Search

Through the treatment of anaemia in dialysis patients part of the iron ions remain free in the serum which is at the bacterias disposal for growth and the strengthening of their virulence. The linear relation of the increased serum iron level and tissue iron stores in the body and the infection incidence in dialysed patients has become more emphasised. The need of a clearly defined upper threshold of the serum iron concentration limit has been mentioned in scientific journals intensely, and consequently the demand for more precise professional instructions for anaemia treatment. For the purpose of participating in these professional and scientific discussions, we have observed the relation between the iron overload of the organism and complication incidence in 120 of our haemodialysis uremic patients, with special emphasis on infections. It has been established that the sepses incidence is much higher in patients with a serum ferritin concentration above 500 microg/L, than in those patients with a ferritin level lower than the mentioned value ( 2 = 7.857, p = 0.005). The incidence of vascular access infection is significantly higher in those patients with a serum ferritin level above 500 microg/L than in those patients with a ferritin level lower than the mentioned value (Chi2 = 23.186, p = 0.001). Furthermore, it has been determined that the incidence of total infection in patients is 3.8 episodes per 100 patients months, which is in accordance to the referral values of other authors. CONCLUSION--In the analysis of the achieved results, it has been determined that the infection incidence is significantly higher in dialysed patients with a serum iron level higher than 500 g/L, than in those patients with lower values.

The mineral metabolism disorder is the most influential factor of the morbidity and mortality incidence of haemodialysis uremic patients. The second most influential factor is the infection, which is the most frequent complication with an undesirable outcome. In recent times, the relation of the increased serum calcium and phosphorus level on the one hand, and the morbidity and mortality of that population in case on the other, has been observed. However, insufficient professional and scientific thought has been given to the relation of the lower serum levels of the aforementioned minerals and the morbidity and mortality incidence. We have researched the relation between lower serum calcium level (hypocalcaemia) and the complication incidence, especially infection. Throughout the time period of 18 months, 120 haemodialysis uremic patients were observed and 76 (63.3%) of them had serum calcium level below the lower threshold of referent values (9.0-9.5 mg/dL). In the patients with a lower serum calcium level (hypocalcaemia) a significant infection incidence (chi2 = 3.99; p = 0.0468), a significant sepses incidence (chi2 = 8.016; p = 0.04), a significant total complication incidence (p < 0.05) were determined, as well as a higher vascular access local infection incidence, but without statistically significant research results of this relation (chi2 = 0.098; p = 0.7598). We are of the belief that the incidence of the vascular access local infection should be examined on a greater number of patients; therefore, the significance of the examined relation in such an instance would be expected. The total infection incidence in all 120 observed patients is 3.8 for 100 months. It is to be concluded that the research findings indicate the association regarding the appearance of low serum calcium concentration (hypocalcaemia) and an increased complication incidence, especially the inflammation that leads to the requirement of further research in order to decrease morbidity, and consequently also the mortality of the observed population of patients by means of programmed therapy approach.

Discussions whether hypoalbuminemia is just a marker for the malnutrition-inflammation syndrome as well as for the increased morbidity and mortality of those patients or is it an etiological factor, are becoming more and more intense. In this research of the relation between hypoalbuminemia and the complications that threaten the vascular access with special reference to infection, and consequently to the life of the patients treated with chronic haemodialysis, we have chosen 120 patients with terminal renal insufficiency (ESRD) treated at the Clinical Hospital Mostar by chronic haemodialysis. The chosen patients for this study were observed throughout a time period of 18 months. Only the patients who, at the moment of starting the research did not exhibit either a local or a systemic infection, as well as no signs of any other complication that might have endangered the vascular access and consequently the life of the patient, were selected. From the 120 (100.0%) patients, 86.8% of them had a serum albumin level below 40.0 g/L. By analysing the research results of the clinical material, it has been established that in patients with serum albumin level below 40.0 g/L, the infection incidence was significantly higher than in those patients with the albumin level above 40.0 g/L (chi2 = 7.215 P = 0.0077). The complication incidence is significantly higher (chi2 = 9.92 P = 0.0022) among the patients with serum albumin level below 40.0 g/L, than in those patients with higher serum level. Among the patients with a serum albumin level lower than 40.0 g/L, the sepses incidence was significantly higher (chi2 = 4.77 P = 0.03), than among those patients with a serum albumin level above this value. However, the difference in incidence of local infection of the vascular access between the group of patients with a serum albumin level below 40.0 g/L and those patients with albumin level above this value is not significant (chi2 = 0.65 P = 0.69). The total infection incidence in the 120 observed patients was 3.8 episodes per 100 patient months, and within the parameters mentioned by other authors.

The functional duration of vascular access in dialysis patients depends on the emergence of threatening complications. Discussions are constantly being held in an attempt to discover their causality and decrease their emergence. In 260 patients undergoing haemodialysis, we have studied the potential existence of a cause-and-effect relation between the emergence of complications in the vascular access and the applied type of arteriovenous (av.) anastomosis in the arteriovenous (AV) fistula. We have observed the incidence of all complications, both that of the thrombosis incidence as well as the primary and secondary fistula patency (survival). The complications--The examinees with the end-to-end anastomosis showed the incidence of 8.08%, 6.15% of the patients with the end-to-side anastomosis and 7.31% of the patients with the side-to-side anastomosis. The differences regarding incidences are statistically significant (chi2-test = 29.25; P = 0.0001). Thrombosis--it has been found that thrombosis was the most frequent complication developing in 30.00% patients with the end-to-end av. anastomosis, in 2.31% patients with end-to-side av. anastomosis and in 5.56% patients with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 27.69%, and it is statistically relevant (chi2-test = 33.920; P = 0.0001). The primary patency (primary survival): within a 6-month interval following the establishment of vascular access, the first complications arose in 62.50% of patients with end-to-end av. anastomosis, 10.76% in those with end-to-side av. anastomosis and 18.88% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 51.74%, which is statistically significant (chi2-test = 49.009; P = 0.0001). The secondary patency: 24 months subsequent to the establishment of vascular access, the AV-fistula was still functional in 52.50% of the patients with end-to-end av. anastomosis, 89.23% in those with end-to-side av. anastomosis and 81.11% in those with side-to-side av. anastomosis. The difference between the highest and the lowest assessment is 36.73%, which is also statistically significant (chi2-test = 26.579; P = 0.0001). According to our research, the end--to-side type of av. anastomosis in vascular access provides better results both in relation to the duration as well as the maintenance of the functionality of the Av-fistula and in the lower incidence of the complications than the other types, and hence it shows a definite advantage.