ABSTRACT
Background: In conditions that may change red blood cell survival, such as hemodialysis, the accuracy of A1c glycosylated hemoglobin (HbA1c) to assess metabolic control can be hampered. Other glycosylated proteins such as fructosamine, could accomplish the role of HbA1c. Aim: To assess if HbA1c is a good metabolic control parameter in diabetic patients on chronic hemodialysis. To compare fructosamine, HbA1c and serial capillary glucose levels in the same patients. Material and Methods: Patients on hemodialysis three times per week were studied. Twenty one subjects with diabetes mellitus and 10 non-diabetic patients were included (70 percent were male). During a period of 14 days, fasting and post prandial capillary glucose levels were measured. Venous glucose, HbA1c and fructosamine were measured at the onset and completion of the monitoring period. Results: Diabetic patients were older than their non-diabetic counterparts (65 and 47 years respectively, p < 0.04). In diabetic and non-diabetic patients respectively, capillary blood glucose levels were 161 +/- 22 and 104 +/- 51 mg/dl, HbA1c levels were 6.8 +/- 1.2 and 5.4 +/- 0.4 percent and fructosamine levels were 282.0 +/- 126.6 and 154.6 +/- 73 umol/L. In all patients there was a positive correlation between blood glucose, HbA1c (r = 0.78 p < 0.01) and fructosamine (r = 0.52, p 0.02). There was a positive correlation between mean capillary glucose, HbA1c (r = 0.77, p < 0.01) and fructosamine (r = 0.69, p < 0.02). Among diabetic patients, the correlation coefficients between mean capillary glucose levels, HbA1c and fructosamine levels were 0.67 (p < 0.01) and 0.51 (NS), respectively. Conclusions: Among diabetic patients on hemodialysis fructosamine levels are not a better indicator of metabolic control than HbA1c.
Subject(s)
Humans , Male , Female , Middle Aged , Diabetes Mellitus/blood , Fructosamine/analysis , Glycated Hemoglobin/analysis , Renal Dialysis , Blood Glucose , Body Mass Index , Diabetes Mellitus/diagnosis , Kidney Failure, Chronic/blood , Prospective StudiesABSTRACT
Background: Hypotension occurs in 20 percent of hemodialysis procedures. Aim: To study the effects of midodrine on hypotension during hemodialysis. Patients and methods: Ten patients on chronic hemodialysis and with a history of hypotension during the procedure, were studied. They received midodrine 10 mg per os or placebo during 5 dialytic procedures each, in a double blind cross over design. Results: Blood pressure levels prior to dialysis were similar during the midodrine or placebo administration periods. During dialysis, systolic blood pressure fell 19.3ñ28 mmHg with midodrine and 23.4ñ28 mmHg with placebo. Diastolic blood pressure fell 7.3ñ11.5 mmHg with midodrine and 11.1ñ12 mmHg with placebo. The reduction in median arterial pressure was also less pronounced with midodrine. Conclusions: Midodrine lessens the fall in arterial pressure during hemodialysis, in patients with symptomatic hypotension
Subject(s)
Humans , Male , Female , Midodrine , Hypotension/drug therapy , Renal Insufficiency, Chronic/complicationsABSTRACT
The aim of this work was to assess the quality of life of 87 patients older than 60 years, out of 200 undergoing chronic hemodialysis in 9 centers at Santiago. A visual analog scale, with scores ranging from 0 (bad) to 100 (optimal) and a specific questionnaire about the impact of hemodialysis in daily activities, with scores ranging from 1 -10 (severe limitation) to +10 (no limitation) were applied to patients and their attending nurses. Using the visual analog scale, patients assesed their quality of life in 51.7 per cent and health personnel in 61.3 per cent . Patients had a questionnaire score of 2.3. Quality of life scores were inversely correlated with the condition of being diabetic and the number of hospital admissions