Branislav Apostolović

Background and Objectives: Sarcopenia is common among patients receiving maintenance hemodialysis, although prevalence estimates vary according to the diagnostic approach. We assessed sarcopenia defined according to the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, its baseline correlates, and its association with 24-month all-cause mortality. Materials and Methods: In this single-center prospective cohort at a tertiary nephrology center, 176 patients enrolled in December 2022 were followed for 24 months. Confirmed sarcopenia required both low handgrip strength and a low appendicular skeletal muscle index assessed by bioelectrical impedance. Physical performance was not assessed. Because the proportional-hazards assumption was not satisfied, restricted mean survival time (RMST) was used as the primary measure of the survival difference. Results: Sarcopenia was present in 46 of 176 participants (26.1%, 95% CI 20.2–33.1). Older age, lower serum albumin and phosphorus concentrations, lower Kt/V, and longer time on maintenance hemodialysis were independently associated with sarcopenia. Thirty-one participants died during follow-up, and survival was lower among those with sarcopenia (log-rank p = 0.035). The adjusted RMST difference was −3.88 months (95% CI −6.49 to −1.28; p = 0.003). A Cox sensitivity analysis yielded a hazard ratio of 2.62 (95% CI 1.06–6.45). There was no evidence of a sarcopenia-by-sex interaction in the adjusted RMST analysis (p = 0.964). Conclusions: Confirmed sarcopenia was present in approximately one quarter of patients and was associated with approximately four months shorter restricted mean survival over 24 months. EWGSOP2-based assessment may provide prognostic information in this setting; whether routine screening or management based on sarcopenia status improves clinical outcomes remains to be determined.

Dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) is considered a marker of vitamin K status and vascular calcification risk in chronic kidney disease. This study assessed the association of serum dp-ucMGP, alone and combined with albumin, with all-cause and cardiovascular mortality in maintenance hemodialysis patients. This single-center observational cohort study included 133 maintenance hemodialysis patients with a two-year survival follow-up. Analyses involving dp-ucMGP and albumin were performed in 113 patients with complete biomarker data. Baseline serum dp-ucMGP, albumin, inflammatory markers, and routine laboratory parameters were measured. Associations with all-cause and cardiovascular mortality were evaluated using group comparisons, ROC curve analysis, Kaplan–Meier analysis, and Cox regression. Patients who died had significantly lower dp-ucMGP and albumin levels and higher inflammatory and hematological indices than survivors, with similar findings for cardiovascular mortality. The combined dp-ucMGP–albumin model showed higher apparent discriminatory performance than either marker alone for all-cause mortality (AUC 0.793, 95% CI 0.708–0.878, p < 0.001) and cardiovascular mortality (AUC 0.778, 95% CI 0.687–0.868, p < 0.001). Lower dp-ucMGP levels were associated with worse survival. In multivariable Cox regression, higher dp-ucMGP and albumin were independently associated with lower mortality. Combined dp-ucMGP and albumin assessment may provide complementary prognostic information in hemodialysis patients but requires validation in larger cohorts.

Reliable mortality statistics are essential for evidence-based public health policy, Sustainable Development Goal (SDG) monitoring, and health system performance evaluation. The WHO-developed ANACONDA framework provides standardised algorithmic metrics to assess cause-of-death (CoD) data quality within Civil Registration and Vital Statistics (CRVS) systems. This study applied ANACONDA (v5.0) to Serbian mortality data (2005–2019), encompassing 1.54 million deaths coded using ICD-10. Key indicators included garbage codes (GC), high-impact GC (Levels 1–3), and the Vital Statistics Performance Index for Quality (VSPI(Q)). The VSPI(Q) improved from medium to high quality, while overall GC declined from 47.3% to 40.5%. The findings demonstrate how algorithmic quality auditing strengthens national mortality intelligence systems and supports data-driven health governance.

Background: Cardiovascular disease (CVD) is the leading cause of mortality in peritoneal dialysis (PD) patients, with traditional risk factors failing to fully explain the accelerated atherosclerosis observed in this group. Hepcidin, a major regulator of iron metabolism and inflammation, has emerged as a potential contributor to vascular remodeling. Methods: We conducted a cross-sectional study of 82 PD patients to assess the relationship between serum hepcidin levels and carotid intima–media thickness (CIMT), a surrogate marker of subclinical atherosclerosis. Clinical, biochemical, and dialysis-related data were collected. Patients were stratified into tertiles by hepcidin levels, and correlation, regression, and ROC analyses were performed. Results: Serum hepcidin levels showed a strong positive correlation with CIMT (ρ = 0.788, p < 0.001). In multivariate linear regression, hepcidin (β = 0.0057, p = 0.012) and dialysis duration (β = 0.0018, p = 0.015) remained independent predictors of CIMT. ROC analysis demonstrated excellent discriminative ability of hepcidin for elevated CIMT (AUC = 0.922), which improved further with the inclusion of dialysis duration (AUC = 0.952). Conclusions: Serum hepcidin is a strong, independent predictor of subclinical atherosclerosis in PD patients. These findings suggest that iron dysregulation and inflammation may play a more prominent role than traditional cardiovascular risk factors in this population. Hepcidin may serve as a valuable biomarker for early vascular risk stratification and a potential therapeutic target.

Introduction: During the COVID-19 pandemic, receiving hemodialysis was recognized as a predictor of poor survival. This study evaluated in-hospital and late survival in patients treated with hemodialysis during COVID-19 hospitalization. Methods: This single-center retrospective study included 176 patients requiring hemodialysis during COVID-19 hospitalization. Patients were divided into three groups: acute kidney injury (AKI), acute-on-chronic kidney disease (aCKD), and chronic hemodialysis (HD). Data was collected from patients' electronic records. Results: The majority (73.3%) of the study population were chronic hemodialysis patients. The overall in-hospital mortality was high (35.8%), and differed significantly among groups: 82.1%, 57.9% and 22.5% in the AKI, aCKD, and HD patients, respectively (p<0.001). After 12 months, death occurred in almost 30% of the reached patients, of whom the majority were from the chronic hemodialysis group. Conclusion: Dialysis-dependent patients experience high mortality during COVID-19, especially those who develop AKI and aCKD. Chronic hemodialysis patients are exposed to better in-hospital survival; however, their one-year mortality remains significant.

This study aims to evaluate the temporal trend in the quality of cause-of-death data and garbage code profiles and to determine its association with socio-economic status in Serbia. A longitudinal study was assessed using data from mortality registers from 2005 to 2019. Computer application Analysis of Causes of National Deaths for Action (ANACONDA) calculates the distribution of garbage codes by severity and composite quality indicator: Vital Statistics Performance Index for Quality (VSPI(Q)). A relationship between VSPI(Q) and country development was estimated by analysing two socio-economic indicators: the Socio-demographic Index and the Human Development Index (HDI). Serbia indicates progress in strengthening cause-of-death statistics. The steady upward trend of the VSPI(Q) index has risen from 55.6 (medium quality) to 70.2 (high quality) over the examined years. Significant reduction of ‘Insufficiently specified causes with limited impact’ (Level 4) and an increase in the trend of ‘High-impact garbage codes’ (Levels 1 to 3) were evident. Decreased deaths of no policy value (annual percentage change of −1.41%) have manifested since 2014. A strong positive association between VSPI(Q) and socio-economic indicators was assessed, where the HDI has shown a stronger association with VSPI(Q). Improved socio-economic conditions on the national level are followed by enhanced cause-of-death data quality. Upcoming actions to improve quality should be directed at high-impact garbage codes. The study underlines the need to prioritise the education and training of physicians with a crucial role in death certification to overcome many cause-of-death quality issues identified in this assessment.

Cardiovascular events are the major reasons for mortality in haemodialysis patients. Fibroblast growth factor 23 (FGF23), Klotho protein and G-395A Klotho gene polymorphism have been associated with effects on the cardiovascular system. Our study investigates the interrelationship between Klotho protein gene variations, mineral–bone metabolism and left ventricular hypertrophy in patients undergoing chronic haemodialysis programme.

Burkholderia cepacia (B. cepacia) is a rare opportunistic pathogen in continuous ambulatory peritoneal dialysis (CAPD) peritonitis. We described the first case of repeated B. cepacia CAPD peritonitis, occurred in outpatient environment, treated with antimicrobial medication without peritoneal catheter removal. B.