Projects / Programmes
RENAL DISEASES AND RENAL REPLACEMENT THERAPY
January 1, 2017
- December 31, 2021
| Code |
Science |
Field |
Subfield |
| 3.06.00 |
Medical sciences |
Cardiovascular system |
|
| 3.07.00 |
Medical sciences |
Metabolic and hormonal disorders |
|
| Code |
Science |
Field |
| B530 |
Biomedical sciences |
Cardiovascular system |
| Code |
Science |
Field |
| 3.02 |
Medical and Health Sciences |
Clinical medicine |
chronic kidney disease, end-stage renal disease, dialysis, plasma exchange, kidney transplantation, Doppler-ultrasonography, mesenchimal stem cells, biomarkers, proteinuria, glomerular filtration rate, anticoagulation, citrate, vascular access, nutrition, immunosuppression, pharmacogenomics
Researchers (22)
Organisations (1)
Abstract
Chronic kidney disease (CKD) and end-stage renal disease (ESRD) represent an international public health problem affecting 5–10% of the population. Our basic and clinical science research will be focused on:
Stem cell transplantation for kidney injury repair in a mouse model: Our goals are to determine (a) efficacy and safety of in-situ vs. intraarterial mesenchimal stem cells (MSC) transplantation to restitute function and morphology in toxic kidney injury, and (b) the role of MSC in achieving immune tolerance in chronic rejection.
Biomarkers for progression of CKD: (a) Proteinuria in CKD: Our objective is to find out which urine sample is the most appropriate for determining proteinuria and to evaluate the prognostic value of different types of proteinuria on outcome in patients with CKD. (b) Glomerular filtration rate (GFR) in primary nephrotic syndrome: The aim is to determine the link between measured GFR with Cr-EDTA clearance, laboratory parameters and pathohistological findings.
Improving outcomes in CKD and ESRD patients: (a) We will continue to focus on citrate use as anticoagulant in extracorporeal hemodialysis procedures aiming to improve safety of citrate anticoagulation and biocompatibility of the extracorporeal circuit. In a randomized study, we will try to assess optimal citrate concentration for the catheter locking solution (4% vs. 30%). (b) Vascular access: In patients with arteriovenous fistula aneurysms, we will explore clinical problems (i.e., high blood flow, rupture risk) and different therapy options (surveillance, aneurysmorrhaphy, or removal). (c) Plasma exchange (PE): We will investigate the effects of PE with citrate anticoagulation on activation or suppression of inflammatory markers, complement components and coagulation factors. In a randomized study, we will explore the role of PE in the treatment of hypertriglyceridemic pancreatitis. (d) Improving nutritional status of CKD and ESRD patients: We will perform an interventional trial testing the hypothesis that plant-based low-fat diet improves the serum cardiovascular risk factors and halts the progression of CKD. In ESRD patients, novel nutritional markers (i.e., over-hydration index, fat tissue index, lean tissue index) will be compared with routine biochemical blood parameters.
Personalized immunosuppression after kidney transplantation: (a) In a prospective study, we will investigate the association of tacrolimus extended release-based immunosuppression and early steroid withdrawal with clinical, ultrasonography, immunologic, and pathohistological biomarkers of insufficient or excess immunosuppression. (b) In a pharmacogenomics study, we will determine allelic variants of the cytochrome genes (CYP3A4, CYP3A5) in our kidney transplant recipients and look for the correlations between allelic variants and daily dosages of immunosupressants. (c) Pre-implantation biopsy study will correlate baseline allograft injury with immunosuppression and kidney allograft function.
Significance for science
The research programme proposal is integration of a series of studies leaded by the experienced and young reasearches of the Department of Nephrology, University Medical Center Ljubljana. Research focus would be acute kidney injury, chronic kidney disease and patients treated by renal replacement therapy (dialysis and kidney transplantation). New element of future research would be addition of experimental research with stem cells on mouse model (Željka Večerić Haler et al. Improved protective effect of umbilical cord stem cell transplantation on cisplatin-induced kidney injury in mice pretreated ba antithymocyte globulin. Stem Cells Int 2016,doi: 10.1155/2016/3585362. Epub 2016 Jan 5.). The study was recently published, the doctoral thesis of the first and leading author, employed at the Department of Nephrology, is in the final phase of evaluation. Focus of the research in the next period would be kidney diseases and replacement therapies - dialysis and kidney transplantation, treatment of complications and subsequent expected improvement of kidney patients survival and quality of life. Research group had a significant numbed of high quality SCI publications in the past. Based on programme proposal and expected involvement of new young nephrologists after completing PhD programme in the next programme funding period we expect significant contribution from our programme to the science of nephrology, dialysis and transplantation in the future.
Significance for the country
Slovenian model of renal replacement therapy (dialysis and kidney transplantation) could be promoted as "a model to follow" in many organizational approaches and treatment outcomes. Intensive research in the field of chronic kidney disease and acute kidney injury and associated comorbidities contributes to the quality improvement in this important part of global health care. Better treatment outcomes are usually associated with cost reduction. The importance of chronic kidney disease, acute kidney injury and renal replacement therapy is illustrated by the World Kidney Day, instituted by the World Health Organization, aiming to increase professional and public awareness on the importance of kidney disease and renal replacement therapy.
Most important scientific results
Annual report
2017,
2018,
2019
Most important socioeconomically and culturally relevant results
Annual report
2017,
2018,
2019
