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Biomedical subjects

B Rutkowski

Publications and source records attributed to B Rutkowski.

At least 19 recordsLinked to original sources
PubMed1999

Haemodialysis-membrane biocompatibility and mortality of patients with dialysis-dependent acute renal failure: a prospective randomised multicentre trial. International Multicentre Study Group.

BACKGROUND: There is controversy as to whether haemodialysis-membrane biocompatibility (ie, the potential to activate complement and neutrophils) influences mortality of patients with acute renal failure. We did a prospective randomised multicentre trial in patients with dialysis-dependent acute renal failure treated with two different types of low-flux membrane. METHODS: 180 patients with acute renal failure were randomly assigned bioincompatible Cuprophan (n=90) or polymethyl-methacrylate (n=90) membranes. The main outcome was survival 14 days after the end of therapy (treatment success). Odds ratios for survival were calculated and the two groups were compared by Fisher's exact test. Analyses were based on patients treated according to protocol (76 Cuprophan, 84 polymethyl methacrylate). FINDINGS: At the start of dialysis, the groups did not differ significantly in age, sex, severity of illness (as calculated by APACHE II scores), prevalence of oliguria, or biochemical measures of acute renal failure. 44 patients (58% [95% CI 46-69]) assigned Cuprophan membranes and 50 patients (60% [48-70]) assigned polymethyl-methacrylate membranes survived. The odds ratio for treatment failure on Cuprophan compared with polymethyl-methacrylate membranes was 1.07 (0.54-2.11; p=0.87). No difference between Cuprophan and polymethyl-methacrylate membranes was detected when the analysis was adjusted for age and APACHE II score. 18 patients in the Cuprophan group and 20 in the polymethyl-methacrylate group had clinical complications of therapy (mainly hypotension). INTERPRETATION: There were no differences in outcome for patients with dialysis-dependent acute renal failure between those treated with Cuprophan membranes and those treated with polymethyl-methacrylate membranes.

APACHE↗
PubMed1999

Recombinant human erythropoietin stimulates production of interleukin 2 by whole blood cell cultures of hemodialysis patients.

The impairment of function of human T lymphocytes, leading to an inappropriate cytokine production, is partially responsible for defective immunological response in hemodialysis patients (HD). Recent data suggest that recombinant human erythropoietin (rhEPO) may exert immunological effects. The aim of this study was to find out whether rhEPO treatment of the HD patients may have an effect on the interleukin 2 (IL-2) production by their whole blood cell cultures. The study was carried out in 10 HD patients receiving rhEPO for 6 months. Compared with the levels seen before the treatment, the concentration of IL-2 increased in the phytohemagglutinin-stimulated whole blood cell cultures of 7 of 10 patients under study. Addition of rhEPO in vitro to the whole blood cell cultures of the HD patients before implementation of erythropoietin confirmed that rhEPO is able to directly stimulate IL-2 production. Our studies show that the therapy with rhEPO affects IL-2 secretion.

Adjuvants, Immunologic↗
PubMed1998

Bilateral nephrectomy: the best, but often overlooked, treatment for refractory hypertension in hemodialysis patients.

Bilateral nephrectomy for treatment of refractory hypertension in chronic hemodialyzed patients has been infrequently carried out. We analyzed the benefits of this operation on blood pressure, clinical state, drug treatment, and quality of life. In 10 hemodialyzed patients with refractory hypertension, systolic (SBP) and diastolic (DBP) blood pressure were measured 1 month before nephrectomy bilateral and 3, 6, 9, and 12 months after. In addition, the use of antihypertensive drugs before and after surgery was evaluated. Four patients had SBP and DBP values characteristic of malignant hypertension. In all 10 patients hypertension responded neither to reduction of plasma volume by ultrafiltration nor to multiple antihypertensive drug therapy. Hypertensive crises were associated with cerebral hemorrhage in two patients, severe encephalopathy with persistent neural dysfunction in one patient, and encephalopathy and diplopia in another. Three months after bilateral nephrectomy blood pressure decreased significantly (P < .005) and was normal in nine patients. In one noncompliant patient with intradialytic body weight increases of nearly 10%, blood pressure was still elevated. Malignant or drug-resistant hypertension with hypertensive crises is an indication for bilateral nephrectomy. The clinical state and quality of life improved in all patients in the present study and antihypertensive treatment is no longer necessary.

Adult↗
PubMed1998

The influence of recombinant human erythropoietin on tumor necrosis factor alpha and interleukin-10 production by whole blood cell cultures in hemodialysis patients.

Impaired immunological response in hemodialysis (HD) patients, which leads to inappropriate cytokine production, is partially caused by the hyperstimulation of both T lymphocytes and monocytes/macrophages. Recent data suggest that human recombinant erythropoietin (rhEPO) may have an immunological action. The goal of our study was to estimate the influence of rhEPO treatment on the production of the inflammatory cytokine tumor necrosis factor alpha (TNFalpha) and antiinflammatory cytokin interleukin-10 (IL-10) in 10 HD patients receiving rhEPO for 6 months. The levels of cytokines were measured in the in vitro cultures of whole blood. The level of IL-10 increased in all treated patients during the therapy, and it was accompanied by a transitory decrease of TNFalpha. The results of our studies suggest that rhEPO may reduce the inflammatory process by decreasing production of TNFalpha and increasing production of IL-10.

Adult↗
PubMed1998

Treatment of end-stage renal disease in central and eastern Europe: overview of current status and future needs.

The situation of end-stage renal disease (ESRD) patients in central and eastern Europe was very poor for many years during the so called socialistic era. Economical and political liberation resulted in the significant growth of renal replacement facilities in this region. The number of hemodialysis units increased significantly (56%) during the period 1990-1996, and the number of patients treated with this modality has risen by 75%. More dramatic progress was achieved in peritoneal dialysis. The number of units performing this method of renal replacement therapy (RRT) increased by 277% and the number of patients by more than 300%. Not only quantitative but also qualitative changes were observed. More modern hemodialysis machines installed in the vast majority of units allow for the performance of bicarbonate dialysis, controlled ultrafiltration, and sodium profile modeling. Also, a wider choice of biocompatible dialyzers has become available during the last few years. The number of centers performing renal transplantation has increased significantly, but the number of renal transplants has not followed this progress. Despite all the progress, further development of all RRT methods is necessary to achieve acceptance rates comparable to those observed in developed countries.

Europe↗
PubMed1998

Evolution of renal replacement therapy in Central and Eastern Europe 7 years after political and economical liberation. Central and Eastern Europe Advisory Board in Chronic Renal Failure.

PURPOSE OF THE STUDY: The conditions of renal replacement therapy (RRT) were very poor in the countries located in Central and Eastern Europe (CEE) when they were members of the so-called 'socialist bloc'. The aim of the present analysis was to document the impact of the socioeconomic changes on dialysis therapy in the CEE countries. DESIGN: This was a special survey with the participation of 12 CEE countries, with data obtained through national registries (with the exception of Russia). RESULTS: During the period 1990-1996 the number of haemodialysis units increased by 56% and the number of centres performing peritoneal dialysis by 296%. The number of patients increased respectively by 78% (haemodialysis) and 306% (peritoneal dialysis). The percentage of patients with diabetic nephropathy and elderly patients rose dramatically during this period. One of the main reasons of such expansion was the rapid development of peritoneal dialysis programmes in the majority of the CEE countries. The introduction of modern haemodialysis machines and a wider choice of different dialysers and concentrates permitted individualization of dialysis procedures. These points and the wider use of erythropoietin had a positive influence on quality of life and treatment outcome. There was also a notable increase in the number of transplant centres, but less so of the number of transplanted patients. CONCLUSION: Renal replacement therapy experienced a major expansion in the CEE countries. Despite the progress achieved, the level of RRT is not yet completely satisfactory in most CEE countries.

Europe↗
PubMed1998

[Platinum-based chemotherapy in renal transplant recipients with malignancies: a case report and review of literature].

Authors present a case of renal transplant recipient treated with a carboplatin-based chemotherapy for testicular embryonal carcinoma. The patient experienced severe treatment-related toxicity and died due to bone marrow aplasia 3 months after the diagnosis of cancer. The safety of platinum-based chemotherapy in renal transplant recipients is discussed with reference to the literature data.

Antineoplastic Agents↗
PubMed1998

[The effect of nasal and skin colonization on the development of exit site and peritoneal catheter tunnel infections in patients on peritoneal dialysis].

ESI remain a major problem in patients undergoing peritoneal dialysis and are frequently the reason for catheter removal. The treatment is often costly and not effective and the need for routine prophylactics has to be clarified. In this study 38 peritoneal dialysis patients (15 F & 23 M, age: 18-73) were analysed prospectively for ESI and TI in respect to skin (exit site and inguinal area) and nostrils colonisation. There were 14 diabetics and 24 non-diabetics. All had standard double-cuff Tenckhoff catheter and none presented with ESI prior to the study. No treatment was applied on the basis of positive culture only. In 27 patients swab were repeated after 6-11 months. Eight episodes of ESI and three TI were recorded. Following pathogens were cultured: S.aureus in 4 Klebsiella pneumoniae in 2, Corynebacterium sp. in 1, negative in 1 and with TI S.aureus in 3. Positive nasal cultures (S.aureus, Klebs.pn.) were observed in 5 patients subsequently developing ESI (p < 0.01) and in 2 with TI. In 2 cases exit site was also colonized by pathogens responsible for ESI (p = NS). Inguinal area was colonized by various pathogens in 7 patients, but only one of these developed ESI (p = NS) and no one TI. There was no difference between diabetic and non-diabetics neither in the frequency of ESI, TI nor in nasal carriage of pathogens. In the majority of patients nostrils and inguinal area were colonized by S.epidermidis. When the second culture was analyzed it appeared that significantly more patients had exit site colonized by S.epidermidis (2 and 11 patients in 2 consecutive cultures respectively (p < 0.01). In conclusion, it appears that nasal carriers of pathogens like S.aureus and Klebsiella pneumoniae are more prone to ESI. Inguinal area and exit site colonization does not seem to precede ESI or TI. We would suggest that nasal carriage status should be routinely identified in all patients entering peritoneal dialysis programme and the carriers properly treated.

Adult↗
PubMed1998

[Treatment with erythropoietin in Central and Eastern Europe].

Human recombinant erythropoietin (r-HuEpo) was introduced widely to the clinical practice more than ten years ago. In many countries belonging to Central and Eastern Europe (CEE) use of this drug was very delayed mainly due to the high costs of treatment. The aim of the presented study was to estimate actual possibilities of r-HuEpo administration in thirteen CEE countries. Survey was performed using especially prepared questionnaires including questions connected with r-HuEpo and filled out by the members of the Central and Eastern Advisory Board in Chronic Renal Failure. Below mentioned numbers of patients were under the control of the responders during performing the survey: on hemodialysis (HD) 1119, on peritoneal dialysis (PD) 205 and 1556 after renal transplantation (RT). Respectively in subsequent groups 53.5% (HD), 41.5% (PD) and 16.2 (RT) of patients were treated using r-HuEpo. Possibilities of treatment differs significantly between two groups of countries. In those with better developed economy (Croatia, Czech, Hungary, Macedonia, Poland, Slovakia, Slovenia, Yugoslavia) 60-70% of dialysed patients were given r-HuEpo and in the rest of countries (Bulgaria, Latvia, Lithuania, Romania, Russia) this drug was administered in 10-35% of patients. The most popular way of the r-HuEpo administration were subcutaneous injections (89.3%) comparing with only 10.7% of patients getting this important hormone intravenously. Average weekly dose of r-HuEpo was 71-90 IU/kg/week in so treated patients and 91-100 IU/kg/week in whom drug was administered i.v., in majority of patients two or three times weekly. Major part of responders tried to achieve as the optimal level of Hb 10-12 g/dl but simultaneously in 1/3 of centres only achieving of the Hb level 9-10 g/dl was possible. The general majority of responders were not satisfied with the obtained results and recognised economical constrains as the main reason of such a situation. These problems were more widely observed in predialysis patients, because only few of them were on r-HuEpo treatment. Side effects of this drug expressed rarely and main of them were development or acceleration of hypertension (16%) and thrombotic complications in the vascular access (8%). The main cause of hyporesponsiveness to drug was iron deficit despite of the adequate monitoring of responders were convinced that further avoiding of economical constrains would be benefit dialysis and predialysis patients. It is especially important looking on the literature finding supported by personal experience showing that r-HuEpo was positive impact on the quality of life, status of the cardiovascular system, endocrine, metabolic and immunological disorders observed in uremic patients.

Drug Administration Schedule↗
PubMed1997

The effect of dietary enrichment with fish-oil on urinary excretion of N-acetyl-beta-D-glucosaminidase and renal function in proteinuric patients with primary glomerulopathies.

The rate of progression of renal disease depends on many factors including serum lipids and tubulo-interstitial injury. Aim of the study was to see whether fish-oil therapy may affect serum lipids and NAG excretion with urine (a marker of tubular cell damage) in humans with renal disease. The effects of dietary fish-oil fatty acids on the serum lipids, NAG urinary excretion and serum arachidonic acid concentration were examined in thirteen primary glomerulonephritic patients with proteinuria and normal renal function. The regular diet enriched with 1650 mg n-3 polyunsaturated fatty acids (18%: 20:5; n-3 EPA and 12%: 22:5; n-3 DHA) was ingested for three months. At the end of fish-oil enriched diet neither creatinine clearance nor urinary protein excretion changed significantly. But serum concentration of HDL and arachidonic acid increased (48.0 +/- 15 vs. 52.0 +/- 14; p < 0.05), (0.47 +/- 0.13 vs. 0.72 +/- 0.29; p < 0.01), respectively. Simultaneously urine NAG excretion and serum LDL decreased (11.2 +/- 7.1 vs. 10.3 +/- 7.3; p < 0.05), (163.0 +/- 57 vs. 149.0 +/- 51, p < 0.01), respectively. We presume that fish-oil supplementation may have a beneficial effect on renal tubular cells in humans and it could be linked with arachidonic acid metabolism.

Acetylglucosaminidase↗
PubMed1997

[The levels of adenine nucleotides and hypoxanthine in blood of patients on long-term hemodialysis using dialysis fluid containing acetate or bicarbonate].

Intraerythrocyte adenine nucleotides concentration reflects energy balance of red cells and plays pivotal role in their function. In hemodialysed patients both ATP and ADP concentration in red cells was higher than in controls, p < 0.001 and p < 0.005 respectively. But AMP and hypoxanthine did not differ from control. No change of ATP, ADP and AMP was observed after hemodialysis, but hypoxanthine fall significantly, p < 0.001. The pattern of nucleotides concentration and its changes during hemodialysis was the same regardless of the mode of the therapy; e.g. acetate or bicarbonate.

Acetates↗
PubMed1997

[Evaluation of prophylaxis and actual prevalence of HBV infection in twelve hemodialysis centers of Northern Poland].

The aim of the study was to estimate the HBV infection preventive measures used in the twelve dialysis centres in north Poland. In all of the centres hepatitis B vaccination and segregation of HBV infected patients (dedicated machines or separate rooms), which are the two basic HBV infection control methods, were introduced. Our results point out that in some of the centres certain modification of these methods would be possible, including universal predialysis vaccination programme, changes in hepatitis B vaccination schedules with most effective routes of vaccination only and dedication for HBV infected patients not only separate rooms but separate dialysis staff as well.

Adolescent↗