Correlation between parathormone and sexual hormones in patients on haemodialysis.

INTRODUCTION: Chronic renal failure is associated with endocrine abnormalities, which in some cases cause polyendocrinopathy responsible for the symptoms and complications. The consequence of secondary hyperparathyroidism is not only bone disease but may be cardiovascular disorders, peripheral nerve damage and impact on the level of sex hormones. THE AIM: To evaluate the interactions between parathyroid hormone and sexual hormones and the effect of elevated levels of parathyroid hormone secretion on various sexual hormones. The study included 72 patients who were undergoing chronic hemodialysis program 3 times a week at the clinic for hemodialysis. Patients were divided into two groups according to parathyroid hormone values and child-bearing age. The study is a retrospective-prospective and lasted for 1 year. At the beginning, after 6 months, and at the end of the study were determined the PTH, FSH, LH, progesterone, testosterone, beta-estradiol, prolactin. RESULTS: During the study period followed are the values of sexual hormones and PTH in 72 patients of which 41 men and 31 women. Of these 33.3% (24) men were in the reproductive age, and 23.6% (17) were women in the reproductive age. The mean age of patients was 53.2 +/- 12.16, and the average duration of hemodialysis was 7.57 +/- 4.0. PTH showed a slight tendency to increase 274.45 +/- 220.74 pg/dL at baseline, at the end of study 383 +/- 313.2 also increased during the study was recorded and the values progesterone. Statistically significant effect of PTH showed the FSH p < 0.01 LH p < 0.05 and prolactin p < 0.01. On average, patients who have elevated PTH levels have lower values of FSH and LH, but higher prolactin values. Parathormone also shows the effect on beta estradiol at level p < 0.01, patients with higher PTH values have lower levels of beta estradiol. CONCLUSION: The increase in the number of younger people with terminal renal insufficiency treated by repeated hemodialysis, often have endocrine disorders and elevated PTH. Normalization of PTH levels affects the normalization of sexual hormone levels and improves quality of life of patients on hemodialysis.

[New vaccination protocol against hepatitis B for hemodialysis patients--a single-centre experience]. / Novi protokol vakcinacije pacijenata na hemodijalizi protiv hepatitisa B--iskustvo jednog centra.

UNLABELLED: Patients with end stage renal disease (ESRD) have a reduced response to vaccination against hepatitis B infection. The aim of the study has been to determine the adequacy of immune response with new protocol of vaccination against hepatitis B infection. PATIENTS AND METHODS: The study included incident hemodialysis patients since 2008 until 2011 at the Clinic of Hemodialysis of the Clinical Center of the University of Sarajevo. We started the new vaccination protocol in September 2009. New protocol implied vaccination six month before starting renal replacement therapy (RRT) and "ic" (intracutaneously) application vaccine vs. "sc" (subcutaneously) application. Vaccination was carried out for over 12 months. The follow up period lasted from 2009 to 2011. RESULTS: The study included 64 patients, men were represented with 57,81% (37), and 42,19% women (27), who were divided in two groups. The first group included patients from the period from 2008 to 2009, who have been vaccinated under the old vaccination protocol, while the second group included patients with the new protocol from September 2009 to 2011. The first group had 28 patients, mean age of patients was 55,17 +/- 11.84 and mean duration of hemodialysis was 24,65 +/- 5,32 months. The second group had 36 patients, mean age of patients was 62,79 +/- 15,88 years, and mean duration of hemodialysis was 22,16 +/- 24,53 month. Neither group of patient has been previously vaccinated, nor these had positive in serum antiHBs before vaccination in second group. Five patients received a booster dose of vaccine, after which 4 showed adequate responses to anti HbS. In the first group of patients, out of total of 28 patients, 15 patients did not respond response with the adequate anti-HbS titer at the end of vaccination. In the second group of patients, out of 36 patients 31 of them responded to the vaccination with the new protocol, which was statistically significant (p<0,005). The total percentage of patients with adequate titer of antiHBs after vaccination towards a new protocol was 97.43% and the percentage of patients who required booster dose of vaccines was 12.82%. CONCLUSION: Vaccination of patients in ESRD,six months before renal replacement therapy and intradermal application of vaccine vs. subcutaneously, improved immune response of our patients.

[Central venous catheters for haemodialysis and optimal blood flow]. / Centralni venski kateteri za hemodijalizu i optimalni protok krvi.

INTRODUCTION: Central venous catheters (CVC) have become and indispensable form of haemodialysis access and represent, in our centre, about 8,58 % of the permanent vascular access with a total number of more than 957 venous catheters in the past 8 years. We used double-lumen catheters. METHODS: The aim of this study was to identify the factors of the catheter dysfunction. We studied prospectively 23 chronic haemodialysed patients with CVC, 14 men and 9 women 63 +/- 14 (51-83), treated with haemodialysis for 3.7 +/- 4 (1-9) years. Catheters were inserted by percutaneous Seldinger techniques in right internal jugular vein. We studied the localization of the catheter tip: superior vena cava, right atrium, the blood pressure before and after haemodialysis, the interdialytic weight gain, and number of symptomatic episodes during 13 last dialysis (one month). The patients were divided into two groups: group I with usual adequate catheter function (n=17) and group II with frequent dysfunction (n=6). RESULTS: In group I the catheters tip was in the right atrium, and in group II in the vena cava superior. Blood pressure was not different between the two groups. We found no correlation between central venous pressure, blood pressure, interdialytic weight gain and symptomatic hypotension, but there was a higher frequency of hypotension in the hypovolemic patients. CONCLUSIONS: Optimal hemodynamic conditions will be provided by a catheters tip in the rights atrium and a central venous pressure over 5 mmHg, which can be provided with vascular filling or dry body weight.

[Prevention of hepatitis C at Center for Haemodialisys of Clinical Centre of University of Sarajevo]. / Prevencija hepatitisa C u Centru za hemodijalizu K.C.U. Sarajevo.

GOAL: The patients with the chronical programm for haemodialisys have the higher risk from getting ill virus hepatitis C in the realtion to the rest population. AIM OF THE WORK: Was the evaluation of the prevalence and incidence of hepatitis C at the Center for Haemodialisys CCU Sarajevo and the effect of the prevalentive measures on the incidence of the serum conversion of hepatitis C, in the period from 2002 till 2004 year. MATERIAL AND METHOD: By the examening is comprehended 155 patients aged 54,58 +/- 14,797 years, with the aproximative length of the haemodialisys 58,9 +/- 53,9 months. Patients at the chronic programm of the bicarbonite haemodialisys taree times per week, and antibodies on the hepatitis C were determined III generation. Also was determined PCR. RESULTS: During the periiod of examination the dialized population was increased also 2002 year the prevalence of hepatitis C was 23,87% (37/155), in 2003 year 29,29% (46/157) and 2004 year the pregalence amounted 26,28% (46/175). Incidence of hepatitis C was significantly decreased in the course of the period of followup and in 2002 year was 16,21%, in 2003 year 13,04%, that in 2004 year would amount 4,34%, that is only in two patients occurred the serum conversion on hepatitis C. CONCLUSION: By applying of the corresponding protocoles and their strict realization (desinfection of the hands, wearing of gloves, apparatus desinfection) and separation of the dialyzed monitors for anti HCV positive and anti HCV negative patients dicreased significantly the hepatitis C incidence in our dialyzed population. The strict application of the preventive measures can completely prevent the speading occurrence of hepatitis C on haemodialisys.