The setup described permits individualized therapy of high quality. The high serum albumin values and our very low incidence of carpal tunnel syndrome underline the importance of water and dialysate quality.
In recent years the percentage of diabetic patients on haemodialysis has increased. Considering the high frequency of intradialytic hypotensive and hypoglycaemic episodes experienced by these patients, it was the aim of the present study to evaluate the influence of different dialysate glucose concentrations (5.5 mmol/L or 11 mmol/L) on blood pressure and glycaemic regulation, using special dialysis equipment - the GENIUS System. This cross-over, prospective and randomised study, total duration 14 weeks, included 20 diabetic patients on maintenance haemodialysis. Group 1: 9 patients dialysed using dialysate with a glucose concentration of 5.5 mmol/L and after 7 weeks switched to dialysate with a glucose concentration of 11 mmol/L. Group 2: vice versa. Results show a statistically higher number of patients with hypoglycaemic and hypotensive episodes using dialysate with a 5.5 mmol/L glucose concentration. Also, mean serum glucose values were higher during haemodialysis sessions with a glucose dialysate concentration of 11 mmol/L. There were no statistical differences between the groups in laboratory values, HbA1C, insulin doses or in anthropometric parameters. Our results suggest that fewer diabetic patients undergoing haemodialysis using a higher dialysate glucose concentration of 11 mmol/L have hypoglycaemic and hypotensive episodes. Since this dialysate glucose concentration had no influence on lipid or hepatic metabolism, anthropometric parameters and especially HbA/1C values in this short-term study, the long term examination of its effects is warranted.
Zusammenfassung
Der vom Gesetzgeber vorgegebene Auftrag gem?? ??137?SGB?V, wonach Qualit?tssicherungsma?nahmen hinsichtlich ihrer Wirksamkeit bewertet werden sollen, ist mit der Qualit?tssicherungsrichtlinie Dialyse (QSD-RL) erfolgt. Mit der Richtlinie ist ein Instrument der vergleichbaren Qualit?t geschaffen worden, welches seit deren Inkrafttreten eine offensichtliche Verbesserung der Dialysequalit?t ergab. In allen 4 ?berwachten Parametern konnten die Ergebnisse in den Jahren nach dem Inkrafttreten der Richtlinie bis zum ausgewerteten Jahr 2013 kontinuierlich verbessert werden (G-BA-Jahresbericht 2013). Der Bericht erm?glicht durch die ?bersichtliche und regional strukturierte Darstellung einen vergleichenden Blick auf die Qualit?t der vertrags?rztlichen Dialysebehandlung in Deutschland: ?Die QSD-RL ist somit ein wichtiges und wirksames Instrument, um die Qualit?tsentwicklung in der ambulanten Dialysebehandlung zu f?rdern und die Qualit?tsentwicklung ? sowohl bezogen auf das gesamte Bundesgebiet als auch auf der Ebene einzelner Kassen?rztlicher Vereinigungen ? abzubilden.?
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