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Results of improvement in adequacy of intermittent hemodialysis (IHD) in uremic patients
Author(s) -
Grzegorzewska A.E.,
Banachowicz W.
Publication year - 2005
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1492-7535.2005.1121bt.x
Subject(s) - medicine , hemodialysis , creatinine , albumin , ferritin , gastroenterology
Increasing number of uremic patients, who need IHD, is a great challenge for every society but especially for poor and developing countries. The aim of our study is to look if small (not very expensive) increase in IHD adequacy is able to improve standard medical parameters. In 40 patients, treated with IHD for 57.5 (1–185) months, Kt/V was monitored on‐line during the middle IHD session in the week, 4 times in each of 6 consecutive months. Measurements of Kt/V based on a conductivity method. In the first month of observation Kt/V was lower (1.09 ± 0.02, p < 0.0009) than in later months, in which Kt/V was ranging from 1.13 ± 0.04 to 1.17 ± 0.01. Blood morphology was estimated every month. At the beginning of study period, after 3 months, and at the end of studies, dry body mass, BMI, the blood pH and serum concentration of calcium, phosphate, intact PTH, total protein, albumin, cholesterol, iron, ferritin, urea, and creatinine were determined. The increase in Kt/V was accompanied by rising values of Hb (99.1 ± 16.6 → 105.1 ± 12.5 g/l, p = 0.022), Hct (31.6 ± 5.2 → 33.8 ± 3.6%, p = 0.004), MCV (95.9 ± 7.7 → 100.7 fl ± 5.7, p = 0.000), iron (58.2 ± 29.6 → 73.2 ± 27.8 μg/dl, p = 0.002), blood pH before (7.26 ± 0.04 → 7.41 ± 0.04, p = 0.000) and after (7.34 ± 0.05 → 7.48 ± 0.05, p = 0.000) IHD session as well as by decreasing values of PTH [918 (38–3500)→ 420 (15–4341) pg/ml, p = 0.036]. Statistically unchanged parameters included dry body mass (70.4 ± 15.6 → 70.9 ± 16.1 kg), BMI (28.21 ± 6.73 → 28.23 ± 6.79 kg/m 2 ), serum concentration of total protein (69.1 ± 5.7 → 70.9 ± 4.8 g/l), phosphate (5.72 ± 1.50 → 5.39 ± 2.02 mg/dl), cholesterol (203 ± 49 → 191 ± 62 mg/dl) and ferritin (740 ± 558 → 632 ± 346 ng/dl) as well as WBC (8.60 ± 3.89 → 6.52 ± 1.50 K/nl) and PLT (251 ± 91 → 195 ± 60 K/nl). There were correlations between Kt/V and serum concentrations of phosphate (r = 0.370, p = 0.019), PTH (r = 0.314, p = 0.048), ferritin (r = 0.417, p = 0.007), Hb (r = −0.376, p = 0.017), and Hct (r = 0.374, p = −0.017). Our results indicate that even a small increase in IHD adequacy leads to beneficial changes in management of uremic patients (better response on erythropoietin, diminished laboratory features of secondary hyperparathyroidism, better iron utilization). Correlation between Kt/V and examined parameters indicate that higher IHD doses were provided to patients in more advanced uremic state. It may partially explain advantages observed with incremental IHD adequacy.