Differentiated individual approach to the treatment of erosive ulcerative bleeding in patients receiving programmed hemodialysis compared with permanent outpatient peritoneal dialysis when chronic kidney disease stage 5
DOI:
https://doi.org/10.11603/2414-4533.2017.4.8259Keywords:
chronic kidney disease, program hemodialysis, permanent outpatient peritoneal dialysis, video endoscopic methods of hemostasis.Abstract
The aim of the work: improvement of the results of complex treatment of patients with chronic kidney disease (CKD) stage 5, receiving programmed hemodialysis (PGD) and permanent outpatient peritoneal dialysis (POPD) in erosive ulcerative bleeding, by optimizing their treatment using video endoscopic minimization technologies.
Materials and Methods. For the period from October 2012 to December 2016, on the basis of Kyiv City Scientific and Practical Center of Nephrology and Dialysis, 1528 patients were treated with programmed hemodialysis and 302 with POPD. Among them there were 679 (36.1%) men and 1151 (62.9%) women.
Results and Discussion. In the structure of the 1830 patients treated with renal replacement therapy (PGD or POPD), 349 (19.1 %) of them during the endoscopic examination revealed erosive-ulcer lesions of the upper digestive tract. Erotic gastropathy has been diagnosed in 191 (54.7%) patients, stomach ulcers – in 65 (18.6 %), duodenal ulcer – in 93 (26.7 %).
During the observation period, erosive ulcer bleeding was detected in 46 patients. Among them, 5 (11 %) patients had erosive bleeding, 12 (26%) had bleeding from stomach ulcers, and 29 (63 %) had bleeding from duodenal ulcer. All patients had a bleeding hemorrhage. It should be noted that erosive ulcer bleeding in patients rece iving POPDs was not observed.
In the early stages of treatment of this category of patients, bleeding from ulcers was induced to surgical treatment (organo-preserving – 7, including anthromectomy – 3). At the same time, mortality reached 33 % and was established in patients with hemorrhoids and severe manifestations of metabolic intoxication syndrome (MIS). The latter served as the reason for the revision of the tactics of treatment of patients with this complication by using video endoscopic minimally invasive hemostasis methods (electrocoagulation – 34, chemical hemostasis – 5, clapping the vessel – 7). Relapse of bleeding occurred in 12 (7 %) patients (3 patients after chemical hemostasis and 9 after electrocoagulation) who overcame repeated video endoscopic combined hemostasis methods, which were not accompanied by lethality. In this case, the treatment program in all cases was supplemented by the mandatory use of PPI monotherapy, giving preference to their 4th generation.
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