Patients who require long-term hemodialysis need long-term vascular access. The transposed autologous vein to brachial artery arteriovenous fistula provides vascular access in the absence of adequate superficial vein. Transposed basilic (brachial) vein to brachial artery fistula have a good long-term patency rate and should be considered early, before prosthetic grafting, in the absence of a suitable superficial veins.

A retrospective analysis of survival of 125 haemodialysis patients was carried out. Evaluation of quality of life (using the SF-36 scoring method) and assessment of clinical and demographic variables have been performed the initial time point of the study. The aim of the work was to assess the predictive value of quality of life scores and clinical data. Quality of life scoring correlated significantly with survival rate. In the group of patients who died during the period of observation (n = 46) the baseline quality of life scores were significantly lower than in the group of survivals. Patient’s self-assessed physical functioning and physical summary score were found to be significant independent predictors of survival as well as the mean ultrafiltration volume, serum albumin level and Са-Р product. No significant correlation was found between the mental health scores and survival rate.

A high incidence of secondary hyperparathyreosis (HPT) was found during examination of 106 patients with the 3-5 stage of chronic kidney disease (CKD). It was revealed in 22 (62,8%) patients with the 3 stage of CKD, in 25 (83,3%) patients with the 4 stage of CKD and in 39 (95,1%) patients with the 5 stage of CKD. The effects of HPT on hemopoiesis, lipid and protein exchange and also its role in the development of systemic inflammation and arterial hypertension peculiar to kidney insufficiency have been revealed. A correlation of parathyreoid hormone level and red blood readings, C-reactive protein, blood albumin in patients with the predialysis stage of CKD (3-4 stages of CKD) has been found. The necessity of diagnosing hyperparathyreosis in the early stages of CKD and timely treatment of this kind of kidney disfunction has been proved.

Analyses of frequency and mechanisms of hyperparathyroidism and its role in bone losses were estimated in cross-match research of 158 kidney and 25 heart transplant recipients. Hyperparathyroidism was more frequent in kidney then in heart transplant patients (74 vs 36%, p < 0,05). The PTH level was elevated in kidney and heart transplant recipients, in women kidney transplant recipients it was higher then in men. Hyperparathyroidism in women correlated with haemodialysis duration before operation and with the estrogen level which was higher in pre- then in post-menopause women while the PTH level was lower in pre- then in post-menopause patients. In men the PTH level in heart and in kidney donor groups correlated with renal function and cumulative prednisolone doses. Hyperparathyroidism in men and women after kidney transplantation correlated with the axial BMD losses. In men after kidney or heart transplantation it correlated with peripheral skeleton (femoral neck) BMD losses.

Last years we have obtained data allowing us to assume a possibility that the thrombotic complications of any location within the renal vasculature are caused by the most frequent genetic thrombophilias: Leiden mutation of the coagulation factor V, mutations of the prothrombin and methylentetrahydrofolate reductase (MTHFR). Unlike other thrombophilias, the mutation of gene MTHFR that leads to hyperhomocysteinemia is characterized by both arterial and venous thromboses. In spite of the numerous researches which have established the important role of various genotypes of MTHFR and hyperhomocysteinemia in development of coronary and cerebral thromboses, the studies of development of thromboses of other localizations in patients with hyperhomocysteinemia are rare. Our case illustrates bilateral renal artery trunk thrombosis in a hemodialysis patient with heterozygous MTHFR C677T mutation and mild hyperhomocysteinemia that was the only cause of renovascular hypertension and severe renal insufficiency. The peculiarity of this case is also the total recovery of renal function following 7.5 years of treatment by long term hemodialysis. As illustrated by this case, long term anticoagulant therapy, young age and additional renal arteries on both sides provided the best circumstances for adaptation to prolonged ischemia and reperfusion of the thrombosed vessels.

Serious adverse events that occur with the administration of iron dextran are due to the high molecular weight preparations. Conclusions that iron sucrose and ferric gluconate are safer than iron dextran may be premature. Published literature comparing safety profiles of available parenteral iron products is reviewed. Administration of iron salts to pre-dialysis patients with chronic kidney disease may not be optimal. We recommend the total dose infusion of low molecular weight iron dextran as an option for iron replacement. Kidney International (2008) 73, 528-530.

Women with terminal renal insufficiency have destroyed functions of hypothalamic-pituitary-ovarian system. It causes reduced fertility, loss of libido and dysfunctional uterine bleeding. Forty percent women - dialytic patient - do have menstruations. According to different surveys, from 40 till 60 percent pregnancies, which appreared on dialysis, complete with the birth of alive babies. The case of a successful management of the pregnancy and its resolution at the dialytic patient, who got hemodialysis medical treatment for more than ten years, is described. At the period of 33 weeks Caesarean section was made and a two-kilogram boy was pulled out.