Asta Stankuvienė

INTRODUCTION: The question of the targets of dialysis dosing remains controversial since the beginning of the long-term dialysis treatment era. It is still uncertain if higher dialysis dose is better. The aim of our study was to investigate issues of dialysis dose in Lithuania during the period of 1998-2005 and to determine associations between hemodialysis dose and survival of patients on chronic hemodialysis. MATERIAL AND METHODS: We analyzed data of all patients who started hemodialysis due to end-stage renal disease in Lithuania between January 1, 1998, and December 31, 2005. The information about hemodialysis frequency, duration, and adequacy (according to Kt/V) was obtained from medical documentation. The overall survival rate was estimated using the Kaplan-Meier method. Survival comparisons were made using the log-rank or Breslow tests. Univariate Cox proportional hazards analysis was used to select variables significantly associated with the risk of death; then these variables were included in multivariate Cox proportional hazards models. RESULTS: During the study period, from 2428 patients who started chronic hemodialysis, 58.5% of patients started hemodialysis three times a week. More than one-third (36.2%) of patients were dialyzed twice weekly, and 5.3% of patients started hemodialysis once weekly. Survival analysis revealed that patients dialyzed less than three times per week survived shorter than patients receiving a higher dialysis dose. Duration of HD session of ≤8 hours per week was an independent risk factor for mortality. A higher mean Kt/V was associated with better survival of patients on chronic hemodialysis. CONCLUSIONS: Dialysis frequency and weekly duration of HD sessions were dependent on HD accessibility in Lithuania during the period of 1998-2005. Better survival of patients on chronic hemodialysis was associated with a higher hemodialysis dose.

Background and Objectives: The prospective study was conducted to evaluate humoral and cellular immune responses after two doses of BNT162b2 (Pfizer-BioNTech) vaccine and possible relation with other factors (medication, etc.) in kidney transplant patients. Materials and Methods: Out of 167 vaccinated patients, 136 agreed to a follow-up visit three to six weeks after vaccination. Results: Only 39 patients (29%) developed antibody response against SARS-CoV-2 (≥35.2 binding antibody units (BAU)/mL) after full vaccination. Multivariate binary logistic regression analysis showed that predictive factors for good antibody response to the COVID-19 vaccine were better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression. For seropositive kidney transplant patients there was a significant negative correlation between anti-SARS-CoV-2 antibody titer and CD4/CD8 ratio (Spearman’s correlation coefficient −0.4, p = 0.02), percentage of CD19+ cells (r = −0.37, p = 0.02), and a positive correlation with percentage of CD8+ cells (r = 0.4, p = 0.01). There was an increase of total leucocyte count after vaccination in the total studied population, and in the group of responders. Conclusions: Only one third of kidney transplant patients develop sufficient antibody responses after full COVID-19 vaccination with Pfizer-BioNTech. Better kidney function, higher hemoglobin level, and no use of mycophenolate mofetil for immunosuppression increases the adequacy of response. The antibody titers correlated positively with relative number of CD8+ cells and negatively with CD4/CD8 ratio in responders.

Seroprevalence rates and molecular characterization of hepatitis E virus (HEV) prevalent in the Lithuanian human population has not yet been evaluated. Immunosuppressed individuals have been recognized as a risk group for chronic hepatitis due to HEV genotype 3 (HEV-3) infections. The objectives of the present study were to determine prevalence rates of anti-HEV antibodies among inflammatory bowel disease (IBD) patients and solid organ transplant (SOT) recipients, to isolate and characterize HEV strain present in the Lithuanian human population, and to investigate its capacity to infect non-human primate (MARC-145 and Vero), swine (PK-15) and murine (Neuro-2a) cells in vitro. In the present study, the significant difference of anti-HEV IgG prevalence between healthy (3.0% (95% CI 0–6.3)) and immunosuppressed individuals (12.0% [95% CI 8.1–15.9]) was described. Moreover, our findings showed that anti-HEV IgG seropositivity can be significantly predicted by increasing age (OR = 1.032, p < 0.01), diagnosis of IBD (OR = 4.541, p < 0.01) and reception of SOT (OR = 4.042, <0.05). Locally isolated HEV strain clustered within genotype 3i subtype of genotype 3 and was capable of infecting MARC-145 cells. This study demonstrates higher HEV seroprevalence in the risk group compared to healthy control individuals without confidence interval overlap. The high level of genetic homology between human and animal strains in Lithuania and the capacity of locally isolated strains to infect cells of non-human origin suggests its potential for zoonotic transmission.

The aim of the study was to evaluate the interconnections between local Schumann resonances of the Earth’s magnetic field and episodes of kidney disease. Materials and Methods: Study participants included 716 males and 624 females who had episodes of kidney disease during the period of 1 January 2021 to 31 December 2021 and attended the Department of Nephrology at the Hospital of Lithuanian University of Health Sciences, Kauno klinikos. Time varying magnetic field data was collected at the magnetometer site located in Lithuania. Results and Conclusions: The study results support the hypothesis that the Earth’s magnetic field has a relationship between the number of nephrology patient hospitalizations per week and the average weekly local Schumann resonances strength in different frequency ranges. Working hypotheses are proposed for the mechanisms of the influence of the Earth’s electromagnetic field on kidney function: а) quantum mechanical features of the atomic composition of renal tissue molecules determine a kidney-specific reaction; b) cyclotron resonance mechanism; c) resonant response of cells of morphological structures of kidney tissue to external bioactive frequencies in the range of 6-8 Hz; d) mechanism of indirect influence of blood as a magnetically saturated medium.

Background. The pandemic of noncommunicable chronic diseases and the high prevalence of combined damage to the cardiovascular system and kidneys determine the relevance of continuing scientific research to solve these medical problems. Therefore, the aim of this study was to compare the influence of the Earth’s electromagnetic field on the occurrence of episodes of kidney disease and myocardial infarction in order to search for new pathogenetic components of cardiorenal syndrome and deepen fundamental knowledge. According to the Lithuanian magnetometer GCI003, a number of stu­dies in 2014–2018 found that changes in the Earth’s electromagnetic field may play an important role in the pathogenesis of cardiovascular diseases as well as their incidence. Since the functioning of the cardiovascular system and kidneys are closely connected through the metabolic processes of the cardiorenal metabolic axis, this study tested the hypothesis that changes in the Earth’s electromagnetic field may also affect the pathogenesis of kidney disease as the changes of local magnetic field have been shown to influence the functioning of the cardiovascular system. Materials and methods. This was a search retrospective study on the relationship between the influence of local Schumann resonances and the occurrence of hospitalizations in 1340 patients with kidney disease. It also examined the relationship between local Schumann resonances and heart attacks in patients admitted to the University Hospital of the Lithuanian University of Health Sciences (703 patients). Mean power of local magnetic field fluctuations in Lithuania was measured in pT2 s2 in five different frequency ranges, which overlaps the Schumann resonance and electroencephalogram’s frequency ranges: SDelta (0–3.5 Hz), STheta (3.5–7 Hz), SAlpha (7–15 Hz), SBeta (15–32 Hz), SGamma (32–66 Hz). The data of hospitalizations to the Nephrology Department of University Hospital and the dynamics of Schumann resonances were analyzed from January 1, 2021 to December 31, 2021. The data of hospitalizations for myocardial infarction to the Cardiology Department of University Hospital and the dynamics of Schumann resonances were studied from January 1, 2016 to December 31, 2016. Results. It was found that changes in the strength of the Earth’s local magnetic field in 2016 and 2021 were comparable and corresponded to the characteristic annual dynamics of the Earth’s local electromagnetic fields. This made it possible to conduct a comparative analysis of annual correlation graphs and establish general trends in the dynamics of indicators and graphical similarities. It confirmed the pre­sence of a general dependence of reactions to the external electromagnetic field of the Earth in female and male patients both with nephrological pathology and myocardial infarction. In nephrological patients of both sexes, all correlation coefficients in all ranges of Schumann resonances were positive. The only negative correlation coefficient P5 (SGamma) [32; 65] Hz (r = –0.069; p = 0.313) was in the female group. This fact as well as the presence of a significant dynamics of the correlation coefficient P5 (SGamma) [32; 65] Hz (r = 0.009; p = 0.475) in the male group indicate that higher magnetic field strength in this frequency range may be associated with a reduced incidence of kidney disease. We obtained data that a higher magnetic field intensity in the gamma range from 32 to 65 Hz as a pathogenetic component can contribute to the destabilization of the cardiovascular system, but at the same time it is associated with a positive effect on the state of nephrological pathology. Based on this, we can tentatively assume the opposite direction of the Earth’s electromagnetic field influence on the pathogenetic mechanisms of renal and cardiovascular diseases. This is clearly demonstrated by comparing the correlation coefficients between the incidence of kidney disease and the occurrence of myocardial infarction in men and women. The Earth’s stronger magnetic field in the gamma range contributes to an increase in the incidence of myocardial infarction, which is confirmed by the large number of patients during this period. Under these same conditions, a decrease in the incidence of kidney disease has been detected. This opposite direction is observed in both sexes. But in women the reaction is stronger, which is confirmed by a larger difference in correlation coefficients. Conclusions. 1. Changes in the Earth’s electromagnetic field are related to the functional state of the cardiovascular system and the condition of the kidneys. 2. It can be assumed that the effect of the Earth’s electromagnetic field on the pathogenetic mechanisms of kidney disease is in the opposite direction of that on the cardiovascular one. 3. Reliable gender differences in correlations between the influence of changes in the local Schumann resonance on the functional state of the cardiovascular system and kidneys were not found. 4. The connection of the Earth’s local geomagnetic field with kidney function may be another new unexplored pathogenetic mechanism in cardiorenal syndrome and noncommunicable chronic diseases.