The 25th Annual Congress of the Hungarian Society of Nephrology, Szeged, 25-27 September 2008

Abstract

The congress was attended by 400 participants including 70 dialysis nurses in their parallel section. Honorary membership was granted to Norbert Lameire, Ghent, Belgium, and Alan R. Watson, Nottingham, UK, who delivered a state-of-the-art lecture: ‘Update on acute kidney injury’ (N. Lameire) and ‘Antenatal detected urinary abnormalities, have they made an impact?’ (A. R. Watson). The main topics of the conference were ‘the possible use of biosimilars’ (I. Kiss); ‘the transitory withholding of erythropoietin treatment causes neocytolysis and oxidative stress in uraemic patients’ (S. Turi et al.); and ‘phosphate management with Sevelamer decreases the occurrence of cardiovascular calcification, mortality and also morbidity’ (A. Bellasi, Italy). Recent experience was presented with the use of sevelamer in the diaverum dialysis centres. Hyperphosphataemia plays an important role in the morbidity and mortality of dialyzed patients. Sevelamer decreases the serum phosphate level, Ca×P, and keeps the serum Ca concentration in the normal range; the vascular calcification is therefore less likely to occur than with Ca-containing phosphate binders (M. Torok). International epidemiological data on end-stage kidney disease were presented (E. Ladanyi). The distribution of patients in renal replacement therapy is variable in Hungary: 483-636/region (J. Szegedi). According to the epidemiological analysis, there were 5558 uraemic patients in dialysis at the end of 2007, which were 332 more than at the beginning of the year. There were 1620 cases with acute renal failure in need of renal replacement therapy; 33.4% of them became chronic dialysis patients. Of the dialyzed cases, 10.6% were in the peritoneal dialysis programme. Kidney transplantation was performed in 254 patients (I. Kulcsar). A clinical study was presented on those HD patients who had a low serum homocysteine concentration (<10 μM): they had a higher frequency of malignant diseases (M. Katko et al.). In a multicentre study of 746 patients with chronic HD and 254 healthy blood donors, the rate of occurrence of the angiotensin-converting enzyme D/D genotype was significantly higher in the uraemic patients. Similar results were observed in diabetic patients with end-stage kidney disease. The I/I genotype was associated with a higher survival rate in diabetic patients with HD (I. Kiss et al.). A total of 993 patients with kidney transplantation were followed for 10 years for cardiovascular risk factors according to the Framingham score. A total of 33% took one, 36% two and 25% took three or more cardioprotective (CP) medications. The rate of complex CP treatment was low. The survival of uraemic patients could be increased with a more aggressive CP therapy (Zs. Nemeth et al.). Chronic renal failure (CRF) is usually associated with hypertension. For the prevention of the rapid progression of CRF, the most effective tool is a decrease of hypertension (R. de Châtel). Of the cerebrovascular diseases, transient ischaemic attack (TIA) and stroke occur more frequently in CRF than in the average population. The risk increases in parallel with decreasing renal function. Besides classical cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, obesity, smoking, age, high sodium and low potassium-containing diet and a low level of physical activity), renal disease-associated risk factors (proteinuria, azotaemia, anaemia and hyperhomocystinaemia) play a role in the development of cerebrovascular diseases. The most effective method is the prevention and appropriate antihypertensive therapy (J. Nagy). Systolic hypertension in the elderly (SHE) is an entity associated with two to three times more frequent cardiovascular morbidity; the mortality is 26% higher and the frequency of stroke is 22% higher than in the other dialyzed patients. In the antihypertensive therapy of SHE, it is necessary to take the left ventricular wall rigidity, diastolic dysfunction, myocardial ischaemia and decreased drug tolerability into consideration. In the treatment of SHE, the combination of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocking agent, diuretics and long-acting dihydropyridine-calcium channel blockers is suggested besides the non-drug therapy (I. Kiss). Vessel wall elasticity can be measured by pulse wave velocity (PWV) that decreases with age. This process is faster in uraemic children. PWV/body height is an age-independent parameter suitable for evaluation of the vessel wall elasticity in growth-retarded children (O. Cseprekal et al.). Microalbuminuria was investigated in Crohn's disease and colitis ulcerosa by high-pressure liquid chromatography (HPLC) and immunoturbidimetry (IT). In both diseases, activity of inflammation correlated better with the values obtained with HPLC than with IT (N. Szigeti et al.). A special symposium was dedicated to the therapeutic role of plasma exchange. Between 1980 and 2007, 397 plasmaphereses were performed in paediatric patients with different aetiologies in Szeged. All patients survived the treatment. The improvement rate was 94% (S. Turi et al.). The indications for plasmaphereses in adulthood were surveyed (Gy. Domjan). Further studies were presented on vasculitis associated with rapidly progressive glomerulonephritis (K. Polner et al., A. Haris et al.). Conflict of interest statement. None declared.