Cilj. Bolesnici na lijecenju hemodijalizom (HD) zbog osnovne te niza pridruženih bolesti moraju uzimati određeni broj lijekova. Dobra suradljivost u uzimanju redovite kronicne terapije preduvjet je ocekivanih ishoda lijecenja te ukupnog preživljenja. Na suradljivost bolesnika, između ostalog, utjece broj lijekova u terapiji, broj pridruženih bolesti, stanje uhranjenosti bolesnika te ukupna sposobnost bolesnika pri obavljanju svakodnevnih aktivnosti. Procjenu suradljivosti najobjektivnije možemo uciniti primjenom Morisky bodovnog sustava. Morisky bodovni sustav sastoji se od upitnika sa osam pitanja vezanih za redovitost u uzimanju propisanih lijekova, zaboravljivost i subjektivno opterecenje bolesnika propisanom terapijom. Željeli smo ispitati suradljivost bolesnika na lijecenju redovitom HD u uzimanju redovne kronicne terapije putem Morisky bodovnog sustava te usporediti dobivene vrijednosti s vrijednostima dobivenim drugim bodovnim sustavima koje rabimo pri ukupnoj procjeni stanja bolesnika u svakodnevnoj klinickoj praksi (Barthelov indeks - sposobnost bolesnika u obavljanju svakodnevnih aktivnosti, malnutricijsko inflamacijski zbroj - MIS te indeks pridruženih bolesti prema Daviesu). Materijali i metode. U presjecno ispitivanje ukljuceni su bolesnici na lijecenju redovitom HD dulje od tri mjeseca u Klinickom bolnickom centru Rijeka. Podatci su dobiveni iz pratece medicinske dokumentacije te direktnim razgovorom uz postelju bolesnika. Na dan srednje HD u tjednu ispunjeni su upitnici za izracun Morisky zbroja, Barthel indeksa, MIS te Davies indeksa. Rezultati. Ukupno je analizirano 120 bolesnika, od toga 70 (60%) muskaraca i 35 (30%) dijabeticara. Srednja životna dob je bila 69±13 godina (raspon 24-83 godine), a prosjecna duljina lijecenja HD 50±46 mjeseci (raspon 3-204 mjeseca). Najcesce osnovne bubrežne bolesti bile su arterijska hipertenzija 41 (34%) i dijabeticka nefropatija 34 (30%). Prema broju propisanih lijekova bolesnici su razvrstani u cetiri skupine [n(%)]: 12 [3 (2%)]. Među muskarcima i ženama nije bilo znacajne razlike u dobi, broju propisanih lijekova, Morisky, Davies te Barthel bodovnom sustavu. MIS je u žena bio znacajno niži (p<0, 05). Morisky bodovni sustav je znacajno pozitivno korelirao sa brojem propisanih lijekova (r=0, 14, p<0, 05), ali nije imao znacajne korelacije sa dobi bolesnika, Davies indeksom i MIS-om. Dob bolesnika i broj lijekova u terapiji su znacajno negativno korelirali (r=0, 15, p<0, 01). Pokazana je znacajna negativna korelacija Barthel indeksa sa MIS (r=-0, 367, p<0, 01) i Davies bodovanjem (r=-0, 16, p<0, 01). Smanjena suradljivost sa barem jednim od osam mogucih bodova po Morisky bodovnom sustavu pokazana je u 53 (44%) bolesnika, bez znacajne razlike između spolova. Zakljucak. Suradljivost HD bolesnika u uzimanju kronicne terapije smanjuje se povecanjem broja propisanih lijekova, dok dob na istu ne utjece. Suradljivost je obrnuto proporcionalna s brojem pridruženih bolesti te proteinsko-energetskom pothranjenosti. Potrebno je uložiti dodatan napor u informiranju HD bolesnika o potrebi redovitog uzimanja cjelokupne propisane kronicne terapije.

Objective: Arterial hypertension (AH) is an adverse effect of erythropoiesis-stimulating agent (ESA) treatment among hemodialysis (HD) patients. Among several mechanisms considered in the pathogenesis of ESA-induced hypertension are rise of hematocrit and erythrocyte mass and direct vasopressor action of ESA. The aim of this study was to determine the effect of different ESA type to the incidence of AH among euvolemic HD patients. Design and method: We included all prevalent HD patients from the Department of Nephrology, Dialysis and Kidney Transplantation, Clinical Hospital Centre Rijeka, from January 1, 2014, to December 31, 2015, allocated into four groups – those without ESA, and those with short, medium and long acting ESA, observing weekly dosage in I.U. Every six months, before starting the midweek HD session, multifrequency bioimpedance analysis (MF-BIA) was performed together with serum albumine and hemoglobine levels. Blood pressure (BP) and mean arterial pressure (MAP) were assessed before and at the end of HD treatment. Patients with volume-dependent AH based on MF-BIA assessement (>2.5 litres overhydration) and not reaching two or more measurements were excluded. Results: A number of 350 measurements were eligible for statistical analysis, made on 153 patients (age 69.1 ± 13.8, range 23–92 yrs, 56% male, 25% diabetic, HD duration 61.34 ± 74.61 months). There was no statistically significant difference between the groups at the baseline. Mean weekly ESA dose was 6998.16 ± 4856.86 I.U. In comparison to non-ESA group (25% measurments); short, medium and long acting ESA showed statistically significant higher incidence of AH (42%,p = 0,03; 50%,p = 0.002; and 43%,p = 0,018, respectively) with highest incidence at medium and long acting ESA (p = 0,016). Both BP and MAP before and after HD session strongly correlated with ESA dose but not with serum albumin and hemoglobin levels. Conclusions: Our study showed that all three types of ESA increased the incidence of AH in euvolemic HD patients, with highest incidence related to medium and long acting ESA. Systolic and dyastolic BP and MAP correlated with weekly ESA dose while serum hemoglobine and albumin levels showed no correlation with BP. Further investigations in greater number of patients are needed.

Background/Aim: Acute kidney injury (AKI) is a clinical syndrome characterized by sudden reduction in renal function, followed by oliguria or anuria. Despite the progress in modern medicine, the mortality from AKI is still high. Therefore, we were interested to analyze the effect of continuous renal replacement therapy (CRRT) on the survival of our patients with AKI. Patients and Methods: In this retrospective study we have analyzed 299 patients treated with CRRT in intensive care unit (ICU) in the period from 01 January 2010 to 30 June 2015. Patients’ demographic characteristic, as well as prescribed CRRT therapy and patients’ outcome were analyzed. Results: Out of 299 analyzed patients, there were 201 (67%) men and 98 (33%) women with an average age over 65 years of age (ranging from 1-89 years). The most common prescribed treatment was a continuous veno-venous hemodialysis (CVVHD) (85% of our patients), followed by veno-venous hemodiafiltration (CVVHDF) (12.7%) patients and continuous veno-venous hemofiltration (CVVH) in 7 (2.3%) of them. CVVHDF using AN69 membrane was applied in 11 (29%) patients. Average duration of treatment lasted for 72 (range 1-489) hours. The average prescribed dialysate flow was 1488 ml/h (500-3000ml / h) and the average flow of replacement of the solution was 1475 ml/h (600-3000 ml/h). Additionally, prescribed predilution (prescribed in 44 patients) and postdilution (prescribed in 45 patients) solutions were ranged from 0-2000ml/h. The average blood flow was adjusted to 200 ml/min (range 30-400 ml/min) with an average ultrafiltration rate of 135 ml/h (range of 0-400ml/h). The most common used anticoagulation were enoxaparin (90%) and fractionated heparin (4.3%). On the other hand, in 1.7% of patients we did not used anticoagulation during the CRRT treatment. Of 299 analyzed patients, 107 (35.8%) of them died, while, 23 (7.7%) of patients did not recovered their renal function and continued further renal replacement therapy. One hundred and thirty (56.5%) patients had recovered their renal function in the end of the CRRT treatment. Conclusion: The incidence of AKI in the ICU was 30% and the mortality rate is around 50%. Although, the mortality rate in patients with AKI treated with CRRT is still high, the percentage of patients with preserved renal function is increasing.