POSEBNOST DIJALIZE u STARIH I VRLO STARIH BOLESNIKA – DILEME

The global increase in the proportion of older population contributes to the increasing number of patients with renal insufficiency. This disorder particularly involves the old (age 70-75) and very old (over 80) population groups. The number of comorbidities is increasing and life expectancy reduced with aging. Cross-sectional analysis of ten-year survival showed a rate of 33.9% in patients treated at the Hemodialysis Center, 23.81% in transplanted patients and 19.35% in dialyzed patients. In patients having started hemodialysis (HD) at the age of ≥70, the mean survival was 20.27±18.62 months, in those that died 15.54±17.35 months, and in survivors 30.29±17.85 months. Among HD treated patients, 35% survived for up to one year, 18% for two years and 8% for ≥3 years. Karnofsky index was below 50% in all patients that survived, while the Malnutrition Inflammation Score and Subjective Global Assessment indicated malnutrition. In Croatia, the number of HD patients is constantly increasing as the result of population aging, better, accessible and equal health care that prolongs life span, easier access to substitution methods, more accesses to the vascular system, development of the national transplant network and good immunosuppressive therapy. All this provides biological, economic and normative space for replacement therapy. Old age, comorbidities and poor nutritional status influence high mortality, poor functional status and impaired quality of life. Survival results correspond to reports in the literature.U svijetu je ubrzan porast broja starijih bolesnika koji trebaju liječenje dijalizom. Ti se izvještaji poklapaju iz raznih zemalja. Problemi koje nosi starija dob su višestruki. Različiti su stavovi za stratifikaciju dobnih granica. Bilo kako bilo, dobne granice su produžene i porast starije populacije sa svim pratećim komorbiditetima je neizbježan. Kronična bubrežna bolest ima puno veću incidenciju u među starom negoli među mlađom populacijom i u stalnom je porastu u svijetu bilo kao bolest, komorbiditet ili posljedica raznih stanja. Ova činjenica nameće pitanja fiziologije i patofiziologije starenja i promjena u glomerularnoj filtraciji (GF). Ima li jasnih stavova o normalnim laboratorijskim vrijednostima prilagođenim dobnoj granici? U kojem stupnju je GF fiziološka varijanta za konkretnu dob? Produžava li liječenje hemodijalizom životni vijek vrlo starih osoba? Odgovori nisu uvijek precizni. Stara populacija često je izložena odlukama liječnika, obitelji ili skrbnika mimo svoje želje, bilo zbog nedostatka komunikacije ili zbog nepoznavanja postupaka. Procedure mogu na bolesnika ostaviti psihičke i fizičke posljedice (patnje), bez obzira na to što su sve napravljene profesionalno, oni često kažu “da sam znao što me čeka, ne bih pristao”. Zbog toga je nužno poštivati odluku bolesnika. Analizom vlastitih podataka vidljiva je prisutnost veoma stare populacije s velikim brojem pridruženih komorbiditeta te visokim stupnjem pothranjenosti (MIS) i Karnofskyjeva skora. U Centru je više od 49,23% populacije starije od 70 godina, s velikom zastupljenošću privremenog ili trajnog centralnog venskog katetera kao pristupa za dijalizu (42,35%). Najviše preživjelih do 1, 2 i 3 godine bilo je u skupini od 76-80 godina, a u skupini starijih od 80 godina nitko nije preživio 4 ili 5 godina. Kod preživjelih bolesnika visoke dobi sposobnost za samostalno funkcioniranje je veoma mala. Karnofskyjev zbir za preživjele 6 mjeseci i više bio je u prosjeku 50%

Generalizirana ateroskleroza, metabolički sindrom i rezistentna hipertenzija - uzroci i posljedice

e components of metabolic syndrome lead to generalized atherosclerotic changes and micro- and macrovascular complications with damage to systems and organs. Consequently, patients’ treatment with the resulting changes in the target organs is costly, complicated, and unpredictable. We present a 65-year-old patient with diabetes diagnosed with hyperlipidemia, unregulated arterial hypertension in the presence of other metabolic syndrome components and who consequently developed complications of generalized atherosclerosis. Despite detailed, individually tailored therapy, in line with current recommendations, we suggest that treatment success is very closely related and dependent on dietary measures, healthy living habits, and patient cooperation.Komponente metaboličkog sindroma dovode do generaliziranih aterosklerotskih promjena te mikro i makrovaskularnih komplikacija s oštećenjem sustava i organa. Slijedom toga, liječenje bolesnika s posljedicama promjena na ciljnim organima vrlo je skupo, složeno i nepredvidljivo. Predstavljamo 65-godišnjeg pacijenta, dijabetičara, kojem je dijagnosticirana hiperlipidemija, neregulirana arterijska hipertenzija u prisutnosti drugih komponenata metaboličkog sindroma i posljedično razvijene komplikacije generalizirane ateroskleroze. Unatoč detaljnoj, individualno prilagođenoj terapiji, u skladu s trenutnim preporukama, smatramo da je uspjeh liječenja vrlo usko povezan i ovisi o prehrambenim mjerama, zdravim životnim navikama i suradnji pacijenta

High-volume post-obstructive choleresis (biliary hyperproduction) with acute kidney injury after choledochotomy, gallstones extraction, and T-tube drainage, successfully treated with octreotide - Report of a case

Only several cases of postprocedural choleresis (biliary hyperproduction) were reported, and guidance on management is scarce, although an application of octreotide was anecdotally described. We herein present a rare post-obstructive choleresis complicated with acute kidney injury due to dehydration, successfully treated with an off-label application of octreotide. A 58-year-old female, following cholecystectomy and choledochotomy with numerous stones extraction, developed excessive bile loss via a T-tube complicated with acute kidney injury. Despite aggressive fluid replacement, the patient continued to deteriorate, prompting a trial of subcutaneous octreotide 0.1 mg three times per day over five days. Therapy yielded a rapid decline in bile production with improved diuresis and normalizing kidney function. The patient was discharged with a ligated T-tube, which we removed a month later. The followup was unremarkable, with normalized laboratory findings and symptom-free. Early use of octreotide could help resolve complicated biliary hyperproduction; however, further research is required to determine the risks and benefits of such an approach