Faculty of Medicine
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Item type:Publication, EMERGING BIOMARKERS AT THE CROSSROADS OF CARDIAC, RENAL, AND HEPATIC DYSFUNCTION: A NEW ERA IN MULTIORGAN RISK STRATIFICATION(Faculty of Medicine, Ss Cyril and Methodius University in Skopje, 2026-03-24); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Pathohistomorphometric and Immuno-Histologic Changes in Early Arteriovenous Fistula Failure in Patients with Chronic Kidney Disease(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2024-07-15); ; ; ; Popov, ZivkoBackground Hemodialysis is a prevalent treatment for the end-stage chronic kidney disease (CKD) worldwide. The primary arteriovenous fistula (AVF), widely considered the optimal hemodialysis access method, fails to mature in up to two-thirds of the cases. The etiology of the early AVF failure, defined as thrombosis or inability to use within three months post-creation remains less understood, and is influenced by various factors including patient demographics, surgical techniques, and genetic predispositions. Neointimal hyperplasia is a primary histological finding in stenotic lesions leading to the AVF failure. However, there are insufficient data on the cellular phenotypes and the impact of the preexisting CKD-related factors. This study aims to investigate the histological, morphometric, and immunohistochemical alterations in the fistula vein, pre-, peri-, and post-early failure. Materials and Methods Eighty-nine stage 4-5 CKD patients underwent standard preoperative assessment, including the Doppler ultrasound, before a typical radio-cephalic AVF creation. Post-failure, a new AVF was created proximally. The vein specimens were collected during the surgery, processed, and analyzed for morphometric analyses and various cellular markers, including Vimentin, TGF, and Ki 67. Results The study enrolled 89 CKD patients, analyzing various aspects of their condition and AVF failures. The histomorphometric analysis revealed substantial venous luminal stenosis and varied endothelial changes. The immunohistologic analysis showed differential marker expressions pre- and post-AVF creation. Conclusion This study highlights the complexity of the early AVF failures in CKD patients. The medial hypertrophy emerged as a significant preexisting lesion, while the postoperative analyses indicated a shift towards neointimal hyperplasia. The research underscores the nuanced interplay of vascular remodeling, endothelial damage, and cellular proliferation in the AVF outcomes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The azygos vein as an alternative route for haemodialysis catheterisation(SMC Media, 2025-05-20); ; Introduction: Central venous catheterisation (CVC) is essential for haemodialysis in end-stage kidney disease, but superior vena cava (SVC) stenosis or occlusion often complicates long-term access. The azygos vein, a collateral drainage pathway, has been rarely used intentionally for catheterisation. Case description: We report on a 68-year-old male on haemodialysis with SVC perforation and stenosis due to prolonged catheter use. After a failed guidewire-assisted exchange, a non-tunnelled CVC was successfully placed in the enlarged azygos vein under fluoroscopy. The patient continued haemodialysis without complications, and the two-month follow-up confirmed catheter patency. Conclusion: This case demonstrates the azygos vein as a viable alternative for haemodialysis access in SVC stenosis. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association Between the Polymorphism of Angiotensin-Converting Enzyme Gene and Interleukin-1 Beta Gene and the Response to Erythropoietin Therapy in Dialysis Patients with Anemia(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-12-01); ; ; Introduction The polymorphism of the angiotensin-converting enzyme (ACE) gene and interleukin-1 beta (IL-1b) gene could be associated with resistance in the treatment of anemia in dialysis patients with recombinant human erythropoietin (rHuEPO). The aim of the study was to evaluate the association between the polymorphism of the ACE and IL-1b genes and the response to rHuEPO therapy in dialysis patients with anemia. Material and methods The study investigated 69 patients on dialysis with anemia treated with recombinant human erythropoietin for 12 months. Genotyping of ACE and IL-1b polymorphism was done in all study patients at the initiation of the study. The patient’s demographic characteristics, dialysis vintage, and laboratory parameters were also evaluated as factors associated with rHuEPO resistance. The erythropoietin resistance index (ERI) was calculated as the weekly rHuEPO dose per kg of body weight, divided by the hemoglobin (Hb) concentration in g/dl. Results The Hb ≥ 110 g/l was registered in 37 (53.6%) patients. Patients with Hb ≥ 110 g/l were characterized by significantly higher serum levels of albumin, cholesterol, and iron than those with Hb < 110 g/l. The serum level of the CRP, the weekly dose of rHuEPO, and ERI were significantly higher in patients with Hb < 110 g/l compared to patients with Hb ≥ 110 g/l. The ERI value of ≥ 10 IUkg/weekly/g/dl was present in 27 (39.1%) patients. The serum levels of ferritin and CRP, and weekly dose of rHuEPO were significantly higher in patients with ERI value ≥ 10 IU kg/weekly/g/dl compared with the patients with ERI value < 10 IUkg/weekly/g/dl. There was no significant association between the ERI and polymorphism of the ACE and IL-1b genes in study patients. Conclusion The polymorphism of the ACE and IL-1b genes was not significantly associated with the response to erythropoietin therapy in dialysis patients with anemia. Iron deficiency, malnutrition, and inflammation were factors associated with anemia and resistance to erythropoietin therapy in dialysis patients. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 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); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Comparison between different methods in evaluating haemodialysis adequacy(Oxford University Press (OUP), 2025-10); ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, 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); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, USE OF HEPARIN GRAFTED DIALYZER (EVODIAL) FOR HEMODIALYSIS IN PATIENTS WITH HIGH RISK OF BLEEDING: A SINGLE CENTER EXPERIENCE(Oxford University Press (OUP), 2023-06); ; ; Background and Aims During hemodialysis exposure of the blood to the dialysis membrane and the tubing system can activate blood cells and promote clotting activation. So usually, some form of anticoagulation, most frequently heparin, is used to prevent blood coagulation. However, there are patients with increased risk for bleeding (patients with active bleeding, major surgery in past 72 hours, severe trombocytopenia) where use of heparin free regime is mandatory. Evodial dialyzer (Gambro-Hospal, France) [1] contains a heparin-grafted membrane aiming to provide a system with a low thrombogenicity that can be used without or with low dose heparin in order to reduce the patients' bleeding risk. As high-quality evidence of the optimal choice of anticoagulation in these patients is limited we wanted to show our experience with the use of Evodial dialyzer. Method During 12 months 106 dialysis sessions in 59 patients were performed. Reasons for using Evodial : active bleeding, hematological conditions, complications of vascular access. Changes in the dialyzer or the blood lines, or any aditional interventions were examined. Results Low dose unfractionated heparin (1250 IE total) was used in 10 (9,4%) sessions, and it was added in 15 (14%) more sessions because of problems with the coagulation. In 4 (2,8%) sessions we had to terminate dialysis because of clotting. Conclusion Heparin grafted dialyzers can be safely used in patients with high risk for bleeding. Although results are worse than the ones reported in literature [2] where regional citrate anticoagulation (RCA) is used, it can be reasonable alternative when RCA is unavailable. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Excess Mortality in a Nephrology Clinic during First Months of Coronavirus Disease-19 Pandemic: A Pragmatic Approach(Oxford University Press, 2020-12-01); ; ; Spasovska-Vasilevska, AdrijanaBACKGROUND: Excess mortality is defined as mortality above what would be expected based on the non-crisis mortality rate in the population of interest. AIM: In this study, we aimed to access weather the coronavirus disease (COVID)-19 pandemic had impact on the in-hospital mortality during the first 6 months of the year and compare it with the data from the previous years. METHODS: A retroprospective study was conducted at the University Clinic of Nephrology Skopje, Republic of Macedonia. In-hospital mortality rates were calculated for the first half of the year (01.01–30.06) from 2015 until 2020, as monthly number of dead patients divided by the number of non-elective hospitalized patents in the same period. The excess mortality rate (p-score) was calculated as ratio or percentage of excess deaths relative to expected average deaths: (Observed mortality rate–expected average death rate)/expected average death rate *100%. RESULTS: The expected (average) overall death mortality rate for the period 2015–2019 was 8.9% and for 2020 was 15.3%. The calculated overall excess mortality in 2020 was 72% (pscore 0.72). CONCLUSION: In this pragmatic study, we have provided clear evidence of high excess mortality at our nephrology clinic during the 1st months of the COVID-19 pandemic. The delayed referral of patients due to the patient and health care system-related factors might partially explain the excess mortality during pandemic crises. Further analysis is needed to estimate unrecognized probable COVID-19 deaths. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Clinical Effectiveness of Single Lumbar Periradicular Infiltration in Patients with Sciatica(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-07-15); ;