Mariusz Stępień | Medical University of Lodz, Lodz, Poland (original) (raw)

Papers by Mariusz Stępień

Nutrients, 2022

Vitamin K (VK) plays many important functions in the body. The most important of them include the... more Vitamin K (VK) plays many important functions in the body. The most important of them include the contribution in calcium homeostasis and anticoagulation. Vascular calcification (VC) is one of the most important mechanisms of renal pathology. The most potent inhibitor of this process—matrix Gla protein (MGP) is VK-dependent. Chronic kidney disease (CKD) patients, both non-dialysed and hemodialysed, often have VK deficiency. Elevated uncarboxylated matrix Gla protein (ucMGP) levels indirectly reflected VK deficiency and are associated with a higher risk of cardiovascular events in these patients. It has been suggested that VK intake may reduce the VC and related cardiovascular risk. Vitamin K intake has been suggested to reduce VC and the associated cardiovascular risk. The role and possibility of VK supplementation as well as the impact of anticoagulation therapy on VK deficiency in CKD patients is discussed.

Medical Science and Technology, 2007

$Research paper thumbnail of Refractory hypertension due to the presence of additional renal arteries$

Medical Science and Technology, 2012

Transylvanian Review, 2017

Objective. The study was perform to assess the association between serum levels of adipokines and... more Objective. The study was perform to assess the association between serum levels of adipokines and chronic inflammation in non-diabetic hypertensive patients with obesity. Methods. 54 patients aged 58±11 years were divided according to BMI into 3 groups of obesity classes: A – class I (n=25); B – class II (n=14); and C – class III (n=15). The patients were also divided into groups receiving statins or fibrates (n=31) or not (n=23). Results. Leptin was higher in group C compared to A and B (62.0±32.1 ng/ml vs. 32.7±21.5 ng/ml; p<0.01 and vs. 36.1±16.4 ng/ml; p<0.05; respectively); hsCRP was higher in group C than in A (3.8±1.7 mg/l vs. 2.1±1.6 mg/l; p<0.01). Resistin, hsCRP and IL-6 were higher in the patients without hypolipidemic treatment (1.11±0.42 ng/ml vs. 0.89±0.26 ng/ml, p<0.05; 3.4±1.9 mg/l vs. 2.4±1.9 mg/l, p<0.05 and 16.1±7.3 pg/ml vs. 13.5±10.3 pg/ml; p<0.01 respectively). Leptin correlated with hsCRP in the whole study population (r=0.318, p<0.05), i...

Medical Science and Technology, 2008

Wiadomości Lekarskie, 2020

Introduction: The Nightscout system is a free Do It Yourself solution. This system appeared in Po... more Introduction: The Nightscout system is a free Do It Yourself solution. This system appeared in Poland in 2016. The concept of the project is to provide insight into measurements from the system of continuous glucose monitoring in interstitial fluid by authorized persons. The aim: The study was carried out to assess the functionality of the Nightscout system and its effect on metabolic control, safety and the incidence of complications in patients with type 1 diabetes mellitus. Material and methods:The study comprised 98 patients with type 1 diabetes. The study was conducted online using an anonymous questionnaire targeted at members of the “Nightscout Polska (Poland)” group on the Facebook. Results: Severe hypoglycaemic episodes with loss of consciousness were more frequent before using the Nightscout system and were reported by 3 adults (1-2 episodes). No severe hypoglycaemic episodes were reported when using the Nightscout system. The number of ketoacidosis episodes was reduced fr...

Journal of Diabetes Science and Technology, 2020

Background: The FreeStyle Libre is a flash glucose monitoring (FGM) system, and glucose levels ar... more Background: The FreeStyle Libre is a flash glucose monitoring (FGM) system, and glucose levels are measured when the reader is brought to the sensor. Additional readers allow for the conversion into a continuous glucose monitoring (CGM) system. These transmitters read data from the sensor and send them to a bluetooth-enabled device thanks to which the user acquires glucose measurements automatically. This modification allows the patient to receive alerts when blood glucose values are abnormal. Methods: The study relied on the results of an anonymous online survey conducted among patients with diabetes or their caregivers who use Facebook groups. A total of 132 respondents who met certain criteria (diabetic who use FGM system longer than 3 months, at least 14 days per month) were enrolled in the study. Results: A significant decrease in self-reported glycated hemoglobin levels was found in adults and children using readers (variable: age P = .008; time P < .001), regardless of the...

Clinical Diabetology, 2019

The paper describes currently available interstitial glucose monitoring systems and discusses the... more The paper describes currently available interstitial glucose monitoring systems and discusses their advantages and disadvantages in comparison with conventional blood glucose measurements using glucose meters. Furthermore, it describes clinical trials assessing these systems in terms of their usefulness, safety and influence on therapeutic management in diabetes.

Current Pharmaceutical Biotechnology, 2017

Chronic kidney disease (CKD) is an important health problem, because of unsuccessful outcomes suc... more Chronic kidney disease (CKD) is an important health problem, because of unsuccessful outcomes such as CKD progression to end stage renal disease and high risk of cardiovascular disease (CVD). Anemia, associated with CKD, is considered a non-traditional risk factor for CVD which may contribute to faster CKD progression. Anemia treatment with erythropoiesis-stimulating agents (ESAs) seems to exert non-hematopoietic effects on different tissues and organs, including cardiovascular system and kidneys. On the other hand, clinical use of high doses of short-acting ESAs and higher target hemoglobin level were associated with higher risk of CVD. Literature data indicate the usefulness of long-acting ESAs in treatment of anemia in non-dialysis CKD patients. In particular, continuous erythropoietin receptor activator seems to be a good choice in these patients because of its efficiency, safety and monthly administration. Continuous but slower erythropoietin receptor activation, using methoxy polyethylene glycol-epoetin beta (MPG-EPO), administered once a month, slowly corrects anemia without exceeding the recommended hemoglobin level. An overview of the available literature may suggest nephroprotective and cardiovascular protective effects of MPG-EPO. It seems possible that anemia treatment with a novel ESAs, MPG-EPO in early stages of CKD may reduce CVD risk in these patients and delay CKD progression. This review of available literature evaluates the correlation between continuous erythropoietin receptor activation using MPG-EPO and CKD progression and CVD risk in non-dialysis CKD patients.

Farmacja Polska, 2002

Chronobiological aspects of antihypertensive therapy. Systolic and diastolic blood pressure shows... more Chronobiological aspects of antihypertensive therapy. Systolic and diastolic blood pressure shows circadian pattern both in normotensive and primary hypertensive patients with morning increase, maximal values during day time activity and than nocturnal fall. This rhythm is disturbed in patients with secondary hypertension, diabetes and often in elderly. Automatic ambulatory 24-hour blood pressure monitoring (ABPM) allows to estimate circadian blood pressure variability. It has diagnostic and prognostic value. Ambulatory blood pressure recording allows also to assess treatment of hypertension. Antihypertensive drugs have different impact on circadian blood pressure variability and rhythm. The most often used antihypertensive drugs are discussed from chronobiological point of view. New perspectives of chonotherapy of hypertension are also presented.

Clinical and Experimental Medical Letters

Background: The study evaluated association of new obesity indices – waist-to-hip ratio (WHtR), b... more Background: The study evaluated association of new obesity indices – waist-to-hip ratio (WHtR), body adiposity index (BAI), visceral adiposity index (VAI) and classical obesity parameters: body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) – with high-sensitivity C-reactive protein (hs-CRP) as a cardiovascular risk factor in obese patients. Material/Methods: Sixty-six adult obese (BMI ≥30 kg/m2) non-diabetic out-clinic patients (F/M – 40/26), aged 55.8±11.6 years, were divided into 3 groups according to hs-CRP serum levels: A – ≤1 mg/L (n=11), B – 1 to 3 mg/L (n=27), and C – >3 mg/L (n=28). Additionally, we divided all the patients into 2 groups: treated with statins/fibrates (n=37) and untreated (n=29). Results: In group C, WHtR was significantly higher compared to group B (0.71±0.07 vs. 0.66±0.06; p<0.05) and group A (0.71±0.07 vs. 0.64±0.06; p<0.05); BMI was significantly higher than in group A (37.9±5.3 kg/m2 vs. 33.4±1.8 37.9±5.3 kg/m2; p<0...

Medical science monitor : international medical journal of experimental and clinical research, Jan 16, 2014

The aim of this cross-sectional study was to examine the relationship between obesity and lipid m... more The aim of this cross-sectional study was to examine the relationship between obesity and lipid markers. We divided 66 non-diabetic adult obese patients (mean age: 55.8±11.6 years) into 3 groups according to body mass index (BMI). All patients were measured for waist circumference (WC), hip circumference (HC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI), and visceral adiposity index (VAI). Serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were determined, and lipid indices TC/HDL, LDL/HDL, and TG/HDL were also estimated. TC and LDL-C in Group III were lower than in Group I (5.0±1.0 vs. 6.0±1.0 mmol/L, and 2.9±0.9 vs. 3.8±1.2 mmol/L; p<0.05 for both). Negative correlations were found between: BMI and TC, LDL, and HDL (r=-0.291; r=-0.310, r=-0.240, respectively); and WC, WHR, VAI, and HDL (r=-0.371, r=-0.296, r=-0.376,...

Angiology, 2012

We compared adipokines and inflammatory markers in obese insulin-sensitive (group A, n = 16) and ... more We compared adipokines and inflammatory markers in obese insulin-sensitive (group A, n = 16) and insulin-resistant (group B, n = 48) patients divided according to homeostasis model assessment of insulin resistance (HOMA-IR). Serum levels of adiponectin, leptin, resistin, high-sensitivity C-reactive protein, interleukin 6, and tumor necrosis factor α were measured. Weight, height, waist (WC) and hip circumferences, waist to hip ratio , weight to height ratio, visceral adiposity index (VAI), and body adiposity index (BAI) were measured. The WC and VAI were significantly higher in group B (113.9 ± 11.1 vs 105.3 ± 9.8cm; P < .01 and 2.3 ± 1.1 vs 1.6 ± 0.9; P < .05, respectively), while serum adiponectin levels were higher in group A (24.5 ± 14.6 vs 15.1 ± 9.6 ng/mL; P < .005). The BAI strongly correlated with adiponectin and leptin in group B ( r = .479; P < .001 and r = .705; P < .001). Insulin resistance is associated with visceral adiposity described by VAI and WC. The...

Medical Science Monitor, 2013

The aim of this study was to estimate obesity parameters: waist circumference (WC), waist-to-hip ... more The aim of this study was to estimate obesity parameters: waist circumference (WC), waist-to-hip ratio (WHR), weight-to-height ratio (WHtR), visceral adiposity index (VAI), body adiposity index (BAI), and serum adipokines (leptin, adiponectin, resistin) and their associations with estimated glomerular filtration rate (eGFR), serum creatinine, and microalbuminuria (MA) in patients with early stages of CKD and in non-CKD obese patients. Material/Methods: 67 non-diabetic obese (BMI ≥30 mg/kg 2) out-clinic patients (25 males, 42 females), aged from 36.5 to 64 years were divided into 2 groups: Group A (n=15)-patients with early stages of CKD (eGFR between 30 and 60 ml/min/1.73 m 2 or with MA >20 mg/l in morning urine sample independently from GFR) and Group B-patients without chronic CKD (n=52). Results: In Group A compared to Group B, BAI and leptin were higher (42.2±7.1 vs. 37.5±7.0; p<0.05 and 51.8±26.7 ng/mL vs. 35.3±24.9 ng/mL; p<0.05; respectively) and negative correlations occurred between eGFR and BAI (r=-0.709; p=0.003), leptin (r=-0.68; p=0.005), and resistin (r=-0.528; p<0.05). In Group B, negative correlations occurred between creatinine and VAI (r=-0.332; p<0.05), BAI (r=-0.619; p<0.0001), leptin (r=-0.676; p<0.0001), and adiponectin (r=-0.423; p=0.002), and between eGFR and resistin (r=-0.276; p<0.05). Conclusions: BAI may be a valuable obesity parameter as a predictor of early stages of CKD in patients with obesity. Leptin may be an important pathogenic factor in obese patients with early stages of CKD. Resistin is associated with eGFR in obese patients, independently of CKD.

Lipids in Health and Disease, 2014

Background: The aim of this study was to estimate associations between inflammatory markers and o... more Background: The aim of this study was to estimate associations between inflammatory markers and obesity indices in normo-and hypertensive subjects. Methods: 65 obese adult subjects were divided into two groups: (A) of hypertensives (n = 54) and (B) of normotensives (n = 11). Waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), visceral adiposity index (VAI), body adiposity index (BAI) and tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and high sensitivity C-reactive protein (hsCRP) serum concentrations were estimated. Results: In group A WHtR was higher (0.69 ± 0.07 vs 0.63 ± 0.06; p < 0.01), hsCRP correlated with BMI and WHtR (r = 0.343; p = 0.011 and r = 0.363; p < 0.01, respectively). BAI correlated with hsCRP in group A and B (r = 0.329; p < 0.05 and r = 0.642; p < 0.05; respectively) and in females and males (r = 0.305; p = 0.05 and r = 0.44; p < 0.05, respectively). In females hsCRP was higher (3.2 ± 2.2 mg/l vs 2.1 ± 1.5 mg/l; p < 0.05). In patients without lipid lowering treatment hsCRP and IL-6 were higher (3.2 ± 1.7 mg/l vs 2.4 ±2.2 mg/l; p = 0.01 and 15.9 ± 7.2 pg/ml vs 13.6 ± 9.9 pg/ml; p < 0.01, respectively). Conclusions: WHtR is a sensitive index associated with chronic inflammation in obese hypertensive subjects. BAI correlates with hsCRP independently of hypertension and sex. hsCRP is more sensitive marker associated with obesity than IL-6 and TNF-α. Lipid lowering treatment influence chronic inflammation.

Current Medical Research and Opinion, 2009

Statins are the first-line drug therapy in the treatment of hypercholesterolemia. The beneficial ... more Statins are the first-line drug therapy in the treatment of hypercholesterolemia. The beneficial clinical impact of statins on the cardiovascular system results not only from their lipid-lowering action but also from other effects. Recently, it has been suggested that statins can reduce blood pressure, especially in hypertensive patients. The role of the hypotensive action of statins and other mechanisms which reduce cardiovascular risk in hypertensive patients are discussed in this review. Electronic databases searched were [MEDLINE (1966 - February 2009), EMBASE and SCOPUS (1965 - February 2009), DARE (1966 -- February 2009)]. Additionally, abstracts from national and international cardiovascular meetings were studied to identify unpublished studies. The main data search terms were: blood pressure, hypertension, hypercholesterolemia and statins. At present, it is difficult to unequivocally assess the impact of statins on blood pressure. However, according to most authors, the impact of statins on the decrease in BP is slight, but significant, especially among patients with hypertension.

Archives of Medical Science, 2012

Introduction: Hypertension often coexists with obesity. Adipokines, ghrelin and insulin play impo... more Introduction: Hypertension often coexists with obesity. Adipokines, ghrelin and insulin play important roles in the pathogenesis of both diseases. The aim of this study was to compare adiponectin, leptin, resistin, insulin and ghrelin mean serum concentrations and insulin resistance (HOMA-IR) in normo-and hypertensive patients with obesity. Material and methods: All included patients were divided on the following groups: non-diabetic hypertensive patients with class I obesity (group A, n = 21) and class II/III obesity (group B, n = 10), and normotensive obese (class I)patients (group C, n = 7). Correlations between obesity indices (body mass index [BMI], waist-tohip ratio [WHR], waist circumference [WC]), HOMA-IR, and hormone and adipokine serum levels were also analyzed. Results: Leptin level and HOMA-IR were significantly higher in group B compared to group C (9.74 ±3.88 ng/ml vs. 4.53 ±3.00 ng/ml; p < 0.02 and 3.30 ±1.59 vs. 1.65 ±0.41; p < 0.02, respectively). A negative correlation between WC and adiponectin level (R =-0.6275; p < 0.01) and a positive correlation between WC and insulin concentration (R = 0.5122; p < 0.05) as well as with HOMA-IR (R = 0.5228; p < 0.02) were found in group A. Negative correlations between BMI and ghrelin level (R =-0.7052; p < 0.05), WHR and adiponectin level (R =-0.6912; p < 0.05) and WHR and leptin level (R =-0.6728; p < 0.05) were observed in group B. Conclusions: Insulin resistance and leptin may be important pathogenic factors in hypertensive patients with severe obesity. Indices of abdominal obesity (WC, WHR) correlate better than BMI with HOMA-IR, insulin, adiponectin and leptin serum levels in hypertensive obese patients.

Archives of Medical Science, 2010

Introduction: In every case of upper gastrointestinal bleeding suspicion, an endoscopic examinati... more Introduction: In every case of upper gastrointestinal bleeding suspicion, an endoscopic examination ought to be performed as a matter of urgency. Finding active bleeding, a visible non-bleeding vessel or a lesion with an adherent clot should be followed by application of an available method of endoscopic therapy. The aim of the study was to compare the effectiveness of various endoscopic treatment techniques such as epinephrine injections, coagulation methods and mechanical methods in the treatment of non-varicose upper gastrointestinal bleeding. Material and methods: Sixty cases of non-varicose upper gastrointestinal bleeding were analysed in terms of the effectiveness of the above-mentioned procedures used in monotherapy or in combination therapy comprising epinephrine injections and clips application. The choice of the applied procedure depended on morphological features and location of the bleeding source, the patient's general condition, as well as technical equipment and manual skills of the endoscopy staff. Results: The study confirmed the effectiveness of endoscopic treatment of nonvaricose upper gastrointestinal bleeding applying the above-mentioned methods. In most patients, this treatment enabled traumatic surgical intervention to be avoided; it was required in only 3 (5%) out of 60 patients with confirmed upper gastrointestinal bleeding. With the first endoscopy, haemostasis was achieved in 47 cases (78.3%) and the second endoscopy, performed due to bleeding recurrence, was successful in the remaining 10 cases (16.7%). Conclusions: In non-varicose upper gastrointestinal bleeding, urgent diagnostic and therapeutic endoscopy should be the first-line management. If the lesion that is the source of bleeding is possible to localize, the endoscopic techniques should be applied. Among the endoscopic procedures used in monotherapy, clips appeared to be the most effective, their effectiveness being comparable to combination therapy. In bleeding from extensive lesions, coagulation methods are considered to be the most efficacious.

Artery Research, 2015

Objective: Patients in hemodialysis frequently have cognitive dysfunction (CO/DY). Hemodialysis s... more Objective: Patients in hemodialysis frequently have cognitive dysfunction (CO/DY). Hemodialysis session often results in acute intravascular volume loss, fluid shifts, hypotensives episodes, decrease of cerebral perfusion and cerebral ischemia, all of which may cause transient deterioration of cognitive function. On the contrary, improvement in "uremic milieu" after a dialysis session can result in improved cognition. The aim of this study is to evaluate the effect of a single, random hemodialysis session on cognitive function, in absent of hypotensive episodes. Method: Global cognitive function was assessed, pre-and post-dialysis by using the Mini Mental State Examination.

Pediatric Endocrinology Diabetes and Metabolism

Nightscout is a non-commercial Do-It-Yourself (DIY) system, developed in 2014 by the parents of c... more Nightscout is a non-commercial Do-It-Yourself (DIY) system, developed in 2014 by the parents of children with type 1 diabetes. In Poland it has been available and supported since 2016. The Nightscout system is not an officially registered solution and patients use it at their own responsibility. The idea of the project is to give authorized users online access to data on continuous glucose monitoring in interstitial fluid. Data are stored on external servers. Glucose data can be read on any number of devices with access to the Internet. This article describes the Nightscout system-required components, operating costs, and other usage options. It also presents the current evaluation of the Nightscout system in scientific publications.