Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients.

OBJECTIVES: The aims of the study were to determine the percentage of patients on regular hemodialysis (HD) in Serbia failing to meet KDOQI guidelines targets and find out factors associated with the risk of time to death and the association between guidelines adherence and patient outcome. METHODS: A cohort of 2153 patients on regular HD in 24 centers (55.7% of overall HD population) in Serbia were followed from January 2010 to December 2012. The percentage of patients failing to meet KDOQI guidelines targets of dialysis dose (Kt/V>1.2), hemoglobin (>110g/L), serum phosphorus (1.1-1.8mmol/L), calcium (2.1-2.4mmol/L) and iPTH (150-300pg/mL) was determined. Cox proportional hazards analysis was used to select variables significantly associated with the risk of time to death. RESULTS: The patients were on regular HD for 5.3±5.3 years, dialyzed 11.8±1.9h/week. Kt/V<1.2 had 42.4% of patients, hemoglobin <110g/L had 66.1%, s-phosphorus <1.1mmol/L had 21.7% and >1.8mmol/L 28.6%, s-calcium <2.1mmol/L had 11.7% and >2.4mmol/L 25.3%, iPTH <150pg/mL had 40% and >300pg/mL 39.7% of patients. Using Cox model (adjustment for patient age, gender, duration of HD treatment) age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy were selected as significant independent predictors of time to death. When targets of five examined parameters were included in Cox model, target for KtV, hemoglobin and iPTH were found to be significant independent predictors of time to death. CONCLUSION: Substantial proportion of patients examined failed to meet KDOQI guidelines targets. The relative risk of time to death was associated with being outside the targets for Kt/V, hemoglobin and iPTH.

[Early continuous dialysis in acute glyphosate-surfactant poisoning].

INTRODUCTION: Treating severe acute glyphosate-surfactant poisoning requires intensive therapy including dialysis. Cases of hemoperfusion and hemodialysis use in renal failure induced by herbicide ingestion have been reported in the current medical literature. We present a case report of successful patient treatment with continuous venovenous hemodiafiltration in acute glyphosate-surfactant poisoning. CASE OUTLINE: A 36-year-old male patient attempted suicide by drinking approximately 300 ml of glyphosate-surfactant about an hour before coming to our Clinic. On admittance the patient was somnolent, normotensive, acidotic and hyperkalemic. Six hours after poison ingestion there was no positive response to symptomatic and supportive therapy measures. The patient became hypotensive, hypoxic with oliguric acute renal failure, so that post-dilution continuous veno-venous hemodiafiltration was started. During the treatment the patient became hemodinamically stabile, diuresis was established along with electrolyte and acid-base status correction and a gradual decrease of blood urea nitrogen and creatinine levels. After a single 27.5-hour treatment, clinical condition and renal function parameters did not require further dialysis. Complete recovery of renal function was achieved on the fifth day. CONCLUSION: Early introduction of continuous veno-venous hemodiafiltration with other intensive therapy measures led to complete recovery in a hemodinamically instable patient.

[Influence of hemoglobin level and dose of administered recombinant human beta erythropoietin on survival of hemodialysis patients].

BACKGROUND/AIM: In patients with end-stage renal disease, treatment with erythropoietin lowers cardiovascular morbidity, improves quality of life and patient survival. The aim of this study was to determine the difference in survival of hemodialysis patients treated with recombinant human beta erythropoietin and patients without this treatment, and to determine the influence of hemoglobin level and erythropoietin dose on the survival of these patients. METHOD: The study included 291 patients undergoing maintenance hemodialysis, 122 were on erythropoietin therapy, 169 patients formed control group. The study was performed at the Clinic for Nephrology and Clinical Immunology, Clinical Center of Vojvodina, during a 69-month period. We analyzed basic demographic parameters, dialysis duration, underlying disease, comorbidities, death causes, blood-work parameters and erythropoietin dosage. Descriptive statistics, Anova, Manova, discriminant function analysis, Cox regressional model and Kaplan Meier survival curves were used as statistical methods. RESULTS: Average age and dialysis duration in the experimental group were 47.88 +/- 13.32 years, and 45.76 +/- 46.73 months, respectively and in the control group 58.73 +/- 12.67 years and 62.80 +/- 55.23 months, respectively. Average level of hemoglobin and hematocrit in the group in which erythropoietin had been administered was 11.40 +/- 8.39 g/dL and 0.35 +/- 0.04/L, while the control group these values were 8.52 +/- 7.73 g/dL and 0.26 +/- 0.04/L, respectively. Average monthly dosage of erythropoietin was 21 587 +/- 10 183.36 IJ/month. Significant difference in survival was determined (p < 0.05) between the stated patient groups. A significant difference (p < 0.05) was found in survival of the patients in which erythropoietin was administered regarding hemoglobin level (< 100 g/L/100-110 g/L/110-120 g/L/ > 120 g/L), as well as in regard of erythropoietin dose applied (< 20 000 IJ/20 000-40 000 IJ/ > 40 000 IJ/month). CONCLUSION: Best survival was noted in patients with hemoglobin > 120 g/L and erythropoietin dose < 20 000 IJ/month.