Background. Tunneled catheters are becoming increasingly used as a permanent dialysis access. Easy way of insertion and good long-term patency make them competitive to fistulas in some groups of patients. Methods. Late complications and survival of 180 tunneled catheters inserted from June 2010 to December 2013 in 171 unselected hemodialysis patients were analyzed. Results. The cumulative time of observation was 2103.5 patient-months and median observation was 9 months (range of 0.5-45 months). Only 19 out of 180 catheters were removed due to complications (12 for infections, 4 due to malfunction and 3 because of mechanical damage). Majority of catheters were removed electively: 27 after maturation of arterio-venous fistula (AVF), 4 after kidney transplant, 5 after transfer to peritoneal dialysis and 3 due to the recovery of renal function. At the end of the observation, 58 catheters were still in use and 64 patients had died with functioning catheter. When censored for elective catheter removal and patient death, 88.2% of catheters survived for 1 year. Catheter survival was significantly better in older patients (over 65 years, in comparison to patients < 65 years, p = 0.046). Conclusions. Nearly 90% of all inserted catheters gave reliable dialysis access as long as it was needed. Among them, over 30% of the inserted catheters were in use at the end of the observation period, and over 30% of patients had died with a functioning catheter. The results of tunneled catheters survival are encouraging and they should be taken into consideration during decision-making on vascular access, especially in the older patients.
Objectives. Post exercise proteinuria (PEP) is found in about 20–40% of sportsmen after intensive exercise. Urinary NGAL is a new marker of tubulointerstitial kidney damage. The relationship between PEP and uNGAL has not been defined yet. In presented study a resting uNGAL as a predictor of PEP was analyzed. The changes of albuminuria after exercise were monitored to estimate a frequency and range of PEP. Methods. 40 amateur healthy runners (mean age 36.65 ±10.61 years) participating in 10-km run took part in the study. Before and after the competition urine was collected. NGAL, albumin and creatinine were subsequently measured in urine. uNGAL to creatinine ratio (NCR) and albumin to creatinine ratio (ACR) were calculated. Results. 28 participants (mean age 37.9 ±11.46, 19 M, 9 F) with uNGAL below 15 ng/ml before competition were analyzed. The increase of ACR was observed in every case. Mean post-exercise ACR was 104.55 ±123.1 mg/g and was significantly higher than pre-exercise ACR 6.33 ±5.86 mg/g (p < 0.0005). The positive correlation was found between resting NCR and post-exercise ACR (r = 0.60, p < 0.05). Conclusions. Resting uNGAL positively correlated with PEP. The possible explanation of these findings is that persons with PEP had some early, occult tubulointersitial kidney damage. It is speculated that those runners have higher risk of chronic kidney disease.
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