Our study illustrated the wide variability in BPsys regardless of the degree of DeltaHS. The HRP provides an invaluable tool for classifying patients in terms of BPsys and DeltaHS and the proximity of these parameters to reference ranges. This represents an important step towards more objective choice of strategies for the optimal treatment of hypertension and FO. Further studies are required to assess the prognostic and therapeutic role of the HRP.
Background: Guidelines recommend regular measurements of the delivered hemodialysis dose Kt/V. Nowadays, automatic non-invasive online measurements are available as alternatives to the conventional method with blood sampling, laboratory analysis, and calculation. Methods:In a prospective clinical trial, three different methods determining dialysis dose were simultaneously applied: Kt/VDau (conventional method with Daugirdas’ formula), Kt/VOCM [online clearance measurement (OCM) with urea distribution volume V based on anthropometric estimate], and Kt/VBCM [OCM measurement with V measured by bioimpedance analysis (Body Composition Monitor)]. Results:1,076 hemodialysis patients were analyzed. The dialysis dose was measured as Kt/VDau = 1.74 ± 0.45, Kt/VOCM = 1.47 ± 0.34, and Kt/VBCM = 1.65 ± 0.42. The difference between Kt/VOCM and Kt/VBCM was due to the difference between anthropometric estimated VWatson and measured VBCM. Compared to Kt/VDau, Kt/VOCM was 15% lower and Kt/VBCM 5% lower. Kt/VDau was incidentally prone to falsely high values due to operative errors, whereas in these cases OCM-based measurements Kt/VOCM and Kt/VBCM delivered realistic values. Conclusions:The automated OCM Kt/VOCM with anthropometric estimation of urea distribution volume was the easiest method to use, but Kt/VBCM with measured urea distribution volume was closer to the conventional method.
Using the method of in vivo magnetic resonance spectroscopy we examined 17 patients with moderately advanced chronic renal insufficiency, 21 patients with chronic renal failure treated by haemodialysis, and 15 dialyzed patients with symptomatic renal osteopathy. The ratios of intracellular phosphocreatine and inorganic phosphate concentrations of these subjects measured at rest were compared with those found in healthy controls. While we noted significantly lower (p < 0.01) ratio values in all patients, subjects with osteopathy showed a lower value than dialyzed patients free of bone disease. Haemodialysis improved the result of examination in 7 patients. The results can be summarized as follows: (1) patients with altered renal function have significantly impaired energy metabolism of skeletal muscle, and (2) the disorder is more severe in patients with renal osteopathy than in those free of it.
Common ghrelin variants may have an effect on changes in biochemical and anthropometric parameters in hemodialyzed patients over time and could be used in the future to plan individualized therapy.
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