Hypertension, overweight and obesity in adolescents: the CRO-KOP study.

The objective of this study was to determine the prevalence of hypertension, overweight and obesity in Croatian adolescents. In this cross-sectional survey (the sub-study of the EH-UH study) 375 boys and 381 girls (mean age 15.9 +/- 0.5 years) from four high schools in the city of Koprivnica were enrolled. Blood pressure, body height and body weight were measured according to the current ESH/ESC guidelines. Data on life style were obtained from questionnaire. Average blood pressure values were higher in boys than in girls (117/74 mmHg vs. 111/69 mmHg; p < 0.001). Significantly higher blood pressure values were obtained in overweight children compared to those with normal weight (119/76 mmHg us. 115/72 mmHg; p < 0.01). Prevalence of hypertension was 8.5% in the whole group being significantly higher in boys than in girls (11.2% vs. 5.8%; p = 0.0007). As expected, prevalence of hypertension was significantly higher in obese children than in those with normal weight (20.0% vs. 6.8%; p = 0.015). A significant correlation was found between body mass index and blood pressure (p = 0.0001). The overall prevalence of obesity was 3.54% (boys 2.2%; girls 4.9%). Our results confirmed positive relationship between overweight, obesity and hypertension starting from childhood pointing again the utmost importance of preventive measures beginning from early life.

[The impact of heparin bolus from dysfunctional lumen of dual lumen central venous catheter on activated partial thromboplastin time during hemodialysis: is additional heparinization necessary?]. / Utjecaj bolusa heparina iz nefunkcionalnog lumena dvoluminalnog centralnog venskog katetera na vrijednosti aktiviranog parcijalnog tromboplastinskog vremena tijekom hemodijalize: da li je potrebna dodatna heparinizacija tijekom hemodijalize?

AIM: The aim of the study was to determine the influence of the heparin bolus, which was administered to a patient due to incapability to aspire heparin from the dysfunctional lumen of dual lumen central venous catheter (CVK), on activated partial thromboplastin time (APTT) values during hemodialysis (HD), as well as to determine the need of additional administration of heparin during HD. PATIENTS AND METHODS: The first group of examinees consisted of 19 patients with chronic renal failure (CRF) on whom the dual lumen CVK was applied as temporary vascular access, whereby the aspiration of heparin from one of its lumens was impossible. Prior to HD, a coagulogram was determined for all the patients. The testing of this group was carried out in accordance with two different protocols: protocol A and protocol B. Under protocol A, 7,500 IU of unfractioned heparin was injected into the patients' circulation from the dysfunctional lumen of CVK. During the four-hour HD process, APTT were determined after ten minutes, after hours 1, 2 and 3, and at the end of HD. During HD, no heparin was administered and every hour during HD there was visual evidence of blood clots in portions of the extracorporeal circuit system. Under protocol B, the APTT values were determined in the same group of patients according to the previous protocol, with the exception of 750 IU of heparin per hour being administered by continuous infusion to the patients during hours 3 and 4. The second group of examinees consisted of patients with CRF who have undergone dialysis via an arteriovenous fistula, while the testing was carried out under protocol C. The examinees in this group received a bolus of 2,500 IU of heparin at the beginning of HD, followed by a continuous administration of 750 IU of heparin per hour during the first three hours of HD (a total of 4,750 IU during the entire HD). During hour 4, HD was carried out without the administration of heparin. The protocol of determining APTT was identical to that carried out on the previous group of patients. RESULTS: APTT values prior to HD: A=34.5 +/- 4.27 sec., B=32.38 +/- 4.16 sec. (p=0.457), C=33.66 +/- 3.63 sec. (p=0.245 in relation to protocol A and p=0.281 in relation to protocol B). APTT values ten minutes after the administration of the heparin bolus: A=210 +/- 21.42 sec., B=204.83 +/- 20.82 sec. (p=0.453), C=47.88 +/- 4.26 sec. (p=0.000 in relation to protocols A and B). APTT values after one hour: A=156 +/- 32.76 sec., B=159.66 +/- 30.39 sec. (p=0.377), C=43.88 +/- 4.5 sec. (p=0.000 in relation to protocols A and B). APTT values after two hours: A=81.54 +/- 0.41 sec., B=74.61 +/- 36.39 sec. (p=0.331), C=40.55 +/- 5.29 sec. (p=0.000 in relation to protocols A and B). APTT values after three hours: A=49.6 +/- 8.38 sec., B=59 +/- 8.93 sec. (p=0.395), C=37.88 +/- 2.58 sec. (p=0.000 in relation to protocols A and B). APTT values at the end of HD: A=40.5 +/- 3.97 sec., B=51.44 +/- 5.07 sec. (p=0.154), C=36.66 +/- 4.22 sec. (p=0.399 in relation to protocol A and p=0.222 in relation to protocol B). Clotting was noticed during the third hour of HD in 11 (57.89%) patients under protocol A, in two (10.5%) patients under protocol B and in three (15.78%) patients under protocol C. After comparing proportions for protocols A and C p=0.02, for protocols B and C p=0.998 and for protocols A and B p=0.006 CONCLUSION: Patients who received the heparin bolus from the dysfunctional lumen of dual lumen CVK needed an additional administration of heparin during hours 3 and 4 of HD in order to reduce the frequency of clotting in the extracorporeal circuit system. The frequency of clotting during HD in this study was not dependent on the total dosage of administered heparin, but rather on the means of its administration.

[Arterial hypertension in patients on long-term haemodialysis]. / Arterijska hipertenzija u bolesnika na kronicnoj hemodijalizi.

Arterial hypertension is one of the most frequent causes of chronic kidney failure but also one of most frequent complications in patients on long-term haemodialysis. The aim of this work is to investigate the prevalence of arterial hypertension in long-term haemodialysis patients, and methods for treating it. A total of 168 patients (86 women and 82 men average age 62.9 +/- 12.9 years) from three dialysis centers were included in this study. Arterial hypertension was defined as blood pressure immediately before hemodialysis > 140/90 mmHg or less if the patient has been on anti-hypertensive therapy. Before the beginning of a long-term hemodialysis program arterial hypertension was registered in 139 (81%) patients. The patients were on haemodialysis 52.5 +/- 45.17 months. All patients were dialyzed three times per week, an average of 11.7 hours per week (9 to 13.5 hours). Body weight of the patients was 68.4 +/- 15.8 kg, and weight gain between dialysis treatments was 2.9 +/- 1.1 kg. Arterial hypertension was recorded in 141 patients (84%), i.e. average blood pressure before haemodialysis in all patients was 157.3 +/- 17.3/85.2 +/- 8 mmHg. The average blood pressure of the remaining patients was 132.6 +/- 8.2/ 78.3 +/- 10.3 mmHg. The patients were treated with a variety of anti-hypertensive drugs. Thirty-seven patients were on monotherapy, while the others were on combined treatment (2-4 antihypertensive drugs). The most frequently used antihypertensive drugs were calcium channel blockers (95 patients, or 67%), ACE inhibitors (47 patients, or 33%), beta-blockers (29 patients, or 20%), angiotensin II receptor blockers and alpha-blockers (25 patients, or 17%), diuretics (11 patients, or seven percent), and nine patients (6%) received central agents or drugs wich acted like an alpha+beta blocker. Prevention and treatment of arterial hypertension is a special problem for haemodialysis patients. Unfortunately, there are still no guidelines for the optimal method of measuring blood pressure in these patients, or optimal values of arterial blood pressure, the first drug of choice or optimal combination of therapies. Perhaps because of this cardiovascular morbidity and mortality among these patients is high.

[Recirculation of urea and dialysis efficiency using dual-lumen dialysis catheters in various locations: may the venous lumen of the catheter be used as the arterial lumen and vice versa?]. / Recirkulacija ureje i ucinkovitost dijalize pri uporabi dvoluminalnih dijaliznih katetera razlicite lokalizacije: smije li se venski krak katetera rabiti kao arterijski i obrnuto?

AIM: To measure percentage of urea recirculation in hemodialysis by a dual-lumen central venous catheters of various localisations (e.g. jugular, subclavian and femoral), and also in cases when the venous lumen of the catheter is used as arterial lumen, and vice versa, and under these conditions to evaluate the efficiency of hemodialysis based on the measurements of urea reduction ratio. METHODS: Percentage of urea recirculation was measured in the patients with acute and chronic renal failure who underwent hemodialysis by a temporary dual-lumen central venous catheter of different localisations (jugular n = 16, subclavian n = 20, femoral n = 20). The measurements were done in cases when arterial line was connected to arterial lumen of the catheter, and venous line to the venous lumen of the catheter (correct connection = RI), and vice versa, i.e., when arterial line was connected to venous lumen of the catheter, and venous line was connected to arterial lumen of the catheter (reversed connection = R2). The efficiency of hemodialysis was evaluated by measuring urea reduction ratio in cases with the reversed (R2) connection. RESULTS: Statistically significant differences were found between R1 and R2 for jugular catheters (R1 = 2.38 +/- 1.09%, R2 = 7.59 +/- 1.42%, n = 16, p = 0), for subclavian catheters (R1 = 3.03 +/- 3.15%, R2 = 15.8 +/- 7.18, n = 20, p = 0), and for femoral catheters (R1 = 9 +/- 6.56%, R2 = 29.2 +/- 11.8%, n = 20, p = 0). Statistically significant differences were also found between R1 of jugular catheters and R1 of subclavian catheters (2.38 +/- 1.09%, n = 16 and 3.03 +/- 3.15%, n = 20, p = 0.0001), further on between R1 of jugular and R1 of femoral catheters (2.38 +/- 1.09%, n = 16 and 9 +/- 6.56%, n = 20, p = 0), as well as between R1 of subclavian and R1 of femoral catheters (2.38 +/- 1.09%, n = 20 and 9 +/- 6.56%, n = 20, p = 0.0001). Also statistically significant differences were found between R2 of jugular and subclavian catheters (7.59 +/- 1.42%, n = 16 and 15.8 +/- 7.18%, n = 20, p = 0.0003), between R2 of jugular and femoral catheters (7.59 +/- 1.42%, n = 16 and 29.2 +/- 11.8%, n = 20, p = 0.0007), and between R2 of subclavian and R2 of femoral catheters (15.8 +/- 7.18%, n = 20 and 29.2 +/- 11.8%, n = 20, p = 0.0029). The measurements of urea reduction ratio that we have done for some of the catheters under R2 conditions showed a statistically significant difference between femoral and subclavian catheters (51.45 +/- 5.62%, n = 20 and 63.75 +/- 7.61, n = 20, p = 0), and between femoral and jugular catheters (51.45 +/- 5.62%, n = 20 and 64.3 +/- 5.23%, n = 16, p = 0). No statistical differences were found in urea reduction ratio between jugular and subclavian catheters (64.3 +/- 5.23, n = 16 and 63.75 +/- 7.61%, n = 20, p = 0.8). CONCLUSION: When hemodialysis is delivered by a correct blood lines connection the measurements have shown a decrease in urea recirculation by 5% for jugular and subclavian catheters, and 5%-10% for femoral catheters. However, in cases when the venous lumen of the catheter is used as an arterial lumen, and vice versa, urea recirculation is below 10% for jugular catheters; whereas in femoral catheters the percentage is higher than 20%. Despite so high percentage of urea recirculation, that we obtained for such use of the catheters, urea reduction ratio in hemodialysis via jugular and subclavian catheters is > 60%, whereas via femoral catheters, the percentage is significantly lower. Consequently, the efficiency of hemodialysis is reduced, and such use of femoral catheters should therefore be avoided.