Dimitrov, H.

Nenov, D.

English

Varna Medical University Press: Journals

S E Q U E N T I A L HAEMODIALYSIS AND ITS INDICATIONS D. Nenov, H. Dimitrov A certain number of patients set to chronic haemodialysis (HD) are siiper-liquescent due to unproper regimen and diet, irregular series of haemodialysis, late beginning of HD, etc. A l l that requires a considerable dehydration of the Fig . 1 patient in the course of HD which results in definite unfavourable additional side-effects and complications: collapse, headache, disequilibrium syndrome, muscle cramps, vomitting, etc. These complications can be easily eliminated by applying of the so-called «sequentional HD» (synonyms: dry dialysis, ultra-diffusion, dry ultrafiltration). Sequentional HD is an elimination of the tissue fluids by using of haemodialysis apparatus — capillary kidney or kidney of the type «shpulla» with increased filtration preasure but no current of any dialysis liquid (1 , 2, 3). Thus, elimination of isotonic fluid is performed and this is the reason that patients set to sequentional HD have no complaints. Besides, sequentional HD provides additional elimination of substances with higher molecular weight off the plasma. I t is another extra improvement of the condition due to the eliminated middle molecular weight molecules, i . e. main toxic substances in patients with uremia (1). We applied sequential HD to patients set to HD-treatment; age between 1 and 5 years. HD was performed with capillary kidneys Hemoflo 1,3 m 2 (Fre-senius). «Dry dialysis» was 1V2 hour, thus eliminating 3,7 1 filtrate; average blood-current of 250—530 ml/min. After the end of this «dry» dialysis the pa-tients were subjected to HD (duration 5 or 2,5 hours). F ig . 1 shows the re-sults of the sequentional HD of one our patient. Ultrafiltrate of 3812 ml eli-minates 8,14 g urea; 0,74 g creatinin; 0,35 g uric acid; 24,89 mEk potassium; 79 526,1 mEk sodium; 376,6 mEk chlorides; 9,45 mEk calcium; 8,8 mEk magne­sium. The hypertension of the patient — up to 220/110 mmHg is treated by 1 — 2 pills dopegit daily and normalizes at the end of treatment. Analysing our 20 sequentional HD we establish average elimination as follows: 3685 ml filtrate; 6,28 g urea; 0,51 g creatinin; 0,319 g uric acid; 18,43 mEk potassium; 482,78 mEk sodium; 369,73 mEk chlorides; 11,03 mEk cal­cium and 7,44 mEk magnesium. Almost all patients restore at the beginning and in the course of the se­quentional HD; a certain number of them report no more itches which can be probably explained with decrease of parat-hormon and considerable elimina­tion of phosphorus. Some of our patients are subjected to a longer dry ultrafiltration (5 hours); as a result of that 12,5—14,0 1 filtrate is obtained. This is very close to the effect of haemofiltration with the only difference that we apply the dialysis apparatuses. The method is applicable in every Department of Dialysis. Conclusion Our data show that the sequentional dialysis is applicable and suitable for all patients with superliquescence and higher percent nitrogen compounds at the beginning of HD. Isotonic tissue fluid removal (elimination) is easily accepted by the patients in comparison to the essential HD; the latter causes considerable loss of weight followed by muscle cramps, hypotonia or disequil­ibrium syndrome. The sequential dialysis can be successfully applied to patients with hyper­parathyroidism, polyneuropathia and arterial hypertension which can not be. influenced by other means. R E F E R E N C E S 1. B e r g s t r o m , J . Ultrafiltration without simultaneous dialysis for removal of excess fluid. — Proc. E D T A , 15, 1979, Tunbridge— Wells, 260—270. — 2. К j е 1 1 -s t r a n d , С. M. Current problems of long-term haemodialysis. — Dialysis and Trans­plantation, 9, 1980, 4, 295—299. — 3. R a m o n , G . , R . N . D u a r t e. Ultrafiltra­tion revisited. —-Dialysis and Transplantation, 6, 1977, 9, 33—39. ИНДИКАЦИИ ПРИМЕНЕНИЯ СЕКВЕНЦИАЛЬНОГО ГЕМОДИАЛИЗА Д. Ненов, Хр. Димитров Р Е З Ю М Е Сообщаются результаты клинического применения секвенциального диализа у боль­ных хронической почечной недостаточностью, находящихся на лечении посредством 7 периодического гемодиализа. Указывается на несколько индикаций секвенциального диализа: позднее включение больных на диализ, с наличием высокой задержки шлаков и с гипергидратацией; с гипер-паратиреоидизмом; с полиневропатией и с неподдающейся лечению посредством диализа артериальной гипертонией. 

SEQUENTIAL HAEMODIALYSIS AND ITS INDICATIONS

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SEQUENTIAL HAEMODIALYSIS AND ITS INDICATIONS

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Varna Medical University Press: Journals