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Forum Nefrologiczne
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ISSN (Print) 1899-3338 - ISSN (Online) 1899-4113
Published by Via Medica

[41 journals]

Roxadustat ― new therapeutic option for treatment of anemia in patients
with chronic kidney disease
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  Authors: Andrzej Chamienia, Alicja Dębska-Ślizień
  Abstract: Chronic kidney disease (CKD) is an increasingly common public health issue. It is estimated that it affects 8–16% of the global population. Anemia is a very common complication of chronic kidney disease, and its occurrence is associated with a reduced quality of life, increased morbidity, and mortality. The main causes of CKD anemia include erythropoietin (EPO) deficiency and iron deficiency (absolute and functional). In addition, the bone marrow response to EPO is reduced in patients with chronic inflammation, which is often present in patients with advanced stages of CKD and dialyzed patients. According to the current guidelines, the treatment of anemia in CKD involves recombinant erythropoiesis-stimulating agents (ESAs) along with iron supplementation. In some patients, intensive correction of anemia requiring high doses of ESA and intravenous iron may increase the risk of adverse events. The correction also requires injections, outpatient visits, and hospital stays, which is especially troublesome for pre-dialysis patients. The discovery of hypoxia-inducible factors (HIFs) responsible for stimulating cells to EPO synthesis and increased activity of oxygen-dependent genes enabled the development of new drugs, so-called HIF-PHI inhibitors (hypoxia-inducible factor-prolyl hydroxylase inhibitors, prolyl hydroxylase inhibitors). Those compounds reversibly inhibit the activityof the enzyme responsible for inactivating the HIF and thus increase endogenous EPO synthesis and affect iron metabolism. This discovery opened new
  options for the treatment of anemia in CKD patients. Phase 2 and 3 clinical trials are conducted with several drugs: daprodustat (GSK-1278863), roxadustat (FG-4592), and wadadustat (AKB-6548). To date, only roxadustat has been approved for treatment of CKD-related anemia. Roxadustat (FG-4592) is a novel orally active, potent, and reversible inhibitor of prolyl hydroxylase (PHI), causing functional activation of target genes that encode proteins such as EPO, EPO receptor, heme biosynthesis enzymes, and proteins that enhance iron absorption and transport and thus promote formation and maturation of red blood cells (RBCs). This study aims to summarize the available results of studies on the use of roxadustat in
  Issue No: Vol. 15
Circadian blood pressure profile in non-dialyzed patients with chronic
kidney disease
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  Authors: Paweł Stróżecki, Zbigniew Włodarczyk
  Abstract: Blood pressure follows a circadian rhythm; its physiological levels are higher during the day and lower at night. Ambulatory blood pressure monitoring (ABPM) facilitates the analysis of circadian blood pressure profiles and the diagnosis of nocturnal hypertension. Circadian blood pressure profiles are classified into 4 types: normal "dipper" profile with blood pressure falling by >10% and ≤20%, "extreme dipper" profile with an excessive blood pressure fall (> 20%), "non-dipper" profile with reduced (≥10%) nocturnal blood pressure fall, and "reverse dipper" profile characterized by nocturnal blood pressure rise. Nocturnal hypertension is diagnosed for nocturnal systolic blood pressure of ³120 mmHg or diastolic blood pressure of ≥70 mmHg. Abnormal circadian blood pressure profiles are observed in the majority of chronic kidney disease (CKD) patients not undergoing dialysis, as well as in the vast majority of kidney transplant recipients. Reduced nocturnal blood pressure dips, particularly in the “reverse dipper” profile, and nocturnal hypertension are associated with more severe hypertension-mediated organ damage, an increased cardiovascular risk, and faster progression of CKD. Hence, more extensive ABPM is required in CKD to identify patients at high risk of complications. Further studies are also required to assess the influence of different therapeutic strategies on the circadian blood pressure profile in CKD patients.
  Issue No: Vol. 15
Definitions and classification of acute kidney injury, acute kidney
disease and chronic kidney disease
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  Authors: Helena Żórawska, Alena Zhymaila, Jolanta Małyszko
  Abstract: Chronic kidney disease is becoming more and more common. Recently, it has become a problem of public health institutions worldwide. On the other hand, with the development of medicine, acute kidney injury is increasingly more commonly diagnosed. There is always a question of defining the disease. The definition of acute kidney injury proposed by KIDIGO has no clinical context and is generally not helpful in daily practice. Therefore, the old pathophysiological classification of prerenal, renal, and postrenal kidney injury is still used. Recently, acute kidney disease has been defined including abnormalities in the structure or function of the kidneys that have a significant impact on health and life, last for less than 3 months, and do not meet the definition criteria for neither acute kidney injury or chronic kidney disease. This can also be referred to as nonspecific kidney impairment. This paper discusses the definition and classification of acute kidney injury, acute kidney disease and chronic kidney disease.
  Issue No: Vol. 15
The use of remote patient management in early diagnosis of ultrafiltration
failure in peritoneal dialysis
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  Authors: Aneta Bubieńczyk, Ewa Suchowierska, Beata Naumnik
  Abstract: The SARS-CoV-2 pandemic has turned the whole world towards telemedicine. Remote patient management is a relatively new trend in managing peritoneal dialysis patients. It has gained importance in the current epidemiological situation. This article presents new possibilities and hopes related to promoting this type of patient supervision. Special attention was paid to the dynamics of ultrafiltration changes in various pathological conditions.
  Issue No: Vol. 15
Principles of management in patients with autosomal dominant polycystic
kidney disease (ADPKD), who are candidates for kidney and/or liver
transplantation — recommendations of PTT Working Group, part I
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  Authors: Alicja Dębska-Ślizień, Roman Danelewicz, Magdalena Jankowska, Hanna Suchanek, Maciej Kosieradzki, Marcin Matuszewski
  Abstract: These guidelines address the management of patients with autosomal dominant polycystic kidney disease who are candidates for kidney and/or liver transplantation. They include issues such as enlisting for transplantation, indications for nephrectomy, indications for simultaneous kidney and liver transplantation, qualification of a living donor, and qualification for renal replacement therapy in a patient with a failing transplanted kidney.
  Issue No: Vol. 15