Ultrafiltration volume is associated with changes in blood pressure in chronically hemodialyzed patients.

INTRODUCTION: Volume overload is a main factor in development of hypertension in hemodialysis patients. In order to demonstrate impact of ultrafiltration volume on blood pressure during 15-months period in a group of patients undergoing chronic hemodialysis therapy, we conducted this study. We hypothesized that ultrafiltration volume different affects the pre/postdialysis systolic pressure, diastolic pressure, mean arterial pressure (MAP), and pulse pressure (PP) values. SUBJECTS AND METHODS: Study subjects were 23 anuric chronically hemodialyzed patients. The overall study time was 15 months, and 136 single hemodialysis treatments were analyzed. RESULTS: Ultrafiltration was negatively correlated with predialysis systolic blood pressure (r = -0.169, p = 0.025), postdialysis systolic blood pressure (r = -0.292, p < 0.001), postdialysis MAP (r = -0.186, p = 0.015), predialysis PP (r = -0.290, p < 0.001), and postdialysis PP (r = -0.370, p < 0.001). Ultrafiltration/dry body mass (UF/W) ratio was negatively correlated with predialysis PP (r = -0.222, p = 0.005), postdialysis PP (r = -0.340, p < 0.001), and postdialysis systolic blood pressure (r = -0.243, p = 0.002). We found significant difference in postdialysis PP between dialyses with UF/W ratio < or = 0.05 an dialyses with UF/W ratio > 0.05 (63.49 +/- 20.76 vs. 56.27 +/- 16.33 mmHg, p = 0.033). CONCLUSION: The ultrafiltration volume strongly affects postdialysis PP values. Evaluation of elevated blood pressure treatment in patients undergoing chronic hemodialysis therapy must be considered in respect of postdialysis PP values, not just depending on pre/postdialysis systolic and diastolic pressur or MAP values.

[Perinatal care in Livno immediately after the war from 1995 to 1999]. / Perinatalna skrb u Livnu u neposrednom poracu 1995.-1999. godine.

The paragraphs of statistics for maternity hospital of county hospital in Livno for period 1995-1999, year are presented and describe perinatal, fetal and early neonatal mortality, newborns to birth-weight, the frequency of caesarean section, eclampsia, vacuum extraction, antenatal care and equipment maternity hospital and morbidity of the infants. Perinatal mortality in 1995 was 5.6@1000, but for 4 years 6.9@1000. Early neonatal mortality was appearing till 1996 year only with one death of newborn (1.1@1000). Fetal mortality was increased to 12.3@1000 in 1997; but the years before was 6.2@1000. According to the weight of newborns, 3.5% were no more than 2.500 g, but 93.5% were between 2.500-3.000 g, while newborns over 4.000 g where 3.0 percent. Watching and closely looking statistics for years in the classified groups does not fortify the major differences, except 1995 when was 1.7% newborns less than 2.500 g, but over 4.000 g 7.9%, that is under average and explaining to the minimum numbers of birth that year, and orienting refugees and exilied pregnant women to the centres with stronger obstetric and neonatal care Eclampsy were 9 and it was 2.2@1000. The number of antenatal visits of pregnant women increase during all these years, so that total number of visits was 20.905, that means 5.2 was the middle number of visits. There are much more without 2.0% or less than 3 visits 5.0%; with 9 or more 29.0%; the average number ultrasound examination is 3.4, and total 13.748, 37.0 percent of pregnant women is with 3 examples and 10.0% with 4 or over it, but 7.0% without ultrasonographc. It is obviously, that the number of the pregnant women without ultrasound examination is falling, so in 1995 there was 14.0% but 2.0% in 1999. Very important is increase those with 3 examination according to 1995 when there was 27.0%, but 47.0% in 1999. The usage of caesarean section is 7.7% but the major increase was in 1998 and it was 9.4% and 1999 is 10.1%. Vacuum extraction was used in 67 (1.7%) of newborns but in 1995 was 3.2%, the obstetric activity does three gynecologists. For perinatal mortality is important to say, that, during the war time, about 6.9@1000 in maternity hospital Livno was ranged into the group with low perinatal mortality. According to, the number of vacuum extraction belongs to the number of maternity hospital with vacuum extractions below 2.0%. Maternity hospital has two incubator after 1997 year and cardiotocographic intrapartal monitoring was used in about 55-65% of all deliveries.