Introduction. A single pass albumin dialysis (SPAD) is a form of extracorporeal liver support system for removing albumin-bound toxins and water-soluble substances that accumulate in liver failure (LF). Case report. We presented three patients hospitalized for LF and treated using the SPAD at the University Clinical Center of Vojvodina, Serbia, from 2018 to 2019. Two of the patients presented with acute LF and one with acute-on-chronic LF. A total of 6 SPAD sessions were performed on each patient, resulting in decreased serum bilirubin and bile acid levels and hepatic encephalopathy grade. On discharge from the hospital, the liver function was improved in all the patients. Conclusion. SPAD removes the hepatotoxic substances without improvement of synthetic liver function. It represents a supportive treatment for LF patients who do not respond to the standard of care, offering a longer time for bridging to organ transplantation or spontaneous recovery of the liver function.

BACKGROUND AND AIMS: A 5-year research was conducted on haemodialysis patients with the aim to determine the effect of therapy on the patency of arteriovenous fistula (AVF) for haemodialysis. METHOD: The study included 338 haemodialysis patients with the incidence of the creation of AVF in 2014. Patients were divided into two groups, according to the duration time of AVF namely short-term (≤6 months) and long-term (>6 months) patency. Clinical and laboratory parameters were analysed as well as type and frequency of complications, characteristics of AVF and treatment. The data were analysed with a chi-squared test, ANOVA test and an ordinally logistic regression. There was a statistical significance, P <0.05. RESULTS: From a total of 338 patients, the average age of 59.06 ± 12.45, 66.6% of patients were men. 80.7% of the patients were in the short-term group. Patients taking anti-platelet drugs make 14.8%, patients taking anticoagulation therapy and double anti-platelets therapy make 1.8%, patients taking statins, angiotensin-converting enzyme inhibitors (ACE)/angiotensin-receptor blockers (ARB) and calcium channel blockers make 47% and 2.6% of patients took no medication. The number of AVF complications was thrombosis in 19.1%, haemorrhage in 1.9%, aneurism and pseudoaneurysm in 0.5%, ‘Steal’ syndrome in 0.3%, infections in 0.3% and other complications in 2.2%. In accordance with the length of anti-platelets therapy (˂30 days, between 30 and 90 days, and ˃90 days) after the creation of AVF, it was concluded that the most influential effect was in the period between 30 and 90 days after creation. Patients with AVF for ˂6 months had significantly more vascular calcifications (P =.0017). The groups did not differ in the length of anti-platelets and anti-coagulation therapy before the creation of AVF (1 year, no therapy), time of maturity of AVF (4–6 weeks, 6–8 weeks, ˃8 weeks), indications for reducing or stopping with anti-platelets or anticoagulation therapy in the moment of AVF creation. Four models of ordinally logistic regression (2015, 2016, 2017, 2018) were created in which the dependent variables were the complications of AVF by years, the factors were the type of treatment and the frequency of each complication for each year, while the covariate was the number of months after the AVF creation (Table). CONCLUSION: Patients that started taking anti-platelets drugs from 30 to 90 days of AVF, had AVF for a significantly longer time. The model showed in years states that the frequency of complications decreases over time and that there are more infections and other complications than thrombosis and haemorrhage.

Inflammation, as one of the common factors contributing to erythropoietin treatment resistance, is lately being assessed by using new markers of inflammation, which are platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR). Their association with this therapy has not been fully investigated. The purpose of our study was to evaluate the relationship between PLR, NLR and erythropoietin therapy responsiveness. Methods: A cross sectional study included 90 hemodialysis patients who underwent physical examination, biochemical analysis and calculation of erythropoietin hyporesponsiveness index (EHRI). Results: It is shown that EHRI has a statistically significant positive correlation with PLR (p < 0.01) and negative correlation with hemoglobin levels (p < 0.01). Significant differences for logarithmically converted EHRI and PLR (p < 0.05) have been found but not for EHRI and NLR (p=0.13). Conclusion: 4 PLR, together with NLR could be used in assessing not only inflammation, but also erythropoietin resistance in hemodialysis patients.

Background and Objectives: Cardiovascular disease is the leading cause of mortality in patients with ANCA-associated vasculitis (AAV) after the first year post-diagnosis. This study investigated relationships between traditional risk factors, echocardiographic findings, disease activity, and major adverse cardiovascular events (MACE) in AAV patients. Aim: This retrospective single-center study aimed to evaluate the impact of traditional cardiovascular risk factors and echocardiographic parameters on the occurrence of MACE in patients with AAV. Materials and Methods: This study included adult patients with AAV who were evaluated between 2020 and 2025. Data collected included demographics, cardiovascular risk factors, Birmingham Vasculitis Activity Score version 3 (BVASv3), laboratory parameters, immunosuppressive therapy, and transthoracic echocardiography (TTE) findings. MACE was defined as myocardial infarction, stroke, revascularization, cardiovascular hospitalization, or cardiovascular death. Results: The cohort comprised 32 females (61.5%) and 20 males (38.5%), with a mean age of 62.4 ± 12.4 years. MACE occurred in 38.5% of patients. Male gender (p = 0.002), overweight (p = 0.016), hyperlipidemia (p = 0.003), and prior cardiovascular disease (p = 0.002) were significantly associated with MACE in univariate analyses. Patients with MACE had larger left atrial anteroposterior dimensions on the parasternal long-axis view (median 3.9 vs. 3.3 cm, p = 0.002) and lower left ventricular ejection fraction assessed by the modified biplane Simpson’s method (median 53% vs. 60%, p = 0.002). Valvular dysfunction was not associated with MACE in a statistically significant manner. Disease activity markers (BVASv3 and CRP) showed no significant correlation with cardiovascular events or echocardiographic parameters. Conclusions: Our results demonstrate that traditional cardiovascular risk factors are stronger determinants of MACE in AAV patients than disease-specific parameters. Cardiac structural changes, including left atrial dilation and decreased left ventricular ejection fraction, were significantly associated with cardiovascular outcomes. These findings underscore the importance of integrating systematic cardiovascular risk assessment and aggressive risk factor modification into standard AAV management protocols.

Introduction/Objective. Acute kidney injury (AKI) is a highly prevalent complication among the critically ill individuals who are admitted to the intensive care unit (ICU). This study deals with identifying the frequency and predictors of the lack of renal function recovery in non-renal functions among critically ill patients requiring dialysis for AKI (AKI-D). Methods. The study included 440 ICU patients from the University Clinical Center of Vojvodina in the period from 2014 to 2018. The patients required Continuous Renal Replacement Therapy (CRRT). In this study, we analyzed various factors including demographic features, clinical characteristics, laboratory parameters, co-morbidities, as well as the need for vasopressor therapy and mechanical ventilation on the day when AKI was confirmed. Additionally, we examined the different modalities of CRRT, which were used. Results. A retrospective analysis of the results included discovered that out of 440 patients with AKI-D, 242 (55%), average age 63.14, did not recover renal function. Significant predictors of renal function non-recovery in critically ill patients with AKI-D were: the patients age over 65 (p = 0.044), starting time of CRRT (p = 0.043), mechanical ventilation (p = 0.044) and previous kidney disease (p = 0.005). Significant predictors of renal function non-recovery in critically ill septic patients with AKI-D were: the patients age over 65 (p = 0.002), diabetes mellitus (p = 0.023), previous kidney disease (p = 0.045), CRP values < 100 mg/l (p = 0.033) and procalcitonin (p = 0.010), while in non-septic patients, the significant predictors of renal function non-recovery includes previous kidney disease (p = 0.035). Conclusion. Out of all examined predictors, both in septic and non-septic patients, previous kidney damage presents the greatest risk for renal function non-recovery in critically ill patients with AKI-D.

Introduction. Rapid diagnosis of metformin-associated lactic acidosis (MALA) and initiation of continuous renal replacement therapy (CRRT) in diabetic patient successfully corrects a severe metabolic disorder of a patient with acute renal failure. Case outline. A 58-year-old male patient with a medical history of type 2 diabetes and alcohol abuse was admitted to Emergency department because of the vomiting, diarrhea and altered mental status. Initial arterial blood gas (ABG) analysis revealed severe metabolic acidosis (pH: 6.8, PaCO2: 12 mmHg, HCO3: 3.2 mmol/l), but the lactate level was too high to measure. MALA was suspected based on progressive lactic acidosis and past intake of metformin. The renal replacement therapy (RRT) was initiated- continuous veno-venous hemodiafiltration (CVVHDF), and as a result a significant improvement of the clinical status, with both blood pH and lactate level showing normalization was achieved after finishing CRRT. Conclusion. Acute metformin-associated lactic acidosis carries an ominous prognosis. This case suggests the application of early initiation of CRRT in hemodynamically unstable diabetic patients with MALA.