Quality of life among diabetic and non-diabetic patients on maintenance haemodialysis.

AIMS: To compare the quality of life of end stage renal disease (ESRD) diabetic and non-diabetic patients undergoing chronic haemodialysis. METHODS: A case-control study of 54 diabetic and 60 non-diabetic patients undergoing maintenance haemodialysis. All subjects completed the Kidney Disease Quality of Life Short Form (KDQOL-SF) version 1.3 questionnaire as well as the SF-36 Health Survey (SF-36). RESULTS: When compared to the control non-diabetic group, physical health was significantly impaired in diabetic dialysis patients (P<0.005) and staff encouragement was significantly worse (P<0.05). In both groups, all other compounds of the SF-46 and variables related to kidney disease were similar. CONCLUSIONS: To improve diabetic haemodialysis patients' quality of life, physical activity should be incorporated to the routine dialysis care and health care professionals should support them more intensively.

[Evaluation of the relationship between the occurrence of headache, use of analgesics and realizing a therapeutic effect among patients with hypertension]. / Ocena zaleznosci pomiedzy wystepowaniem bólów glowy i stosowaniem leków przeciwbólowych a realizacja zalecen terapeutycznych wsród chorych na nadcisnienie tetnicze.

The aim of the study was to assess the prevalence of headaches and analgesic use in hypertensive patients and to evaluate the relationship between taking analgesic drugs and adherence to antihypertensive therapy. 754 consecutive hypertensive patients (446 women and 308 men, aged 18-89 years, median age--58 years) from 7 out-patient centres participated in the study. Anonymous questionnaires consisted of 13 simple questions concerning demographic parameters (age, gender), clinical data (the duration of hypertension and antihypertensive therapy), the history of headache and use of analgesics were distributed among the participants. Among the hypertensives participating in the study, 82.9% (625) reported headaches. Analgesics were used by 65.3% (408) of hypertensive patients with headaches. There was significant, positive linear correlation between the history of headaches and the duration of analgesic use in hypertensive patients. The rate of non-compliance was significantly higher among patients with headaches who reported regular use of analgesics when compared to non-users of analgesics. There were statistically more non-compliants among patients taking more than 1 type of analgesics than in hypertensives reporting use of only 1 analgesic drug. The prevalence of headaches and the rate of analgesic use is considerably significant among hypertensive patients. Analgesic consumption seems to be a risk factor for non-adherence to antihypertensive medication.

[The evaluation of hypertensive patients' adherence to the pharmacological treatment of hypertension]. / Ocena realizacji zalecen terapeutycznych przez chorych na nadcisnienie tetnicze.

Evaluation of patients' compliance is very important considering possible influence on the effectiveness of antihypertensive treatment. The adherence to the rules of pharmacological therapy was assessed by anonymous questionnaires. 414 patients with hypertension participated in the study. Non-compliance is one of the commonest therapeutic problems. Forgetting is the most frequent reason of irregular administration of medicine.

[The effect of hemodialysis with frequent use of cuprophan and polysulfone membranes on activation of complement in patients with chronic renal failure]. / Wplyw hemodializy z wielokrotnym uzyciem blony kuprofanowej i polisulfonowej na aktywacje ukladu dopelniacza u chorych na przewlekla niewydolnosc nerek.

UNLABELLED: During haemodialysis in patients with chronic renal failure plasma proteins have contact with dialysis membranes. Complement activation is one of effects of this contact. Intensity of this activation depends on structure of material that the membrane is made of, and it is a determinant of hemocompatibility of dialysis membrane. Our studies were designed to evaluate complement activation during haemodialysis in patients with chronic renal failure and therefore measurements of concentration of C3c factor in serum of hemodialyzed patients were performed. Furthermore, changes in concentration of C3c factor in serum during first and second use of cuprophan and polysulfone dialysis membrane were compared. An artificial kidney Fresenius 4008E, polysulfone dialyzers F5, cuprophan dialyzers C121 and acetate dialysing solution were used in the study. For the purpose of our study we have selected 10 patients hemodialyzed three times a week for 4 hours (5 of them suffered from diabetic nephropathy and the rest of our patients had chronic pyelonephritis) and 10 healthy subjects. Serum concentration of C3c was measured before haemodialysis, in 15', 60' and 240' minute of haemodialysis; measurement were performed on first and second use (after reutilization) of polysulfone and cuprophan membranes, respectively. C3c concentration in blood samples was measured with special reagent kits (turbidometric method). Statistically significant increase of serum C3c level was observed in studied group of patients in 15th minute of first use of cuprophan dialysing membrane. When values of C3c concentration in patients' serum during 60' and 15' of haemodialysis on first use of cuprophan membrane were compared, it was shown that there was a statistically significant decrease of serum C3c level in 60th minute of haemodialysis. RESULTS: 1. Haemodialysis in patients with chronic renal failure is associated with complement activation via the alternative pathway. 2. Maximal activation of complement pathway takes place in 15th minute of the first haemodialysis with use of cuprophan membrane. 3. Usage of the polysulfone dialyzer has no influence on concentration of C3c factor in serum during haemodialysis 4. Polysulfone membranes are characterized with higher haemocompatibility than cuprophan membranes.

[Effect of hemodialysis on the pituitary adrenocortical axis in patients with diabetic nephropathy]. / Wplyw hemodializy na czynnosc osi przysadkowo-nadnerczowej u chorych z nefropatia cukrzycowa.

Pituitary-adrenocortical axis is disturbed in patients with chronic renal failure. Such abnormalities have been described in diabetic patients, too. The studies were performed to answer the following questions: 1) Is there a difference in basal ACTH and cortisol plasma level between patients with diabetic nephropathy and normal subjects? 2) Does haemodialysis affect ACTH and cortisol plasma level in patients with diabetic nephropathy? 18 patients with diabetic nephropathy and 10 normal controls were the subjects of this study. Blood samples for ACTH and cortisol determination were collected from each patient with diabetic nephropathy four times: before haemodialysis from the arterial line of dialyzer (0a) after 60 minutes of haemodialysis from the arterial (60a) and the venous (60v) line of dialyzer and after 240 minutes of haemodialysis from the arterial line (240a). Blood samples from normal controls were collected at 6 a.m. to determine ACTH and cortisol level. All the diabetic patients were on chronic 4-hour-haemodialysis 3 times a week. An artificial kidney Fresenius 4008 E, polysulfone dialyzers F5 and acetate dialysing solution were used in the studies. Plasma samples were analyzed for cortisol and ACTH by RIA. The studies brought to following conclusions: 1) The basal ACTH plasma level is significantly higher in patients with diabetic nephropathy than in normal controls. There is no significant difference in cortisol plasma level between diabetic patients and the control group. 2) Haemodialysis effects significant decrease of ACTH in plasma of diabetic patients. There is no statistic significance in cortisol plasma level in diabetic patients during haemodialysis.