Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2008, vol. 17, nr 1, January-February, p. 5–14

Publication type: editorial article

Language: English

Differences in Clinical Evaluation of Dialyzed Patients with or Without Congestive Heart Failure

Różnice w ocenie klinicznej dializowanych chorych z zastoinową niewydolnością serca lub bez niej

Alicja E. Grzegorzewsk1,, Monika Młot−Michalska1,

1 Chair and Department of Nephrology, Transplantology and Internal Diseases, Karol Marcinkowski University of Medical Sciences, Poznań, Poland

Abstract

Objectives. To look for clinical and laboratory parameters which might be different in dialysis patients with congestive heart failure (CHF) from those without CHF.
Material and Methods. The CHF group (NYHA I–III) included 13 patients (mean ± SD age: 63.9 ± 13.5 years, median dialysis vintage: 15.2, range: 7.0–59.6 months). The group without CHF consisted of 17 persons (age: 50.3 ± 18.7 years, dialysis vintage: 24.7, range: 6.3–45.5 months). Clinical and laboratory parameters were compared in both groups.
Results. The CHF patients were older (p = 0.035) and had higher white blood cell counts (8.05±1.87 vs. 6.50 ± 1.89 × 109/l, p = 0.034), serum glucose (141 ± 61 vs. 95.1 ± 14.6 mg/dl, p = 0.022), total body mass (TBM: 77.7 ± 13.8 vs. 68.0 ± 8.8 kg, p = 0.035), body mass index (BMI: 29.5 ± 8.2 vs. 24.5 ± 3.1 kg/m2, p = 0.035), and extracellular water (ECW) as the percentage of total body water (TBW) (46.5 ± 5.9 vs. 42.7 ± 2.8, p = 0.026). Serum albumin was lower in the CHF patients (3.38 ± 0.44 vs. 3.69 ± 0.45 g/dl, p = 0.045) and negatively correlated with ECW in all patients (r = –0.485, p = 0.007). After adjustment for gender and age, only differences in serum glucose, TBM, and BMI remained significant. There were no significant differences in the other examined parameters.
Conclusion. CHF in dialysis patients is associated with advanced age, glucose intolerance/diabetes, and overweight/obesity. Severity of uremic toxicity, hyperlidemia, hyperparathyroidism, inflammation, hypertension, and cigarette smoking may not be more evident in this group than in that without CHF.

Streszczenie

Cel pracy. Poszukiwanie klinicznych i laboratoryjnych wskaźników, które mogą różnić dializowanych chorych z zastoinową niewydolnością serca (z.n.s.) od chorych bez z.n.s.
Materiał i metody. Grupa chorych z z.n.s. (NYHA I–III) obejmowała 13 osób (63,9 ± 13,5 lat, długość dializowania 15,2; 7,0–59,6 miesięcy). Grupa chorych bez z.n.s. składała się z 17 osób (50,3 ± 18,7 lat, długość dializowania 24,7; 6,3–45,5 miesięcy). W obu grupach porównywano wskaźniki kliniczne i laboratoryjne.
Wyniki. Chorzy z z.n.s. byli starsi (63,9 ± 13,5 vs 50,3 ± 18,7 lat; p = 0,035), wykazywali większą liczbę białych komórek krwi (8,05 ± 1,87 vs 6,50 ± 1,89 G/l; p = 0,034), większe stężenie glukozy w surowicy (141 ± 61 vs 95,1 ± 14,6 mg/dl; p = 0,022), większą całkowitą masę ciała (TBM: 77,7 ± 13,8 vs 68,0 ± 8,8 kg, p = 0,035), większy wskaźnik masy ciała (BMI: 29,5 ± 8,2 vs 24,5 ± 3,1 kg/m2; p = 0,035) i większą objętość wody pozakomórkowej (ECW) wyrażoną jako % całkowitej objętości wody (TBW) (46,5 ± 5,9 vs 42,7 ± 2,8; p = 0,026). Stężenie albuminy było mniejsze u chorych z z.n.s. (3,38 ± 0,44 vs 3,69 ± 0,45 g/dl; p = 0,045). U wszystkich chorych stężenie albuminy ujemnie korelowało z ECW (r = –0,485; p = 0,007). Po uwzględnieniu w analizie statystycznej wpływu płci i wieku, statystycznie istotne pozostały jedynie różnice w stężeniu glukozy w surowicy, TBM i BMI. Nie było znamiennych różnic w innych badanych wskaźnikach.
Wnioski. Z.n.s. u dializowanych chorych wiąże się z bardziej zaawansowanym wiekiem, nietolerancją glukozy/cukrzycą i nadwagą/otyłością. Ciężkość toksemii mocznicowej, hiperlipidemia, nadczynność przytarczyc, stan zapalny, nadciśnienie tętnicze lub palenie papierosów mogą wyraźnie nie różnić tej grupy od chorych bez z.n.s..

Key words

dialysis, congestive heart failure, age, glucose, obesity

Słowa kluczowe

dializa, zastoinowa niewydolność serca, wiek, glukoza, otyłość

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