Aluminij u vodi za pripravu dijalizata i u serumu dijaliziranih pacijenata

The aim of this study was to develop and verify the electrothermal atomic absorption method for aluminium determination in human serum and correlate the concentration of aluminium in serum of patients on dialysis and in water for preparation of dialysate. Two centres were included: centre A with accidentally enhanced concentration of aluminium in water for preparation of dialysate and centre B with very low water aluminium. Aluminium level in serum of healthy people was also analysed. The results showed that the analytical method was reproducible and sufficiently accurate in determining serum and water aluminium. Normal values obtained for aluminium in the sera of healthy people ranged from 0.9 to 12 ug/L and wars significantly lower than all values obtained from the dialysis centre A. The aluminium concentration in serum of dialysed patients displayed linear correlation to aluminium concentration in water used for preparation of dialysate.Svrha ovog rada bila je: a) razviti i verificirati metodu određivanja aluminija (Al) u serumu elektrotermalnom atomskom apsorpcijskom spektrometrijom (ET AAS), b) odrediti koncentraciju aluminija u serumu zdravih ljudi i c) usporediti koncentraciju aluminija u vodi za pripravu dijalizata i u serumu pacijenata na dijalizi. Metoda ET AAS sastoji se u razrjeđivanju uzorka na koncentraciju mjernog područja od 2 do 10 µg Al/L i primjenu modifikatora matriksa Mg(NO3)2 Mjerenjem referentnih uzoraka dobiveno je iskorištenje od 98 i 105% za Seronorm odn. BRP otopinu albumina. Ponovljivost metode (koeficijent varijabilnosti izražen kao %) unutar dana je 5,6 odn. 9% i između dana je 3,5 odn. 8,6%. Granica detekcije metode je 0,9 µg Al/L. a karakteristična masa je 3,4 pg Al. U skupini od 50 zdravih ispitanika dobivena je vrijednost aluminija u serumu od 4,5 do 2,8 (aritmetička sredina ± standardna devijacija) s rasponom od 0,9 do 12 µg/L. Koncentracije aluminija u deioniziranoj vodi za pripremu dijalizata u serumu pacijenata na dijalizi mjerene su u dva različita centra za dijalizu (contar A i B) u Hrvatskoj 1995. do 1997 godine. Nakon kvara na uređaju u centru A voda za pripremu dijalizata sadržavala je 125 µg Al/L, a koncentracija Al u serumu pacijenata u to vrijeme iznosila je 140 ± 54 (N-9). Nakon servisnog popravka vrijednosti Al u vodi snižene su na 8 odn. 27 µg Al/L, a u serumu pacijenata na 30 ± 30 (N-50) odn. 75 x 38 (N=50). U centru B voda za pripravu dijalizata bila je tijekom praćenja ispod granice detekcije metode, tj. <0,9 µg Al/L. U isto vrijeme serumi pacijenata iznosili su 191 ± 22 (N-21) odn. 19 ± 11 (N=16) pg Al/L. Rezultati pokazuju linearnu povezanost između koncentracije aluminija u vodi za pripravu dijalizata i koncentracije aluminija u serumu pacijenata na dijalizi. Mali porast koncentracije aluminija u vodi odražava se na porastu aluminija u serumu. Stoga bi redovita kontrola aluminija ne samo u vodi za pripravu dijalizata već i u serumu pacijenata bila nužna

Bone mineral density in adolescents with chronic kidney disease: a follow-up study

Cilj istraživanja jest odrediti promjenu koštane gustoće u bolesnika adolescentne dobi s kroničnim zatajenjem bubrega i odrediti utjecaj visine i težine, odnosno veličine skeleta na koštanu gustoću. U ispitivanju je sudjelovalo 30 bolesnika, prosječne dobi 13,5±3,5 godina. Svim ispitanicima denzitometrijski je određena mineralna gustoća kosti na kralježnici i cijelom skeletu metodom dvoenergetske apsorpciometrije X zraka (DXA). Laboratorijski su određeni kalcij, fosfor i PTH u serumu i izračunat je klirens kreatinina. Prosječno vrijeme između početnoga i kontrolnoga mjerenja bilo je 15,7 mjeseci. Utvrđenje značajan porast visine i težine u ispitanika, ali su u oba mjerenja antropometrijske varijable bile ispod referentnoga prosjeka (Z vrijednost za visinu i težinu < -1). Mineralna gustoća skeleta na kralježnici i cijelom skeletu je također značajno porasla između dva mjerenja, ali nakon korekcije prema visini i težini, taj porast više nije bio značajan. Zato je kod djece s kroničnim zatajenjem bubrega potrebno izvršiti korekciju koštane gustoće u odnosu na njihovu visinu i težinu, obzirom daje brzina njihovoga rasta usporena.The aim of this follow-up study was to analyze the change of bone mineral density in adolescents with chronic kidney disease and to determine the influence of height, weight and bone size on bone density The study included 30 patients, aged 13.513.5 years. Regular biochemistry included serum calcium, phosphorus and PTH. Bone mineral density (BMD) was measured by dual energy absorptiometry (DXA). The mean time between baseline and follow up measurements was 15.7 months. Despite the significant increase in weight and height in all participants, anthropometric variables were below one standard deviation from reference values in both measurements (Z value < -1, for height and weight). After correction for height and weight, the increase of BMAD between two measurements was not significant. It is necessary to correct the bone density for height and weight in children with chronic kidney disease, due to their retarded growth velocity

Bone mineral density in adolescents with chronic kidney disease: a follow-up study

Cilj istraživanja jest odrediti promjenu koštane gustoće u bolesnika adolescentne dobi s kroničnim zatajenjem bubrega i odrediti utjecaj visine i težine, odnosno veličine skeleta na koštanu gustoću. U ispitivanju je sudjelovalo 30 bolesnika, prosječne dobi 13,5±3,5 godina. Svim ispitanicima denzitometrijski je određena mineralna gustoća kosti na kralježnici i cijelom skeletu metodom dvoenergetske apsorpciometrije X zraka (DXA). Laboratorijski su određeni kalcij, fosfor i PTH u serumu i izračunat je klirens kreatinina. Prosječno vrijeme između početnoga i kontrolnoga mjerenja bilo je 15,7 mjeseci. Utvrđenje značajan porast visine i težine u ispitanika, ali su u oba mjerenja antropometrijske varijable bile ispod referentnoga prosjeka (Z vrijednost za visinu i težinu < -1). Mineralna gustoća skeleta na kralježnici i cijelom skeletu je također značajno porasla između dva mjerenja, ali nakon korekcije prema visini i težini, taj porast više nije bio značajan. Zato je kod djece s kroničnim zatajenjem bubrega potrebno izvršiti korekciju koštane gustoće u odnosu na njihovu visinu i težinu, obzirom daje brzina njihovoga rasta usporena.The aim of this follow-up study was to analyze the change of bone mineral density in adolescents with chronic kidney disease and to determine the influence of height, weight and bone size on bone density The study included 30 patients, aged 13.513.5 years. Regular biochemistry included serum calcium, phosphorus and PTH. Bone mineral density (BMD) was measured by dual energy absorptiometry (DXA). The mean time between baseline and follow up measurements was 15.7 months. Despite the significant increase in weight and height in all participants, anthropometric variables were below one standard deviation from reference values in both measurements (Z value < -1, for height and weight). After correction for height and weight, the increase of BMAD between two measurements was not significant. It is necessary to correct the bone density for height and weight in children with chronic kidney disease, due to their retarded growth velocity

Croatian Recommendations for Dialysis of HIV-Positive Patients

Abstract Human immunodeficiency virus (HIV) infection may be associated with renal impairment since about 0.4% of all HIV-positive patients develop end-stage renal disease. The share of patients with HIV infection in hemodialysis centers throughout the world ranges from 0.3% to as high as 38%. In Croatia, renal replacement therapy was needed by 1% of all the HIV-positive patients from 1985 until the end of 2014. Healthcare professionals (HP) should be aware of the risks of occupational exposure to blood-borne infections in their daily work. Performing dialysis in HIV-positive patients increases the risk of exposure to HIV during the extracorporeal circulation of the infected blood. However, post-exposure prophylaxis (PEP) with effective antiretroviral drugs significantly reduces the risk of infection after occupational exposure. On behalf of the Croatian Society of Nephrology, Dialysis and Transplantation, the authors of this paper have proposed recommendations for the management of HIVpositive patients on dialysis, which aim to prevent the transmission of HIV among patients and HPs. The important recommendations include the following: 1. when the need arises, it is necessary to provide HIV-positive patients with dialysis in the vicinity of their place of residence. 2. HIV-positive patients should be dialyzed with a separate hemodialysis machine in an isolated area. Alternatively, they can be dialyzed in an area for the hemodialysis of HCV-positive and/or HBVpositive patients. 3. Specialized and trained personnel should be provided during the hemodialysis procedure, together with strict compliance with the standard precautions for the prevention of blood-borne infections. 4. There should be a good and prompt cooperation with the National Referral Center for HIV infection