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DIABETES AND INFLUENCE IN PROGRESS CHRONIC KIDNEY · PDF file DIABETES AND INFLUENCE IN PROGRESS CHRONIC KIDNEY FAILURE . 1. Prof.Dr. Lutfi Zylbeari 1,2MD,PhD, 2.Prof. Dr. Nasir Behxheti

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  • International Journal of Scientific & Engineering Research, Volume 7, Issue 2, February-2016 561 ISSN 2229-5518

    IJSER © 2016 http://www.ijser.org

    DIABETES AND INFLUENCE IN PROGRESS CHRONIC KIDNEY

    FAILURE

    1. Prof.Dr. Lutfi Zylbeari1,2MD,PhD, 2.Prof. Dr. Nasir Behxheti 2, 3. Mr. Dr. Gazmend Zylbeari2.4. Mr. Dr.Zamira Bexheti 3 ,5. Mr.Phar. Mirlid Behxheti2

    1. Private Special Hospital For Nefrology and Hemodialysis ,,Vita Medical Group” - Tetova, Macedonia 2. State University of Tetova, Medical Faculty, Tetova, Macedonia Abstract: Diabetes mellitus with thee remains a serious health problem with a high prevalence in developed countries and developing countries, and is the main cause of failure chronic renal insufficiency, chronic renal terminals of manifsetuar with increased high rate of mortality due kardiovaskulaer disease (CVD). Diabetes is calculated as the fourth cause of mortality in developed countries. (1). Nephropathy diabetic (DN) is typically defined by macroalbuminuria-that is, a urinary albumin excretion above 300 mg in the urins 24-hour meeting, or mikroalbuminuri. In the United States and Western countries with ND diabetes, counted as the main cause of ESRD. A large number of epidemiological studies have shown that 1/3 of patients treated with hemodialysis (HD) with chronic diabetes are type 2 (2,3,4) . Clinically, diabetic nephropathy is characterized by a progressive increase of proteinuria, hypertension and decline of glomerular filtration (GFR-glomerular filtration Rate) and a higher risk of mortality from cardiovascular diseases (CVD) and cerebrovaskualar disease.The aim of the paper: the purpose of this paper was to verify and document the impact of diabetes unbalanced, hyperglycemia and risk factors in the progress of progress in ESRD, and the correlation between hyperglycemia with CVD disease and arteriosclerosis early that manifested in patients with uremia treated with hemodialysis, compared with the control group of healthy individuals. Material and methods of work In this prospective cohort research (,, cross-section ") are included 360 examiners of whom 180 were patients with DN and ESRD treated with HD (80 (45%) of them were women with an average age of 56.80 ± 9:50 while 100 (55%) were men, with an average age: 57.90 ± 10:00 years) and 180 were healthy individuals who served as a control group, of whom 100 were male with average age of 57.20±11:00, while 80 (45%) were female with an average age of 58.00 ± .50 = year. Of the total number of patients treated (NO=180), 100 were patients with diabetes mellitus of the insulin dependent (addicted -insuline Tip1 DM), while 80 were patients with diabetes mellitus treated with oral hypoglycemic and diabetes as they computed mellitus type-2 (DM type 2) table number 1. the two groups of patients and control group were analyzed within 12 months -once every three months, with 4 total measurement of glycemic profile, hemoglobin glycosylated (HbA1c) , lipid profile. The patients treated with HD we made the measurement of body mass index - BMIx (Body Mass Index) Numerous studies have verified that the check and normalization of hyperglycemia and HbA1c, normalization of arterial hypertension, and regulation of profile lipid visible impact in preventing rapid progress of renal injuries presenting to ESRD and micro /macralbuminur events with micro/macrova-sculare and cardiovascular disease (CVD).

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  • International Journal of Scientific & Engineering Research, Volume 7, Issue 2, February-2016 562 ISSN 2229-5518

    IJSER © 2016 http://www.ijser.org

    Index terms: Diabetic Nephropathi, Diabetes Mellitus (DM),ESRD, blood glucose (Gl), HbA1c , lipids profile.

    1 INTRODUCTION Terminal chronic renal failure represents ireveryibil progressive reduction of renal function and glomerular filtration. When glomerular filtration rate (GFR-glomerular Filtration Rate) reduced

  • International Journal of Scientific & Engineering Research, Volume 7, Issue 2, February-2016 563 ISSN 2229-5518

    IJSER © 2016 http://www.ijser.org

    Values Microalbuminuria Proteinuria

    F < 25 mg/L F= 25- 355 mg/L F= 355mg/L

    M= 17-250 mg/L M= < 17mg/L M > 250mg/L

    Patients with chronic kidney disease (CKD) and diabetes are obliged to obey the rules of the consumption of protein (when cleaning the endo-genes creatinine is 1.0 g/24 h < 1.0 g/24 h < 0.3 g/24 h

    Levels of FG

    FG diminished

    FG stable

    FG increased

    The structure of the kidney

    FG exacerbated FG stable FG improved

    Increased protein in the urine can be reduced if the patient was referred to the councils of the following: the use of low doses of ACE blockers, restriction salt s, the use of beta blokerëve, angiotensin II receptor antagonist (when the value of K is

  • International Journal of Scientific & Engineering Research, Volume 7, Issue 2, February-2016 564 ISSN 2229-5518

    IJSER © 2016 http://www.ijser.org

    check and normalization of hyperglycemia and HbA1c, normalization of arterial hypertension, and regulation of profile lipid visible impact in preventing rapid progress of renal injuries presenting to ESRD and micro /macralbuminur events with micro/macrova-sculare and cardiovascular disease (CVD).Methods of determining the concentrations of lipids, glycaemia (Gl) and HbA1c are

    presented below. Reference value for glycaemia and HbA1c were taken according to the criteria proposed by the World Health Organization (WHO)-for glycaemia=5- 6.5 mmol/l and HbA1c %=4.4% -6.6 %. All analyzes provided by the study protocol, were defined at the Institute of Clinical Laboratory at the University Clinical Centre of Skopje.

    Table no. 4: reference values and methods by authors whose concentrations are determined a blood glucose, HbA1c and lipid profiles are presented in Table 4.

    Table number 5. Presentation of diabetes patients under therapy

    Tot. Pacients D.M Tip 1 (insulin- dependent )

    D.M Tip 2 (oral hypoglicemic)

    No=180 100 80

    Table number. 6: Distribution of patients by sex and age average

    Gender Number The average age

    Men 100 ( 55%) 57.90 ± 10.00

    Women 80 ( 45%) 56.80± 9.50

    Table number 7: Distribution of control group average by gender and age

    Parameters examined

    Reference values Authors

    LT 4-10 g/l Zollner & Kirsch (27 )

    TG 0,68- l,70 mmol /l G. Buccola & H. David ( 28 )

    TCh 3,l-5,2 mmol/l CC. Allain et al (29)

    LDL-ch 4,1 mmol/1 Friedewalde & Fredrickson (30)

    HDL-ch >1,6mmol/1, danger at adults < 0,9 mmol/1 G. Warnick et al (31 )

    Glicemia (Gl)

    3.5-6.5 mmol/L Turbidimetric, Aparat Cobas-Integra 400

    HbA1 c % 4.4-6.6 % Turbidimetric, Aparat Cobas-Integra 400 IJSER

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  • International Journal of Scientific & Engineering Research, Volume 7, Issue 2, February-2016 565 ISSN 2229-5518

    IJSER © 2016 http://www.ijser.org

    Gender Number The average age

    Men 100 (55%) 57.20±11.00

    Women 80 (45%) 58.00±10.50

    Table. 8: Distribution of patients according BMIx: male=100 and female =80

    BMIx Women=80 Men=100

    Poor feeding 18 30

    Normal feed 30 42

    More feed 26 18

    Obesity instance II-a 6 10

    From the total number of examinated patients – 180 (100% ) by BMIx, with the highest percentage of 32.0% were patients that belong to the group that were normal feeded, than follows the group of patients fed highly with 45.0 %, then the group fed poor 13.0%, and finally the group with second-degree obesity –a (II-a) with 10.0%, under the table and

    graph number 8. The difference between patients according to statistics is not significant with p

  • International Journal of Scientific & Engineering Research, Volume 7, Issue 2, February-2016 566 ISSN 2229-5518

    IJSER © 2016 http://www.ijser.org

    Table nr.9. Presentation of the average values of the parameters analyzed to examine patients with DM type 1 - the Insulin-Dependent N0=100) and DM type 2 (with oral hypoglycemic-N0=80)

    Parameters Number Average Minimum Maximum ± SD

    Patients with Diabetes Mellitus, Type 1 (insulin-dependent N0 = 75 )

    HbA1c % 100 9.60 6.80 13.50 6.70

    Glycaemia 100 10.18 7.50 11.40 3.80

    LT 100 7.40 2.80 12.60 2.00

    TG 100 3.60 1.90 4.60 1.30

    Cholesterol 100 5.80 2.80 7.20 3.50

    HDL-ch 100 1.10 0.50 3.80 0.90

    LDL-ch 100 4.80 3,20 5.80 1.20

    Patients with type 2 D. Melltus tip 2 ( oral hypoglycemic - N0 = 45)

    Glycaemia 80 7.50 4.00 9.00 3.80

    HbA1c % 80 8.10 5.80 8.50 3.50

    LT 80 7.40 5.80 10.40 4.60

    TG 80 3.80 2.60 4.20 0.90

    Cholesterol 80 5.20 3.60 6.20 2.80

    HDL-ch 80 1.04 0.90 2.40 0.90

    LDL-ch 80 4.80 3.10 5.90 1.50

    Table number 10. The average values of the analyzed paramaters for urea, creatinin and uric acid (serume values) and GFR d