Projects / Programmes
RENAL DISEASES AND RENAL REPLACEMENT TREATMENT
January 1, 2009
- December 31, 2012
| Code |
Science |
Field |
Subfield |
| 3.06.00 |
Medical sciences |
Cardiovascular system |
|
| Code |
Science |
Field |
| B560 |
Biomedical sciences |
Urology, nephrology |
| Code |
Science |
Field |
| 3.02 |
Medical and Health Sciences |
Clinical medicine |
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
Researchers of the Department of Nephrology, University Medical Center Ljubljana participate in the research program P3-0323 »Kidney diseases and renal replacement therapy«. They are active in research on chronic and acute kidney injury and renal replacement therapy. In the period 2009-2012 they have published as (co)authors 58 original manuscripts. They participated as the partners in two large EU-funded research projects: NephroQUEST – European Quality Nephrology Improvement Network in ARCH - Patient-specific image-based computational modelling for improvement of short- and long-term outcome of vascular access in patients on hemodialysis therapy. In addition to that, they participated in the CTS – Collaborative Transplant Study. The most important publications in this period were two big randomized studes performed at the Department of Nephrology, University Medical Center Ljubljana. The first one was from kidney transplantation (Basiliximab versus daclizumab combined with triple immunosuppression in deceased donor renal transplantation: a prospective, randomized study). It was published in one of the most influential transplantation journals, Transplantation, in 2010. The second study was from the field of acute kidney injury (Intermittent high-volume predilution on-line haemofiltration versus standard intermittent haemodialysis in critically ill patients with acute kidney injury: a prospective randomized study). It was published in the December 2012 issue Nephrology, Dialysis and Transplantation. This study was accompanied by an editorial in the same issue of the journal, with detailed analysis of the study implications for further clinical practice and research. Three doctoral and one master thesis were completed in period 2009-2012 under (co)mentorship of the researchers of the program. We have organized two conferences with international participation: The 5th Slovenian Congress of Nephrology in 2012 and the Symposium celebrating 40th anniversary of dialysis and kidney transplantation in Slovenia in 2010. Results from our studies were presented on these meetings. We have also organized two courses in collaboration with international scientific societies: Winter School of the European Society for Artificial Organs in Kranjska Gora in 2009 and ERA/EDTA CME Course (European Renal Associatioin/European Dialysis and Transplant Association) in Bled in 2011. Researchers from the program were the principal investigators of the 11 tertiary research projects funded by the University Medical Center Ljubljana. Research is continued intensively in the 2013. Presentations at the most important international meetings in the field of nephrology, dialysis and transplantation and original manuscripts submitted or accepted for publications in the next months show that research activity and productivity of the Department of Nephrology, University Medical Center research group will probably increase in the next years.
Significance for the country
The level of health care for the patients with kidney diseases and renal replacement therapy in Slovenia is very high. Comparison with other countries in the quality parameters of dialysis and kidney transplantation shows that some important renal replacement therapy outcomes in Slovenia are significantly better than average in some developed coutries. In addition to clinical outcomes, intensive research through research program P3-0323 contributes to the improvement of the everyday clinical care of the patients with kidney diseases. With intensive research, publications, presentations on international conferences and invited lectures on international meetings, slovenian model of dialysis and transplantation is actively promoted as a potential model-to-follow for the country or region of similar size and transplant activity. Department of Nephrology at University Medical Center Ljubljana is becoming increasingly popular destination for the colleagues from the other countries, as a training center of certain skills in nephrology, dialysis and transplantation. All these activities are important in the view of free flow of patients through EU that is planned to be realized in near future. Slovenia, with high quality of health care delivered for the patients with kidney diseases and need for renal replacement therapy may become desirable destination for the patients from other countries for certain health care services.
Most important scientific results
Annual report
2009,
2010,
2011,
final report,
complete report on dLib.si
Most important socioeconomically and culturally relevant results
Annual report
2009,
2010,
2011,
final report,
complete report on dLib.si
