[Clinical usefulness of heparin-coated dialyzers]. / Przydatnosc kliniczna dializatorów heparynizowanych.

Hemodialysis procedures involve activation of the coagulation system, which creates the need for heparinization to prevent clotting in the extra- corporeal circulatory system. Heparin-based anticoagulation in dialysis, increases the risk of bleeding during and after hemodialysis procedure. Patients with active bleeding or an increased its risk should be dialyzed without heparin or with limited anticoagulation, while ensuring protection against clotting in the dialyzers and dialysis lines. The search for a reliable and comfortable manner of hemodialysis in patients at risk of bleeding did not bring long-term satisfactory results. It seems that a breakthrough in this field was the introduction of dialyzers with polyacrylonitrile membrane with adsorption capacity of heparin during their pre-rinse and then membrane dialyzers with hydrogel polyacrylonitrile heparinized during the manufacturing process. The authors evaluated the clinical usefulness of heparinized dialyzers based on 1140 Evodial hemodialysis sessions performed in 11 patients with increased risk of bleeding in the Dialysis Unit of the Department of Nephrology, University Hospital, Krakow during years 2012-2014. It has been shown that heparinized dialyzers are useful not only in patients with acute bleeding organ, but also in patients with chronic bleeding or chronic bleeding risk non responding for therapeutic methods. Their use allows the individualization of anticoagulation therapy by reducing the dose of heparin.

[Patient receiving peritoneal dialysis after treatment of ovarian cancer]. / Pacjentka dializowana otrzewnowo, po leczeniu nowotworu zlosliwego jajnika.

Peritoneal dialysis is one of the three available options for renal replacement therapy. This method of treatment of end-stage renal disease gives patients relatively high sense of independence and control over their disease, especially in comparison with hemodialysis, and therefore is often preferable method for young individuals wishing to lead an active lifestyle. We present a case of 22 year old female patient with stage 5 of chronic kidney disease, which is a consequence of multi-agent chemotherapy for endo-dermal sinus tumor of the right ovary (diagnosed at the age of 13). Particularly important in the context of treating our patient with peritoneal dialysis is the fact of confirmed metastases into the peritoneum, which was the reason for the use of chemotherapy reserved for high-risk patients (ifosfamide + etoposide + cisplatin). The selected program of chemotherapy provided effective eradication of cancer, but a side effect of treatment was renal tubular damage. In the period from 03.2006 to 05.2007 our patient required hemodialysis (with gradually reduce dose of dialysis), at a later time to 12.2011 patient did not require renal replacement therapy (stable renal function were observed at the stage 4 of chronic kidney disease), but in 12.2011 resumption of dialysis was necessary and the patient, in accordance with her selection, is receiving peritoneal dialysis. Qualification of our patient for treatment with peritoneal dialysis was associated with reasonable concern about the ability to provide acceptable adequacy of dialysis. Apprehensions proved to be unfounded, the clinical observation of the patient presents proper ratios of dialysis adequacy. Our patient was also qualified for renal transplantation.