Metabolic acidosis is a common complication of chronic kidney disease (CKD). The kidneys play a crucial role in acid–base balance, maintaining pH within the normal range (isohydria) by following mechanisms: bicarbonate reabsorption, ammogenesis, and titratable acidity. The anion gap describes the amount of unmeasured anions and is classically evaluated as the difference between the major cation (sodium) and the sum of the two major anions (chloride and bicarbonate). Metabolic acidosis can be divided into two types: normal anion gap metabolic acidosis and high anion gap metabolic acidosis. A high anion gap level is considered unfavorable in terms of prognosis as it is associated with increased mortality. Treatment of metabolic acidosis in patients with chronic kidney disease, despite available therapeutic options, is a challenge. Supplementation with bicarbonates does not improve prognosis on the one hand, and on the other hand, it may be harmful. The new KDIGO guidelines for 2024 have been significantly modified compared to 2012 after negative results of studies on bicarbonate supplementation. Bicarbonate supplementation is currently recommended only when levels are less than 18 mmol/L. This review provides an overview of the current knowledge on the pathophysiology, classification, and therapeutic options, including dietary recommendations and new pharmacology agents.

Background: Heavily calcified lesions in acute coronary syndrome (ACS) still represent a challenging subset for percutaneous coronary intervention (PCI). Rota-lithotripsy—a marriage of rotational atherectomy and intravascular lithotripsy—has recently been introduced to clinical practice as a novel therapeutic option. Methods: This study is among the to present the 6-month clinical outcomes of rota-lithotripsy when performed in the ACS setting. The study cohort consisted of 15 consecutive ACS patients who underwent a rota-lithotripsy-PCI due to the presence of a highly calcified, undilatable lesion. Results: The procedural success ratio reached 100%. During the 6-month follow-up, in two of the patients, instances of MACE (major adverse cardiac events) occurred, including one fatal event. Additionally, during the observation period, one target lesion failure, due to subacute stent thrombosis, was identified. Conclusions: Rotational atherectomy with the subsequent use of shockwave intravascular lithotripsy appears to be a safe and effective therapeutic bail-out option for the management of highly calcified coronary artery lesions. Despite, these initial favorable outcomes, carrying out a large number of studies with long-term observations is still necessary in order to establish the potential benefits and shortcomings of rota-lithotripsy.

The sale and popularity of dietary supplements have been increasing each year, yet knowledge about them still remains insufficient. Supplements are consumed by nearly 50% of the population, and the main motivation is the desire to improve health and boost immunity. Many individuals mistakenly identify supplements as drugs, but they do not realise the differences in the manufacturing processes of these substances. Supplements are widely available not only in pharmacies but also in herbal shops and online. The aim of this literature review is to draw attention to the potential dangers associated with the use of herbs and dietary supplements by kidney transplant recipients. Such products are widely used by patients across all age groups and considered as a “safe and natural” form of therapy. The most popular supplements and herbs are discussed, including mint, chamomile, Ginkgo biloba, cranberry, ginseng, and green tea infusions. These substances can affect the metabolism of many drug groups by acting as transporters, co-transporters, or enzymes, leading to significant interactions with immunosuppressive drugs. Post-transplant pharmacotherapy requires avoiding drugs and food ingredients that may interact with immunosuppressants. The success of the kidney transplant procedure depends on close cooperation between the doctor and the patient, and strict compliance with medical recommendations. Therefore, it is crucial to continually increase public awareness about the benefits and potential risks associated with dietary supplementation.

DOI: 10.20452/pamw.16279, Published online: June 28, 2022, Authors: Bartłomiej Błaszczyk, Justyna Korus, Piotr Donizy, Agata Szczurowska, Magdalena Krajewska, Dorota Kamińska

Background: The ability of hemoglobin to bind and dissociate oxygen is crucial in delivering oxygen to tissues and is influenced by a range of physiological states, compensatory mechanisms, and pathological conditions. This may be illustrated by the oxyhemoglobin dissociation curve (ODC). The key parameter for evaluating the oxygen affinity to hemoglobin is p50. The aim of this study was to evaluate the impact of hemodialysis on p50 in a group of patients with chronic kidney disease (CKD). An additional goal was to assess the correlation between p50 and the parameters of erythropoiesis, point-of-care testing (POCT), and other laboratory parameters. Methods: One hundred and eighty patients (106 male, 74 female), mean age 62.5 ± 17 years, with CKD stage G4 and G5 were enrolled in this cross-sectional study. Patients were divided into two groups, including 65 hemodialysis (HD) patients and 115 patients not receiving dialysis (non-HD). During the standard procedure of arteriovenous fistula creation, blood samples from the artery (A) and the vein (V) were taken for POCT. The causes of CKD, as well as demographic and comorbidity data, were obtained from medical records and direct interviews. Results: The weekly dose of erythropoietin was higher in HD patients than in non-HD patients (4914 ± 2253 UI vs. 403 ± 798 UI, p < 0.01), but hemoglobin levels did not differ between these groups. In the group of non-HD patients, more advanced metabolic acidosis (MA) was found, compared to the group with HD. In arterial and venosus blood samples, the non-HD group had significantly lower pH, pCO₂ and HCO₃⁻. This group had a higher proportion of individuals with MA with HCO₃⁻ < 22 mmol/L (42% vs. 24%, p < 0.01). The absolute difference of p50 in arterial and venous blood was determined using the formula Δp50 = (p50-A) − (p50-V). Δp50 was significantly higher in the HD group in comparison to non-HD (0.08 ± 2.05 mmHg vs. −0.66 ± 1.93 mmHg, p = 0,02). There was a negative correlation between pH and the p50 value in arterial (pH-A vs. p50-A, r = −0.56, p < 0.01) and venous blood (pH-V vs. p50-V, r = −0.45, p < 0.01). In non-HD patients, hemoglobin levels correlated negatively with p50 (r = −0.29, p < 0.01), whereas no significant relation was found in HD patients. Conclusions: The ODC in pre-dialysis CKD (non-HD) patients is shifted to the right due to MA, and this is an additional factor influencing erythropoiesis. Hemodialysis restores the natural differences in hemoglobin’s dissociation characteristics in the arterial and venous circulation.

The following work is a review of the literature on the use of robots in the operating room in various fields of surgery. Due to the progress of medicine and technology, the management of a patient requiring surgery is changing and new technologies are increasingly being used, including robotic surgery and the da Vinci robot. They have found application in various fields of surgery, such as urology, gynecology, general surgery, and cardiothoracic surgery, examples of which are described in the following work. Both its positive aspects, which include precision, better visibility of the operating field and the possibility of visualization in 3D HD technology, have been discussed. On the other hand, there are also negative aspects such as the need for specialist staff training and the cost of surgery using a robot. All of the above should be taken into account when qualifying the patient for the method of performing the surgery and considering the possible benefits that he or she is able to achieve. The use of this treatment method requires an individual approach and the determination of specific indications and contraindications to ensure the greatest possible safety and the best possible outcome.