Cardiovascular risk in patients undergoing maintenance hemodialysis with Helixone® membrane: a multicenter randomized study.

INTRODUCTION: The high prevalence and incidence of atherosclerotic vascular complications, such as cardiovascular disease, remain the major cause of morbidity and mortality in patients undergoing dialysis. OBJECTIVES: The aim of the study was to evaluate cardiovascular risk factors in patients dialyzed with a high­flux polysulfone membrane (Helixone®) compared with those dialyzed with a low­flux polysulfone membrane. PATIENTS AND METHODS: This was a crossover randomized study including 90 hemodialysis patients. Group 1 was treated first with high­flux and then with low­flux membranes, while group 2, first with low­flux and then with high­flux membranes for 13 months. Clinical, biochemical, and echocardiographic data were evaluated at baseline and every 3 months during the study. RESULTS: After 6 months of high­flux dialysis, we observed a significant decrease in ß2­microglobulin, lipoprotein(a), C­reactive protein, and parathormone levels and an increase in serum albumin levels. Initially, both groups showed left ventricular hypertrophy. After 6 months of high­flux dialysis, we observed a tendency for an increase in the cardiac index and cardiac output and a decrease in isovolumic relaxation time. CONCLUSIONS: Our study showed that the use of high­flux dialysis with the Helixone® membrane, in comparison with low­flux dialysis with polysulfone membranes, improves middle-molecular clearance. In addition, we showed that a reduction in chronic inflammation during high­flux dialysis may decrease cardiovascular risk. However, further research with longer follow­up is needed to verify our echocardiographic findings.

[Results of QC vs QL study (quality of care vs quality of life) 2006-2009. The way of providing hemodialysis and a concomitant therapy]. / Wyniki badania QC vs QL (jakosc zycia vs jakosc leczenia) 2006-2009. Sposób prowadzenia hemodializy i terapii towarzyszacej.

Healthcare development is the fact in the present world. Because of this the improvement of the quality of care and life of patients is of great importance. Since six years in our country, the study concerning quality of life and care of hemodialysed patients (QC vs QL) is performed annually. In three subsequent papers results of studies performed between 2006 and 2009 are summarised. Almost 7000 patients were studies in the analysed period. This was more than 10% of dialysed patients in every year. In the present paper we focused on the hemodialysis modalities and concomitant therapy. The increase of high-flux hemodialysis usage as well as plasmapheresis but not hemodiafiltration was noticed in the analysed period. Adequacy of the therapy was evaluated as Kt/V and was stable in the whole study. Treatment with erythropoesis stimulating agents (ESA) was provided in 100% of dialysis units, the dosage frequency was connected with long acting ESA. Because of changed trends and the payer requirements apart from frequency the route has also changed. The average haemoglobin level reflected European and county guidelines and changed during the observation. Additional help from psychologist and dietician is available in too small number of dialysis units. Summarizing, based on performed analysis the development of hemodialysis treatment and a high level of provided therapy comparable to other European countries was observed in Poland. Support for further development and improvement of renal replacement therapy is needed to achieve also better quality of life of our patients.

How are hemodialysis patients treated in the Lublin region--based on the selected issues of diagnosis and therapy.

The aim of the paper was to answer the questions about the quality of life of dialysis patients treated in the selected dialysis centres of the Lublin region in relation to the recent quantitative and qualitative breakthrough in dialysis therapy in Poland. The studies including 288 patients of 7 medium-sized centres were performed using the questionnaires filled in by interviewers. The present paper describes the results of analysis of the questions addressed to the centre staff but concerning the way of treatment of a particular patient. The results show that to follow the world-wide trends, chronic dialysis treatment should be of an optimum quality and the methods evaluating it widely propagated. Moreover, much is to be done in the field of the latest diagnostic procedures and therapy of dialysis patients. On the other hand, the technical aspects of dialysis therapy look quite good. To evaluate the changes in the aforementioned processes more accurately, it should be worthy to broaden the studies including the remaining centres of our region and to continue them in the future.

Care provided for hemodialysis patients in selected dialysis centres of the Lublin region.

The aim of the study was to answer the questions about the quality of dialysis for the patients treated in the selected dialysis centres of the Lublin region in relation to a quantitative and qualitative breakthrough observed in the field of Polish dialysis therapy in recent years. The study including 288 patients in 7 medium-sized centres used the questionnaire filled in by interviewers. The present paper analyses the patients' answers to the questions about medical care provided in a particular centre. It is difficult to interpret the results explicity since there are no available standards of such management. We believe that this study could be used to define them. Nevertheless, the authors think that medical care for the patients treated in dialysis centres of our region is good, although only the patients' answers were analysed. To evaluate possible changes in the processes mentioned above, it should be worthy to broaden the studies including the remaining centres of our region and to continue them in the future.