Objective. Paroxysmal atrial fibrillation (AF) observed in patients undergoing chronic hemodialysis program with higher rates is an important morbidity and mortality cause that negatively influences ...the hemodynamics and leads to thromboembolic complications. It is known that P wave dispersion (PWD) facilitating the development of paroxysmal atrial fibrillation is increasing during intradialytic process. This study researched the influence of various amounts of ultrafiltration that applied in the various hemodialysis sessions in the same patient cohort on PWD. Materials and Methods. 25 patients in a chronic hemodialysis program undergoing four hours bicarbonate hemodialysis three times a week were included in the study. The patient cohort was divided into four groups regarding the amount of ultrafiltration (UF) performed during a four-hour standard hemodialysis session as following: UF up to 1 liter, UF of 1-2 liters, UF of 2-3 liters, and UF of 3-4 liters. Notes were kept until each patient had been included once into each group regarding the amount of ultrafiltration performed parallel to intradialytic weight gain in different hemodialysis session. A 12-lead ECG was taken from the patients immediately before the hemodialysis and within 20 minutes after completion of the session, and maximum P wave duration (Pmax), minimum P wave duration (Pmin) and PWD values (i.e., the difference between Pmax and Pmin) were measured. The inter-group data was assessed with a one-way ANOVA, and the within-group assessments were performed with paired samples test. Mann Whitney U test was used for the evaluations performed according to the presence of diabetes. Findings. The mean age of 25 patients (15 male and 10 female) was 62.7 ± 20.2 (range: 21-89). PWD after UF was decreased significantly in group 1 (56.12 ± 15.26 vs. 46.60 ± 18.45 ms, p = 0.018) and were increased in groups with UF more than 1 liter: group 2 (39.68 ± 21.26 vs. 47.12 ± 21.20 ms, p = 0.020), group 3 (41.60 ± 23.99 vs. 65.92 ± 31.04 ms, p = 0.001), and group 4 (17.52 ± 14.67 vs. 26.80 ± 15.52 ms, p = 0.007). Furthermore, while PWD before UF was significantly higher in a diabetic group compared to a nondiabetic group (68.85 ± 10.44 vs. 51.16 ± 14.06 ms, p = 0.007), it was seen that PWD difference had disappeared after UF application (57.14 ± 17.99 vs. 42.50 ± 17.40 ms, p = 0.065). Conclusion. UF application of more than 1 liter during hemodialysis session increases the PWD value significantly. Hypervolemia exceeding 1 liter between two dialysis sessions should be avoided in all patient groups, especially in diabetics, and an effective UF planning should be arranged because of a decrease in PWD values with UF observed in diabetics.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Introduction and aim. Familial Mediterranean Fever (FMF) is an autosomal recessive disease with a defect in the pyrine gene and is manifested with short attacks of inflammatory serositis, fever, and ...erysipelas-like skin lesions. Secondary amyloidosis is the most serious complication of the disease, in which extracellular deposits of amyloid (an amorphous and eosinophilic protein) are seen in tissues. Glycosaminoglycans are mucopolysaccharide molecules that take place in amyloid deposits with fibrillar links to amyloid. They form glycoproteins by linking to proteins, and their free forms are excreted in the urine in the form of polysaccharides. The aims of this study were to evaluate if the urinary levels of glycosaminoglycans have a predictive value in the diagnosis of amyloidosis secondary to FMF and if these levels are affected by treatment with colchicine. Materials and methods. The study included 55 volunteer patients (age range: 18-36 years) with FMF (15 with amyloidosis) of the same socio-economic circumstances without other concomitant inflammatory, malignant, or chronic diseases, along with 20 healthy subjects as control. Urinary glycosaminoglycan levels were determined twice, once when the patients were on medication and once after they have stopped treatment for two weeks. Results. Initial mean urinary GAG levels were significantly lower in amyloidosis patients. Mean urinary GAG levels determined two weeks after the cessation of colchicine was also significantly lower than controls in both amyloidosis and non-amyloidosis FMF patients. Likewise, in patients with a disease duration longer than ten years, urinary GAG levels were also lower than those with a disease duration of less than three years. Conclusion. Urinary GAG level can have a predictive value for amyloidosis in patients with FMF, and it can also be used as a non-invasive marker for screening the effects of colchicine on fibrillogenesis as well as for the follow-up of the patients.
Despite being widely reported in patients with neoplasms, vena cava superior (VCS) syndrome linked to thrombosis is a major catheter complication that can be encountered during the use of the ...hemodialysis catheter. Antithrombin III (AT-III), responsible for a large part of thrombin inactivation capacity in plasma, is the most powerful inhibitor of the thrombosis process. This report describes a case of VCS syndrome developing two weeks following the extraction of a right-sided subclavian catheter in a patient transferred from peritoneal dialysis to hemodialysis for one week due to leakage. The patient presented complaining of swelling and pain in the right arm. At Doppler examination, total thrombosis was observed in the subclavian and internal jugular vein. At advanced examinations due to lack of response to heparin and clinical worsening, VCS and AT-III deficiency were determined. Following thrombolytic therapy with streptokinase, AT-III levels were raised by the administration of plasma, and clinical and radiological stabilization was established by continuing heparin and continuous oral anticoagulant therapy.
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