Pre-existing serum indoxyl sulfate and COVID-19 outcomes in patients undergoing hemodialysis: A retrospective cohort study

Patients undergoing hemodialysis (HD) are at increased risk of severe complications from COVID-19 due to compromised immune function and comorbidities. This retrospective study aimed to investigate the association between pre-existing serum indoxyl sulfate (IS) concentrations and COVID-19 outcomes in HD patients. Methods. Data on pre-existing IS and proinflammatory cytokines, such as interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor-alpha (TNF-α) were extracted from an existing patient database. The patients were followed up for 1.5 years and compared according to median serum IS concentration: low-IS (< 22.2 μg/mL) and high-IS (≥22.2 μg/mL) groups. The primary outcomes focused on assessing the risk and severity of COVID-19 infection. Results. A total of 56 patients aged 62 (56-67) years with a dialysis vintage of 37.5 (30-168) months were included in the analysis. Serum levels of IS were significantly correlated with Kt/V values (p = 0.043), arterial hypertension (p = 0.001), IL-6 (p = 0.023), MCP-1 (p = 0.023), and TNF-α (p = 0.033) concentrations. Elevated serum IS levels were significantly associated with an increased risk of COVID-19 infection (p < 0.0001) and a higher likelihood of hospitalization (p = 0.03). Patients with higher IS levels exhibited more severe lung involvement (p < 0.0001) and a greater need for respiratory support (p = 0.004). A serum IS concentration of 21.5 μg/mL was the optimal threshold for predicting COVID-19 infection in HD patients (sensitivity of 83.4% and specificity of 92.3%, p < 0.0001). Conclusion: Our study highlights the detrimental impact of serum IS on COVID-19 infection and its clinical outcomes in patients undergoing HD. Further research is warranted to elucidate the underlying mechanisms and explore potential therapeutic strategies targeting IS in this population.

One year of the full-scale war in Ukraine and kidney replacement therapy: Where do we stand now? A brief report of the Ukrainian Renal Disaster Relief Committee of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists

The war in Ukraine is now entering its ninth year, and a year has passed since the russian army invaded Ukraine on a large scale. A few months ago, the Ukrainian Renal Disaster Relief Committee of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists was established and began its work to provide immediate support to kidney patients during the war. In this brief report, we present the first data collected on the number of patients receiving kidney replacement therapy, the possibility of enrolling new patients, and the availability of an autonomous electricity and water supply in all regions of Ukraine accessible for communication. In addition, we provide a brief analysis of the dynamics of the regional distribution of patients treated with kidney replacement therapy in the war year.

Long-COVID sequelae are associated with oxidative stress in hemodialysis patients

pathophysiology of long-COVID sequelae in the general population of SARS-CoV-2-infected patients has been shown to be strongly influenced by oxidative stress. However, the potential role of oxidative stress in the development of long-COVID sequelae in hemodialysis patients (HD) has never been investigated. The present study aimed to evaluate the oxidative status of HD patients 3.5 months after SARS-CoV-2 infection in relation to the presence of long-COVID sequelae and the severity of the acute phase COVID-19. Methods. This cross-sectional cohort study included 63 HD patients with a median age of 55 (43-62.5) years and a dialysis vintage of 42 (25-73) months who had been infected with COVID-19 at least 3 months before recruitment. Patients were divided into two groups according to the occurrence of long-COVID sequelae: Group 1 included 31 (49.2%) HD patients with sequelae, while Group 2 included 32 (50.8%) fully recovered individuals. At 3.5 (3.2-4.6) months after the acute phase of COVID-19, malondialdehyde (MDA) and erythrocyte levels (MDAe), sulfhydryl groups (SH -groups), serum catalase activity, transferrin, and ceruloplasmin were measured. A comparison of the obtained data was performed using the Student’s test or the Mann-Whitney test according to the data distribution. A correlation was evaluated with the Spearman test. Results. HD patients with persistent long-COVID sequelae had significantly higher concentrations of MDAs (p = 0.002), MDAe (p = 0.0006), and CTs (p = 0.02), and lower serum levels of SH-groups (p = 0.03) and ceruloplasmin (p = 0.03) compared with Group 2. The concentration of most studied indicators of pro- and antioxidant status did not depend on the severity of the acute phase COVID-19, and only catalase activity was statistically significantly related to the need for hospitalization (r = 0.59; p = 0.001), oxygen support (r = 0.44; p = 0.02), and the percentage of lung injury according to computed tomography (p = 0.03). Although the serum concentration of transferrin did not differ between the studied groups, the individual analysis showed that its value was statistically higher in HD patients with severe COVID-19 even 3.5 months after infection (p < 0.0001). Conclusions. Long-term COVID-19 sequelae in HD patients are associated with oxidative stress. High levels of catalase activity and serum transferrin 3.5 months after COVID-19 may be a consequence of the severe course of the acute phase of the disease. The obtained data suggest that the use of antioxidants may be one of the possible strategies to treat the long-term consequences of COVID in HD patients.  

Recommendations of the Ukrainian Renal Disaster Relief Committee of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists regarding medical care to kidney disease patients during the war

Abstract. The occurrence of an emergency situation (ES) forced international (ISN, EDTA/ERA) and national (Turkey) nephrological associations to establish the Renal Disaster Relief Task Force, which is primarily concerned with the treatment of patients with acute kidney injury and end-stage renal disease requiring dialysis. The war started by the RF is putting the Ukrainian state, Ukrainian society, and the healthcare system in the catastrophic ES. Under these circumstances, all nephrological patients became one of the most vulnerable categories of patients. To provide immediate support in solving problems within the Ukrainian Association of Nephrologists and Kidney Transplant Specialists (UAN&KTS), the Ukrainian Renal Disaster Relief Committee (URDRC) has been established. One of the most important tasks was to form a group of experts to develop recommendations for specialized medical care for kidney patients in wartime.  According to the experts, the key person for this type of medical care is the leading nephrologist in the region or city. He/she establishes a local Renal Disaster Relief Committee (LRDRC) and decides through horizontal (with other LRDRC) or vertical (with UAN &KTS) collaboration, using available communication tools, on the problems that arise; the most appropriate tool is the Viber platform "Nephrology. Dialysis. Transplantation". In this way, a network without administrative subordination and a non-hierarchical functional system was created, which, on the one hand, functions according to similar working principles, but, on the other hand, may differ in terms of LRDRC composition, communication methods, and more. The LRDRC divides all patients into three groups and provides work preparation measures before, during and after the cancellation of ES.

Specialized medical care for chronic kidney disease patients during the war in Ukraine

         Russian invasion is an unprecedented test for the Ukrainian state, Ukrainian society, and the health care system.          According to the Ministry of Health of Ukraine, more than 600 healthcare facilities suffered serious damage (more than 100 hospitals and 450 pharmacies were ruined, and more than 200 emergency medical vehicles were destroyed).          Patients with chronic diseases in the occupied territories and war zones are deprived of medical care and support, which is a direct threat to their lives.          Chronic kidney disease (CKD) patients are one of the most vulnerable groups. Before the war, almost 10,000 patients were treated with dialysis kidney replacement therapy (KRT) and more than 1,500 had a functioning renal graft in Ukraine. The vast majority of patients with end-stage kidney disease receiving dialysis treatment were evacuated to safer regions, and some of them continued the treatment abroad. However, the war will significantly increase the number of patients in need of kidney care. In addition to the existing number of CKD patients, there will be a large group of patients with acute kidney injury (AKI) as a result of polytrauma, bleeding, injuries, or long-term compression syndrome. Currently, we cannot predict the incidence of AKI. However, according to the previously published data (18% - 34.6% of war victims), we should expect a significant increase in the population of CKD patients shortly which will require immediate changes in both organization and staffing of nephrology care. The medical community recognizes the insurmountable difficulties in providing medical support to Ukrainian citizens during the war, in particular patients receiving KRT or kidney recipients. In our opinion, special programs should be created by relevant professional associations together with the institutes of the Ministry of Health of Ukraine and the National Academy of Medical Sciences of Ukraine at both the state and regional levels in all areas. Therefore, we consider it extremely important to establish a committee for the organization of the healthcare system for CKD patients during wartime. The committee could be created within the Ukrainian Association of Nephrologists and Kidney Transplantation Specialists, for example, as the Renal Disaster Relief Task Force established by the International Association of Nephrologists. The main tasks of the committee are to create a consensus of the Ukrainian Association of Nephrologists and Kidney Transplantation Specialists on the management of CKD patients and patients with AKI during the war and the post-war period. On behalf of the Editorial Board of the Ukrainian Journal of Nephrology and Dialysis, we would like to express our sincere gratitude to all health professionals who, at the risk of their own lives, continue to save patients. All members of the Ukrainian nephrological community are doing everything possible and impossible to ensure the most adequate treatment of kidney patients in wartime. Thank you again. We pray for our heroic warriors who fearlessly defend us and defend Ukraine's independence!   Slava Ukraini! Heroiam slava!

Peritoneal dialysis and peritoneal fibrosis: molecular mechanisms, risk factors and prospects for prevention

Peritoneal dialysis (PD) leads to structural and functional changes in the peritoneal membrane, the endpoint of which is peritoneal fibrosis. Peritoneal fibrosis is diagnosed in 50% and 80% of PD patients within 1 and 2 years of treatment initiation, respectively. A key role in the development of peritoneal fibrosis is played by mesothelial-mesenchymal transformation, a complex biological process of transition from mesothelium to mesenchyme. This review summarizes the current knowledge on the changes in peritoneal function and morphology, the molecular mechanisms of peritoneal fibrosis development, and its clinical consequences during PD. Special attention is given to established and potential risk factors for peritoneal fibrosis, and existing prevention strategies are considered.

Association of early maladaptive schemas and psychiatric disorders between sex offenders

Introduction

Schema-therapy (ST) - one of the promising integrative models of psychotherapy, which shows its efficacy in many mental disorders. ST has main theoretical concepts: early maladaptive schemas (EMS), coping styles, modes and basic needs. EMS are self-defeating emotional and cognitive patterns established from childhood and repeated throughout life. Existing literature shows the connection between EMS and behavioral problems, which could be more significant for patients with personality disorders. The prevalence of personality disorders is relatively low in the general population, but it’s highly overrepresented in the forensic population, especially in groups of sex offenders.

Objectives

The aim of this study is to examine if there is a prevalence of some EMS between sex offenders and their association with a diagnosed psychiatric disorder.

Methods

Medical records and criminal case materials of 27 patients were reviewed, all of them were blamed for committing sex crimes and had to stay at the department for one month for forensic psychiatry examination. During their stay patients were examined several times and questioned with YSQ S3R.

Results

Most of the patients had psychiatric disorder: specific personality disorders (14), pedophilia (3), dependence syndrome (4), organic personality disorder (3). Some of them had several psychiatric diagnoses. The most prevalent EMS were abandonment, emotional deprivation, insufficient self-control and defectiveness.

Conclusions

These findings show the prevalence of personality disorder and several EMS in sex offenders, which could be useful for the full understanding of the concept of PD and improve the organization of medical care for these individuals.

Disclosure

No significant relationships.

Post-COVID syndrome in dialysis patients and kidney transplant recipients

Abstract. Patients on maintenance dialysis treatment and kidney transplant recipients who survive coronavirus disease 2019 (COVID-19) are at higher risk of post-COVID syndrome compared to the general population. However, a detailed assessment of the causes, features, and clinical outcomes of the post-COVID syndrome in this patients’ cohort does not yet been established. In this review, we summarize published research on this issue to use these available data to predict the development, treatment and prevention of the post-COVID syndrome in dialysis patients and kidney transplant recipients.

Prognostic Assessment of Stress-Related Factors in Healthcare Workers During the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic is an extraordinary challenge for all countries and affects the psychological wellbeing of healthcare professionals working with people suffering from COVID-19 and puts them at a high risk of mental health problems. The aim of the study was to identify stress-related factors that affect the mental health of healthcare workers during the COVID-19 pandemic in Ukraine.

SUBJECTS AND METHODS

A total of 1098 Ukrainian healthcare workers were surveyed using an online questionnaire consisting of questions relating to a) socio-demographic characteristics; b) perceptions of the COVID-19 related situation; and c) stress and protective factors. Respondents were divided into two groups, depending on whether they provided care to the patients with COVID-19 or not.

RESULTS

Of the 1087 healthcare workers, 863 (79.4%) were found to have anxiety / fear caused by the COVID-19. No significant difference was detected between professionals who did and did not provide personal assistance to patients with COVID-19 concerning anxiety / fear related to COVID-19 (p=0.0776). Based on logistic regression model (χ²(6)=263.70, p=0.000) the most significant predictive factors for anxiety / fear caused by the COVID-19 were factors related to safety and risk perception (the risk of getting infected, dying, infecting loved ones, perception of the threat of the epidemic spread), information factors (constant news about COVID-19), as well as factors related to the organisation of care (lack of staff in health care facilities).

CONCLUSIONS

Negative risk perception, high consumption of COVID-19 news, and shortage of staff in health care facilities were significant predictors of anxiety / fear caused by the COVID-19.

State Institution ‘Institute of Nephrology of the National Academy of Medical Sciences of Ukraine’: 20 years afterward

Abstract. The Institute of Nephrology of the Academy of Medical Sciences of Ukraine was established in 2001. Since then, the Institute has been constantly evolving and, currently, it is a national scientific, methodological and medical center in the field of nephrology. The achievements of the Institute's staff are recognized in Ukraine and the world scientific community. The article presents an analysis of the results of the Institute's activities for 2001-2021.

High-density lipoproteins and clinical outcomes of COVID-19 in hemodialysis patients: A multicenter, propensity-score matched case-control study

Abstract. A decline in high-density lipoprotein (HDL) has been observed in the general population of COVID-19 infected patients. However, little research has been devoted to this topic in hemodialysis (HD) patients and there is a general lack of data on the association between the baseline HDL level and COVID-19 outcomes in HD patients. The present study aimed to assess the association between baseline HDL levels and the risk of developing severe outcomes of COVID-19 infection in HD patients. Methods. A total of 428 HD patients aged 55 (44-64) years and a dialysis vintage of 44 (21-76.6) months were enrolled in this multicenter propensity-score matched case-control study. After propensity-score matching (1 :1), 142 COVID-19 infected HD patients were compared with 142 HD patients who had never been infected with COVID-19. Propensity scores were estimated with MedCalc software based on potential confounding variables (age, diabetes, dialysis vintage and cardiovascular events). Baseline HDL levels were obtained from electronic health records of the patients (the last measurements were carried out before the COVID-19 onset). The endpoints of the study were COVID-19-related hospitalization, oxygen maintenance, and death. The data were presented as the median and the interquartile ranges [Me (Q25-Q75)] and compared using the Mann-Whitney or Kruskal-Wallis tests, as appropriate. The Spearmen correlation test was used to assess the association between HDL and other markers. The multivariate logistic regression and the receiver operating characteristic (ROC) analyses were performed to evaluate the ability of HDL for predicting the severity of COVID-19 infection. The Cox regression analysis was used to determine the association between HDL and COVID-19-associated mortality. Results. Among 142 patients infected with COVID-19, 40 patients (28%) patients were hospitalized, 34 patients (24%) needed oxygen supplements and 16 patients (11.3%) died. The baseline HDL level was significantly lower in the COVID-19 patients compared with the non-infected patients (1.22 (0.97-1.59) vs 1.52 (1.08-1.85) mmol/L, p = 0.011). Moreover, the baseline HDL level was significantly negatively associated with CT findings of pulmonary involvement (r = -0.76, p < 0.0001) and had a strong inverse correlation with serum C-reactive protein (r = -0.42, p = 0,0002) and D-dimer (r = -0.65, p < 0.0001). The multivariate logistic regression analysis demonstrated that HD patients with HDL concentration <1.22 mmol/l have 3 times higher risk of COVID-19 infection (OR 2.8; 95% CI 1.2; 6.5, p = 0.003).  In the Cox regression analysis adjusted for the patients’ age, diabetic status, dialysis vintage and cardiovascular events, low HDL level (<1.22 mmol/L) was found to be associated with COVID-19-related mortality in the HD patients (χ2 = 9.2, p = 0.002). Conclusions. Baseline low HDL-C level was independently associated with COVID-19 morbidity, severity and mortality in HD patients.

Prevention, diagnosis and management of acute kidney injury: Adapted clinical guidelines of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists

Over the last decade, the paradigm of acute renal injury has been changed fundamentally. Unfortunately, the routine clinical practice in Ukraine demonstrates extremely unsatisfactory awareness of the medical community on these issues. In this regard, the Expert Group of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists has created the Adapted Clinical Guidelines on this important issue to improve the professional expertise of doctors, awareness of patients and their families.

Plasma oxalic acid as a trigger for oxidative processes in end-stage renal disease patients

The present study aimed to evaluate the changes in oxidative stress markers according to the concentration of plasma oxalic acid (POx) in end-stage renal disease (ESRD) patients. Methods. We conducted a cross-sectional observational study involving 72 ESRD patients and 30 relatively healthy individuals who served as a control reference group for evaluation of POx concentration. Among ESRD patients there were 32 hemodialysis (HD) patients and 40 peritoneal dialysis (PD). POx concentration was measured spectrophotometrically using a commercially available kit (MAK315, Sigma, Spain). Malonic dialdehyde (MDA), ceruloplasmin (CP), transferrin (TR), sulfhydryl groups (SH-groups), antioxidant blood capacity (AOC) and total peroxidase activity of erythrocytes (TPA) were measured and the oxidative stress index (OSI) was calculated in all examined patients. Results. A significant increase in POx concentration was observed in ESRD patients compared with healthy volunteers (p < 0.0001). The concentrations of MDA in serum, OSI in erythrocytes and serum of the examined patients were gradually increased, while serum levels of CP, AOC, SH-groups and TPA in erythrocytes, on the contrary, were decreased in accordance with the increasing trend of POx concentrations. Correlation analysis demonstrated a statistically significant direct relationship between POx concentration and MDA (r = 0.57; p <0.0001) and OSI (r = 0.64; p <0.0001). The inverse correlation was determined between POx and antioxidant markers: CP (r = -0.35; p = 0.007), SH-groups in serum (r = -0.3; p = 0.04) and erythrocytes (r = -0.53 ; p <0.0001). Conclusions. The intensity of oxidative-antioxidant balance disorders in the blood of ESRD patients has been associated with the POx concentration: the higher the concentration of POx was the more active oxidative processes and the more pronounced lack of antioxidant protective factors occurred. Further studies are needed to determine the role of POx in the initiation of oxidative stress and chronic inflammation in ESRD patients.

Evaluation of the BAX® System for Detection of Listeria monocytogenes in Foods: Collaborative Study

A multilaboratory study was conducted to compare the automated BAX® system and the standard cultural methods for detection of Listeria monocytogenes in foods. Six food types (frankfurters, soft cheese, smoked salmon, raw, ground beef, fresh radishes, and frozen peas) were analyzed by each method. For each food type, 3 inoculation levels were tested: high (average of 2 CFU/g), low (average of 0.2 CFU/g) and uninoculated controls. A total of 25 laboratories representing government and industry participated. Of the 2335 samples analyzed, 1109 were positive by the BAX system and 1115 were positive by the standard method. A Chi square analysis of each of the 6 food types, at the 3 inoculation levels tested, was performed. For all foods, except radishes, the BAX system performed as well as or better than the standard reference methods based on the Chi square results.

[PREDICTION OF RECURRENT PYELONEPHRITIS BY AN INDEX OF OXIDATIVE STRESS]

We examined the indicators of oxidant/antioxidant (O/A) balance in the blood of, 118 women with chronic pyelonephritis. (PN), aged 18 to 69 years (mean 36.0 +/- 7.9 years) and 30 conventionally healthy donors: 82 (69.5%) of patients had the recurrent PN, 36 (30.5%) of women had the sporadic PN. The malondialdehyde in serum, ceruloplasmin, transferrin and the number of sulfhydryl groups, which allowed to calculate the index of oxidative stress (IOS) were included into the complex research of O/A balance. IOS was significantly increased in patients with recurrent PN 4.27 2.06 vs. 2.30 +/- 1.06 for sporadic PN (P < 0;001). It allowed us to conduct the multivaiate analysis using binary logistic regression. The analysis demonstrated alhigh quality (>80 %) of regression model chi2 = 74.3; P < 0.001, odds ratio (OR) = 7.5, 95% CI 3.3-7.1. We have created an additional examinational sample to confirm the adequacy of this model which included the test results of 23 pa- tients with acute PN in 6 (26%) of them have developed recurrent PN. We defined a high quality of examinational model chi2 = 11.2; P = 0.0008, OR =3.34, 95% CI 1.3-10.3. The optimal criteria for IOS was > 3, sensitivity 100%, and for specificity 94%. Thus, for the prediction of recurrent PN can be evaluated the IOS. The development of recurrent PN can be predicted with probability 97.6% if value of IOS > 2.5; this will optimize the rehabilitation program of patients Vith acute PN.

Evaluation of the BAX system for detection of Listeria monocytogenes in foods: collaborative study

A multilaboratory study was conducted to compare the automated BAX system and the standard cultural methods for detection of Listeria monocytogenes in foods. Six food types (frankfurters, soft cheese, smoked salmon, raw, ground beef, fresh radishes, and frozen peas) were analyzed by each method. For each food type, 3 inoculation levels were tested: high (average of 2 CFU/g), low (average of 0.2 CFU/g) and uninoculated controls. A total of 25 laboratories representing government and industry participated. Of the 2335 samples analyzed, 1109 were positive by the BAX system and 1115 were positive by the standard method. A Chi square analysis of each of the 6 food types, at the 3 inoculation levels tested, was performed. For all foods, except radishes, the BAX system performed as well as or better than the standard reference methods based on the Chi square results.