KONTINUIRANO NADOMJEŠTANJE BUBREGA KOD STARIJIH BOLESNIKA S AKUTNOM OZLJEDOM BUBREGA

Acute kidney injury is one of the most intriguing challenges in medicine, as it is followed by high mortality rates despite the progress in understanding and treating the condition. Elderly patients form a particularly sensitive group, due to the complications that come with age and various comorbid conditions. The aim of the study was to analyse the outcome of patients on CRRT, specifi cally mortality, loss or recovery of kidney functions, along with parameters which could infl uence outcome and which could be improved during therapy for a better outcome. The study included all patients that were treated for acute kidney injury at the Clinical Hospital Centre Rijeka in the last 5 years. Total number of patients was 178, of which 64 were female, and 114 were male. Average age was 74,35 } 5,46 (65- 89). All analyzed patients were treated with continuous renal replacement therapy. Patients were divided into three groups in relation to the outcome (group that passed away, group with the loss and group with the recovery of kidney function). The most common indications for continuous renal replacement therapy were of cardiogenic (n=89, 50,0%) and infectious etiology (n=52, 29,2%). Mortality in patients with acute kidney injury that were treated with continuous renal replacement therapy in our study was 70,79% (n=126), while recovery of renal function occurred in 6,18% (n=11) of the patients. Permanent loss of renal function was more common than recovery, and it occurred in 23,03% (n=41) of the patients. Analysis of parameters revealed that initial creatinine levels, 24-hour diuresis, glomerular fi ltration, potassium levels and multiple organ failure can be predictors of acute kidney injury outcome in elderly patients.Akutna bubrežna ozljeda je jedan od intrigantnijih problema medicine, budući da je i dalje prati visok mortalitet unatoč napretku u liječenju i razumijevanju same bolest. Posebno osjetljivu skupinu čine stariji pacijenti, koji su zbog same dobi i svih komorbiditeta posebno ugroženi. Cilj studije bio je analizirati ishod pacijenata na CRRT-u, odnosno mortalitet, gubitak i oporavak bubrežne funkcije, kao i parametre koji bi potencijalno mogli upućivati na mogući ishod, no na koje bi se ujedno moglo i utjecati u svrhu boljeg preživljenja. U ispitivanju su sudjelovali pacijenti oboljeli od ABO liječeni u Kliničkom bolničkom centru Rijeka u razdoblju od 5 g. Ukupan broj ispitanika bio je 178, od toga 64 osoba ženskog i 114 osobe muškog spola. Prosječna dob iznosila je 74,35 } 5,46 (65-89) godina. Svi analizirani pacijenti su se liječili kontinuiranim nadomještanjem bubrežne funkcije. Pacijenti su raspoređeni u tri skupine ovisno o ishodu bolesti, odnosno smrt, gubitak i oporavak bubrežne funkcije. Najčešće indikacije za primjenu kontinuiranog nadomještanja bubrežne funkcije bile su kardiogene etiologije (n=89, 50,0 %) te infektivne etiologije (n=52, 29,2 %). Mortalitet pacijenata oboljelih od ABO koji su bili na kontinuiranom nadomještanju bubrežne funkcije iznosi 70,79 % (n=126), dok se renalna funkcija oporavila u 6,18 % pacijenata (n=11), a 23,03 % pacijenata je moralo nastaviti jednom od metoda nadomještanja bubrežne funkcije (n=41). Analizom podataka dobiveno je da vrijednosti inicijalno mjerenog kreatinina, 24-satne diureze, glomerularne fi ltracije, kalija, kao i višestruko zatajenje organa, mogu biti jedan od prediktora ishoda ABO u starijih pacijenata

Comparison of clinical assessment and multifrequency bioimpedance analysis as methods of estimating volume status in peritoneal dialysis patients - A single-center experience

INTRODUCTION. Clinical assessment (CA) is frequently used for the evaluation of volume status in peritoneal dialysis (PD) patients despite its subjectivity. Multiple-frequency bioelectrical impedance analysis (MF-BIA) is objective, accurate, and quick, proving to be a promising technique for measuring volume status. The aim of this study was to assess volume status in PD patients using CA and MF- BIA and to compare results. MATERIALS AND METHODS. Incident PD patients were prospectively analyzed between January 1, 2014, and January 1, 2016, at the Clinical Hospital Center of -Rijeka, Croatia. Volume status measurements were performed once a month for 6 consecutive months. The presence of symptoms and signs associated with hyper- or hypovolemia were detected by CA. Euvolemia was defined as a symptom-free state or up to 2 symptoms maximum. Patients lacking up to 1.2 L of volume or with up to 1.2 L in excess were considered euvolemic, as measured by MF-BIA. RESULTS. A total of 45 PD patients were analyzed ; 51% were men, 27% were diabetic, the mean age was 52±26 years, and PD duration was 11.5±6.5 months. In comparison to MF-BIA, CA showed a significant difference in detected hypervolemia between baseline and follow-up (p=0.708 vs. p=0.01, respectively) and among all measurements (p<0.01). Contrary to CA, volume status measured by MF-BIA correlated significantly with systolic and diastolic blood pressure (R=0.29 ; p≤0.01 and R=0.26 ; p≤0.01, respectively). CA showed low sensitivity (0.24) and high specificity (0.92) in detecting hypervolemia. CONCLUSION. MF-BIA is an effective, objective, and safe method for assessing volume status in PD patients. Longitudinal monitoring of body composition changes - including hydration state - leading to adequate therapeutic intervention is a promising and potential application of MF- BIA along with CA