Abstract
Chronic renal failure is a clinical syndrome treated conservatively in the early stages, while in the end stage (GFR < 5 ml/min) it is necessary to replace the renal function by dialysis treatment. However, main complications of chronic renal failure continue to appear due to insufficient removal of the metabolic waste products and inadequate restoration of many hormonal and metabolic functions by dialysis treatment. These complications seems to play an important role on patients’physical and psychological rehabilitation. Polyneuropathy, renal osteodystrophy, cardiomyopathy and psychological impact are the main complications of long term renal function replacement.Hemodialysis remains the prevalent treatment for the end stage of chronic renal failure. Under the technological progress, many different methods of hemodialysis have appeared, having the better treatment of the patients as ulterior purpose. These different methods are the followings: ■ Conventional hemodialysis. ■ Hemofiltra ...
Chronic renal failure is a clinical syndrome treated conservatively in the early stages, while in the end stage (GFR < 5 ml/min) it is necessary to replace the renal function by dialysis treatment. However, main complications of chronic renal failure continue to appear due to insufficient removal of the metabolic waste products and inadequate restoration of many hormonal and metabolic functions by dialysis treatment. These complications seems to play an important role on patients’physical and psychological rehabilitation. Polyneuropathy, renal osteodystrophy, cardiomyopathy and psychological impact are the main complications of long term renal function replacement.Hemodialysis remains the prevalent treatment for the end stage of chronic renal failure. Under the technological progress, many different methods of hemodialysis have appeared, having the better treatment of the patients as ulterior purpose. These different methods are the followings: ■ Conventional hemodialysis. ■ Hemofiltration. ■ The combination of the two previews methods.■ The variations of conventional hemodialysis. The aim of this study was to investigate the effect of two different dialysis methods (conventional hemodialysis vs hemofiltration) on the appearance and importance of the complications of chronic renal failure, as far as it is well known that these complications are strongly related with the better reaccession of the patients to the society. For the purpose of this study, seventeen patients were investigated, having mean age of 49 ± 11 years and mean duration on dialysis treatment 57,8 ± 53,9 months. The patients were divided in two groups according to the dialysis method: (a) In group A nine patients undergoing conventional hemodialysis were included, with mean age of 44,2 ± 12,53 years and mean duration ondialysis treatment 18,67 ± 4,33 months. (S) In group B eight patients undergoing hemofiltration were included, with mean age of 55,25 ± 5,23 years and mean duration on dialysis treatment 24 ± 7,65 months. The patients were subjected three times, with intervals of twelve months, in the following studies: 1. An electrophysiological evaluation for polyneuropathy, in which therecording of the somatosensory evoked potentials after peripheral stimulation of the median and femoral nerves was included. Measurements of the distal latency time of the sensory fibers (median, ulnar and sural nerves) as well as measurements of the distal latency time and peripheral conduction velocity of the motor fibers (median and peroneal nerves) were performed. 2. A measurement ofthe bone density of the lumbar spine region by dual energy X -ray absorptiometry (DEXA). 3. An échocardiographie evaluation of the cardiac function. 4. A measurement of quality of life and psychological status of the patients through specific questionnaires - scales (Health Questionnaire, Nottingham - Health Profile, Hamilton, Standardized Psychiatric Index). The results of this study indicated that: A/ The group A patients (conventional hemodialysis) showed: ■ A significant decrease in the bone density of the lumbar spine region. ■ A significant increase of the left venticular mass, the left ventricular index mass, the intraventricular septum, the left ventricular posterior wall thickness, as well as a deterioration of the left ventricular diastolic function. ■ A worsening of the motor and sensory conductance of the upper and lower limbs. ■ A worsening of the emotional status, as well as of the rest of the subjective and objective quality of life indicators. B/ On the contrary, group B patients (hemofiltration) showed: ■ An improvement of the bone density of the lumbar spine region. ■ Stability of the cardiac function and morphology. ■ An improvement of the motor and sensory conductance of the upper and lower limbs. ■ No significant change of the psychological status and quality of life. As a conclusion from the analysis of the above mentioned results, it seems that hemofiltration, compared with conventional hemodialysis, has a beneficial effect on bone metabolism, on the stability of the cardiovascular system, on the peripheral nervous system function and on the quality of life of patients. The last one is especially important because it seems that, through hemofiltration, it is possible to combine the physical improvement with the patients’ psychological and social well - being.
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