, supported by COST (European Cooperation in Science and Technology).Peer reviewe

Renal Anemia Control in Lithuania: Influence of Local Conditions and Local Guidelines

Erythropoietin stimulating agents had a long haul in Lithuania—we had no epoetin till 1994 and there was no intravenous iron in 2001–2004. The aim of this study was to assess the changes of renal anemia control in hemodialysis patients from early independence of Lithuania till nowadays and to evaluate the link of anemia with hospitalization rates and survival and hemoglobin variability in association with mortality. In December of each year since 1996 all hemodialysis centers have been visited and data has been collected using special questionnaires. The history of renal anemia control in Lithuania was complicated; however, a significant improvement was achieved: 54.7% of hemodialysis patients reached the target hemoglobin; all patients have a possibility of treatment with epoetin and intravenous iron. The involuntary experiment with an intravenous iron occurred in Lithuania because of economic reasons and confirmed the significant role of intravenous iron in the management of renal anemia. Hemoglobin below 100 g/L was associated with a 2.5-fold increase in relative risk of death and 1.7-fold increase in relative risk of hospitalization in Lithuanian hemodialysis patients. Although hemoglobin variability was common in Lithuanian hemodialysis patients, we did not find the association between hemoglobin variability and all-cause mortality in our study

The Role of Pre- and Post-Transplant Hydration Status in Kidney Graft Recovery and One-Year Function

Background and Objectives: Early improvements to graft function are crucial for good outcomes in kidney transplantation (kTx). Various factors can influence early graft function. This study aimed to evaluate the pre- and post-transplant hydration statuses of kTx recipients using bioimpedance analysis (BIA) and lung ultrasonography (LUS) and to investigate the hydration status’ relationship with the function of the transplanted kidney during the first year after transplantation. Materials and Methods: This observational prospective cohort study included deceased kidney recipients transplanted in the Hospital of the Lithuanian University of Health Sciences between September 2016 and January 2023. BIA and LUS were performed before transplantation, on days 3 and 7, and at discharge. Data on recipient and donor clinical characteristics were collected. Graft function was evaluated according to the serum creatinine reduction ratio and the need for dialysis. Hydration status was evaluated by calculating B-lines (BL) on LUS and the ratio of extracellular/total body water on BIA. Results: Ninety-eight kTx recipients were included in the study. Patients with immediate graft function (IGF) were compared to those with slow or delayed graft function (SGF + DGF). Recipients in the SGF + DGF group had a higher sum of BL on LUS before transplantation. After transplantation in early postoperative follow-up, both groups showed hyperhydration as determined by BIA and LUS. After one year, recipients with no BL before transplantation had better graft function than those with BL. Logistic regression analysis showed that having more than one BL in LUS was associated with a 2.5 times higher risk of SGF or DGF after transplantation. Conclusions: This study found that lung congestion detected by LUS before kTx was associated with slower graft recovery and worse kidney function after 1 year. Meanwhile, the hyperhydration status detected by BIA analysis did not correlate with the function of the transplanted kidney

Взаємозв'язок між локальним резонансом Шумана та епізодами захворювання нирок

Abstract. The aim of the study was to evaluate the interconnections between local Schumann resonances of the Earth’s magnetic field and episodes of kidney disease. Materials and Methods: Study participants included 716 males and 624 females who had episodes of kidney disease during the period of 1 January 2021 to 31 December 2021 and attended the Department of Nephrology at the Hospital of Lithuanian University of Health Sciences, Kauno klinikos. Time varying magnetic field data was collected at the magnetometer site located in Lithuania. Results and Conclusions: The study results support the hypothesis that the Earth’s magnetic field has a relationship between the number of nephrology patient hospitalizations per week and the average weekly local Schumann resonances strength in different frequency ranges. Working hypotheses are proposed for the mechanisms of the influence of the Earth’s electromagnetic field on kidney function: а) quantum mechanical features of the atomic composition of renal tissue molecules determine a kidney-specific reaction; b) cyclotron resonance mechanism; c) resonant response of cells of morphological structures of kidney tissue to external bioactive frequencies in the range of 6-8 Hz; d) mechanism of indirect influence of blood as a magnetically saturated medium. Анотація. Метою дослідження було оцінити взаємозв’язок між місцевим резонансом Шумана поля Землі та епізодами захворювань нирок. Матеріали та методи: дослідження включали 716 чоловіків і 624 жінки, які мали епізоди захворювання нирок під час період з 01.01.2021 по 31.12.2021 та відвідував відділення нефрології у лікарні Литовського університету наук про здоров’я, Кауно клінікос. Час змінюється дані магнітного поля були зібрані на майданчику магнітометра, розташованому в Литві. Результати і Висновки: результати дослідження підтверджують гіпотезу про те, що магнітне поле Землі має a)співвідношення між кількістю госпіталізацій нефрологічних пацієнтів на тиждень і середнім тижнева сила локальних резонансів Шумана в різних діапазонах частот. Робочі гіпотези. запропоновано механізми впливу електромагнітного поля Землі на нирки функція: а) квантово-механічні особливості атомного складу молекул ниркової тканини визначити специфічну для нирок реакцію; б) механізм циклотронного резонансу; в) резонансний відгук клітин морфологічних структур ниркової тканини до зовнішніх біоактивних частот в діапазоні 6-8 Гц; г) механізм опосередкованого впливу крові як магнітно насиченого середовища

Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients

Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (&ge;35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman&rsquo;s correlation coefficient &minus;0.4, p = 0.02), percentage of CD19+ cells (r = &minus;0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders

Molecular Characterization and Seroprevalence of Hepatitis E Virus in Inflammatory Bowel Disease Patients and Solid Organ Transplant Recipients

Seroprevalence rates and molecular characterization of hepatitis E virus (HEV) prevalent in the Lithuanian human population has not yet been evaluated. Immunosuppressed individuals have been recognized as a risk group for chronic hepatitis due to HEV genotype 3 (HEV-3) infections. The objectives of the present study were to determine prevalence rates of anti-HEV antibodies among inflammatory bowel disease (IBD) patients and solid organ transplant (SOT) recipients, to isolate and characterize HEV strain present in the Lithuanian human population, and to investigate its capacity to infect non-human primate (MARC-145 and Vero), swine (PK-15) and murine (Neuro-2a) cells in vitro. In the present study, the significant difference of anti-HEV IgG prevalence between healthy (3.0% (95% CI 0–6.3)) and immunosuppressed individuals (12.0% [95% CI 8.1–15.9]) was described. Moreover, our findings showed that anti-HEV IgG seropositivity can be significantly predicted by increasing age (OR = 1.032, p &lt; 0.01), diagnosis of IBD (OR = 4.541, p &lt; 0.01) and reception of SOT (OR = 4.042, &lt;0.05). Locally isolated HEV strain clustered within genotype 3i subtype of genotype 3 and was capable of infecting MARC-145 cells. This study demonstrates higher HEV seroprevalence in the risk group compared to healthy control individuals without confidence interval overlap. The high level of genetic homology between human and animal strains in Lithuania and the capacity of locally isolated strains to infect cells of non-human origin suggests its potential for zoonotic transmission.</jats:p

Immune Response after SARS-CoV-2 Vaccination in Kidney Transplant Patients

Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman’s correlation coefficient −0.4, p = 0.02), percentage of CD19+ cells (r = −0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.</jats:p