Chronic kidney disease (CKD) is a progressive disease that might result in an end stage renal disease (ESRD), raising cardiovascular morbidity and mortality. Life expectancy among patients with CKD could significantly be reduced as a result of an advanced atherosclerosis and followed by a premature death from cardiovascular disease (CVD). CVD is a condition of a subclinical systematic inflammation that involves cytokines produced by adipose tissue. Visfatin is an adipocytokine with potentially important effects on glucose metabolism and atherosclerosis. Therefore, it could be treated like a new marker of endothelial dysfunction (ED) in CKD patients. It has been suggested that visfatin levels could increase as CKD progresses, which could be due to either the chronic inflammation associated with CKD and/or the hypoxia resulting from tubular necrosis, anemia and reduced capillary blood flow. As CKD progresses, visfatin levels among these patients most often spell increased mortality caused by cardiovascular events. The current research has been conducted among a total of 80 subjects with CKD who were divided into two groups - pre-dialysis (30) and hemodialysis treatment (50) patients from the Nephrology and Dialysis Clinic at the UMHAT “Sveta Marina” Varna. Demographics indicators and levels of visfatin, iFGF-23 and iPTH were inevstigated.

Bone and mineral disorders (BMDs) in chronic kidney disease (CKD) are increasingly being studied, and prophylaxis and treatment are conducted, but they still remain one of the most severe systemic illnesses in patients with CKD. In patients with end-stage CKD and secondary hyperparathyroidism, accompanying metabolic disorders of calcium and phosphorus homeostasis may lead to pathological changes in bone and blood vessels, which increase the risk of bone fractures and cardiovascular (CV) events. High levels of parathyroid hormone (PTH), calcium and phosphorus are associated with increased morbidity and mortality in dialysis patients. Dialysis treatment is a renal replacement method that continues the life of patients with CKD, temporarily improving existing bone pathology, but it more often accelerates its progression. Therefore, the symptoms, developmental and complications of BMD-CKD are demonstrated and manifested in patients with extracorporeal treatment. Treatment of BMD requires constant monitoring of CaP exchange, PTH, serum of Vitamin D levels and the protein bone markers-osteocalcin, bone alkaline phosphatase. Despite the systemic use of active metabolites of vitamin D, phosphate binders and calcimimetics, in many patients with secondary hyperparathyroidsm, inadequate biochemical control has been observed. In the Dialysis Clinic at St. Marina University Hospital, Varna, two groups of patients on hemodialysis (HD) and with CKD-2/3 stage with secondary hyperparathyroidism, were followed and had their serum biomarker levels compared-PTH, bone alkaline phosphatase (BAP), osteocalcin, and vitamin D. The results showed statistically significant differences between the two groups in the investigated serum levels of the indicators.

Интрадиализната хипотония има значителна роля за заболеваемостта и смъртността, свързана с поддържащата хемодиализа. По-голямата точност при определяне на сухото тегло, използвайки технология за биоимпеданс и системи за обратна обратна връзка, предназначени да предотвратят бързи колебания в обема на кръвта, наскоро показват, че намаляват честотата на това усложнение. Фармакологичните стратегии, предназначени да поддържат периферна съдова резистентност при пациенти с недостатъчно освобождаване на ендогенни вазоконстриктори, продължават да бъдат изследвани. Внезапното и бързо развитие на интрадиализната хипотония може да отговори на специфични антагонисти на хипотензивни медиатори.

No abstract

The creation and maintenance of effective and functioning vascular access together with successful management of its frequent complications cause still more close collaboration of different specialists engaged with the morbidity, hospitalisation and treatment of patients with chronic kidney diseases (CKD). The organisation of a follow-up, including adequate assessment and monitoring of clinical parameters of vascular access as well as the quality of dialysis should be unified in all dialysis centres. This proactive approach and care are expected to lower the incidence of thrombosis, infections and achieve good long term results. Imaging and functional testing methods are crucial for the duration of dialysis treatment and better quality of life for patients. Collaboration between specialists nephrologists and other reference points (vascular surgeons, imaging specialists, general surgeons and therapists) underlies the modern algorithm for ECC treatment. Imaging and other functional, methods have a decisive significance for the duration of dialysis treatment and the good quality of life of the patients. The collaboration between nephrologists and other specialists (vascular surgeons, image specialists, general surgeons and internists) is the basis for contemporary algorithm for extracorporeal treatment.

Chronic kidney disease (CKD) is a risk factor with an independent significance for the development and progression of cardiovascular diseases and mortality. In recent years, great attention has also been paid to the type of heart and blood vessel involvement in CKD. The cardiorenal syndrome occurs with a disruption of the healthy relationship between the kidney function and the heart, maintaining hemodynamics and maintaining organ perfusion. The dysfunction of one organ creates prerequisites for an altered function of the other target organ. A common finding in advanced kidney failure is mitral, aortic sclerosis and calcinosis. Clinical thinking of the physician for cardiovascular syndrome and understanding of its pathophysiological characteristics will significantly improve prognosis and quality of life in patients with cardiovascular and chronic kidney disease.

Онлайн-хемодиафилтрацията (OL-HDF) като бъбречнозаместителна терапия набира значителна скорост последните години поради допълнителната полза от повишения клирънс на средните молекули, отговорни за органната увреда и развитието на усложненията при пациентите с краен стадий на ХБЗ (ESRD). Благоприятният ефект на OL-HDF върху смъртността от различни причини, както и сърдечносъдовата смъртност и заболеваемост се докладва от някои клинични проучвания. Качеството на живот, свързано със здравето (HRQOL), е важен компонент на грижите при пациентите на хемодиализа и представлява интерес както за доставчиците на здравни услуги, така и за пациентите. Подобреното качество на живот при пациенти на хемодиализа е свързано както с намален процент на хоспитализации, заболеваемост и смъртност, така и с по-високо самочувствие, благосъстояние и психологически комфорт. Данните за HRQOL при пациенти в краен стадий на бъбречно заболяване (ESRD) при OL-HDF са оскъдни и с незначително качество.В Клиниката по нефрология и диализа при УМБАЛ " Св. Марина" -Варна, направихме сравнителен анализ върху 41 пациенти на ХД на средна възраст 58,6±12 години ( 36 -70) , разпределени в две групи -I група (n=19), провеждащи конвенционална ХД, и II група (n=22), провеждащи онлайн-ХДФ в продължение на 6 месеца. Основният метод на изследването се основава на стандартизиран въпросник за качеството на живот при бъбречни заболявания (KDQOL-SF36), съдържащ 36 елемента за оценка на осем здравни концепции на HRQOL, както и статистическите данни за хоспитализации, заболяемост и смъртност при пациентите .Проучването показва,че използването на OL-HDF е свързано с по-добро качеството на живот, свързано със здравето, и в двете измерения: скала на физическия компонент и скалата на психичните компоненти. Отчита се намален брой годишни хоспитализации, по-малка честота на сърдечносъдовите инциденти, подобрение на артериалната хипертония, хроничната болка и скованост в ставите, сърбежите, както и подобрен хранителен статус и отговор към еритропоетиновата терапия.

methods of extracorporeal technological substitution of damaged or even lost organ functions but also on the professio0nal psychological management of accompanying stress and anxiety due to the disease.The stress model introduces the social aspect as a bridge between the psychological and somatic functions and this way integrates the etiopathogenic factors. It is suggested that stress causes physiological dysfunctions through psychological mechanisms.The psychological hypertension and injuries exert a powerful influence on the already existing disease. This stands out mainly in the patients with chronic diseases and with CRF in particular. They are traumatised not only by the physical suffering due to the specificity of the primary disease but also ABSTRACT PURPOSE: Any patients with chronic diseases, and especially those with chronic renal failure, face not only the specific physical aspects of their own primary pathology but also the psychological distress when realizing the severity of the progression of this disease and its poor prognosis. The objective of this study was to reveal some psychological features of the patients on haemodialysis. MATERIAL AND METHODS: The investigation covered 70 patients, 43 males and 27 females with chronic renal failure treated in the Clinic of Dialysis of Varna and in the Dialysis Centre of Targovishte. The patients filled in anonymous questionnaires and underwent a psychological examination according to a modified anxiety scale.RESULTS: Recently, the number of emergency cases in both haemodialysis centres increased. In Varna, the emergency cases were 34 out of 37 while in Targovishte, these amounted to 8 out of 11. This hampered the provision of sufficient information about the disease to the patients. At the onset of treatment, social activity was preserved in 44% of the patients while after 12 months this persisted in 16% of them. More than 85% of the patients retired due to disability caused by the renal disease. The influence on the interpersonal relations of the disease-related stress and anxiety was very unfavourable. CONCLUSION: There is a necessity to apply individualized psychotherapeutic approach to the patients with chronic renal failure in order to improve their adjustment to this severe pathology and collaboration with the physician as well as to minimize their feeling of inevitability.