[Causes of chronic renal failure and clinical status of patients during initiation of hemodialysis therapy in upper Silesian region]. / Przyczyny przewleklej niewydolnosci nerek i stan kliniczny chorych w chwili rozpoczecia hemodializoterapii na obszarze Górnego Slaska.

UNLABELLED: The aim of this study was to evaluate the causes of chronic renal failure and clinical status of patients during the onset of hemodialysis therapy in Upper Silesian region. Medical documentation and questionnaires of 175 patients initiating hemodialysis therapy from November 1999 to October 2000 were analyzed. Concentrations of creatinine, calcium, phosphorus in serum, hemoglobin in blood, concomitance of hypertension, frequency of uremic symptoms, HBV and HCV infections, and occurrence of mature arterio-venous fistula before the first hemodialysis were assessed. The main causes of end stage kidney disease were: chronic glomerulonephritis (29%), diabetic nephropathy (27%), polycystic kidney disease (15%), interstitial (11%) and hypertensive (9%) nephropathy. The first contact with nephrologist for 30% of patients was the admission for the initiation of renal replacement therapy. 33% of patients were treated due to chronic renal failure shorter than 1 year. Only 53% of patients had matured arterio-venous fistula during the first hemodialysis session. Anemia, hyperphosphatemia (>1.7 mmol/l) and arterial hypertension were found in 87%, 49.5% and 82% of patients starting hemodialysis therapy, respectively. The main symptoms of chronic uremia were weakness, pruritus, swelling, nausea and insomnia. CONCLUSIONS: Most of patients with chronic renal failure is referred to the nephrologists at the advanced stage of the disease. It is especially true for patients with diabetic nephropathy.

[Prevalence of anemia, calcium-phosphorus abnormalities and metabolic acidosis in different stages of chronic renal failure]. / Stopien niewydolnosci nerek a czestosc wystepowania niedokrwistosci, zaburzen gospodarki wapniowo-fosforanowej oraz kwasicy metabolicznej.

BACKGROUND: Chronic kidney disease (CKD) is associated with the reduction of haemoglobin concentration and a variety of biochemical abnormalities including changes in serum concentration of sodium, potassium, calcium, phosphate, bicarbonate, and hydrogen ions. However, data concerning epidemiology of these abnormalities are rare and incomplete, especially among subjects with mild to moderate CKD. PATIENTS AND METHODS: Patients with a serum creatinine concentration > 110 micromol/l hospitalized in the Department of Nephrology, Endocrinology and Metabolic Diseases Medical University of Silesia from 1998 to 2002 were analyzed. Patients with acute renal failure or chronic renal failure treated with renal replacement therapy were excluded from this study. A total of 653 patients (262F and 391M) were divided into 9 subgroups differing from each other by progressive decline of glomerular filtration rate (GFR). RESULTS: A statistically significant decrease in haemoglobin concentration and increase in the prevalence of anaemia were found in patients with GFR < 50 ml/min. In a large number of patients with a GFR < 80 but > 50 ml/min, Hb concentration <11 g/dl was observed. Mean MCV, MCH and serum iron concentration were similar in all studied subgroups. A progressive increase in serum phosphorus concentration and decrease of calcaemia was found in patients with GFR < 30 ml/min. The elevated Ca x P product (> 4.44 mmol2/12) was noticed almost exclusively in patients with GFR< 30 ml/min. A decompensated metabolic acidosis was observed in 29.8% of patients with GFR <30 ml/min. CONCLUSIONS: Anaemia is an early symptom of chronic kidney disease preceding disturbances of calcium, phosphate and hydrogen ions metabolism. These abnormalities seem to be of therapeutic relevance.