Screening for and treating asymptomatic bacteriuria are common in KTRs despite uncertainties around the benefits and harms. In an era of antimicrobial resistance, further studies are needed to address the diagnosis and management of asymptomatic bacteriuria in these patients.

Background and Aims It is widely known that chronic dialysis patients experience significantly higher cardiovascular (CV) death rates than the overall population. Among other CV risk factors, recent research has shown pulmonary hypertension (PH) as a consequence of chronic kidney disease and end-stage renal failure. The present study aimed to determine the risk factors that impact survival in chronic haemodialysis and peritoneal dialysis patients and to analyse the correlation of these factors with pulmonary hypertension. Method We studied 125 stable haemodialysis and peritoneal patients (females 40%, mean age 52.42 ±11.88 years) on RRT for more than three months with a two-year follow-up. Demographic information, clinical characteristics, blood tests, and a thorough echocardiographic evaluation were collected at the optimal dry weight. After conventional echocardiographic examination, a tissue Doppler echocardiographic (TDE) examination was performed to evaluate the global and regional myocardial systolic and diastolic functions and pulmonary hypertension. Systolic pulmonary artery pressure (sPAP) of 35 mmHg was used to define PH. Results The cardiovascular mortality rate was 15.5%. In ROC analysis for CV mortality, the area under the curve (AUC) for PH and CRP was found 0.8; for LVM-I, E/E', and PP, the AUC was 0.76, 0.75, 0.72, respectively, while the inverse relationship was found with MASa and TASa with AUC = 0.66 and 0.95 respectively. According to the echocardiographic findings, PH was found in 28% (35 patients) of all patients. The mean PH was 33.46±5.38 mmHg. The higher level of higher parathormone (PTH), C-reactive protein (CRP), and E/E’ average, the lower left ventricular ejection fraction (EF), the peak systolic velocity at the lateral mitral annulus (MASa), and the peak systolic velocity at the lateral tricuspid annulus (TASa) were found to be predictors of PH. Patients evaluated with PH have a significantly lower cardiovascular survival rate [Long Rank (Mantel-Cox) p = 0.0001. Conclusion Our research demonstrates that cardiovascular morbidity and death in dialysis patients are mainly attributed to pulmonary hypertension, inflammation, vascular stiffness, and left ventricular hypertrophy. PH is common among dialysis patients. Inflammation, CKD-MBD biomarkers linked to systolic and diastolic left and right ventricular dysfunction, and inflammation all influence it. These conditions are all connected. Cardiovascular imaging is simple to use, offers a favourable viewpoint in the early identification of cardiac abnormalities and quick treatment of this disease, and is thus strongly advised in the dialysis population.

Background and Aims Mineral bone disease and cognitive impairment are related diseases in the CKD population. Vascular calcification, a marker of MBD, may play a role in the early detection of cognitive decline. This study aims to identify a relationship between MBD biomarkers and cognitive function and to identify dialysis patients with a high risk of dementia. Method A total of 98 patients participated in this cross-sectional study, with 63 on hemodialysis and 35 on peritoneal dialysis. They underwent the Montreal Cognitive Assessment (MoCA) questionnaire, which categorized mild, moderate, severe, and severe based on scoring. PTH, P, Ca, ALP, and Mg serum concentrations and vascular calcification were measured as MBD biomarkers. The Adragaos score was applied to graphs of the hands and pelvis to evaluate vascular calcification. Results The mean MoCA score was 20,28±5.8. Based on the responses, it was concluded that 70% of HD patients had mild cognitive impairment, compared to 63% of PD patients. According to the descriptive data, patients whose underlying CKD was caused by nephroangisclerosis had the lowest MOCA test results compared to other groups (p<0.001). The degree of calcification was observed to have an adverse effect on cognitive performance in both groups (p<0.012); the high Adragaos score contributed to the decline in the MoCA test score. In multivariate logistic regression analysis, hypercalcemia and hypomagnesemia were independent variables for cognitive function impairment (p = 0.006 and p = 0.04, respectively). The serum concentration of PTH (p = 0.008) and ALP (p = 0.001) were found to be risk factors for HD patients during the evaluation of the MoCA test in each of the groups. Conclusion Vascular calcifications are considered a risk factor for cognitive impairment. In our study, vascular calcification risk is positively impacted by indicators such as hyperparathyroidism, hypercalcemia, high levels of ALP, and hypomagnesemia. Recently research has demonstrated the effectiveness of magnesium as a vascular calcification inhibitor. So, nephrologists should be more careful in monitoring levels of MBD biomarkers.

Conservative treatment of chronic kidney disease, apart from simply treating symptoms and associated complications, consists in slowing chronic kidney disease progression, in order to improve patient and family quality of life, to postpone the need for renal replacement therapy and to reduce the treatment costs. Slowing chronic kidney disease progression involves therapeutic strategies, aiming to avoid/treat malnutrition and inflammation, correct anemia, treat mineral bone disorders of CKD and correct vitamin, mineral and microelement’s deficit. This review aims to shed light to the rationale behind these strategies through evidence from clinical studies and the recent guideline recommendations for use of ketoanalogues, essential aminoacids, calcium, Vit D3, iron, Vit B12, folates and unsaturated fatty acid supplements.