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.
Хроничното бъбречно заболяване (ХБЗ) е прогресивно болестно състояние, което може да достигне до терминален стадий на хронична бъбречна недостатъчност (ESRD). От съществено значение е да можем да идентифицираме хората с висок риск за прогресия на ХБЗ и свързаните с него сърдечно-съдови заболявания (ССЗ). Протеинурията е най-чувствителният маркер за прогресия на ХБЗ в клиничната практика, особено когато се комбинира с eGFR, но те имат известни ограничения. Идентифицирани са обещаващи специфични и високоселективни биомаркери, свързани с ранното установяване и превенция на ХБЗ. Качеството на живот (QOL) при тези пациенти е изключително важно и е свързано с тяхната функционална активност, благополучие, общо възприемане на здравето във физически, психологически и социални аспекти. Наблюдаваната при пациенти с ХБЗ малнутриция, промяна в ритъма на ежедневието, също допринася съществено за влошеното им качество на живот.
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 part of the modern pandemic of chronic, non-communicable diseases, which is one of the leading causes and causes of death among the world's population. CKD affects nearly 850 million people worldwide and is the 6th leading cause of death. In Bulgaria, the incidence is 12.8%, and 90% of the patients have advanced kidney disease. According to the summarized data of the National Statistical Institute (NSI) and the National Center for Public Health and Analysis at the Ministry of Health for 2018, urogenital diseases accounted for 1.4% of mortality in the country, and this percentage increased in 2019 by 1.7%. The reasons for this probably lie in the increasing frequency of risk factors among the population. In order to early detect the risk factors for CKD and the timely diagnosis of patients with hidden kidney disease and their further followup, in July 2020, the Clinic of Nephrology at the St. Marina University Hospital in Varna, supported by a project of the Medical University of Varna, conducted a free screening campaign for 147 people among the population of Dalgopol municipality. In addition, the campaign aimed to raise public awareness of CKD and renal replacement therapy methods (hemodialysis, peritoneal dialysis, and kidney transplantation). During the campaign, 58 participants (39%) were newly diagnosed with kidney disease. This indicates the lack of routine physical, imaging and laboratory tests and failure to diagnose kidney disease in its early stages. The financial burden that undiagnosed kidney problems, and subsequently end-stage renal disease, entail, puts even highly developed economies to a severe test. Screening and prevention can prevent chronic kidney disease, and where management strategies are in place, the incidence of end-stage renal disease is reduced.
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.
Трудовата адаптация е продължителен процес на приспособяване към средата и запознаване на новопостъпилите медицински сестри със специфичната професионална дейност в отделението. Това е период на привикване към утвърдените правила и колектива, настъпва промяна във възгледите и поведението на работещите по посока, съответстваща на външните условия. Цел: Целта на направеното проучване бе да се изследва периодът на адаптация към работата на медицинската сестра в хемодиализен център.
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.
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