Mirjana Lausevic

Efficacy of bolus intravenous iron treatment in peritoneal dialysis patients

INTRODUCTION Normocytic, normochromic anemia is one of the first signs of chronic renal failure and it is common in patients on chronic dialysis treatment. It causes decrease in oxygen supply to tissues, increases cardiac minute volume, causes left ventricular hyperthrophy, cardiac insufficiency, disorders related to cognitive functions and immune response, and increases morbidity and mortality rates. The leading cause of anemia in patients on chronic peritoneal dialysis (PD) is iron depletion and most patients on PD need oral or parenteral iron supplementation. The aim of this study was to evaluate our first experience with bolus intravenous ferrogluconate therapy in patients on chronic peritoneal dalysis at the Nephrology Clinic of the Clinical Center of Serbia (CCS). MATERIAL AND METHODS We examined 11 patients, 7 males and 4 females, mean-age 49 years (range 31 to 68 years) on chronic PD. All patients received blood transfusions, oral or intramuscular iron supplementation before 465 to 665 mg ferrogluconate therapy was given in 500 ml. saline intravenous infusion: 5 of them were on erythropoietin therapy and 2 of them started with EPO therapy after the ferrogluconate therapy. RESULTS The blood count improved during the first 3 months after application of bolus intravenous iron therapy (ferrogluconate); erytrhopoietin dose was not increased during the follow-up. Some patients suffered from side effects during infusion and 6 patients received the complete treatment. DISCUSSION Blood count improves in a number of patients affected by endstage renal desease during the first months on continuous ambulatory peritoneal dialysis (CAPD) treatment. But a large number of patients on chronic CAPD treatment are iron-depleted and they require oral or parenteral substitution. Side effects and complications of intravenous iron therapy were not severe and only one patient suffered from allergic manifestations. Ferremia and blood count improved in patients who did not receive erythropoietin during the follow-up, and patients on erythropoietin therapy required lower doses after receiving the intraveonous iron therapy. CONCLUSION Blood count improvement and the lack of severe side effects speak in favor of further iron supplementation with bolus intravenous iron replacement.

Early Detection of Sepsis, MOF and Outcome Prediction in Severely Traumatized Patients

© 2012 Lausevic and Lausevic, licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Early Detection of Sepsis, MOF and Outcome Prediction in Severely Traumatized Patients

Residual renal function and blood count in patients on continuous ambulatory peritoneal dialysis

INTRODUCTION Most of patients with chronic renal failure are affected by normochromic, normocytic anemia caused by different etiological factors. Anemia causes a series of symptoms in chronic renal failure, which can hardly be recognized from the uremic signs. Anemia adds to morbidity and mortality rates in patients affected by advanced chronic renal failure. Blood count partially improves during the first months after starting the chronic renal replacement therapy, in correlation with the quality of depuration program, with extension of erythrocyte lifetime and with hemoconcentration due to reduction of plasma volume. Recent trials found that higher residual renal function (RRF) significantly reduced co-morbidity, the rate and duration of hospitalization and risk of treatment failure. OBJECTIVE The aim of the study was to follow blood count parameters in 32 patients on chronic continuous ambulatory peritoneal dialysis (CAPD) during the first six months of treatment, to evaluate the influence of demographic and clinical factors on blood count and RRF, and to examine the correlation between RRF and blood count parameters. METHOD A total of 32 patients affected by end-stage renal disease of different major cause during the first six months of CADP treatment were studied. RRF and blood count were evaluated as well as their relationship during the follow-up. RESULTS Blood count significantly improved in our patients during the first six months of CAPD treatment even if Hb and HTC failed to reach normal values. Iron serum level slightly decreased because of more abundant erythropoiesis and iron utilization during the first six months of treatment. RRF slightly decreased. After six months of CAPD treatment, the patients with higher RRF had significantly higher Hb, HTC and erythrocyte number and a lot of positive correlations between RRF and anemia markers were observed. CONCLUSION After 6-month follow-up period, the patients with higher RRF had significantly higher blood count parameters, and several positive correlations between RRF and blood count markers were confirmed.

Effectiveness of peritonaeal dialysis

Introduction. In the last few years, an increasing number of patients suffering from terminal renal disease of various leading causes was treated with renal replacement therapy. Peritonaeal dialysis involves an exchange of water and solutes between blood in the peritonaeal capillaries and dialysate in the peritonaeal cavum throughout the peritonaeum. Effective dialysis treatment should provide good quality of life, decrease the number of physical complaints, and bring the incidence of morbidity and mortality closer to the incidence of morbidity and mortality in the healthy population. Aim. The aim of this study was the evaluation of peritonaeal transport characteristics and dialysis effectiveness in 58 patients affected by terminal renal disease who underwent peritonaeal dialysis treatment during August 2003 at the Clinic of Nephrology of the Clinical Centre of Serbia. Method. We examined 30 male and 28 female patients, with an average age of 52 years (range 26 to 78 years). The average duration of peritoneal dialysis treatment was 20 months (ranging from 2 to 66 months), and the end-stage renal failure was caused by different leading disease in our patients. We applied different dialysis modalities: continuous ambulatory peritonaeal dialysis (CAPD) with three to five 2- or 3-litre exchanges daily, cyclic peritonaeal dialysis (CCPD), intermittent peritonaeal dialysis (IPD), or automatic peritonaeal dialysis (APD), according to the transport characteristics of the peritonaeal membrane, the residual renal function (RRF), and the clinical status of the patients, in order to perform adequate depuration as suggested by the new international criteria. A peritonaeal equilibrium test (PET) was performed according to the new international advice; urea and creatinine clearances (Kt/V and Ccr) as well as RRF were calculated using the internationally suggested formulas. Results. Most of our patients received effective dialysis treatment, thanks to the modulation of number, volume, and timing of exchanges. Conclusion. Adequate dialysis improved blood count, nutritional status, and quality of life in our patients, while reducing the incidence of infection to a significant degree.