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Chronic kidney disease (CKD) is an increasing public health challenge, affecting about 11% of adults worldwide. Kidney diseases are now the third fastest-growing cause of death globally, and the number of patients reaching end-stage kidney disease continues to rise, resulting in growing demand for renal replacement therapy. A variety of clinical and individual factors influence the management of the disease. However, meaningful patient participation in this process is only possible when patients possess adequate knowledge of their disease and treatment options. Patient education is therefore a fundamental component of CKD management. It promotes behaviors that improve disease control and slow disease progression, while empowering patients to actively engage in shared decision-making and enhancing quality of life. Although both Polish and international guidelines highlight the need for structured education and its integration into comprehensive care models, practical recommendations on how such programs should be organized remain scarce. This article presents an expert opinion based on clinical experience and current literature. The recommendations outline key principles for designing and implementing high-quality educational initiatives that can be applied across nephrology centers and tailored to different stages of CKD. They also provide a framework for establishing a nationwide nephrology education system built on best practices and evidence-based standards.

Euvolemia is an important adequacy parameter in peritoneal dialysis (PD) patients. However, accurate tools to evaluate volume status in clinical practice and data on volume status in PD patients as compared to healthy population, and the associated factors, have not been available so far. We used a bio-impedance spectroscopy device, the Body Composition Monitor (BCM) to assess volume status in a cross-sectional cohort of prevalent PD patients in different European countries. The results were compared to an age and gender matched healthy population. Only 40% out of 639 patients from 28 centres in 6 countries were normovolemic. Severe fluid overload was present in 25.2%. There was a wide scatter in the relation between blood pressure and volume status. In a multivariate analysis in the subgroup of patients from countries with unrestricted availability of all PD modalities and fluid types, older age, male gender, lower serum albumin, lower BMI, diabetes, higher systolic blood pressure, and use of at least one exchange per day with the highest hypertonic glucose were associated with higher relative tissue hydration. Neither urinary output nor ultrafiltration, PD fluid type or PD modality were retained in the model (total R² of the model = 0.57). The EuroBCM study demonstrates some interesting issues regarding volume status in PD. As in HD patients, hypervolemia is a frequent condition in PD patients and blood pressure can be a misleading clinical tool to evaluate volume status. To monitor fluid balance, not only fluid output but also dietary input should be considered. Close monitoring of volume status, a correct dialysis prescription adapted to the needs of the patient and dietary measures seem to be warranted to avoid hypervolemia.

Vaccination against COVID-19 in patients with end-stage renal disease (ESRD) on replacement therapy and kidney transplant recipients (KTRs) is particularly important due to the high mortality rate. Here, we tested the local and systemic immunity to the novel Pfizer BioNTech (BNT162b2) messenger RNA (mRNA) in ESRD, KTR patients, and healthy individuals (150 subjects). The ESRD group was divided into: hemodialysis (HD) and peritoneal dialysis (PD). We investigated the local and systemic immunity based on anti-N (nucleoprotein) and anti-S (spike1/2) Immunoglobulin A (IgA) and Immunoglobulin G (IgG) antibodies, respectively. Additionally, we performed an Interferon gamma (IFN-γ) release test Interferon-gamma release assay (IGRA) to monitor the cellular component of vaccine response. The control group had the highest level of anti-S IgG antibodies (153/2,080 binding antibody units (BAU)/ml) among all analyzed patients after the 1st and 2nd dose, respectively. The HD group (48/926 BAU/ml) had a diminished antibody level compared to PD (93/1,607 BAU/ml). Moreover, the seroconversion rate after the 1st dose was lower in HD than PD (56% vs. 86%). KTRs had extremely low seroconversion (33%). IgA-mediated immunity was the most effective in the control group, while other patients had diminished IgA production. We observed a lower percentage of vaccine responders based on the IFN-γ level in all research participants (100% vs. 85% in control, 100% vs. 80% in PD, 97% vs. 64% in HD). 63% of seropositive KTRs had a positive IGRA, while 28% of seronegative patients produced IFN-γ. Collectively, PD patients had the strongest response among ESRD patients. Two doses of the Pfizer vaccine are ineffective, especially in HD and KTRs. A closer investigation of ESRD and KTRs is required to set the COVID-19 vaccine clinical guidance.

The purpose of the study was to assess the impact of cancer knowledge and patient’s lifestyle on QOL and the relationship between QOL and various environmental factors in patients with non-small-cell lung cancer treated with chemotherapy. The study group consisted of 129 patients with metastatic lung cancer patients treated between May 2010 and December 2015 in two centres. The knowledge of cancer and their lifestyle was rated by method of diagnostic survey, using the Behavioral Health Inventory IZZ by Prof. Juczyński. We sought factors affecting to response to treatment, overall survival and quality of life. The general level of knowledge of cancer and the level of health behaviours was low. Ninety percent of lung cancer patients were smokers. The average age of the study group was 64 years. Eighty-nine patients received chemotherapy with cisplatin, 28 schemes containing carboplatin, 6 inhibitors of EGFR tyrosine kinase, and 6 vinorelbine or gemcitabine monotherapy. Complete regression was observed in 2 patients, partial response in 33 patients (26%), stable disease in 51 (40%) and 54 (42%) patients had progression. In multivariate analysis, significant effects on survival were performance status, schemes of treatment and response to treatment. Quality of life before and after treatment did not differ from each other. We found impact on quality of life: performance status, response to treatment and knowledge of cancer and lifestyle. The level of knowledge of oncological patients and their lifestyle observed in clinical practice are associated with QOL.

The effectiveness of peritoneal dialysis (PD) relies on dialysate-induced solute and water transport across the peritoneal membrane, facilitated by concentration and type of osmotic agents. Standard PD solutions predominantly use glucose as an osmotic agent due to its well-known metabolism, effective ultrafiltration during shorter dwells, and low cost. However, glucose exposure may damage the structure and function of the peritoneal membrane and cause systemic metabolic complications, including insulin resistance and cardiovascular disease, underscoring the need for glucose-sparing strategies with alternative solutions, such as solutions with icodextrin and amino acids as osmotic agents, and glucose-based, less bioincompatible fluids with physiological pH and reduced glucose degradation products. This brief narrative review examines the unwanted effects of glucose-based solutions and the clinical rationales behind glucose-sparing strategies that may reduce these effects and potentially improve clinical outcomes.

The aim of this study was to analyze the waning of anti-spike (S) antibodies after mRNA vaccination against COVID-19 in maintenance dialysis patients, and to assess the safety and effectiveness of the complementary third dose. This was a prospective, longitudinal study in which we analyzed the kinetics of antibodies up to six months after a two-dose vaccination (first protocol) in infection-naïve dialysis patients (IN-Ds), previously infected dialysis patients (PI-Ds) and subjects without chronic kidney disease (the controls), as well as their humoral response to the third dose of the same mRNA vaccine (second protocol). The respective reduction in antibody titer after 3 and 6 months by 82.9% and 93.03% in IN-Ds (n = 109), 73.4% and 93.36% in PI-Ds (n = 32) and 75.5% and 88.8% in the controls (n = 20) was demonstrated. Consequently, a protective antibody titer above 141 BAU/mL was found in only 47.7% and 23.8% of IN-Ds after 3 and 6 months, respectively. After the third vaccine dose, a significant increase in antibody titer was observed in all groups, with increases by a factor of ×51.6 in IN-Ds, ×30.1 in the controls and ×8.4 in PI-Ds. The median antibody titer after the third dose differed significantly between groups, and was the highest in PI-Ds: PI-Ds, 9090 (3300–15,000) BAU/mL; the controls, 6945 (2130–11,800); IN-Ds, 3715 (1470–7325) (p < 0.001). In conclusion, we observed similar degrees of antibody waning in all patients. After 3 months, over half of the infection-naïve dialysis patients had a very low antibody titer, and almost twenty percent of them had no antibodies at all. The humoral response to the third dose was very good, raising their titer of antibodies to a higher level than those in the general population who have received the primary two-dose scheme. The results support the administration of a complementary third dose of the mRNA vaccine for dialysis patients as soon as possible.

Patients with end-stage renal disease (ESRD) who receive dialysis have been shown to have impaired neuropsychological performance. It remains unclear, however, whether cognitive deficits associated with ESRD and/or dialysis are reversible after successful kidney transplantation. Thus, the main purpose of this study was to longitudinally compare the cognitive performance of adequately dialyzed patients with ESRD before and shortly after kidney transplantation. Twenty-two dialyzed patients with ESRD who subsequently received a kidney transplant, 20 dialyzed patients who were medically qualified and awaiting kidney transplant but did not receive it, and 30 matched controls were the participants for this study. Overall, our results demonstrate that a successful kidney transplant is associated with improved neuropsychological performance in patients with ESRD. Specifically, a significant improvement was seen on measures of psychomotor speed, visual planning, retrieval of learnt material, and abstract thinking. Additionally, the degree of cognitive improvement following kidney transplant was significantly associated with some pre-, intra-, and postoperative factors (e.g., age, duration of chronic kidney disease, postoperative graft function). The results of this study also show that the cognitive performance of adequately dialyzed patients without a kidney transplant, although often below that of matched controls, remains relatively stable over time . (JINS, 2009, 15, 684–694.)

Chronic kidney disease (CKD) is linked to an elevated risk of malnutrition and sarcopenia, contributing to the intricate network of CKD-related metabolic disorders. Adipokines and myokines are markers and effectors of sarcopenia and nutritional status. The aim of this study was to assess whether the adipokine–myokine signature in patients on kidney replacement therapy could help identify malnutrition and sarcopenia. The study involved three groups: 84 hemodialysis (HD) patients, 44 peritoneal dialysis (PD) patients, and 52 kidney transplant recipients (KTR). Mean age was 56.1 ± 16.3 years. Malnutrition was defined using the 7-Point Subjective Global Assessment (SGA) and the Malnutrition-Inflammation Score (MIS). Sarcopenia was diagnosed based on reduced handgrip strength (HGS) and diminished muscle mass. Concentrations of adipokines and myokines were determined using the enzyme-linked immunosorbent assay (ELISA). 32.8% of all study participants were identified as malnourished and 20.6% had sarcopenia. For malnutrition, assessed using the 7-Point SGA, in ROC analysis albumin (area under the curve (AUC) 0.67 was the best single biomarker identified. In dialysis patients, myostatin (AUC 0.79) and IL-6 (AUC 0.67) had a high discrimination value for sarcopenia, and we were able to develop a prediction model for sarcopenia, including age, albumin, adiponectin, and myostatin levels, with an AUC of 0.806 (95% CI: 0.721–0.891). Adipokines and myokines appear to be useful laboratory markers for assessing malnutrition and sarcopenia. The formula we propose could contribute to a better understanding of sarcopenia and potentially lead to more effective interventions and management strategies for dialysis patients.

Successful kidney transplantation was recently shown to lead to improvement in the cognitive performance of patients on chronic dialysis. To examine whether the early cognitive benefits of transplantation continue to develop over time, along with the patients’ ongoing recovery, we addressed these questions in a prospective controlled study of 27 dialyzed patients who subsequently received a kidney transplant, 18 dialyzed patients awaiting kidney transplant, and 30 matched controls without kidney disease. Overall, successful kidney transplant contributed to a statistically significant improvement in performance on tests of motor/psychomotor speed, visual planning, memory, and abstract reasoning tested 1 year later. We also studied whether the cognitive performance of patients maintained on dialysis is stable or declines over time and found that it actually declined over this time even in adequately dialyzed patients. Measures of memory functions were particularly affected. This study indicates that the early beneficial effects of transplantation are not transient and were still evident 1 year following transplantation.

Purpose The study was focused on the influence of the kinesitherapy on fatigue and the quality of life in the terminal hospice cancer patients. Patients and methods Forty-nine patients were included into the study and divided into experimental group A (with kinesitherapy) with 30 subjects and control group B (without kinesitherapy) with 19 subjects. Patients from group A did the exercises three times a week, for 20–30 min, for the period of 3–4 weeks. The exercises were individually supervised by a physiotherapist, following a carefully worked out pattern. In both groups, the changes in the intensity of fatigue and the quality of life were observed by means of using Rotterdam symptom checklist, brief fatigue inventory, and visual analogue fatigue scale. Results In group A, the intensity of fatigue decreased significantly after 3 weeks of kinesitherapy. In group B, fatigue deteriorated significantly in comparison with the initial measurement. The intensity of physical symptoms in group A decreased significantly after 2 weeks of kinesitherapy, whereas in group B, increased after 2 weeks of observation. The quality of life in group A remained stable throughout the study. A tendency towards the deterioration of the quality of life with the time passing in group B was noticeable. Conclusion Our analysis showed that, on average, after 3 weeks of kinesitherapy, a significant decrease of the intensity of fatigue was observed, while in the control group, it increased after 2 weeks of observation. The obtained results provide evidence that a planned set of exercises decreases cancer-related fatigue effectively.