Faculty of Medicine

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Predictive Admission Risk Factors, Clinical Features and Kidney Outcomes in Covid-19 Hospitalised Patients with Acute Kidney Injury
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-12-01)
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Milenkova, Mimoza
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Vasileva, Adrijana Spasovska
Introduction: In COVID-19 patients, acute kidney injury (AKI) is recognized as a cause of high mortality. The aim of our study was to assess the rate and the predictors of AKI as well as survival among COVID-19 patients. Methods: We analyzed clinical and laboratory admission data, predictors of AKI and outcomes including the need for renal replacement therapy (RRT) and mortality at 30 days. Results: Out of 115 patients, 62 (53.9%) presented with AKI: 21 (33.9%) at stage 1, 7(11.3%) at stage 2, and 34 (54.8%) at stage 3. RRT was required in 22.6% of patients and was resolved in 76%. Pre-existing CKD was associated with a 13-fold risk of AKI (p= 0.0001). Low albumin (p = 0.017), thrombocytopenia (p = 0.022) and increase of creatine kinase over 350UI (p = 0.024) were independently associated with a higher risk for AKI. Mortality rates were significantly higher among patients who developed AKI compared to those without (59.6% vs 30.2%, p= 0.003). Low oxygen blood saturation at admission and albumin were found as powerful independent predictors of mortality (OR 0.937; 95%CI: 0.917 – 0.958, p = 0.000; OR 0.987; 95%CI: 0.885–0.991, p= 0.024, respectively). Longer survival was observed in patients without AKI compared to patients with AKI (22.01± 1.703 vs 16.69 ± 1.54, log rank p= 0.009). Conclusion: Renal impairment is significant in hospitalized COVID-19 patients. The severity of the disease itself is emphasized as main contributing mechanism in the occurrence of AKI, and lower blood saturation at admission is the strongest mortality predictor, surpassing the significance of the AKI itself.
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THE TREND OF RENAL REPLACEMENT THERAPY IN N. MACEDONIA FROM 2015 TO 2020: DATA FROM THE ERA-EDTA ANNUAL REGISTRY
(Oxford University Press (OUP), 2023-06)
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Cibrev, Dragan
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Background and Aims Kidney Failure (KF) is treated with three modalities of renal replacement therapy (RRT): kidney transplantation (Tx), hemodialysis (HD), and peritoneal dialysis (PD). Our study aimed to present the trend of RRT in N. Macedonia from 2015 to 2020. Method The epidemiological retrospective study analyzed the patients with kidney failure by gender, age, etiology of kidney disease, and modality of RRT. The data were processed from the annual reports of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA). The study patients were divided into group 1 (prevalent) with patients on the RRT at the current year, group 2 (incidence at Day 1) with patients on the RRT with a duration of at least 1 day, and group 3 (incidence at Day 91) with patients on the RRT with a duration beyond 91 days. Results A total of 10395 patients were analyzed with a mean age of 59.2 ± 9.5 years (median 60.4 years), of which 60.2% were male. From 2015 to 2019, there was an increasing trend in all groups, and most patients were reported in 2019. In group 1, 1598 patients were registered in 2015, and 1762 patients were registered in 2020, which is an increasing trend of 10.3%. The number of patients in group 2 was increasing every following year, with the highest growth in 2019 up to 12.1%, compared to 2018. The number of patients in group 3 also showed significant growth from 253 patients in 2015 to 324 patients in 2019, but there was a decrease of 16.4% in 2020 (271 patients). Deviations are observed in 2020, with a decrease in the number of patients in group 1 and group 3, as well as a slowdown in the growth dynamics of patients in group 2, which might be associated with the start of the SARS-CoV-2 pandemic. According to the modality, most of the patients (84.7%) were on HD in 2015 and 85.9% in 2020. The most frequent age group of patients was from 45 to 64 years, from 36.3% to 49.4%. There was an increasing trend of patients from older age groups (over 64 years) and male patients. The increasing number of patients from the age group 75+ years was also noted in all groups. Etiology of kidney disease: hypertension (25.8%) and diabetes mellitus (17.4%) were the leading causes of KF in patients requiring RRT. Conclusion The study showed a constantly increasing trend of patients with KF requiring RRT. The largest number of patients were men, aged from 45 to 64 years. Hypertension and diabetes mellitus were the leading causes of KF, and most of the patients were treated with HD.
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Diabetic Kidney Disease Position Paper of the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO), Macedonian Society of Cardiology (MSC), and Scientific Association of Endocrinologists and Diabetologists of Macedonia (SAEDM)
(Walter de Gruyter GmbH, 2024-11-01)
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Diabetic kidney disease (DKD) is a significant and growing global health concern, affecting a substantial proportion of individuals with diabetes mellitus. This position paper of Scientific societies of endocrinologists, nephrologists and cardiologists has been consensually brought at a couple of mutual meetings, aiming to synthesize current knowledge on screening, diagnosis and staging of DKD, emphasizing the need for an early detection and intervention in order to prevent progression to end-stage renal disease (ESRD). The role of glycemic control, blood pressure management, lipid management and the use of reno and cardioprotective agents, including angiotensin-converting enzyme inhibitors, sodium-glucose co-transporter 2 inhibitors and non-steroidal mineralocorticisteroid receptor antagonist has been entirely considered. Furthermore, we highlight the importance of a multidisciplinary approach in the care of patients with DKD, integrating lifestyle modifications and patient education into the clinical practice. This paper advocates for the implementation of standardized screening protocols and the development of personalized treatment strategies to optimize patient outcomes. By addressing the complexities of DKD, we aim to provide a comprehensive framework for healthcare professionals to enhance the quality of care for individuals at risk of or living with this condition.
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Living donor kidney transplantation in a patient with inherited skin fragility disorder in a resource-limited setting: a case report
(Oxford University Press (OUP), 2025-11-29)
Dohchev, Sasho
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Trifunovski, Aleksandar
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Trajkovski, Dimitar
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Janchulev, Josif
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Kidney transplantation in individuals with congenital skin fragility diseases is exceedingly uncommon due to perioperative concerns such as compromised wound healing, respiratory complications, and issues with vascular access. Herein, we report a case of successful living-donor kidney transplantation in a 37-year-old male with dystrophic epidermolysis bullosa and end-stage renal disease. Multidisciplinary planning, customized anesthesia, and protective intraoperative measures are essential to avoid these problems. Epidural anesthesia combined with mild sedation facilitated surgery without the need for airway instrumentation, while meticulous handling maintained skin integrity. The operation and recovery were unremarkable, and the graft function was maintained at 12 months. This case demonstrates that complex transplantation is achievable in environments with limited resources, through personalized perioperative treatment and interdisciplinary cooperation.
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Association of FGF23 with markers of macrovascular complications, lipid profile, and inflammation in patients with type 2 diabetes mellitus and early-stage chronic kidney disease
(Balkan Cities Association of Nephrology, Dialysis, Transplantation and Artificial Organs, 2025-12)
Minova Nedeska, Natasha
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Kostovska, Irena
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Baloski M
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Ilievska CV
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A New Hope on the Horizon for Kidney and Cardiovascular Protection with SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Mineralocorticoid Receptor Antagonists in Type 2 Diabetic and Chronic Kidney Disease Patients
(Mary Ann Liebert Inc, 2024-04)
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Rroji, Merita
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Hristov, Goce
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Bushljetikj, Oliver
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Spahia, Nereida
Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD). In addition, the cardiovascular prevalence in diabetic patients is around 32.2%, with a two-fold increased mortality risk compared to those without diabetes. Recent investigations have shed light on the promising cardioprotective and nephroprotective benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) for individuals with T2D. The evidence robustly indicates that SGLT2i and GLP-1RA significantly reduce the risk of CKD and cardiovascular disease (CVD), all while effectively managing blood glucose levels. Furthermore, combining SGLT2i with nsMRAs amplifies the benefits, potentially offering a more profound reduction in cardiovascular and renal outcomes. The data analysis strongly supports the integration of these pharmacological agents in the management strategies for CKD and CVD prevention among T2D patients, highlighting the importance of awareness among nephrologists, especially in regions with limited healthcare resources.
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Omics Studies in CKD: Diagnostic Opportunities and Therapeutic Potential
(Wiley, 2025-06)
Rroji, Merita
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Omics technologies have significantly advanced the prediction and therapeutic approaches for chronic kidney disease (CKD) by providing comprehensive molecular insights. This is a review of the current state and future prospects of integrating biomarkers into the clinical practice for CKD, aiming to improve patient outcomes by targeted therapeutic interventions. In fact, the integration of genomic, transcriptomic, proteomic, and metabolomic data has enhanced our understanding of CKD pathogenesis and identified novel biomarkers for an early diagnosis and targeted treatment. Advanced computational methods and artificial intelligence (AI) have further refined multi-omics data analysis, leading to more accurate prediction models for disease progression and therapeutic responses. These developments highlight the potential to improve CKD patient care with a precise and individualized treatment plan .
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Effect of spironolactone wash-out on albuminuria after long-term treatment in individuals with type 2 diabetes and high risk of kidney disease-An observational follow-up of the PRIORITY study
(Wiley, 2025-01)
Wasehuus, Victor
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Rotbain Curovic, Viktor
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Tofte, Nete
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Lindhardt, Morten
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Currie, Gemma
This study aimed to explore the effect of discontinuation of long-term spironolactone treatment on markers of kidney function in individuals with type 2 diabetes (T2D) at high risk of kidney disease enrolled in the Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria (PRIORITY) study.
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Transforming Diabetes Care: The Molecular Pathways through Which GLP1-RAs Impact the Kidneys in Diabetic Kidney Disease
(MDPI AG, 2024-03-14)
Rroji, Merita
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Diabetic kidney disease (DKD) is a substantial complication of type 2 diabetes (T2D), presenting challenges in chronic kidney disease (CKD) management. In addition to traditional and recent therapies, including angiotensin, converting enzyme (ACE) inhibitors, angiotensin receptor blockers, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists, the evolution of antihyperglycemic treatments has introduced a promising agent, glucagon-like peptide-1 receptor agonist (GLP-1RA) for the management of DKD. GLP-1RAs enhance insulin release and reduce glucagon release, offering a novel approach to DKD management. This review analyzes the molecular pathways through which GLP1-RAs confer renal protection in T2D and DKD, which are complex and multifaceted. They include modulation of renal hemodynamics, antioxidative and anti-inflammatory actions, metabolic regulation, and direct cellular effects. These mechanisms highlight GLP1-RA's potential as a therapeutic option for glycemic control and direct or indirect renal function protection in diabetic patients, emphasizing the potentiality of GLP-1RAs for dual therapy, with cardiovascular and renal protection as a holistic approach. Clinical evidence supports GLP-1RAs in reducing albuminuria and enhancing kidney outcomes, highlighting their value in a comprehensive DKD management strategy.
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Drugs with a negative impact on cognitive functions (part 3): antibacterial agents in patients with chronic kidney disease
(Oxford University Press (OUP), 2024-08)
Liabeuf, Sophie
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Hafez, Gaye
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Pešić, Vesna
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Bobot, Mickaël
The relationship between chronic kidney disease (CKD) and cognitive function has received increased attention in recent years. Antibacterial agents (ABs) represent a critical component of therapy regimens in patients with CKD due to increased susceptibility to infections. Following our reviewing work on the neurocognitive impact of long-term medications in patients with CKD, we propose to focus on AB-induced direct and indirect consequences on cognitive function. Patients with CKD are predisposed to adverse drug reactions (ADRs) due to altered drug pharmacokinetics, glomerular filtration decline, and the potential disruption of the blood-brain barrier. ABs have been identified as a major cause of ADRs in vulnerable patient populations. This review examines the direct neurotoxic effects of AB classes (e.g. beta-lactams, fluoroquinolones, aminoglycosides, and metronidazole) on the central nervous system (CNS) in patients with CKD. We will mainly focus on the acute effects on the CNS associated with AB since they are the most extensively studied effects in CKD patients. Moreover, the review describes the modulation of the gut microbiota by ABs, potentially influencing CNS symptoms. The intricate brain-gut-kidney axis emerges as a pivotal focus, revealing the interplay between microbiota alterations induced by ABs and CNS manifestations in patients with CKD. The prevalence of antibiotic-associated encephalopathy in patients with CKD undergoing intravenous AB therapy supports the use of therapeutic drug monitoring for ABs to reduce the number and seriousness of ADRs in this patient population. In conclusion, elucidating AB-induced cognitive effects in patients with CKD demands a comprehensive understanding and tailored therapeutic strategies that account for altered pharmacokinetics and the brain-gut-kidney axis.

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