Analysis of nutrition and nutritional status of haemodialysis patients

Background: Chronic kidney disease (CKD) is a common disease of civilization where nutrition is part of the treatment. Diet therapy is difficult as it is necessary to control the intake of: energy, protein and minerals ­ Na, K, Ca and P in the daily food rations (DFR). Objective: The aim of the study was to assess the nutritional status and diets of haemodialysis (HD) patients. Material and method: The study involved 141 haemodialysis patients, at the average age of 65.9. The patients were divided into groups taking into consideration their sex and diagnosis for diabetes. The information on the diets were collected using a 7-day dietary recall. In the DFRs the amount of energy and 22 nutrients were calculated. Obtained results were compared with requirements for HD patients. Results: Appropriate nutritional status (measured with BMI) was reported for majority of women (70.6%) and almost half of men, however, excessive weight was recognized in every third female patient and more than half male patients, and type I obesity was noted in 7.8% of men. The analysis of the results showed that diets of all examined patients were deficient in energy and protein (except women with diabetes), whereas the consumption of fat was appropriate in both groups of women. The recommendations with respect to the amount of cholesterol were met but dietary fibre was too low. Intake of vitamins B1, D, C, folates and Ca and Mg was lower and intake of vitamin B12 was higher than recommended. Conclusions: Assessment of the coverage of the demand on nutrients in HD patients should not be based on the analysis of their nutritional status (BMI) only but also on the analysis of diets, especially in case of diabetes.

Influence of glucose in the dialysate on the activity of erythrocyte-glutathione-peroxidase and blood selenium concentration in hemodialyzed patients.

BACKGROUND: The aim of the study was to show the influence of glucose in the dialysate on the intensity of oxidative stress, activity of glutathione peroxidase (GSHPx) and concentration of selenium in patients undergoing regular hemodialysis. METHODS: The study was comprised of 85 patients hemodialyzed with dialysate containing glucose [HD-g(+)] or not containing glucose [HD-g(-)], patients with chronic renal failure on conservative treatment and control group. The concentrations of the products of reaction with thiobarbituric acid (TBARS), concentration of selenium in erythrocytes and plasma, concentration of copper in erythrocytes and the activity of GSHPx were determined. RESULTS: GSHPx had significantly higher activity in HD-g(-) group before HD than in control group. In HD-g(+) group before hemodialysis, the activity of GSHPx was significantly lower than in the control group. After HD, the activity showed a statistically significant increase. In both hemodialyzed groups, selenium concentration before hemodialysis both in plasma and erythrocytes was significantly lower, compared to control group. In the group of patients with CRF on conservative treatment, selenium concentration in RBC was significantly higher, compared to concentrations obtained in other groups except for control group. The increase of copper concentration in erythrocytes was accompanied by the increase of oxidative stress and increase of TBARS concentration. The opposite relationship was observed for selenium-its concentration was inversely correlated to copper concentration. CONCLUSIONS: In both groups of hemodialyzed patients, hemodialysis caused the increase of GSHPx in erythrocyte activity and increase of plasma and erythrocyte selenium concentration.

Do trace elements modify the activity of erythrocyte sodium-proton exchanger in hemodialyzed patients?

The kinetics (Vmax and Km) of the erythrocyte Na+-H+ exchanger was studied in a group of 21 patients undergoing regular hemodialysis (HD) and in 21 control subjects. The activity of antioxidative enzymes--superoxide dismutase and glutathione peroxidase--as well as the concentrations of their cofactors--zinc, copper, and selenium--in plasma and in erythrocytes were determined. The thiobarbituric acid-reactive substances (TBARS) concentration served as an indicator of oxidative stress intensity in plasma and erythrocytes. It was found that in the control group the concentration of copper in erythrocytes was positively correlated with Km and Vmax. When the concentration of copper increased, the shape of the kinetic curve changed from sigmoidal to hyperbolic. In the control group, the concentration of zinc in erythrocytes also correlated with Km. However, the results obtained for the group of hemodialyzed patients were the opposite: when the erythrocyte concentration of copper increased, a Km decline was observed and the shape of the curve changed from hyperbolic to sigmoidal. In the group of hemodialyzed patients, we also found a positive correlation between Km and the concentration of selenium in erythrocytes, and a negative correlation between Km and erythrocyte TBARS.

[Nosocomial infections in a neonatology department, 1995-2002]. / Zakazenia szpitalne w oddziale neonatologii w latach 1995-2002.

Nosocomial infections in newborns department are common due to number of invasive diagnostic and therapeutic procedures, prolonged hospitalization and development antibiotic resistance culture. Sepsis achieved 1 to 8 newborn infants for 1000 live births. This is still unresolved very important medical, organization, ethical and medical problem. The aim of this study was the estimation on the number, etiology and clinical form of nosocomial infection in Neonatology Department as well as the way of spread. We analyzed nosocomial infection in 8770 newborn infants in Neonatology Department with Intensive Therapy Chair and Clinic Obstetric and Perinatology Pomeranian University of Medicine from 1995 to 2002. For this retrospective study we used data from Commission for Nosocomial Infection. In analyzed period total percentage of newborn infants with nosocomial infection was under 1%, but in NICU was over 11%. Inborn vertical infection was 26.8% and horizontal strictly nosocomial infection was diagnosed in 73.2%. Etiology was mainly due to Gram negative bacterial infection. Clinically sepsis, pneumonia and meningitis was diagnosed. Clinical manifestation and laboratory tests like CRP, PCT, blood count, leukocyte index and microbiological culture was used for diagnosis. The most often positive bacterial culture was obtained from cock, washstand, bath and medical staff. Nosocomial infections in neonatology department are significant medical problem which need continuous monitoring, systemic prevention and in case of infection early intervention.