The study presents the epidemiological features of patients treated with renal replacement therapy (RRT) in Serbia from 1997 to 2009 and compares the results of hemodialysis treatment in 1999 and 2009. Epidemiological data were obtained from the National Registry of RRT patients and data on hemodialysis treatment from special surveys conducted in 1999 and 2009. Within the period 1997-2009 the incidence of patients on RRT increased from 108 to 179 per million population (pmp), prevalence rose from 435 to 699 pmp, while mortality rate fell from 20.7% to 16.7%. The frequency of patients with glomerulonephritis decreased, while that of patients with diabetes and hypertensive nephropathy increased. In late 2009 there were 5208 patients receiving RRT in Serbia. Within the examined period new hemodialysis and reverse osmosis equipment were purchased, high-flux dialyzers with synthetic membranes were increasingly used and the number of patients receiving hemodiafiltration increased to 17.6%. Kt/V greater than 1.2 was recorded in 16% of the patients in 1999 but 52% in 2009. Options for correction of anemia and mineral disorders have also improved. The percentage of patients with HbsAg (13.8% vs. 4.8%) as well as anti-hepatitis C virus antibodies positive patients (23.2% vs. 12.7%) was significantly lower in 2009 than in 1999. Both the incidence and prevalence of RRT patients in Serbia are rising continuously, while the mortality rate is falling. More favorable conditions for dialysis treatment have brought about significant improvement in the results over the last 10 years.

No abstract

C-reactive protein is a known risk factor for cardiovascular diseases, but the association of CRP with the early phase of atherosclerosis has been insufficiently investigated. The aim of the present study was to investigate the relationship between CRP and indicators of subclinical atherosclerosis in hemodialysis patients. Intima-media thickness, lumen-diameter and cross-sectional intima-media area (CSIM area) of the common carotid artery were established using B-mode ultrasound imaging in 43 HD patients and 21 age- and gender-matched healthy controls. CSIM area and LD were significantly higher in HD patients compared with control subjects. Inflammation (CRP> 10 mg/l) was present in 58.1% of HD patients and was associated with higher values of all ultrasonographic markers of atherosclerosis, as well as higher prevalence of atherosclerotic vascular diseases. Higher CSIM area was associated with elevated CRP level (r=0.619, p=0.000), advanced age (R=0.704, p=0.005) and smoking habits (R=0.742, p=0.039). Results of our investigation support the concept on key role of inflammation in the development of atherosclerosis in HD patients.

Fosinopril carries less risk of hyperkalemia in hypertensive hemodialysis patients than enalapril. Although definite conclusion may be drawn after well-designed studies, the results presented in this pilot study suggest that fosinopril may be recommended for hypertensive hemodialysis patients who are at risk to develop inter-dialytic hyperkalemia.

Hypertension associated with chronic kidney disease (CKD) is related with a high risk of cardiovascular disease (CVD), which is the most common cause of morbidity and mortality in patients with CKD. Control of hypertension is important primarily because it reduces the risk of CVD and all-cause mortality in patients with CKD. The new KDIGO (Kidney Disease: Improving Global Outcomes) guideline for the management of blood pressure in CKD were published in 2021 and represented an updated version of the original guideline from 2012. This guideline covers all topics contained in the original instructions, such as optimal blood pressure targets, lifestyle interventions, choice of antihypertensive drugs, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid control and smoking, are excluded. In addition, this guideline introduces a chapter dedicated to proper blood pressure measurement as all large randomized trials from which the evidence and recommendations of this guide emerged used standardized preparation and measurement protocols adhered to by patients and clinicians. The key recommendation of the KDIGO guideline refers to target systolic blood pressure under120 mmHg in most adults with CKD, provided that the standardized office blood pressure measurement is used. Despite recommendations for lowering target blood pressure, general lack of evidence, especially in patients with diabetes and advanced CKD, still suggests the need to individualize targets according to the characteristics, tolerances, and preferences of each patient. Larger randomized controlled trials are needed to examine the effects of blood pressure targets on major adverse events and mortality in patients with CKD, especially in subpopulations that were not adequately represented in previous studies.