ABSTRACT
INTRODUCTION: Based on the statistics the population in Bosnia and Herzegovina is getting older. In 2013 the average life span for women was 73.6 years and 68.1 for men. The chronic hemodialysis program is mainly reserved for elderly patients with high mortality risk. The most common cause of hemodialysis mortality relates to cardiovascular diseases (60.2%), regardless of frequent innovations and improvement of hemodialysis procedures. THE AIM OF THE STUDY: was to determine the mortality rate by age groups with comments on the presence of non-traditional predictors (anemia, hypoalbuminemia, CRP, vascular access and PTH) in dialysis patients in the follow-up period of 36 months. METHODS: The study included all patients undergoing chronic hemodialysis treatment at the Clinic of Hemodialysis of the Clinical Center University of Sarajevo (CCUS). RESULTS: Out of a total number of hemodialysis patients (n=232), the specific mortality rate in patients under 65 years of age was 16.8%, and 50.5% in patients over 65 years of age. According to the age groups the mortality rate in elderly patients is as follows: from 65 to 74 years (45.1%), from 75 to 84 years (55.0%), over ≥85 years (75.0%). The most frequent vascular access in patients under and above 65 is arteriovenous fistula (79.6% and 62.1 %), temporary hemodialysis catheter (11.7% and 43.8 %) and long-term hemodialysis catheter (8.8% and 4.2 %). In the age group under 65 years of age the temporary hemodialysis catheter is significantly and more frequently used in diseased patients in respect to survivors (34.8% vs. 7.0%) [χ(2)(2)=15.769, p=0.001]. Diseased patients from the age group over 65 had a significantly lower mean value of haemoglobin in blood (M=100.9±17.5 g/L) in respect to survivors (M=109.2±17.1)[t(93)=2.339; p=0.021], lower mean value of albumin in blood (Me=32.0; IQR=29.0 do 35.0) in respect to survivors (Me=34.0; IQR=32.0 to 38.0) [U=762.5; p=0.006], and higher mean value of CRP in blood (Me=19.3 mg/L; IQR=6.6 to 52.0) in respect to survivors (Me=7.8; IQR=4.0 to 16.7) [U=773.5; p=0.008]. Diseased patients belonging to the age group over 65 had lower mean value of PTH, but without statistical significance (p>0.05). CONCLUSION: older age, temporary vascular access, anaemia and hypoalbuminemia are strong predictors of mortality in hemodialysis patients. Old age does not present contraindication for hemodialysis treatment, and treatment of terminal renal illness should not be abandoned.
ABSTRACT
INTRODUCTION: Chronic renal failure is associated with endocrine abnormalities, which in some cases cause polyendocrinopathy responsible for the symptoms and complications. The consequence of secondary hyperparathyroidism is not only bone disease but may be cardiovascular disorders, peripheral nerve damage and impact on the level of sex hormones. THE AIM: To evaluate the interactions between parathyroid hormone and sexual hormones and the effect of elevated levels of parathyroid hormone secretion on various sexual hormones. The study included 72 patients who were undergoing chronic hemodialysis program 3 times a week at the clinic for hemodialysis. Patients were divided into two groups according to parathyroid hormone values and child-bearing age. The study is a retrospective-prospective and lasted for 1 year. At the beginning, after 6 months, and at the end of the study were determined the PTH, FSH, LH, progesterone, testosterone, beta-estradiol, prolactin. RESULTS: During the study period followed are the values of sexual hormones and PTH in 72 patients of which 41 men and 31 women. Of these 33.3% (24) men were in the reproductive age, and 23.6% (17) were women in the reproductive age. The mean age of patients was 53.2 +/- 12.16, and the average duration of hemodialysis was 7.57 +/- 4.0. PTH showed a slight tendency to increase 274.45 +/- 220.74 pg/dL at baseline, at the end of study 383 +/- 313.2 also increased during the study was recorded and the values progesterone. Statistically significant effect of PTH showed the FSH p < 0.01 LH p < 0.05 and prolactin p < 0.01. On average, patients who have elevated PTH levels have lower values of FSH and LH, but higher prolactin values. Parathormone also shows the effect on beta estradiol at level p < 0.01, patients with higher PTH values have lower levels of beta estradiol. CONCLUSION: The increase in the number of younger people with terminal renal insufficiency treated by repeated hemodialysis, often have endocrine disorders and elevated PTH. Normalization of PTH levels affects the normalization of sexual hormone levels and improves quality of life of patients on hemodialysis.
