Korelacija indeksa tjelesne mase djece pri upisu u 1. razred osnovne škole i indeksa tjelesne mase njihovih roditelja

Prevalencija preteške i pretile djece značajno je porasla u zadnjih 20 godina. Preteška i pretila djeca vrlo često su preteški i pretili odrasli. Preteška i pretila djeca nisu zdrava djeca već djeca s nizom rizičnih čimbenika za nastanak srčanožilnih bolesti. U ovom je radu ispitivana skupina od 196 djece (85 (43.4%) djevojčica, 111 (56.6%) dječaka) koja su pristupila pregledu za upis u 1. razred osnovne škole. Svakom djetetu i njegovim roditeljima određen je indeks tjelesne mase (ITM). Cilj je bio odrediti prevalenciju preteške i pretile djece i vezu između njihovog ITM i ITM njihovih roditelja. Prosječni je ITM djece iznosio 16,16 ±2,45 kg/m2. Ukupno je 45 (22,9%) djece bilo preteških, a 29 (14,8%) pretilih. ITM djece bio je u značajnoj korelaciji sa ITM i njihovih majki (r=0,324, p<0,01) i njihovih očeva (r=0,362, p<0,01). Od 85 djevojčica preteških je bilo 23 (27,1%), a pretilih 14 (16,5%). Od 111 dječaka preteških je bilo 22 (19,8%), a pretilih 15 (13,5%). Nema značajne razlika po spolu u učestalosti niti preteške niti pretile djece (χ2-test = 1,046, p>0,05). Od 45 preteške djece, 21 (46,7%) dijete ima pretešku majku, 33 (73,3%) djeteta oca, a 17 (37,78%) djece oba roditelja sa ITM iznad 25 kg/m2. Od 151 djeteta sa ITM ispod 17,2, odnosno ispod 17,35 kg/m2, 58 (38,4%) djece ima majke, 102 (67,6%) očeve, a 45 (29,8%) oba roditelja sa ITM iznad 25 kg/m2. Prema χ2-testu, preteška djeca u odnosu na normalno tešku djecu nemaju značajno češće preteške roditelje (χ2-test = 0,239, p>0,05).Od 62 djece čija su oba roditelja sa ITM iznad 25 kg/m2  16 (25,8%) ih je preteško. Od 153 djece čiji je bar jedan roditelj sa ITM iznad 25 kg/m2  36 (23,5%) ih je preteško. Od 43 djece čija su oba roditelja sa ITM ispod 25 kg/m2  samo 7 (16,3%) ih je preteško. Ipak, prema χ2-testu preteška djeca ne sreću se češće u obitelji preteških roditelja (χ2-test = 4,81, p>0,05). ) Rezultati govore da je u našoj sredini visoka prevalencija preteške i pretile djece prije upisa u 1. razred osnovne škole, da postoji značajna korelacija između ITM djece i ITM njihovih roditelja, da preteška i pretila djeca ove dobi nemaju značajno češće preteške i pretile roditelje od nepreteške djece, a da ni preteški i pretili roditelji nemaju značajno češće pretešku i pretilu djecu ove dobi od nepreteških roditelja

Erythrocyte sedimentation rate in patients undergoing hemodialysis or peritoneal dialysis

Povišena sedimentacija eritrocita (SE) je skoro stalni nalaz u bolesnika s kroničnim bubrežnim zatajenjem, kako u onih liječenih ponavljanim hemodijalizama, tako i u onih liječenih peritonejskom dijalizom. Zbog toga je upitna korist njenog određivanja. Etiologija nije jsna, a ni razlike između dvije skupine bolesnika. U ovom radu uspoređene su prosječne vrijednosti SE, određene modificiranom Westergrenovom metodom, bolesnika liječenih hemodijalizom i peritonejskom dijalizom, s ciljem da se razlika dovede u uzročnu vezu sa eventualnim razlikama niza analiziranih laboratorijskih parametara. Bolesnici liječeni hemodijalizom (n = 49) imali su značajno nižu SE (55,51±32,21 mm/3,6 ks) od bolesnika liječenih peritonejskom dijalizom (n = 24 (91,75±31,94 mm/3,6 ks) (t = 4,54 p < 0,01). No, razlika se ne može u potpunosti objasniti nađenim razlikama prosječnih vrijednosti hematokrita, leukocita, srednjeg korpuskularnog volumena eritrocita, fibrinogena, Creaktivnog proteina, pojedinih elektroforezom dobivenih komponenti proteina plazme, kolesterola i triglicerida. U zaključku autori ističu da je povišena SE skoro stalni nalaz u bolesnika liječenih dijalizom i da je izrazito viša u bolesnika liječenih peritonejskom dijalizom. Njeno određivanje u ovih bolesnika je od male koristi.Elevated erythrocyte sedimentation rate (ESR) is almost a regular finding in patients suffering from chronic renal failure and undergoing maintenance hemodialysis or peritoneal dialysis. Therefore, the benefit of its determination remains questionable. The etiology of this finding is unclear as wel as its different levels in the two groups of dialysis patients. The mean ESR in hemodialysis patients, determined by a modified Westergren\u27s method were compared to those in patients treated with peritoneal dialysis in order to determine causal relation skip of the obtained difference with the sequence of examined laboratory features. Patients treated with maintenance hemodialysis (n = 49) had significantly lower ESR (55,51±32,21 mm/3,6 ks) compared to those treated with peritoneal dialysis (n = 24) (91,75±31,94 mm/3,6 ks) (t = 4,54 p < 0,01). However, the difference could not be completely explained by the difference found in the values of leucocytes number, haematocrit, erythrocyte mean corpuscular volume, fibrinogen, C-reactive protein, single plasma protein compounds, cholesterol and triglycerids, respectively. In conclusion, elevated ESR was found almost as the rule in chronic dialysis patients and was significantly higher in patients treated with peritoneal than in those undergoing hemodialysis. Its determination in these patients has little clinical utility

Sensorineural Hearing Loss in Hemodialysis Patients

Chronic renal failure affects all organ systems. Senses are not exception and hearing impairment is common, particularly sensorineural hearing loss (SNHL). The term »SNOS of unknown origin« or »uremic deafness« is related to only a smaller part of the cases with unclear etiology of the impairment. The study searched for SNOS in 66 chronic hemodialysis (HD) patients, mean age 51.50±12.70 years. They were treated by HD for 69.70±53.80 months. The relation between the severity of the impairment and the patients’ age, duration of HD treatment (months) and a set of laboratory parameters typical for chronic HD patients was examined. The aim of the study was to detect potential causes of the impairment. The increased hearing threshold (HT) of above 20 dB for all frequencies was found in 42 patients (mean HT 26±10.50 dB), for speaking area frequencies in 22 patients (mean HT 19.70±8.80 dB), and in 56 patients for high frequencies (mean HT 41.70±19.70 dB). The significant positive correlation of HT was found only with the patients’ age (r=0.49, p<0.01). The patients older than 45 years had higher mean HT than those younger, and those older than 65 also had higher HT than the younger ones. Patients with pathological value of HT were significantly more common among the older subgroup of patients, when divided according to the age at both cutoff values of 45 and of 60 years. Mean HT did not differ significantly according to the duration of HD treatment (subgroups A- no longer than 60 months, B- from 61 to 120 months, and C- longer than 120 months). The patients with pathological HT did not differ significantly in frequency among those subgroups, and the subgroups were not different according to the mean age (A- 50.30±13.20 years; B- 51.40±12.75 years; C- 55.80±10.55 years). In conclusion, our results along with other authors’ published data report on SNHL as very frequent finding among chronic HD patients and suggest multifactorial etiology. Accurate proportion of those with SNHL of unknown origin is not possible to determine. Those cases are probably not caused by uremic polyneuropathy and/or preterm vascular aging only, although those factors are likely to play crucial roles

Are Lipoprotein Disturbances in Chronic Hemodialyzed Patients only Renal Failure Related?

Chronically hemodialyzed (HD) patients frequently suffer from quantitative and even more often qualitative serum lipids disorders. Mostly they have increased triglycerides and VLDL-cholesterol, slightly increased or normal total and LDL-cholesterol and decreased HDL-cholesterol concentrations. The study compared lipid profile between two groups of chronic HD patients coming from regionally distinct areas, the continental and the maritime one. The aim was to examine the hypothetic influence of their different dietary habits on lipid profile. The study included 72 patients from continental region (39 men) and 50 from maritime part of the country (30 men). Patients suffering from diabetes mellitus, hypothyroidism, liver disease, alcoholics as well as sevelamer treated patients were not included. Prior to a HD session the patients were determined fasting total cholesterol, triglycerides, HDL- and LDL-cholesterol, total proteins, albumins and C-reactive protein serum concentrations. All patients were undergoing bicarbonate hemodialysis with polysulphone dialysers of low permeability. The continental group of patients were somewhat older, undergoing HD for longer period of time, of lower height, greater weight, greater body mass index, higher total (4.70±0.91: 4.42±1.02 mmol/L), and LDL-cholesterol (2.78±0.74:2.66±0.75 mmol/L) concentrations, while lower triglycerides (1.72±0.84:1.81±0.83 mmol/L) and HDL-cholesterol (1.13±0.42:1.16±0.54 mmol/L). However, all the differences were without statistical significance. Chi-square test showed that the continental group of patients consumed more often pork, bacon, smoked and cured meats, margarine, butter, walnuts, almonds, garlic, cream and full-fat cheese than fish. They prepare food more often with lard and sunflower oil. Almost every fourth continental patient received statins, while only every 25th in the maritime group of patients. There were not any statistically significant Chi-square values for differences in frequencies of patients with total cholesterol greater than 5.2 mmol/L, triglycerides above 1.6 mmol/L, HDL-cholesterol less than 1.1 mmol/L, LDL-cholesterol greater than 2.6 mmol/L, obesity and malnutrition between the two groups. Based on the results of this study we have concluded that diet has significant influence on lipid profile of HD patients. Even though the continental and the maritime groups of patients differed significantly in diet, they were similar in plasmatic lipoprotein concentrations. However, this similarity was ascribed only to statin treatment, which was more frequent in the continental group of patients. The influence of ESRD and HD as a method of renal replacement therapy on lipid profile was not more dominant than diet

Microbiological quality of water for hemodialysis and dialysates

Bolesnici liječeni ponavljanim hemodijalizama izloženi su tjedno količini od oko 400-500 litara dijalizata, koji nastaje miješanjem vode za hemodijalizu s dijaliznim koncentratom. Od krvi bolesnika dijeli ga samo polupropusna membrana. Zbog toga mora zadovoljavati i stroge standarde mikrobiološke kvalitete. U ovom radu, uz iznošenje vlastitih rezultata, govori se o mikrobiološkoj kvaliteti vode za hemodijalizu i dijalizata, njenom određivanju, utjecaju na zdravlje i kontroli, uz napomenu da su infekcije, nakon kardiovaskularnih bolesti, najčešći uzrok smrti ove skupine bolesnika. Obradom redovitih mikrobioloških analiza, rađenih tijekom 6-mjesečnog razdoblja, nađeno je da, uz redovite dezinfekcije središnjeg uređaja za pripremu vode za hemodijalizu i aparata za hemodijalizu, 10% uzoraka vode za hemodijalizu i 21,43% uzoraka dijalizata ne zadovoljava AAMI standarde. Osim Pseudomonas speciesa nisu identificirane druge bakterijske vrste. U razdoblju promatranja nije bilo pirogenih reakcija. U zaključku autori ističu da značajan postotak uzoraka vode za hemodijalizu i dijalizata nije u skladu s preporučenim standardima. Unatoč tome dobiveni rezultati ne odstupaju značajno od rezultata drugih istraživača.Chronic hemodialysis patients are exposed to nearly 400- 500 liters of dialysate weekly, which is prepared by mixing up water for hemodialysis with concentrate for hemodialysis. The dialysate is separated from patient\u27s blood only by a se-mipermeable membrane. Therefore it has to satisfy the strict standards of microbiological quality. Beside reporting our own results, this paper deals with microbiological quality of water for hemodialysis and dialysate, its determination, its influence on health and modes of its control, taking into consideration that after cardiovascular diseases, infections are the most common cause of death in this population. Analysing the results of regular microbiological tests carried out during a 6-month period, it has been found that, in spite of regular disinfections of the central water for hemodialysis treatment system and hemodialysis machines, 10% of the samples of water for hemodialysis and 21.43% of the samples of dialysate do not comply to the AAMI standards. No other bacterial strain except Pseudomonas species was identified. During the observation period there were no pyrogenic reactions. The authors conclude that a significant percentage of the samples of water for hemodialysis and the samples of dialysate are not in accordance with the recommended standards. In spite of that, the obtained results do not differ significantly from the results of other authors

Microbiological quality of water for hemodialysis and dialysates

Bolesnici liječeni ponavljanim hemodijalizama izloženi su tjedno količini od oko 400-500 litara dijalizata, koji nastaje miješanjem vode za hemodijalizu s dijaliznim koncentratom. Od krvi bolesnika dijeli ga samo polupropusna membrana. Zbog toga mora zadovoljavati i stroge standarde mikrobiološke kvalitete. U ovom radu, uz iznošenje vlastitih rezultata, govori se o mikrobiološkoj kvaliteti vode za hemodijalizu i dijalizata, njenom određivanju, utjecaju na zdravlje i kontroli, uz napomenu da su infekcije, nakon kardiovaskularnih bolesti, najčešći uzrok smrti ove skupine bolesnika. Obradom redovitih mikrobioloških analiza, rađenih tijekom 6-mjesečnog razdoblja, nađeno je da, uz redovite dezinfekcije središnjeg uređaja za pripremu vode za hemodijalizu i aparata za hemodijalizu, 10% uzoraka vode za hemodijalizu i 21,43% uzoraka dijalizata ne zadovoljava AAMI standarde. Osim Pseudomonas speciesa nisu identificirane druge bakterijske vrste. U razdoblju promatranja nije bilo pirogenih reakcija. U zaključku autori ističu da značajan postotak uzoraka vode za hemodijalizu i dijalizata nije u skladu s preporučenim standardima. Unatoč tome dobiveni rezultati ne odstupaju značajno od rezultata drugih istraživača.Chronic hemodialysis patients are exposed to nearly 400- 500 liters of dialysate weekly, which is prepared by mixing up water for hemodialysis with concentrate for hemodialysis. The dialysate is separated from patient\u27s blood only by a se-mipermeable membrane. Therefore it has to satisfy the strict standards of microbiological quality. Beside reporting our own results, this paper deals with microbiological quality of water for hemodialysis and dialysate, its determination, its influence on health and modes of its control, taking into consideration that after cardiovascular diseases, infections are the most common cause of death in this population. Analysing the results of regular microbiological tests carried out during a 6-month period, it has been found that, in spite of regular disinfections of the central water for hemodialysis treatment system and hemodialysis machines, 10% of the samples of water for hemodialysis and 21.43% of the samples of dialysate do not comply to the AAMI standards. No other bacterial strain except Pseudomonas species was identified. During the observation period there were no pyrogenic reactions. The authors conclude that a significant percentage of the samples of water for hemodialysis and the samples of dialysate are not in accordance with the recommended standards. In spite of that, the obtained results do not differ significantly from the results of other authors

The peritoneal membrane function and aging

U bolesnika liječenih peritonejskom dijalizom, peritonejska membrana djelomično zamjenjuje ekskretornu funkciju bubrega. Pitanje je smanjuje li se funkcija peritonejske membrane sa starenjem slično kao i bubrežna funkcija. Da bi odgovorili na to pitanje autori su analizirali funkciju peritonejske membrane (Kt/V i klirens kreatinina) 27 anuričnih bolesnika, prosječne dobi 58,84±10,65 godina, liječenih s ukupno 8 litara dijalizata dnevno, prosječno 32,56±28,41 mjesec. U skupini kao cjelini nađena je negativna značajna korelacija dobi s tjednim Kt/V (r=-0,627, p<0,05) i negativne neznačajne korelacije s tjednim kliren-som kreatinina peritonejske membrane (r=-0,321, NS) i s nemasnom tjelesnom masom (r=-0,085, NS). Svrstavanjem bolesnika u dvije skupine, prema dobi, nije nađena značajna razlika prosječnih vrijednosti Kt/V (1,95±0,25 : 2,08±0,36; t= 1,04, NS) i tjednog klirensa kreatinina peritonejske membrane (59,85±6,03 : 64,07 ±6,35 1/1,73 m2 tjelesne površine; t=l,73, NS) između bolesnika starijih (n=16) i mlađih (n=ll) od 60 godina. Stariji bolesnici imali su značajno manje izlučivanje kreatinina dijalizatom (81,84±18,33 : 99,82±19,64 jimol/kg tjelesne težine dnevno; t=2,40, p<0,05). Autori su zaključili da u bolesnika liječenih peritonejskom dijalizom nije nađena statistički značajna razlika funkcijskih pokazatelja peritonejske membrane usporedbom mlađih i starijih od 60 godina. Utjecaj dobi na funkciju peritonejske membrane ipak se ne može negirati, jer dobiveni rezultati pokazatelji su funkcije membrane i stanja karakterističnih za stariju dob.In patients undergoing peritoneal dialysis, peritoneal membrane substitutes partially the excretory renal function. The question remains whether the function of peritoneal membrane changes significantly with age. Therefore, the authors analysed the function of peritoneal membrane (Kt/V, creatinine clearance) in 27 anuric patients, mean age 58.84±10.65 years, treated with total of 8 liters dialysate daily, during the period of 32.56±28.41 months on average. For the whole group of examines there was a significant negative correlation found between age and weekly Kt/V (r~0.627, p<0.05), but not between age and creatinine cleance (r=-0.321, NS) or age and lean body mass (r=-0.085, NS). When divided into two groups: those older than 60 (n=16), those up to 60 years of age (n=ll), no significant difference was found regarding the mean values of weekly Kt/V (1.95±0.25 : 2.08±0.36; t=1.04, NS) and weekly creatinine clearance of peritoneal membrane (59.85±6.03 : 64.07±6.35 1/1.73 m2 body surface area; t=1.73, NS). Howewer, older patients had lower creatinine excretion per kg of body weight (81.84 ±18.33 : 99.82 ±19.65 jiimol; t=2.40, p<0.05). In conclusion, no significant difference in peritoneal membrane function was found between patients older and younger than 60 years. The difference in the function of peritoneal membrane established between the two groups of peritoneal dialysis patients could not be explained as the consequence of aging solely, i.e. the influence of accompaning features of an advanced age should not be neglected

The peritoneal membrane function and aging

U bolesnika liječenih peritonejskom dijalizom, peritonejska membrana djelomično zamjenjuje ekskretornu funkciju bubrega. Pitanje je smanjuje li se funkcija peritonejske membrane sa starenjem slično kao i bubrežna funkcija. Da bi odgovorili na to pitanje autori su analizirali funkciju peritonejske membrane (Kt/V i klirens kreatinina) 27 anuričnih bolesnika, prosječne dobi 58,84±10,65 godina, liječenih s ukupno 8 litara dijalizata dnevno, prosječno 32,56±28,41 mjesec. U skupini kao cjelini nađena je negativna značajna korelacija dobi s tjednim Kt/V (r=-0,627, p<0,05) i negativne neznačajne korelacije s tjednim kliren-som kreatinina peritonejske membrane (r=-0,321, NS) i s nemasnom tjelesnom masom (r=-0,085, NS). Svrstavanjem bolesnika u dvije skupine, prema dobi, nije nađena značajna razlika prosječnih vrijednosti Kt/V (1,95±0,25 : 2,08±0,36; t= 1,04, NS) i tjednog klirensa kreatinina peritonejske membrane (59,85±6,03 : 64,07 ±6,35 1/1,73 m2 tjelesne površine; t=l,73, NS) između bolesnika starijih (n=16) i mlađih (n=ll) od 60 godina. Stariji bolesnici imali su značajno manje izlučivanje kreatinina dijalizatom (81,84±18,33 : 99,82±19,64 jimol/kg tjelesne težine dnevno; t=2,40, p<0,05). Autori su zaključili da u bolesnika liječenih peritonejskom dijalizom nije nađena statistički značajna razlika funkcijskih pokazatelja peritonejske membrane usporedbom mlađih i starijih od 60 godina. Utjecaj dobi na funkciju peritonejske membrane ipak se ne može negirati, jer dobiveni rezultati pokazatelji su funkcije membrane i stanja karakterističnih za stariju dob.In patients undergoing peritoneal dialysis, peritoneal membrane substitutes partially the excretory renal function. The question remains whether the function of peritoneal membrane changes significantly with age. Therefore, the authors analysed the function of peritoneal membrane (Kt/V, creatinine clearance) in 27 anuric patients, mean age 58.84±10.65 years, treated with total of 8 liters dialysate daily, during the period of 32.56±28.41 months on average. For the whole group of examines there was a significant negative correlation found between age and weekly Kt/V (r~0.627, p<0.05), but not between age and creatinine cleance (r=-0.321, NS) or age and lean body mass (r=-0.085, NS). When divided into two groups: those older than 60 (n=16), those up to 60 years of age (n=ll), no significant difference was found regarding the mean values of weekly Kt/V (1.95±0.25 : 2.08±0.36; t=1.04, NS) and weekly creatinine clearance of peritoneal membrane (59.85±6.03 : 64.07±6.35 1/1.73 m2 body surface area; t=1.73, NS). Howewer, older patients had lower creatinine excretion per kg of body weight (81.84 ±18.33 : 99.82 ±19.65 jiimol; t=2.40, p<0.05). In conclusion, no significant difference in peritoneal membrane function was found between patients older and younger than 60 years. The difference in the function of peritoneal membrane established between the two groups of peritoneal dialysis patients could not be explained as the consequence of aging solely, i.e. the influence of accompaning features of an advanced age should not be neglected