On Whether Ca-125 Is the Answer for Diagnosing Overhydration, Particularly in End-Stage Kidney Disease Patients-A Systematic Review

Overhydration (OH) is a prevalent medical problem that occurs in patients with kidney failure, but a specific marker has still not been found. Patients requiring kidney replacement therapy suffer from a water imbalance, which is correlated with mortality rates in this population. Currently, clinicians employ techniques such as bioimpedance spectroscopy (BIS) and ultrasound (USG) markers of overhydration or markers of heart and kidney function, namely NT-pro-BNP, GFR, or creatinine levels. New serum markers, including but not limited to Ca-125, galectin-3 (Gal-3), adrenomedullin (AMD), and urocortin-2 (UCN-2), are presently under research and have displayed promising results. Ca-125, which is a protein mainly used in ovarian cancer diagnoses, holds great potential to become an OH marker. It is currently being investigated by cardiologists as it corresponds to the volume status in heart failure (HF) and ventricular hypertrophy, which are also associated with OH. The need to ascertain a more precise marker of overhydration is urgent mainly because physical examinations are exceptionally inaccurate. The signs and symptoms of overhydration, such as edema or a gradual increase in body mass, are not always present, notably in patients with chronic kidney disease. Metabolic disruptions and cachexia can give a false picture of the hydration status. This review paper summarizes the existing knowledge on the assessment of a patient's hydration status, focusing specifically on kidney diseases and the role of Ca-125.

Show Me What You Have Inside-The Complex Interplay between SIBO and Multiple Medical Conditions-A Systematic Review

The microbiota, as a complex of microorganisms in a particular ecosystem, is part of the wider term-microbiome, which is defined as the set of all genetic content in the microbial community. Imbalanced gut microbiota has a great impact on the homeostasis of the organism. Dysbiosis, as a disturbance in bacterial balance, might trigger or exacerbate the course of different pathologies. Small intestinal bacterial overgrowth (SIBO) is a disorder characterized by differences in quantity, quality, and location of the small intestine microbiota. SIBO underlies symptoms associated with functional gastrointestinal disorders (FGD) as well as may alter the presentation of chronic diseases such as heart failure, diabetes, etc. In recent years there has been growing interest in the influence of SIBO and its impact on the whole human body as well as individual systems. Therefore, we aimed to investigate the co-existence of SIBO with different medical conditions. The PubMed database was searched up to July 2022 and we found 580 original studies; inclusion and exclusion criteria let us identify 112 eligible articles, which are quoted in this paper. The present SIBO diagnostic methods could be divided into two groups-invasive, the gold standard-small intestine aspirate culture, and non-invasive, breath tests (BT). Over the years scientists have explored SIBO and its associations with other diseases. Its role has been confirmed not only in gastroenterology but also in cardiology, endocrinology, neurology, rheumatology, and nephrology. Antibiotic therapy could reduce SIBO occurrence resulting not only in the relief of FGD symptoms but also manifestations of comorbid diseases. Although more research is needed, the link between SIBO and other diseases is an important pathway for scientists to follow.

Use of short prosthesis segments for brachiocephalic arteriovenous fistulas in elderly hemodialysis population

INTRODUCTION

The autogenous brachiocephalic fistula is a recognized secondary access for hemodialysis. However, veins in the antecubital fossa are often damaged, due to repeated venipunctures and subsequent scarring. Sometimes their anatomy does not enable successful arteriovenous fistula creation. In cases when the proximal part of the cephalic vein seemed patent, during ultrasound Doppler examination, we decided to use a short segment of 6 mm polytetrafluoroethylene graft to connect the vein with the brachial artery. We report our series of this procedure.

MATERIAL AND METHODS

Over an 8-year period, 34 patients underwent such an operation. Grafts were anastomosed either to the end of the cephalic vein or to the side. The decision was made based on the vein condition: small-caliber veins were considered better for the end-to-side anastomosis. All procedures were performed under local anesthesia, and were well tolerated.

RESULTS

Thirty-three fistulas were successfully cannulated at 2-8 weeks after the operation. Fistula patency rates were 84%, 73% and 55% at 12, 24 and 36 months. Comparison of two anastomosis types showed differences, 50% and 62.8% at 36 months, yet without statistical significance (p = 0.27, log-rank test). Fistula patency was not influenced by patient's age, sex or comorbidities.

CONCLUSIONS

The described procedure provides satisfactory cumulative patency with an acceptable complication rate. It can enhance the number of cephalic veins used with its main advantages of simple surgical technique and low perioperative morbidity.

To close or not to close: fistula ligation and cardiac function in kidney allograft recipients

INTRODUCTION

 Arteriovenous fistulas are a preferred access for hemodialysis. Subsequent hemodynamic changes in systemic circulation may cause heart failure. The general conclusions that can be drawn from the few available studies are that high‑flow fistulas causing symptomatic heart failure should be subjected either to reconstruction or ligation. However, it is still unclear whether a well‑functioning fistula should be ligated after successful kidney transplantation.

OBJECTIVES

 The aim of our study was to assess the effect of the fistula on heart function in patients after kidney transplantation.

PATIENTS AND METHODS

 The study included 18 patients after kidney transplantation. Five patients underwent fistula ligation for esthetic reasons; 4 fistulas thrombosed shortly after transplantation. A group of 9 patients with a patent fistula was matched for age and sex. Heart function was assessed by physical examination and echocardiography.

RESULTS

 The study group consisted of 6 women and 3 men, aged 32 to 64 years, with 6 forearm and 3 arm fistulas, and with hemoglobin levels ranging from 6.95 to 9.63 mmol/l. The control group consisted of 6 women and 3 men, aged 38 to 66 years, with 5 forearm fistulas and  hemoglobin levels ranging from 7.32 to 9.25 mmol/l. Control echocardiography was performed in each patient 3 months after fistula closure and did not reveal any significant differences compared with baseline examination.

CONCLUSIONS

 Fistula ligation performed in a stable kidney allograft recipient does not seem to have a beneficial effect on cardiac function during short-term follow-up. Decision making should be cautious and balanced, because the creation of a new access may be extremely difficult and not always feasible.

Cardiovascular complications in patients with diabetic nephropathy receiving pharmacological versus renal replacement therapy

INTRODUCTION

Diabetic nephropathy is a significant complication of diabetes mellitus and one of the major causes of renal replacement therapy. Cardiovascular complications are predominant causes of death in these patients.

OBJECTIVES

To evaluate the influence of hemodialysis on cardiovascular risk factors and on their frequency in diabetic nephropathy patients.

PATIENTS AND METHODS

4 groups of renal failure patients were studied. Group 1 consisted of 71 hemodialyzed patients with non-diabetic nephropathy. Group 2 consisted of 29 hemodialyzed patients with diabetic nephropathy. Group 3 consisted of 50 patients with renal failure in the predialysis period (glomerular filtration rate < 60 ml/min). Group 4 consisted of 50 non-dialyzed patients with diabetic nephropathy in the pre-dialysis period. Complete blood count, blood gas, blood urea nitrogen, creatinine, glucose, lipidogram, electrolytes, parathormone, iron and dialysis adequacy (Kt/V) were assessed. Arterial blood pressure, resting ECG, echocardiography, body mass index, ankle-arm index, the prevalence of ischemic heart disease, myocardial infarction and chronic heart failure (NYHA classification) were also evaluated. RESULTS. In hemodialyzed patients with diabetic nephropathy lower complete blood count, less severe calcium-phosphate disorders, higher triglycerides and lower high-density lipoproteins cholesterol, with more frequent obesity, ischemic heart disease and peripheral arterial obstructive disease were found. Myocardial hypertrophy, cardiac arrhythmias, contractility disturbances, myocardial infarction and chronic heart failure were more common in the hemodialyzed patients, regardless of the cause of the renal disease.

CONCLUSIONS

The risk factor for cardiovascular complications is greater in patients with diabetic nephropathy. Hemodialysis increases the frequency of cardiovascular complications in these patients and adversely affects the outcomes.

[Arterio-venous fistula and cardiovascular system disturbances]

There is an increasing number of patients with end-stage renal disease all over the world, mainly in the population of patients with diabetic nephropathy and in the elderly. One of the most important issues in nephrology care is the vascular access. The closest to the ideal vascular access is the native arterio-venous fistula. On the other hand, patients with end-stage renal failure are prone to cardiovascular complications, including left ventricular hypertrophy, cardiomyopathy, accelerated arterio- and atherosclerosis, vascular remodeling. Congestive heart failure is 20-fold more common than in the general population, and is found in about 30% of dialyzed patients, whereas left ventricular hypertrophy in 75%. Creating vascular access in patients with already established cardiovascular complications, may enhance the risk of exacerbation of cardiovascular complications with a negative effect on the patients' survival. The novel cardiovascular problems following vascular access creation may include: decompensation of congestive heart failure, pulmonary hypertension, inadequately low blood flow in the fistula with subsequent inadequate dialysis and fistula thrombosis, fistula infection (with local and systemic symptoms), and micro-inflammation (particularly in the politetrafluoroethylene grafts). The data concerning mutual relationship between vascular access and cardiovascular system in hemodialyzed patients are very scarce, mainly casual. In the review the updated status concerning the effects of vascular access creation on the cardiovascular system is presented.