Papers by Mihaela Dora Donciu
Revista de Chimie
In hemodialysis patients malnutrition-inflammation syndrome, evaluated by biochemical laboratory ... more In hemodialysis patients malnutrition-inflammation syndrome, evaluated by biochemical laboratory analysis and through bioimpedance spectroscopy, was associated to impaired quality of life and with an increased risk of mortality. The present study goal was to investigate, in a cross-sectional analysis, performed in 122 hemodialysis patients, the association between biochemical parameters and bioimpedance-derived measurements the association of undernutrition with quality of life and illness perception. The results showed that our cohort perceived an impaired quality of life and illness perception and that these psychometric evaluation was associated with malnutrition markers.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Jan 2, 2017
The presumed superiority of renin-angiotensin-aldosterone system (RAAS)-blocking agents over othe... more The presumed superiority of renin-angiotensin-aldosterone system (RAAS)-blocking agents over other antihypertensive agents in patients with diabetes to delay development of end-stage kidney disease (ESKD) has recently been challenged. In addition, there is ongoing uncertainty whether RAAS-blocking agents reduce mortality and/or delay ESKD in patients with diabetes and chronic kidney disease (CKD) stages 3-5. In this subgroup, there might be an expedited need for renal replacement therapy (RRT) when RAAS-blocking agents are used. We conducted a meta-analysis of randomized controlled trials (RCTs) of at least 6-months duration in adult patients with diabetes who also have non-dialysis CKD stages 3-5. RCTs comparing single RAAS-blocking agents to placebo or alternative antihypertensive agents were included. Outcomes of interest were all-cause mortality, cardiovascular morbidity, progression of renal function, ESKD and adverse events. A total of nine trials (n = 9797 participants with C...
Nephrology Dialysis Transplantation, 2015
International Urology and Nephrology, 2017
Periodontal disease is a chronic infectious disease. Individuals with end-stage kidney disease (E... more Periodontal disease is a chronic infectious disease. Individuals with end-stage kidney disease (ESKD) experience impaired quality of life (QoL) and low oral health. This is the first comprehensive study which aimed to explore the link between periodontal disease and quality of life, assessed with the Short Form 36-Item Health Survey in hemodialysis patients. In total, 101 patients (57 females) with ESKD were recruited from two Romanian dialysis centers. Periodontal disease assessment included the measurement of periodontal disease index, with its three components: the gingival and periodontal index (GP), the bacterial plaque index (PI) and the calculus index (CI). For assessing QoL, we used the Short Form 36-Item Health Survey (SF-36), with its two components: physical component (PCS) and mental component (MCS). The mean age was 52.5 ± 14.3 years. The dialysis vintage was 6.7 ± 5.6 years. According to periodontal status, the mean value of GP was 4.0 ± 1.3, mean PI was 1.8 ± 0.9, and mean CI was 1.3 ± 0.7. Regarding the QoL, the means for PCS and MCS were 38.0 ± 17.3 and 45.0 ± 16.3, respectively. In univariate analysis, the physical and mental components of QoL were significantly associated with the gingival and periodontal index, the bacterial plaque index and the calculus index. In the multivariable linear regression, only the gingival and periodontal index remained significantly associated with physical component (β = -3.26, p = 0.04, 95% CI -6.39 to -0.13) and mental component (β = -5.57, p = 0.001, 95% CI -8.74 to -2.41) of QoL. Our study shows a high prevalence and severity of periodontal disease. The gingival and periodontal index was associated with low QoL, both on physical and on mental components.
Nephrology Dialysis Transplantation, 2016
Angiology, Jan 21, 2016
Contrast-induced acute kidney injury (CI-AKI) is a common cause of hospital-acquired acute kidney... more Contrast-induced acute kidney injury (CI-AKI) is a common cause of hospital-acquired acute kidney injury (AKI). We evaluated the evidence that uric acid (UA) plays a pathogenic role in CI-AKI. Ten studies were eligible for inclusion for meta-analysis. Hyperuricemia predicted risk for cases with AKI in prospective cohort studies. Higher levels of serum UA (SUA), as defined by the authors, were associated with a 2-fold increased risk to develop AKI (pooled odds ratio 2.03; 95% confidence interval [CI] 1.48-2.78). Significant heterogeneity was found in cohort studies (P = .001, I (2) = 85.7%). In 2 clinical trials, lowering of SUA with saline hydration was significantly associated with reduced risk for AKI compared with saline hydration alone or saline hydration with N-acetyl cysteine. An analysis of 2 randomized controlled trials found that allopurinol with saline hydration had a significant protective effect on renal function (assessed by serum creatinine values) compared with hydrat...
Hemodialysis International, 2016
Introduction Cognitive impairment is a major, but underdiagnosed, risk factor for negative outcom... more Introduction Cognitive impairment is a major, but underdiagnosed, risk factor for negative outcomes in patients with chronic kidney disease (CKD). The main goal of this study was to evaluate, for the first time, the relationship between arterial stiffness and cognitive impairment in a cohort of hemodialysis patients. Methods We prospectively analyzed the cognitive function and pulse wave velocity (PWV) of 72 hemodialysis patients, mean age 56.54 ± 13.96 y, from two Romanian dialysis centers. We administered to all patients the Mini Mental State Examination (MMSE), Trail Making Test Part-A (TMTA) and Part-B (TMTB), and Mini-Cog Test. Radial arterial waveforms during 40 cardiac cycles were recorded in each patient. Findings Mean MMSE score was 25.13 ± 3.47, mean MiniCog score was 3.51 ± 1.18, mean TMTA (sec) was 103.77 ± 53.13 and mean TMTB (sec) was 214.93 ± 112.25. In linear unadjusted regression, PWV values were associated with worse MMSE scores (β = -0.36, P = 0.001, 95% CI: -0.68 to -0.17), and MiniCog scores (β = -0.26, P = 0.02, 95% CI: -0.19 to -0.01). Also, PWV value was significant associated with TMTA test, but not with TMTB. After further adjustments, PWV remained a strong predictor for cognitive impairment measured by MMSE, TMTA, MiniCog, but not for TMTB. Discussion Cognitive impairment was associated with higher PWV values in our cohort. Further evidence is needed in order to support arterial stiffness as a long-term predictor for cognitive decline in ESRD patients.
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
The number and severity of physical and psychological symptoms reported by chronic hemodialysis (... more The number and severity of physical and psychological symptoms reported by chronic hemodialysis (HD) patients are significant and increasing; with a clear need to clarify which symptom intervention is the most needed. Measurements of quality of life (QoL) have shown, for many decades, an impairment of both physical and psychological aspects in both chronic kidney disease (CKD) pre-dialysis and in end stage renal disease (ESRD) patients. This cross-sectional study was conducted assess the quality of life of a Romanian hemodialysis population and the impact of several clinical and biochemical factors. A total of 102 patients (41 males, 61 females) with a mean age of 52.5 +/- 12.0 years, who were treated with HD three times per week in our dialysis center were included in the study. All subjects completed the Short Form Health Survey Questionnaire (SF-36). Clinical and biochemical parameters were extracted from the EUCLID electronic database. Our measurement showed a deteriorated QoL i...
Revista Romana De Bioetica, Jan 23, 2014
During the past years the number of organ donors in Romania has declined after a slow but steady ... more During the past years the number of organ donors in Romania has declined after a slow but steady increase since 2000. Improving consent rate for solid organ donation from deceased donor is a key component of strategies to increase de availability of organs for transplantation. In our country, the law is currently clear on what forms consent may take, during life or after death -through family approval. The factors determining such actions include both positive altruistic motives and negative psychological responses. The national program of organ donation is an opt-in system. Without having a centralized program of organ donors, which makes the request consent for donation more difficult, some potential organs for transplant can be lost because of lack of consent. The present article largely discusses: the strategies and policies for organ procurement in our country and two other countries, with important transplant rates, even if they have different systems of donation.
PLOS ONE, 2016
The Roma minority represents the largest ethnic group in Central and South-East European countrie... more The Roma minority represents the largest ethnic group in Central and South-East European countries. Data regarding the mortality in Roma hemodialysis subjects are limited. We evaluated the 3 year mortality of ESRD Roma patients treated with hemodialysis (HD). Our prospective cohort study included 600 ESRD patients on HD therapy recruited from 7 HD centers, from the main geographical regions of Romania. The median age of the patients was 56 (19) years, 332 (55.3%) being males, 51 (8.5%) having Roma ethnicity. Roma ESRD patients initiate dialysis at a younger age, 47.8 years vs. 52.3 years (P = 0.017), present higher serum albumin (P = 0.013) and higher serum phosphate levels (P = 0.021). In the Roma group, the overall 3 year mortality was higher when compared to Caucasians (33.3% vs. 24.8%). The multivariate survival analysis revealed that being of Roma ethnicity is an independent risk factor for mortality (HR = 1.74; 95% CI = 1.04-2.91; P = 0.035). Roma patients with ESRD initiate HD therapy at a younger age as compared to Caucasians. They have a higher 3 year mortality rate and are dying at a younger age. Roma ethnicity represents an independent risk factor for mortality in our cohort.
Revista Medico Chirurgicală̆ a Societă̆ţ̜ii De Medici Şi Naturalişti Din Iaşi, Nov 1, 2013
The number and severity of physical and psychological symptoms reported by chronic hemodialysis (... more The number and severity of physical and psychological symptoms reported by chronic hemodialysis (HD) patients are significant and increasing; with a clear need to clarify which symptom intervention is the most needed. Measurements of quality of life (QoL) have shown, for many decades, an impairment of both physical and psychological aspects in both chronic kidney disease (CKD) pre -dialysis and in end stage renal disease (ESRD) patients. This cross-sectional study was conducted assess the quality of life of a Romanian hemodialysis population and the impact of several clinical and biochemical factors. Material and methods: A total of 102 patients (41 males, 61 females) with a mean age of 52.5 ± 12.0 years, who were treated with HD three times per week in our dialysis center were included in the study. All subjects completed the Short Form Health Survey Questionnaire (SF-36). Clinical and biochemical parameters were extracted from the EUCLID ® electronic database. Results: Our measurement showed a deteriorated QoL in our population, all of the included subjects presenting with much lower scores in both physical and mental components than the reference values of SF-36. We did not found any statistic significant correlation between hemoglobin (Hgb) levels or dialysis adequacy and different domains of the SF-36. The only significant association was found between age and the physical component of the SF-36, implying that older patients perceive a more degraded quality of life. Conclusion: HD patients experience a great burden from physical and psychological symptoms of the disease, perceiving an important impairment in their quality of life, esp ecially regarding the physical component.
drawal of treatment due to adverse events (RR, 1.18 [CI 0.77– 1.81], 10 trials, n = 1,958 partici... more drawal of treatment due to adverse events (RR, 1.18 [CI 0.77– 1.81], 10 trials, n = 1,958 participants) for patients at higher hemoglobin (Hb) targets. Furthermore, no statistically significant differences in mortality (Risk Ratio [RR] 1.10 [CI 0.90– 1.35], 16 trials, n = 8,082 participants) were observed. Key Messages: There is no evidence that ESA treatment affects renal function in patients with CKD. Use of these agents should not therefore be influenced by considerations about influencing CKD progression.
Introduction Cognitive impairment is a major, but underdiagnosed, risk factor for negative outcom... more Introduction Cognitive impairment is a major, but underdiagnosed, risk factor for negative outcomes in patients with chronic kidney disease (CKD). The main goal of this study was to evaluate, for the first time, the relationship between arterial stiffness and cognitive impairment in a cohort of hemo-dialysis patients. Methods We prospectively analyzed the cognitive function and pulse wave veloc
American Journal of Kidney Diseases, 2010
In patients with euvolemic and hypervolemic hyponatremia, the effect of vasopressin antagonists i... more In patients with euvolemic and hypervolemic hyponatremia, the effect of vasopressin antagonists is yet undefined. Systematic review and meta-analysis of randomized controlled trials (RCTs). In- and outpatients with euvolemic or hypervolemic hyponatremia. We included all RCTs regardless of publication status or language. Vasopressin antagonists with or without fluid restriction versus placebo or no treatment with or without fluid restriction. Response rate defined as normalization of serum sodium level or significant increase in serum sodium level at 3-7 days (primary) and later, change from baseline serum sodium level at 3-7 days and later, adverse events, rate of rapid sodium level correction, and rate of hypernatremia. 15 RCTs were identified. Vasopressin antagonist treatment significantly increased response rate both early (RR, 3.15; 95% CI, 2.27-4.37; 11 trials) and late (RR, 2.27; 95% CI, 1.79-2.89; 4 trials). Response rates were high in trials assessing mostly euvolemic patients and those assessing mostly hypervolemic patients, with greater effect estimate in the former. Change from baseline serum sodium level was significantly increased both early (weighted mean difference, 5.27 mEq/L; 95% CI, 4.27-6.26, 13 trials) and late (weighted mean difference, 3.49 mEq/L; 95% CI, 2.56-4.41, 8 trials). Although there was an increased rate of rapid sodium correction (RR, 2.52; 95% CI, 1.26-5.08, 8 trials) with vasopressin antagonists, hypernatremia rates were not significantly higher (RR, 2.21; 95% CI, 0.61-7.96; 5 trials), adverse events were not increased, and there were no reports of osmotic demyelination syndrome. Significant heterogeneity in the primary outcome. Vasopressin antagonists are effective for the treatment of hypervolemic and euvolemic hyponatremia.
Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
The number and severity of physical and psychological symptoms reported by chronic hemodialysis (... more The number and severity of physical and psychological symptoms reported by chronic hemodialysis (HD) patients are significant and increasing; with a clear need to clarify which symptom intervention is the most needed. Measurements of quality of life (QoL) have shown, for many decades, an impairment of both physical and psychological aspects in both chronic kidney disease (CKD) pre-dialysis and in end stage renal disease (ESRD) patients. This cross-sectional study was conducted assess the quality of life of a Romanian hemodialysis population and the impact of several clinical and biochemical factors. A total of 102 patients (41 males, 61 females) with a mean age of 52.5 +/- 12.0 years, who were treated with HD three times per week in our dialysis center were included in the study. All subjects completed the Short Form Health Survey Questionnaire (SF-36). Clinical and biochemical parameters were extracted from the EUCLID electronic database. Our measurement showed a deteriorated QoL i...
Journal of clinical hypertension (Greenwich, Conn.), Jan 28, 2015
Cardio-Renal Clinical Challenges, 2014
International Urology and Nephrology, 2014
MEDLINE to January 2014 and reference lists without language restriction. Meta-analysis using a r... more MEDLINE to January 2014 and reference lists without language restriction. Meta-analysis using a random-effects model was done for all-cause and cardiovascular mortality, hospitalization for heart failure, changes in clinical assessment of HF, serum sodium concentration (Na), kidney function and treatment-specific side effects. Results We identified 13 trials and 5,525 participants. In 10 trials, participants received standard therapy for HF. In low-quality evidence, VRAs in patients with HF had no effect on all-cause mortality risk ratios (RR 0.98; CI 0.88-1.08), cardiovascular mortality (RR 1.03; CI 0.91-1.16) or change in creatinine mean difference (MD −0.01; CI −0.10 to 0.09 mg/dL), but reduced body weight by 0.8 kg from baseline (MD −0.83; CI −1.10 to −0.55 kg) and increased Na (MD 2.61; 95 % CI 1.88-3.35 mmol/L). Compared with placebo, VRAs increased the risk of adverse events by 14 % (RR 1.14; CI 1.04-1.26). Studies were generally limited to short-term follow-up with limited data available on patient important outcomes. Conclusions Vasopressin receptors antagonists may reduce body weight and increase Na but do not improve all-cause mortality, cardiovascular mortality or kidney function. In addition, acceptability of long-term treatment side effects and hospitalization appears problematic.
American Journal of Nephrology, 2014
drawal of treatment due to adverse events (RR,], 10 trials, n = 1,958 participants) for patients ... more drawal of treatment due to adverse events (RR,], 10 trials, n = 1,958 participants) for patients at higher hemoglobin (Hb) targets. Furthermore, no statistically significant differences in mortality (Risk Ratio [RR] 1.10 [CI 0.90-1.35], 16 trials, n = 8,082 participants) were observed. Key Messages: There is no evidence that ESA treatment affects renal function in patients with CKD. Use of these agents should not therefore be influenced by considerations about influencing CKD progression.
Nephrology Dialysis Transplantation, 2013
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Papers by Mihaela Dora Donciu