Browsing by Author "Stolic, Radojica V. (9739642000)"

Cannulation technique has the potential to impact arteriovenous fistula (AVF) function. The aim of this research was to determine the impact of cannulation technique on the length of the functioning AVFs in older adult patients on hemodialysis. The study included 110 participants with fistula thrombosis who had used area technique or rope ladder technique. Biochemical parameters, gender, demographic, and clinical variables were determined. Patients who used the area cannulation technique differed significantly from patients using the rope ladder technique with regard to duration of hemodialysis (p < 0.001), outcome of the AVF revision (p = 0.045), and positioning of the anastomosis (p = 0.013). The group that used the area cannulation technique had a longer duration of hemodialysis, proximal anastomoses, and more successful revisions of AVFs. Copyright© by the American Nephrology Nurses Association.

Purpose: The number of elderly patients with end-stage kidney disease is on the rise. Nonalcoholic fatty liver disease (NAFLD) is characterized by parenchymal fat accumulation in patients without information about alcohol abuse. The aim of our study was to determine correlation between NAFLD and cardiovascular diseases in elderly hemodialysis patients. Methods: The examination was organized as observational and cross-sectional study in elderly patients on hemodialysis. An abdominal ultrasound examination was made in order to define NAFLD. Intima-media thickness of the carotid arteries was quantified by Doppler ultrasound. Biochemical parameters, gender, anthropometric characteristics, duration, adequacy of hemodialysis, blood pressure, smoking and cardiovascular disease were determined. Respondents were divided into a group with NAFLD (37/72 patients, 51 %) and group without NAFLD (35/72 patients, 49 %). Results: Patients with NAFLD have significantly more cardiovascular disease (p = 0.017) as well as significantly higher values of intima-media thickness of the carotid arteries (p = 0.03) in correlation with patients without NAFLD. Patients without NAFLD have a statistically lower triglyceride (p = 0.04), aspartate aminotransferase (p = 0.006), alanine aminotransferase (p = 0.013) and gamma-glutamyl transpeptidase (p = 0.029) compared to patients with NAFLD. Patients with cardiovascular disease have a higher risk of NAFLD; likewise, patients with NAFLD have a three times higher chance for developing cardiovascular diseases (OR 3.01). Conclusion: Elderly patients on hemodialysis with cardiovascular disease have a higher risk of NAFLD; likewise, patients with NAFLD have a three times higher chance for developing cardiovascular diseases. © 2016, Springer Science+Business Media Dordrecht.

Background: Physical rehabilitation is an important segment in the treatment of hemodialysis patients as they often have numerous comorbidities, functional constraints and severe disabilities resulting from physical inactivity. Aim: To determine the effect of strength training program on muscle mass in patients on hemodialysis. Methodology: The study was organized in the Center for Hemodialysis, Kosovska Mitrovica, Serbia for the duration of 8 weeks. It involved 25 patients, 18 (72%) men and 7 (28%) women, of average age 52.9 ± 14 years, who had received chronic hemodialysis for 3 x 3-4 hours for at least 3 months using commercially available dialysers. During the first two hemodialyses, twice a week for 15-20 minutes, exercises were performed with a load to increase muscle mass of the upper and lower extremities together with isometric muscle contractions to strengthen the quadriceps, as well as a lateral flexion of the spinal column. Measurements were made before and after exercise. Routine laboratory analyses, oxygen saturation, demographic, anthropometric and clinical characteristics of the subjects were also evaluated. Results: After exercise oxygen saturation (p = 0.04) and venous pressure (p = 0.009) were significantly lower than pre-exercise values. Muscle strength of the fist (p = 0.001), the upper arm (p = 0.005) and forearms (p <0.001) also differed significantly before and after exercise. After exercise lower extremity muscles were significantly stronger, both in relation to the left and right muscles of the shin and thighs. Left side (p = 0.002) and right-side (p = 0.017) spinal column flexion was significantly higher after exercise. Conclusion: The study confirmed the positive effect of strength training program on the size of the exercising muscles, lateral flexion of the spinal column and venous pressure. © 2018 A. CARBONE Editore. All rights reserved.

Introduction: Arteriovenous fistulas (AVFs) are the preferred form vascular access for hemodialysis (HD), as they have a low rate of complications and durable function. The aim of our investigation was to analyze the factors that might influence the function of AVFs. Methods: Data were taken from the computerized patient record system in the Clinic of Urology and Nephrology, Clinical Center, Kragujevac, Serbia, for a 2-year period. We analyzed patients who had requested re-creation of AVFs as a secondary procedure. During this period 112 patients, 73 (65%) men and 39 (35%) women, had AVF thromboses. All relevant clinical and laboratory parameters that could affect the function and survival of AVF were evaluated. Findings: In univariate logistic regression analysis, statistically significant predictors influencing the duration of the fistula were magnesium (P < 0.001), triglycerides (P = 0.041), smoking (P = 0.001), antiplatelet therapy (P < 0.001), and type of HD (bicarbonate vs. hemodiafiltration) (P < 0.001). In the multiple logistic regression model, high concentrations of magnesium (B = 7434; P < 0.001) and antiplatelet therapy (B - 1.042; P = 0.04) were significantly associated with the length of AVF function. Discussion: After successful establishment of an AVF, there is a compelling need to maintain fistula patency. Factors that affect functioning of the AVFs are presently under intense scrutiny. According to our results, some clinical factors may determine long term fistula duration, such as concentration of the magnesium and antiplatelet therapy. © 2017 International Society for Hemodialysis

Purpose: Magnesium insufficiency is a pro-atherogenic factor involved in endothelial dysfunction, atherosclerosis, and vascular calcification. Our aim was to examine the role of magnesium in the development of arteriovenous fistula complications in hemodialysis. Methods: This was a retrospective clinical investigation of data from 88 patients who were divided into two groups: those with and without arteriovenous fistula complications. We examined the influence of sex, demographics, and clinical and laboratory parameters. The existence of fistula stenosis was determined by measuring Doppler flow, while B-mode ultrasound was used to detect plaques and evaluate the carotid artery intima–media thickness. Results: Patients with arteriovenous fistula complications had significantly higher leukocyte counts (p = 0.03), platelet counts (p = 0.03), phosphate concentrations (p = 0.044), and alkaline phosphatase concentrations (p = 0.04). Patients without complications had significantly greater blood flow through the arteriovenous fistula (p < 0.0005), higher magnesium concentrations (p = 0.004), and a lower carotid artery intima–media thickness (p = 0.037). The magnesium level was inversely correlated with leukocyte (p = 0.028) and platelet (p = 0.016) counts. The magnesium concentration was significantly lower in patients with carotid artery plaques (p = 0.03). Multiple linear regression, using magnesium as the dependent variable in patients with arteriovenous fistula complications, indicated statistically significant correlations with platelet (p = 0.005) and leukocyte (p = 0.027) counts and carotid plaques (p = 0.045). Conclusions: Hypomagnesemia is a significant pro-atherogenic factor and an important predictor of arteriovenous fistula complications. © 2016, Springer Science+Business Media Dordrecht.

Elderly patients with end stage kidney disease represent a challenge for surgeons to create a vascular access. Determine predictive parameters functionality of the arteriovenous fistulas for hemodialysis in the elderly. The study was organized as a retrospective study at the Center for Dialysis, Clinic for Urology and Nephrology, Clinical Center Kragujevac. The study included patients older than 65 years with arteriovenous fistula thrombosis, in the period of four years, in which there is information on the length of the functioning fistula. The study included 48 patients, mean age 71.3±5.2 years, 29 (60%) men and 19 (40%) women. The data were analyzed according to gender and demographic structure, type of anastomosis, positioning, length of functioning fistulas, and the lumen diameter of the arteries and veins that are used to create a fistula. The median length of functioning arteriovenous fistula, based on Kaplan-Meier model, is 16 months (95% CI 6.9- 25.1). Median functioning for proximaly located fistulas was 24 months (range, 1-259), while median functioning in patient with distally located fistulas was 8 months (range, 1-96). The difference in relation to the positioning of the fistula was statistically significant (p=0.006). In univariate Cox regression model, a statistically significant predictor of the functioning of arteriovenous fistulae is fistula positioning (B=0.700; p=0.022). The predictive parameter of survival of arteriovenous fistulas in elderly is proximally located fistula. © 2019, University of Kragujevac, Faculty of Science. All rights reserved.

Introduction: Metabolic syndrome is considered as one at the most important public health problems and in hemodialysis patients it is one of the main factors of mortality. The aim of the study was to determine the predictive parameters of the mortality of patients with metabolic syndrome. Materials and methods: In a nine-year study, the outcome of the clinical treatment of 108 hemodialysis patients was analyzed, divided into a group of patients with metabolic syndrome and group of patients without metabolic syndrome. The demographic, anthropometric, clinical and laboratory characteristics of the examinees were evaluated. Results: Mortality of patients with metabolic syndrome was 28.1% and in the group of patients without metabolic syndrome 13.2%. Statistically significant difference was found between the group of patients with and without metabolic syndrome in comparison with body mass index (p <0.001), age (p = 0.027), diabetic nephropathy (p <0.001), number of comorbidities (p <0.001), the number of leukocytes (p = 0.043), total proteins (p = 0.044), albumin (p = 0.001), calcium (p = 0.016), glycemia (p = 0.002) and creatinine (p = 0.032). Predictive parameters of survival in patients on hemodialysis with metabolic syndrome are the body mass index (B - 0.056; SE 0.008; p <0.001) and diabetic nephropathy (B 0.397; SE 0.098; p <0.001). Conclusion: Lower body mass index and diabetic nephropathy are, in our study, the predictive parameters of mortality of patients on hemodialysis. © 2019 A. CARBONE Editore. All rights reserved.

Background and objectives: In patients on hemodialysis, erectile dysfunction is an independent mortality factor. This study aimed to determine the risk factors that affect the survival of hemodialysis patients with erectile dysfunction. Materials and Methods: During a seven-year period, erectile dysfunction was identified among the fatalities reported in patients receiving chronic hemodialysis, on the basis of the International Index of Erectile Function questionnaire. The study covered 70 patients of mean age 57 ± 6.7 years. During the examined period, 42 (60%) patients died at the mean age 57 ± 6.8 years. The study was completed by 28 (40%) patients, aged 57 ± 6.55 years. Laboratory, demographic, anthropometric, and clinical characteristics were recorded using standard methods. Results: Statistically significant differences between the two groups of respondents were found concerning dialysis duration (p < 0.001), number of leukocytes (p = 0.003), adequacy of hemodialysis (p = 0.004), intima media thickness of the carotid artery (p < 0.001), presence of cardiovascular disease (p = 0.03), residual diuresis (p = 0.04), and hemodiafiltration (p < 0.001). Hemodialysis adequacy (B = −9.634; p = 0.017), intima media thickness (B = 0.022; p = 0.003), residual diuresis (B = −0.060; p = 0.007), and lower rates of cardiovascular disease (B = 0.176; p = 0.034) were significant survival predictors among our patients with erectile dysfunction. Conclusions: Risk factors that are associated with improved survival of patients on hemodialysis with erectile dysfunction in our study are: preserved diuresis, high-quality hemodialysis, lower incidence of cardiovascular disease, and less thickening of the intima media of the carotid arteries. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.