BACKGROUND: Low bone mineral density (BMD) and trabecular bone score (TBS) are established risk factors for fractures even in hemodialysis population and they seem to be significantly lower in comparison with general population. The aim of our study was to describe 2-year loss of BMD and TBS and their predictors in hemodialysis patients. METHODS: From 59 non-selected patients (mean age 67.6 ± 13.1 years) from one dialysis centre, treated with hemodiafiltration (HDF), clinical and laboratory characteristics were obtained and densitometry examinations (with BMD and TBS results) were performed initially and at the end of 2-year follow-up. RESULTS: Two-year decrease in BMD of lumbar spine reached 4.1% (ns), of proximal femur 9.1% (p = 0.004), and of femoral neck 1.3% (ns). In the co-educated cohort, BMD decrease in all the sites correlated significantly with age and only the change of BMD of lumbar spine was negatively associated with serum calcium (r = - 0.39; p = 0.04) and dialysis vintage (r = - 0.387; p = 0.062), no other predictors of BMD loss were identified. Some predictors of BMD loss were identified with regard to gender. TBS decrease was 0.05 (3.9%; p = 0.03), and similarly, it was not predicted by any of selected parameters. No differences in BMD changes or TBS were observed between the patients with and without fractures. CONCLUSIONS: In patients with HDF, significant BMD and TBS annual losses were observed, and they were associated only with age and (in BMD of lumbar spine) with serum calcium and dialysis vintage.
- Klíčová slova
- BMD, Follow-up, Hemodialysis, Loss, TBS,
- MeSH
- absorpční fotometrie MeSH
- bederní obratle diagnostické zobrazování patofyziologie MeSH
- chronické selhání ledvin komplikace patofyziologie terapie MeSH
- dospělí MeSH
- hemodiafiltrace MeSH
- kostní denzita * MeSH
- krček femuru diagnostické zobrazování patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- osteoporotické fraktury etiologie MeSH
- osteoporóza komplikace diagnostické zobrazování patofyziologie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sexuální faktory MeSH
- trabekulární kostní tkáň patofyziologie MeSH
- vápník krev MeSH
- věkové faktory MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- vápník MeSH
The objective of the work was to evaluate the results of sonographic examination of the diameter of the vena cava inferior (VCI) as a parameter of hydratation of haemodialyzed patients. In a group of 84 haemodialyzed patients, mean age 66.32 years, the collapsibility index of the IVC was measure. The collapsibility index (CI) was calculated according to the formula: [formula: see text] where IVCexp = the maximum diameter of the IVC in maximum inspiration. Values of the index within the range from 40-75% corresponded to normal hydratation. The results were compared with ultrafiltration (total and expressed as % of body weight after haemodialyzation), "dry" body weight and with changes of BP during haemodialysis. The mean value of CI was 63.24 +/- 18.54. In 54 instances it was within the normal range (62.26 +/- 11.4), in 10 it was lower (27.7 +/- 6.02; possible sign of inadequate ultrafiltration during dialysis) and in 20 instances it was higher (84.9 +/- 7.53; risk of excessive ultrafiltration). Clinically assessed "dry" weight was adequate in 64% cases. In 24% UF was excessive. With this corresponded also the incidence of hypotension (40%) and in these patients the "dry" weight was subsequently elevated. The predictive importance of low values of CI for inadequate UF is however not unequivocal. Some of these patients were hypotensive even in case of low UF and did not tolerate its increase.
- MeSH
- dialýza ledvin MeSH
- dospělí MeSH
- hemodiafiltrace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ultrasonografie MeSH
- vena cava inferior diagnostické zobrazování MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: A number of haemodialysis studies have demonstrated beneficial effects of cooler dialysates on global haemodynamics in chronic dialysis patients. However, the effects of continuous venovenous haemofiltration (CVVH)-induced cooling on regional perfusion and energy metabolism in critically ill septic patients have not been well defined. METHODS: Nine septic mechanically ventilated patients (age 40-69 years) were investigated during CVVH (ultrafiltration 30-35 ml/kg/h). Baseline data (=WARM 1) were collected when core temperature (Tc) was >37.5 degrees C; the second data set (=COLD) was obtained after 120 min of 'cooling'; and a third set (=WARM 2) was obtained after 120 min of 'rewarming'. During 'warming' (WARM 1 and 2, respectively), both substitution fluids (SFs) and 'returned' blood (RB) were warmed (37 degrees C), whereas during 'cooling', the SFs were at 20 degrees C and RB was not warmed. We measured hepatic venous (HV) haemoglobin oxygen saturation (ShvO(2)), blood gases, lactate and pyruvate. Gastric mucosal PCO(2) (PgmCO(2)) was measured by air tonometry and the gastric mucosal - arterial PCO(2) difference (PCO(2) gap) was calculated. Haemodynamic monitoring was performed with arterial and pulmonary arterial thermodilution catheters. RESULTS: Tcs were significantly altered [WARM 1, 37.9 degrees C (37.6, 38.3); COLD, 36.8 degrees C (36.3, 37.1); WARM 2, 37.5 degrees C (37.0, 38.0); P<0.001; data are median, 25th and 75th percentiles, respectively]. Systemic vascular resistance significantly increased during cooling. As a result, mean arterial pressure increased. Cooling was associated with significant decreases in heart rate, cardiac output, systemic oxygen delivery and consumption. ShvO(2) did not change [WARM 1, 51.0% (44.0, 59.5); COLD, 49.0% (42.0, 58.0); WARM 2, 51.0% (46.0, 57.0); P = NS]. The splanchnic oxygen extraction ratio, the HV lactate to pyruvate ratio, HV acid base status and PCO(2) gap remained unchanged. CONCLUSION: Mild core cooling induced by CVVH may not affect hepatosplanchnic oxygen and energy balance in septic critically ill patients, even though it affects global haemodynamics.
- MeSH
- dospělí MeSH
- energetický metabolismus fyziologie MeSH
- hemodynamika fyziologie MeSH
- hemofiltrace metody MeSH
- kritický stav MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři MeSH
- sepse patofyziologie terapie MeSH
- splanchnický oběh fyziologie MeSH
- spotřeba kyslíku fyziologie MeSH
- terapeutická hypotermie * MeSH
- umělé dýchání MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
The authors compare changes of intraocular pressure during haemodialysis and haemofiltration in six patients. The measurements were made with the patients in a sitting position, using an applanation tonometer according to Perkins, during both operations every hour. A rise to 25 torr was recorded in one patient repeatedly during haemofiltration in both eyes one hour after the blood pressure had risen to 220/120 and 210/110. In the other patients the variations of the intraocular pressure were within the physiological range. Based on data in the literature the authors recommend the use of haemofiltration in patients with glaucoma and after eye surgery.
- MeSH
- dialýza ledvin * MeSH
- dospělí MeSH
- hemofiltrace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nitrooční tlak * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
Phosphorus removal by hemoelimination procedure is a important mechanism to maintain phosphorus level in acceptable level in patients on dialysis. Phosphorus is removed by both diffusion and convection, but in clinical practice, it is not possible to differentiate the contribution of this two transport modalities. We used Gutzwiller formula to quantify the amount of removed phosphorus and compared it in low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD), and on-line hemodiafiltration (HDF). There were no significant differences in phosphorus predialysis concentration, duration of procedure, processed blood volume and ultrafiltration, e.g., factors, which could possibly influence phosphorus elimination. All three tested dialysis modes also did not differ in urea dialysis dose (Kt/V) as a parameter of small molecular weight removal (LFHD, 1.50 ± 0.04 vs HFHD, 1.5 ± 0.06 vs HDF, 1.5 ± 0.05). The amount of removed phosphorus in LFHD, HFHD, and HDF was 34.0 ± 1.2, 37.8 ± 1.6, and 38.3 ± 1.4 mmol, respectively. Statistically significant increase in phosphorus removal was seen only with use of high-flux membrane (HFHD and HDF) when compared with the low-flux one. No difference was, however, found between HFHD and HDF. It can thus be concluded that phosphorus removal in all three dialysis modes is a predominantly diffusive issue and contribution of convection to it is minor to negligible.
- MeSH
- dialýza ledvin metody MeSH
- dospělí MeSH
- fosfor krev MeSH
- hemodiafiltrace metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- fosfor MeSH
BACKGROUND: Acetate-free biofiltration (AFB) is a haemodiafiltration method which is used nowadays in the treatment of chronic renal failure. In AFB a dialyzation solution without a buffer is used, in the haemofilter some 2 1/hour are filtred. Simultaneously a sodium bicarbonate infusion in a postdilution mode is administered. The AFB investigation was conceived with the aim to introduce the method into clinical practice and to record the effect of AFB on the patient. METHODS AND RESULTS: Using the apparatus Monitral SC 30 of Hospal Co. the author made 120 AFB in 23 patients on long-term bicarbonate haemodialysis. In the investigation capillary haemofilters with an AN 69 membrane (Filtral 10 and 12) were used. The blood flow rate was 260 +/- 23 ml/min, the infusion rate of the substitution solution (NaHCO3 with a concentration of 167 mmol/l) was 1.7 +/- 0.1 l/h, the AFB period of 3.64 +/- 0.25 h. Before and after AFB values of the acid-base balance were investigated as well as the ion concentration, nitrogen catabolites, beta-2-microglobulin and cardiovascular stability of the patients. Optimal adjustment of metabolic acidosis was proved, the pH value before vs. after AFB was 7.359 +/- 0.053 vs. 7.444 +/- 0.048, p < 0.001, standard HCO3 20.2 +/- 2.6 vs. 26.0 +/- 2.1 l mmol/l, p < 0.001, adjustment of the ion balance, nitrogen catabolites were effectively eliminated, the Kt/V value was 1.03 +/- 0.22, beta-2-microglobulin declined after AFB from 36.3 +/- 10.0 to 23.8 +/- 8.2 mg/l, p < 0.001. Cardiovascular stability of patients in the course of AFB was very good, symptomatic hypotension was recorded in one patient (0.83%). CONCLUSIONS: AFB is considered by the authors, based on the results of their study and according to data in the literature, an effective and perspective form of substitution of renal function. AFB is particularly suitable for patients with circulatory instability and for those with a limited perspective of renal transplantation who are thus threatened by complications of long-term dialyzation treatment.
- MeSH
- chronické selhání ledvin terapie MeSH
- dialýza ledvin MeSH
- dospělí MeSH
- hemodiafiltrace * MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE: Bone involvement represents one of the complications of end-stage chronic kidney disease, with fractures being its major risk. The aim of our study was to assess the frequency and predictors of low-trauma fractures in a cohort of maintenance hemodialysis patients followed-up on for 2 years. METHODS: 59 patients (67.6 ± 13.1 years, 43 males) treated with hemodiafiltration underwent initially laboratory (markers of calcium-phosphate metabolism and bone turnover markers) and densitometry examination with TBS assessment (Lunar Prodigy, TBS software 2.1.2). During 24-month follow-up, the frequency of low-trauma fractures was assessed and possible predictors of increased fracture risk were identified using product-moment correlation matrices. RESULTS: Altogether 7 (11.9%) low-trauma fractures were observed. In the whole group, age (P = 0.047), T-score in proximal femur (P = 0.04), low vitamin D, low BMI (P = 0.03 for both), and higher FRAX for major osteoporotic fracture (P = 0.01) were connected with fractures, but in multi-variate analysis only BMI remained significantly negatively associated with fractures (P = 0.047). TBS and bone turnover markers failed to predict fractures. However, women with fractures had significantly lower serum phosphate (P = 0.03) and higher parathyroid hormone (P = 0.04). Parameters of hip structure analysis significantly correlated with FRAX, but not with fractures. CONCLUSIONS: In a group of hemodialysis patients from one centre, T-score in proximal femur, low vitamin D, low BMI, and high FRAX for major osteoporotic fracture were associated with low-trauma fractures, however, in multi-variate analysis only low BMI remained a significant predictor of fracture risk.
- Klíčová slova
- Bone mineral density, FRAX, Fracture, Hemodialysis, Hip structure analysis, Trabecular bone score,
- MeSH
- acyltransferasy krev MeSH
- chronické selhání ledvin krev terapie MeSH
- fraktury kostí krev epidemiologie MeSH
- hemodiafiltrace MeSH
- index tělesné hmotnosti * MeSH
- kostní denzita MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- parathormon krev MeSH
- proteiny z Escherichia coli krev MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vitamin D analogy a deriváty krev MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- 25-hydroxyvitamin D MeSH Prohlížeč
- acyltransferasy MeSH
- PagP protein, E coli MeSH Prohlížeč
- parathormon MeSH
- proteiny z Escherichia coli MeSH
- vitamin D MeSH
BACKGROUND: Metabolic acidosis (MAC) is a common aspect of dialysis-dependent patients. It is definitely caused by acid retention; however, the influence of other plasma ions is unclear. Understanding the mechanism of MAC and its correction is important when choosing the dialysis solution. Therefore, we assessed the relationship between intradialytic change of acid-base status and serum electrolytes. METHODS: We studied 68 patients on post-dilution hemodiafiltration, using dialysate bicarbonate concentration 32mmol/L. The acid-base disorders were evaluated by the traditional Siggaard-Anderson and modern Stewart approaches. RESULTS: The mean pre-dialysis pH was 7.38, standard base excess (SBE) -1.5, undetermined anions (UA(-)) 7.5, sodium-chloride difference (Diff(NaCl)) 36.2mmol/L. MAC was present in 34% of patients, of which 83% had an increased UA(-) as a major cause of MAC. The mean nPCR was 0.99g/kg/day and correlated negatively with SBE. After dialysis, metabolic alkalosis predominated in 81%. The mean post-dialysis pH was 7.45, SBE 4, UA(-) 2.6, Diff(NaCl) 36.9mmol/L. ΔSBE significantly correlated with ΔUA(-), but not with ΔDiff(NaCl) or ΔCl(-). CONCLUSIONS: MAC in patients on hemodiafiltration is mainly caused by acid retention and is associated with higher protein intake. We did not prove the effect of sodium or chloride on acid-base balance. Even though we used a relatively low concentration of dialysate bicarbonate, we recorded a high proportion of post-dialysis alkalosis caused by the excessive decrease of undetermined anions, which had been completely replaced by bicarbonate and indicated the elimination of undesirable anions, as well as of normal endogenous anions.
- Klíčová slova
- Acid-base, Base excess, Electrolyte, Hemodiafiltration, Sodium-chloride difference, Stewart,
- MeSH
- chronické selhání ledvin komplikace terapie MeSH
- elektrolyty krev MeSH
- hemodiafiltrace škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- poruchy acidobazické rovnováhy etiologie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- elektrolyty MeSH
We describe our experience with plasma exchange (PE) and immunoadsorption in patients with myasthenia gravis. The group of 27 patients consists of 21 patients treated with PE and 6 patients who received immunoadsorption. PE therapy led to stabilization in 20 patients. In patients treated with immunoadsorption, therapy could be discontinued in 2 patients after 13 months of therapy, and the other 4 patients were stabilized without myasthenic crises after 6-9 years of therapy. Extracorporeal elimination therapy through PE or immunoadsorption is effective and sometimes life saving and is safe in the hands of an experienced team (6% complication rate).
- MeSH
- časové faktory MeSH
- hemofiltrace metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- myasthenia gravis terapie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výměna plazmy metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
