Natasa Eftimovska-Otovic, Risto Grozdanovski, Borjanka Taneva and Olivera Stojceva-Taneva
Introduction: Intradialytic hypertension with a prevalence of 15% among hemodialysis patients is with unknown pathophysiology, demographic, laboratoiy and clinical characteristic of patients, and it’s influence on longtenn clinical effects (cardiovascular morbidity and mortality, rate of hospitalization). The aim of the study is to present the clinical, laboratoiy and demographic characteristics of patients with intradialytic hypertension in our dialysis center.
Materials and methods: Out of 110 hemodialysis patients, 17 patients (15,45%) had intradialytic hypertension - started at a systolic pressure greater than 140 nun Hg or had an increase in systolic pressure more than 10 mm Hg during the session, and 17 patients were nonnotensive or had a drop in blood pressure dining the dialysis. HD were performed 3 times per week with a duration of 4-5 hours, on machines with controlled ultrafiltration and high flux syntetic membrane (polyetersulfon) sterilized with gamma rays. A dialysate with standard electrolytes content was used (Na+ 138 mmol/L, K+ 2,0 mmol/L, Ca++ 1,5 mmol/L, Mg +1,0 mmol/L, CH3COO- 3,0 mmol/L, Cl -110 mmol/1, HCO3- 35 mmol/L). We analysed the following demographic and clinical characteristics: gender, age, BMI, dialysis vintage, vascular acces, cardiovascular comorbidity (cardiomyopathy, ischemic cardiac disease, peripheral artery disease, heart valve disease), number and type of antihypertensive drugs, weekly dose of erythropoesis - stimulating agent, standard monthly, three and six months laboratoiy analyzes, and sp Kt/V and PCR. Statistical analysis was performed using the statistical software SPSS 17.0.
Results: hi both groups men were predominant (IDH group 88.23%, control group 64.07%). The IDH group was older (59.00 ± 7.64 versus 49.00 ± 13.91, p = 0.314) and with lower BMI (p = 0.246) compared to the control group. The DDH patients had significantly lower serum sodium and higher sodium gradient (135.75 ± 2.03 versus 137.33 ± 1.97, p = 0.042; 2.25 ± 1.98 versus 0.66 ± 1.44, p = 0.0267, respestively). All other laboratoiy findings showed no statistically significant differences between the two groups. The IDH group had significantly higher interdialysis weight gain and less effective ultrafiltration individually at each dialysis session compared to the control group (2.23 ± 0.866 versus 2.37 ± 0.69, p = 0.011; 3.87 ± 1,26 versus 3.56 ± 1.18, p = 0.025, respectively). The systolic and mean arterial pressure after the HD were statistically higher in the IDH group.
Conclusion: Older age, lower BMI, borderline hyponatremia, higher sodium gradient and smaller ultrafiltration rate are the clinical characteristics of patients with intradialytic hypertension.
Nikolina Smokovska, Risto Grozdanovski and Goce Spasovski
Introduction. Patients on hemodialysis (HD) are proven to have impaired Health Related Quality of Life (HRQoL) compared to the general population. Recovery from the hemodialysis session is a permanent problem among majority of patients receiving HD treatment. A partial explanation may be the osmotic imbalance between different compartments of the body due to the fluid and electrolyte movement across the cell membrane which is a part of the HD process itself. The aim of our study was to see whether the length of recovery time (RT) is associated with different clinically relevant variables and dialysis treatment features in our HD population.
Methods. We performed a cross-sectional study on patients receiving trice weekly HD in a single hemodialysis center. The recovery time was defined by posing a single question "How long does it take you to recover after a hemodialysis session?" and was calculated in hours (up to 2, 2-6, 6-12, and 12-24 hours) / minutes. Various demographic and clinical characteristics were analyzed for association with the RT.
Results. The mean RT was 364.62±339.24 minutes. From all of the analyzed variables a significant statistical correlation was obtained with the level of albumin, urea, interdialytic weight gain (IDWG), protein catabolic rate (PCR), body mass index (BMI) and the level of hemoglobin (p<0.05 for all parameters). The longest mean RT had patients with hypertension and glomerulonephritis as a primary cause of ESRD and the shortest, patients with an adult dominant polycystic kidney disease. With the multiple regression analysis a significant correlation was obtained only for the level of hemoglobin (Hb) with a coefficient for partial regression analysis - 0.2635. The t-test showed that the influence of the level of hemoglobin on recovery time in patients was statistically significant (p = 0.039).
Conclusions. RT in our study was associated with IDWG, albumin, urea, BMI, and PCR, while the level of hemoglobin was also shown to have a significant impact on the RT and on patients’ overall health status. Hence, we could conclude that maintaining Hb levels in dialysis patients within reference values among the other benefits, may improve the recovery time and HRQoL of our patients.
Momir Polenakovic, Stevka Bogdanovska, Koco Cakalaroski, Sonja Dzikova, Gjorgji Masin, Jelka Masin-Spasovska, Angel Oncevski, Vesna Gerasimovska, Goce Spasovski, Risto Grozdanovski, Olivera Stojceva-Taneva, Ladislava Grcevska, Aleksandar Sikole, Petar Dejanov, Liljana Tozija, Katica Zafirovska, Ninoslav Ivanovski, Ljubica Lozance and Vladimir Pusevski
The fast development of nephrology in the world, especially in the second half of the 20th century demanded protocol (guidelines) for nephrological activity for all levels of medical care, of doctors and specialists. The International Society of Nephrology, the European Renal Association and other national associations created their own protocol (guidelines) for nephrological activity. The Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO) proclaimed the First Protocol for Performing Nephrological Activity in the Republic of Macedonia at the First Congress of the MSNDTAO, held in Ohrid 1993, and it was published in the Macedonian Medical Review, 1994; Supplement 14: 397–406 . The update of the Protocol for Performing Nephrological Activity in the Republic of Macedonia was proclaimed at the Fourth Congress of MSNDTAO, held in Ohrid 2012 and it presented in this text.