[The value of bone mineral density assessment by dual-energy x-ray absorptiometry for prediction of cardiovascular mortality in patients treated with hemodialysis].

AIM: Determine whether bone mineral density (BMD) assessed by dual-energy x-ray absorptiometry can be used as predictor of increased risk of death in hemodialysis patients. MATERIALS AND METHODS: A prospective study was performed of 516 patients with chronic kidney disease treated with hemodialysis (men 265, women 251, mean age 44.811.4 years) who were observed for 5.73.2 years. Before inclusion in the study, in all patients was analyzed bone mineral density using dual-energy X-ray absorptiometry in three standard departments: lumbar vertebrae, proximal femur and distal forearm. The probability analysis of the outcome was carried out using the KaplanMeier method and Cox. RESULTS: During follow-up period 111 (21.5%) patients died, 50.5% from cardiovascular events. Survival analysis by KaplanMeier method allowed to prove the increased risk of death from cardiovascular pathology in hemodailysis patients with low bone mineral density of all evaluated areas. Step-by-step multivariate Cox regression analysis showed that the T score of the femur, showing the difference of BMD of the patient with normal value of BMD for young adult, had the greatest prognostic significance. CONCLUSION: Reduced bone mineral density in patients receiving hemodialysis is associated with an increased risk of death from cardiovascular disease. Dual energy x-ray absorptiometry can be used for assessment of this risk.

[Hemodynamic effects of succinate-containing dialyzing solution].

AIM: To assess the results of using an acetate-free succinate-containing dialyzing solution (SDS) against natremia and blood pressure (BP) in patients on chronic hemodialysis (HD). SUBJECTS AND METHODS: Ninety-two patients were transferred from 3 Saint Petersburg HD centers to 3-month HD treatment using SDS. The investigators measured blood biochemical indicators immediately before and 1 and 3 months after the investigation, BP before and after a successive HD session, and the patients' weight and its gain in the period between HD sessions. Hypotensive and hypertensive episodes were recorded during HD sessions throughout the investigation. RESULTS: Following 3-month treatment using SDS, there were statistically significant decreases in blood sodium levels and systolic BP (SBP) prior to a HD session. At the same time, patients with a baseline pre-HD SBP of less than 100 mm Hg were observed to have a statistically significant increase in this indicator by the end of the investigation. Pre-dialysis diastolic BP (DBP) and post- dialysis SBP and DBP substantially unchanged. After 3 months of SDS use, there was a statistically significant reduction in weight gain in the period between HD sessions. When SDS was administered, the frequency of hypertensive episodes tended to decline after a HD session. CONCLUSION: The use of SDS causes a drop in pre-dialysis blood sodium levels, ensuring adequate dehydration in patients and improving hypertension control. In doing so, SDS prevents hypotension during a HD session.