Spasovski, Goce
Preferred name
Spasovski, Goce
Official Name
Spasovski, Goce
Alternative Name
Spasovski, GB
Main Affiliation
Email
goce.spasovski@medf.ukim.edu.mk
119 results
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Item type:Publication, Pharmacotherapeutic options for the prevention of kidney transplant rejection: the evidence to date(Informa UK Limited, 2022-08); ; Although early rejection episodes are successfully controlled, the problem of unrecognized production of de novo anti-HLA antibodies and associated chronic rejection still persists. - Some of the metrics are blocked by yourconsent settings
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Item type:Publication, Funding kidney research as a public health priority: challenges and opportunities(Oxford University Press (OUP), 2021-12-31) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Cognitive impairment in CKD patients: a guidance document by the CONNECT network(Oxford University Press (OUP), 2024-09) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, KIDNEY FUNCTION DECLINE AND MORTALITY IN DONORS WITH EXPANDED CRITERIA - FIVE YEARS FOLLOW UP STUDY(Macedonian Association of Anatomists and Morphologists, 2024); ; ; ; Kidney donors are considered healthy, but with a need for continued medical follow up and encouragement for continued healthy lifestyle, especially when expanded criteria for donation are applied. This study aims to analyse the five years follow up of kidney donors after explanation, encountering risks of kidney function decline and donors’ mortality. In a retrospective study we evaluated a donor cohort with 5 years of follow up. Demographic characteristics as age, gender and the presence comorbidities as diabetes, hypertension, hyperlipidemia and Body Mass Index (BMI) >30kg/m2 were analyzed. Estimated glomerular filtration rate (eGFR) by CKD EPI formula was notified prior donation, and annually afterwards. Consultations with nephrologist or other specialists were notified. In a multivariate regression analysis, the reduction ratio (RR) of eGFR was explored as dependent variable. Cox regression analysis exploited mortality; Kaplan Meier survival curve was applied in respect of BMI. Seventy-five donors with average age above 55 years were predominantly women (69%), nearly every nineth patient had diabetes or obesity (9%). Proportion of donors referred to nephrologist at the 12 months, declined up to 58% at the fifth year, ignoring medical checks showed ascending trend to 16% at the end of second and third year and 12% at the end of observational period. The univariate regression analysis found diabetes, hyperlipidemia and hypertension, the presence of multiple comorbidities, gender and age as insignificant predictors of eGFR 12 months reduction ratio. The nephrologist referral showed borderline significance (β = - 0.103, p=0.076). Only BMI over 30kg/m2 worsened the kidney function (β = 0.600, p=0.001). Five years mortality rate was 6.7%. The diseased donors were significantly older, more frequently had diabetes and obesity also they had significantly lower eGFR pre-donation, at the end of the first year but also and more step decline of it after 12 months. In the multivariate analysis BMI>30kg/m2 emerged as most powerful predictor of mortality (HR 40.02; CI: [4.11-389), p=0.0001). Survival of obese patients was significantly shorter when compared with patients with lower body weight (43.28 ± 7.51 vs. 59.33±0.65, Log rank p=0.000), respectively. Our study demonstrates that the mortality and declination of renal function after donation are associated with nephrologist referral and other potentially modifiable factors, especially obesity. Improved protocols for pre-donation information, education and adequate after-donation follow up is mandatory to achieve better longevity and kidney function survival in these frail and precious individuals. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Capacity for the management of kidney failure in the International Society of Nephrology Eastern and Central Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)(Elsevier BV, 2024-04) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Present and future of CONNECT: a new and compelling project of modern medicine(Oxford University Press (OUP), 2021-12-28) - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Current State of Nuclear Nephrology in Modern Medicine(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2023-12-01); ; ; ; Poposka, DanielaGlomerular filtration rate (GFR) is the most reliable parameter of renal function. Regarding the complexity of the gold standard inulin clearance, different estimating equations have been developed with CKD-EPI creatinine equation recommended as the most reliable one. In some clinical situations where creatinine based equations might not be valid, alternative methods are needed. Nuclear medicine methods for measuring GFR with 51Cr EDTA and 99mTc DTPA have been widely used for decades. There are different methodologies for the measurement of kidney function with radiopharmaceuticals: urinary clearance, plasma clearance, multiple plasma sampling, slope intercept, single sample plasma equation, slope only, and the gamma camera-based method. Greater precision of measuring GFR is needed in certain clinical situations. The most common are diagnosis and follow up of chronic kidney disease and definition of the beginning of replacement therapy. The assessment of renal function is also important for potential kidney donors. In recent years, with the introduction of new chemotherapeutic drugs and targeted therapy, oncologic patients treated with nephrotoxic drugs have become more commonly referred for measuring GFR. The monitoring of renal function is important during treatment in order to detect the transformation from reversible acute kidney injury to irreversible chronic kidney disease as well as in the cases of renal insufficiency reduce the dosage and prevent accumulation of the drug and avoid dosage related toxic effects. Assessment of kidney function using measured mGFR will be an important milestone in the creation of more accurate and expanding personalized medicine principle in current onconephrology practice. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, The Onset and Prognosis of Hepatorenal Syndrome - Three Year Single Center Experience(BANTAO Association, 2010-12); ; Introduction: The hepatorenal syndrome (HRS) refers to the development of acute renal failure in the setting of advanced liver disease. It can occur in a substantial proportion of patients with fulminate hepatic failure from any cause. The aim of our study was to investigate the onset, outcome and prognosis of patients with hepatorenal syndrome hospitalized at our unit. Methods: This is a cross-sectional retrospective study in a cohort of 543 cirrhotic patients, during a period of 3 years (January, 2008 - December, 2010). Hepatorenal syndrome was detected in 20 (3.7%) patients and in all of them a few variables such as: age, gender, history of cirrhosis or other liver disease, etiology of cirrhosis, Child-Pugh classification, other complications of the cirrhosis except for HRS, treatment and survival were analyzed. Results: The average preceding time up to the occurrence of HRS was around 3 years (36.8±47.8 months), although there were 4 patients who developed HRS only a month after the onset of cirrhotic symptoms. A group of seven patients with HRS diagnosed during the first year of the onset of symptoms. The mean age of patients was 55.5±13.3 years. There was a significant difference in the gender distribution, three quarters of patients being males. With regard to the etiology, 12 patients had alcoholic abuse, and a half of them (50%) were with mixed etiology (Hepatitis B plus alcohol abuse). Two patients had a pure chronic hepatitis B virus (HBV) infection as a cause of cirrhosis. Four were with chronic liver disease of unknown etiology (2 of them with confirmed histology of chronic hepatitis). All of the cirrhotic patients were scored as grade C according to the Child – Pugh classification. Hepatic encephalopathy was the most predominant concomitant complication present in 17 (85%) patients with HRS. Only 2 showed signs of malignancy with suspected hepatocellular carcinoma (HCC). The estimated average hospital stay was 6.15 days, ranging from 1-14 days. The applied treatment was generally unsuccessful. Majority of cases (14) were supported with albumin and fresh frozen plasma transfusion and haemodialysis was performed in 4 patients. The mortality rate was high, reaching 80% (16 patients) with an average time of death at 6.8±4.4 days after the hospital admission. Although the evaluation period was short, there is a clear raising trend in number of detected patients with HRS at our Clinical Center. Conclusion: Compared to other reports, our single centre experience shows lower occurrence rate. Despite the use of available conservative medical treatment, there was no recovery of the hepatic failure in any of HRS patients. The absence of liver transplantation or TIPS in our country is the second contributing factor related to the high mortality rate in our cohort. Finally, gastroenterohepatologists should be aware and try to prevent iatrogenic precipitants of HRS as an aggressive diuretic treatment or removal of large volumes of ascitic fluid by paracentesis without compensating for fluid depletion by intravenous replacement could additionally impair the renal failure. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, POSTOPERATIVE SERUM CREATININ LEVEL IN TWO DIFERENT HYDRATION REGIMES IN LIVING DONOR KYDNEY TRANSPLANATATION(Department of Anaesthesia and Reanimation, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Macedonia, 2017-04); ; ; Introduction: Early graft function is very important and can be achieved with adequate intraopeartive perfusion characteristics of the graft and urine output. The goal of this study was to examine the influence of targeting central venous pressure (CVP) on early graft function. Material and methods: After approval of Ethical committee of the Medical Faculty-Skopje, we obtained inform consent of 60 patients, ASA 2-3 undergoing renal transplantation of livingrelated person in the Clinic of Urology – Skopje. A prospective clinical study was performed in the period of 2 years. Patients were divided into 2 groups of thirty patients : group A receiving normal saline intraoperatively targeting for CVP to 15 mmHg until vascular clamps were off and group B receiving normal saline 10ml/kg/h. We recorded lactate at the end of the surgery, onset of diuresis and total urine output from unclamping the renal vessels to the end of the surgery in both groups and postoperative serum creatinine in 3times (3, 12, 36 hours). Results: The onset of diuresis in seconds was insignificantly longer in group B p>0,05 (p=o,31). The average value of postoperative levels of the lactate showed that in group B the levels of the lactate were significantly higher for Z=-5,79 and p<0,001 (p=0,000). We didn’t find any statistical differences in postoperative serum creatinine in both groups. Conclusion: Our study didn’t show any benefit from targeting CVP to 15 mmHg. We couldn’t find any significant difference on onset of diuresis and urine output after the unclamping the vessels. However, in the constant infusion group (group B) the level of the lactate was higher CVP. In postoperative biochemical parameters we had no statistical difference between the average values of serum cratinine.