Projects / Programmes
RENAL DISEASES AND RENAL REPLACEMENT TREATMENT
July 1, 2004
- December 31, 2008
| Code |
Science |
Field |
Subfield |
| 3.06.00 |
Medical sciences |
Cardiovascular system |
|
| Code |
Science |
Field |
| B560 |
Biomedical sciences |
Urology, nephrology |
renal diseases, chronic renal failure, acute renal failure, dialysis, hemodialysis, peritoneal dialysis, apheresis, renal transplantation, vascular access, arterial hypertension
Researchers (24)
Organisations (1)
Abstract
The number of patients with end stage kidney failure has been increasing worldwide and also in Slovenia as well as the number of older patients with progressive kidney disease. We would like to establish the most frequent kidney diseases connected with the worsening of kidney function and end stage kidney failure; to investigate the risk factors for progression of kidney disease and study clinical and histopathologic connections, and analyze factors that would influence on kidney and patient survival.
Long-term survival and quality of life of patients on dialysis is dependent on the adequacy of dialysis via an appropriately placed vascular access. It has been shown beyond doubt that an optimally functioning AVF is a good prognostic factor of patient morbidity and mortality in the pre-dialysis phase. Recent clinical practice guidelines recommend the creation of an AVF as vascular access before the start of chronic haemodialysis therapy to prevent the need for complication-prone dialysis catheters. We will follow how early and late referral to nephrologist influence the time of construction of AVF and what is the influence of different point of view of nephrologist on an AVF construction. We will follow patients with early and late AVF construction before and after haemodialysis treatment: survival and morbidity of patients in both groups. In group of transplanted patients we will follow a long-time survival of AVF after transplantation and influence of AVF thrombosis on the transplant function. Methodology of those studies will be non-invasive diagnostic (duplex sonography), laboratory values and clinical examination.
In patients on peritoneal dialysis the investigators would study the biocompatibility of newer dialiysis solutions in respect to standard solutions in respect to frequncy of peritonitis, ultrafiltration, lipid profile, residual kidney functions and some other markers.
The aim of prospective randomized study is assessment of efficacy, safety and tolerability of immunosuppression with basiliximab and daclizumab in adult recipients of cadaveric kidneys. These two drugs will be combined with cyclosporine, mycophenolate mophetil, and low dose of steroids. Approximately 200 patients will be included in this study. Recipients will be followed 5 years after transplantation. The function of transplanted kidneys, frequency of acute rejection episodes, frequency and severity of infections, malignancies, and eventual hypersensitivity reactions will be studied.
Recurrence of focal segmental glomerular sclerosis (FSGS) in transplanted kidney can lead to severe graft injury and lose of graft function. In recent years there have been promissing reports in the literature of favourable effect of membrane plasma exchange and immunoadsorption on graft function when recurrence of FSGS occurred. In the prospective clinical study the effect of chronic membrane plasma exchange or immunoadsorption therapy on recurrence of FSGS have been assesed.
The Annual report of renal replacement therapy in Slovenia is the important tool to evaluate quantity and quality of this therapy. It enables timely correction and planning of dialysis centers network, staff and finantial coverage. Comparison with other countries is also enabled.
Histomorphologic changes and bone mineral density in kidney transplant patients will be studied.
Significance for science
The results of research program bring a piece of contribution to the general scientific progres in the field of end-stage renal disease treatment. On the basis of good and comparable results of patient management to the best of western countries, following important and results are established: -comparative analysis of effects and clinical impact of anti-IL2-receptor monoclonal antibodies induction antirejection treatment; -finding of the risk factors and cardiovascular risk mechanisms in kidney transplant patients; -the development of citrate anticoagulation for hemodialysis, hemodiafiltration, and apheresis; -epidemiological analyisis of the patient population in end-stage renal disease; -analysis of the effects of novel peritoneal dialysis solutions on peritoneal membrane inflammation and performance; -dialysis access management. In the 2004-2008 period, we published 21 orginal research papers and detected 451 (SICRIS methodology) citations of our works.
Significance for the country
The research programe results are important for the slovenian scientific progress in the following aspects: 1.) The research in the fields of dialysis and citrate anticoagulation has resulted in the development of the most recent and updated protocols for citrate anticoagulation, which enable to perform safe dialysis treatment under the conditions of insufficient hemostasis and coagulation and lead to safe and efficient dialysis treatment of critically ill slovenian patients in intensive care units and elswhere. 2.) The establishment of the Slovenian renal replacement therapy registry enables to survey the epidemiology of end stage renal disease in Slovenia and trends in renal replacement therapy. This is a crucial informational source for health politics planning. 3.) Through research in the field of renal transplantation we have developed modern transplantation protocols , which yield good results above the average of comparable european regions. 4.) THe research work in this programe enables us to meet with the advanced technology and methods, which will eventually become a part of rutine clinical patient management.
Most important scientific results
Final report,
complete report on dLib.si
Most important socioeconomically and culturally relevant results
Final report,
complete report on dLib.si
