Therapy with renin‐angiotensin‐aldosterone system (RAAS)‐blocking drugs prevents the development of fibrosis and angiogenesis in animal models and humans. In our study we have evaluated the systemic effect of RAAS blockade and the effect on peritoneal growth factors, cytokine production and membrane transport characteristics in patients on peritoneal dialysis. Thirty‐seven peritoneal dialysis (PD) patients were enrolled in our cross‐sectional study. Aldosterone and angiotensin II concentrations were measured in serum to determine the RAAS activity. The inflammatory and profibrotic activity was evaluated by measuring the concentration of C‐reactive protein (CRP), serum albumin, and peritoneal concentration of interleukin‐6 (IL‐6), vascular endothelial growth factor (VEGF), plasminogen activator inhibitor‐1 (PAI‐1), transforming growth factor‐β (TGF‐β) and cancer antigen‐125 (CA‐125). The transport characteristics of the peritoneal membrane were analyzed with a peritoneal equilibration test (PET). Results were compared between the group with RAAS‐blocking drugs (RAAS group) and the group without them (non‐RAAS group). Mean serum aldosterone concentration was significantly lower in patients treated with ARB‐blocking drugs (P = 0.001) and serum angiotensin II concentration was lower in patients treated with ACE inhibitors (P = 0.009). RAAS blockade resulted in lower peritoneal PAI‐1 levels (748.1 to 1222.7 ng/L; P = 0.07) without any influence on CRP, peritoneal concentrations of IL‐6, VEGF, TGF‐β and CA‐125, or alteration in peritoneal membrane characteristics tested by PET. RAAS‐blocking drugs could be effective in preventing peritoneal fibrosis due to possible reduction of peritoneal PAI‐1 concentrations that have already been etiologically linked with fibrin deposition in the pathogenesis of encapsulating peritoneal sclerosis.

This report provides a summary of the 2011 Slovenian renal replacement therapy (RRT) data. Data were obtained from 24 renal centers: 23 dialysis and one transplant center, referred as of 31 December 2011, with 100% response rate to individual patient questionnaires. Slovenia has a population of approximately 2 million (2 052 496 in 2011). The total number of patients treated by RRT was 2011, that is, 980 per million of population (pmp); 0.4% decrease compared to 2010. 1347 (67.0%) were treated by hemodialysis, 60 (3.0%) by peritoneal dialysis, and 604 (30.0%) had a functioning kidney graft. A total of 236 incident patients, 115 pmp (at day one), started RRT, their median age was 68 years, 64.8% were men, 36.4% were diabetics. Regarding hemodialysis patients, 59.3% were treated with on-line hemodiafiltration, 86% with ultrapure dialysis fluid. Median weekly duration of hemodialysis was 12.5 h, median dry body weight 70 kg, mean blood flow 275 +/- 46 mL/min, 7.1% were dialyzed in a single-needle mode. Vascular accesses were native arteriovenous fistula in 79%, polytetrafluoroethylene graft in 6%, and catheter in 15%. The crude death rate was 15.9% in dialysis patients, 1.9% in transplant recipients, and 12.0% in all RRT patients (both dialysis and transplant, incident patients at day 1 included). Slovenia has been a member of Eurotransplant since 2000. Forty-six kidney transplantations were performed in 2011, all from deceased donors. A slight decrease in prevalent number of RRT patients was observed in 2011, for the first time in 40 years. The number and proportion of patients with functioning kidney grafts is increasing, reaching 30% in 2011.

Severe peritonitis causing death and/or technique termination (catheter explanted) is one of the most devastating complications of peritoneal dialysis (PD). The aim of this case series study was to reveal the predictors of risk and clinical characteristics of these cases. We included 38 patients with either peritonitis causing death (18 patients, 47%) or catheter removal (20 patients, 53%) in the period 1996-2006. Their last clinical, laboratory and peritoneal equilibration test data before the peritonitis episode and hospitalization data after the start of peritonitis were reviewed. Their median (range) age was 66 (25-85) years, 61% were male, and the median PD duration was 60 (1-144) months. Baseline C-reactive protein (17.5 +/- 19.1 mg/L) was substantially higher than in contemporary stable controls from our unit (3.5 +/- 4.2 mg/L, P = 0.002). For 14 patients (37%), this was their first episode, with a significantly lower mortality of 14% as opposed to 47% across the whole group (P = 0.002). Almost half the patients (42%) had a causative abdominal condition identified, such as diverticulitis or cholecystitis. Clinical and laboratory data at presentation were variable and not different according to survival. Non-surviving cases had a significantly larger proportion of fast transporters (83 vs. 45%, P = 0.03), a significantly lower estimate of daily protein intake (0.72 vs. 0.88 g/kg/day, P = 0.007), and a significantly higher proportion of non-Gram-positive causative microorganisms (72 vs. 40%, P = 0.019). The patients with severe peritonitis were characterized as older with a longer PD duration, and a higher baseline C-reactive protein. Fast peritoneal transport, lower normalized protein catabolic rate, and non-Gram-positive causative bacteria were associated with mortality.

The beneficial effects of novel peritoneal dialysis solutions low in glucose degradation products regarding peritoneal cell apoptosis and necrosis are well established in vitro, however in vivo data is lacking. Cell-free DNA quantification is a possible method to determine cell damage through apoptosis and necrosis in vivo. We performed a prospective, cross-over study on 26 stable continuous ambulatory peritoneal dialysis (CAPD) patients, treating each patient for 3 months in a randomized order with a conventional, lactate-buffered, acidic solution (solution D) and a novel, bicarbonate/lactate-buffered neutral solution (solution P). The timed overnight peritoneal effluent was sampled for cell-free DNA quantification using a fluorometric assay. The effluent samples of eighteen patients were finally available for DNA quantification. The concentration range of cell-free DNA in the peritoneal effluents was 1.8-9.5 microg/L. The coefficient of intrapatient variation in overnight effluent cell-free DNA appearance was 15.6 +/- 12.4%. Cell-free DNA peritoneal appearance using solutions D and P was 14.9 +/- 6.8 microg and 11.8 +/- 3.4 microg, respectively (P = 0.02), with the average difference of 3.1 microg (95% CI, 0.7-5.6 microg). Our results show that cell-free DNA is present in the overnight peritoneal effluent of stable CAPD patients. A significant decrease in the cell-free DNA appearance with solution P was found; however, before accepting this as an indicator of a more biocompatible profile causing less peritoneal membrane cell necrosis and apoptosis, confirmatory data on larger patient samples are needed. Our results indicate the potential future role of cell-free DNA in the diagnosis and prognosis of therapy-related peritoneal membrane degeneration.

Encapsulating peritoneal sclerosis (EPS) is a rare complication in patients on peritoneal dialysis (PD), the prevalence of which increases with the time spent on PD. Various causative factors have been proposed, but the pathogenesis still remains unclear. The aim of our retrospective study was to analyze the basic clinical characteristics and outcomes of five patients diagnosed with EPS out of 423 patients treated with PD between January 1983 and December 2003. One patient was admitted due to ultrafiltration failure of the peritoneal membrane, and four patients were admitted for acute peritonitis. All of our patients presented with clinical symptoms suggestive of obstructive ileus. We confirmed the diagnosis of EPS with a computer tomography scan, a diagnostic laparotomy or laparoscopy, and a biopsy of the parietal peritoneum. We treated all of our patients with catheter removal, transferal to hemodialysis, antibiotics, complete parenteral nutrition, methylprednisolone, and tamoxifen for 6 months. One patient was treated with surgical enterolysis and died of septic complications, another patient died of sudden cardiac death during treatment. Three patients were doing well for 4-7 months after the treatment was started. The incidence of EPS was 1.2% and the mortality rate was 40%. EPS is a rare complication in longstanding PD patients in our institution. Despite treatment with hemodialysis, complete parenteral nutrition, steroids, tamoxifen and surgical intervention, the mortality rate is high and comparable to other reports.

BACKGROUND:This study was designed to compare the effects of a conventional lactate-based peritoneal dialysis (PD) solution (D) and a new biocompatible bicarbonate/lactate-based solution with a low concentration of glucose degradation products (P) on peritoneal ultrafiltration (UF) and other peritoneal membrane indices.METHODS:Twenty-six stable, prevalent PD patients were enrolled in this prospective study. They sequentially underwent 3 months of therapy with the D solution and 3 months with the P solution in a randomized order. Daily, overnight and 4-h UF on PET were measured and other peritoneal membrane indices were also assessed using PET with 2.27% glucose solution.RESULTS:Twenty-one patients successfully completed the study. The mean daily peritoneal UF with D was 1324 +/- 602 ml and 881 +/- 633 ml with P (P < 0.001) and this lower daily UF of 443 ml (95% CI 275-610 ml) with P was associated with a similarly lower daily total fluid removal of 394 ml (95% CI 210-577 ml), as urine volume did not differ between D and P. The decrement in UF with the P solution was reversible. There were no significant differences in other peritoneal membrane indices (D/P creatinine, D/D0 glucose, 4-h UF at PET, weekly creatinine clearance, weekly urea Kt/V) or blood pressure and body weight between the solutions whereas calculated peritoneal fluid absorption rate was significantly higher with the P than with the D solution.CONCLUSION:This study shows that the daily UF with the P solution may be lower than with the D solution. The mechanism for this short-term and reversible effect that conceivably reflects differences in biocompatibility is not clear although our results implicate that the peritoneal fluid absorption rate may differ between the two solutions.

OBJECTIVEThe presence of comorbidity is a risk factor for both poor nutrition and poor outcome in continuous ambulatory peritoneal dialysis (CAPD) patients. In CAPD specifically, peritoneal glucose load is associated with a possible suppression of appetite, contributing to protein malnutrition. This study sought to explore the factors associated with malnutrition indices in stable peritoneal dialysis patients without significant comorbidity, and to assess the impact of peritoneal glucose absorption on nutrition parameters.DESIGNThis was a cross-sectional observational study.SETTINGThis study took place in the peritoneal dialysis department of a university hospital, and involved outpatients.PATIENTSThere were 23 stable, comorbidity-free CAPD patients (9 women), aged 54 +/- 12 years, with a CAPD duration of 28 +/- 25 months (values are mean +/- SD unless otherwise noted).METHODSNutritional status was evaluated by means of anthropometric and serum measurements. A peritoneal equilibration test was performed, and daily glucose absorption was measured. Lean body mass (LBM) was assessed through creatinine kinetics.RESULTSA significant impact of CAPD duration was found. Patients in the upper quartile of CAPD duration had worse nutritional parameters compared with the rest of the group: their mid-upper-arm surface area and fat surface area were lower (65 +/- 9 cm(2) vs. 78 +/- 6.2 cm(2) and 16 +/- 5.3 cm(2) vs. 26 +/- 9.5 cm(2), respectively, P < .05), their albumin concentration was lower (36 +/- 0.5 g/L vs. 42 +/- 4 g/L, P < .05), and their cholesterol and triglycerides were lower (3.5 +/- 0.5 vs. 5.2 +/- 1 mmol/L and 1.3 +/- 0.6 vs. 2.3 +/- 1.1 mmol/L, respectively, P < .05). No significant correlations between peritoneal glucose absorption and these indices were found.CONCLUSIONThe duration of dialysis treatment, but not peritoneal glucose absorption, is a predictor of malnutrition in stable, comorbidity-free CAPD patients.

Objectives: This study was designed to compare the local peritoneal and systemic inflammatory effects of a conventional lactate-based ( Lac) peritoneal dialysis ( PD) solution and a new biocompatible bicarbonate/lactate-based ( Bic/Lac) solution having low concentration of glucose degradation products.Methods: 26 stable, prevalent PD patients were enrolled in this prospective study. They sequentially underwent 3 months of therapy with the Lac solution and 3 months with the Bic/Lac solution in a randomized order. Flow cytometry was used to measure the expression of inflammatory molecules on peritoneal cells in overnight effluent collected at the end of each study period.Results: 21 patients successfully completed the study. Mean fluorescence intensity of human leukocyte antigen (HLA)-DR and CD14 expression by macrophages were not different between Lac and Bic/Lac. The peritoneal appearance rate of cancer antigen 125 (kU/minute) was 68 +/- 37 with Lac and 133 +/- 66 with Bic/Lac (p < 0.001), and of interleukin (IL)-6 (ng/minute), 0.28 +/- 0.2 with Lac and 0.18 +/- 0.16 with Bic/Lac (p = 0.014). HLA-DR macrophage expression and IL-6 peritoneal appearance rates did not correlate. Serum concentrations with Lac and Bic/Lac were, for IL-6, 3.49 +/- 2.28 and 3.72 +/- 2.46 ng/L (p = 0.17), and for high-sensitivity C-reactive protein, 2.31 +/- 2.98 and 2.71 +/- 3.31 mg/L (p = 0.32) respectively. The concentration of effluent macrophages (x 10(6)/L) with Lac was 1.6 +/- 1.6 and with Bic/Lac 2.6 +/- 3.3 (p = 0.07).Conclusions: We conclude that, although there was a significant reduction in peritoneal IL-6 in patients using Bic/Lac solution, systemic levels of inflammatory markers did not differ between the two solutions and no changes were present in macrophage surface activation markers, suggesting perhaps a less important role of peritoneal macrophages in the intraperitoneal chronic inflammatory process. The number of effluent macrophages tended to be higher in patients using the Bic/Lac solution, possibly contributing to improved intraperitoneal defense.

Several studies found an increased risk of Staphylococcus aureus (SA) exit‐site and/or tunnel infections (ESI/TI) or peritonitis (P) in SA nasal carriers. The aim of our study was to determine efficacy of local preventive therapy with mupirocin in nasal carriers of SA. In this prospective study, from January 1997 to December 2003, 127 patients (pts) were included and observed for 4696 pt‐months. The ones with one or more positive smears were treated with mupirocin for five consecutive days, twice daily, every month. In acute or chronic ESI/TI with SA, the mupirocin was applied during daily exit‐site care. The pts with good or perfect exit‐sites were not treated. For statistic analysis, the proportion test and Pearson¢s correlation test were used. Among our pts the number of nasal carriers has decreased significantly ( P < 0.05) from 1997 (49.3%) to 2003 (18.0%). Simultaneously, the rates of SA peritonitis dropped from 0.032 episode/pt year in 1997 to 0.022 in 2003 ( P = 0.25). Significantly less ( P = 0.005) new SA ESI/TI were registered, from 0.113 episode/pt‐year in 1997 to 0.018 in 2001 and 0.022 in 2003. Two cases of mupirocin‐resistant SA were isolated, both in 2003, present in nasal as well as in ESI/TI swab. Diagnosis and treatment of SA nasal carriers among PD pts has proved to be important. The decrease in incidence of new ESI/TI was statistically significant, while peritonitis rates decreased less significantly. Mupirocin‐resistance in our study is low. When peritoneal catheter exit‐site is good or perfect, treatment with mupirocin is not necessary.

Introduction The problems of divalent ions, trace elements and bones are present in chronic dialysis patients despite optimal diet and therapy. Many patients have signs and symptoms of uremic osteopathy.Aim of the study To evaluate divalent ion metabolism and bone diseases in patients of our center for peritoneal dialysis.Methods In cross‐section study, we studied 41 patients (14 women, 27 men, mean age 56.6 ± 14.2 years) who were at least for 6 months (mean 52.9 ± 34.5 months) in our peritoneal dialysis (PD) program in the year 2003. Besides clinical, ultrasound, and X‐ray data, we evaluated their laboratory data in the last 3 years where available.Results Twenty‐seven patients used CAPD, 14 CCPD methods, 5/41 used PD1 solution, 34/41 PD4 and 2 both solutions. Thirty‐four patients used CaCO3, 18 aluminum hydroxide, and 9 sevelamer hydrochloride as phosphate binder as monotherapy or in combination. Sixteen patients used calcitriol and 9 sodium bicarbonate. Mean serum Ca in this population was 2.38 ± 0.09 (range 2.16–2.56) mmol/L, mean serum PO4 1.46 ± 0.2 (range 1.13–2.23) mmol/L, mean serum alkaline phosphatase 1.44 ± 0.74 (range 0.61–5.3) µkat/L, mean serum Al 21.7 ± 12.1 (range 6.5–47.3) µg/L, mean i‐PTH was 454.07 ± 484 (range 1–1828) pg/mL and mean product of Ca and PO4 was 3.48 ± 0.53 mmol2/L2 (range 2.52–4.84). We found positive correlation between alkaline phosphatase and i‐PTH (P = 0.000153) and between i‐PTH and serum Ca (P = 0.025291). 25/41 (61%) patients had maximum i‐PTH higher than 200 pg/mL, 13/41 (32%) patients had maximum i‐PTH even higher than 600 pg/mL, 4 patients were waiting for parathyroidectomy, meanwhile 8/41 (19.5%) of patients had i‐PTH < 100 pg/mL, in 4 of them parathyroidectomy was done in the past.Conclusions Divalent metabolism is quite optimally achieved but secondary hyperparathyroidism still prevails in our PD patients. Management of divalent ions is very important before the beginning of peritoneal dialysis.

Background Regional citrate anticoagulation (RCA) during hemodialysis is alternative to heparin in patients at high risk of bleeding. It enables excellent antithrombotic effect in the circuit, but requires strict monitoring during the procedure. The aim of our retrospective clinical study is to evaluate safety and efficacy of RCA performed according to our unit protocol.Methods Data from 40 protocols for RCA performed between April and June 2004 were analyzed. Double‐needle vascular access was obtained via either arteriovenous fistula or hemodialysis catheter. Hollow‐fiber dialyzer Polyflux 14 S (Gambro, Lund, Sweden) was used in all dialysis sessions. Calcium‐free dialysate was used and set to: Na 137 mEq/L, bicarbonate 28 mEq/L, magnesium 0.5 mEq/L, potassium 2.0 mEq/L, glucose 0 mEq/L. Potassium and glucose were added into the dialysate or intravenously if needed, respectively. Blood flow rate was maintained between 250–300 mL/min. 4% trisodium citrate was infused in the arterial line of the circuit, proximally from the arterial bubble trap, at the initial rate 300 mL/hour and adjusted accordingly to the blood flow rate and targeted clotting time (15–20 minutes in the circuit). One molar CaCl2 was infused in the venous line (distally from the venous bubble trap) at the initial rate 13 mL/h and was adjusted to maintain ionized calcium concentration (iCa) within normal range. Clotting time, iCa, Na, and bicarbonate were measured during hemodialysis. Clot formation in the dialyzer was estimated by counting the number of clotted fibers and assessment of clot presence in bubble traps.Results (see Table A26) preHD At 60 min At 120 min At 180 min Post HD Clotting time (min) – 11.0 ± 3.4 11.0 ± 3.3 11.2 ± 3.0 11.2 ± 2.7 iCa (mmol/L) 1.15 ± 0.31 1.0 ± 0.12 1.03 ± 0.09 1.04 ± 0.10 1.07 ± 0.20 Sodium (mmol/L) 137 ± 4 139 ± 3 139 ± 4 140 ± 3 140 ± 3 Bicarbonate (mmol/L) 21.4 ± 3.0 – – – 25.02 ± 3.3 pH 7.39 ± 0.04 – – – 7.45 ± 0.07 At 60 min At 120 min At 180 min At 240 min Blood flow rate (mL/min) 268 ± 24 266 ± 25 267 ± 23 267 ± 23 Citrate infusion rate (mL/h) 297 ± 11 298 ± 23 297 ± 22 300 ± 15 1M CaCl2 inf. rate (mL/h) 12.95 ± 0.45 13.12 ± 1.4 13.17 ± 1.55 13.35 ± 1.1 Assessment of clotting in the circuit 23/40 dialyzers (57.5%) were estimated as excellent (<10 clotted fibers), 14/40 (35%) as very good (11–20 clotted fibers), 2/40 (5%) as good (21–50 clotted fibers) and one dialyzer (2.5%) was full of small thrombi (50–100 clotted fibers capillaries). We noted significant clots in the venous bubble trap in two dialysis sessions. In addition, significant clots in the arterial bubble trap was noted in two dialysis sessions. No dialysis session was terminated prematurely because of technical or clinical problems.Conclusion Regional citrate anticoagulation performed according to our protocol was safe and effective. Clotting time was lower than targeted, but excellent macroscopic antithrombotic activity in the circuit was achieved.

Objectives The aim of our study was to: (i) assess the number of patients who need epoetin treatment and the adequacy of iron treatment, (ii) assess the influence of presence of diabetes mellitus, polycystic kidney disease and the influence of therapy with aluminum phosphate binders and angiotensin system antagonists on the epoetin requirements, (iii) assess the role of other factors possibly influencing epoetin resistance – secondary hyperparathyroidism, inflammation, dialysis dose and residual renal function.Design and Methods Fifty‐one stable peritoneal dialysis (PD) patients (mean age ± SD was 52 ± 13 years, 20 women) without recent bleeding, surgery, bone marrow disease, malignancy, or hypothyroidism were recruited in four Slovenian centers. The dose of epoetin was adjusted to maintain a target hemoglobin of above 110 g/L. At the time of inclusion (median 36 months of PD, range 3–124 months) the PET test results and relevant clinical and laboratory parameters were recorded. Index of epoetin resistance (IRE) was expressed as weekly epoetin dose/body weight/hemoglobin concentration.Results Twenty four percent of patients did not need epoetin treatment, the rest were treated with Epoetin‐beta at a dose of 70 ± 56 U/kg/week s.c.; hemoglobin concentration was 124 ± 15 g/L; 14% had hemoglobin below 110 g/L. Iron adequacy parameters (ferritin > 100 µg/L and TSAT > 20%) were fulfilled by 63% of patients, and their IRE was lower (0.43 ± 0.5 U/kg/week/g/L vs. 0.6 ± 0.72 U/kg/week/g/L), but not significantly (P = 0.502). Patients with polycystic kidneys had lower IRE (0.13 ± 0.3 vs. 0.52 ± 0.55 U/kg/week/g/L, P = 0.011) and majority of them (71%) did not need epoetin treatment (P = 0.006). No difference was found for diabetic patients. Treatment with angiotensin system antagonists, but not with aluminum phosphate binders, is associated with increased IRE (0.56 ± 0.59 vs. 0.3 ± 0.4 U/kg/week/g/L, P = 0.038). A statistically significant correlation was found for IRE and CRP (r = 0.48, P = 0.001) and iPTH (r = 0.46, P = 0.001). No correlation between IRE and residual renal function was found (r = −0.2, P = 0.173). Stepwise linear regression analysis for multiple variables (residual renal glomerular filtration rate, total weekly creatinine clearance, CRP, iPTH, iron adequacy, angiotensin system antagonist treatment, presence of polycystic kidneys) showed CRP and treatment with angiotensin system antagonists to be the most significant variables influencing IRE.Conclusion Our results show that systemic inflammation and angiotensin system antagonist treatment are the most important parameters affecting epoetin requirements in stable peritoneal dialysis patients.

The objective of our study was to assess the influence of residual renal function and other factors on epoetin requirements in chronic peritoneal dialysis patients. Fifty-one stable patients (mean age +/- SD: 52 +/- 13 years; 20 women) without recent bleeding, bone marrow disease or malignancy were recruited in four Slovenian centers. The target hemoglobin was above 110 g/L. The peritoneal equilibration test results and relevant clinical and laboratory parameters were recorded. The epoetin resistance index was expressed as a weekly epoetin dose/body weight/hemoglobin concentration. Twenty-four percent of the patients did not need epoetin treatment, the rest were treated with epoetin-beta in a dose of 70 +/- 56 U/kg per week s.c.; the hemoglobin concentration was 124 +/- 15 g/L. Ferritin > 100 mu g/L and transferrin saturation > 20% fulfilled 63% of patients whose epoetin resistance index was not significantly lower (0.43 +/- 0.5 U/kg per week per g/L vs 0.6 +/- 0.72 U/kg per week per g/L, P = 0.502). No difference was found between diabetic and non-diabetic patients. Treatment with angiotensin system antagonists, but not with aluminum phosphate binders, was associated with increased epoetin resistance index (0.56 +/- 0.59 vs 0.3 +/- 0.4 U/kg per week per g/L, P = 0.038). No correlation between epoetin resistance index and residual glomerular filtration rate was found (r = -0.2, P = 0.173). A multiple linear regression analysis showed C-reactive protein, intact parathormone level, female sex and treatment with angiotensin system antagonists to be the independent predictors influencing epoetin resistance index. Our results show that systemic inflammation, secondary hyperparathyroidism and angiotensin system antagonist treatment are the most important modifiable parameters affecting epoetin requirements in stable peritoneal dialysis patients.

The purpose of our report is to present the long-term outcomes of three renal transplant recipients with high-grade stenosis and suboptimal percutaneous angioplasty (PTA) because of technical difficulties. Two men and one woman of age 67, 53, and 54 years, who maintained functional cadaveric graft for 17, 9, and 13 years, and had diagnosed significant renal transplant artery stenosis at 2, 1, and 2 years after renal transplantation, respectively, were studied. Stenoses were diagnosed angiographically in the first patient and by Doppler in other two patients, then confirmed by angiography. All three patients had difficult-to-treat hypertension with deterioration of graft function in the presence of or after introducing ACE-inhibitor therapy. PTA was performed in all patients with suboptimal or unsuccessful results as assessed by angiography or control Doppler examination—the residual stenosis was significant and practically unchanged. Surgery was not performed because of high risk, so patients were further treated conservatively. Hypertension was treated avoiding ACE inhibitors. Twelve, 7, and 7 years after angioplasty the serum creatinine is stable in all patients, even decreased compared to pre-PTA and early post-PTA levels, namely, 134, 102, and 75 μmol/L, respectively. Control Doppler examinations revealed a residual stenotic jet in all patients, with slightly decreased peak systolic velocity over time, indicating a slightly decreased grade of stenosis. These observations suggest that renal transplant artery stenosis, even of high grade, can be stable, or even regress with time with excellent long-term graft survival. Randomized studies comparing conservative treatment versus revascularization are warranted.

Kaplan-Pavlovcic, S.; Lakic, N. Chwatal; Malovrh, M.; Buturovic-Ponikvar, J.; Gucek, A.; Urbancic, A.; Surlan, M. Author Information