OPTIMIZATION OF PERITONEAL DIALYSIS ІN 7 STEPS OF EDUCATIONAL WORK WITH A PATIENT

Informing the end-stage renal disease (ESRD) patients about the modalities of dialysis renal replacement therapy (DRRT), patient’s aware choice of peritoneal dialysis (PD) and regular qualified medical training are the main components of successful implementation of PD program with obtaining optimal treatment results. The aim of the review is to summarize current knowledge regarding the process of modality selection and PD-patient training, improving professional development of the PD-specialists

ALPHA–LIPOIC ACID ANTIOXIDANT EFFICIENCY IN TREATMENT OF PERITONEAL DIALYSIS PATIENTS

The aim of the study was to evaluate the effectiveness of the antioxidant alpha–lipoic acid in peritoneal dialysis (PD) patients taking into account the state of lipid peroxidation (LPO) and antioxidant protection (AOP) before and after treatment. Patients and methods. The research revealed the intensity of oxidative processes in 20 patients treated with continuous ambulatory peritoneal dialysis (CAPD) on the basis of а–lipoic acid applied parenterally in a dose of 600 mg for 2–weeks followed by a transfer to the 6 weeks of oral reception. The intensity of oxidative processes was evaluated before and after treatment through determining the content of MDA in serum (MDAs) and erythrocytes (MDAe). AOP activity was evaluated by the content of the antioxidant enzyme ceruloplasmin (CP), transferrin (Tr), SH–groups and total peroxidase activity (TPA) of red blood cells. The control group consisted of30 individuals comparable on for age and sex. Results. The effects on the study of PD patients (positive decrease of MDAs, increase in CP higher than control group, a significant increase in the content of SH–groups (p=0,04), TPA (p=0,009), Tr (p=0,002) and catalase serum) demonstrated a considerable positive dynamics of LPO /AOP influenced by the use of а–lipoic acid. Conclusions. The research opens up the prospect for further study ofLPO /AOP blood in PD patients and proves the application expediency of alpha–lipoic acid for this group. Use of the latter lowers the activity of oxidative processes significantly and restores AOP indicators substantially, which in turn minimizes the negative influence of oxidative stress on a patient’s body

AUTONOMIC STATUS OF PERITONEAL DIALYSIS PATIENTS AND ITS RELATION WITH INDICATORS OF LIPID METABOLISM

The research objective had been to evaluate the autonomic status in peritoneal dialysis (PD) patients and to identify its lipid metabolism interaction. Patients and methods. During the research process 40patients had been examined who received continuous ambulatory peritoneal dialysis (CAPD). The autonomic status was studied using the questionnaire (A.N. Wayne test) and sympathetic skin response (SSR) by electroneuromyograph «Neuro–MEP–4». 20 conventionally healthy individuals formed the control group matched according to age and sex. Results. Obtained questionnaire data showed clinical symptoms of autonomic dysfunction in 37 cases among 40 (92,5%) PD patients. Analysis of the correlation level of autonomic disorders with lipid metabolism showed a significant dependence with the concentration of high density lipoprotein (HDL) (p=–0,43;p=0,01), low density lipoprotein (LDL) (p=0,55; p=0,001) and atherogenic index. Also a comparative analysis of the main CSAP PD patients’ indicators and conditionally healthy individuals showed a statistically significant decrease in the amplitudes of the first and second phases of SSR. Also SSR results analysis in conjunction with the autonomic disorders clinical implications afforded the ground for the lower extremities polyneuropathy diagnosis in 18 cases among 25 (72%) patients. Moreover, the study of lipid profile showed the correlation of total cholesterol (TC) with all studied SSR parameters: A1 (r=0,64; p=0,0006), A2 (r=0,79; p<0,0001), latent period (LP) (r=–0,45; p=0,04). Conclusions. The autonomic status of CAPD patients is characterized by low level of vegetative regulation total power and the imbalance of sympathetic and parasympathetic influences in comparison with conventionally healthy individuals and it is correlated with lipid spectrum