Faculty of Medicine

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    Beyond Sodium: Inflammation as the Strongest Predictor of Mortality Among Non-Diabetic Hemodialysis Patients
    (Macedonian Academy of Sciences and Arts, 2026-06-01)
    Eftimovska-otovikj Natasha
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    Poposka, Elizabeta
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    Popovska, Bojana
    ;
    ;
    : Standard dialysate sodium concentration (sDNa) may not adequately reflect individual sodium requirements in each hemodialysis patient, potentially contributing to interdialytic weight gain (IDWG), hypertension and inflammation. The aim of this study was to compare clinical and biochemical outcomes between individualized and standard dialysate sodium prescriptions and to assess factors associated with mortality. : This was a prospective interventional study conducted in two phases. In the first phase, patients were treated with standard hemodialysis (HD) using a fixed dialysate sodium concentration of 138 mmol/L. In the second phase, dialysate sodium was individualized based on each patient's pre-dialysis serum sodium concentration. Each patient served as their own control. Outcomes included IDWG, blood pressure, thirst score, dialysis adequacy (Kt/V, URR), nutritional markers, C-reactive protein (CRP), electrolytes, and mortality. : Individualized dialysate sodium prescription was associated with a significant reduction in IDWG (1.93 ± 0.64 vs 2.17 ± 0.79 kg; p = 0.001) and improved dialysis adequacy (Kt/V: 1.50 ± 0.24 vs 1.36 ± 0.22; p < 0.001). Survivors had higher serum albumin levels and lower CRP values compared to non-survivors. Serum and dialysate sodium concentrations were not independently associated with mortality. In logistic regression analysis, CRP >10 mg/L showed the strongest observed association with mortality (OR 10.278; 95% CI 1.709-61.826; p = 0.011). : Individualized dialysate sodium prescription may improve fluid control and dialysis adequacy in selected patients. Inflammation was significantly associated with mortality in this cohort; however, results should be interpreted with caution due to the limited number of events.
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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
    ;
    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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    Sonographic assessment of the anatomy and common pathologies of clinically important bursae
    (Sciendo, 2019-11)
    Ivanoski, Slavcho
    ;
    High-resolution ultrasonography has many advantages in the imaging of the musculoskeletal system, when compared to other imaging methods, particularly in superficial, easily accessible parts of the body. It is a perfect diagnostic tool for visualizing the most common pathologies of the musculoskeletal system, including the bursae. Inflammation of bursae is frequent, and it can mimic other diseases of the musculoskeletal system. Therefore, knowledge of normal ultrasound anatomy of the bursae, their exact location in the human body, and the sonographic signs of their most common pathologies is essential for establishing a quick and accurate diagnosis by ultrasound. Common conditions affecting bursae, leading to bursitis, include acute trauma, overuse syndromes, degenerative diseases, inflammatory conditions (rheumatoid arthritis, psoriatic arthritis, gout etc.), infections such as tuberculosis, synovial tumors and tumor-like conditions (pigmented villonodular synovitis, osteochondromatosis), and many more. This review article presents and explains ultrasound examples of the most frequent pathological conditions affecting bursae. Images include normal and pathological conditions of bursae around the shoulder joint, elbow, hip, knee, and ankle joint.