Renal replacement therapy in Bosnia and Herzegovina: report of the Society of Nephrology, Dialysis and Transplantation of Bosnia and Herzegovina.

Introduction Renal replacement therapy (RRT) had been established in Bosniaand Herzegovina before the war in 1992–1995. During thewar, the activity of the dialysis centres could only continuebecause of donations of supply provided by Medicine Du Mondeand the European Union [1]. Since 1997, the expenses of dialysistreatment are again met by the government of Bosnia and Herzegovina. In 1997, the Society of Nephrology, Dialysis and Transplantationof Bosnia Herzegovina was founded and continues to receive organizationaland financial help from Medicine Du Monde. In 1999, the societyfounded the renal registry of Bosnia and Herzegovina. Completedata reporting was achieved in 2001, covering all 20 dialysiscentres in Bosnia Herzegovina, with a return rate of 100%. Inthe following,     

Pulmonary Hypertension in Dialysis Patients

Pulmonary hypertension in end-stage renal disease patients is associated with significantly increased morbidity and mortality. The prevalence of pulmonary hypertension in dialysis patients is relatively high and varies in different studies from 17% to 49.53% depending on the mode of dialysis and other selection factors, such as the presence of other cardiovascular comorbidities. The etiopathogenic mechanisms that have been studied in relatively small studies mainly include arteriovenous fistula-induced increased cardiac output, which cannot be accomodated by, the spacious under normal conditions pulmonary circulation. Additionally, pulmonary vessels show signs of endothelial dysfunction, dysregulation of vascular tone due to an imbalance in vasoactive substances, and local as well as systemic inflammation. It is also believed that microbubbles escaping from the dialysis circuit can trigger vasoconstriction and vascular sclerosis. The non-specific therapeutic options that proved to be beneficial in pulmonary artery pressure reduction are endothelin inhibitors, phosphodiesterase inhibitor sildenafil, and vasodilatory prostaglandins in various forms. The specific modes of treatment are renal transplantation, size reduction or closure of high-flow arteriovenous fistulas, and transfer from hemodialysis to peritoneal dialysis—a modality that is associated with a lesser prevalence of pulmonary hypertension.     

Pulmonary Hypertension in Dialysis Patients

Cardiovascular complications are encountered frequently in end-stage renal disease (ESRD) patients. The study was designed as a prospective cohort study and a total of 105 dialysis patients, 77 hemodialysis and 28 peritoneal dialysis patients, were investigated. All patients had undergone M-Mode Doppler echocardiography every 6 months by which their systolic pulmonary arterial pressures (sPAPs) and left ventricular mass indices (LVMIs) were recorded. Thirty-nine (37.1%) patients had pulmonary hypertension (PHT), that is, a mean sPAP of more than 35 mmHg. The frequency of PHT was higher in peritoneal dialysis patients but the difference was insignificant (p = 0.08). However, the frequency of left ventricular hypertrophy (LVH) was found to be significantly higher in peritoneal dialysis patients than in hemodialysis patients (p = 0.001). When patients with and without PHT were compared, the duration of dialysis (p = 0.02), hemoglobin (p = 0.01), HbA1c (p = 0.03), and serum albumin levels (p = 0.003) were found to be significantly higher in patients with PHT than those without PHT. In conclusion, although nonsignificant, we found a higher prevalence of PHT in peritoneal dialysis patients when compared with hemodialysis patients. This might be due to the significantly higher prevalence of LVH, hence hypervolemia, in peritoneal dialysis patients. The prevention and treatment of PHT in dialysis patients is very important for the improvement of survival in these patients. Hence, the increased prevalence of PHT in ESRD patients necessitates understanding the multiple and interacting factors, such as LVH, serum albumin and hemoglobin levels, and control of diabetes, that might contribute to this pathology in these patients.     

An established tradition--the Eighth Congress of the Balkan Association of Nephrology, Dialysis, Transplantation and Artificial Organs (BANTAO) Belgrade, Serbia, 16-19 September 2007

The 8th Congress of the Balkan Association of Nephrology, Dialysis,Transplantation and Artificial Organs (BANTAO) took place, from16 to 19 September 2007, in Belgrade, Serbia. After the sevenprevious successful congresses and this latest one in Belgrade,we are convinced that BANTAO has become firmly established asa professional and cultural phenomenon. Born in Ohrid 1993 and followed by     

Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows

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Treatment of Hypertension in Dialysis and Essential Hypertension Patients with Nifedipine

The immediate antihypertensive effect of 10mg nifedipine sublingually (nifedipine test), was measured in 19 chronic renal failure hypertensive patients on dialysis and 34 essential hypertensive patients with normal kidney function. The blood pressure decreased significantly in both groups. The minimal values were observed between 30 and 60 minutes after the sublingual administration of nifedipine. The blood pressure decreased from 178±3.3 / 104.0±3.9 to 136.0±4.7 / 87.0±5.1 mm Hg (p<0.001) in dialysis patients and from 176.8±4.5 /107.1±2.4 to 133.0±3.0 / 81.7±2.2 mm Hg in essential hypertension patients (p<0.001). The decrease in blood pressure during the test had a significant positive correlation with the pre-test values.

Thirteen hypertensive patients on dialysis and 20 essential hypertensive patients completed 2 weeks of daily oral nifedipine therapy, with a dose of 30 to 40 mg per day. The mean blood pressure at the end of the 2 weeks of treatment decreased from 179.5±4.5 / 108.5±5.3 mm Hg to 154.4±6.3 / 82.3±2.6 mm Hg (p<0.001) in dialysis patients, and from 176.8±5.8 / 110.3±2.9 to 151.3±5.3 / 93.5±2.6 mm Hg (p<0.001) in essential hypertension patients.

The present results reveal that nifedipine has a powerful immediate as well as a long-term antihypertensive action in dialysis patients with high blood pressure. This effect is similar to that obtained in essential hypertensive patients.