Chronic kidney disease (CKD) is among the most significant health problems, with the associated cardiovascular disease and bone metabolism disorders being the leading cause of morbidity and mortality in these patients. The aim of the study was to determine markers of bone turnover in patient sera (phosphates, calcium, alkaline phosphatase, parathyroid hormone and osteoprotegerin (OPG)) in all stages of kidney failure including kidney transplant recipients. We also wanted to determine whether dialysis vintage affects recovery of bone markers one year after transplantation. There were 164 study patients, whereas 30 healthy individuals served as a control group. Serum OPG progressively increased with decline of the glomerular filtration rate. The highest OPG concentration was recorded in dialysis group. We observed a statistically significant OPG increase in stage 2 CKD. In kidney transplant group, there was positive correlation between OPG and dialysis vintage. We also found that serum OPG was lower in patients treated with dialysis for less than 4 years prior to transplantation. We confirmed that CKD-mineral and bone disorder began in stage 3 CKD with parathyroid hormone and OPG elevation, and a statistically significant OPG increase in stage 2 CKD might be an early sign of CKD-mineral and bone disorder. Dialysis vintage longer than 4 years is associated with more significant disturbances in mineral and bone metabolism.

Objective: The aim of our study was to compare the values of blood pressure (BP) and pulse pressure (PP) in the brachial artery and in the central aorta by outpatient non-invasive methods in different patients age groups and according to the presence of chronic renal disease and diabetes. Design and method: The study included 110 outpatients older than 18 years of age with diagnosed and treated arterial hypertension (AH), under the care of Clinical Hospital Centre Rijeka in the period from June 1 to December 1, 2021. Peripheral BP, PP, and central aortic pressure (CAP) were measured in all patients on the same day. The average values of peripheral arterial pressure and the corresponding PP were obtained by the method of continuous blood pressure monitoring (CBPM). CAP and associated PP were measured on the same day by the method of radial arterial tonometry. Patients were divided into three groups according to the age (18–44 years, group I; 45–64 years, group II, and > 65 years, group III). Systolic and diastolic peripheral blood pressure (SPBP, DPBP), systolic CAP and diastolic CAP (SCAP, DCAP), and both peripheral and central PP (PPP, CPP) were nalysed among groups and according to the presence of chronic kidney disease (CKD). Results: In total, 98 patients were nalysed (mean age 55,08 ± 15,52 years; 79,6% essential hypertension; diabetics 12,23%; 26,53% CKD; 48,98% men). There were significant positive correlations between SPBP and SCAP, DPBP and DCAP, and PPP and CPP in group I and group III. There was no significant correlation between SPBP and SCAP (r = 0,268), and there were significant correlations between DPBP and DCAP, and PPP and CPP in group II. According to the presence of CKD, there was no significant correlation between SPBP and SCAP (r = 0,104), and there were positive correlations between DPBP and DCAP, and PPP and CPP. Conclusions: There was no significant correlation between SPBP and SCAP in 45–65 years old and CKD group, which tells us in favor of the atherosclerosis variability in these patient groups, which was expected. Further research on greater number of patients should be done.

COVID-19 infection in patients treated in dialysis centers is a particular challenge given that there is a significantly increased risk of transmitting the infection to medical staff, other staff of the institution, other patients, and family members of the patients. The purpose of our work is to share our experiences in the implementation of preventive and epidemiological measures with reference to patients on a chronic outpatient hemodialysis program. Nurses play an important role in education and caring for the dialysis patient.

Global assessment of the prevalence chronic kidney disease (CKD) ranges from 11% to 13% with 50% of the elderly showing signs of kidney dysfunction. The aim of the study was to determine whether structured predialysis program affects the choice of treatment, method and timing of treatment initiation in all patients, with special reference to older adult patients. Retrospective analysis included 634 patients with CKD treated at the Nephrology Department, Rijeka University Hospital Centre from January 1, 2008 till the end of 2017. Patients were divided into three groups based on predialysis education or renal replacement therapy. Furthermore, as a separate group, we analyzed patients having presented to nephrology for the fi rst time or started some of the alternative methods at age ≥65 years. In the group of senior adults, we analyzed data on 319 patients. We divided patients into three groups and followed the time line defi ned in Event 1-3 expressed in years, from the fi rst nephrologic review until the end of 2017. The analysis showed no statistically signifi cant gender difference (p>0.670). The χ2-test showed statistical signifi cance for diabetes mellitus type 2 compared to other PKD causes (p<0.001). In group 1, 52.38% of 147 patients started some of the follow-up methods and 47.61% of patients were treated conservatively or were preparing for dialysis. The patients in this group statistically signifi cantly preferred PD compared to the other two groups (p<0.05). The ANOVA and LSD test in older adults showed a statistically signifi cant difference in the timeline in group 1 as compared to the other two groups (p<0.001). Gehan’s Wilcoxon test (p=0.00043) and Cox’s F-test (p=0.00001) in survival analysis showed a statistically signifi cant difference in survival between the groups (p<0.05). Survival analysis revealed that preparation or treatment after ten years of survival curve, there was no difference between the groups regardless of the choice. The study opened up the question of continuation with greater emphasis on planned, extended diagnosis after the fi rst patient referral, especially at an older age that might have interpreted survival more clearly.

INTRODUCTIONClinical assessment (CA) is frequently used for the evaluation of volume status in peritoneal dialysis (PD) patients despite its subjectivity. Multiple-frequency bioelectrical impedance analysis (MF-BIA) is objective, accurate, and quick, proving to be a promising technique for measuring volume status. The aim of this study was to assess volume status in PD patients using CA and MF-BIA and to compare results.MATERIALS AND METHODSIncident PD patients were prospectively analyzed between January 1, 2014, and January 1, 2016, at the Clinical Hospital Center of -Rijeka, Croatia. Volume status measurements were performed once a month for 6 consecutive months. The presence of symptoms and signs associated with hyper- or hypovolemia were detected by CA. Euvolemia was defined as a symptom-free state or up to 2 symptoms maximum. Patients lacking up to 1.2 L of volume or with up to 1.2 L in excess were considered euvolemic, as measured by MF-BIA.RESULTSA total of 45 PD patients were analyzed; 51% were men, 27% were diabetic, the mean age was 52 ± 26 years, and PD duration was 11.5 ± 6.5 months. In comparison to MF-BIA, CA showed a significant difference in detected hypervolemia between baseline and follow-up (p = 0.708 vs. p = 0.01, respectively) and among all measurements (p < 0.01). Contrary to CA, volume status measured by MF-BIA correlated significantly with systolic and diastolic blood pressure (R = 0.29; p ≤ 0.01 and R = 0.26; p ≤ 0.01, respectively). CA showed low sensitivity (0.24) and high specificity (0.92) in detecting hypervolemia.CONCLUSIONMF-BIA is an effective, objective, and safe method for assessing volume status in PD patients. Longitudinal monitoring of body composition changes - including hydration state - leading to adequate therapeutic intervention is a promising and potential application of MF-BIA along with CA.

Clinical guideline for central venous catheter (CVC) maintenance stresses regular care of the insertion site and safety checks. The study aimed to assess the advantage of using suture-free fi xation system to secure catheter position and prevention of infection. A total of 40 patients with CVC vascular access for hemodialysis were followed from 01/10 through six months at Division of Nephrology, Dialysis and Kidney Transplantation, Rijeka University Hospital Centre. Patients were divided into two groups of 20 patients. In group 1, suture-free fi xation system was used as an additional measure of securing CVC position, while group 2 served as a control group where ordinary measures were used. Protocol saw changing of dressings and suture-free fi xation system once a week. In group 1, 11 patients with temporary and 9 patients with permanent catheters were followed. Five complications were observed during the study period and one patient required additional sutures. In the control group, 12 temporary and 8 permanent catheters were followed. Additional sutures were required in four patients and eight complications were observed. Blood stream infection was observed in only one patient. The use of suture-free fi xation system reduced the number of complications to 25%, compared to 40% in the control group. Satisfaction was rated at 9.6/10 by patients, 9.4/10 by nurses, and 9.8/10 by nephrologists. Allergic reactions were not observed. In conclusion, for such a large area of use, it is necessary to follow patients for a longer period; still this research confi rmed the advantage of using suture-free fi xation system.