Bosnian Journal of Basic Medical Sciences, May 20, 2009
Patients with End-Stage Renal Disease (ESRD) are at high risk of death as a result of the cardiov... more Patients with End-Stage Renal Disease (ESRD) are at high risk of death as a result of the cardiovascular disease (CVD), which cannot be explained by the conventional risk factors only. Haemodialysis patients frequently have elevated serum concentrations of the cardiac troponins T, specifi c markers of myocardial injury. Plasma levels of brain natriuretic peptide (BNP) are elevated in fl uid volume overload and heart failure, and decreased during dialysis. Currently, LV hypertrophy and LV dysfunction are considered the strongest predictors of cardiovascular mortality in dialysis population, and the synthesis of cardiac natriuretic peptides is high in the presence of alterations in the left ventricular (LV) mass and function. Th e aim of this study was to investigate the factors associated with the increased serum levels of BNP and CTN in haemodialysis patients, and their impact on cardiovascular morbidity. In this cross-sectional study we included patients with ESRD, without coronary symptoms, who were subjected to regular dialysis treatment three times a week for the duration of four hours. Heart failure was defi ned as an ejection fraction (EF) of < , and dyspnoea associated with either elevated jugular pressure or interstitial oedema evidenced in chest X-ray. All patients were in sinus rhythm at the time of the study. Twenty-fi ve patients were on erythropoietin treatment. Blood samples were taken before and after the dialysis session. Our study included patients ( males, females). Th e average age was , years (total range -) divided into two groups: euvolemic and hypervolemic. Th e average dialysis time was ,±, months. All haemodialysis patients had excessively high levels of BNP ,±, ng/cm . Plasma cTnT was found to be increased in , of patients. Patients with hypervolemia had signifi cantly higher cTnT levels (,±,), as compared to the euvolemic patients ,±, p<,. Th e elevated cTnT signifi cantly correlated with the level of BNP (p<,), while average post-dialysis BNP was not signifi cantly lower (,±,; R=,; p-ns.) as compared to the pre-dialysis BNP (,±,; R=; p<,). Th e pre-dialysis cTnT was lower (,±,) as compared to the post-dialysis cTnT (average ,). Euvolemic patients had BMI ,±,, as compared to the hypervolemic patients BMI ,±, (p-n.s.
Aim: To determine the effect of a 16-week intradialytic exercise program consisting of 30 minutes... more Aim: To determine the effect of a 16-week intradialytic exercise program consisting of 30 minutes of exercise during the first two hours of dialysis with three times a week frequency, on the quality of life (QoL), level of depression/anxiety and physical perfor- mance in hemodialysis (HD) patients. Methods: The clinical, longitudinal, prospective study with one-group repeated measures design was conducted during a 16-week period. A convenience sample of 52 HD patients, who had been on HD for a minimum of 6 months, were included. QoL, level of depression and anxiety (questionnaires: SF-36, Back Depression Inventory (BDI) and Back Anxiety Inventory (BAI)) and physical performance (modifying Visual Analogue Scale (VAS) and Manual Muscle Testing (MMT)) were assessed at baseline and after 4-month exercise program. Results: The following scales of SF-36 questionnaire were improved after 16-week exercise program: role functioning/emotional (P=0.01 8), energy/fatigue (P = 0.002) and social functi- oning (P = 0.030). Level of depression and anxiety were significantly decreased in males (P = 0.007 and P = 0.022, respectively) and females (P = 0.001 and P = 0.000, respectively). VAS scale and MMT were significantly increased in males (P = 0.000 and P = 0.001, respectively) and females (P = 0.01 9 and P = 0.001, respectively) after 16-week exercise program. Conclusion: Exercise program improves some aspects of QoL and physical performance, and decreases the level of depression and anxiety in HD patients.
Patients with End-Stage Renal Disease (ESRD) are at high risk of death as a result of the cardiov... more Patients with End-Stage Renal Disease (ESRD) are at high risk of death as a result of the cardiovascular disease (CVD), which cannot be explained by the conventional risk factors only. Haemodialysis patients frequently have elevated serum concentrations of the cardiac troponins T, specific markers of myocardial injury. Plasma levels of brain natriuretic peptide (BNP) are elevated in fluid volume overload and heart failure, and decreased during dialysis. Currently, LV hypertrophy and LV dysfunction are considered the strongest predictors of cardiovascular mortality in dialysis population, and the synthesis of cardiac natri-uretic peptides is high in the presence of alterations in the left ventricular (LV) mass and function. The aim of this study was to investigate the factors associated with the increased serum levels of BNP and CTN in haemodialysis patients, and their impact on cardiovascular morbidityIn this cross-sectional study we included 30 patients with ESRD, without coronary ...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2011
Cardiovascular diseases are one of the main causes of morbidity and mortality in dialysis patient... more Cardiovascular diseases are one of the main causes of morbidity and mortality in dialysis patients. High incidence of cardiovascular diseases in patients with chronic kidney disease (CKD) can not soley be explained by traditional risk factors. Several studies have confirmed association between vascular calcification and increased mortality. This study included total of 44 patients on chronic hemodialysis program, 18 women and 26 men, with average age of 50.66 +/- 11.62 years and average duration of treatment of 100.25=52.83 months. We analyzed socio-demographic parameters and standard laboratory findings. X-ray of hand and pelvis was obtained from each patient along with echocardiography and carotid ultrasound imaging. To estimate the level of vascular calcifications on the X-rays, we used the simple vascular score (sVC). Using noninvasive methods, we found vascular calcifications in 26 (59%) patients. In 22 (45%) patients, vascular calcifications were found in X-rays. Four (9%) pat...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2011
Patients with end stage renal disease (ESRD) have a reduced response to vaccination against hepat... more Patients with end stage renal disease (ESRD) have a reduced response to vaccination against hepatitis B infection. The aim of the study has been to determine the adequacy of immune response with new protocol of vaccination against hepatitis B infection. The study included incident hemodialysis patients since 2008 until 2011 at the Clinic of Hemodialysis of the Clinical Center of the University of Sarajevo. We started the new vaccination protocol in September 2009. New protocol implied vaccination six month before starting renal replacement therapy (RRT) and "ic" (intracutaneously) application vaccine vs. "sc" (subcutaneously) application. Vaccination was carried out for over 12 months. The follow up period lasted from 2009 to 2011. The study included 64 patients, men were represented with 57,81% (37), and 42,19% women (27), who were divided in two groups. The first group included patients from the period from 2008 to 2009, who have been vaccinated under the old v...
The patients with the chronical programm for haemodialisys have the higher risk from getting ill ... more The patients with the chronical programm for haemodialisys have the higher risk from getting ill virus hepatitis C in the realtion to the rest population. Was the evaluation of the prevalence and incidence of hepatitis C at the Center for Haemodialisys CCU Sarajevo and the effect of the prevalentive measures on the incidence of the serum conversion of hepatitis C, in the period from 2002 till 2004 year. By the examening is comprehended 155 patients aged 54,58 +/- 14,797 years, with the aproximative length of the haemodialisys 58,9 +/- 53,9 months. Patients at the chronic programm of the bicarbonite haemodialisys taree times per week, and antibodies on the hepatitis C were determined III generation. Also was determined PCR. During the periiod of examination the dialized population was increased also 2002 year the prevalence of hepatitis C was 23,87% (37/155), in 2003 year 29,29% (46/157) and 2004 year the pregalence amounted 26,28% (46/175). Incidence of hepatitis C was significantly...
Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske, 2012
HaLima resiĆ, seLma ajaNoviĆ, NiHad kukavica, aida ĆoriĆ, faHrudiN mašNiĆ, ameLa beĆiraGiĆ klinik... more HaLima resiĆ, seLma ajaNoviĆ, NiHad kukavica, aida ĆoriĆ, faHrudiN mašNiĆ, ameLa beĆiraGiĆ klinika za hemodijalizu, klinički centar univerziteta u sarajevu, sarajevo, bosna i Hercegovina Centralni venski kateteri se kod hemodijaliznih pacijenata mogu koristiti kao trajni vaskularni pristup za liječenje hemodijalizom. Sama nazočnost katetera povećava rizik od nastanka bakterijemije kod hemodijaliznih pacijenata. Cilj radai: Evaluacija riziko faktora infekcije kod hemodijaliznih pacijenata povezana s upotrebom katetera kao vaskularnog pristupa za hemodijalizu. Pacijenti i metode: U studiju je bilo uključeno 38 pacijenta s plasiranim trajnim tuneliranim kateterom kao vaskularnim pristupom za hemodijalizu, u razdoblju od 1.1.2011. godine do 1.3.2012. godine. Od ukupno 38 pacijenata uključenih u studiju, 23 su bili muškarci, a 15 žene, prosječne starosne dobi od 67,48 ± 13,9 godina. Duljina trajanja hemodijaliznog liječenja bila je 108,9±16,54 mjeseci. Za obradu podataka korišten je Student T test. Rezultati: Kod 9 pacijenata javila se bakterijemija povezana s upotrebom tuneliranog katetera kao vaskularnog pristupa. Incidenca infekcije bila je 3,5 slučaja na 1000 kateter dana. Kod 3(33%) pacijenta kao uzrok infekcije pronađeni su gram-pozitivni, a kod 5 (56%) pacijenata gram-negativni uzročnici. Kod jedne (11%) pacijentice pronađena je polimikrobna flora. Kod 7(75%) pacijenata tunelirani kateter je odstranjen i zamijenjen privremenim kateterom za potrebe hemodijaliznog liječenja; kod 2 (25%) pacijenta primijenjena je "Antibiotik-lock" tehnika, odnosno infuzija otopine antibiotika u kateter. Nije postojala značajna razlika (p<0,05) u starosnoj dobi, duljini dijaliznog liječenja, vrijednosti hemoglobina, željeza, saturaciji transferina, vrijednosti feritina i albumina kod pacijenata bez infekta i kod onih pacijenata koji su razvili infekciju. Jedna pacijentica je razvila teški oblik sepse praćen trombocitopenijom i letalnim ishodom zbog profuznog gastrointestinalnog krvarenja. Zaključak:Tunelirani venski kateter je sve češći vaskularni pristup kod hemodijaliznih pacijenata, ali ujedno predstavlja i čest uzrok infekcija. U cilju prevencije infekcija povezanih s kateterima,pravilna njega i upotreba katetera, donošenje jedinstvenog protokola njegei algoritma liječenja zauzimaju značajno mjesto u radu svakog hemodijaliznog centra. Ključne riječi: hemodijaliza, infekcija, centralni venski kateter za hemodijalizu, kateter sepsa.
Hemodialysis (HD) is the most frequently used form of renal replacement therapy for many patients... more Hemodialysis (HD) is the most frequently used form of renal replacement therapy for many patients with end-stage renal disease (ESRD). One of the leading causes of morbidity and mortality in HD patients is cardiovascular disease (CVD). In 1998, the National Kidney Foundation reported that, at er stratifying for age, race, and gender, mortality from CVD in HD patients was 10-30 times greater than in the general population (1). Despite the neutral ef ect, HD is associated with a number of biochemical abnormalities including dyslipidemia and oxidative stress. Renal dyslipidemia is caused by certain dialysis-related parameters, which may signii cantly af ect lipoprotein metabolism and modify the composition of plasma lipoproteins. It appears that a reduced catabolism and clearance of Apo B-containing lipoproteins of hepatic and intestinal origin constitutes the main abnormality. SUPEROXIDE DISMUTASE ACTIVITY AND SERUM LIPID PROFILE IN HEMODIALYSIS PATIENTS
Kronicna bubrežna bolest (HBB) je važan javno-zdravstveni problem (1). Prema definiciji KDIGO (Ki... more Kronicna bubrežna bolest (HBB) je važan javno-zdravstveni problem (1). Prema definiciji KDIGO (Kidney Disease: Improving Global Outcomes) HBB je definirana kao strukturno ili funkcionalno ostecenje bubrega, koje traje >3 mjeseca, s posljedicama za zdravlje i klasificirana je na osnovi uzroka, kategorije glomerularne filtracije i kategorije albuminurije (2). HBB ima nekoliko stadija, a posljednji, terminalni stadij ili end-stage of renal disease (ESRD) odgovara uremiji s glomerularnom filtracijom 90 dana se također povecala i u 2011. godini iznosila 123,1 (3). Također, i u drugim zemljama koje vode renalni registar, zabilježen je porast incidencije i prevalencije pacijenata s ESRD. U svijetu je, u odnosu na modalitet tretmana zamjene bubrežne funkcije u razdoblju 2001.-2010. godina, bila najzastupljenija HD (68,5-69,2 %), zatim transplantacija bubrega (22,5-23,1 %), te peritonejska dijaliza (8,3-8,5 %) (4). U Bosni i Hercegovini u razdoblju 2006.-2011., HD je najucestalija metoda ...
DOAJ (DOAJ: Directory of Open Access Journals), Feb 1, 2011
To evaluate frequency of CVD in dialysis population, in relationship to patients with and without... more To evaluate frequency of CVD in dialysis population, in relationship to patients with and without diabetes, and their most common treatment. This retrospective study included 187 patients, 106 males and 81 females, divided in two groups, diabetics and non-diabetics, treated by chronic hemodialysis. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; analyses included: anamnesis, ECG, chest X-rays, echocardiogram, laboratory examinations for calcium (Ca), phosphorus (P), parathormone (PTH), cholesterol (chol), triglicerids (TG), C-reactive protein (CRP), hemoglobin (Hb) and uric acid. In addition, we analyzed groups of drugs used by patients as prescribed by cardiologists. Average age was 58.0 years, most of them between 51 and 60. Average hemodialysis length was 4 years. Primary kidney diseases were pyelonephritis and glomerulonephritis. 19,78% of patients had diabetes. 165 patients (88,23%) had one or more cardiovascular diseases. 110 patients (58,2%) had hypertension, most of them used ACE inhibitors. Using test of multiple correlation, statistically significant correlations, among others, were shown between BMI and Ca, uric acid and P, albumin and PTH in diabetics, at the statistical significance level at p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. Cardiovascular diseases are the most common comorbidity and cause of mortality in hemodialysis population. There was no statistical significance in age, however there is a statistical difference in the dialysis duration variable, but in some biochemical laboratory parameters there was some difference. ACE inhibitors were most commonly used in the treatment of hypertension and systolic dysfunction, alone or with beta-blockers.
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2012
Hepatitis C virus infection (HCV) is an important cause of morbidity and mortality in patients wi... more Hepatitis C virus infection (HCV) is an important cause of morbidity and mortality in patients with end-stage renal disease (ESRD). In this prospective, observational study, 205 patients, 37 (18%) of them with chronic HCV infection, were followed up for a one-year period at Department of Hemodialysis, Sarajevo Clinical Center, University of Sarajevo. The following parameters were analyzed: dialysis duration, sex, PCR RNA, HCV genotypes and biochemical parameters. Thirteen anti-HCV PCR RNA positive patients were treated with pegylated interferon alpha (Pegasys, Hoffman-La Roche). The goal of therapy was to reach sustained virologic response. The presence of anti-HCV antibodies in serum was detected by enzyme linked immunosorbent assay (ELISA). Of 37 anti-HCV positive patients, there were 20 (54%) males and 17 (45.9%) females with the mean hemodialysis duration of 143.67 +/- 57.64 months and mean age of 54.45 +/- 8.93 years. Of 37 anti-HCV positive patients, 30 (81.08%) patients were ...
Background and Aims Some of the conditions which occur in maintenance hemodialysis (MHD) patients... more Background and Aims Some of the conditions which occur in maintenance hemodialysis (MHD) patients with a high incidence resulting in a decline in their quality of life, include malnutrition, renal osteodystrophy, refractory hypertension and chronic systemic inflammation. In developing countries, due to the low level of economic development, low-flux dialysis is the main means of extracorporeal blood purification therapy. But it can hardly remove the middle and large molecule uremic toxins and protein-bound toxins; as a result, the patients suffer from long-term complications and poor quality of life. In this study, we attempted to investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the clearance rate of middle and large molecule uremic toxins so as to improve their uremic complications. Method A total of 54 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into two g...
Introduction: Calciphylaxis is a rare, but serious, kidney complication. Calciphylaxia is a vascu... more Introduction: Calciphylaxis is a rare, but serious, kidney complication. Calciphylaxia is a vasculopathy of small blood vessels characterized by the deposition of calcium deposits in intimal arterioles with the consequent proliferation of intima, fibrosis and thrombosis. Aim: The aim was to show the significance of recognition of calciphylaxis relies on heightened clinical awareness of the presence of atypical skin nodules or ulcers that occur in patients with hemodialysis dependence and to characterize features of calciphylaxis or components of treatment that may lead to improved outcome. Case report: We present the case of 84-year-old woman with chronic kidney disease and diabetes mellitus as well as severely painful, firm, indurated plaques on the lower extremities. The plaques progressed to involve larger areas with associated local ulceration and necrosis. Laboratory testing revealed hyperparathyroidism and incisional skin biopsy confirmed calciphylaxis. Wound microbiology confirmed Staphylococcus aureus. Conclusion: The diagnosis can be based on clinical grounds, supported by histological analysis if possible. The laboratory workout must cover all the possible implications of chronic kidney disease with special attention to Ca+ and P+ values and evidence of skin or systemic infection. Calciphylaxis must be known by dermatologist as early diagnosis and proper management can be decisive for better prognosis.
Introduction. Bone disease is a chronic complication of chronic kidney disease and major clinical... more Introduction. Bone disease is a chronic complication of chronic kidney disease and major clinical problem in hemodialysis (HD) patients. The aim of our study was to assess the influence of treatment longevity on biochemical parameters of mineral and bone metabolism in HD patients, and to identify the most important parameters. Methods. The research was observational and retrospective, involved 70 patients, mean age 58.69±12.54, divided into groups in respect to the duration of dialysis treatment (Group I-5 years, Group II-5-10 years and Group III-over 10 years). Results. Serum phosphorus was increased, but the values tend to increase along with dialysis duration - (Group I: 1.93±0.45; Group II: 1.97±0.50; Group III: 2.01±0.37; p>0,05). Calcium values were also not significantly increased based on the duration of treatment [Group I: 2.3 (2.2-2.41); Group II: 2.46 (2.15-2.6), Group III: 2.35 (2.10-2.52)]. Dialysis and PTH correlated positively in the first group of patients (Rho=0....
Cardiovascular diseases are the leading cause of death in hemodialysis patients. The decline of r... more Cardiovascular diseases are the leading cause of death in hemodialysis patients. The decline of residual renal function increases the prevalence and severity of risk factors of cardiovascular morbidity and mortality in these patients. Hypertension is common in dialysis patients and represents an important independent factor of survival in these patients.The study included 77 patients who are on chronic HD for longer than 3 months. Depending on the measured residual diuresis patients were divided into two groups. The study group consisted of patients with residual diuresis >250 ml/day, while patients from control group had residual diuresis <250 ml/day. All patients had their blood pressure measured before 10 consecutive hemodialysis treatments. Collected data were statistically analyzed using SPSS 16.0.The study included 77 hemodialysis patients, mean age of 56.56±14.6 years and mean duration of hemodialysis treatment of 24.0 months. Of the total number of patients, 39(50.6%) ...
Introduction: Increased levels of C-Reactive Protein are found in 30-60% on hemodialysis patients... more Introduction: Increased levels of C-Reactive Protein are found in 30-60% on hemodialysis patients and it is closely associated with the progression of atherosclerosis, cardiovascular morbidity and mortality. Non enzymatic antioxidants are antioxidants which primarily retain potentially dangerous ions of iron and copper in their inactive form and thereby prevent its participation in the production of free radicals. Aim: The aim of the study was to examine the relationship of CRP and non enzymatic antioxidants (albumin, ferritin, uric acid and bilirubin) i.e. examine the importance of CRP as a serum biomarker in assessing the condition of inflammation and its relationship to antioxidant protection in patients on hemodialysis. Methods: The study was cross-sectional, clinical, comparative and descriptive. The study involved 100 patients (non diabetic) on chronic hemodialysis. The control group consisted of 50 subjects without subjective and objective indicators of chronic renal disease. In all patients, the concentration of CRP as well as concentrations of non enzymatic antioxidants were determined. Results: In the group of hemodialysis patients 60% were men and 40% women. The average age of hemodialysis patients was 54.13 ± 11.8 years and the average age of the control group 41.72 ± 9.8 years. The average duration of hemodialysis treatment was 91.42 ± 76.2 months. In the group of hemodialysis patients statistically significant, negative linear correlation was determined between the concentration of CRP in and albumin concentration (rho =-0.251, p = 0.012) as well as negative, statistics insignificant, linear correlation between serum CRP and the concentration of uric acid (r =-0.077, p = 0.448). Furthermore, the positive, linear correlation was determined between serum CRP and ferritin (r = 0.159, p = 0.114) and positive linear correlation between CRP and total serum bilirubin (r = 0.121, p = 0.230). In the control group was determined a statistically significant, positive, linear correlation between serum CRP and uric acid concentration (rho = 0.438, p = 0.001) and statistically significant, positive, linear correlation between serum CRP and total serum bilirubin (rho = 0.510, p = 0.0001) A statistically significant, negative linear correlation was determined between CRP and albumin concentration (rho=-0.393, p = 0.005) as well as statistically significant, negative linear correlation between serum CRP and ferritin control group (rho =-0.391, p = 0.005). Conclusion: Elevated CRP level is a strong and independent predictor of low levels of serum albumin, which indicates that the hypoalbuminemia in hemodialysis patients could be more due to inflammation than malnutrition. There was no statistically significant correlation between CRP and other non enzymatic antioxidants (uric acid, ferritin, bilirubin), which shows that indicators of antioxidant defense in hemodialysis patients must be individually measured to determine their actual stocks and activity.
Introduction: Based on the statistics the population in Bosnia and Herzegovina is getting older. ... more Introduction: Based on the statistics the population in Bosnia and Herzegovina is getting older. In 2013 the average life span for women was 73.6 years and 68.1 for men. The chronic hemodialysis program is mainly reserved for elderly patients with high mortality risk. The most common cause of hemodialysis mortality relates to cardiovascular diseases (60.2%), regardless of frequent innovations and improvement of hemodialysis procedures. The aim of the study was to determine the mortality rate by age groups with comments on the presence of non-traditional predictors (anemia, hypoalbuminemia, CRP, vascular access and PTH) in dialysis patients in the follow-up period of 36 months. Methods: The study included all patients undergoing chronic hemodialysis treatment at the Clinic of Hemodialysis of the Clinical Center University of Sarajevo (CCUS). Results: Out of a total number of hemodialysis patients (n=232), the specific mortality rate in patients under 65 years of age was 16.8%, and 50.5% in patients over 65 years of age. According to the age groups the mortality rate in elderly patients is as follows: from 65 to 74 years (45.1%), from 75 to 84 years (55.0%), over ≥85 years (75.0%). The most frequent vascular access in patients under and above 65 is arteriovenous fistula (79.6% and 62.1 %), temporary hemodialysis catheter (11.7% and 43.8 %) and long-term hemodialysis catheter (8.8% and 4.2 %). In the age group under 65 years of age the temporary hemodialysis catheter is significantly and more frequently used in diseased patients in respect to survivors (34.8% vs. 7.0%) [χ 2 (2)=15.769, p=0.001]. Diseased patients from the age group over 65 had a significantly lower mean value of haemoglobin in blood (M=100.9±17.5 g/L) in respect to survivors (M=109.2±17.1)[t(93)=2.339; p=0.021], lower mean value of albumin in blood (Me=32.0; IQR=29.0 do 35.0) in respect to survivors (Me=34.0; IQR=32.0 to 38.0) [U=762.5; p=0.006], and higher mean value of CRP in blood (Me=19.3 mg/L; IQR=6.6 to 52.0) in respect to survivors (Me=7.8; IQR=4.0 to 16.7) [U=773.5; p=0.008]. Diseased patients belonging to the age group over 65 had lower mean value of PTH, but without statistical significance (p>0.05). Conclusion: older age, temporary vascular access, anaemia and hypoalbuminemia are strong predictors of mortality in hemodialysis patients. Old age does not present contraindication for hemodialysis treatment, and treatment of terminal renal illness should not be abandoned.
Background and Aims The occurance of mid- and longterm uremic complications is related to the low... more Background and Aims The occurance of mid- and longterm uremic complications is related to the low clearance rate of middle and large molecule uremic toxins when hemodialysis (HD) alone is adopted. As the uremic toxins and their corresponding biological effects become increasingly clear, blood purification treatment that aims to remove these toxins, has developed from a stage of life-sustaining to improving the quality of life. The objective of this study was to evaluated demographic, clinical and laboratory data in patients who underwent the combination of maintenance hemodialysis with hemoperfusion (HP) and in those who recieved HD alone and to investigate whether this combination could improve the clearance rate of middle and large molecule uremic toxins. Method A total of 26 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into three groups: Group 1 (7 patients) received combined treatment of HD with HP biweekly (HD 2...
Bosnian Journal of Basic Medical Sciences, May 20, 2009
Patients with End-Stage Renal Disease (ESRD) are at high risk of death as a result of the cardiov... more Patients with End-Stage Renal Disease (ESRD) are at high risk of death as a result of the cardiovascular disease (CVD), which cannot be explained by the conventional risk factors only. Haemodialysis patients frequently have elevated serum concentrations of the cardiac troponins T, specifi c markers of myocardial injury. Plasma levels of brain natriuretic peptide (BNP) are elevated in fl uid volume overload and heart failure, and decreased during dialysis. Currently, LV hypertrophy and LV dysfunction are considered the strongest predictors of cardiovascular mortality in dialysis population, and the synthesis of cardiac natriuretic peptides is high in the presence of alterations in the left ventricular (LV) mass and function. Th e aim of this study was to investigate the factors associated with the increased serum levels of BNP and CTN in haemodialysis patients, and their impact on cardiovascular morbidity. In this cross-sectional study we included patients with ESRD, without coronary symptoms, who were subjected to regular dialysis treatment three times a week for the duration of four hours. Heart failure was defi ned as an ejection fraction (EF) of < , and dyspnoea associated with either elevated jugular pressure or interstitial oedema evidenced in chest X-ray. All patients were in sinus rhythm at the time of the study. Twenty-fi ve patients were on erythropoietin treatment. Blood samples were taken before and after the dialysis session. Our study included patients ( males, females). Th e average age was , years (total range -) divided into two groups: euvolemic and hypervolemic. Th e average dialysis time was ,±, months. All haemodialysis patients had excessively high levels of BNP ,±, ng/cm . Plasma cTnT was found to be increased in , of patients. Patients with hypervolemia had signifi cantly higher cTnT levels (,±,), as compared to the euvolemic patients ,±, p<,. Th e elevated cTnT signifi cantly correlated with the level of BNP (p<,), while average post-dialysis BNP was not signifi cantly lower (,±,; R=,; p-ns.) as compared to the pre-dialysis BNP (,±,; R=; p<,). Th e pre-dialysis cTnT was lower (,±,) as compared to the post-dialysis cTnT (average ,). Euvolemic patients had BMI ,±,, as compared to the hypervolemic patients BMI ,±, (p-n.s.
Aim: To determine the effect of a 16-week intradialytic exercise program consisting of 30 minutes... more Aim: To determine the effect of a 16-week intradialytic exercise program consisting of 30 minutes of exercise during the first two hours of dialysis with three times a week frequency, on the quality of life (QoL), level of depression/anxiety and physical perfor- mance in hemodialysis (HD) patients. Methods: The clinical, longitudinal, prospective study with one-group repeated measures design was conducted during a 16-week period. A convenience sample of 52 HD patients, who had been on HD for a minimum of 6 months, were included. QoL, level of depression and anxiety (questionnaires: SF-36, Back Depression Inventory (BDI) and Back Anxiety Inventory (BAI)) and physical performance (modifying Visual Analogue Scale (VAS) and Manual Muscle Testing (MMT)) were assessed at baseline and after 4-month exercise program. Results: The following scales of SF-36 questionnaire were improved after 16-week exercise program: role functioning/emotional (P=0.01 8), energy/fatigue (P = 0.002) and social functi- oning (P = 0.030). Level of depression and anxiety were significantly decreased in males (P = 0.007 and P = 0.022, respectively) and females (P = 0.001 and P = 0.000, respectively). VAS scale and MMT were significantly increased in males (P = 0.000 and P = 0.001, respectively) and females (P = 0.01 9 and P = 0.001, respectively) after 16-week exercise program. Conclusion: Exercise program improves some aspects of QoL and physical performance, and decreases the level of depression and anxiety in HD patients.
Patients with End-Stage Renal Disease (ESRD) are at high risk of death as a result of the cardiov... more Patients with End-Stage Renal Disease (ESRD) are at high risk of death as a result of the cardiovascular disease (CVD), which cannot be explained by the conventional risk factors only. Haemodialysis patients frequently have elevated serum concentrations of the cardiac troponins T, specific markers of myocardial injury. Plasma levels of brain natriuretic peptide (BNP) are elevated in fluid volume overload and heart failure, and decreased during dialysis. Currently, LV hypertrophy and LV dysfunction are considered the strongest predictors of cardiovascular mortality in dialysis population, and the synthesis of cardiac natri-uretic peptides is high in the presence of alterations in the left ventricular (LV) mass and function. The aim of this study was to investigate the factors associated with the increased serum levels of BNP and CTN in haemodialysis patients, and their impact on cardiovascular morbidityIn this cross-sectional study we included 30 patients with ESRD, without coronary ...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2011
Cardiovascular diseases are one of the main causes of morbidity and mortality in dialysis patient... more Cardiovascular diseases are one of the main causes of morbidity and mortality in dialysis patients. High incidence of cardiovascular diseases in patients with chronic kidney disease (CKD) can not soley be explained by traditional risk factors. Several studies have confirmed association between vascular calcification and increased mortality. This study included total of 44 patients on chronic hemodialysis program, 18 women and 26 men, with average age of 50.66 +/- 11.62 years and average duration of treatment of 100.25=52.83 months. We analyzed socio-demographic parameters and standard laboratory findings. X-ray of hand and pelvis was obtained from each patient along with echocardiography and carotid ultrasound imaging. To estimate the level of vascular calcifications on the X-rays, we used the simple vascular score (sVC). Using noninvasive methods, we found vascular calcifications in 26 (59%) patients. In 22 (45%) patients, vascular calcifications were found in X-rays. Four (9%) pat...
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2011
Patients with end stage renal disease (ESRD) have a reduced response to vaccination against hepat... more Patients with end stage renal disease (ESRD) have a reduced response to vaccination against hepatitis B infection. The aim of the study has been to determine the adequacy of immune response with new protocol of vaccination against hepatitis B infection. The study included incident hemodialysis patients since 2008 until 2011 at the Clinic of Hemodialysis of the Clinical Center of the University of Sarajevo. We started the new vaccination protocol in September 2009. New protocol implied vaccination six month before starting renal replacement therapy (RRT) and "ic" (intracutaneously) application vaccine vs. "sc" (subcutaneously) application. Vaccination was carried out for over 12 months. The follow up period lasted from 2009 to 2011. The study included 64 patients, men were represented with 57,81% (37), and 42,19% women (27), who were divided in two groups. The first group included patients from the period from 2008 to 2009, who have been vaccinated under the old v...
The patients with the chronical programm for haemodialisys have the higher risk from getting ill ... more The patients with the chronical programm for haemodialisys have the higher risk from getting ill virus hepatitis C in the realtion to the rest population. Was the evaluation of the prevalence and incidence of hepatitis C at the Center for Haemodialisys CCU Sarajevo and the effect of the prevalentive measures on the incidence of the serum conversion of hepatitis C, in the period from 2002 till 2004 year. By the examening is comprehended 155 patients aged 54,58 +/- 14,797 years, with the aproximative length of the haemodialisys 58,9 +/- 53,9 months. Patients at the chronic programm of the bicarbonite haemodialisys taree times per week, and antibodies on the hepatitis C were determined III generation. Also was determined PCR. During the periiod of examination the dialized population was increased also 2002 year the prevalence of hepatitis C was 23,87% (37/155), in 2003 year 29,29% (46/157) and 2004 year the pregalence amounted 26,28% (46/175). Incidence of hepatitis C was significantly...
Acta medica Croatica : Časopis Akademije medicinskih znanosti Hrvatske, 2012
HaLima resiĆ, seLma ajaNoviĆ, NiHad kukavica, aida ĆoriĆ, faHrudiN mašNiĆ, ameLa beĆiraGiĆ klinik... more HaLima resiĆ, seLma ajaNoviĆ, NiHad kukavica, aida ĆoriĆ, faHrudiN mašNiĆ, ameLa beĆiraGiĆ klinika za hemodijalizu, klinički centar univerziteta u sarajevu, sarajevo, bosna i Hercegovina Centralni venski kateteri se kod hemodijaliznih pacijenata mogu koristiti kao trajni vaskularni pristup za liječenje hemodijalizom. Sama nazočnost katetera povećava rizik od nastanka bakterijemije kod hemodijaliznih pacijenata. Cilj radai: Evaluacija riziko faktora infekcije kod hemodijaliznih pacijenata povezana s upotrebom katetera kao vaskularnog pristupa za hemodijalizu. Pacijenti i metode: U studiju je bilo uključeno 38 pacijenta s plasiranim trajnim tuneliranim kateterom kao vaskularnim pristupom za hemodijalizu, u razdoblju od 1.1.2011. godine do 1.3.2012. godine. Od ukupno 38 pacijenata uključenih u studiju, 23 su bili muškarci, a 15 žene, prosječne starosne dobi od 67,48 ± 13,9 godina. Duljina trajanja hemodijaliznog liječenja bila je 108,9±16,54 mjeseci. Za obradu podataka korišten je Student T test. Rezultati: Kod 9 pacijenata javila se bakterijemija povezana s upotrebom tuneliranog katetera kao vaskularnog pristupa. Incidenca infekcije bila je 3,5 slučaja na 1000 kateter dana. Kod 3(33%) pacijenta kao uzrok infekcije pronađeni su gram-pozitivni, a kod 5 (56%) pacijenata gram-negativni uzročnici. Kod jedne (11%) pacijentice pronađena je polimikrobna flora. Kod 7(75%) pacijenata tunelirani kateter je odstranjen i zamijenjen privremenim kateterom za potrebe hemodijaliznog liječenja; kod 2 (25%) pacijenta primijenjena je "Antibiotik-lock" tehnika, odnosno infuzija otopine antibiotika u kateter. Nije postojala značajna razlika (p<0,05) u starosnoj dobi, duljini dijaliznog liječenja, vrijednosti hemoglobina, željeza, saturaciji transferina, vrijednosti feritina i albumina kod pacijenata bez infekta i kod onih pacijenata koji su razvili infekciju. Jedna pacijentica je razvila teški oblik sepse praćen trombocitopenijom i letalnim ishodom zbog profuznog gastrointestinalnog krvarenja. Zaključak:Tunelirani venski kateter je sve češći vaskularni pristup kod hemodijaliznih pacijenata, ali ujedno predstavlja i čest uzrok infekcija. U cilju prevencije infekcija povezanih s kateterima,pravilna njega i upotreba katetera, donošenje jedinstvenog protokola njegei algoritma liječenja zauzimaju značajno mjesto u radu svakog hemodijaliznog centra. Ključne riječi: hemodijaliza, infekcija, centralni venski kateter za hemodijalizu, kateter sepsa.
Hemodialysis (HD) is the most frequently used form of renal replacement therapy for many patients... more Hemodialysis (HD) is the most frequently used form of renal replacement therapy for many patients with end-stage renal disease (ESRD). One of the leading causes of morbidity and mortality in HD patients is cardiovascular disease (CVD). In 1998, the National Kidney Foundation reported that, at er stratifying for age, race, and gender, mortality from CVD in HD patients was 10-30 times greater than in the general population (1). Despite the neutral ef ect, HD is associated with a number of biochemical abnormalities including dyslipidemia and oxidative stress. Renal dyslipidemia is caused by certain dialysis-related parameters, which may signii cantly af ect lipoprotein metabolism and modify the composition of plasma lipoproteins. It appears that a reduced catabolism and clearance of Apo B-containing lipoproteins of hepatic and intestinal origin constitutes the main abnormality. SUPEROXIDE DISMUTASE ACTIVITY AND SERUM LIPID PROFILE IN HEMODIALYSIS PATIENTS
Kronicna bubrežna bolest (HBB) je važan javno-zdravstveni problem (1). Prema definiciji KDIGO (Ki... more Kronicna bubrežna bolest (HBB) je važan javno-zdravstveni problem (1). Prema definiciji KDIGO (Kidney Disease: Improving Global Outcomes) HBB je definirana kao strukturno ili funkcionalno ostecenje bubrega, koje traje >3 mjeseca, s posljedicama za zdravlje i klasificirana je na osnovi uzroka, kategorije glomerularne filtracije i kategorije albuminurije (2). HBB ima nekoliko stadija, a posljednji, terminalni stadij ili end-stage of renal disease (ESRD) odgovara uremiji s glomerularnom filtracijom 90 dana se također povecala i u 2011. godini iznosila 123,1 (3). Također, i u drugim zemljama koje vode renalni registar, zabilježen je porast incidencije i prevalencije pacijenata s ESRD. U svijetu je, u odnosu na modalitet tretmana zamjene bubrežne funkcije u razdoblju 2001.-2010. godina, bila najzastupljenija HD (68,5-69,2 %), zatim transplantacija bubrega (22,5-23,1 %), te peritonejska dijaliza (8,3-8,5 %) (4). U Bosni i Hercegovini u razdoblju 2006.-2011., HD je najucestalija metoda ...
DOAJ (DOAJ: Directory of Open Access Journals), Feb 1, 2011
To evaluate frequency of CVD in dialysis population, in relationship to patients with and without... more To evaluate frequency of CVD in dialysis population, in relationship to patients with and without diabetes, and their most common treatment. This retrospective study included 187 patients, 106 males and 81 females, divided in two groups, diabetics and non-diabetics, treated by chronic hemodialysis. Patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; analyses included: anamnesis, ECG, chest X-rays, echocardiogram, laboratory examinations for calcium (Ca), phosphorus (P), parathormone (PTH), cholesterol (chol), triglicerids (TG), C-reactive protein (CRP), hemoglobin (Hb) and uric acid. In addition, we analyzed groups of drugs used by patients as prescribed by cardiologists. Average age was 58.0 years, most of them between 51 and 60. Average hemodialysis length was 4 years. Primary kidney diseases were pyelonephritis and glomerulonephritis. 19,78% of patients had diabetes. 165 patients (88,23%) had one or more cardiovascular diseases. 110 patients (58,2%) had hypertension, most of them used ACE inhibitors. Using test of multiple correlation, statistically significant correlations, among others, were shown between BMI and Ca, uric acid and P, albumin and PTH in diabetics, at the statistical significance level at p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. Cardiovascular diseases are the most common comorbidity and cause of mortality in hemodialysis population. There was no statistical significance in age, however there is a statistical difference in the dialysis duration variable, but in some biochemical laboratory parameters there was some difference. ACE inhibitors were most commonly used in the treatment of hypertension and systolic dysfunction, alone or with beta-blockers.
Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti, 2012
Hepatitis C virus infection (HCV) is an important cause of morbidity and mortality in patients wi... more Hepatitis C virus infection (HCV) is an important cause of morbidity and mortality in patients with end-stage renal disease (ESRD). In this prospective, observational study, 205 patients, 37 (18%) of them with chronic HCV infection, were followed up for a one-year period at Department of Hemodialysis, Sarajevo Clinical Center, University of Sarajevo. The following parameters were analyzed: dialysis duration, sex, PCR RNA, HCV genotypes and biochemical parameters. Thirteen anti-HCV PCR RNA positive patients were treated with pegylated interferon alpha (Pegasys, Hoffman-La Roche). The goal of therapy was to reach sustained virologic response. The presence of anti-HCV antibodies in serum was detected by enzyme linked immunosorbent assay (ELISA). Of 37 anti-HCV positive patients, there were 20 (54%) males and 17 (45.9%) females with the mean hemodialysis duration of 143.67 +/- 57.64 months and mean age of 54.45 +/- 8.93 years. Of 37 anti-HCV positive patients, 30 (81.08%) patients were ...
Background and Aims Some of the conditions which occur in maintenance hemodialysis (MHD) patients... more Background and Aims Some of the conditions which occur in maintenance hemodialysis (MHD) patients with a high incidence resulting in a decline in their quality of life, include malnutrition, renal osteodystrophy, refractory hypertension and chronic systemic inflammation. In developing countries, due to the low level of economic development, low-flux dialysis is the main means of extracorporeal blood purification therapy. But it can hardly remove the middle and large molecule uremic toxins and protein-bound toxins; as a result, the patients suffer from long-term complications and poor quality of life. In this study, we attempted to investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the clearance rate of middle and large molecule uremic toxins so as to improve their uremic complications. Method A total of 54 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into two g...
Introduction: Calciphylaxis is a rare, but serious, kidney complication. Calciphylaxia is a vascu... more Introduction: Calciphylaxis is a rare, but serious, kidney complication. Calciphylaxia is a vasculopathy of small blood vessels characterized by the deposition of calcium deposits in intimal arterioles with the consequent proliferation of intima, fibrosis and thrombosis. Aim: The aim was to show the significance of recognition of calciphylaxis relies on heightened clinical awareness of the presence of atypical skin nodules or ulcers that occur in patients with hemodialysis dependence and to characterize features of calciphylaxis or components of treatment that may lead to improved outcome. Case report: We present the case of 84-year-old woman with chronic kidney disease and diabetes mellitus as well as severely painful, firm, indurated plaques on the lower extremities. The plaques progressed to involve larger areas with associated local ulceration and necrosis. Laboratory testing revealed hyperparathyroidism and incisional skin biopsy confirmed calciphylaxis. Wound microbiology confirmed Staphylococcus aureus. Conclusion: The diagnosis can be based on clinical grounds, supported by histological analysis if possible. The laboratory workout must cover all the possible implications of chronic kidney disease with special attention to Ca+ and P+ values and evidence of skin or systemic infection. Calciphylaxis must be known by dermatologist as early diagnosis and proper management can be decisive for better prognosis.
Introduction. Bone disease is a chronic complication of chronic kidney disease and major clinical... more Introduction. Bone disease is a chronic complication of chronic kidney disease and major clinical problem in hemodialysis (HD) patients. The aim of our study was to assess the influence of treatment longevity on biochemical parameters of mineral and bone metabolism in HD patients, and to identify the most important parameters. Methods. The research was observational and retrospective, involved 70 patients, mean age 58.69±12.54, divided into groups in respect to the duration of dialysis treatment (Group I-5 years, Group II-5-10 years and Group III-over 10 years). Results. Serum phosphorus was increased, but the values tend to increase along with dialysis duration - (Group I: 1.93±0.45; Group II: 1.97±0.50; Group III: 2.01±0.37; p>0,05). Calcium values were also not significantly increased based on the duration of treatment [Group I: 2.3 (2.2-2.41); Group II: 2.46 (2.15-2.6), Group III: 2.35 (2.10-2.52)]. Dialysis and PTH correlated positively in the first group of patients (Rho=0....
Cardiovascular diseases are the leading cause of death in hemodialysis patients. The decline of r... more Cardiovascular diseases are the leading cause of death in hemodialysis patients. The decline of residual renal function increases the prevalence and severity of risk factors of cardiovascular morbidity and mortality in these patients. Hypertension is common in dialysis patients and represents an important independent factor of survival in these patients.The study included 77 patients who are on chronic HD for longer than 3 months. Depending on the measured residual diuresis patients were divided into two groups. The study group consisted of patients with residual diuresis >250 ml/day, while patients from control group had residual diuresis <250 ml/day. All patients had their blood pressure measured before 10 consecutive hemodialysis treatments. Collected data were statistically analyzed using SPSS 16.0.The study included 77 hemodialysis patients, mean age of 56.56±14.6 years and mean duration of hemodialysis treatment of 24.0 months. Of the total number of patients, 39(50.6%) ...
Introduction: Increased levels of C-Reactive Protein are found in 30-60% on hemodialysis patients... more Introduction: Increased levels of C-Reactive Protein are found in 30-60% on hemodialysis patients and it is closely associated with the progression of atherosclerosis, cardiovascular morbidity and mortality. Non enzymatic antioxidants are antioxidants which primarily retain potentially dangerous ions of iron and copper in their inactive form and thereby prevent its participation in the production of free radicals. Aim: The aim of the study was to examine the relationship of CRP and non enzymatic antioxidants (albumin, ferritin, uric acid and bilirubin) i.e. examine the importance of CRP as a serum biomarker in assessing the condition of inflammation and its relationship to antioxidant protection in patients on hemodialysis. Methods: The study was cross-sectional, clinical, comparative and descriptive. The study involved 100 patients (non diabetic) on chronic hemodialysis. The control group consisted of 50 subjects without subjective and objective indicators of chronic renal disease. In all patients, the concentration of CRP as well as concentrations of non enzymatic antioxidants were determined. Results: In the group of hemodialysis patients 60% were men and 40% women. The average age of hemodialysis patients was 54.13 ± 11.8 years and the average age of the control group 41.72 ± 9.8 years. The average duration of hemodialysis treatment was 91.42 ± 76.2 months. In the group of hemodialysis patients statistically significant, negative linear correlation was determined between the concentration of CRP in and albumin concentration (rho =-0.251, p = 0.012) as well as negative, statistics insignificant, linear correlation between serum CRP and the concentration of uric acid (r =-0.077, p = 0.448). Furthermore, the positive, linear correlation was determined between serum CRP and ferritin (r = 0.159, p = 0.114) and positive linear correlation between CRP and total serum bilirubin (r = 0.121, p = 0.230). In the control group was determined a statistically significant, positive, linear correlation between serum CRP and uric acid concentration (rho = 0.438, p = 0.001) and statistically significant, positive, linear correlation between serum CRP and total serum bilirubin (rho = 0.510, p = 0.0001) A statistically significant, negative linear correlation was determined between CRP and albumin concentration (rho=-0.393, p = 0.005) as well as statistically significant, negative linear correlation between serum CRP and ferritin control group (rho =-0.391, p = 0.005). Conclusion: Elevated CRP level is a strong and independent predictor of low levels of serum albumin, which indicates that the hypoalbuminemia in hemodialysis patients could be more due to inflammation than malnutrition. There was no statistically significant correlation between CRP and other non enzymatic antioxidants (uric acid, ferritin, bilirubin), which shows that indicators of antioxidant defense in hemodialysis patients must be individually measured to determine their actual stocks and activity.
Introduction: Based on the statistics the population in Bosnia and Herzegovina is getting older. ... more Introduction: Based on the statistics the population in Bosnia and Herzegovina is getting older. In 2013 the average life span for women was 73.6 years and 68.1 for men. The chronic hemodialysis program is mainly reserved for elderly patients with high mortality risk. The most common cause of hemodialysis mortality relates to cardiovascular diseases (60.2%), regardless of frequent innovations and improvement of hemodialysis procedures. The aim of the study was to determine the mortality rate by age groups with comments on the presence of non-traditional predictors (anemia, hypoalbuminemia, CRP, vascular access and PTH) in dialysis patients in the follow-up period of 36 months. Methods: The study included all patients undergoing chronic hemodialysis treatment at the Clinic of Hemodialysis of the Clinical Center University of Sarajevo (CCUS). Results: Out of a total number of hemodialysis patients (n=232), the specific mortality rate in patients under 65 years of age was 16.8%, and 50.5% in patients over 65 years of age. According to the age groups the mortality rate in elderly patients is as follows: from 65 to 74 years (45.1%), from 75 to 84 years (55.0%), over ≥85 years (75.0%). The most frequent vascular access in patients under and above 65 is arteriovenous fistula (79.6% and 62.1 %), temporary hemodialysis catheter (11.7% and 43.8 %) and long-term hemodialysis catheter (8.8% and 4.2 %). In the age group under 65 years of age the temporary hemodialysis catheter is significantly and more frequently used in diseased patients in respect to survivors (34.8% vs. 7.0%) [χ 2 (2)=15.769, p=0.001]. Diseased patients from the age group over 65 had a significantly lower mean value of haemoglobin in blood (M=100.9±17.5 g/L) in respect to survivors (M=109.2±17.1)[t(93)=2.339; p=0.021], lower mean value of albumin in blood (Me=32.0; IQR=29.0 do 35.0) in respect to survivors (Me=34.0; IQR=32.0 to 38.0) [U=762.5; p=0.006], and higher mean value of CRP in blood (Me=19.3 mg/L; IQR=6.6 to 52.0) in respect to survivors (Me=7.8; IQR=4.0 to 16.7) [U=773.5; p=0.008]. Diseased patients belonging to the age group over 65 had lower mean value of PTH, but without statistical significance (p>0.05). Conclusion: older age, temporary vascular access, anaemia and hypoalbuminemia are strong predictors of mortality in hemodialysis patients. Old age does not present contraindication for hemodialysis treatment, and treatment of terminal renal illness should not be abandoned.
Background and Aims The occurance of mid- and longterm uremic complications is related to the low... more Background and Aims The occurance of mid- and longterm uremic complications is related to the low clearance rate of middle and large molecule uremic toxins when hemodialysis (HD) alone is adopted. As the uremic toxins and their corresponding biological effects become increasingly clear, blood purification treatment that aims to remove these toxins, has developed from a stage of life-sustaining to improving the quality of life. The objective of this study was to evaluated demographic, clinical and laboratory data in patients who underwent the combination of maintenance hemodialysis with hemoperfusion (HP) and in those who recieved HD alone and to investigate whether this combination could improve the clearance rate of middle and large molecule uremic toxins. Method A total of 26 patients, who underwent routine hemodialysis, were assessed in this study. Those patients were randomly divided into three groups: Group 1 (7 patients) received combined treatment of HD with HP biweekly (HD 2...
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