One of the most common associated diseases in dialysis patients is anemia. The number of erythrocytes, hemoglobin and hematocrit is reduced in patients that suffer from anemia. These three measurement parameters represent the most important "red part" of the blood count. Due to renal insufficiency, patients on hemodialysis do not have enough erythropoietin, which healthy kidneys excreted, and is necessary for hematopoiesis. Erythropoietin (EPO) is the main regulator of the daily production of red blood cells. EPO that is execrated by peritubular capillary membrane cells in the kidneys circulates within plasma in order to interact with target cells in the bone marrow to maintain or stimulate erythropoiesis. The main purpose of the action of EPO is the formation of erythroid colonies. During observation of differences in the ordination of EPO in each group between men and women, there is no statistical significance evident in the incidence of anemia before and after therapy, as in p=0.70. The target concentration of hemoglobin, which must be constantly maintained in people with chronic renal anemia, is 110-120 g/l, while the target value of the number of red blood cells is 4-5x10 12 /l and the hematocrit value is 0.35-4.5 l/l, with a slight outflow depending on the gender of the patient. The final values of the participants in our study treated with epoetin alpha show higher values of hemoglobin, hematocrit and erythrocytes, while the average values recorded in participants treated with darbepoetin decreased.
One of the most common associated diseases in dialysis patients is anemia. The number of erythrocytes, hemoglobin and hematocrit is reduced in patients that suffer from anemia. These three measurement parameters represent the most important "red part" of the blood count. Due to renal insufficiency, patients on hemodialysis do not have enough erythropoietin, which healthy kidneys excreted, and is necessary for hematopoiesis. Erythropoietin (EPO) is the main regulator of the daily production of red blood cells. EPO that is execrated by peritubular capillary membrane cells in the kidneys circulates within plasma in order to interact with target cells in the bone marrow to maintain or stimulate erythropoiesis. The main purpose of the action of EPO is the formation of erythroid colonies. During observation of differences in the ordination of EPO in each group between men and women, there is no statistical significance evident in the incidence of anemia before and after therapy, as in p=0.70. The target concentration of hemoglobin, which must be constantly maintained in people with chronic renal anemia, is 110-120 g/l, while the target value of the number of red blood cells is 4-5x10 12/l and the hematocrit value is 0.35-4.5 l/l, with a slight outflow depending on the gender of the patient. The final values of the participants in our study treated with epoetin alpha show higher values of hemoglobin, hematocrit and erythrocytes, while the average values recorded in participants treated with darbepoetin decreased.
Chronic kidney disease (CKD) is one of the leading public health problems in the world, and according to research conducted on different races and in different parts of the world, approximately one in 10 adults has some form of kidney damage. In stage 3 CKD, the kidneys lose the ability to remove excess phosphorus that accumulates in the body, leading to hyperphosphatemia, which promotes an increase in parathyroid hormone (PTH), and the appearance of secondary hyperparathyroidism. It is associated with increased morbidity and mortality and negatively affects the quality of life of patients with chronic kidney disease. It is generally considered that parathyroid hormone is a systemic "toxin" in CKD and its increased secretion is a sign of progression of kidney disease. Homeostasis of calcium and phosphorus is maintained through a complex connection between bones, intestines, kidneys and parathyroid glands. A retrospective - prospective study will be conducted in the hemodialysis center of the Živinice Health Center. 49 patients suffering from secondary hyperparathyroidism will be included in the study. Patients are of both sexes, aged 18 to 85 years. As part of secondary hyperparathyroidism in hemodialysis patients, 75.5% of patients had PTH values below 1000 pg/ml, while 24.5% had PTH values above 1000 pg/ml. A decrease in serum Ca and P values was recorded in 32% of subjects who were treated with paricalcitol. A decrease in serum Ca and P values was recorded in 56% of cases. Observing the effect of paricalcitol and cinacalcet, it is observed that the greatest reduction in PTH values in patients who had PTH values higher than 1000pg/ml - treated with cinacalcet is 44%.
People with arterial blood pressure >140/90 mmHg (hypertension) have accelerated development of atherosclerosis and changes in blood vessels and other organs of the body, therefore, such arterial blood pressure must be treated. A hypertensive crisis is defined as an extreme increase in arterial blood pressure with a systolic blood pressure over 180 mmHg and diastolic blood pressure over 120 and 130 mmHg, respectively, and poses an immediate danger to the patient's life. At the heart of each hypertensive crisis is severe hypertension. In the Emergency medicine center Zivinice has been carried out a prospective study ehich include four study groups were formed as a sequential sample of 160 participants of both sexes. By administering a combination of furosemide amp. And diazepam amp. The mean systolic blood pressure in all observed groups decreased from 186.25 mmHg to 167.5 mmHg, and the mean diastolic blood pressure decreased from 120.53 mmHg to 97.5 mmHg. By prescribing a combination of nifedipine tab., furosemide amp. and diazepam amp., the average systolic blood pressure all observed groups was reduced from 186.25 mmHg to 152 mmH, and the average diastolic blood pressure was reduced from 120.53 mmHg to 91.2 mmHg.
Spironolactone is a diuretic and is often used in the treatment of hypertension. This medicine is very good when it comes to lowering the blood pressure, and this is also a drug of choice when it comes to the stage of hypertensive urgencies and emergencies. It can be administered intravenously, and the effects reach a maximum within 30 minutes. Due to the fact that this medicine can causes hifher level of potassium ions it can a blood glucose and arrhythmias. A prospective random study was carried out in Hemodyalisis center of Public Health Institution Center “Zivinice’’, where we analyzed 120 patients which were suffering from hypertension heart disease, and diabetes. We included all 120 patient whom suffering from hypertension and diabetes. Clinical and laboratory data of patients were collected during period from February to August 2022. Looking at all the three groups of patients, it can be noticed that the maximum value of arterial blood pressure upon arrival at the Hemodyalisis ceneter had patients suffering from hypertension and diabetes, where the average value of arterial blood pressure was 173/113 mmHg. According to analysis for all three observed groups of patients, after treatment with spironolactone there is no statistical significance in the incidence of arrhythmias between the groups where. Looking at the summary for all three groups of patients, the average value increase of blood glucose after treatment with spironolactone is 0.9 mmol/l. Spironolactone is safe for the treatment of hypertension in diabetic patients.
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