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Hemodializuojamų ligonių skaičius pasaulyje kasmet auga, dializuojama vis daugiau vyresnio amžiaus ligonių, turinčių sunkią gretutinę patologiją. Todėl tenka dažniau juos stacionarizuoti, didėja finansinė šių ligonių gydymo našta visuomenei. Daugelis pasaulyje atliekamų hemodializuojamų ligonių stacionarizavimą vertinančių tyrimų apima atskiras būkles, kaip anemijos, kaulų ir mineralų metabolizmo sutrikimų reikšmę, gretutines ligas ir kitus veiksnius. Mes savo tyrime sujungėme dažniausias hemodializuojamiems ligoniams aprašomas komplikacijas, kad įvertintume bendrą suminę jų reikšmę stacionarizavimui. Tai pirmasis tyrimas, nagrinėjantis Lietuvos hemodializuojamų ligonių stacionarizavimo priežastis ir sąlygojančius veiksnius. Taip pat pirmą kartą nustatytos Lietuvos hemodializuojamų ligonių gydymo išlaidos. Perspektyvusis tyrimas atliktas Kauno Medicinos universiteto Nefrologijos klinikoje. Į tyrimą įtraukti visi galutinės stadijos inkstų nepakankamumu sergantys ligoniai, kurie buvo hemodializuoti visuose Kauno krašto hemodializės centruose 5 metų laikotarpiu (2002-2006 metais). Nustatėme, kad hospitalizavimui svarbūs tiek demografiniai veiksniai, tiek gretutinės ligos, tiek kai kurių laboratorinių rodiklių pokyčiai, tiek ir režimo pažeidimai. Increasing numbers of hemodialysis patients is influenced by growing life expectancy. increasing burden of diabetes and hypertension. Dialysis population becomes older with heavy comorbidities and high risk for hospitalization. Treatment of those patients is a big financial burden for society. So it is necessary to evaluate the predisposing factors for hospitalization and to assess possibilities of ambulatory treatment optimization and reduction of hospitalization rates in hemodialysis patients. Most of the studies in hemodialysis patients investigate hospitalization risk according to separate conditions, like influence of anemia, bone-mineral metabolism, comorbidities and other factors. In our study we tested together most common complications of end stage renal disease in order to evaluate a combined value of various different factors on hospitalization risk and to discriminate the most important ones. This is the first study which examined hospitalizations rates and factors related to hospitalization in Lithuanian hemodialysis population. Also for the first time treatment expenditures of Lithuanian hemodialysis patients were estimated. Prospective study was performed in the Nephrology department of Kaunas University of Medicine. We enrolled all end stage renal disease patients dialysed in the years 2002-2006 in all centers in Kaunas region. In order to reduce hospitalization risk, a contribution of the doctor and the patient is needed as both treatment failure and... [to full text]

Increasing numbers of hemodialysis patients is influenced by growing life expectancy. increasing burden of diabetes and hypertension. Dialysis population becomes older with heavy comorbidities and high risk for hospitalization. Treatment of those patients is a big financial burden for society. So it is necessary to evaluate the predisposing factors for hospitalization and to assess possibilities of ambulatory treatment optimization and reduction of hospitalization rates in hemodialysis patients. Most of the studies in hemodialysis patients investigate hospitalization risk according to separate conditions, like influence of anemia, bone-mineral metabolism, comorbidities and other factors. In our study we tested together most common complications of end stage renal disease in order to evaluate a combined value of various different factors on hospitalization risk and to discriminate the most important ones. This is the first study which examined hospitalizations rates and factors related to hospitalization in Lithuanian hemodialysis population. Also for the first time treatment expenditures of Lithuanian hemodialysis patients were estimated. Prospective study was performed in the Nephrology department of Kaunas University of Medicine. We enrolled all end stage renal disease patients dialysed in the years 2002-2006 in all centers in Kaunas region. In order to reduce hospitalization risk, a contribution of the doctor and the patient is needed as both treatment failure and non-adherence to the treatment increase the hospitalization risk.

Infekcija yra svarbi hemodializuojamų ligonių sergamumo ir mirtingumo priežastis. Dėl infekcijos ligoniai dažnai hospitalizuojami. Tyrimo tikslas. Įvertinti hemodializuojamų ligonių hospitalizavimo dažnį ir rizikos veiksnius hospitalizuoti dėl infekcijos, remiantis Kauno apskrities hemodializuojamų ligonių duomenimis. Išanalizuotos ambulatorinės kortelės visų 533 negrįžtamosios stadijos inkstų nepakankamumu sergančių ligonių, kurie buvo hemodializuoti Kauno apskrities hemodializės centruose trejų metų laikotarpiu (2001–2004). Duomenys apie ligonio būklę ir laboratorinius tyrimus rinkti 2001, 2002 ir 2003 metų lapkričio mėnesį. Toliau pacientai prospektyviai stebėti 12 mėnesių ir rinkti duomenys apie jų hospitalizavimą dėl infekcijos. Kiekvienais metais tiriami ligoniai vertinti kaip nauji ir atlikta suminė duomenų analizė. Statistinė duomenų analizė atlikta kompiuteriu naudojant statistinius duomenų paketus „SPSS“ ir „STATISTICA“. Atliekant vienfaktorinę statistinę duo¬menų analizę, lygintos ligonių, hospitalizuotų dėl infekcijos, ir nehospitalizuotų ligonių grupės. Reliatyvi hospitalizavimo dėl infekcijos rizika nustatyta taikant daugiafaktorinę Cox regresinę analizę, įvertintas laikas iki pirmojo hospitalizavimo dėl infekcijos. Hospitalizavimo dėl infekcijos dažnis buvo 0,2 hospitalizavimo ligoniui per metus ir sudarė 18 proc. visų hospitalizavimų. Vieno hospitalizavimo trukmės mediana – 11 dienų. Vienfaktorinėje analizėje hospitalizavimas dėl infekcijos buvo susijęs su... [toliau žr. visą tekstą] Infection is an important cause of morbidity and mortality in hemodialysis patients. These patients are frequently hospitalized for infections. The objective of our study was to evaluate hospitalization rate for infections and to determine risk factors for infection-related hospitalizations of hemodialysis patients in Kaunas region, Lithuania. Ambulatory case records of 533 patients with end-stage renal disease, dialyzed in all hemodialysis centers in Kaunas region during the period of 2001–2004, were analyzed. Data on patient’s condition and routine laboratory tests were collected in November of 2001, 2002, and 2003. These patients then were followed up for the next 12 months in order to evaluate infection-related hospitalization rate. All patients were considered new patients every year, and general analysis of three-year data was performed. Statistical analyses were carried out using SPSS (Statistical Package for Social Sciences) and STATISTICA. Univariate statistical analysis was performed comparing the groups of patients that were hospitalized because of infections and were not hospitalized. Relative risk of infection-related hospitalization was estimated using Cox regression evaluating the time to first infection-related hospitalization. The unadjusted infection-related hospitalization rate was 0.2 per patient a year (18% of all hospitalizations). The median length of hospital stay for infections was 11 days. Univariate statistical analysis showed a statistically... [to full text]

Sparčiai augant hemodializuojamų ligonių skaičiui, didėja ir išlaidos, skirtos šiems ligoniams gydyti. Darbo tikslas. Surinkti ir išanalizuoti duomenis apie 2005 metais Kauno medicinos universiteto klinikose hemodializuojamų ligonių gydymui ligonių kasų skirtas vidutines metines išlaidas ir ligonio priemoką medikamentams bei palyginti su 2001 metais atlikto analogiško tyrimo duomenimis. Išanalizuotos ambulatorinės kortelės visų 106 negrįžtamosios stadijos inkstų nepakankamumu sergančių ligonių, kurie buvo ambulatoriškai hemodializuoti Kauno medicinos universiteto klinikose vienerius metus: nuo 2004 metų lapkričio 1 dienos iki 2005 metų spalio 31 dienos. Surinkti duomenys apie hemodializių skaičių, hospitalizavimų skaičių, vartojamus medikamentus. Ligoniai vidutiniškai hemodializuoti 2,8±0,4 karto per savaitę. Išlaidos hemodializės procedūroms – 38094,12±5003,17 litų/ligoniui/metams (11041 eurų) ir tai sudarė 63 proc. visos hemodializuojamų ligonių gydymui skirtos sumos. Ligoniai buvo hospitalizuoti 1,4±1,8 karto/ligoniui/metams, hospitalizavimo kaina – 1538,4±1941 litai/metams (446 eurų) sudarė 3 proc. visos hemodializuojamų ligonių gydymui skirtos sumos. Ligoniams vidutiniškai skirta 7,7±2,17 medikamentų, iš jų 2,12±1,6 antihipertenzinių. Ligonių kasų kompensuojamų medikamentų suma vidutiniškai buvo 20639,82±15439,3 lito/ligoniui/metams (5983 eurų). 92 proc. šios sumos sudarė išlaidos eritropoetinui ir intraveniniam geležies preparatui. Apskaičiuotos vidutinės vieno... [toliau žr. visą tekstą] With increasing number of hemodialysis patients, expenditures for the treatment of hemodialysis patients are rising every year. The objective of our study was to collect and analyze the data on estimated average treatment expenditures, which were covered by State Patients’ Fund, for patients undergoing hemodialysis in Kaunas University of Medicine Hospital in 2005 and the costs of medications paid by patient and to compare with the analogical data of the year 2001. We analyzed ambulatory case records of all 106 patients with end-stage renal disease who were hemodialyzed in Kaunas University of Medicine Hospital from November 1, 2004, to October 31, 2005. Data on medications used and number of hemodialysis procedures and hospitalizations were collected. On average, 2.8±0.4 hemodialysis procedures per patient a week were carried out. Expenditures for hemodialysis procedures were 38 094.12±5003.17 litas (11 041 euros) per patient per year, and this accounted for 63% of all expenditures for hemodialysis patient. Hospitalization rate was 1.4±1.8 per patient a year; expenditures for hospitalizations were 1538.4±1941 litas (446 euros) per patient a year (3% of all expenditures for hemodialysis patients). The mean number of drugs prescribed per patient monthly was 7.7±2.17 including 2.12±1.6 antihypertensive medications. The total costs of drugs reimbursed by State Patients’ Fund were 20 639.82±15 439.3 litas (5983 euros) per patient per year, of which 92% was spent on... [to full text]

Darbo tikslas – įvertinti mažakraujystės įtaką Kauno krašto hemodializuojamų ligonių hospitalizavimui ir mirštamumui. Išanalizuotos ambulatorinės kortelės visų 148 ligonių, kurie 2001 metų lapkričio mėnesį buvo ambulatoriškai hemodializuoti Kauno apskrities hemodializės centruose. Tyrimas atliktas dviem etapais: per pirmąjį etapą surinkti duomenys apie ligonių amžių, lytį, inkstų nepakankamumą sukėlusią priežastį, hemoglobino kiekį 2001 metų lapkričio mėnesį; per antrąjį etapą šie ligoniai prospektyviai stebėti 12 mėnesių, rinkti duomenys apie jų mirštamumą, hospitalizavimo dažnį ir jo trukmę, hospitalizavimo priežastis. Tyrimo pradžioje vidutinis hemoglobinas (Hb) – 101,2±13,8 g/l. Daugiau kaip pusės (59 proc.) hemodializuojamų ligonių hemoglobinas – 100 g/l ir didesnis. Tolesnis ligonių tyrimas 2002 metais parodė statistiškai reikšmingą Hb skirtumą tarp mirusiųjų ir toliau dializuojamų ligonių: mirusiųjų ligonių vidutinis Hb buvo 92,4±18,6 g/l, o ligonių, ku¬riems pakaitinė inkstų terapija tęsiama – 102,81±12,48 g/l, p=0,02. Hb sumažėjimas 1 g/l didina mirštamumo riziką 5 proc. (p=0,027). Ligonių palyginimas pagal hospitalizavimų skaičių per 2002 m. parodė, kad ligoninėje negulėjusių ligonių Hb buvo 104,2±11,1 g/l, hospitalizuotų ligonių Hb – 99±15,1 g/l, be to, šis skirtumas buvo statistiškai reikšmingas (p=0,02). Hb sumažėjimas 1 g/l didina hospitalizavimo riziką 5 proc. (p=0,027). Palyginus ligonius pagal Hb kiekį (Hb mažesnis ir didesnis nei 100 g/l), nustatytas... [toliau žr. visą tekstą] The objective of our study was to evaluate the influence of anemia on hospitalization and mortality in hemodialysis patients of Kaunas region. We analyzed ambulatory case records of 148 patients dialyzed in all 7 hemodialysis centers of Kaunas region in November 2001. The study consisted of two parts: in the first part data on patient age, gender, primary cause of end-stage renal disease, hemoglobin concentration were collected in November 2001 and in the second part these patients were followed up for 12 months in order to evaluate rate and length of hospitalization, reasons for hospitalization and mortality. At the beginning of the study mean hemoglobin (Hb) value was 101.2±13.8 g/l and more than a half of the patients (59%) had hemoglobin value higher than 100 g/l. Further follow-up of the patients during the year 2002 revealed that hemoglobin level of the patients who died was lower from the patients who followed hemodialysis. Mean hemoglobin of dead and alive patients was 92.4±18.6 g/l and 102.81±12.48 g/l, respectively (p=0.02). Lower hemoglobin concentrations were associated with a 5% higher relative risk of mortality for every 1 g/l decrease in hemoglobin (p=0.027). Analysis showed that mean hemoglobin value was 104.2±11.1 g/l for the patients who were not hospitalized and 99±15.1 g/l for the patients who were hospitalized during the year 2002 (p=0.02). Lower hemoglobin concentrations were associated with a 5% higher relative risk for hospitalization for every... [to full text]

Išanalizuotos ambulatorinės kortelės visų ligonių (n=186), kurie ambulatoriškai buvo hemodializuoti septyniuose Kauno krašto hemodializės centruose 2002 metais. Atskirai nagrinėti 42 ligoniai, sergantys cukriniu diabetu, ir jų tyrimų duomenys palyginti su nesergančių cukriniu diabetu. Hemodializuojamų ligonių, sergančių ir cukriniu diabetu, mirė daugiau negu nesergančių cukriniu diabetu (atitinkamai – 22,5 ir 7,3 proc.; p

Research goal: Evaluate body structure and nutrition indicators of hemodialysis patients in 2016 and compare it with data collected in 2015. Tasks: 1) Compare hemodialysis patients body structure in 2015 and 2016. 2) Evaluate laboratory nutrition indicators changes of dialysis patients in 2015 and 2016. 3) Evaluate phase angle connection with bioimpedance indicators and laboratory nutrition markers. 4) Evaluate 2015 and 2016 hemodialysis patients match by Protein Energy Waste syndrome categories based on BIA and laboratory nutrition indicators. Methodology: Retrospective instant research method (sept, 2016) was being used to evaluate patients nutrition and body structure indicators. Body structure is evaluated by BIA and nutrition indicators by routine laboratory research. Collected data compared with the research results from September, 2015 of the same patients. SPSS 23.0 statistics program and Microsoft Excel (2007) both were used to accomplish this study. Percent, frequencies, averages, standard deviation and statistic reliability were calculated in this study. Differences considered reliable if margin of error was less than 0.05. Research participants: 18 years old patients with ESCKD and under dialysis for around 3 months. Rejection criteria: amputated limb, pacemaker, large metal implants (joint prosthetics) or when BIA is impossible. Conclusions: 1) In a period of one year (2015-2016) the body fat mass had increased in 9,3% of patients. The Phase angle average had increased in 72,09% of patients. None of our patients had been decreased the skeletal muscle mass during the period of one year. 2) There were no reliable differences between laboratory parameters in patients during one year period. 3) Phase angle average at lower values showed body cell mass, non-fat body mass and albumin rank averages being lower as well. 4) None of the patients had all Protein energy wasting syndrome criterias.

Kristina Dimšaitė. Relation between hydration status, survival and blood pressure control in patients undergoing maintenance hemodialysis. Objective: to estimate hydration status and blood pressure control level of patients undergoing maintenance dialysis, identify relation between overhydration, arterial hypertension and one year survival. Material and methods: Observational study enrolled 65 patients with end stage renal disease undergoing maintenance hemodialysis (HD). In 2014, September we collected data about blood pressure, echocardiogram, laboratory tests, hydration status, which was measured by bioimpedance electrical analysis method by extracellular and total body water ratio. Normohydration was defined as ratio of 0,39. Patients were followed up for one year. Data analyses were performed using Statistical Package for Social Sciences (SPSS), Version 21.0. The Student t test was used to compare the means of the continuous variables. Fisher test was used to compare the means of qualitative values, significance level p

Patients to be treated with chronic hemodialysis (HD) must have blood vessel connection. There are three types of blood vessel connections: native arteriovenous fistula (AVF), synthetic prosthesis and permanent central venous catheter. Each connection has its strengths and weaknesses. Primary AVF dysfunction occurs in 7.5% of the whole population of patients receiving HD, and in up to 80% of high risk patients (those with diabetes, elderly patients, and women) [Mann et al 2005]. Compared to other blood vessel connections (permanent central venous catheter or synthetic prosthesis) function of properly formed AVF is the longest, and incurs the lowest incidence of infectious and thrombotic complications. All international guidelines on HD procedures recommend native AVF as the method of choice. Formation of blood vessel junctions and treatment of their complications account for up to 20% of all hospitalizations of patients with end stage renal failure in USA [Allon et al 2002], up to 30% in Canada [Mann et al 2005], and up to 25% in Europe [Pissoni et al 2002]. It should be stated that formation of AVF and treatment of their complications are very expensive, and therefore determining the causes of the development of AVF complications and their timely diagnosis and correction are extremely important. Various methods of monitoring of AVF function are used in many European and USA HD centers; however, the most important criterion of early diagnosis of AVF complications has not been established yet [Paulson et al 2012]. Although large scale studies, such as DOPPS, as well as smallerscale (one country or one centre) studies that are in place in the USA and European countries look into peculiarities of AVF formation, incidence of complications and methods of their correction, no studies of AVF problems have been carried out in Lithuania. Aim and objectives Aim of the study: to determine factors related to the duration of AVF function and to evaluate benefit of monitoring AVF function in order to increase of longevity of AVF functioning. Objectives: 1. To evaluate benefits of AVF function monitoring for the increase of longevity of AVF function. 2. To determine relation between the method of the first HD procedure and duration of patient’s hospitalization. 3. To determine factors related with the duration of AVF function. 4. To determine significance of presence and site of central venous catheter to the duration of AVF function. 5. To evaluate relation between AVF maturation and duration of AVF function. 6. To evaluate significance of preoperative blood vessel ultrasound examination to the development of primary dysfunctions of fistula and duration of AVF function. Scientific novelty of the study Many nephrologists globally examine issues of AVF formation, function, and complications. However, studies examine mostly only one of above mentioned issues. In our study we analyzed problems starting from formation of AVF and the first HD procedure to AVF thrombosis and formation of new AVF. This is the first study in Lithuania examining problems of AVF formation, function and complications development. For the first time in Lithuania AVF function monitoring and preventive fistula stenosis treatment using percutaneous transluminal angioplasty (PTA) were implemented. MATERIAL AND METHODS Study was carried out in the Clinic of Nephrology of the Lithuanian University of Health Sciences; permission No. BE-2-20 of the Kaunas Region Ethical Committee was obtained. All patients with end stage renal disease treated with HD procedures in the Department of Detoxication of the Clinic of Nephrology of Kaunas Medical University from January 1, 2000 to December 31, 2010 were involved in to this study. Only patients over 18 years old were involved. Part of data has been collected retrospectively from medical documentation: personal health history (Form No. 025/a), hospital records (Form No. 003/a), and outpatients HD protocols. Other information concerning patients’ laboratory tests data and HD procedures parameters was collected during the whole study. The CRF were filled by data available for particular variable: Initial HD treatment of patient with end stage renal failure CRF. Patient's demographic data (gender, age, underlying disease causing endstage renal failure, concomitant diseases), method of the initial HD (scheduled beginning of HD through AVF or urgent procedure through central vein catheter), data concerning hospitalization for the beginning of HD procedures were collected using this CRF. Patient’s hospitalization due to AVF thrombosis CRF. Data collected using this CRF: duration of hospitallization, time to AVF formation, site of central vein catheter and its complications, site of AVF, its maturation time and data collected during blood vessels preoperative ultrasound examination. Arteriovenous fistula monitoring CRF. This CRF was filled in only for monitored patients. Patient’s laboratory blood tests data, HD efficacy marker, HD procedure parameters, and AVF fistula examination data were collected using this questionnaire. Principles of monitoring of arteriovenous fistula Parameters of every HD procedure were recorded in HD procedure protocols (they are filled in by HD center staff during HD procedures). Since January 1, 2009 arterial and venous blood flow resistance was recorded in these protocols; this parameter has been measured 15 minutes after the beginning of HD procedure when volume of blood passing through HD apparatus was 200 ml/min. Parameters of the procedure performed during the last week of the month were recorded in the questionnaire. Nurse working in the HD center performed clinical examination of AVF and in case of changes informed investigator on the same day. Indications for fistula ultrasound examination At least one of the following: 1. Kt/V decrease 0.4–0.5 when there are no other objective reasons for decrease. 2. 20–30% decrease of volume of blood flowing through HD apparatus during procedure when there are no other objective reasons for decrease. 3. >50% increase of arterial and venous blood flow resistance during one month when there are no other objective reasons for increase. 4. All abnormal findings during clinical examination of fistula. During our study all ultrasound examinations were performed by one investigator, radiologist, who had several years experience of AVF examination, the same ultrasound machine was used for ultrasound examinations. Indications for percutaneous transluminal angioplasty of the fistula At least one of the following: 1. Diameter of AVF anastomosis < 2.0 mm; 2. Peripheral stenosis of venous part of AVF with or without partial thrombosis; 3. Partial AVF thrombosis; 4. Volume of blood flowing through brachial artery 25% decrease of blood flow through brachial artery through time. PTA procedures were performed within one week from the establishing of indications for this procedure. All procedures were performed by one physician, invasive radiologist, who had several years experience in the treatment of AVF complications. Statistical data analysis Statistical analysis of study data has been performed using IBM SPSS statistical software package 19.0 version. To test a hypothesis that quantitative values of population are distributed according to Gauss distribution we used modified Kolmogorov-Smirnov test with Lillefors correction. To describe normally distributed (Gauss distribution) quantitative values we used main characteristic of position, mean with standard error (±SE), and standard deviation (s) characterizing dispersion of data. To describe normally distributed rank and qualitative values we calculated median value. Nominal values were described using relative frequencies. To compare means of several normally distributed (Gauss distribution) quantitative values we used parametric criteria (t-test, ANOVA), and in order to test if attributes of not normally distributed rank and qualitative values are uniform we use nonparametric criteria (Mann-Whittney, Cruscal-Wollis rank criteria). Confidence level was P=0.95, and significance level was α=p=0.05. To evaluate statistically significant dependence of two quantitative values and their homogeneity of distribution within comparison group we used χ2 test for independence (homogeneity). Strength of dependence of two quantitative values within the sample was evaluated by calculating Pearson contingency coefficient. Probability of qualitative value within two analyzed groups was compared using criteria of parity of probabilities (Z-test). Time period from the formation of AVF to its thrombosis or development of critical stenosis when it was necessary to form a new fistula we called AVF survival. In order to present diagram of AVF survival we used Kaplan-Meier method. Log-rank criterion (log-rank test) was used to compare these functions. Influence of single attributes (factors influencing AVF survival) on the fistula life time was evaluated during analysis of AVF survival. Model of proportional risks (Cox model) was used for this purpose. CONCLUSIONS 1. Monitoring of AVF function statistically significantly improved one year survival of fistulas. Thrombosis risk was 0.245 times lower in monitoring group fistulas compared to historical group; thrombosis risk in partially monitored group was 0.132 times lower compared with historical group. 2. Duration of hospital stay for patients who underwent urgent HD treatment through central venous catheter was statistically significantly longer (average duration of hospital stay was 33.15±1.55 days) compared to patients who underwent HD through matured AVF (average duration of hospital stay was 15.12±1.15 days) (p