OBJECTIVES: Chronic kidney disease (CKD) is a global health issue, ranking as the third leading cause of death worldwide. CKD diagnosis and management depend on clinical laboratory tests, necessitating consistency for precise patient care. Global harmonization of CKD testing through clinical practice guidelines (CPGs) is recommended. Prior to CPG development, assessing the current CKD testing landscape is crucial. In 2022, the European Federation of Laboratory Medicine (EFLM) conducted an online survey among European laboratories associated with EFLM, evaluating CKD testing practices, including new glomerular filtration rate (GFR) estimation methods. This report summarizes the 2022 survey findings and offers recommendations for improving CKD test standardization. METHODS: An online survey was conducted in November 2022 using a questionnaire hosted on LimeSurvey sent to European laboratories affiliated with the EFLM. The survey results were recorded in Excel files and analysed. RESULTS: The results highlight significant discrepancies among countries in unit expression, methods, cystatin C use, and GFR calculation equations. Additionally, limited attention to pediatric renal biology specifics, varied proteinuria and albuminuria result expressions, and limited awareness of GFR measurement methods through iohexol clearance are noted. CONCLUSIONS: In an effort to enhance the standardization of crucial biomarkers utilized in nephrology for evaluating renal function and diagnosing kidney injuries, the EFLM Task Group on CKD suggests nine practical recommendations tailored for European laboratories. The group is confident that implementing these measures will minimize result expression discrepancies, ultimately leading to enhanced patient care.

• Klíčová slova
• creatinine, cystatin C, equations, glomerular filtration rate, recommendations, survey,
• MeSH
• biologické markery MeSH
• chronická renální insuficience * diagnóza   MeSH
• dítě MeSH
• hodnoty glomerulární filtrace MeSH
• kreatinin metabolismus   MeSH
• laboratoře * MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• vyšetření funkce ledvin metody   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• biologické markery MeSH
• kreatinin MeSH

Progressive CKD is generally detected at a late stage by a sustained decline in eGFR and/or the presence of significant albuminuria. With the aim of early and improved risk stratification of patients with CKD, we studied urinary peptides in a large cross-sectional multicenter cohort of 1990 individuals, including 522 with follow-up data, using proteome analysis. We validated that a previously established multipeptide urinary biomarker classifier performed significantly better in detecting and predicting progression of CKD than the current clinical standard, urinary albumin. The classifier was also more sensitive for identifying patients with rapidly progressing CKD. Compared with the combination of baseline eGFR and albuminuria (area under the curve [AUC]=0.758), the addition of the multipeptide biomarker classifier significantly improved CKD risk prediction (AUC=0.831) as assessed by the net reclassification index (0.303±-0.065; P<0.001) and integrated discrimination improvement (0.058±0.014; P<0.001). Correlation of individual urinary peptides with CKD stage and progression showed that the peptides that associated with CKD, irrespective of CKD stage or CKD progression, were either fragments of the major circulating proteins, suggesting failure of the glomerular filtration barrier sieving properties, or different collagen fragments, suggesting accumulation of intrarenal extracellular matrix. Furthermore, protein fragments associated with progression of CKD originated mostly from proteins related to inflammation and tissue repair. Results of this study suggest that urinary proteome analysis might significantly improve the current state of the art of CKD detection and outcome prediction and that identification of the urinary peptides allows insight into various ongoing pathophysiologic processes in CKD.

• Klíčová slova
• CKD, albuminuria, biomarker, extracellular matrix, fibrosis, renal progression,
• MeSH
• biologické markery moč   MeSH
• chronická renální insuficience moč   MeSH
• dospělí MeSH
• hodnoty glomerulární filtrace MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• peptidy moč   MeSH
• progrese nemoci MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Názvy látek
• biologické markery MeSH
• peptidy MeSH

PURPOSE OF REVIEW: Chronic kidney disease (CKD) is associated with a significantly increased risk of cardiovascular disease (CVD). This review summarizes known risk factors, pathophysiological mechanisms, and current therapeutic possibilities, focusing on lipid-lowering therapy in CKD. RECENT FINDINGS: Novel data on lipid-lowering therapy in CKD mainly stem from clinical trials and clinical studies. In addition to traditional CVD risk factors, patients with CKD often present with non-traditional risk factors that include, e.g., anemia, proteinuria, or calcium-phosphate imbalance. Dyslipidemia remains an important contributing CVD risk factor in CKD, although the mechanisms involved differ from the general population. While statins are the most commonly used lipid-lowering therapy in CKD patients, some statins may require dose reduction. Importantly, statins showed diminished beneficial effect on cardiovascular events in patients with severe CKD and hypercholesterolemia despite high CVD risk and effective reduction of LDL cholesterol. Ezetimibe enables the reduction of the dose of statins and their putative toxicity and, in combination with statins, reduces CVD endpoints in CKD patients. The use of novel drugs such as PCSK9 inhibitors is safe in CKD, but their potential to reduce cardiovascular events in CKD needs to be elucidated in future studies.

• Klíčová slova
• Cardiovascular Disease, Chronic Kidney Disease, Dyslipidemia, Lipid-lowering Drugs, Vascular Pathology,
• MeSH
• anticholesteremika * terapeutické užití   MeSH
• chronická renální insuficience * komplikace   epidemiologie   MeSH
• kardiovaskulární nemoci * epidemiologie   etiologie   prevence a kontrola   MeSH
• LDL-cholesterol MeSH
• lidé MeSH
• proproteinkonvertasa subtilisin/kexin typu 9 MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• rizikové faktory MeSH
• statiny * terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• anticholesteremika * MeSH
• LDL-cholesterol MeSH
• PCSK9 protein, human MeSH Prohlížeč
• proproteinkonvertasa subtilisin/kexin typu 9 MeSH
• statiny * MeSH

Methylglyoxal production is increased in diabetes. Methylglyoxal is efficiently detoxified by enzyme glyoxalase 1 (GLO1). The aim was to study the effect of diabetic and CKD milieu on (a) GLO1 gene expression in peripheral blood mononuclear cells; (b) GLO1 protein levels in whole blood; and (c) GLO1 activity in RBCs in vivo in diabetic vs. non-diabetic subjects with normal or slightly reduced vs. considerably reduced renal function (CKD1-2 vs. CKD3-4). A total of 83 subjects were included in the study. Gene expression was measured using real-time PCR, and protein levels were quantified using Western blotting. Erythrocyte GLO1 activity was measured spectrophotometrically. GLO1 gene expression was significantly higher in subjects with CKD1-2 compared to CKD3-4. GLO1 protein level was lower in diabetics than in non-diabetics. GLO1 activity in RBCs differed between the four groups being significantly higher in diabetics with CKD1-2 vs. healthy subjects and vs. nondiabeticsfig with CKD3-4. GLO1 activity was significantly higher in diabetics compared to nondiabetics. In conclusion, both diabetes and CKD affects the glyoxalase system. It appears that CKD in advanced stages has prevailing and suppressive effects compared to hyperglycaemia. CKD decreases GLO1 gene expression and protein levels (together with diabetes) without concomitant changes of GLO1 activity.

• Klíčová slova
• chronic kidney disease, diabetes, diabetic nephropathy, glyoxalase,
• MeSH
• chronická renální insuficience krev   patologie   MeSH
• diabetes mellitus krev   patologie   MeSH
• diabetické nefropatie krev   patologie   MeSH
• laktoylglutathionlyasa krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pyruvaldehyd krev   MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• GLO1 protein, human MeSH Prohlížeč
• laktoylglutathionlyasa MeSH
• pyruvaldehyd MeSH

The global widespread of the chronic kidney disease (CKD) is a worldwide health problem. Its increasing incidence and prevalence and adverse outcomes (including decreased quality of life, increased morbidity and mortality) represents a huge challenge for all recent health are systems. Reflecting this situation, the new, global initiative (KDIGO) was established to enhance communication and clinical decision-making, promote the use of evidence based medicine and facilitate clinical research. The new definition, evaluation and classification of "renal osteodystrophy"; has been one of the first outcome of this initiative, suggesting the topic of chronic kidney disease--mineral and bone disorder (CKD-MBD) to be a hot problem of recent nephrology. The new terminology is consistent with a recent view on this topic and describes CKD-MBD as a complex syndrome, including abnormal mineral and PTH metabolism, altered bone structure as far as extra-skeletal calcifications.

• MeSH
• akademie a ústavy organizace a řízení   MeSH
• celosvětové zdraví MeSH
• chronické selhání ledvin komplikace   epidemiologie   MeSH
• cíle organizace MeSH
• hodnocení výsledků zdravotní péče MeSH
• incidence MeSH
• kalcinóza etiologie   terapie   MeSH
• komplexní management jakosti organizace a řízení   MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• minerálová a kostní nemoc při chronickém onemocnění ledvin klasifikace   diagnóza   epidemiologie   etiologie   terapie   MeSH
• nefrologie metody   normy   trendy   MeSH
• osobní újma zaviněná nemocí MeSH
• prevalence MeSH
• rizikové faktory MeSH
• směrnice pro lékařskou praxi jako téma * MeSH
• stupeň závažnosti nemoci MeSH
• terminologie jako téma * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Our study aimed to establish the best prediction equation for different age ranges in estimating Glomerular Filtration Rate (GFR) in clinical practice in Slovakia. The GFR by 24-hour creatinine clearance (Ccr) and the estimated GFR (eGFR) using the Cockcroft-Gault (CG), the four-variable Modification of Diet in Renal Disease (MDRD4) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were obtained in adults aged 30-80 (n = 433, 10-years intervals). The correlation between these prediction equations and Ccr was evaluated. Errors in prediction equations were detected by moving average and by comparisons of the formulas for GFR < 1.5 ml/s and > 1.5 ml/s. The best correlations were established between Ccr and MDRD4 for women (r = 0.7790) and men (r = 0.8009), and between Ccr and CKD-EPI for women (r = 0.7780) and men (r = 0.8002) in the 60-69 age range. High correlation was also established between Ccr and CG (r = 0.8655) and MDRD4 (r = 0.8713) for men in the 40-49 age range. With the exception of the 30-40 age range, a low prediction error was observed for each age range in both genders when GFR was < 1.5 ml/s. We recommend utilization of the MDRD4 and CG equations for men (40-49 years) and MDRD4 and CKD-EPI for women and men (60-69 years), as preferred substitutes for Ccr.

• MeSH
• chronická renální insuficience diagnóza   patofyziologie   MeSH
• dospělí MeSH
• hodnoty glomerulární filtrace fyziologie   MeSH
• kreatinin krev   moč   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prediktivní hodnota testů MeSH
• senioři MeSH
• věkové rozložení MeSH
• vyšetření funkce ledvin metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika MeSH
• Názvy látek
• kreatinin MeSH

INTRODUCTION: Decisions on whether to screen for chronic kidney disease (CKD) or not remain contentious in nephrology. This study provides a global overview of early CKD identification efforts. METHODS: Guidelines for scoping reviews were followed and studies were identified by searching MEDLINE, EMBASE, Cochrane Library, CINAHL, ISI Web of Science, and PsycINFO. Data extracted from included studies focused on the following 4 themes: study population, measurement methods, interventions used, and available policies. RESULTS: We identified 290 CKD screening and detection programs from 83 countries. Overall sample size was 3.72 million (North East Asia: 1.19 million), detection of CKD was the aim in 97.6%, 63.1% used population-based screening methods, and only 12.4% were in rural populations. Reported CKD prevalence (stages 3-5) was higher in targeted- (14.8%) than population-based studies (8.0%). Number of persons needed to screen (NNS) to identify 1 case was also lower in targeted studies (7 vs. 13). Single measurements (80%) and the combination of estimation of glomerular filtration rate with a urine test (albuminuria/proteinuria) (71.4%) were frequently used to detect CKD. Only 2.8% of studies included an intervention such as pharmacotherapy in identified cases. Policies on early identification were available in 30.1% of countries included. CONCLUSION: Methods for early CKD identification vary worldwide, often leading to wide variations in the reported prevalence. Efforts to standardize measurement methods for early detection focusing on high-risk populations and ensuring appropriate interventions are available to those identified with CKD will improve the value of programs and improve patient outcomes.

• Klíčová slova
• chronic kidney disease, early detection, estimated glomerular filtration rate, intervention, measurement, screening,
• Publikační typ
• časopisecké články MeSH
• Scoping Review MeSH

This study aimed at understanding the predictive potential of genetic risk scores (GRS) for diabetic kidney disease (DKD) progression in patients with type 2 diabetes mellitus (T2DM) and Major Cardiovascular Events (MCVE) and All-Cause Mortality (ACM) as secondary outcomes. We evaluated 30 T2DM and CKD GWAS-derived single nucleotide polymorphisms (SNPs) and their association with clinical outcomes in a central European cohort (n = 400 patients). Our univariate Cox analysis revealed significant associations of age, duration of diabetes, diastolic blood pressure, total cholesterol and eGFR with progression of DKD (all P < 0.05). However, no single SNP was conclusively associated with progression to DKD, with only CERS2 and SHROOM3 approaching statistical significance. While a single SNP was associated with MCVE - WSF1 (P = 0.029), several variants were associated with ACM - specifically CANCAS1, CERS2 and C9 (all P < 0.02). Our GRS did not outperform classical clinical factors in predicting progression to DKD, MCVE or ACM. More precisely, we observed an increase only in the area under the curve (AUC) in the model combining genetic and clinical factors compared to the clinical model alone, with values of 0.582 (95 % CI 0.487-0.676) and 0.645 (95 % CI 0.556-0.735), respectively. However, this difference did not reach statistical significance (P = 0.06). This study highlights the complexity of genetic predictors and their interplay with clinical factors in DKD progression. Despite the promise of personalised medicine through genetic markers, our findings suggest that current clinical factors remain paramount in the prediction of DKD. In conclusion, our results indicate that GWAS-derived GRSs for T2DM and CKD do not offer improved predictive ability over traditional clinical factors in the studied Czech T2DM population.

• Klíčová slova
• Diabetes mellitus, Diabetic kidney disease, Genetic predisposition, Genetic risk score, Single nucleotide polymorphism,
• MeSH
• celogenomová asociační studie MeSH
• chronická renální insuficience * genetika   patologie   MeSH
• diabetes mellitus 2. typu * genetika   komplikace   MeSH
• diabetické nefropatie * genetika   MeSH
• genetická predispozice k nemoci * MeSH
• genetické rizikové skóre MeSH
• jednonukleotidový polymorfismus * MeSH
• lidé středního věku MeSH
• lidé MeSH
• progrese nemoci * MeSH
• rizikové faktory MeSH
• senioři MeSH
• sfingosin-N-acyltransferasa genetika   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• sfingosin-N-acyltransferasa MeSH

INTRODUCTION: The aim of the study is to assess the degree of adherence of medical laboratories to Kidney Disease Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (CKD) in laboratory practice in Czechia and Slovakia. MATERIALS AND METHODS: An electronic questionnaire on adherence to KDIGO 2012 guideline was designed by an external quality assessment (EQA) provider SEKK spol. s.r.o. The questionnaire was placed and distributed through website to all medical biochemistry laboratories in Czechia and Slovakia (N = 396). RESULTS: A total of 212 out of 396 laboratories responded to the questions, though some laboratories only answered some questions, those applicable to their practice. A total of 48 out of 212 laboratories adopted the KDIGO 2012 guideline in full extent. The metrological traceability of creatinine measurement to standard reference material of SRM 967 was declared by 180 out of 210 laboratories (two of the responding laboratories did not measure creatinine). Thirty laboratories are not well educated on traceability of creatinine measurement and seven laboratories do not calculate estimated glomerular filtration rate (eGFR). Both urinary albumin concentration and albumin to creatinine ratio are reported by 144 out of 175 laboratories (37 of the responding laboratories did not measure urinary albumin). CONCLUSION: Majority of laboratories in Czechia and Slovakia adopted some parts of the KDIGO 2012 guideline in their practice, but only 23% of the laboratories apply them completely. Thus, further education and action should be conducted to improve its implementation.

• Klíčová slova
• creatinine, cystatin C, estimated glomerular filtration rate, glomerular filtration, post-analytical phase,
• MeSH
• chronická renální insuficience diagnóza   patologie   MeSH
• hodnoty glomerulární filtrace MeSH
• kreatinin moč   MeSH
• laboratoře nemocniční normy   MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• směrnice jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Slovenská republika MeSH
• Názvy látek
• kreatinin MeSH

BACKGROUND: Heart failure (HF) is a frequent cause of morbidity and mortality of end-stage kidney disease (ESKD) patients on hemodialysis. It is not easy to distinguish HF from water overload. The traditional HF definition has low sensitivity and specificity in this population. Moreover, many patients on hemodialysis have exercise limitations unrelated to HF. Therefore, we postulated two new HF definitions ((1) Modified definition of the Acute Dialysis Quality Improvement working group; (2) Hemodynamic definition based on the calculation of the effective cardiac output). We hypothesize that the newer definitions will better identify patients with higher number of endpoints and with more advanced structural heart disease. METHODS: Cohort, observational, longitudinal study with recording predefined endpoints. Patients (n = 300) treated by hemodialysis in six collaborating centers will be examined centrally in a tertiary cardiovascular center every 6-12 months lifelong or till kidney transplantation by detailed expert echocardiography with the calculation of cardiac output, arteriovenous dialysis fistula flow volume calculation, bio-impedance, and basic laboratory analysis including NTproBNP. Effective cardiac output will be measured as the difference between measured total cardiac output and arteriovenous fistula flow volume and systemic vascular resistance will be also assessed non-invasively. In case of water overload during examination, dry weight adjustment will be recommended, and the patient invited for another examination within 6 weeks. A composite major endpoint will consist of (1) Cardiovascular death; (2) HF worsening/new diagnosis of; (3) Non-fatal myocardial infarction or stroke. The two newer HF definitions will be compared with the traditional one in terms of time to major endpoint analysis. DISCUSSION: This trial will differ from others by: (1) detailed repeated hemodynamic assessment including arteriovenous access flow and (2) by careful assessment of adequate hydration to avoid confusion between HF and water overload.

• Klíčová slova
• Hemodialysis, arteriovenous access, effective cardiac output, heart failure,
• MeSH
• chronická renální insuficience * komplikace   MeSH
• chronické selhání ledvin * diagnóza   terapie   komplikace   MeSH
• dialýza ledvin škodlivé účinky   MeSH
• lidé MeSH
• longitudinální studie MeSH
• pozorovací studie jako téma MeSH
• srdeční selhání * diagnóza   etiologie   terapie   MeSH
• voda MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• voda MeSH