YEARS AND LIFE (AS OBJECTIVE REALITY) ON REGULAR HEMODIALYSIS

THE AIM of the investigation is an analysis of clinicolaboratory and biophysical indices characterizing the metabolic shifts in chronic hemodialysis patients under continuous observation. PATIENTS AND METHODS. During 201 sessions of regular hemodialysis 108 patients with the terminal stage of CRF were examined. Repeated examinations were performed on 36 patients within 1.5 years after the observations were started, 22 patients were examined once more within 5.3 years. The level of parathyroid hormone in blood was determined in 59 patients. Reliability of differences in the data before and after the hemodialysis sessions (p<0.05) was estimated by the value of Student’s coefficient, the hemodialysis effectiveness  by the value Kt/V. Survival of the patients was calculated by the moment method, the average period of life at the hospital department and its dispersion were also determined. Acid hemolysis was performed after Terskov and Gitelzon, ultrasonic  with the apparatus of ultrasonic therapy UST 1.03 U. Osmotic resistance was determined in a 0.45% solution of NaCl calorimetrically. The immunoenzymic method was used to determine the content of parathyroid hormone in blood, all other clinical parameters were determined according to standard unified methods. RESULTS. For the recent decade the average term of life of these patients has become two times longer. Positive dynamics was noted in the indices of the state of the cardiovascular system: the duration of hemodialysis treatment had negative correlation with systolic arterial pressure (r = 0.246±0.070, p<0.001 before session; r = 0.349±0.067, p<0.0001after session), diastolic arterial pressure (r = 0.286±0.069, p<0.001 before session; r = 0.340±0.068, p<0.0001after session), and pulse pressure after session (r =  0.293±0.069, p<0.0001). A correlation was established of the electrolyte status of plasma with the duration of hemodialysis treatment: Na+ concentration before hemodialysis session decreased (r = 0.232±0.070, p = 0.001), and Ca2+  increased (r =0.327±0.068, p<0.0001). The increased intensity of protein metabolism was expressed as a gradually increased concentration of the total blood protein (r = 0.234±0.080, p = 0.001), albumin (r = 0.157±0.071, p= 0.028) and urea concentration in blood plasma (r = 0.229±0.070, p= 0.001). Dry weight of the patients decreased in due course (r = 0.264±0.068, p <0.0001). Stability of the erythrocyte membranes grew up: acid hemolysis time shortened (r = 0.152±0.071, p=0.034 before session), hematocrit increased (r = 0.190±0.070, p=0.008 before session). Coefficients of correlation of arterial pressure with the patients’ weight before and after hemodialysis sessions are presented as well as with the concentration of Na+ in blood plasma. Their sufficiently stable status was noted with the exception of the mineral metabolism indices. Even with the optimal values of the phosphoruscalcium product activity of alkaline phosphatase becomes 60% higher for 89 years of chronic hemodialysis treatment. An analysis of clinicolaboratory indices disclosed the most possible mechanisms of impairments of the cardio vascular system, proteinlipid metabolism, waterelectrolyte and nutritional status. The priority directions in correction are determined. CONCLUSION. In case of successful adaptation of the patient to regular hemodialysis treatment at the initial period his condition gradually becomes better in the following 23 years, and later for 79 years remains fairly stable. The high quality hemodialysis therapy effectively corrects the impaired protein and lipid metabolism, maintains nutritional status, adequately corrects anemia, and the cardiovascular system parameters do not deteriorate. The cellular structures become stable, the membrane systems improve. The state of mineral metabolism is the only thing that remains problematic.

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