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Continuous Performance Test in Iranian Patients Undergoing Hemodialysis  

Directory of Open Access Journals (Sweden)

Full Text Available "nObjective: Memory and concentration may be affected by hemodialysis in "nend-stage renal disease. In this study, changes in cognitive function "nparameters such as attention, impulsiveness, and reaction time were "nmeasured and evaluated in the Iranian hemodialysing patients. "nMethods: In this analytic observational study, cognitive function of 38 "nhemodialysis patients was measured before and after hemodialysis sessions "nusing Conners' continuous performance test. "nResults: Mean age of patients was 37.97 ± 12.58 years. There wasn't any "nsignificant difference between numbers of matches successfully recognized, "nnumber of Miss Faire and mean of reaction time of those matches "nsuccessfully recognized before and after hemodialysis. There weren't any "ndifferences between history of hemodialysis and number of matches "nsuccessfully, matches missed and mean reaction time of matches. "nEducational level of patients was significant effect on number of Miss Faire "nduring hemodialysis. "nConclusions: It has been concluded that hemodialysis did not have any "nsignificant impact on the cognitive function. However, this hypothesis needs "nto be checked and confirmed by careful selection of patients and other "ncognitive function tests.

Mostafa Najafi; Hamid Nasri; Mohammad Ebrahim Rastegari

2006-01-01

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Effect of Applying Continuous Care Model on Sleepiness in Patient Undergoing Hemodialysis in Shahinshahr Hemodialysis Center in 2009  

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Full Text Available Introduction: Sever daily sleepiness is one of the problems of patient with chronic renal failure. There are evidences indicating different sleep pathology in patients undergoing hemodialysis. This study was conducted to evaluate the effect of applying continuous monitoring model on sleepiness of hemodialysis patients in Shahinshahr/ Isfahan. Methods: This semi-experimental study was performed on 40 hemodialysis patients. Data gathering was done by Epwort Questionnaire. The questionnaire was used twice before the intervention with the interval of one month. The applied model contained four steps: orientation, sensitization, control and evaluation. Patients were divided into five groups and 4-6 training sessions during three weeks were held for each group and during the remained 9 weeks, consultations for continuous sleep monitoring, control and evaluation were performed. The questionnaire was filled out immediately after the intervention and one month later. Data were analyzed through SPSS 15 through descriptive and analytic statistics. Results: The study findings revealed that mean score of sleepiness before intervention was 11/06 (± 3/32). Therefore, after intervention it increased significantly to 5.54 (± 2/85) (P=0/0001). The percentage of sleepiness before the intervention was 74/4 that decreased significantly to 38/8 % (p = 0/0001). Conclusion: Using continuous care model as an ethnic model can reduce many problems of patients. It is recommended to study monitoring model more elaborately in order to utilize it on other hemodialysis patients.

M Azizzadeh Forouzi; H Sadeghi; AA Haghdoost; S Mohammad Alizadeh

2013-01-01

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Vitamin D status in dark-skinned patients undergoing hemodialysis in a continually sunny country.  

UK PubMed Central (United Kingdom)

BACKGROUND: Vitamin D (vitD) insufficiency is common in end-stage renal disease. Seasonal and ethnic differences in vitD status have been reported previously. We hypothesized that vitD status in Afro-Caribbean patients on hemodialysis (HD) living in a country with a constant sunny climate would be better than that in African-American HD patients living in countries with a winter season. METHOD: A cross-sectional study was conducted in 152 Afro-Caribbean HD patients in a dialysis center located in Guadeloupe. We evaluated the prevalence of vitD insufficiency, defined as serum 25-hydroxyvitamin D (25(OH)D) levels below 30 ng/mL, compared with those results previously reported in African-American HD patients (88%). RESULTS: Prevalence of vitD insufficiency was 60% and thus lower than that in the African-American patients considered as the reference population (p<0.001). In our diabetic patients, this prevalence was 72.4%. Globally, 9.2% of patients had 25(OH)D below 15 ng/mL. Alfacalcidol therapy was prescribed in 29%. Mean 25(OH)D levels were higher in treated than in untreated patients (32 vs. 27 ng/mL; p=0.009). Patients with vitD insufficiency had dyslipidemia and diabetes more frequently. No significant differences were found between patients with and without vitD insufficiency for serum calcium, phosphorus and parathyroid hormone (PTH). In untreated patients, no significant correlation was found between 25(OH)D and PTH levels. CONCLUSION: Prevalence of vitD insufficiency in Afro-Caribbean HD patients was lower than that previously reported in African Americans undergoing HD in the United States. This finding may be due to the constantly sunny weather with a high intensity of UVB radiation in Guadeloupe.

Foucan L; Ducros J; Merault H

2012-11-01

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Continuous venovenous hemodialysis.  

Science.gov (United States)

Hemodialysis and peritoneal dialysis are the main renal replacement therapies for patients with acute renal failure. These patients are often unable to tolerate drastic fluid shifts and other complications of conventional dialysis. Continuous hemodialysis, however, provides protection from the hemodynamic consequences and osmotic stressors of conventional dialysis and is rapidly becoming the treatment of choice for critically ill patients. We present a case in which a patient with a spontaneous cerebellar hemorrhage developed acute renal failure. Surgical evacuation was not an option. Clinical management included the use of continuous venovenous hemodialysis, which is described in the setting of a patient with a posterior fossa mass. The risks of anticoagulation, hemodynamic instability, and development of dialysis disequilibrium syndrome are discussed. PMID:8167781

Strohschein, B L; Caruso, D M; Greene, K A

1994-03-01

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Continuous venovenous hemodialysis.  

UK PubMed Central (United Kingdom)

Hemodialysis and peritoneal dialysis are the main renal replacement therapies for patients with acute renal failure. These patients are often unable to tolerate drastic fluid shifts and other complications of conventional dialysis. Continuous hemodialysis, however, provides protection from the hemodynamic consequences and osmotic stressors of conventional dialysis and is rapidly becoming the treatment of choice for critically ill patients. We present a case in which a patient with a spontaneous cerebellar hemorrhage developed acute renal failure. Surgical evacuation was not an option. Clinical management included the use of continuous venovenous hemodialysis, which is described in the setting of a patient with a posterior fossa mass. The risks of anticoagulation, hemodynamic instability, and development of dialysis disequilibrium syndrome are discussed.

Strohschein BL; Caruso DM; Greene KA

1994-03-01

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Tuberculosis in children undergoing hemodialysis  

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Full Text Available Gargah Tahar1, Goucha-Louzir Rim2, Lakhoua Mohamed Rachid11Department of Pediatric Nephrology, 2Department of Nephrology, Charles Nicolle Hospital, Tunis, TunisiaAbstract: Tuberculosis (TB) remains a public health problem in Tunisia. Its incidence is higher in immunocompromised hosts than in the general population. In children and during hemodialysis, TB is characterized by the frequency of extrapulmonary localizations and diagnostic difficulties. The aim of this retrospective study is to evaluate the incidence of TB in Tunisian children undergoing hemodialysis and to determine its clinical features as well as the results of chemotherapy.Method: This retrospective study includes seven TB children among 112 children on hemodialysis at the pediatric nephrology department in Charles Nicolle Hospital from 2002 to 2008. The diagnosis of TB was established by a combination of clinical, radiological, biochemical, microbiological, and histological examinations. Treatment with anti-TB drugs, the results of therapy, and the outcome of patients were noted.Results: There were four girls and three boys aged 10 to 16 years (mean, 13 years). They had been on hemodialysis for 2 to 5 years (mean, 3 years). Noted clinical features were weight loss and fever in five cases, chest pain in one case, cervical lymph node in one case, and spinal pain in one case. The organ systems involved were pleural in two cases, pulmonary in one case, peritoneal in one case, cervical lymphatic in one case, and spinal in one case. One patient was treated empirically with a good response. Diagnosis was made by isolation of mycobacterium TB in three cases, by specific histological signs observed in a lymph node biopsy in one case, in peritoneal biopsy in one case, and in discovertebral biopsy in one case. In the remaining patient, the clinical and radiological presentations were compatible with pulmonary TB. All patients received four anti-TB drugs: isoniazid, rifampicin, pyrazinamide, and ethambutol. One patient died with miliary TB. The other patients had favorable outcomes.Conclusions: TB in hemodialysis children has a nonspecific clinical presentation. Extrapulmonary locations are most common. Diagnosis is often difficult, but successful outcomes are possible when made at an early stage.Keywords: child, hemodialysis, tuberculosis

Gargah Tahar; Goucha-Louzir Rim; Lakhoua Mohamed Rachid

2010-01-01

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Peginesatide in patients with anemia undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Peginesatide, a synthetic peptide-based erythropoiesis-stimulating agent (ESA), is a potential therapy for anemia in patients with advanced chronic kidney disease. METHODS: We conducted two randomized, controlled, open-label studies (EMERALD 1 and EMERALD 2) involving patients undergoing hemodialysis. Cardiovascular safety was evaluated by analysis of an adjudicated composite safety end point--death from any cause, stroke, myocardial infarction, or serious adverse events of congestive heart failure, unstable angina, or arrhythmia--with the use of pooled data from the two EMERALD studies and two studies involving patients not undergoing dialysis. In the EMERALD studies, 1608 patients received peginesatide once monthly or continued to receive epoetin one to three times a week, with the doses adjusted as necessary to maintain a hemoglobin level between 10.0 and 12.0 g per deciliter for 52 weeks or more. The primary efficacy end point was the mean change from the baseline hemoglobin level to the mean level during the evaluation period; noninferiority was established if the lower limit of the two-sided 95% confidence interval was -1.0 g per deciliter or higher in the comparison of peginesatide with epoetin. The aim of evaluating the composite safety end point in the pooled cohort was to exclude a hazard ratio with peginesatide relative to the comparator ESA of more than 1.3. RESULTS: In an analysis involving 693 patients from EMERALD 1 and 725 from EMERALD 2, peginesatide was noninferior to epoetin in maintaining hemoglobin levels (mean between-group difference, -0.15 g per deciliter; 95% confidence interval [CI], -0.30 to -0.01 in EMERALD 1; and 0.10 g per deciliter; 95% CI, -0.05 to 0.26 in EMERALD 2). The hazard ratio for the composite safety end point was 1.06 (95% CI, 0.89 to 1.26) with peginesatide relative to the comparator ESA in the four pooled studies (2591 patients) and 0.95 (95% CI, 0.77 to 1.17) in the EMERALD studies. The proportions of patients with adverse and serious adverse events were similar in the treatment groups in the EMERALD studies. The cardiovascular safety of peginesatide was similar to that of the comparator ESA in the pooled cohort. CONCLUSIONS: Peginesatide, administered monthly, was as effective as epoetin, administered one to three times per week, in maintaining hemoglobin levels in patients undergoing hemodialysis. (Funded by Affymax and Takeda Pharmaceutical; ClinicalTrials.gov numbers, NCT00597753 [EMERALD 1], NCT00597584 [EMERALD 2], NCT00598273 [PEARL 1], and NCT00598442 [PEARL 2].).

Fishbane S; Schiller B; Locatelli F; Covic AC; Provenzano R; Wiecek A; Levin NW; Kaplan M; Macdougall IC; Francisco C; Mayo MR; Polu KR; Duliege AM; Besarab A

2013-01-01

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Preventing infections in patients undergoing hemodialysis.  

Science.gov (United States)

Infections continue to be a major cause of morbidity and mortality in patients with end-stage renal disease. While rates of all-cause hospitalization of prevalent end-stage renal disease patients receiving hemodialysis reported by the United States Renal Data System fell from 1993 to 2007, rates of hospitalization for infections rose by 26%. Developing a better understanding of the reasons for this rise and employing strategies to reverse it have become a priority for patients, providers and regulatory agencies in the USA. In addition, recent episodes of transmission of bloodborne hepatitis viruses in outpatient healthcare facilities, including hemodialysis centers, related to suboptimal infection control and injection safety practices, have raised concerns about patient safety. In this article, we review many of the current infection control challenges facing outpatient dialysis centers and discuss recommended infection control policies and practices aimed at combating these challenges. PMID:20521893

Kallen, Alexander J; Arduino, Matthew J; Patel, Priti R

2010-06-01

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Valvular heart disease in patients undergoing chronic hemodialysis  

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Full Text Available Valvular heart disease is a common phenomenon in patients undergoing chronic hemodialysis. Abnormalities include valvular and annular thickening and calcification of any of the heart valves, causing regurgitation and/or stenosis. Valvular thickening or sclerosis in patients undergoing chronic dialysis treatment usually affects the aortic and mitral valve. Aortic valve calcification is recorded in up to a half of hemodialyzed patients, occurring from 10 to 20 years earlier than in the general population. Valvular regurgitation occurs mostly in mitral, tricuspid and less commonly in aortic valve. The aim of the article was to determine the incidence of valvular heart disease in asymptomatic patients undergoing chronic dialysis.The analysis involves a total of 50 patients, of whom 35 (70%) are treated by hemodialysis and 15 (30%) by continuous ambulatory peritoneal dialysis. Valvular thickening or sclerosis was diagnosed in 20 (40%) patients. Sclerosis of mitral cusps was diagnosed in 9 (18%) patients and sclerosis of aortic cusps was diagnosed in 11 (22%) patients. Heart valve calcifications were diagnosed in 12 (31%) patients. Mild aortic stenosis was present in 3 (6%) patients. Mitral regurgitation was diagnosed in 38 (76%) patients, aortic regurgitation in 14 (28%), and tricuspid regurgitation in 24 (48%) patients.The evaluation of the valve apparatus for all patients undergoing chronic dialysis program requires echocardiographic examination that is to be performed, considering the high prevalence of valvular heart diseases.

Loncar Daniela; Tabakovic Mithat; Mulic-Bacic Suada; Hadzovic Djani; Brkic Esad; Smajic Elnur; Jasarevic Lejla; Jasarevic Amila

2013-01-01

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The efficacy of incretin therapy in patients with type 2 diabetes undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although incretin therapy is clinically available in patients with type 2 diabetes undergoing hemodialysis, no study has yet examined whether incretin therapy is capable of maintaining glycemic control in this group of patients when switched from insulin therapy. In this study, we examined the efficacy of incretin therapy in patients with insulin-treated type 2 diabetes undergoing hemodialysis. METHODS: Ten type 2 diabetic patients undergoing hemodialysis received daily 0.3?mg liraglutide, 50?mg vildagliptin, and 6.25?mg alogliptin switched from insulin therapy on both the day of hemodialysis and the non-hemodialysis day. Blood glucose level was monitored by continuous glucose monitoring. After blood glucose control by insulin, patients were treated with three types of incretin therapy in a randomized crossover manner, with continuous glucose monitoring performed for each treatment. RESULTS: During treatment with incretin therapies, severe hyperglycemia and ketosis were not observed in any patients. Maximum blood glucose and mean blood glucose on the day of hemodialysis were significantly lower after treatment with liraglutide compared with treatment with alogliptin (p < 0.05), but not with vildagliptin. The standard deviation value, a marker of glucose fluctuation, on the non-hemodialysis day was significantly lower after treatment with liraglutide compared with treatment with insulin and alogliptin (p < 0.05), but not with vildagliptin. Furthermore, the duration of hyperglycemia was significantly shorter after treatment with liraglutide on both the hemodialysis and non-hemodialysis days compared with treatment with alogliptin (p < 0.05), but not with vildagliptin. CONCLUSIONS: The data presented here suggest that patients with type 2 diabetes undergoing hemodialysis and insulin therapy could be treated with incretin therapy in some cases.

Terawaki Y; Nomiyama T; Akehi Y; Takenoshita H; Nagaishi R; Tsutsumi Y; Murase K; Nagasako H; Hamanoue N; Sugimoto K; Takada A; Ito K; Abe Y; Sasatomi Y; Ogahara S; Nakashima H; Saito T; Yanase T

2013-01-01

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Cognitive function and adherence of older adults undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

As the number of older adults undergoing hemodialysis increases, it is important for nurses to consider cognitive impairment as a contributing factor to non-adherence. The purpose of this exploratory study was to identify cognitive markers that nurses can use to alert them to potential problems with adherence among older adults undergoing hemodialysis. Stories of the health challenge of making lifestyle change were analyzed with a linguistic analysis software program. A standardized instrument (3MS) that measures global cognitive function was administered. Determination of adherence level was the last activity of data collection. In this sample (n=63), 39.7% of the participants had evidence of cognitive impairment (3MS score less than 80); 58.2% of the 39.7% had evidence of non-adherence. There was a significant relationship between word use and cognitive function (p < .01). Cognitive impairment is prevalent among older adults undergoing hemodialysis and words might be a proxy for recognizing this.

Hain DJ

2008-01-01

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Prevalence of pulmonary hypertension in patients undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Pulmonary hypertension (PH) is one of the most important accompanying comorbidities with hemodialysis in patients with end-stage renal disease. The prevalence of hemodialysis-induced PH is still a subject of debate. The goal of the present work was to determine the prevalence of PH in patients undergoing hemodialysis. MATERIALS AND METHODS: This study was carried out on patients undergoing hemodialysis for at least 6 months. Pulmonary artery pressure (PAP) was measured by a cardiologist using echocardiography, and a value equal to or higher than 35 mm Hg was considered PH. The relationship of a high PAP with demographic and clinical characteristics of the patients was assessed. RESULTS: A total of 102 patients were included in the study. The mean of age was 59 +/- 18 years. The most common cause of end-stage renal disease was diabetes mellitus (35%). The mean duration of hemodialysis was 24 +/- 17 months. The mean ejection fraction and PAP were 57 +/- 5% (range, 44% to 73%) and 39 +/- 9 mm Hg (range, 25 mm Hg to 70 mm Hg), respectively. Overall, 66% of the patients had PH. These patients were more likely to be on dialysis for a longer duration and to have low ejection fractions. They were also older than other patients. CONCLUSION: Our findings show that PH is associated with duration of dialysis, age, and ejection fraction. Due to the high prevalence of PH among hemodialysis patients, it is necessary to screen this disorder and minimize its effects.

Fadaii A; Koohi-Kamali H; Bagheri B; Hamidimanii F; Taherkhanchi B

2013-01-01

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Quality of sleep in patients undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Sleeping problems are common in hemodialysis (HD) patients. The aim of this study was to determine sleep quality (SQ) in HD patients and to evaluate its relationship with patient's quality of life (QoL), sociodemographic and laboratory data. METHODS: Two hundred HD patients from the Hemodialysis Clinic, Bosnia and Herzegovina, were enrolled in the study. There were 122 men and 78 women with a mean age of 56.8 ± 14.3 (range 20-85) years and a mean HD duration of 62.6 ± 57.0 months. We used the Pittsburgh Sleep Quality Index (PSQI) and the Health Survey for Dialysis Patients (SF-36). RESULTS: Seventy-three percent of patients showed a poor SQ response. The average sleep latency of patients was 48.2 min, and the average sleep duration was 4.9 h. Ninety-eight percent of patients experienced some sort of sleep disturbances on weekly basis. The most common sleep disturbances were insomnia (84.5%), day and night sleep reversal (39.0%), excessive daytime sleepiness (EDS) (34.0%), nightmares (25%) and restless legs syndrome (RLS) (20.5%). The most frequent causes of sleep disorders were snoring (47%), pain (35%), daytime napping (34%), breathing problems (30%) and pruritus (28%). Ninety-three percent of patients experienced daytime dysfunction and 46.5% of them were taking sleep medications. Younger patients, employed patients and patients in 3rd HD shift showed significantly better SQ compared to the others. Compared with good sleepers, poor sleepers were more frequently on conventional HD and had higher serum phosphate and PTH and significantly lower Hb. CONCLUSION: The poor SQ in our HD population significantly correlated with their QoL.

Cengi? B; Resi? H; Spasovski G; Avdi? E; Alajbegovi? A

2012-04-01

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Salivary function in patients with chronic renal failure undergoing hemodialysis  

International Nuclear Information System (INIS)

The aim of this study was to evaluate the changes in salivary gland function in patients with chronic renal failure (CRF) undergoing hemodialysis. The group consisted of 23 patients with CRF (13 female, 10 male; mean age: 40±13 yr) and 14 healthy control subjects (mean age: 40±13 yr). All underwent dynamic salivary gland scintigraphy with gustatory stimulation. After intravenous administration of 99mTc pertechnetate, first, perfusion images at 2 seconds per frame were acquired for 1 minute, then dynamic images at 1 minute per frame were acquired for 45 minutes. At 30 minutes after injection , 10 ml lemon juice was given for 15 minutes as a gustatory stimulus. We obtained time-activity curves derived from regions of interest centered over the four major salivary glands. The following functional indices were calculated for each gland: the time of maximum radioactivity (Tmax) for the prestimulated period, the time of minimum radioactivity (Tmin), as an indicator of velocity of secretion after stimulation, and the Lem E5% value as an indicator of the secretion function. When the patients with CRF undergoing hemodialysis were compared to the controls, there were statistically significant differences in Tmax, Tmin and Lem E5% values for bilateral parotid glands, and Tmin values for bilateral submandibular glands (pmax and Lem E5% values for bilateral submandibular glands. There were also significant differences in Tmax and Lem E5% values for bilateral parotid glands between mild oral problems and severe oral problems in patients with CRF (undergoing hemodialysis). In this study, prolonged Tmax and Tmin values, and decreased Lem E5% values for parotid glands and prolonged Tmin values for submandibular glands on salivary scintigraphy pointed out decreased parenchymatous and excretory function in patients with CRF undergoing hemodialysis. (author)

2002-01-01

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Upper extremities function in patients undergoing hemodialysis treatment.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the effects of hemodialysis treatment on upper extremities functional ability. METHODS: This study was carried out from June 2003 to March 2004 at Pamukkale University School of Physical Therapy, Denizli, Turkey. One hundred patients with chronic renal failure (CRF) undergoing hemodialysis treatment for at least 2 months participated in the study, and were compared with a control group (N=40 healthy subjects). The 100 patients were divided into 4 groups according to the length of hemodialysis duration: 19 patients dialyzing for less than one year (Group 1); 42 patients dialyzing for 1-4 years (Group 2); 21 patients dialyzing for 4.1-8 years (Group 3); 18 patients dialyzing for 8.1 or more years (Group 4). All participants were evaluated for range of motion by goniometry, muscle strength by manual muscle testing, sensation disturbances by Semmes-Weinstein monofilaments, static grip strength by hand dynamometer, and functional status of upper limbs by the Disabilities Arm Shoulder Hand Questionnaire (DASH-T). RESULTS: The results showed that the patients with CRF had significantly more functional problems associated with CRF and hemodialysis treatment than the healthy controls. In addition to these results, the scores of the DASH-T also showed that the most independent group was the control group with a mean score of 0.72+/-0.86, whereas, the most dependent group was the 3rd group of the hemodialysis groups (mean score of 2.70+/-1.77). CONCLUSION: Musculoskeletal or functional problems decreasing functional ability of the upper limbs are a common complaint in hemodialysis patients.

Calik BB; Yagci N; Cavlak U

2006-07-01

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Ototoxicity Probably Due To Isoniazid in a Patient Undergoing Hemodialysis  

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Full Text Available Patients with end-stage renal failure (ESRF) have a high incidence of tuberculosis. Antituberculosis drug-induced ototoxicity may sometimes be a problem in these group of patients. Streptomycin is an antituberculosis drug with well-known ototoxic side effects. However, ototoxicity with combinations not including streptomycin has been reported only in a report in 7 of 42 ESRF patients undergoing hemodialysis and isoniazid has been suggested as a probable responsible drug which has well-known neurotoxic side effects. Here, we presented a 78- year-old man developed hearing loss who was on hemodialysis program and taking antituberculosis drug combination therapy including not streptomycin, but isoniazid, and the probable role of isoniazid in ototoxicity was discussed.

Deniz YERDELEN; Meliha TAN

2008-01-01

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Rosuvastatin and cardiovascular events in patients undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved. METHODS: We conducted an international, multicenter, randomized, double-blind, prospective trial involving 2776 patients, 50 to 80 years of age, who were undergoing maintenance hemodialysis. We randomly assigned patients to receive rosuvastatin, 10 mg daily, or placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Secondary end points included death from all causes and individual cardiac and vascular events. RESULTS: After 3 months, the mean reduction in low-density lipoprotein (LDL) cholesterol levels was 43% in patients receiving rosuvastatin, from a mean baseline level of 100 mg per deciliter (2.6 mmol per liter). During a median follow-up period of 3.8 years, 396 patients in the rosuvastatin group and 408 patients in the placebo group reached the primary end point (9.2 and 9.5 events per 100 patient-years, respectively; hazard ratio for the combined end point in the rosuvastatin group vs. the placebo group, 0.96; 95% confidence interval [CI], 0.84 to 1.11; P=0.59). Rosuvastatin had no effect on individual components of the primary end point. There was also no significant effect on all-cause mortality (13.5 vs. 14.0 events per 100 patient-years; hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P=0.51). CONCLUSIONS: In patients undergoing hemodialysis, the initiation of treatment with rosuvastatin lowered the LDL cholesterol level but had no significant effect on the composite primary end point of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. (ClinicalTrials.gov number, NCT00240331.)

Fellström BC; Jardine AG; Schmieder RE; Holdaas H; Bannister K; Beutler J; Chae DW; Chevaile A; Cobbe SM; Grönhagen-Riska C; De Lima JJ; Lins R; Mayer G; McMahon AW; Parving HH; Remuzzi G; Samuelsson O; Sonkodi S; Sci D; Süleymanlar G; Tsakiris D; Tesar V; Todorov V; Wiecek A; Wüthrich RP; Gottlow M; Johnsson E; Zannad F

2009-04-01

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Liver enzymes in patients with chronic kidney disease undergoing peritoneal dialysis and hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english OBJECTIVE: The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis. PATIENTS AND METHODS: Twenty patients on peritoneal dialysis and 40 on hemodialysis were assessed, and the patients were matched according to the length of time that they had been on dialysis. Blood samples were collec (more) ted (both before and after the session for those on hemodialysis) to measure the enzymes and the hematocrit. RESULTS: In the samples from the patients who were undergoing peritoneal dialysis, the aspartate and alanine aminotransferase levels were slightly higher compared with the samples collected from the patients before the hemodialysis session and slightly lower compared with the samples collected after the hemodialysis session. The levels of gamma-glutamyl transferase in the hemodialysis patients were slightly higher than the levels in the patients who were undergoing peritoneal dialysis. In addition, the levels of aminotransferases and gamma-glutamyl transferase that were collected before the hemodialysis session were significantly lower than the values collected after the session. The hematocrit levels were significantly lower in the patients who were on peritoneal dialysis compared with the patients on hemodialysis (both before and after the hemodialysis session), and the levels were also significantly lower before hemodialysis compared with after hemodialysis. CONCLUSION: The aminotransferase levels in the patients who were undergoing peritoneal dialysis were slightly higher compared with the samples collected before the hemodialysis session, whereas the aminotransferase levels were slightly lower compared with the samples collected after the session. The hematocrits and the aminotransferase and gamma-glutamyl transferase levels of the samples collected after the hemodialysis session were significantly higher than the samples collected before the session. Taken together, the present data suggest that hemodilution could alter the serum levels of liver enzymes.

Liberato, Isabella Ramos de Oliveira; Lopes, Edmundo Pessoa de Almeida; Cavalcante, Maria Alina Gomes de Mattos; Pinto, Tiago Costa; Moura, Izolda Fernades; Loureiro Júnior, Luiz

2012-01-01

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Reviewing and comparing self-concept in patients undergoing hemodialysis and peritoneal dialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Chronic renal disease is a health problem in today's world. In the end-stages of renal disease patients depend upon alternative therapies including dialysis for their survival. However, dialysis causes several stressors on physical, mental and social performance of patients. The present study aimed to review and compare the self-concept in patients undergoing hemodialysis and peritoneal dialysis. MATERIALS AND METHODS: This was a case-control study including two groups of patients, undergoing hemodialysis and peritoneal dialysis, who referred to Al-Zahra and Ali Asghar Hospitals, which are affiliated to Isfahan University of Medical Sciences. These groups were compared to the control group. Data were collected through completing the form of demographic characteristics and a questionnaire, written by the researcher, pertaining to the self-concept which was collected by the samples. The data were analyzed by the Software SPSS version 18. FINDINGS: ANOVA (analysis of variance) showed that statistically there was a significant difference between mean score of self-concept in the three physical (body-image), psychological, and social self aspects in the two groups of hemodialysis and peritoneal dialysis with the control group; however, Duncan's post-hoc analysis showed no significant difference between mean score of self-concept in the three mentioned aspects in the two groups of hemodialysis and peritoneal dialysis. Furthermore, ANOVA (analysis of variance) showed that there was no significant difference between mean score of the spiritual aspect of the self-concept in the two groups of hemodialysis and peritoneal dialysis with the control group. Duncan's post-hoc analysis also showed no significant difference in this aspect between the two groups of hemodialysis and peritoneal dialysis. CONCLUSIONS: Patients undergoing dialysis have many psychological disorders and the type of dialysis is not of much importance in this regard; therefore, adequate education and information for clients in order to use appropriate methods of adaptation as well as appropriate social relationship, continuing social support and developing health policies seem necessary in order to prevent mental disorders and providing required services and supports for patients.

Shahgholian N; Tajdari S; Nasiri M

2012-02-01

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Low serum testosterone is associated with atherosclerosis in postmenopausal women undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Low serum testosterone levels have been recently linked to endothelial dysfunction, arterial stiffness, and worse outcomes in male hemodialysis patients. We tested the hypothesis that low serum testosterone levels are also associated with atherosclerosis risk factors in postmenopausal women undergoing hemodialysis. METHODS: We measured serum testosterone in 115 confirmed postmenopausal ethnically Japanese women undergoing hemodialysis with mean age of 68.1 ± 10.6 years and median dialysis vintage of 73 months. The severity of atherosclerosis was evaluated by carotid intima-media thickness (cIMT) and cardio-ankle vascular index (CAVI). In addition, we also included a control cohort of 32 age-matched postmenopausal women without chronic kidney disease. RESULTS: Serum testosterone was significantly lower in women undergoing hemodialysis than in age-matched controls. Women undergoing hemodialysis who had undetectable testosterone concentration presented higher cIMT and higher CAVI than women undergoing hemodialysis with testosterone concentration above detection limits (P < 0.05 for all). Multiple logistic regression analyses confirmed the independence of these associations. CONCLUSION: Serum testosterone levels in postmenopausal women undergoing hemodialysis are abnormally low and associated with features of atherosclerosis.

Shiraki N; Nakashima A; Doi S; Carrero JJ; Sugiya N; Ueno T; Stenvinkel P; Kohno N; Masaki T

2013-07-01

 
 
 
 
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Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study.  

UK PubMed Central (United Kingdom)

CONCLUSIONS: Frailty, a validated construct in the elderly, was a strong and independent predictor of falls in adults undergoing hemodialysis, regardless of age. Our results may aid in identifying frail hemodialysis patients who could be targeted for multidimensional fall prevention strategies.

McAdams-Demarco MA; Suresh S; Law A; Salter ML; Gimenez LF; Jaar BG; Walston JD; Segev DL

2013-10-01

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Evaluation of Conner?s Continuous Performance Test in Hemodialysis Patients  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Memory and cognitive abnormalities such as decreased attention span, impulsiveness, and slow reaction are common among chronic hemodialysis patients. We studied the changes these parameters in 38 hemodialysis patients before and after hemodialysis sessions via Conner?s continuous performance ...

Najafi Mostafa

23

LDL-apheresis dramatically improves generalized calciphylaxis in a patient undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

We present the first documented case of generalized calciphylaxis that dramatically improved after low-density lipoprotein-apheresis (LA) in a patient undergoing long-term hemodialysis. Calciphylaxis was diagnosed by skin biopsy and was manifest as painful ulcers on the right leg, left buttock, and glans penis. Skin perfusion pressure (SPP), which has recently been used as an indicator of impaired capillary perfusion in distal lesions of the lower extremities, was markedly reduced. The ulcers continued to worsen despite general wound care, correction of levels of calcium × phosphate product, hyperbaric oxygen therapy, and use of bisphosphonate, antiplatelet therapy, and vasodilators. Because LA is known to exert favorable effects on peripheral arterial disease through improved hemorheology, anti-inflammatory action, vasodilation, and angiogenesis, we introduced LA to produce the same effects on calciphylaxis. LA dramatically increased SPP and promoted ulcer healing, demonstrating that LA can be a useful treatment option for calciphylaxis.

Iwagami M; Mochida Y; Ishioka K; Oka M; Moriya H; Ohtake T; Hidaka S; Kobayashi S

2012-10-01

24

LDL-apheresis dramatically improves generalized calciphylaxis in a patient undergoing hemodialysis.  

Science.gov (United States)

We present the first documented case of generalized calciphylaxis that dramatically improved after low-density lipoprotein-apheresis (LA) in a patient undergoing long-term hemodialysis. Calciphylaxis was diagnosed by skin biopsy and was manifest as painful ulcers on the right leg, left buttock, and glans penis. Skin perfusion pressure (SPP), which has recently been used as an indicator of impaired capillary perfusion in distal lesions of the lower extremities, was markedly reduced. The ulcers continued to worsen despite general wound care, correction of levels of calcium × phosphate product, hyperbaric oxygen therapy, and use of bisphosphonate, antiplatelet therapy, and vasodilators. Because LA is known to exert favorable effects on peripheral arterial disease through improved hemorheology, anti-inflammatory action, vasodilation, and angiogenesis, we introduced LA to produce the same effects on calciphylaxis. LA dramatically increased SPP and promoted ulcer healing, demonstrating that LA can be a useful treatment option for calciphylaxis. PMID:23036228

Iwagami, Masao; Mochida, Yasuhiro; Ishioka, Kunihiro; Oka, Mochida; Moriya, Hidekazu; Ohtake, Takayasu; Hidaka, Sumi; Kobayashi, Shuzo

2012-10-01

25

Vildagliptin is Effective for Glycemic Control in Diabetic Patients Undergoing either Hemodialysis or Peritoneal Dialysis.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Vildagliptin can be used in patients with type 2 diabetes mellitus and renal impairment. However, there have been few reports investigating the clinical effectiveness of vildagliptin in diabetic patients undergoing hemodialysis. No previous studies have evaluated the use of vildagliptin in patients undergoing peritoneal dialysis. The authors determined the usefulness of vildagliptin for treating type 2 diabetic patients receiving chronic dialysis, including peritoneal dialysis. METHODS: A retrospective study of ten diabetic patients undergoing peritoneal dialysis and five diabetic patients undergoing hemodialysis who were treated with 50 mg/day of vildagliptin was performed. Clinical parameters were investigated for a period of 6 months starting from the vildagliptin therapy. RESULTS: The hemoglobin A1c (HbA1c) levels were significantly reduced after baseline in both the peritoneal dialysis and hemodialysis groups, whereas the hemoglobin levels did not change during the follow-up period. The mean change in the HbA1c level (?HbA1c) was -0.6 ± 0.9% and -0.5 ± 0.7% among the patients undergoing peritoneal dialysis and hemodialysis, respectively. The glycated albumin (GA) levels were also significantly reduced compared with baseline in the peritoneal dialysis group, although the serum albumin levels did not change. The mean change in the GA level (?GA) was -3.4 ± 3.1% and -2.1 ± 2.5% among the patients undergoing peritoneal dialysis and hemodialysis, respectively. Stepwise multivariate analyses demonstrated the level of HbA1c at baseline to be significantly associated with the ?HbA1c and that the level of GA at baseline was significantly associated with the ?GA. CONCLUSION: Vildagliptin exhibits effectiveness in patients with type 2 diabetes mellitus undergoing peritoneal dialysis or hemodialysis. The degree of improvement in the HbA1c and GA levels was dependent on these levels at baseline, similar to the findings of previous reports of subjects without end-stage kidney disease.

Ito H; Mifune M; Matsuyama E; Furusho M; Omoto T; Shinozaki M; Nishio S; Antoku S; Abe M; Togane M; Koga S; Sanaka T

2013-06-01

26

Noninvasive continuous monitoring of digital pulse waves during hemodialysis  

DEFF Research Database (Denmark)

Intermittent hemodynamic instability during hemodialysis treatment is a frequent complication in patients with end-stage renal failure. A noninvasive method for continuous hemodynamic monitoring is needed. We used noninvasive digital photoplethysmography and an algorithm for continuous, investigator-independent, automatic analysis of digital volume pulse in 10 healthy subjects and in 20 patients with end-stage renal failure during the hemodialysis session. The reflective index was defined representing the diastolic component of the digital pulse wave. The properties of the reflective index were studied in healthy control subjects (n=10). An increased reflective index was due to increased peripheral pulse wave reflection (e.g., vasoconstriction). During a hemodialysis session, the reflective index increased significantly from 36+/-3 arbitrary units to 41+/-3 arbitrary units (n=20; p

Burkert, Antje; Scholze, Alexandra

2009-01-01

27

Hepatic arterial infusion of oxaliplatin for a patient with hepatic metastases from colon cancer undergoing hemodialysis.  

Science.gov (United States)

There has been no previous report of oxaliplatin administration in patients undergoing hemodialysis. A 65-year-old female with end-stage renal disease who was undergoing hemodialysis presented with anemia in August 2005. She was diagnosed with colon cancer with multiple liver metastases. After colectomy, hepatic arterial infusion chemotherapy of 5-fluorouracil was initiated and systemic administration of irinotecan was later added. After 3 months of treatment, liver metastases were strikingly reduced in size, and the carcinoembryonic antigen level decreased from 336 to 14.2 ng/ml. Eight months after treatment initiation, liver metastases increased in size with higher levels of carcinoembryonic antigen, therefore hepatic arterial infusion of oxaliplatin 60 mg was initiated. Hepatic arterial infusion was performed biweekly during hemodialysis and blood platinum concentrations were assessed. At the first cycle, the area under the curve of total platinum was 19.39 microg h/ml and that of free platinum was 5.51 microg h/ml. After six treatment cycles, the carcinoembryonic antigen level declined from 335 to 123 ng/ml. After eight treatment cycles, she experienced transient fever and impaired consciousness as a result of cholangitis, which improved following administration of antibiotics. We propose that limited cycles of hepatic arterial infusion of oxaliplatin are feasible in patients undergoing hemodialysis and this may become a strategy for treating hepatic metastases from colon cancer in patients undergoing hemodialysis. PMID:17675650

Shitara, Kohei; Munakata, Masaki; Muto, Osamu; Okada, Ristuko; Mitobe, Sumako; Mino, Masanari; Ikami, Isao; Sakata, Yuh

2007-08-04

28

Hepatic arterial infusion of oxaliplatin for a patient with hepatic metastases from colon cancer undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

There has been no previous report of oxaliplatin administration in patients undergoing hemodialysis. A 65-year-old female with end-stage renal disease who was undergoing hemodialysis presented with anemia in August 2005. She was diagnosed with colon cancer with multiple liver metastases. After colectomy, hepatic arterial infusion chemotherapy of 5-fluorouracil was initiated and systemic administration of irinotecan was later added. After 3 months of treatment, liver metastases were strikingly reduced in size, and the carcinoembryonic antigen level decreased from 336 to 14.2 ng/ml. Eight months after treatment initiation, liver metastases increased in size with higher levels of carcinoembryonic antigen, therefore hepatic arterial infusion of oxaliplatin 60 mg was initiated. Hepatic arterial infusion was performed biweekly during hemodialysis and blood platinum concentrations were assessed. At the first cycle, the area under the curve of total platinum was 19.39 microg h/ml and that of free platinum was 5.51 microg h/ml. After six treatment cycles, the carcinoembryonic antigen level declined from 335 to 123 ng/ml. After eight treatment cycles, she experienced transient fever and impaired consciousness as a result of cholangitis, which improved following administration of antibiotics. We propose that limited cycles of hepatic arterial infusion of oxaliplatin are feasible in patients undergoing hemodialysis and this may become a strategy for treating hepatic metastases from colon cancer in patients undergoing hemodialysis.

Shitara K; Munakata M; Muto O; Okada R; Mitobe S; Mino M; Ikami I; Sakata Y

2007-07-01

29

Self-care management in adults undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

The research literature on self-care management for adults with end stage renal disease being treated with hemodialysis was reviewed to ascertain the current state of knowledge, identify gaps, and propose future research. Sixty-four studies were reviewed. Many studies focused on compliance and whether subjects were meeting predetermined values of outcome variables set by professionals. Self-care management of ESRD is multidimensional and warrants further research from the client professional, and health care system perspectives.

Richard CJ

2006-07-01

30

Clearance and synthesis rates of beta 2-microglobulin in patients undergoing hemodialysis and in normal subjects  

Energy Technology Data Exchange (ETDEWEB)

Retention of {beta} 2-microglobulin in patients undergoing hemodialysis is associated with a {beta} 2-microglobulin-derived amyloidosis. Removal of {beta} 2-microglobulin by renal replacement therapy has been proposed for the prevention of this amyloidosis. Currently, however, data on the {beta} 2-microglobulin synthesis rate in patients undergoing hemodialysis are scarce, and consequently it remains speculative how much removal would be necessary to counterbalance synthesis. The plasma kinetics of iodine 131-labeled {beta} 2-microglobulin were therefore examined in 11 patients with anuria who were undergoing long-term hemodialysis. Five healthy persons served as controls. Kinetic modeling of the plasma curves showed that the data fitted a two-pool model (r2 greater than 0.96) consisting of a rapid 2 to 4 hour distribution phase followed by a less steep curve, described by the plasma (metabolic) clearance (Clp). Synthetic rates were calculated from Clp and the {beta} 2-microglobulin steady state plasma concentration (plus {beta} 2-microglobulin removal during hemodialysis in the case of high flux hemodialysis). The results showed a significantly higher Clp in normal controls as compared with patients undergoing hemodialysis (65.5 {plus minus} 12.8 ml/min (mean {plus minus} SD) versus 3.4 {plus minus} 0.7 ml/min). In contrast, the {beta} 2-microglobulin synthesis rate in the patient group (3.10 {plus minus} 0.79 mg/kg/day) was not significantly different from that of normal controls (2.40 {plus minus} 0.67 mg/kg/day), which was due to markedly elevated {beta} 2-microglobulin plasma concentrations in the patients (37.6 {plus minus} 14.1 mg/L vs 1.92 {plus minus} 0.27 mg/L). These findings suggest that the presence of end-stage renal disease does not have a significant impact on the beta 2-microglobulin generation rate.

Floege, J.; Bartsch, A.; Schulze, M.; Shaldon, S.; Koch, K.M.; Smeby, L.C. (Department of Nephrology, University Hospital of Hannover (Germany))

1991-08-01

31

Clearance and synthesis rates of beta 2-microglobulin in patients undergoing hemodialysis and in normal subjects  

International Nuclear Information System (INIS)

[en] Retention of ? 2-microglobulin in patients undergoing hemodialysis is associated with a ? 2-microglobulin-derived amyloidosis. Removal of ? 2-microglobulin by renal replacement therapy has been proposed for the prevention of this amyloidosis. Currently, however, data on the ? 2-microglobulin synthesis rate in patients undergoing hemodialysis are scarce, and consequently it remains speculative how much removal would be necessary to counterbalance synthesis. The plasma kinetics of iodine 131-labeled ? 2-microglobulin were therefore examined in 11 patients with anuria who were undergoing long-term hemodialysis. Five healthy persons served as controls. Kinetic modeling of the plasma curves showed that the data fitted a two-pool model (r2 greater than 0.96) consisting of a rapid 2 to 4 hour distribution phase followed by a less steep curve, described by the plasma (metabolic) clearance (Clp). Synthetic rates were calculated from Clp and the ? 2-microglobulin steady state plasma concentration (plus ? 2-microglobulin removal during hemodialysis in the case of high flux hemodialysis). The results showed a significantly higher Clp in normal controls as compared with patients undergoing hemodialysis (65.5 ± 12.8 ml/min (mean ± SD) versus 3.4 ± 0.7 ml/min). In contrast, the ? 2-microglobulin synthesis rate in the patient group (3.10 ± 0.79 mg/kg/day) was not significantly different from that of normal controls (2.40 ± 0.67 mg/kg/day), which was due to markedly elevated ? 2-microglobulin plasma concentrations in the patients (37.6 ± 14.1 mg/L vs 1.92 ± 0.27 mg/L). These findings suggest that the presence of end-stage renal disease does not have a significant impact on the beta 2-microglobulin generation rate

1991-01-01

32

Frequency of onychomycoses in chronic renal failure patients undergoing hemodialysis in Porto Alegre, Brazil.  

UK PubMed Central (United Kingdom)

Onychomycosis is one of the most frequent infections affecting the fingernails or the toenails and it is caused mainly by dermatophytes. The aim of the study was to assess the frequency of onychomycoses in hemodialysis patients and to relate sex, age, duration of hemodialysis and causes of renal failure to the development of nail disorders. The study included 100 patients with chronic renal failure undergoing hemodialysis. The patients underwent detailed clinical examination of the toenails and those with any kind of clinical finding had nail scraping for mycological testing. In the study population, the frequency of onychomycosis was 39%. The most commonly isolated fungi were dermatophytes (69.23%), Candida spp. (15.38%) and nondermatophyte molds (15.38%). T. interdigitale was the most prevalent fungus followed by Candida ssp. and T. rubrum. The risk of onychomycosis increases by 1.9% for each additional year in age and diabetic patients are 88% more likely to develop onychomycosis than nondiabetic ones. The duration of hemodialysis treatment and sex were not associated with the development of onychomycosis. In conclusion, in hemodialysis patients, the frequency of onychomycosis was higher in those at advanced age and with diabetes.

Lamb FM; Ottonelli Stopiglia CD; Vetoratto G; Goldani JC; Scroferneker ML

2013-01-01

33

Oral health-related quality of life and periodontal health status in patients undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Health-related quality of life (HRQOL) is a multidimensional concept regarding quality of life (QOL) as it relates specifically to health and disease. The effect of ongoing hemodialysis on a person's oral health can be determined by clinical variables, but these do not reflect the person's perception of health versus illness. The authors conducted a study to determine the periodontal status, attitude toward oral health and self-perceived oral health in patients undergoing hemodialysis, as well as to evaluate the effect of oral health on QOL within this group. METHODS: Patients undergoing hemodialysis were evaluated for socio-demographic and periodontal variables. The authors evaluated oral health-related quality of life (OHRQOL) by means of the short-form Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI). They measured perceived oral health by asking a single question. RESULTS: The study involved 47 patients undergoing hemodialysis. Plaque index score, gingival index score, probing depth and bleeding-on-probing status were 2.21 +/- 0.66, 1.24 +/- 0.77, 2.17 millimeters +/- 0.53 mm and 33.51 percent +/- 24.58 percent, respectively. Participants reported being uncomfortable when eating or swallowing. Participants reported being sensitive to hot or cold (69.8 percent), having a worse sense of taste (90.8 percent) and having painful aching in the mouth (72.1 percent). The mean OHIP-14 and GOHAI scores were 19.40 +/- 7.74 and 15.72 +/- 8.68, respectively. CONCLUSIONS: The self-perceived health of 72.7 percent of participants undergoing hemodialysis was fair or poor, and the impact of OHRQOL was moderate, which means that oral health was not a major concern. These results underscore the importance of using subjective and self-reported oral assessments to determine more convenient and satisfying treatment approaches for each patient. CLINICAL IMPLICATIONS: Clinicians should use oral health assessment tools to determine individual treatment and approaches to promote the oral health of patients undergoing hemodialysis and improve their QOL.

Guzeldemir E; Toygar HU; Tasdelen B; Torun D

2009-10-01

34

Severe hyperkalemia following colon diversion surgery in a patient undergoing chronic hemodialysis: a case report.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Potassium (K+) homeostasis in healthy subjects is maintained mainly by urinary excretion of K+. In patients with end-stage renal disease, the intestinal tract might assume an accessory K+ excretory role in the face of declining renal excretory function. Here, we report the case of a patient with end-stage renal disease who developed severe hyperkalemia following colon diversion surgery. CASE PRESENTATION: A 56-year-old Caucasian woman undergoing hemodialysis experienced ischemic colitis, leading to ileocecal resection and a temporary ileostomy. She made a good recovery and her dietary intake improved. However, her pre-dialysis serum K+ level three weeks later was 7.2mmol/L, which was much higher than her previous level (range 4.9 to 6.1mmol/L). Despite dietary restriction of K+ and use of oral cation-exchange resin and low K+ dialysate, her serum K+ level remained high (6.1 to 8.3mmol/L). Six months later, her bowel continuity was restored and her serum K+ decreased to the previous level. Her fecal K+ concentration before and after stoma reversal showed a marked difference: 23mmol/L before and 60mmol/L after. CONCLUSIONS: We assume that the severe hyperkalemia seen in our patient was caused by reduced colonic K+ secretion due to the colon diversion. Our patient's case demonstrates the importance of colonic K+ secretion for the maintenance of K+ homeostasis in patients with end-stage renal disease.

Kononowa N; Dickenmann MJ; Kim MJ

2013-01-01

35

Severe hyperkalemia following colon diversion surgery in a patient undergoing chronic hemodialysis: a case report  

Science.gov (United States)

Introduction Potassium (K+) homeostasis in healthy subjects is maintained mainly by urinary excretion of K+. In patients with end-stage renal disease, the intestinal tract might assume an accessory K+ excretory role in the face of declining renal excretory function. Here, we report the case of a patient with end-stage renal disease who developed severe hyperkalemia following colon diversion surgery. Case presentation A 56-year-old Caucasian woman undergoing hemodialysis experienced ischemic colitis, leading to ileocecal resection and a temporary ileostomy. She made a good recovery and her dietary intake improved. However, her pre-dialysis serum K+ level three weeks later was 7.2mmol/L, which was much higher than her previous level (range 4.9 to 6.1mmol/L). Despite dietary restriction of K+ and use of oral cation-exchange resin and low K+ dialysate, her serum K+ level remained high (6.1 to 8.3mmol/L). Six months later, her bowel continuity was restored and her serum K+ decreased to the previous level. Her fecal K+ concentration before and after stoma reversal showed a marked difference: 23mmol/L before and 60mmol/L after. Conclusions We assume that the severe hyperkalemia seen in our patient was caused by reduced colonic K+ secretion due to the colon diversion. Our patient’s case demonstrates the importance of colonic K+ secretion for the maintenance of K+ homeostasis in patients with end-stage renal disease.

2013-01-01

36

[The evaluation of the level of hope of elderly chronic kidney disease patients undergoing hemodialysis].  

UK PubMed Central (United Kingdom)

The objective of the present study was to evaluate the level of hope of elderly chronic kidney disease patients undergoing hemodialysis, using the Herth Hope Scale (HHS). This cross-sectional descriptive study was performed at a Renal Replacement Therapy Unit located in upstate São Paulo. The sample consisted of 50 elderly patients currently undergoing hemodialysis treatment. After obtaining the participants' consent to participate, individual interviews were performed with the elderly individuals, utilizing a characterization instrument and the Herth Hope Scale. All of the ethical premises were complied with (protocol 512/2009). Regarding the results, most participants were male (60%) and their mean age was 70.20 (±6.1) years. The mean score on the Herth Hope Scale was 36.20 (±2.90). In conclusion, compared with the Brazilian study regarding the validation of the Herth Hope Scale, the subjects' level of hope was lower, thus indicating a need to intervene regarding this feeling.

Orlandi Fde S; Pepino BG; Pavarini SC; Dos Santos DA; de Mendiondo MS

2012-08-01

37

Leukemoid Reaction after Methotrexate-Induced Pancytopenia in a Patient undergoing Continuous Ambulatory Peritoneal Dialysis  

Directory of Open Access Journals (Sweden)

Full Text Available Methotrexate has been used as an important alternative therapy in the treatment of variousrheumatic diseases. Life threatening marrow suppression in end-stage renal diseasepatients undergoing hemodialysis or continuous ambulatory peritoneal dialysis has beenreported. A 33-year-old woman with systemic lupus erythematosus undergoing chronic peritonealdialysis developed severe mucositis and pancytopenia after low-dose methotrexatetreatment for arthritis. The leukocyte count recovered after methotrexate was withdrawn buta leukemoid blood picture developed during her recovery. No evidence of leukemia wasfound on bone marrow biopsy. The leukocyte count gradually returned to normal with conservativetherapy.

Chiao-Ying Sun; Hou-Chang Lin; Yung-Chih Chen; Chi-Ren Tsai; Mai-Szu Wu

2006-01-01

38

[Anesthesia for a hemodialysis patient with HIT undergoing CABG using argatroban].  

UK PubMed Central (United Kingdom)

Anesthetic Management of CABG in a Hemodialysis patient complicated by heparin-induced thrombocytopenia (HIT) type II is one of the different procedures in hemodialysis patients using heparin. An 81-year-old man receiving hemodialysis complicated by HIT type II was scheduled for coronary artery bypass grafting (CABG). Anesthesia was induced and maintained with propofol, remifentanil and rocuronium. During artificial cardiopulmonary bypass, activated clotting time (ACT) was maintained above 300 sec by in initial 0.1 mg x kg(-1) and subsequent 2.0-7.0 microg x kg(-1) x min(-1) doses of argatroban; a direct thrombin inhibitor. Immediately after the completion of the external cardiopulmonary circulation, continuous infusion of argatroban was discontinued. Seven hours later ACT was restored to the preoperative level. Both intra and postoperative courses were uneventful.

Goto S; Hiramori T; Kuroiwa K; Mochizuki N; Takano T; Nishizawa M

2012-04-01

39

[Anesthesia for a hemodialysis patient with HIT undergoing CABG using argatroban].  

Science.gov (United States)

Anesthetic Management of CABG in a Hemodialysis patient complicated by heparin-induced thrombocytopenia (HIT) type II is one of the different procedures in hemodialysis patients using heparin. An 81-year-old man receiving hemodialysis complicated by HIT type II was scheduled for coronary artery bypass grafting (CABG). Anesthesia was induced and maintained with propofol, remifentanil and rocuronium. During artificial cardiopulmonary bypass, activated clotting time (ACT) was maintained above 300 sec by in initial 0.1 mg x kg(-1) and subsequent 2.0-7.0 microg x kg(-1) x min(-1) doses of argatroban; a direct thrombin inhibitor. Immediately after the completion of the external cardiopulmonary circulation, continuous infusion of argatroban was discontinued. Seven hours later ACT was restored to the preoperative level. Both intra and postoperative courses were uneventful. PMID:22590944

Goto, Shinya; Hiramori, Tomoko; Kuroiwa, Kaori; Mochizuki, Noriaki; Takano, Takahiro; Nishizawa, Masaaki

2012-04-01

40

Base excision repair capacity in chronic renal failure patients undergoing hemodialysis treatment.  

UK PubMed Central (United Kingdom)

The aim of this study was to determine if the differences observed in the levels of DNA damage in a group of patients suffering from chronic renal failure are due to differences in the repair capability. DNA damage was initially measured with the comet assay in 106 hemodialysis patients. A selected group of 21 patients representing high (ten patients) and low (11 patients) levels of DNA damage were obtained for determination of base excision repair capacity. This was measured in an in vitro assay where protein extracts from lymphocytes were incubated with a substrate of DNA containing 8-oxoguanine, and the rate of incision was measured with the comet assay. Patients with high levels of genomic damage showed, as an average, significantly lower repair capacity (12·73?±?1·84) in comparison with patients with low levels of genomic damage (18·13?±?1·13). Nevertheless, the correlation coefficient between repair ability and levels of genomic damage was found to be only close to the significance value (r:-0·423, p: 0·056). Although DNA damage was clearly related to time on hemodialysis, base excision repair capacity was not. This is one of the few studies providing information on the repair capacity of chronic renal failure patients undergoing hemodialysis. As a summary, our results would indicate that DNA damage levels are in part associated to the repair capacity of the patients, and this repair capacity is not associated with the duration of hemodialysis treatment. Copyright © 2013 John Wiley & Sons, Ltd.

Stoyanova E; Pastor S; Coll E; Azqueta A; Collins AR; Marcos R

2013-07-01

 
 
 
 
41

Nutritional status of zinc and activity superoxide dismutase in chronic renal patients undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Chronic kidney disease promotes changes in the zinc nutritional status and in the antioxidant defense system. This study assessed the relationship between the parameters of the zinc nutritional status and the activity of superoxide dismutase in patients with chronic renal failure who are receiving hemodialysis. METHODS: 134 individuals, aged between 18 and 85 years, were divided into two groups: case group (hemodialyzed patients, n = 63) and control group (n = 71). Zinc concentrations in plasma and erythrocytes were determined using the flame atomic absorption spectrophotometry technique. The activity of superoxide dismutase enzyme was determined according to Ransod kit. RESULTS: The mean values of plasma zinc were 62.02 ± 13.59 ?g/dL and 65.58 ± 8.88 ?g/dL, and for erythrocytary zinc the values were 54.52 ± 22.82 ?gZn/gHb and 48.01 ± 15.08 ?gZn/gHb for the chronic renal patients and the control group, respectively. The activity of superoxide dismutase was significantly lower in patients when compared with the control group (p < 0.05). CONCLUSION: The activity of superoxide dismutase in patients with chronic renal failure undergoing hemodialysis, which is influenced by zinc concentracions, was significantly lower. There was an inadequate response of this enzyme to oxidative stress in patients undergoing hemodialysis.

Noleto Magalhães RC; Guedes Borges de Araujo C; Batista de Sousa Lima V; Machado Moita Neto J; do Nascimento Nogueira N; do Nascimento Marreiro D

2011-11-01

42

Factors associated with self-management by people undergoing hemodialysis: A descriptive study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Improving the level of self-management by people undergoing hemodialysis is an effective way to reduce the incidence of mortality and complications and improve quality of life. A better understanding of what influences an individual's level of self-management can help nurses find appropriate ways to improve self-management. OBJECTIVES: To examine self-management levels, and discuss the factors influencing self-management, in a sample of patients undergoing hemodialysis in Beijing. DESIGN: A descriptive study design was chosen. SETTINGS AND METHODS: A convenience sample of 216 patients undergoing hemodialysis was recruited from dialysis centers in three tertiary hospitals in Beijing from September 2010 to January 2011. Questionnaires were used to examine the variables: level of self-management; knowledge of hemodialysis; self-efficacy; anxiety and depression; and social support. Data analysis involved descriptive statistics, including frequency, percentage, mean and standard deviations, while Spearman correlation, non-parametric Z and ?(2) and multiple linear regression were used for comparative purposes. RESULTS: The number of returned questionnaires was 198 (91.67% response rate). The overall score of self-management was 56.01 (SD=10.75). The average item scores for each of the four self-management subscales were 3.02 for partnership, 2.98 for problem-solving skills, 2.74 for self-care and 2.47 for emotional management. Multiple linear regression analyses for overall self-management and the four subscales indicated that knowledge, self-efficacy, the availability of social support and depression were the main influencing factors which explained 34.1% of the variance of self-management. CONCLUSION: The level of self-management by those undergoing hemodialysis in this study was less than ideal, varying from 'rare' to 'sometimes' for use of self-management behaviors. For the different subscales of self-management, partnership was the most used and emotional management the least used strategy. Patients' knowledge, self-efficacy, the availability of social support and depression were the main factors influencing self-management.

Li H; Jiang YF; Lin CC

2013-06-01

43

Frequency and Genotype of Hepatitis D Virus Infection in Patients Infected with HIV and Those Undergoing Hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Hepatitis D virus (HDV) is a defective virus dependent on hepatitis B virus (HBV) for its replication. Due to HDV transmission routes, patients undergoing hemodialysis and those with HIV infection are at risk of acquiring HDV. OBJECTIVES: This study was aimed to determine the frequency and genotype of HDV infection among patients with HIV infection and those undergoing hemodialysis. PATIENTS AND METHODS: 720 cases including 120 patients undergoing hemodialysis, and 600 patients with HIV infection were studied. All cases with positive results for HBsAg were evaluated for the presence of anti-HDV antibodies. Samples with Anti-HDV positive results were subjected to nested PCR for HDV-RNA confirmation, and sequenced for HDV genotype determination. RESULTS: HBsAg was found in 9 (7.5%) of 120 patients undergoing hemodialysis, and 9 (1.5%) of 600 patients with HIV infection. 3 (33.3%) of patients undergoing hemodialysis with positive results for HBsAg, and 5 (55.5%) of cases with HIV infection and positive results for HBsAg, had positive findings for anti-HDV which were then subjected to nested PCR. The amplification results confirmed that in 3 (37.5%) samples HDV-RNA was detected. Overall 2.5% of patients undergoing hemodialysis, and 0.8% of cases infected with HIV had positive results for anti-HDV and 1.7% and 0.2% of cases undergoing hemodialysis and patients infected with HIV had positive findings for HDV-RNA respectively. All of the HDV isolates were clustered in clade 1. CONCLUSIONS: The survey showed that overall HDV frequency was not high in our high risk cases. Therefore, practitioners and health care managers should become aware of the risk of dual infection with HBV and HDV especially in high risk patients.

Aghasadeghi MR; Mohraz M; Bahramali G; Aghakhani A; Banifazl M; Foroughi M; Ahmadi F; Eslamifar A; Sadat SM; Ramezani A

2013-05-01

44

Frequency and Genotype of Hepatitis D Virus Infection in Patients Infected with HIV and Those Undergoing Hemodialysis  

Science.gov (United States)

Background Hepatitis D virus (HDV) is a defective virus dependent on hepatitis B virus (HBV) for its replication. Due to HDV transmission routes, patients undergoing hemodialysis and those with HIV infection are at risk of acquiring HDV. Objectives This study was aimed to determine the frequency and genotype of HDV infection among patients with HIV infection and those undergoing hemodialysis. Patients and Methods 720 cases including 120 patients undergoing hemodialysis, and 600 patients with HIV infection were studied. All cases with positive results for HBsAg were evaluated for the presence of anti-HDV antibodies. Samples with Anti-HDV positive results were subjected to nested PCR for HDV-RNA confirmation, and sequenced for HDV genotype determination. Results HBsAg was found in 9 (7.5%) of 120 patients undergoing hemodialysis, and 9 (1.5%) of 600 patients with HIV infection. 3 (33.3%) of patients undergoing hemodialysis with positive results for HBsAg, and 5 (55.5%) of cases with HIV infection and positive results for HBsAg, had positive findings for anti-HDV which were then subjected to nested PCR. The amplification results confirmed that in 3 (37.5%) samples HDV-RNA was detected. Overall 2.5% of patients undergoing hemodialysis, and 0.8% of cases infected with HIV had positive results for anti-HDV and 1.7% and 0.2% of cases undergoing hemodialysis and patients infected with HIV had positive findings for HDV-RNA respectively. All of the HDV isolates were clustered in clade 1. Conclusions The survey showed that overall HDV frequency was not high in our high risk cases. Therefore, practitioners and health care managers should become aware of the risk of dual infection with HBV and HDV especially in high risk patients.

Aghasadeghi, Mohammad Reza; Mohraz, Minoo; Bahramali, Golnaz; Aghakhani, Arezoo; Banifazl, Mohammad; Foroughi, Maryam; Ahmadi, Farrokhlagha; Eslamifar, Ali; Sadat, Seyed Mehdi; Ramezani, Amitis

2013-01-01

45

Cerebrovascular autoregulation in critically ill patients during continuous hemodialysis.  

UK PubMed Central (United Kingdom)

PURPOSE: In chronic renal failure, intermittent hemodialysis decreases cerebral blood flow velocity (CBFV); however, in critically ill patients with acute renal failure, the effect of continuous venovenous hemodialysis (CVVHD) on CBFV and cerebrovascular autoregulation (AR) is unknown. Therefore, a study was undertaken to investigate the potential effect of CVVHD on CBFV and AR in patients with acute renal failure. METHODS: This cohort study investigated 20 patients with acute renal failure who required CVVHD. In these patients, the CBFV and index of AR (Mx) were measured using transcranial Doppler before and during CVVHD. RESULTS: The median Mx values at baseline were 0.33 [interquartile range (IQR): 0.02-0.55], and during CVVHD, they were 0.20 [0.07-0.40]. The differences in Mx (CVVHD--baseline) was (median [IQR]) -0.015 [-0.19-0.05], 95% confidence interval (CI) -0.16 to 0.05. The Mx was > 0.3 in 11/20 patients at baseline measurement. Six of these patients recovered to Mx < 0.3 during CVVHD. The CBFV was (median [IQR]) 47 [36-59] cm · sec(-1) at baseline and 49 [36-66] cm · sec(-1) during CVVHD. The difference of CBFV was 0.0 [-4 - 2.7], 95% CI -2.5 to 4.2. CONCLUSION: Compared with patients with intermittent hemodialysis, CVVHD did not influence CBFV and AR in critically ill patients with acute renal failure, possibly due to lower extracorporeal blood flow, slower change of plasma osmolarity, and a lower fluid extraction rate. In a subgroup of patients with sepsis, the AR was impaired at baseline in more than half of the patients, and this was reversed during CVVHD. The trial was registered at ClinicalTrials.gov ID: NCT01376531.

Schramm P; Closhen D; Wojciechowski J; Berres M; Klein KU; Bodenstein M; Werner C; Engelhard K

2013-06-01

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Association of Systemic Collagen Type IV Formation with Survival among Patients Undergoing Hemodialysis.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The 7S domain of collagen type IV (P4NP_7S) assessed in plasma represents systemic collagen type IV formation. The objective of the study was to investigate the association of systemic collagen type IV formation with survival among patients undergoing hemodialysis. METHODS: We performed an observational cohort study of 371 hemodialysis patients. Plasma P4NP_7S was analyzed using a specific enzyme-linked immunosorbent assay detecting the amino-terminal propeptide of type IV procollagen. Association between categories of plasma P4NP_7S concentrations and survival was initially assessed by Kaplan-Meier analysis, then in an adjusted Cox model. RESULTS: For hemodialysis patients in the highest category of systemic collagen type IV formation, i.e. plasma P4NP_7S concentrations more than 775 pg/L, an increased risk for death was observed (highest P4NP_7S category vs all other categories, hazard ratio, 1.934; 95% confidence interval, 1.139 to 3.285). Survival analysis showed an increased risk of death in the highest P4NP_7S category compared to the other categories (Chi square 6.903; P?=?0.032). Median survival was only 105 days in the highest P4NP_7S category whereas it was 629 days in the medium category, and 905 days in the lowest category. Multivariable-adjusted Cox regression showed increased odds for death with higher age and higher P4NP_7S categories. Systemic collagen type IV formation was associated with plasma concentrations of the collagen IV degradation product C4M (Spearman r?=?0.764; P<0.0001) confirming extracellular matrix turnover. CONCLUSION: Among hemodialysis patients elevated systemic collagen type IV formation suggesting accelerating systemic fibrosis was associated with increased risk of death.

Leeming DJ; Karsdal MA; Rasmussen LM; Scholze A; Tepel M

2013-01-01

47

Spirometry Parameters in Patients Undergoing Hemodialysis With Bicarbonate and Acetate Dialysates  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. End-stage renal disease causes impairment of all body organs including the heart and the lung. The main problems in the afflicted patients are pulmonary edema due to increased permeability of the capillaries, intravascular and interstitial volume overload, hypertension, and congestive heart failure. These changes cause altered physiologic and mechanical function of the lungs and subsequently increase in airway resistance. We aimed to study the impact of hemodialysis on spirometry parameters.Materials and Methods. In a cross-sectional study performed on 41 patients on maintenance hemodialysis, spirometry was done before and after the dialysis session. The patients were on either acetate or bicarbonate hemodialysis with the same method, dialysis machine, and duration of dialysis. Alterations in spirometry parameters including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and maximal midexpiratory flow rate were determined and their relation with serum electrolytes, serum creatinine, blood urea nitrogen, and hemoglobin were analyzed.Results. Twenty-nine patients undergoing dialysis with bicarbonate dialysate and 21 on dialysis with acetate were compared. Improvement in spirometry parameters was only significant in patients undergoing dialysis with bicarbonate dialysate. All spirometry parameters showed significant increases in the bicarbonate group except for the FEV1/FVC ratio. Furthermore, significant increase in these parameters was only prominent in the men. Postdialysis weight reduction and laboratory indexes had no significant correlation with improvement of spirometry parameters. Conclusions. Dialysis with bicarbonate dialysate causes significant improvement in spirometry parameters in men on maintenance dialysis. This effect might be independent of the effect of removing the volume overload by dialysis.

Kazem Navari; Hossein Farshidi; Fatemeh Pour-Reza-Gholi; Mohsen Nafar; Saeed Zand; Hamid Sohrab Pour; Tasnim Eqbal Eftekhaari

2009-01-01

48

Satisfaction with life for patients undergoing hemodialysis and patients suffering from osteoarthritis.  

UK PubMed Central (United Kingdom)

Two groups of chronically ill patients, alike in some respects of psychological stress and physical limitations but differing in degrees of physical threat to life because of treatment, were compared in terms of quality of life. Twenty patients undergoing hemodialysis at a satellite center and 20 patients with severe osteoarthritis receiving care at a hospital clinic, ranging in age from 40 to 60 years, were randomly selected and asked to rate themselves on Cantril's self-anchoring scale in relation to pase, present, and future life satisfaction. An ANOVA for simple main effects indicated that patients undergoing hemodialysis viewed present life satisfaction significantly higher, F = 4.81, p less than .05, than did patients with arthritis. Expectation for greater life satisfaction tended to be slightly better for dialysis patients, but not significantly so; past life satisfaction was the same for both groups. Dialysis patients viewed their present life better than past life, whereas arthritis patients had the opposite viewpoint. The increased life satisfaction among dialysis patients may be the result of an increased sense of physical well-being because of the dialysis procedure, and chronic pain may be a factor in the decreased life satisfaction among arthritis patients.

Laborde JM; Powers MJ

1980-03-01

49

Comparison of quality of life of patients on continuous ambulatory peritoneal dialysis, hemodialysis, and after transplantation.  

UK PubMed Central (United Kingdom)

Preliminary findings regarding quality of life of 458 renal patients treated by in-center hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), or transplantation indicate more favorable adjustment for CAPD patients when compared with center hemodialysis patients. Patients with a successful transplant show the highest overall adjustment when compared with both groups of dialysis patients.

Simmons RG; Anderson C; Kamstra L

1984-11-01

50

[Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization among outpatients undergoing hemodialysis treatment].  

UK PubMed Central (United Kingdom)

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) is frequent among hemodialysis patients and lead to increased morbidity and mortality rates. It is known that nasal colonization plays an important role for the development of MRSA infections. The aim of this study was to determine the prevalence and risk factors for MRSA colonization among outpatients undergoing hemodialysis. A total of 466 adult patients (199 female, 267 male; age range: 18-89 years, mean age: 55.8 ± 15.1 years) who were under hemodialysis between September-December 2008 in different health centers at Pamukkale/ Denizli region, Turkey, were included in the study. Swab samples obtained from anterior nares of patients were cultivated on sheep-blood agar and mannitol-salt agar media. The isolates were identified by conventional bacteriological methods. S.aureus strains were isolated from 204 (43.8%) patients and 34 (16.7%) were found methicillin-resistant. Thus the rate of MRSA colonization in hemodialysis patients was detected as 7.3% (34/466). All of the MRSA strains were found susceptible to vancomycin, linezolid and tigecycline, while the resistance rates for the other antimicrobial agents were as follows: 70.6% to azithromycin and claritromycin; 64.7% to erythromycin; %58.8 to clindamycin, gentamicin and trimethoprim-sulfamethoxazole; 55.9% to ciprofloxacin; 44.1% to tetracycline and rifampin; 5.9% to chloramphenicol. Inducible clindamycin resistance in MRSA isolates was %23.5 (8/34), and multidrug resistance rate was 76.5% (26/34). Multivariate analysis revealed that the history of previous hospitalization within a year [odds ratio (OR), 3.426; 95% confidence interval (CI), 1.595-7.361, p= 0.002] and the presence of chronic obstructive lung disease (OR, 5.181; 95% CI, 1.612-16.648, p= 0.006) were independent risk factors for MRSA colonization in this population. A better understanding of the prevalence and risk factors for nasal MRSA colonization among hemodialysis population may hold significant implications for both the treatment strategies and prevention of MRSA infections to establish appropriate infection control measures.

Köseo?lu O; Say?n Kutlu S; Cevahir N

2012-01-01

51

Association of Systemic Collagen Type IV Formation with Survival among Patients Undergoing Hemodialysis  

Science.gov (United States)

Objective The 7S domain of collagen type IV (P4NP_7S) assessed in plasma represents systemic collagen type IV formation. The objective of the study was to investigate the association of systemic collagen type IV formation with survival among patients undergoing hemodialysis. Methods We performed an observational cohort study of 371 hemodialysis patients. Plasma P4NP_7S was analyzed using a specific enzyme-linked immunosorbent assay detecting the amino-terminal propeptide of type IV procollagen. Association between categories of plasma P4NP_7S concentrations and survival was initially assessed by Kaplan-Meier analysis, then in an adjusted Cox model. Results For hemodialysis patients in the highest category of systemic collagen type IV formation, i.e. plasma P4NP_7S concentrations more than 775 pg/L, an increased risk for death was observed (highest P4NP_7S category vs all other categories, hazard ratio, 1.934; 95% confidence interval, 1.139 to 3.285). Survival analysis showed an increased risk of death in the highest P4NP_7S category compared to the other categories (Chi square 6.903; P?=?0.032). Median survival was only 105 days in the highest P4NP_7S category whereas it was 629 days in the medium category, and 905 days in the lowest category. Multivariable-adjusted Cox regression showed increased odds for death with higher age and higher P4NP_7S categories. Systemic collagen type IV formation was associated with plasma concentrations of the collagen IV degradation product C4M (Spearman r?=?0.764; Phemodialysis patients elevated systemic collagen type IV formation suggesting accelerating systemic fibrosis was associated with increased risk of death.

Leeming, Diana J.; Karsdal, Morten A.; Rasmussen, Lars M.; Scholze, Alexandra; Tepel, Martin

2013-01-01

52

Association between uremic toxins and depression in patients with chronic kidney disease undergoing maintenance hemodialysis.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Patients with chronic kidney disease (CKD) who are undergoing maintenance hemodialysis have a higher prevalence of depression than the general population. The underlying cause of this association is unknown, but may be related to accumulation of uremic toxins. Little is known about the association of accumulation of uremic toxins and depression in hemodialysis patients. METHOD: We conducted a cross-sectional study of 209 CKD patients from a single institution to evaluate the associations of a soluble small uremic toxin (urea), a soluble large uremic toxin (?2 microglobulin) and two protein-bound uremic toxins [total p-cresol sulfate (PCS) and indoxyl sulfate (IS)] with the presence of depression. RESULTS: A total of 47 patients (22.4%) had depression. Depressive patients had lower body mass index, lower serum creatinine, lower serum albumin and lower total IS. Univariate and multivariate logistic regression analyses that adjusted for age, gender and other statistically significant variables indicated that depression was significantly and independently associated with lower serum albumin and lower total IS. The levels of urea, ?2 microglobulin and PCS were not significantly associated with depression. CONCLUSION: Our results indicate that depression in patients with CKD was significantly and independently associated with lower serum albumin and lower total IS. However, the pathological mechanisms underlying these associations are unknown.

Hsu HJ; Yen CH; Chen CK; Wu IW; Lee CC; Sun CY; Chang SJ; Chou CC; Hsieh MF; Chen CY; Hsu CY; Tsai CJ; Wu MS

2013-01-01

53

Approaches to resolve health challenges in a population of older adults undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

Research is lacking regarding the health challenges older adults undergoing hemodialysis face when attempting to make lifestyle changes. The purpose of this study was to identify the health challenges of making lifestyle changes in this population and to identify approaches for resolving these challenges. Story theory guided data collection, and data were analyzed using Liehr and Smith's story inquiry method. Within these stories of health challenges, three themes captured the essence of what "matters most" to participants: (a) Living a Restriction-Driven Existence; (b) Balancing Independence/Dependence; and (c) Struggling With Those Providing Care. The approaches to resolving the health challenges exist on a continuum, with "unhappy passive acceptance" on one end and "assertive behavior intended to get what you want" on the other. The findings suggest that these approaches may change over time. Identifying health challenges could lead to self-management behaviors that support positive health outcomes for this population.

Hain DJ; Wands L; Liehr P

2011-01-01

54

Role of alpha-lipoic acid in the management of anemia in patients with chronic renal failure undergoing hemodialysis  

Science.gov (United States)

Introduction Anemia associated with chronic kidney disease is a serious complication necessitating expenditure of huge medical efforts and resources. This study investigates the role of alpha-lipoic acid (ALA) in end stage renal disease patients undergoing hemodialysis. By the virtue of its antioxidative effects, ALA is expected to act as an erythropoietin (EPO) adjuvant, and also has extended beneficial effects on endothelial dysfunction. Methods Forty-four patients undergoing hemodialysis and receiving EPO were randomized into two groups: the first group received ALA 600 mg once daily for 3 months; while the other group represented the control group. Parameters measured at baseline and at end of study were hemoglobin, EPO doses, EPO resistance index (ERI), iron store indices, malondialdehyde, oxidized low-density lipoprotein (ox-LDL), interleukin-6 (IL-6), tumor necrosis factor-? (TNF-?), and asymmetric dimethylarginine (ADMA), as well as routine laboratory follow-up. Results EPO doses and ERI were significantly decreased in the treatment group, while they did not change in the control group. Hemoglobin, iron store indices, malondialdehyde, oxidized ox-LDL, IL-6, TNF-?, and ADMA were similar in both treatment and control groups at baseline, and did not change by the end of study period. Likewise, routine laboratory measures were not affected by the treatment. Conclusion ALA could be used in hemodialysis patients to reduce requirements for EPO. However, larger and longer term studies are required to clarify the exact role of ALA in hemodialysis as well as in pre-hemodialysis patients.

El-Nakib, Gehad A; Mostafa, Tarek M; Abbas, Tarek M; El-Shishtawy, Mamdouh M; Mabrouk, Mokhtar M; Sobh, Mohammed A

2013-01-01

55

Electrocardiographic Changes Due to Hyperkalemia in Patients with Acute and Chronic Renal Failure Undergoing Chronic Hemodialysis  

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Full Text Available Introduction:Hyperkalemia is a common disorder among renal failure patients and is considered as an important internal medicine emergency. On the other hand, considering the non-specific symptoms of hyperkalemia and its similarity to the underlying diseases’ symptoms, the occurrence of dangerous side effects is probable. One of the most important effects is on myocardium. Considering the immature mechanism of potassium conformity in confrontation with hyperkalemia in Acute Renal Failure (ARF) patients, the toxic effects of hyperkalemia occurs in lower potassium levels. The aim of this study is comparing the EKG changes due to hyperkalemia in patients with acute and chronic renal failure undergoing chronic hemodialysis. Methods : The recent study was an analytic cross-sectional one performed on patients hospitalized in hemodialysis ward in Hashemi Nejad, Shohadaye-hafte- tir and Rasoul Akram hospitals, during 1382-1383. The serum electrolyte levels and EKG changes of 138 patients with End Stage Renal Disease (ESRD) who were under chronic hemodialysis and 91 patients with ARF, who were hospitalized in different wards, were measured and evaluated, using SPSS V.11 software and t and Chi Square tests   Results : Among 229 patients, 138 (60%) were ESRD patients who were under chronic hemodialysis and 91 (40%) had acute renal failure. The mean potassium level in ARF and ESRD patients were 5.66 ± 1.2 and 5.77 ± 0.91 mE/l which did not differ significantly (p=0.4). In EKG evaluations, the mean height of T wave, R wave and T/R ratio in ARF patients were 6.3 ± 2.4 mm, 5.7 ± 2.1 mm and 1.3 ± 0.9 mm respectively. These data in ESRD patients were 6 ± 2.2 mm, 5.6 ± 2.3 mm and 1.2 ± 0.78 mm. No significant difference was seen among two groups (P = 0.3, 0.8 and 0.7). In ARF and ESRD patients, there was a significant relationship between peaked tall T wave frequency and hyperkalemia severity (p<0.001). In the simultaneous presence of hyperkalemia and hypocalcemia, peaked tall T wave frequency, mean of R wave height and T/R ratio in ARF and ESRD groups were not significantly different. On the other hand, in the coincidence of hyperkalemia and hyponatremia peaked tall T wave frequency and T/R ratio in ARF and ESRD groups were significantly different. (P <0.05). Conclusion : Severe hyperkalemia, hyperkalemia in the setting of ARF and the simultaneous presence of hyperkalemia and hyponatremia may increase the probability of cardiac changes. These groups of patients who undergo hemodialysis need vigorous care considering the cardiac complications.

M Jabbari; H Salehi; A Jenabi; B Lotfi; L Zahedi-Shoolami; A Mouraki

2011-01-01

56

Oral and salivary changes among renal patients undergoing hemodialysis: A cross-sectional study.  

UK PubMed Central (United Kingdom)

We wanted to assess oral and salivary changes in end stage renal disease (ESRD) patients undergoing hemodialysis (HD) and to understand the correlation of such changes with renal insufficiency. The cross-sectional study was performed among 100 ESRD patients undergoing HD. Among these, 25 patients were randomly selected to assess the salivary changes and compared with 25 apparently healthy individuals who formed the control group. Total duration of the study was 15 months. Oral malodor, dry mouth, taste change, increased caries incidence, calculus formation, and gingival bleeding were the common oral manifestations. The flow rates of both unstimulated as well as stimulated whole saliva were decreased in the study group. The pH and buffer capacity of unstimulated whole saliva was increased in the study group, but stimulated whole saliva did not show any difference. ESRD patients undergoing HD require special considerations during dental treatment because of the various conditions inherent to the disease, their multiple oral manifestations and the treatment side-effects.

Kaushik A; Reddy SS; Umesh L; Devi BK; Santana N; Rakesh N

2013-03-01

57

Evaluation of Conner?s Continuous Performance Test in Hemodialysis Patients  

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Full Text Available Memory and cognitive abnormalities such as decreased attention span, impulsiveness, and slow reaction are common among chronic hemodialysis patients. We studied the changes these parameters in 38 hemodialysis patients before and after hemodialysis sessions via Conner?s continuous performance test. Mean age of the study patients was 38.0 ± 12.6 years. There was no significant difference before and after hemodialysis in the number of the successfully recognized matches, the number of the miss fires, and the mean of reaction time of matches. In addition, there was no significant effect of the duration of hemodialysis therapy on the number of successfully recognized matches, the number of missed matches, and the mean reaction time of matches. Educational level of patients did not significantly impact on the number of successfully recognized matches and the mean of reaction time of matches. However, this impact was significant on the number of miss fires during hemodialysis. (P = 0.04). We conclude from our results that hemodialysis did not significantly impact on the cognitive function. However, this hypothesis must be confirmed by other cognitive function tests on larger hemodialysis population.

Najafi Mostafa

2008-01-01

58

The evaluation of self-care and self-efficacy in patients undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study is to assess patients' self-care ability and self-efficacy, to examine the relationship between them and to determine the factors affecting self-care ability and self-efficacy in people undergoing hemodialysis (HD). METHODS: This research was conducted as a descriptive survey study by 138 people with ESRD who were patients of HD units service in Sivas. The data were collected with a Personal Information Form, Exercise of Self-Care Agency (ESCA) Scale and Self-Efficacy Assessment Form. Data collected from the study were analysed using percent, mean, Tukey test, significance test of two means, one-way variant analysis and Kruskal-Wallis test. RESULTS: The study results demonstrate that while there is a correlation between self-care ability and education level, work status, income level and frequency of HD application, factors such as age, gender, education level, work status, income level and frequency of HD application determine self-efficacy. Furthermore, a positive correlation was found between patients' self-care ability and self-efficacy. It was determined that as the level of self-care ability increases self-efficacy level also increases. CONCLUSIONS: Hemodialysis application affects patients' self-care ability and self-efficacy levels. There is a positive correlation between self-care ability and self-efficacy. In view of this study's results, it is recommended to organize education programmes to increase self-care ability and self-efficacy levels of HD patients and prepare comprehensive plans including patients' families.

Ba? E; Mollao?lu M

2010-06-01

59

Contaminated product water as the source of Phialemonium curvatum bloodstream infection among patients undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

OBJECTIVE: We investigated a cluster of cases of bloodstream infection (BSI) due to the mold Phialemonium at a hemodialysis center in Illinois and conducted a cohort study to identify risk factors. DESIGN: Environmental assessment and cohort study. SETTING: A hemodialysis center in a tertiary care hospital. METHODS: A case patient was defined as a person who underwent dialysis at the center and had a blood sample that tested positive for Phialemonium curvatum on culture. We reviewed microbiology and medical records and tested water, surface, and dialysate samples by culture. Molds isolated from environmental and clinical specimens were identified by their morphological features and confirmed by sequencing DNA. RESULTS: We identified 2 case patients with BSI due to P. curvatum. Both became febrile and hypotensive while undergoing dialysis on the same machine at the same treatment station, although on different days. Dialysis machines were equipped with waste handling option ports that are used to discard dialyzer priming fluid. We isolated P. curvatum from the product water (ie, water used for dialysis purposes) at 2 of 19 treatment stations, one of which was the implicated station. CONCLUSION: The source of P. curvatum was likely the water distribution system. To our knowledge, this is the first report of patients acquiring a mold BSI from contaminated product water. The route of exposure in these cases of BSI due to P. curvatum may be related to the malfunction and improper maintenance of the waste handling option ports. Waste handling option ports have been previously implicated as the source of bacterial BSI due to the backflow of waste fluid into a patient's blood line. No additional cases of infection were noted after remediation of the water distribution system and after discontinuing use of waste handling option ports at the facility.

Rao CY; Pachucki C; Cali S; Santhiraj M; Krankoski KL; Noble-Wang JA; Leehey D; Popli S; Brandt ME; Lindsley MD; Fridkin SK; Arduino MJ

2009-09-01

60

Role of alpha-lipoic acid in the management of anemia in patients with chronic renal failure undergoing hemodialysis  

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Full Text Available Gehad A El-Nakib,1 Tarek M Mostafa,2 Tarek M Abbas,4 Mamdouh M El-Shishtawy,3 Mokhtar M Mabrouk,2 Mohammed A Sobh41Mansoura University Hospitals, Mansoura, Egypt; 2Faculty of Pharmacy, Tanta University, Tanta, Egypt; 3Faculty of Pharmacy, Mansoura University, Mansoura, Egypt; 4Urology and Nephrology Centre, Faculty of Medicine, Mansoura University, Mansoura, EgyptIntroduction: Anemia associated with chronic kidney disease is a serious complication necessitating expenditure of huge medical efforts and resources. This study investigates the role of alpha-lipoic acid (ALA) in end stage renal disease patients undergoing hemodialysis. By the virtue of its antioxidative effects, ALA is expected to act as an erythropoietin (EPO) adjuvant, and also has extended beneficial effects on endothelial dysfunction.Methods: Forty-four patients undergoing hemodialysis and receiving EPO were randomized into two groups: the first group received ALA 600 mg once daily for 3 months; while the other group represented the control group. Parameters measured at baseline and at end of study were hemoglobin, EPO doses, EPO resistance index (ERI), iron store indices, malondialdehyde, oxidized low-density lipoprotein (ox-LDL), interleukin-6 (IL-6), tumor necrosis factor-? (TNF-?), and asymmetric dimethylarginine (ADMA), as well as routine laboratory follow-up.Results: EPO doses and ERI were significantly decreased in the treatment group, while they did not change in the control group. Hemoglobin, iron store indices, malondialdehyde, oxidized ox-LDL, IL-6, TNF-?, and ADMA were similar in both treatment and control groups at baseline, and did not change by the end of study period. Likewise, routine laboratory measures were not affected by the treatment.Conclusion: ALA could be used in hemodialysis patients to reduce requirements for EPO. However, larger and longer term studies are required to clarify the exact role of ALA in hemodialysis as well as in pre-hemodialysis patients.Keywords: alpha-lipoic acid, anemia, asymmetric dimethylarginine, erythropoietin, hemodialysis, oxidative stress

El-Nakib GA; Mostafa TM; Abbas TM; El-Shishtawy MM; Mabrouk MM; Sobh MA

2013-01-01

 
 
 
 
61

Spiritual Emotional Freedom Technique (SEFT) to Reduce Depression for Chronic Renal Failure Patients are in Cilacap Hospital to Undergo Hemodialysis  

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Full Text Available Hemodialysis is the process of separation and retention of excess fluid metabolic waste substances from the blood into the dialysis fluid through a membrane that is semi permiabel the dialysis machine by diffusion, ultrafiltration and convection so that the composition of substances and fluids in the near normal blood. Giving SEFT aims to determine the effectiveness SEFT to lower levels of depression in patients with chronic renal failure undergoing hemodialysis. Participants in the study were 12 patients with chronic renal failure undergoing hemodialysis at hospitals Cilacap on Monday and Friday. SEFT includes three stages: the set-up (to neutralize the negative energy that is in your body), the tune-in (the mind on the place of pain), the tapping (lightly tapping with two fingers at specific points on the human body). This is consistent with the techniques used in relaxation techniques in psychotherapy behavioristik. The research instrument was Beck Depression Inventory (BDI). The method used in this study is a quasi-experiment research. The design study is a nonrandomized pretest-posttest one group design. With the t-test performed on the data pretest and posttest can be concluded that there are differences in the level of depression experienced by hemodialysis patients before and after treatment the depression levels decreased after therapy. This is demonstrated by the significant results, with paired samples correlations 0182 >0.05 (significant) and Sig F Change 0.000 <0.01 (highly significant).The results of this study indicate that SEFT effective to reduce the level of depression in patients with chronic renal failure undergoing hemodialysis.

Rias Pratiwi Safitri; Ria Safaria Sadif

2013-01-01

62

Changes of the cerebral metabolite patterns in patients undergoing hemodialysis due to chronic renal failure: evaluation with proton magnetic resonance spectroscopy  

International Nuclear Information System (INIS)

We wanted to evaluate the cerebral metabolites in patients with chronic renal failure (CRF) and who were undergoing hemodialysis by performing proton MR spectroscopy and were wanted to evaluate the correlation between the changes in the cerebral metabolite ratios and the duration after starting the initial hemodialysis. Proton MR spectroscopy was performed in 15 patients with CRF and who were undergoing hemodialysis and in ten healthy volunteers. The changes in N-acetylaspartate (NAA), choline-containing compounds (Cho), myo-inositol (Myo), glutamine/glutamate complex (Glx), and creatine (Cr) were analyzed. MR spectroscopy was performed before and after hemodialysis. For the patients with CRF before hemodialysis, the Cho/Cr ratio in the gray matter (?

2007-01-01

63

Prevalence of gastrointestinal and psychosomatic symptoms among Asian patients undergoing regular hemodialysis.  

UK PubMed Central (United Kingdom)

AIM: Gastrointestinal (GI) symptoms are reported to be common among patients with chronic disorders including end-stage renal disease (ESRD). This questionnaire study assessed the prevalence of GI symptoms among patients undergoing hemodialysis (HD) and to correlate with the presence of diabetes mellitus and psychosomatic symptoms in Asian patients with ESRD. METHODS: A total of 123 patients (male 47.2%) participated in this study. GI symptoms (upper GI: anorexia, nausea, vomiting, odynophagia, dysphagia, early satiety, heartburn, dyspepsia and lower GI: abdominal bloating, non-epigastrium abdominal pain, bowel habit and bleeding per rectum) and psychosomatic symptoms (anxiety, backache, depression, headache and insomnia) in the previous 12 months were enquired and compared with age and gender matched controls (n?=?197). RESULTS: The mean age of patients was 51.8?±?12.9 years with mean duration of HD of 28?±?38.2 months. Overall, 70.7% of ESRD patients had experienced any GI symptoms; upper GI, 65% and lower GI, 34.1%, significantly more than controls (P?undergoing regular HD. The presence of underlying psychosomatic symptoms but not diabetes mellitus correlated significantly with the presence of GI symptoms.

Chong VH; Tan J

2013-02-01

64

Changes of the cerebral metabolite patterns in patients undergoing hemodialysis due to chronic renal failure: evaluation with proton magnetic resonance spectroscopy  

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We wanted to evaluate the cerebral metabolites in patients with chronic renal failure (CRF) and who were undergoing hemodialysis by performing proton MR spectroscopy and were wanted to evaluate the correlation between the changes in the cerebral metabolite ratios and the duration after starting the initial hemodialysis. Proton MR spectroscopy was performed in 15 patients with CRF and who were undergoing hemodialysis and in ten healthy volunteers. The changes in N-acetylaspartate (NAA), choline-containing compounds (Cho), myo-inositol (Myo), glutamine/glutamate complex (Glx), and creatine (Cr) were analyzed. MR spectroscopy was performed before and after hemodialysis. For the patients with CRF before hemodialysis, the Cho/Cr ratio in the gray matter ({rho} < 0.001) and the Myo/Cr ratio in both the gray and white matter ({rho} < 0.01) were significantly elevated compared with those in the control subjects. For the patients with CRF after hemodialysis, their Cho/Cr ratios were significantly reduced in both the gray and white matter compared with that before hemodialysis ({rho} < 0.05). There was a significant positive correlation between the Cho/Cr ratio and serum Cr in the gray matter of CRF patients after hemodialysis (r = 0.54, {rho} < 0.05). The cerebral metabolite ratios were not significantly correlated with the duration after starting the initial hemodialysis. The cerebral metabolite patterns are significantly different between the patients with CRF and who are undergoing hemodialysis and the normal controls. The cerebral metabolite ratios are not significantly correlated with the duration after starting the initial hemodialysis.

Baik, Hye Won; Yu, Hyeon; Yu, Soo Jeong; Kim, Gi Hyeon [Chung-Ang University Medical Center, College of Medicine, Seoul (Korea, Republic of)

2007-08-15

65

Quality of life among women with sexual dysfunction undergoing hemodialysis: a cross-sectional observational study  

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Full Text Available Abstract Background Sexual function among women undergoing hemodialysis (HD) is under-studied and there is no consensus about the effect of sexual dysfunction (SD) on their quality of life (QoL). We aimed to determine the prevalence of SD and to compare QoL between women undergoing maintenance HD with and without SD. Methods We included female end-stage renal disease (ESRD) patients undergoing HD during June 2011 in the only renal unit in the north of Ceará state, northeastern Brazil. The criteria for inclusion were age between 18 and 55, at least three months on dialysis and being sexually active. Women using antidepressant medication were excluded. We used the Female Sexual Function Index (FSFI), which evaluates six domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction and pain. The patients were classified as presenting SD if the total FSFI score was less than 26. For QoL evaluation, we used the validated Brazilian version of SF-36. This is a widely used 36-item questionnaire covering eight dimensions of QoL. Demographic data, time on dialysis, underlying etiology of ESRD, and laboratory measures were assessed in unit records. Results Of a total of 58 women, 46 (79.3%) presented SD. There were lower scores related to physical functioning (48.2 vs. 71.2; p?=?0.007), bodily pain (45 vs. 67.5; p?=?0.010), vitality (52.1 vs. 69.1; p?=?0.026) and social functioning (57.2 vs. 76.1; p?=?0.034) among women with SD compared to women without SD. Physical functioning and role-physical presented positive linear correlation with FSFI scores, respectively, r?=?0.322 (p?=?0.013) and r?=?0.345 (p?=?0.007). Conclusion The prevalence of SD among women on HD is very high, reaching nearly 80%. Women on HD with SD had worse QoL, especially physical aspects of QoL, when compared to women without SD. Therefore, approaches aiming to improve QoL among women undergoing HD should be considered.

Santos Paulo; Júnior José Roberto Frota Gomes Capote; Cavalcanti Juliana; Vieira Cyntia; Rocha Ana Rochelle; Apolônio Natália Alves; de Oliveira Elaine

2012-01-01

66

Quality of life among women with sexual dysfunction undergoing hemodialysis: a cross-sectional observational study  

Science.gov (United States)

Background Sexual function among women undergoing hemodialysis (HD) is under-studied and there is no consensus about the effect of sexual dysfunction (SD) on their quality of life (QoL). We aimed to determine the prevalence of SD and to compare QoL between women undergoing maintenance HD with and without SD. Methods We included female end-stage renal disease (ESRD) patients undergoing HD during June 2011 in the only renal unit in the north of Ceará state, northeastern Brazil. The criteria for inclusion were age between 18 and 55, at least three months on dialysis and being sexually active. Women using antidepressant medication were excluded. We used the Female Sexual Function Index (FSFI), which evaluates six domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction and pain. The patients were classified as presenting SD if the total FSFI score was less than 26. For QoL evaluation, we used the validated Brazilian version of SF-36. This is a widely used 36-item questionnaire covering eight dimensions of QoL. Demographic data, time on dialysis, underlying etiology of ESRD, and laboratory measures were assessed in unit records. Results Of a total of 58 women, 46 (79.3%) presented SD. There were lower scores related to physical functioning (48.2 vs. 71.2; p?=?0.007), bodily pain (45 vs. 67.5; p?=?0.010), vitality (52.1 vs. 69.1; p?=?0.026) and social functioning (57.2 vs. 76.1; p?=?0.034) among women with SD compared to women without SD. Physical functioning and role-physical presented positive linear correlation with FSFI scores, respectively, r?=?0.322 (p?=?0.013) and r?=?0.345 (p?=?0.007). Conclusion The prevalence of SD among women on HD is very high, reaching nearly 80%. Women on HD with SD had worse QoL, especially physical aspects of QoL, when compared to women without SD. Therefore, approaches aiming to improve QoL among women undergoing HD should be considered.

2012-01-01

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Tuberculous lymphadenitis in patients undergoing continuous ambulatory peritoneal dialysis  

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The aim of this study was to review the clinical features of tuberculous (TB) lymphadenitis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Nine cases of TB lymphadenitis were diagnosed among 910 patients over a period of 10 years. There were five men and four women with a m...

Lui, SL; Yip, T; Tse, KC; Chan, TM; Lai, KN; Lo, WK

68

Personal abilities in patients undergoing peritoneal dialysis and hemodialysis. A pilot study using the existence scale.  

UK PubMed Central (United Kingdom)

Personality psychology is increasingly used in various clinical medicine settings to help in decision-making in difficult situations, especially in chronic disease. Patients with chronic renal disease are very dependent on modern medicine, and psychological aspects could help give answers in certain circumstances. Logotherapy and Existence analysis, after Viktor Frankl (Third Viennese School of Psychotherapy), is the theory of the possibilities and conditions for a fulfilled existence and evaluates a different aspect of personality psychology, namely meaning (in life). We used the existence scale questionnaire in this pilot study to investigate the personal abilities self-distancing, self-transcendence, freedom and responsibility in dialysis patients and compared a group of hemodialysis (HD) patients with patients treated with continuous ambulatory peritoneal dialysis (CAPD). We studied a mixed dialysis cohort (24 HD, 24 CAPD) at two Austrian centers (Innsbruck Medical University Hospital and Wilhelminenspital of the City of Vienna). Overall, results for dialysis patients (n = 48) were very close to those reported for healthy persons; however, CAPD patients scored significantly better than HD patients (p = 0.017) on the subscale self-distancing. This significant difference was also seen in the overall scores (p = 0.045). Our results might indicate that contented CAPD patients have personal abilities that predestine them for this type of treatment. The existence scale might help decide between CAPD and HD treatment alternatives.

Schwaiger JP; Kopriva-Altfahrt G; Söllner W; König P

2007-01-01

69

Personal abilities in patients undergoing peritoneal dialysis and hemodialysis. A pilot study using the existence scale.  

Science.gov (United States)

Personality psychology is increasingly used in various clinical medicine settings to help in decision-making in difficult situations, especially in chronic disease. Patients with chronic renal disease are very dependent on modern medicine, and psychological aspects could help give answers in certain circumstances. Logotherapy and Existence analysis, after Viktor Frankl (Third Viennese School of Psychotherapy), is the theory of the possibilities and conditions for a fulfilled existence and evaluates a different aspect of personality psychology, namely meaning (in life). We used the existence scale questionnaire in this pilot study to investigate the personal abilities self-distancing, self-transcendence, freedom and responsibility in dialysis patients and compared a group of hemodialysis (HD) patients with patients treated with continuous ambulatory peritoneal dialysis (CAPD). We studied a mixed dialysis cohort (24 HD, 24 CAPD) at two Austrian centers (Innsbruck Medical University Hospital and Wilhelminenspital of the City of Vienna). Overall, results for dialysis patients (n = 48) were very close to those reported for healthy persons; however, CAPD patients scored significantly better than HD patients (p = 0.017) on the subscale self-distancing. This significant difference was also seen in the overall scores (p = 0.045). Our results might indicate that contented CAPD patients have personal abilities that predestine them for this type of treatment. The existence scale might help decide between CAPD and HD treatment alternatives. PMID:17634892

Schwaiger, Johannes P; Kopriva-Altfahrt, Gertrude; Söllner, Wolfgang; König, Paul

2007-01-01

70

Quality of life in patients undergoing hemodialysis and renal transplantation--a meta-analytic review.  

UK PubMed Central (United Kingdom)

The purpose of this review was to determine the magnitude of effect of renal transplant on quality of life measures when compared with hemodialysis. Sixteen studies were analyzed, and the summary effect sizes were as follows: general quality of life was 0.98, physical functioning was 0.77, and psychosocial functioning was 0.39. Compared to hemodialysis, renal transplantation was significantly more effective in improving all three domains, particularly general overall quality of life and physical functioning.

Landreneau K; Lee K; Landreneau MD

2010-01-01

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Brachio-cephalic ('Gracz') fistula use for continuous hemofiltration in a hemodynamically unstable hemodialysis patient without venous vascular access: a case report  

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Even in patients with chronic renal failure and chronic intermittent hemodialysis, continuous venovenous hemofiltration (CVVH) is the most often practiced renal replacement technique in the intensive care unit. Although patients show less hemodynamic instability during CVVH than during hemodialysis,...

Spronk, Peter E; Barendregt, Jos NM; Crooijmans, Guus; Vermeeren, Yolande M; Rommes, Johannes H

72

[Evaluation of clinical presentation and prognosis of tuberculosis in patients undergoing hemodialysis].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Patients with chronic renal failure treated with hemodialysis represent a high risk group for the development of tuberculosis (TB) in comparison to general population. AIM: The aim of the study was to evaluate clinical presentation, biochemical parameters and outcome of tuberculosis in patients attending the Center for Hemodialysis, Sarajevo University Clinical Center. PATIENTS AND METHODS: The study conducted during the 2000-2005 period included four patients with tuberculosis that were already treated with chronic hemodialysis. Three of these four patients had pulmonary type and one had extrapulmonary type (bone type) of tuberculosis diagnosed by bone biopsy. Miliary TB diagnosis was verified with radiographic lung imaging and appropriate bacteriologic and biochemistry tests. RESULTS: The mean age of the study patients was 66.5 +/- 59.6 years and mean hemodialysis duration 6.7 +/- 4.5 years. During the study period, we diagnosed four cases of active tuberculosis in 200 patients receiving hemodialysis therapy (2%). Tuberculin test was performed in all four patients and was negative. Clinical presentation was predominated by inappetence, feebleness and elevated body temperature. Biochemical tests revealed anemia (Htc 0.25 +/- 0.15), hypoalbuminemia (36.0 +/- 28.5) and extremely raised sedimentation raste (86 +/- 30). Increased transaminases were present in two of four patients; the culture of Mycobacterium tuberculosis was found in patients with pulmonary type of TB. Radiographic tests revealed miliary changes in two patients and pleural effusion in one patient. All patients were administered tuberculostatic drugs and six-month treatment resulted in full recovery. CONCLUSION: Negative PPD test does not exclude the occurrence of TB in hemodialysis patients and the existence of pulmonary infiltrate and pleural effusion on radiographic chest images suggests the presence of the TB.

Resi? H; Dizdarevi? Z; Cori? A; Avdi? E; Kukavica N; Mesi? E

2008-02-01

73

[Nutritional evaluation and use of a nutritional complement in children undergoing periodical hemodialysis].  

UK PubMed Central (United Kingdom)

Six uremic dhildren in periodic hemodialysis with protein-calorie malnutrition were studied. Three of them were given diet supplementation with a compound constituted by carbohydrates and essential amino acids. Evaluation at ,3 and 6 months with somatometry, rutine laboratory analysis, intravenous glucose tolerance test and plasma amino acid determinations, showed that patients with diet supplementation had a slight increase in height and body weight, improved glucose in tolerance, that was initialy detected, and an abnormal pattern of plasma amino acids not modified during the study. Patients without diet supplementation showed no changes in height, body weight, glucose tolerance and plasma amino acids. These results suggest that diet supplementation with carbohydrates and amino acids is useful to improve nutrition in uremic children on hemodialysis, but it is neccesary to study more patients.

López Uriarte A; Ledón Valenzuela S; López Gámez C; Rosríguez Pantiño G; Martínez Figueroa C; Santos Atherton D; Muñóz Olvera R; Velázquez Cabrera A

1977-03-01

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The effects of Losartan on oxidative stress and inflammation in non-diabetic patients undergoing chronic hemodialysis.  

UK PubMed Central (United Kingdom)

INTRODUCTION: We aimed to evaluate the effects of Losartan, an angiotensin receptor blocker, on serum inflammatory markers, plasma thiol groups, and oxidative stres indexes among patients undergoing hemodialysis (HD) treatment. PATIENTS AND METHODS: Fiftytwo end-stage renal disease (ESRD) patients undergoing chronic HD programme for at least 12 months, and thirty age and gender matched healthy volunteers were enrolled into this prospective clinical trial. Plasma levels of thiol groups (SH), total antioxidant capacitiy (TAC), and total oxidant status (TOS) were studied. Oxidative stress index (OSI) was calculated by TOS/TAC. Firstly results of patients were compared with healthy subjects and then patients were treated by Losartan 50-100 mg and followed up for three months. RESULTS: Among patients, SH Groups, TAC, TOS, and OSI were statistically higher than controls. Also the inflammatory markers were significantly higher in patients than controls and albumin was lower among patients. At the end of the 3 months among all patients the mean value of TAC was increased to 1.7±0.4 micromol Trolox Eqv./L. from 1.4±0.2, and SH groups to 0.33±0.02 mmol/L from 0.22±0.01, (p < 0.001) while TOS decreased to 7.2±1.1 micromol H(2)O(2) Eqv./L from 9.5±4.5, and OSI decreased to 5.0±0.8 from 7.1±3.2 (p < 0.001). CONCLUSIONS: Losartan was effective in controlling blood pressure, and decreasing OSI, a marker of elevated oxidative stress, and increasing plasma levels of SH groups, an antioxidant, in ESRD patients undergoing hemodialysis. So, it may not be only a hypotensive drug, but also improves OS, particularly in patients with ESRD.

Kayabasi H; Yilmaz Z; Sit D; Kadiroglu AK; Yilmaz E

2013-01-01

75

Impact of incident comorbidity on functional loss in elderly chronic kidney disease patients undergoing hemodialysis.  

UK PubMed Central (United Kingdom)

The incidence of end stage renal disease in older persons has been increasing progressively over the last 10 years. Improved survival rates with renal replacement therapy are making this increased prevalence even more pronounced. The usual risks of morbidity and requirements for specialized care associated with older people increase dramatically when they have chronic kidney disease (CKD). It has been seen that the majority of patients in hemodialysis units are over the age of 60, and have significant co-morbidities. The relationship between older age, chronic disorders and functional dependence (FD) is well known. Accordingly, nursing care planning must be designed with this in mind. The aim of this study was to assess whether the comorbidity associated with CKD modifies FD in patients on hemodialysis. We undertook a prospective longitudinal cohort study of hemodialysis outpatients in Málaga, Spain, using the Barthel test to establish FD and the Charlson comorbidity index to quantify comorbidity. All health events were analyzed to select those study patients with incident comorbidity, understood as the appearance of a new disease that could modify the Charlson comorbidity index, and determine the change in FD. Multivariate linear regression showed that the best model for predicting functional loss was that which considered comorbidity adjusted for age, particularly when it occurred as a result of hospital admission, as it was shown to have an important predictive value for the onset of a decrease in functional dependency scores in patients with CKD.

Mansilla Francisco JJ; Díez De los Ríos Cuenca F; Cabrera Azaña S; Cortés Torres J; Macías López MJ; González Castillo JA; Ferreras Duarte JL

2012-01-01

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Relationship between Calcium-Phosphorus Product and Severity of Valvular Heart Insufficiency in Patients Undergoing Chronic Hemodialysis  

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Full Text Available Background: Recent interests have mainly focused on the roles of serum calcium and phosphorus and their product (Ca-P product) in the development of valvular heart disease. The present study assessed the relationship between the Ca-P product and the severity of valvular heart disease in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis.Methods: This cross-sectional study reviewed the clinical course of 72 consecutive patients with the final diagnosis of ESRD candidated for chronic hemodialysis. The severity of valvular heart disease was determined using M-mode two-dimensional echocardiography. The serum calcium and phosphate values adopted were those values measured on the day between the two consecutive dialyses, and the Ca-P product was calculated.Results: The most common causes of ESRD were diabetic nephropathy, malignant hypertension, and chronic glomerulonephritis. The mean Ca-P product level in the dialysis patients was 50.44 ± 17.78 mg2/dL2. The receiver-operator characteristic (ROC) curve illustrated that a Ca-P product level > 42 mg2/dL2 was the optimal value in terms of sensitivity and specificity for predicting the presence of valvular insufficiency. Aortic insufficiency was directly associated with a high Ca-P product value after adjustment for age, gender, serum albumin, diabetes, hypertension, hyperlipidemia, coronary artery disease, and serum creatinine (? = 0.412, SE = 158, p value= 0.011).Conclusion: A positive relationship between the Ca-P product value and the severity of aortic insufficiency is expected. Achieving an appropriate control of the Ca-P product level may decrease aortic valve calcification and improve the survival of patients on chronic hemodialysis.

Masoumeh Kahnooji; Mohammad Masoomi; Ali Naderinasab; Akram Zaeem; Mehrdad Sheikhvatan

2010-01-01

77

Regional citrate anticoagulation for high volume continuous venovenous hemodialysis in surgical patients with high bleeding risk.  

Science.gov (United States)

Acute kidney injury requiring renal replacement therapy occurs in up to 10% of all intensive care unit patients. Those who are hemodynamically unstable are often treated with continuous renal replacement therapy requiring continuous anticoagulation of the extracorporeal circuit. This is usually achieved by infusion of unfractionated heparin, which subsequently increases the risk of bleeding. To avoid systemic anticoagulation for continuous renal replacement therapy, regional anticoagulation with citrate has been introduced. We studied safety and efficacy of regional citrate anticoagulation for continuous venovenous hemodialysis in surgical patients requiring high dialysis doses. This was an observational prospective study in a 40-bed surgical intensive care unit at a university hospital. During a 12-month study period, all consecutive critically ill patients with high risk of bleeding requiring continuous renal replacement therapy continuous renal replacement therapy were treated with citrate anticoagulation for continuous venovenous hemodialysis. Prescribed dialysis dose was 45 mL/kg per h with a 10% increase for expected downtime. We studied filter lifetime, delivered dialysis dose, control of acid-base status, bleeding episodes, and adverse effects, that is, citrate intolerance. The total number of filters analyzed in 75 patients was 100. Mean (± standard deviation) filter running time was 78 ± 25 h. Fifty-one circuits had to be renewed because of extended filter running time (96 ± 18 h), 33 discontinued for reasons not related to renal replacement therapy (62 ± 19 h), and 13 due to filter clotting (58 ± 18 h). The mean dialysis dose during the first 72 h was 49 ± 14 mL/kg per h. Overall, acid-base status after 72 h was well controlled in 62% of patients, metabolic alkalosis (pH > 7.45) occurred in 29%, and metabolic acidosis (pH < 7.35) in 9%. In one patient, treatment was stopped because of citrate accumulation. Citrate intoxication or overt bleeding episodes were not observed. Regional citrate anticoagulation for continuous venovenous hemodialysis is a safe and effective method to deliver a high dialysis dose in critically ill patients with a high risk of bleeding. Filter patency was excellent, acid-base status was well controlled, and clinically relevant adverse effects were not observed. Therefore, citrate anticoagulated continuous venovenous hemodialysis is a useful treatment option for patients with acute kidney injury requiring high dialysis doses and at risk of bleeding. PMID:23551677

Kalb, Robert; Kram, Rainer; Morgera, Stanislao; Slowinski, Torsten; Kindgen-Milles, Detlef

2012-08-29

78

Regional citrate anticoagulation for high volume continuous venovenous hemodialysis in surgical patients with high bleeding risk.  

UK PubMed Central (United Kingdom)

Acute kidney injury requiring renal replacement therapy occurs in up to 10% of all intensive care unit patients. Those who are hemodynamically unstable are often treated with continuous renal replacement therapy requiring continuous anticoagulation of the extracorporeal circuit. This is usually achieved by infusion of unfractionated heparin, which subsequently increases the risk of bleeding. To avoid systemic anticoagulation for continuous renal replacement therapy, regional anticoagulation with citrate has been introduced. We studied safety and efficacy of regional citrate anticoagulation for continuous venovenous hemodialysis in surgical patients requiring high dialysis doses. This was an observational prospective study in a 40-bed surgical intensive care unit at a university hospital. During a 12-month study period, all consecutive critically ill patients with high risk of bleeding requiring continuous renal replacement therapy continuous renal replacement therapy were treated with citrate anticoagulation for continuous venovenous hemodialysis. Prescribed dialysis dose was 45 mL/kg per h with a 10% increase for expected downtime. We studied filter lifetime, delivered dialysis dose, control of acid-base status, bleeding episodes, and adverse effects, that is, citrate intolerance. The total number of filters analyzed in 75 patients was 100. Mean (± standard deviation) filter running time was 78 ± 25 h. Fifty-one circuits had to be renewed because of extended filter running time (96 ± 18 h), 33 discontinued for reasons not related to renal replacement therapy (62 ± 19 h), and 13 due to filter clotting (58 ± 18 h). The mean dialysis dose during the first 72 h was 49 ± 14 mL/kg per h. Overall, acid-base status after 72 h was well controlled in 62% of patients, metabolic alkalosis (pH > 7.45) occurred in 29%, and metabolic acidosis (pH < 7.35) in 9%. In one patient, treatment was stopped because of citrate accumulation. Citrate intoxication or overt bleeding episodes were not observed. Regional citrate anticoagulation for continuous venovenous hemodialysis is a safe and effective method to deliver a high dialysis dose in critically ill patients with a high risk of bleeding. Filter patency was excellent, acid-base status was well controlled, and clinically relevant adverse effects were not observed. Therefore, citrate anticoagulated continuous venovenous hemodialysis is a useful treatment option for patients with acute kidney injury requiring high dialysis doses and at risk of bleeding.

Kalb R; Kram R; Morgera S; Slowinski T; Kindgen-Milles D

2013-04-01

79

Continuous urine oxygen tension monitoring in patients undergoing cardiac surgery.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To evaluate the effect of cardiopulmonary bypass (CPB) on urine oxygen tension (PuO2) and to determine whether perioperative PuO2 can predict postoperative renal dysfunction in patients undergoing cardiac surgery. DESIGN: Prospective clinical study. SETTING: A university research laboratory, a university-affiliated hospital. PARTICIPANTS: Ninety-eight consecutive adult patients undergoing coronary artery bypass surgery or valvular surgery. INTERVENTIONS: PuO2 was continuously measured by inserting a polarographic electrode into the urinary tube connected to a Foley catheter. MEASUREMENTS AND MAIN RESULTS: PuO2 was constant before CPB and then progressively decreased after the start of CPB. It partially recovered at weaning from CPB but did not completely return to its original level until the end of surgery. Postoperative serum creatinine concentrations were significantly higher in patients whose PuO2 decreased after CPB, as compared with those whose PuO2 was constant or increased. The amplitude and the rate of recovery in PuO2 after CPB were significantly associated with peak values of postoperative serum creatinine concentrations. CONCLUSIONS: These results suggest the possibility of PuO2 detecting an early stage of renal dysfunction in cardiac surgery, although further studies will be required to substantiate it.

Kainuma M; Yamada M; Miyake T

1996-08-01

80

Nutritional and epidemiological aspects of patients with chronic renal failure undergoing hemodialysis from Brazil, 2010.  

UK PubMed Central (United Kingdom)

INTRODUCTION: The Nutrition Committee of the Brazilian Society of Nephrology (SBN) held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention. OBJECTIVE: To describe epidemiological and nutritional aspects of hemodialysis patients. METHOD: Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected. RESULTS: 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%), Diabetic Nephropathy (24.6%), unknown/undiagnosed causes (19.9%), Glomerulopathies (13.6%) and others (11.2%). Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years. CONCLUSION: This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.

Biavo BM; Martins CT; Cunha LM; Araujo ML; Ribeiro MM; Sachs A; Uezima CB; Draibe SA; Rodrigues CI; Barros EJ

2012-07-01

 
 
 
 
81

Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Hip fractures in patients with end-stage renal disease are associated with frequent complications. This study analyzed clinical outcomes for patients on chronic hemodialysis who sustained hip fractures and were treated with a variety of fracture repair methods. METHODS: Twenty-nine patients with thirty-two hip fractures were analyzed in three groups. Group 1 consisted of eleven hips in eleven patients with an intertrochanteric fracture that was treated with internal fixation; Group 2, thirteen hips in ten patients with a femoral neck fracture that was treated with screw fixation; and Group 3, eight hips in eight patients with a femoral neck fracture that was treated with hemiarthroplasty. The outcomes and early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were compared. RESULTS: In Group 1, eight complications occurred in six hips and nonunion developed in five hips. In Group 2, sixteen complications developed in eleven hips. Union was achieved in two of the thirteen hips, nine hips had nonunion, and two hips had osteonecrosis develop. In Group 3, only one hip had early complications, there were no late complications, and three patients died. The mean duration of follow-up was twenty-three months, and the overall mortality rate was 45%. There were no significant differences among the groups with respect to the cumulative survival proportions. Regression analysis of age, sex, and total hemodialysis duration in relation to mortality risk revealed that only age had a significant influence on mortality (p = 0.019). CONCLUSIONS: Surgical treatment of hip fractures in patients with end-stage renal disease who are on chronic hemodialysis is associated with frequent complications and a high mortality rate. Osteosynthesis is an acceptable option for treating intertrochanteric fractures and nondisplaced femoral neck fractures, but displaced femoral neck fractures should be treated with hemiarthroplasty.

Karaeminogullari O; Demirors H; Sahin O; Ozalay M; Ozdemir N; Tandogan RN

2007-02-01

82

Bacteriemia por Chryseobacterium indologenes em diabético em hemodiálise ambulatorial Bacteremia by Chryseobacterium indologenes in a diabetic patient undergoing ambulatory hemodialysis  

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Full Text Available Chryseobacterium indologenes é uma bactéria de baixa virulência, encontrada no meio ambiente, raramente associada às infecções não hospitalares. A maioria das infecções causadas por ela associa-se ao uso de dispositivos invasivos durante a permanência em hospital. O presente relato trata de paciente renal crônico, diabético, apresentando episódios de bacteriemia durante sessões de hemodiálise ambulatorial por meio de cateter permcath.Chryseobacterium indologenes is a low-virulent bacterium found in the environment, which is rarely associated with non-nosocomial infections. Most infections caused by this pathogen are associated with the use of invasive devices in hospitalized patients. This study reports the case of a diabetic patient with chronic renal disease presenting episodes of bacteremia undergoing ambulatory hemodialysis with permcath catheter.

Marcus Machado Ramos Souza de Souza; Cassiano Augusto Braga Silva; Edson Luiz Paschoalin; José Andrade Moura Júnior; Raphael Pereira Paschoalin; Ernesto Pereira de Oliveira

2012-01-01

83

Bacteriemia por Chryseobacterium indologenes em diabético em hemodiálise ambulatorial/ Bacteremia by Chryseobacterium indologenes in a diabetic patient undergoing ambulatory hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Chryseobacterium indologenes é uma bactéria de baixa virulência, encontrada no meio ambiente, raramente associada às infecções não hospitalares. A maioria das infecções causadas por ela associa-se ao uso de dispositivos invasivos durante a permanência em hospital. O presente relato trata de paciente renal crônico, diabético, apresentando episódios de bacteriemia durante sessões de hemodiálise ambulatorial por meio de cateter permcath. Abstract in english Chryseobacterium indologenes is a low-virulent bacterium found in the environment, which is rarely associated with non-nosocomial infections. Most infections caused by this pathogen are associated with the use of invasive devices in hospitalized patients. This study reports the case of a diabetic patient with chronic renal disease presenting episodes of bacteremia undergoing ambulatory hemodialysis with permcath catheter.

Souza, Marcus Machado Ramos Souza de; Silva, Cassiano Augusto Braga; Paschoalin, Edson Luiz; Moura Júnior, José Andrade; Paschoalin, Raphael Pereira; Oliveira, Ernesto Pereira de

2012-02-01

84

Stabilizing effects of cool dialysate temperature on hemodynamic parameters in diabetic patients undergoing hemodialysis  

International Nuclear Information System (INIS)

To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3+-7.5) chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 C) temperature dialysis solution. During the study, all the dialysis conditions were maintained the same except cooling the dailysate from 37C to 35C. Hemodynamic parameters including SBP, DBP and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic and mean arterial pressure decreased significantly during standard compared to cool dialysis. Maximum decrease of systolic, diastolic and mean arterial pressure was observed during the third hour of dialysis and magnitude of decrease was 18, 17 and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialysis levels decreased significantly with cool and standard temperature dialysate (59+-5 vs. 37+-4, and 63+-7 vs. 41+-5, umol/L respectively, P

2008-01-01

85

Hemoglobin maintenance and dosing strategies using intravenous continuous erythropoietin receptor activator in Japanese hemodialysis patients.  

UK PubMed Central (United Kingdom)

Methoxy polyethylene glycol-epoetin beta, a continuous erythropoietin receptor activator (CERA), is reported to be effective in managing renal anemia but there is little data about CERA in Japan. This study aimed to ascertain the effects of CERA in Japanese hemodialysis patients and the appropriate starting dose of CERA when switching from other erythropoiesis-stimulating agents. We switched 61 stable hemodialysis patients to 4-weekly intravenous CERA, from either epoetin beta (rHuEPO) or darbepoetin alpha (DA). When determining the initial dose of CERA, we used guidelines recommended by the Japanese supplier for switching from rHuEPO, but for DA we based the CERA dose on European reports, because no Japanese guidelines exist. Fifty-two patients completed the 28-week study. Hemoglobin was maintained within the target range (10.0-12.0?g/dL). The required CERA dose decreased over the 28 weeks. The hemoglobin level and CERA dose stabilized faster when switching from DA. CERA showed similar efficacy in diabetic and non-diabetic patients. The effect of CERA is similar regardless of whether patients switch from low- or high-dose erythropoiesis-stimulating agents. In conclusion, CERA is effective for Japanese hemodialysis patients at a lower dose than expected.

Hirai T; Nishizawa Y; Nakazono H; Asai M; Yamashita H; Sasaki A; Yamashita T; Yamashita K; Shigemoto K; Harada S; Mizuiri S

2013-10-01

86

Anti-heparin-platelet factor 4 antibody is a risk factor for vascular access obstruction in patients undergoing hemodialysis.  

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Since heparin is an anticoagulant commonly used in hemodialysis and the patients on hemodialysis are repeatedly exposed to heparin, heparin may be the cause of the development of heparin-dependent antibodies and thrombotic complications in patients on hemodialysis. The purpose of this study was to d...

Lee, Eun-Young; Hwang, Kyu-Yoon; Yang, Jong-Oh; Hong, Sae-Yong

87

Vascular access-related infections in HIV patients undergoing hemodialysis: case description and literature review  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU) may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When i (more) nfections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required.

Castro, Carlos E. Figueroa; Madariaga, Miguel G.

2008-12-01

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Patterns of Medication Exposures in Hospitalized Pediatric Patients With Acute Renal Failure Requiring Intermittent or Continuous Hemodialysis.  

UK PubMed Central (United Kingdom)

OBJECTIVES:: Care for the pediatric patient with acute renal failure who requires hemodialysis (including continuous renal replacement therapy) is made more complex, as this intervention may significantly affect drug clearance, potentially altering, to a degree that is largely unknown, the effectiveness and safety of the multiple medications used to manage this complex patient population. This study aims to describe patterns of drug utilization among a large cohort of pediatric patients requiring hemodialysis and to document the easily accessible existing data available for dosing guidance of frequently prescribed medications. STUDY DESIGN:: Retrospective cohort using the Pediatric Health Information System database. SETTING:: Forty freestanding children's hospitals throughout the United States. PATIENTS:: Two thousand seven hundred thirty-eight pediatric patients with acute renal failure treated with hemodialysis from 2007 to 2011. INTERVENTION:: A retrospective review of all patients requiring hemodialysis from 2007 to 2011 was conduction using the Pediatric Health Information System Database. MAIN RESULTS:: Over 6% of pediatric patients with acute renal failure treated with hemodialysis were exposed to hemodialysis for over 2 weeks. Cumulative exposure to distinct drugs increased substantially with more prolonged courses of hemodialysis. Of the 50 most frequently prescribed medications in the cohort with acute renal failure treated with hemodialysis, 10% have readily available and easily accessible information to guide dosing adjustments with the use of hemodialysis. Furthermore, only 18% of these medications have clear recommendations for dosing in pediatric patients of all age groups with renal failure. CONCLUSIONS:: Pediatric patients with acute renal failure managed with hemodialysis are exposed to a broad variety of medications, with a high prevalence of polypharmacy. There is a trend for longer courses of hemodialysis in these patients, which leads to an increase in cumulative drug exposure, complexity of drug interactions, and potential toxicity. For the vast majority of medications that are being used to treat this complex patient population, pediatric dosing guidance is not easily accessible. These findings underscore the need for targeted pharmacologic studies of medications used in the pediatric population managed with hemodialysis.

Rizkalla NA; Feudtner C; Dai D; Zuppa AF

2013-08-01

89

Risk factors for re-recurrent carpal tunnel syndrome in patients undergoing long-term hemodialysis.  

UK PubMed Central (United Kingdom)

The purpose of this study was to evaluate risk factors for re-recurrent carpal tunnel syndrome (CTS) in long-term renal hemodialysis (HD) patients. Fifteen wrists of ten HD patients, follow-up period of minimum seven years after reoperation of CTS, were included in this study. Duration of HD, period from first operation to reoperation, shunt side was involved or not, presence of trigger finger and cervical destructive spondyloarthritis, and operative procedure performed during the reoperation (synovectomy was performed or not) were evaluated. Re-recurrent CTS was identified in four out of 15 wrists (27%). The period from first operation to reoperation, which was 3.8 years in the re-recurrence group and eight years in the no re-recurrence group, and the operative procedure had significant differences (synovectomy groups had no re-recurrence vs. no synovectomy groups had 82% re-recurrence). The results of this study suggested that synovectomy would be necessary for recurrent CTS in HD patients.

Kikuchi K; Matsumoto K; Seo K; Ito Y; Tomari S

2013-01-01

90

A review article: access recirculation among end stage renal disease patients undergoing maintenance hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: The presence of arterio-venous (A-V) fistula recirculation among hemodialysis (HD) patients markedly decrease adequacy of dialysis. OBJECTIVES: The present article summarize some of observations about clinical significance, causes, the most common techniques for measurement, and main source of pitfall in calculation of access recirculation. MATERIALS AND METHODS: A variety of literature sources such as PubMed, Current Content, Scopus, Embase, and Iranmedex; with key words such as inadequate dialysis and arterio-venous fistula access recirculation were used to collect current data. Manuscripts published in English language as full-text articles or as abstract form were included in our review study. RESULTS: Any access recirculation among HD patients should be considered abnormal and if it presents prompt investigation should be performed for its causes. There are two most common techniques for accurate assessment of access recirculation: Urea (or chemical) and nonurea-based method by ultrasound dilution technique. The most common causes of access recirculation are the presence of high-grade venous stenosis, inadequate arterial blood flow rate, close proximity, or misdirection of arterial and venous needles placement by HD staff especially in new vascular accesses due to a lack of familiarity with the access anatomy. CONCLUSIONS: The presence of access recirculation among HD patients can lead to significant inadequate dialysis thereby resulting in reducing the survival of these patients. Therefore, periodic assessment of access recirculation should be performed in HD wards.

Zeraati A; Beladi Mousavi SS; Beladi Mousavi M

2013-01-01

91

[Serum complement in patients with chronic renal insufficiency undergoing periodic hemodialysis  

UK PubMed Central (United Kingdom)

Assessment of Clq, Cls, C4, C3, C3a, C5, C9, C3PA, C1INH fractions and CH50 activity of serum complement was performed in 24 patients with renal failure undergoing periodic haemodialysis. Alternate pathway activation was found together with high levels of non involved fractions. Mechanisms and biological implications are discussed.

De Simone C; Perricone R; Taccone Gallucci M; Rovina R; Fontana L; Casciani CU

1979-01-01

92

Continuous hemodialysis for the management of acute renal failure in the presence of cerebellar hemorrhage. Case report.  

Science.gov (United States)

In this report the authors describe the use of continuous venovenous hemodialysis (CVVHD) in a medically unstable patient who suffered from a spontaneous cerebellar hemorrhage. Conventional dialysis techniques carry the risk of developing the dialysis disequilibrium syndrome (DDS) when performed in the presence of a variety of intracranial diseases. The CVVHD technique was used successfully in a morbidly obese, short-statured woman with a spontaneous hypertensive intraparenchymal cerebellar hemorrhage. The woman experienced acute renal failure several days after her hemorrhage and her general medical condition prevented her from undergoing surgical evacuation. The CVVHD did not result in elevations in intracranial pressure (ICP) and the patient made a full recovery from both acute renal failure and life-threatening posterior fossa hemorrhage. This case is noteworthy because of the absence of abnormally high ICP elevations or development of DDS in a patient with a large acute posterior fossa intraparenchymal brain hemorrhage and acute renal failure whose case was managed with CVVHD in the acute period. PMID:9761062

Caruso, D M; Vishteh, A G; Greene, K A; Matthews, M R; Carrion, C A

1998-10-01

93

Continuous hemodialysis for the management of acute renal failure in the presence of cerebellar hemorrhage. Case report.  

UK PubMed Central (United Kingdom)

In this report the authors describe the use of continuous venovenous hemodialysis (CVVHD) in a medically unstable patient who suffered from a spontaneous cerebellar hemorrhage. Conventional dialysis techniques carry the risk of developing the dialysis disequilibrium syndrome (DDS) when performed in the presence of a variety of intracranial diseases. The CVVHD technique was used successfully in a morbidly obese, short-statured woman with a spontaneous hypertensive intraparenchymal cerebellar hemorrhage. The woman experienced acute renal failure several days after her hemorrhage and her general medical condition prevented her from undergoing surgical evacuation. The CVVHD did not result in elevations in intracranial pressure (ICP) and the patient made a full recovery from both acute renal failure and life-threatening posterior fossa hemorrhage. This case is noteworthy because of the absence of abnormally high ICP elevations or development of DDS in a patient with a large acute posterior fossa intraparenchymal brain hemorrhage and acute renal failure whose case was managed with CVVHD in the acute period.

Caruso DM; Vishteh AG; Greene KA; Matthews MR; Carrion CA

1998-10-01

94

Short- and long-term outcomes in patients undergoing valve surgery with end-stage renal failure receiving chronic hemodialysis.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The objective of this study was to evaluate the effect of chronic preoperative hemodialysis for end-stage renal failure in patients undergoing valve surgery. METHODS: A retrospective review of patients undergoing primary valve with or without coronary artery bypass surgery from 1996 to 2008 at a US academic center was performed. The patients were divided into two groups: group 1 underwent valve surgery without preoperative dialysis (n = 5084) and group 2 underwent valve surgery with preoperative dialysis (n = 224). The outcomes were evaluated using multivariate regression analysis, and long-term survival was assessed with Kaplan-Meier plots. RESULTS: The patients in group 2 were younger (P < .001), were more likely women (P = .04), and presented with New York Heart Association class III-IV (P < .001). The ejection fraction was similar between the two groups (P = .36). The adjusted perioperative morbidity was similar between the two groups for stroke (P = .79) and myocardial infarction (P = .68). Resource use (postoperative length of stay) was greater in group 2 (P < .001), as was in-hospital mortality (group 1, 263/5084 [5.2%] vs group 2, 41/224 [18.3%]; P < .001). The 1-, 5-, and 10-year survival was less in group 2 (P < .001); the median survival was 12 or more years in group 1 and 1.8 years in group 2. Preoperative end-state renal disease, among others, show a trend as an independent predictor for short-term mortality and was a significant predictor for long-term mortality. CONCLUSIONS: In this large cohort of patients, preoperative dialysis conferred a high risk of perioperative morbidity and mortality and poor long-term survival after valve surgery. Risk stratification and future research efforts should focus on more precise identification of the benefits of valve surgery in this high-risk patient population.

Thourani VH; Sarin EL; Kilgo PD; Lattouf OM; Puskas JD; Chen EP; Guyton RA

2012-07-01

95

Estresse e ansiedade em pacientes renais crônicos submetidos à hemodiálise/ Stress and anxiety in chronic renal patients undergoing hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese A deficiência renal crônica é uma doença sistêmica que provoca a perda da autonomia do paciente, levando-o a limitações físicas, restrições laborais e também a perdas sociais. Pacientes com esse tipo de patologia geralmente são submetidos a sessões regulares de hemodiálise, um tratamento rigoroso e debilitante. O objetivo deste estudo foi investigar o nível de estresse e a ansiedade de pacientes submetidos à hemodiálise no Instituto do Rim de Natal, no es (more) tado do Rio Grande do Norte, Brasil. Para a coleta de dados, foram utilizados dois instrumentos: Inventário de Sintomas para Stress para Adultos de Lipp e Inventário de Ansiedade Traço-Estado. A amostra (n=100) apresentou homogeneidade em relação ao sexo, com média de idade de 46 anos e predominância de indivíduos casados, aposentados e com renda familiar baixa. Os resultados obtidos no primeiro instrumento revelaram que 71% dos pacientes encontravam-se estressados, dos quais 47% estavam na fase de resistência. Todos os pacientes entrevistados apresentaram ansiedade com níveis de moderado (66%) a severo (34%). Esses dados levam a descrever esse grupo de pacientes como altamente sujeitos ao estresse e à ansiedade. Abstract in english Chronic renal failure is a systemic disease that provokes the loss of autonomy of the patient leading to physical limitations, work restrictions, and social losses. Patients with this type of pathology are usually treated by hemodialysis, a rigorous and debilitating treatment. The goal of this study was to assess levels of stress and anxiety in patients undergoing hemodialysis at the Instituto do Rim clinic in Natal in the state of Rio Grande do Norte, Brazil. The Lipp St (more) ress Symptoms Inventory and the Trait-State Anxiety Inventory were used for the data collection. The sample (n=100) showed homogeneity in relation to gender, with a mean age of 46 and a predominance of married and retired individuals, with low family incomes. The results showed that the majority of the patients (71%) suffered high levels of stress, specifically in the resistance phase, and the incidence of psychological symptoms was greater than the physical manifestations. Furthermore, all the individuals presented moderate (66%) or high levels (34%) of anxiety. According to these data patients with chronic renal failure showed high levels of stress and anxiety.

Valle, Lionezia dos Santos; Souza, Valéria Fernandes de; Ribeiro, Alessandra Mussi

2013-03-01

96

Effects of applying continuous care model on blood tests in hemodialysis patients  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The kidney is a complex and vital organ, regulating the electrolyte and fluid status of the human body. In clients with a chronic disease, such as end-stage renal disease, functioning status and hematologic indexes are different than among the general population. Electrolyte and hematologic changes may induce many illnesses for such patients. The purpose of this study is to determine the effects of applying the continuous hemodialysis (HD) the blood test results of HD patients.Methods: This quasi-experimental, before-after study included 38 HD patients from Hamedan, Iran in 2005. Subjects were selected using simple randomized sampling and were assigned to one group for the purpose of this research and investigated over a period of six months. Data collection tools included demographic questionnaire and control check lists. The first phase of the research involved orientation of the control group, which was limited to completion of the questionnaires and control check lists. Immediately after, the same patients became the case group, upon which continuous HD was applied and hemoglobin, hematocrit, blood urea nitrogen (BUN), potassium, sodium, and albumin tests were performed. Statistical analysis of the data employed SPSS (version 13), descriptive statistics, paired t-test and the Friedman test.Results: In this group, 47.2% of the subjects were male and 52.8% female. Data analysis shows that, using repeated measurement ANOVA test, a significant relationship between application of the continuous HD and improvement in hemoglobin, hematocrit, BUN, potassium, sodium, and albumin levels (p<0.05). conclusion: Application of continuous HD causes a significant improvement in the blood test results of HD patients. We recommend that continuous HD be used, whenever appropriate, to resolve the common causes of complications in HD clients, including abnormal levels of electrolytes, especially potassium and phosphorus, as well as BUN and creatinine.

Rahimi A; Ahmadi F; Gholyaf M

2008-01-01

97

Relationship of Na-K-ATPase inhibitors to blood-pressure regulation in continuous ambulatory peritoneal dialysis and hemodialysis.  

UK PubMed Central (United Kingdom)

Inhibitors of sodium-potassium-activated adenosine triphosphatase (Na-K-ATPase) have been implicated in the pathogenesis of hypertension. In the study presented here, an attempt was made to determine whether differences in the plasma levels and the removal rates of high-molecular weight (HMW) and low-molecular weight (LMW) forms of Na-K-ATPase inhibitors might relate to blood-pressure control in hemodialysis (N = six ultrafiltered and N = six non-ultrafiltered) and CAPD (N = six long-term and N = five short-term) patients. The latter group was studied before the initiation of continuous ambulatory peritoneal dialysis (CAPD) and 2 wk after starting the treatment. The mean blood pressure was significantly reduced after dialysis in the nonultrafiltered hemodialysis group and in both CAPD groups. Plasma levels of both HMW and LMW inhibitors were found to be elevated before dialysis in all patients and were modified only slightly after dialysis. Irrespective of whether ultrafiltration was utilized in hemodialysis patients and despite significant losses of both HMW and LMW inhibitors into CAPD effluent. Because CAPD effluent was found to contain vasopressors that were not exclusively Na-K-ATPase inhibitors, losses of these other vasopressors may contribute to improved blood-pressure control in CAPD in contrast to hemodialysis.

Weiler EW; Saldanha LF; Khalil-Manesh F; Prins BA; Purdy RE; Gonick HC

1996-03-01

98

The impact of HBV/HCV coinfection on HBV DNA levels and the severity of liver diseases in HBV-infected patients undergoing hemodialysis  

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Full Text Available ObjectiveTo investigate the impact of hepatitis B virus (HBV)/hepatitis C virus (HCV) coinfection on HBV DNA levels and the severity of liver diseases in HBV-infected patients undergoing hemodialysis. MethodsA total of 178 hemodialysis patients showing positivity for HBV infection were enrolled for study and divided into two groups according to co- or monoinfection status. Eighty-six patients tested positive for both HBV and HCV (HBV+/HCV+ group), and 92 patients tested positive for HBV and negative for HCV (HBV+/HCV- group). HBV DNA levels and blood biochemical parameters were measured. The significance of inter-group differences was assessed by t-test (normally distributed data) or Mann-Whitney U test (non-normally distributed data). Multivariate logistic stepwise regression was use to evaluate the association of parameters with HCV infection. ResultsThe two groups showed similar levels of serum aminotransferase (P?0.05). In contrast, the HBV+/HCV+ patients showed significantly lower levels of serum HBV DNA than the HBV+/HCV- patients ?(0.42±0.10) vs. (1.25±0.28)log scale/ml, P?0.01?. HCV infection was found to be independently associated with lower HBV DNA levels (OR=0.316, 95% CI: 0.236-0.865, P?0.01). ConclusionIn hemodialysis patients, HBV/HCV coinfection is associated with lower HBV DNA levels but not more severe liver diseases.

ZHU Fusheng

2013-01-01

99

Brachio-cephalic ('Gracz') fistula use for continuous hemofiltration in a hemodynamically unstable hemodialysis patient without venous vascular access: a case report  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Even in patients with chronic renal failure and chronic intermittent hemodialysis, continuous venovenous hemofiltration (CVVH) is the most often practiced renal replacement technique in the intensive care unit. Although patients show less hemodynamic instability during CVVH than d...

Spronk Peter E; Barendregt Jos NM; Crooijmans Guus; Vermeeren Yolande M; Rommes Johannes H

100

Brachio-cephalic ('Gracz') fistula use for continuous hemofiltration in a hemodynamically unstable hemodialysis patient without venous vascular access: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Even in patients with chronic renal failure and chronic intermittent hemodialysis, continuous venovenous hemofiltration (CVVH) is the most often practiced renal replacement technique in the intensive care unit. Although patients show less hemodynamic instability during CVVH than during hemodialysis, it requires a blood flow exceeding 200 ml/min in the extracorporeal circuit necessitating the use of large bore catheters. Vascular access in critically ill septic and edematous patients is sometimes difficult, or even impossible. We describe a technique of using a brachio-cephalic arterio-venous fistula in a hemodialysis patient for continuous hemofiltration (HF) resulting in improved hemodynamic stability.

Spronk Peter E; Barendregt Jos NM; Crooijmans Guus; Vermeeren Yolande M; Rommes Johannes H

2007-01-01

 
 
 
 
101

A Comparison of Diagnostic Value of Anthropometric Indices with Laboratory Criteria for Malnutrition Detection in Chronic Undergoing Hemodialysis Patients  

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Full Text Available Malnutrition is a main problem in undergone hemodialysis patients. Early diagnosis is important and life saving. Using anthropometric indices can help for rapid diagnoses. This study was done to compare anthropometric indices with biochemical parameters. We monitored 60 patients that underwent hemodialysis in Shaheed Rahnemoon hospital. Biochemical parameters and anthropometric indices were measured and compared. On the basis of anthropometric indices, BMI, TSF, MAC; malnutrition prevalence was 18.3%, 21.7%, 28% respectively. By using biochemical parameters include albumin, transferrin, cholesterol, Creatinine and white blood cell Count malnutrition prevalence was 8.3%, 15%, 13%, 10%, 8.3% respectively. Only MAC index has a positive correlation with serum transferrin (r=0.169, p=0.002). Sensitivity and specificity of this test is 40% and 53.33% respectively. Its Negative predictive value is 84.21%. MAC index can be used as a reliable test for rule outing malnutrition in chronic undergone hemodialysis Patients.

Mohammad Rahimian; Farzaneh Najafi; Amirreza Goharian; Amir Bahrami Ahmadi

2006-01-01

102

Continuous reduction of plasma paraoxonase activity with increasing dialysis vintage in hemodialysis patients  

DEFF Research Database (Denmark)

Plasma paraoxonase (PON) is an enzyme that hydrolyzes organic phosphate and aromatic carboxylic acid esters. Reduced activity is associated with early events of atherogenesis. The relevance of PON phenotypes is not well characterized in hemodialysis patients. In a cross-sectional study we measured PON activity in 377 hemodialysis patients photometrically using the substrates 4-nitrophenylacetate and phenylacetate. The PON ratio was calculated from 4-nitrophenylacetate-derived activity divided by phenylacetate-derived activity. Frequency distribution of the PON ratio showed three different PON phenotypes. 74% of hemodialysis patients showed PON phenotype 1, 21% PON phenotype 2, and 5% PON phenotype 3. Compared to hemodialysis patients with PON 1, patients with PON 2 or 3 showed higher conversion rates for 4-nitrophenylacetate. We observed a significant reduction of PON ratio with increasing dialysis vintage (P

Henning, Bernhard F; Holzhausen, Helge

2010-01-01

103

Dosagem de marcadores de lesão endotelial em pacientes com doença renal crônica em hemodiálise Endothelial lesion markers dosage in chronic renal disease patients undergoing hemodialysis  

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Full Text Available INTRODUÇÃO: Pacientes com doença renal crônica (DRC) em diálise têm como principal causa de morte doença cardiovascular (DCV) aterosclerótica, tendo a inflamação e a disfunção endotelial relação direta com a aterosclerose. Além disso, a infecção pelo vírus da hepatite C (HCV), comum nestes pacientes, seria outro fator de piora do estado inflamatório. Níveis aumentados de marcadores de disfunção endotelial são encontrados em pacientes com DRC e hepatite C, e poderiam ser importantes marcadores de aterosclerose nestes indivíduos. OBJETIVO: Comparar atividade endotelial de pacientes em hemodiálise com e sem hepatite C. METODOLOGIA: Selecionamos 28 pacientes em hemodiálise que foram divididos em dois grupos: 1-HCV(+): 18 pacientes (anti-HCV[+] e PCR[+]) e 2-HCV(-): 10 pacientes (anti-HCV[-]). Antes da primeira diálise da semana foi coletada amostra de sangue para dosagem sérica de molécula de adesão intercelular-1 (ICAM-1), fator de crescimento vascular endotelial (VEGF), aspartato alanina aminotransferase (ALT) e tempo de atividade da protrombina (TAP) dos grupos. RESULTADOS: Os níveis de ICAM-1 foram elevados em 60,71%, sendo maiores no grupo HCV(+), porém não estatisticamente significativos (p = 0,2024). Não houve correlação entre os níveis de ICAM-1 e tempo de diálise ou níveis de ALT em nenhum dos grupos. Já os níveis de VEGF foram normais em 92,85%; apenas dois pacientes HCV(+) tinham níveis elevados. Também não houve correlação com tempo de diálise ou níveis de ALT em nenhum grupo. CONCLUSÃO: Pacientes em hemodiálise possuem elevada lesão endotelial, porém a presença de infecção crônica pelo HCV não se mostrou um fator agravante deste quadro. Este resultado pode ter ocorrido por conta do pequeno número de pacientes, sendo necessárias análises com maior número de indivíduos para conclusões mais definitivas.INTRODUCTION: Chronic renal patients undergoing hemodialysis treatment have cardiovascular atherosclerotic disease as the main cause of death. Inflammation and endothelial dysfunction are directly associated with atherosclerosis. Furthermore, the infection resulting from hepatitis C virus, common among such patients, would be another worsening factor of the inflammatory state. Increased levels of endothelial dysfunction markers are found in chronic renal disease and hepatitis C, which could be important markers of atherosclerosis among these subjects. OBJECTIVE: To compare endothelial activity in patients undergoing hemodialysis with and without hepatitis C. METHODOLOGY: We selected 28 patients undergoing hemodialysis and classified them into two groups: 1-HCV(+): 18 patients (anti-HCV[+] and PCR[+]) and 2-HCV(-): 10 patients (anti-HCV[-]). Before the first weekly dialysis, blood samples from both groups were collected for ICAM-1, VEGF, ALT and TAP serum dosage. RESULTS: ICAM-1 levels were high in 60.71%. The highest levels were found in HCV(+) group, though not statistically significant (p = 0.2024). There was no correlation between ICAM-1 levels and the hemodialysis time or ALT levels in any group. On the other hand, VEGF levels were normal in 92.85%. Only two patients HCV(+) had high levels. There was also no correlation between VEGF levels and the dialysis time or ALT levels. CONCLUSION: Patients undergoing hemodialysis have high endothelial lesion, nevertheless, the presence of HCV chronic infection did not prove to be an aggravating factor. This result may be due to the small number of patients, hence further analyses with a larger sample are required for definitive conclusions.

Cláudia Maria Pereira Alves; Maria do Carmo Borges Teixeira; Maria Cristina De Martino

2010-01-01

104

The effects of hypnosis on anxiety, depression, fatigue, and sleepiness in people undergoing hemodialysis: a clinical report.  

UK PubMed Central (United Kingdom)

This study investigated the effect of hypnosis on anxiety, depression, fatigue, and sleepiness in hemodialysis patients. Twenty-nine patients participated in the 15-day study. A single hypnosis session was performed on Day 8. Anxiety, depression, fatigue, and sleepiness were measured at baseline, on Day 8, and on Day 15 (HADS, MFI, ESS). Daily fatigue was also measured numerically. Anxiety, depression, and sleepiness significantly decreased after hypnosis. Weekly measures of fatigue remained stable; however, daily fatigue decreased.

Untas A; Chauveau P; Dupré-Goudable C; Kolko A; Lakdja F; Cazenave N

2013-01-01

105

The effects of hypnosis on anxiety, depression, fatigue, and sleepiness in people undergoing hemodialysis: a clinical report.  

Science.gov (United States)

This study investigated the effect of hypnosis on anxiety, depression, fatigue, and sleepiness in hemodialysis patients. Twenty-nine patients participated in the 15-day study. A single hypnosis session was performed on Day 8. Anxiety, depression, fatigue, and sleepiness were measured at baseline, on Day 8, and on Day 15 (HADS, MFI, ESS). Daily fatigue was also measured numerically. Anxiety, depression, and sleepiness significantly decreased after hypnosis. Weekly measures of fatigue remained stable; however, daily fatigue decreased. PMID:23957264

Untas, Aurélie; Chauveau, Philippe; Dupré-Goudable, Catherine; Kolko, Anne; Lakdja, Fabrice; Cazenave, Nicolas

2013-01-01

106

ORIGINAL PAPER: The association of 25-hydroxyvitamin D levels with secondary hyperparathyroidism in end-stage renal failure patients undergoing regular hemodialysis  

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Full Text Available Introduction: To investigate the role of 25-OHD as a marker of nutrition and its association with mineral metabolism and serum parathormone secretion in end-stage renal failure patients undergoing regular hemodialysis (HD), a cross sectional study was carried out on a group of maintenance hemodialysis patients. Material and methods: Serum 25-hydroxy (25-OH vitamin D) levels, Intact serum PTH (iPTH) and also serum C-reactive protein(CRP), calcium, phosphorus and alkaline phosphatase (ALP) were measured. Results: In the study, significant differences of serum 25-OH vitamin D between diabetic and non-diabetics of male dialysis patients with more values in nondiabetic HD patients and a significant positive correlation of serum 25-OH vitamin D with BMI and also a near significant inverse correlation of serum 25-OH vitamin D with serum phosphorus were found, also a significant inverse correlation of serum 25-OH VitD with serum calcium was seen, too. Moreover, a weakly significant inverse correlation of serum 25-OH vitamin D with serum iPTH was seen, too. In this study no significant association between serum 25-OH vitamin D with serum albumin, CRP, ALP, dialysis adequacy and ages of the patients, duration and sessions of dialysis were found. Conclusions: In hemodialysis patients, low serum 25-OHD levels could be a risk factor for secondary hyperparathyroidism. Serum 25-OHD could show the nutritional status of HD patients. In dialysis patients, we suggest that the plasma levels of 25-OHD are maintained around the upper limit of the reference range of sunny countries.

Hamid Nasri; Azar Baradaran

2005-01-01

107

Ifosfamide-induced neurotoxicity reversal with continuous veno-venous hemodialysis. A case report.  

UK PubMed Central (United Kingdom)

Ifosfamide is an alkylating agent used to treat different types of malignancies including lymphomas, sarcomas and germinal cell tumors. Symptoms of ifosfamide neurotoxicity can range from mild confusion, dizziness and hallucination to overt encephalopathy. Various treatment options like methylene blue, albumin infusion and rarely hemodialysis have been used to treat ifosfamide neurotoxicity. We hereby report a case of a patient with relapsed diffuse large B cell lymphoma who received methylene blue after experiencing acute renal failure and encephalopathy due to ifosfamide with no improvement. The prompt use of hemodialysis in this case has led to reversal of both renal failure and neurotoxicity.

Cherry MA; Bhardwaj H; Hopps S; Srour S; Pant S

2013-09-01

108

Thrombocytopenia in the Setting of Hemodialysis Using Biocompatible Membranes  

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Thrombocytopenia is a known potential side effect of hemodialysis, however, it is rarely seen in patients who undergo hemodialysis using biocompatible membranes. This case demonstrates hemodialysis-associated thrombocytopenia with use of biocompatible dialysis membranes that expose blood directly to...

Muir, Kathryn B.; Packer, Clifford D.

109

Métodos de avaliação da composição corporal em pacientes submetidos à hemodiálise/ Methods of body composition assessment in patients undergoing hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese A avaliação da composição corporal de pacientes com insuficiência renal crônica em hemodiálise é de suma importância para propiciar uma conduta clínica e nutricional adequada, de forma a contribuir para a redução da elevada taxa de morbidade e mortalidade observada nesta população. No entanto, fatores relacionados à doença tais como anormalidades no estado de hidratação e presença de osteodistrofia renal, podem afetar a validade das técnicas de avalia? (more) ?ão da composição corporal de pacientes com insuficiência renal crônica. Apesar dos inúmeros métodos de análise de composição corporal existentes, a maioria apresenta limitações para utilização na prática clínica da população em hemodiálise. Este artigo tem como objetivo revisar os métodos de composição corporal de fácil aplicabilidade na rotina clínica dos pacientes em hemodiálise tais como a somatória de pregas cutâneas, a bioimpedância elétrica e a interactância do infravermelho próximo. Abstract in english The evaluation of body composition in chronic renal failure patients on hemodialysis is of paramount importance for an adequate clinical and nutritional intervention, so that it can contribute to reduce the high morbidity and mortality observed in this population. However, factors related to the disease process, such as abnormalities in the hydration status and presence of renal osteodystrophy, may affect the validity of body composition evaluation techniques in patients (more) with chronic renal failure. Although there are a number of studies concerning body composition analysis methods, the majority presents limitations for utilization in clinical practice of the hemodialysis population. This paper aims to review the methods of body composition analysis that are easily applicable in the clinical routine of hemodialysis patients, such as the sum of skinfold thicknesses, bioelectrical impedance analysis and near-infrared interactance.

Kamimura, Maria Ayako; Draibe, Sérgio Antônio; Sigulem, Dirce Maria; Cuppari, Lílian

2004-03-01

110

Métodos de avaliação da composição corporal em pacientes submetidos à hemodiálise Methods of body composition assessment in patients undergoing hemodialysis  

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Full Text Available A avaliação da composição corporal de pacientes com insuficiência renal crônica em hemodiálise é de suma importância para propiciar uma conduta clínica e nutricional adequada, de forma a contribuir para a redução da elevada taxa de morbidade e mortalidade observada nesta população. No entanto, fatores relacionados à doença tais como anormalidades no estado de hidratação e presença de osteodistrofia renal, podem afetar a validade das técnicas de avaliação da composição corporal de pacientes com insuficiência renal crônica. Apesar dos inúmeros métodos de análise de composição corporal existentes, a maioria apresenta limitações para utilização na prática clínica da população em hemodiálise. Este artigo tem como objetivo revisar os métodos de composição corporal de fácil aplicabilidade na rotina clínica dos pacientes em hemodiálise tais como a somatória de pregas cutâneas, a bioimpedância elétrica e a interactância do infravermelho próximo.The evaluation of body composition in chronic renal failure patients on hemodialysis is of paramount importance for an adequate clinical and nutritional intervention, so that it can contribute to reduce the high morbidity and mortality observed in this population. However, factors related to the disease process, such as abnormalities in the hydration status and presence of renal osteodystrophy, may affect the validity of body composition evaluation techniques in patients with chronic renal failure. Although there are a number of studies concerning body composition analysis methods, the majority presents limitations for utilization in clinical practice of the hemodialysis population. This paper aims to review the methods of body composition analysis that are easily applicable in the clinical routine of hemodialysis patients, such as the sum of skinfold thicknesses, bioelectrical impedance analysis and near-infrared interactance.

Maria Ayako Kamimura; Sérgio Antônio Draibe; Dirce Maria Sigulem; Lílian Cuppari

2004-01-01

111

Adherence to prescribed oral medication in adult patients undergoing chronic hemodialysis: A critical review of the literature  

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Full Text Available Abstract Objective Poor adherence to complex multimodal therapies is a widely recognized problem in the daily care of dialysis patients, contributing to excess morbidity and mortality of this population. While a few studies have been devoted to understanding patient nonadherence, their results were somewhat controversial. The goals of this review are to quantify nonadherence to certain oral medications, to raise awareness of factors that may cause problems in a patient's adherence to this treatment, and to describe strategies that may be used to improve adherence to prescribed pharmacotherapy. Methods A systematic literature review in the MEDLINE and PubMed database (1971-2008) was performed. Quantitative studies, which accurately indicated the total percentages of nonadherence to oral medication in adult patients receiving chronic hemodialysis, were identified. Results A total of 19 studies fulfilled the search criteria. Rates of nonadherence to the oral medication ranged from 3 - 80%. More than half of the included studies reported nonadherence rates of ? 50% (mean 67%). The use of phosphate binding therapy was the prevalent surveyed oral medication. Self reports, structured interviews, and predialysis serum phosphate levels were the most frequent assessment tools used to record adherence rates. Limitations of the reviewed studies included small patient cohorts, inconsistent definitions of adherence, and a lack of standardized methods for measuring nonadherence. Conclusions Nonadherence to oral medication in hemodialysis patients is still an underestimated, but life-threatening behaviour.

Schmid H; Hartmann B; Schiffl H

2009-01-01

112

The Effect of Coadminstration of Nicotinamide and Calcium-based Phosphate Binder on Hyperphophatemia in Patients Undergoing Hemodialysis  

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Full Text Available Background: Hyperphosphatemia remains a common problem in patients receiving maintenance dialysis. Niacinamide inhibits intestinal sodium/phosphorus co transporters and reduces serum phosphorus level in some clinical studies. Objective: Assessment the safety and the efficacy of nicotinamide as adjunctive therapy to calcium carbonate (as phosphate binder). Study design and setting: A prospective, interventional, open-labeled, case control randomized trial was performed at Ain Shams University Specialized Hospital and Al Motamayz hemodialysis center, Cairo, Egypt, from August 2010 to December 2010. Patients and Methods: Sixty hemodialysis patients with serum phosphorus level ? 5.0 mg/dl were classified into two groups; group I (control group) in which patients received calcium carbonate tablets in dose of 500mg to 1000mg three t.i.d. And group II (study group) in which patients received calcium carbonate in dose of 500mg to 1000mg t.i.d. and nicotinamide tablets in a dose titrated to 1000mg/day for 8 weeks. Serum calcium, phosphorus and intact parathyroid hormone were measured at week 1 and 9 to assess the efficacy of treatment. Results: Fifty six patients successfully completed the trail. Serum phosphorus level falls significantly from 6.75 to 5.47 mg/dl with group II and not with group I (from 6.46 to 6.53 mg/dl). A concurrent fall in calciumphosphorus product was seen with nicotinamide treatment (from 58.7 to 48.55 mg2/dl2), whereas serum calcium, intact parathyroid hormone, uric acid, platelet count, total cholesterol, hemoglobin, AST, and ALT remained stable in both arms. A trend toward increasing HDL and reducing LDL and triglycerides were reported in nicotinamide group however the overall changes were statistically non significant. Diarrhea and other gastrointestinal disturbances symptoms were the major adverse effects seen with nicotinamide treatment. Conclusion: Nicotinamide in single dose of 1000 mg daily can effectively reduce serum phosphorus level when administered with calcium carbonate (as phosphate binder) with less potential side effects.Key words: Hyperphosphatemia; Hemodialysis; Nicotinamide; Phosphate binder

Shaimaa Allam; Manal El-Hamamsy; Magdy El Sharkawy

2012-01-01

113

Patency and Life-Spans of Failing Hemodialysis Grafts in Patients Undergoing Repeated Percutaneous De-Clotting  

Science.gov (United States)

We set out to determine retrospectively the primary and secondary patency rates, as well as the life-spans, of failing polytetrafluoroethylene dialysis grafts after repeated percutaneous mechanical de-clotting. The study group consisted of all patients who had undergone percutaneous mechanical de-clotting, balloon angioplasty, or angiography of their polytetrafluoroethylene hemodialysis grafts at our institution from 1 January through 30 April 1999. Patency of the hemodialysis grafts was calculated using Kaplan-Meier analysis. A total of 161 percutaneous de-clotting procedures were performed on 59 of 71 patients. At 1 year, the primary and secondary surgical patency rates of the grafts were 29% and 61.4%, respectively. The life-spans of the polytetrafluoroethylene grafts after repeated percutaneous de-clotting and surgical interventions was 93.5% at 6 months, 78% at 1 year, 58.8% at 2 years, and 35% at 3 years. The patency rates after the 1st, 2nd, and 3rd de-clotting procedures were 55.9%, 61.9%, and 55.8% at 3 months and 32.2%, 40.8%, and 31.4% at 6 months, respectively (P=0.40). The patency rate of grafts after mechanical de-clotting using the Arrow-Trerotola thrombectomy device was not statistically different from that of the crossed angioplasty balloon technique alone (P=0.38). Further, there was no difference in the life-spans of grafts whether they were located in the upper or lower extremity. Because reocclusion rates are similar following 1st, 2nd, and 3rd occlusions, regardless of the percutaneous mechanical de-clotting technique used, repeated percutaneous management should be undertaken to preserve each graft regardless of the number of previous de-clotting procedures. (Tex Heart Inst J 2001;28:249–53)

Mansilla, Alberto V.; Toombs, Barry D.; Vaughn, William K.; Zeledon, Jorge I.

2001-01-01

114

Day-to-day variation of insulin requirements of patients with type 2 diabetes and end-stage renal disease undergoing maintenance hemodialysis.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate day-to-day variations of insulin needs in type 2 diabetic patients with end-stage renal disease (ESRD) on maintenance hemodialysis. RESEARCH DESIGN AND METHODS: We developed a 24-h euglycemic clamp in patients who received an average of 2,200 calories in a standardized three-meal and two-snack regimen per day, adjusted to body size and sex. Intravenous insulin was adjusted every 30 min to achieve 5.5 +/- 1.1 mmol/l glycemia over 24 h prehemodialysis, during hemodialysis session, and 24 h posthemodialysis in 10 type 2 diabetic patients, aged 55.7 +/- 8.7 years with 11.9 +/- 4.5 years diabetes duration, undergoing maintenance hemodialysis for 2.3 +/- 2.3 years. Insulin requirements were derived from the dose of insulin administered to maintain euglycemia per period of time and day-to-day comparisons performed. RESULTS: Mean capillary glycemia was 5.5 +/- 0.3 mmol/l prehemodialysis and 5.3 +/- 0.2 mmol/l posthemodialysis (P = 0.39). Pre- and posthemodialysis areas under the glucose curve were comparable. This was achieved by infusing 23.6 +/- 7.7 IU/24 h prehemodialysis vs. 19.9 +/- 4.9 IU/24 h posthemodialysis, indicating a 15.3% decrease posthemodialysis (P = 0.09). Basal insulin needs decreased from 0.4 +/- 0.1/h prehemodialysis to 0.3 +/- 0.1/h posthemodialysis (P = 0.01). Total boluses were decreased by 2.2 +/- 3.1 IU (P = 0.15). Changes in blood urea did not correlate with changes in insulin needs (r = 0.1, P = 0.79). CONCLUSIONS: The present study has demonstrated a significant 25% reduction in basal insulin requirements the day after dialysis compared with the day before. No significant change in boluses was observed, and overall the reduction of total insulin requirements was -15% equivalent to -4 IU/day posthemodialysis of marginal statistical significance.

Sobngwi E; Enoru S; Ashuntantang G; Azabji-Kenfack M; Dehayem M; Onana A; Biwole D; Kaze F; Gautier JF; Mbanya JC

2010-07-01

115

Impacto do hábito de jantar sobre o perfil dietético de pacientes em hemodiálise Effects of customary dinner on dietetical profile of patients undergoing hemodialysis  

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Full Text Available OBJETIVO: Analisar os efeitos do comportamento alimentar, entre o hábito de jantar ou não jantar, no perfil de ingestão de macronutrientes e micronutrientes de pacientes com insuficiência renal crônica em hemodiálise. MÉTODO: Estudo transversal em uma clínica de diálise de Belo Horizonte, em Minas Gerais. Participaram do estudo 90 pacientes em tratamento hemodialítico. Foram coletados dados pessoais, clínicos e dietéticos (registro alimentar de três dias). Foi considerado jantar uma refeição completa e não jantar a sua ausência ou substituição por lanches. As estimativas das quantidades de nutrientes ingeridos foram feitas em software específico Dietwin®. RESULTADOS: Os valores de carboidrato, tiamina, riboflavina, ácido ascórbico, cálcio e selênio ingeridos não apresentaram diferença entre os grupos de pacientes que jantavam e não jantavam (p > 0,05). Os valores de Índice de Massa Corporal (IMC), energia, proteína, lipídeos, niacina, ácido pantotênico, piridoxina, ácido fólico, cobalamina, potássio, fósforo, zinco e magnésio ingeridos apresentaram diferença entre estes mesmos grupos (p INTRODUCTION: To assess the effects of the habit of having evening dinner on the dietary macro- and micronutrient profile of chronic kidney failure patients on hemodialysis. METHODS: Cross-sectional study carried out at a dialysis clinic at the city of Belo Horizonte, state of Minas Gerais. The study comprised 90 patients undergoing hemodialysis. Personal, clinical, and dietary (three-day food record) data were collected. The habit of having dinner was considered as having a complete evening meal, and the lack of that habit was considered as not having it or replacing it by a fast meal. The amounts of nutrient intake were estimated in the specific software Dietwin®. RESULTS: The carbohydrate, thiamine, riboflavin, ascorbic acid, calcium, and selenium intake values showed no difference between the group having a complete evening meal and that not having it (p > 0.05). Both groups did not differ in the following: body mass index, and energy, protein, lipid, niacin, pantothenic acid, pyridoxine, folic acid, cobalamin, potassium, phosphorus, zinc, and magnesium intake values (p < 0.05). Regarding nutrient adequacy, the complete evening meal group performed better than the other group, except for carbohydrates, lipids, pantothenic acid, ascorbic acid, potassium, calcium, and zinc (p < 0.05). None of the patients showed the adequate pyridoxine, folic acid, and selenium intake values. Few patients in both groups showed adequate energy, pantothenic acid, and zinc intake values. CONCLUSION: The habit of having a complete evening meal influenced positively the micro and macronutrient intakes in chronic kidney failure patients on hemodialysis.

Marcia Machado Cunha Ribeiro; Melissa Luciana de Araújo; Michele Pereira Netto; Lucas Maciel Cunha

2011-01-01

116

Prevalence of latent tuberculosis infection and risk of infection in patients with chronic kidney disease undergoing hemodialysis in a referral center in Brazil.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the prevalence of latent tuberculosis infection (LTBI) and the risk of infection in patients with chronic kidney disease treated at a hemodialysis center. METHODS: We included 307 patients with chronic kidney disease undergoing hemodialysis at the Mineiro Institute of Nephrology, located in the city of Belo Horizonte, Brazil. All of the patients were submitted to tuberculin skin tests (TSTs). We investigated the booster effect and TST conversion. If the initial TST (TST1) was negative, a second TST (TST2) was performed 1-3 weeks later in order to investigate the booster effect. If TST2 was also negative, a third TST (TST3) was performed one year after TST2 in order to determine whether there was TST conversion. RESULTS: When we adopted a cut-off induration of 5 mm, the prevalence of LTBI was 22.2% on TST1, increasing by 11.2% on TST2. When we adopted a cut-off induration of 10 mm, the prevalence of LTBI was 28.5% on TST1, increasing by 9.4% on TST2. The prevalence of LTBI increased significantly from TST1 to TST2 (booster effect), as well as from TST2 to TST3 (p < 0.01 for both). In our sample, the mean annual risk of infection was 1.19%. CONCLUSIONS: In the population studied, the prevalence of LTBI was high, and the mean annual risk of infection was similar to that reported for the general population of Brazil, which suggests recent infection.

Fonseca JC; Caiaffa WT; Abreu MN; Farah Kde P; Carvalho Wda S; Spindola de Miranda S

2013-03-01

117

Adesão ao tratamento farmacológico de pacientes em hemodiálise/ Adherence to pharmacological treatment in adult patients undergoing hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese INTRODUÇÃO: A adesão ao tratamento do paciente em terapia hemodialítica não é um processo simples. As estratégias para promover a adesão vão ao encontro da necessidade de melhorias no processo de orientação sobre a doença e o seu tratamento farmacológico. OBJETIVOS: Identificar a adesão ao tratamento farmacológico de pacientes em hemodiálise e os principais fatores relacionados, por meio do uso de uma Escala de Adesão. MÉTODOS: Estudo observacional, desc (more) ritivo e transversal. Foram realizadas entrevistas para o levantamento de dados socioeconômicos, farmacoterapêuticos e de autorrelato de adesão farmacológica. RESULTADOS: Dos 65 pacientes participantes, 55,4% demonstraram não adesão. A média de medicamentos utilizados foi de 4,1 ± 2,5 (autorrelato) e 6,2 ± 3,0 (prescrição). A análise estatística mostrou diferença significativa entre adesão e idade em diferentes faixas etárias (> 60 anos apresentaram maior adesão). CONCLUSÕES: Uma proporção significativa dos pacientes tem dificuldades para aderir ao tratamento e o principal fator citado foi o esquecimento. Em relação à idade, os pacientes idosos se mostraram mais aderentes. O baixo nível de conhecimento sobre os medicamentos utilizados pode ser um dos motivos da má adesão, sendo o processo de orientação do paciente por parte da equipe de profissionais envolvidos na assistência uma estratégia para promover a adesão. Abstract in english INTRODUCTION: Adherence to treatment in patients on hemodialysis is not a simple process. Strategies to promote adherence will meet the need for improvements in the process of orientation concerning the disease and its pharmacological treatment. OBJECTIVES: To identify compliance with pharmacological treatment of patients on hemodialysis and the main factors related to it we used the Adherence Scale. METHODS: Observational, descriptive and cross-sectional study. Interview (more) s were conducted to collect socioeconomic, pharmacological data, as well as those regarding self-reported adherence to drug. RESULTS: Out of the 65 participants, 55.4% showed non-compliance. The mean number of drugs used was 4.1 ± 2.5 (self-report) and 6.2 ± 3.0 (prescription). Statistical analysis showed significant differences concerning compliance at different ages (> 60 years are more adherent). CONCLUSIONS: A significant proportion of patients have difficulty to comply with treatment and the main factor was forgetfulness. Regarding age, elderly patients are more adherent to treatment. The low level of knowledge about the used drugs may be one of the reasons for the lack of adherence, and the patient's orientation process by a team of multiprofessionals involved in assisting is a strategy to promote adherence.

Sgnaolin, Vanessa; Figueiredo, Ana Elizabeth Prado Lima

2012-06-01

118

Study of oxidative stress in patients with advanced renal disease and undergoing either hemodialysis or peritoneal dialysis.  

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Oxidative stress (OS) is directly involved in the formation of atheroma plaque and has been shown to be present since the early stages of Chronic Kidney Disease (CKD); however, the net role that dialytica techniques may play in OS process is yet to be determined. We studied three groups: hemodialysis (HD, n = 30), peritoneal dialysis (PD, n = 31), predialysis (pre-D, n = 32), and one control group (C, n = 67). Using highresolution liquid chromatography columns (HPLC), the superoxide dismutase (SOD), glutathione oxidized/reduced ratio (GSSG/GSH), and nuclear, as well as mitochondrial 8-oxo-dG (8-oxo-dG mit) were measured in lymphocytes. Protein carbonyls and F2-isoprostanes were measured in plasma. The antioxidant enzyme activity was evaluated by a spectrophotometric assay of catalase, glutathione peroxidase (GPX), glutathione reductase (GSR), and superoxide dismutase (SOD). Compared to the control group, all groups had significantly higher levels of products derived from molecular oxidation with a significant decrease in antioxidant enzymes. Patients in the pre-D group showed higher values for most of the oxidized molecules. The PD group showed a better oxidative balance, with no significant differences in levels of mitochondrial 8-oxo-dG when compared to the control group. We speculated that the better control of OS observed in patients receiving PD might be explained by the fact that this technique is more biocompatible, and this might help reduce the risk of cardiovascular events. PMID:23782545

Puchades, Maria J; Saez, Guillermo; Muñoz, M Carmen; Gonzalez, Miguel; Torregrosa, Isidro; Juan, Isabel; Miguel, Alfonso

2013-09-01

119

Experience with daptomycin daily dosing in ICU patients undergoing continuous renal replacement therapy.  

UK PubMed Central (United Kingdom)

PURPOSE: For critically ill patients undergoing continuous renal replacement therapy (CRRT), daptomycin dosing recommendations are scarce. We, therefore, retrospectively assessed routinely measured daptomycin plasma concentrations, daptomycin dose administered and microbiological data in 11 critically ill patients with Gram-positive infections that had received daptomycin once daily. METHODS: The retrospective analysis included critically ill patients treated at the intensive care unit (ICU) who had daptomycin plasma concentrations measured. RESULTS: Daptomycin dose ranged from 3 to 8 mg/kg/q24 h in patients undergoing CRRT (n = 7) and 6 to 10 mg/kg/q24 h in patients without CRRT (n = 4). Peak and trough concentrations showed a high intra- and inter-patient variability in both groups, independent of the dosage per kg body weight. No drug accumulation was detected in CRRT patients with once-daily daptomycin dosing. Causative pathogens were Enterococcus faecium (n = 6), coagulase-negative Staphylococcus (n = 2), Staphylococcus aureus (n = 2) and unknown in one patient. Microbiological eradication was successful in 8 of 11 patients. Two of three patients with unsuccessful microbiological eradication and fatal outcome had an Enterococcus faecium infection. CONCLUSION: In critically ill patients undergoing CRRT, daptomycin exposure with once-daily dosing was similar to ICU patients with normal renal function, but lower compared to healthy volunteers. Our data suggest that daptomycin once-daily dosing is appropriate in patients undergoing CRRT.

Preiswerk B; Rudiger A; Fehr J; Corti N

2013-04-01

120

[Prognostic value of dobutamine stress echocardiography in patients with terminal renal insufficiency undergoing hemodialysis--a 5-year follow up].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Patients with end-stage renal failure have high morbidity and mortality rates due to cardiovascular complications. Screening for coronary heart disease in these patients is of utmost importance. The aim of this study was to investigate the prognostic value of the dobutamine test in patients on hemodyalisis during a 5-year follow-up period. MATERIAL AND METHODS: During the pretransplantation period, 24 patients on chronic hemodialysis underwent echocardiography and dobutamine echocardiography. The average age of patients was 51.50 +/- 7.35 years. The mean duration of dialysis was 74 +/- 40 months. RESULTS: The dobutamine stress test was positive in 50% of patients, and undefined in 12.5%. The wall motion score index before the test was 1, and after the test it was 1.54 +/- 0.27. There were no serious complications. Left ventricular mass, diastolic and systolic dimension and posterior wall were significantly higher in patients with positive dobutamine stress results and they were associated with late cardiac morbidity and mortality. Five-year survival in patients with positive dobutamine stress results was 33.3% and 52.3% in patients with negative dobutamine results. Causes of mortality were as follows: cardiac 45.4%, cerebrovascular 18.1%, other causes 36.4%. Cardiogical complications were not the cause of death in any of the patients with negative dobutamine results. In dobutamine positive group 62.5% died from cardiological complications. During the 5-year period, cardiac death and manifest coronary disease occurred in 75% of patients with positive dobutamine stress results and only in one patient with negative dobutamine results. Sensitivity was 75%, specificity 89% and positive predictive value 90%. CONCLUSION: Dobutamine stress echocardiography has a good predictive value for future cardiac events in hemnodyalisis patients, and in screening for coronary disease.

Krotin M; Vukovi? D; Stojanovi? O; Milovanovi? B; Celeketi? D; Blagojevi? R

2007-07-01

 
 
 
 
121

Prognostic value of dobutamine stress echocardiography in patients with terminal renal insufficiency undergoing hemodialysis: A 5-year follow up  

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Full Text Available Introduction. Patients with end-stage renal failure have high morbidity and mortality rates due to cardiovascular complications. Screening for coronary heart disease in these patients is of utmost importance. The aim of this study was to investigate the prognostic value of the dobutamine test in patients on hemodyalisis during a 5-year follow-up period. Material and methods. During the pretransplantation period, 24 patients on chronic hemodialysis underwent echocardiography and dobutamine echocardiography. The average age of patients was 51.50±7.35 years. The mean duration of dialysis was 74±40 months. Results. The dobutamine stress test was positive in 50% of patients, and undefined in 12.5%. The wall motion score index before the test was 1, and after the test it was 1.54±0.27. There were no serious complications. Left ventricular mass, diastolic and systolic dimension and posterior wall were significantly higher in patients with positive dobutamine stress results and they were associated with late cardiac morbidity and mortality. Five-year survival in patients with positive dobutamine stress results was 33.3% and 52.3% in patients with negative dobutamine results. Causes of mortality were as follows: cardiac 45.4%, cerebrovascular 18.1%, other causes 36.4%. Cardiogical complications were not the cause of death in any of the patients with negative dobutamine results. In dobutamine positive group 62.5% died from cardiological complications. During the 5-year period, cardiac death and manifest coronary disease occurred in 75% of patients with positive dobutamine stress results and only in one patient with negative dobutamine results. Sensitivity was 75%, specificity 89% and positive predictive value 90%. Conclusion. Dobutamine stress echocardiography has a good predictive value for future cardiac events in hemodyalisis patients, and in screening for coronary disease. .

Krotin Mirjana; Vukovi? Dejana; Stojanovi? Olivera; Milovanovi? Branislav; ?eleketi? Dušica; Blagojevi? Radmila

2007-01-01

122

Hemodialysis access.  

UK PubMed Central (United Kingdom)

The number of patients requiring dialysis is increasing, in particular those patients over the age of 75. The arteriovenous fistula is the preferred access for hemodialysis due to fewer complications and decreased mortality. Access complications are common and require early recognition and treatment. Postoperative access surveillance is important to ensure timely diagnosis and treatment of access-related complications. There is a continued need for high-quality data to assist in determining the best access for each patient.

Rose DA; Sonaike E; Hughes K

2013-08-01

123

Effects of action planning and coping planning within the theory of planned behaviour : a physical activity study of patients undergoing hemodialysis  

DEFF Research Database (Denmark)

Objective: Patients on dialysis have low physical activity levels. The aim of the study was to examine the validity of action planning and coping planning within the theory of planned behaviour framework, for predicting physical activity behaviour of patients on hemodialysis. Methods: One hundred and forty four patients who were undergoing emodialysis were selected from dialysis centers. The mean age of the patients was 56.61 (SD= 11.38) years. The patients completed a questionnaire including variables from the theory of planned behaviour, action planning and coping planning. Physical activity was prospectively assessed at 4-weeks with the validated International Physical Activity Questionnaire self-report measure. A hierarchical regression analysis was performed to examine the effects of action planning and coping planning on physical activity behaviour. Results: There was a main effect for coping planning but not for action planning. Moreover, the analyses resulted in a significant amount of incremental variance accounted for by the interaction of coping planning and intention. Conclusion: Results suggest the combination of high levels of coping planning and intention is associated with increases in physical activity.

Pakpour, Amir H.; Zedi, Isa mohammadi

2011-01-01

124

Successful leukocytapheresis therapy in a patient with rheumatoid arthritis on maintenance hemodialysis.  

UK PubMed Central (United Kingdom)

We report the case of a 44-year-old female undergoing maintenance hemodialysis in whom early-phase rheumatoid arthritis (RA) was successfully treated by leukocytapheresis (LCAP). The effects of prednisone, tacrolimus, and etanercept were limited, but LCAP was highly effective and its efficacy continued even after cessation of LCAP. Moreover, remission was maintained for 2 years after discontinuation of medication. LCAP may be an important treatment option for RA patients with end-stage renal failure who are on hemodialysis.

Maeshima K; Torigoe M; Iwakura M; Yamanaka K; Ishii K

2013-03-01

125

Impacto do hábito de jantar sobre o perfil dietético de pacientes em hemodiálise/ Effects of customary dinner on dietetical profile of patients undergoing hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: Analisar os efeitos do comportamento alimentar, entre o hábito de jantar ou não jantar, no perfil de ingestão de macronutrientes e micronutrientes de pacientes com insuficiência renal crônica em hemodiálise. MÉTODO: Estudo transversal em uma clínica de diálise de Belo Horizonte, em Minas Gerais. Participaram do estudo 90 pacientes em tratamento hemodialítico. Foram coletados dados pessoais, clínicos e dietéticos (registro alimentar de três dias). Fo (more) i considerado jantar uma refeição completa e não jantar a sua ausência ou substituição por lanches. As estimativas das quantidades de nutrientes ingeridos foram feitas em software específico Dietwin®. RESULTADOS: Os valores de carboidrato, tiamina, riboflavina, ácido ascórbico, cálcio e selênio ingeridos não apresentaram diferença entre os grupos de pacientes que jantavam e não jantavam (p > 0,05). Os valores de Índice de Massa Corporal (IMC), energia, proteína, lipídeos, niacina, ácido pantotênico, piridoxina, ácido fólico, cobalamina, potássio, fósforo, zinco e magnésio ingeridos apresentaram diferença entre estes mesmos grupos (p Abstract in english INTRODUCTION: To assess the effects of the habit of having evening dinner on the dietary macro- and micronutrient profile of chronic kidney failure patients on hemodialysis. METHODS: Cross-sectional study carried out at a dialysis clinic at the city of Belo Horizonte, state of Minas Gerais. The study comprised 90 patients undergoing hemodialysis. Personal, clinical, and dietary (three-day food record) data were collected. The habit of having dinner was considered as havin (more) g a complete evening meal, and the lack of that habit was considered as not having it or replacing it by a fast meal. The amounts of nutrient intake were estimated in the specific software Dietwin®. RESULTS: The carbohydrate, thiamine, riboflavin, ascorbic acid, calcium, and selenium intake values showed no difference between the group having a complete evening meal and that not having it (p > 0.05). Both groups did not differ in the following: body mass index, and energy, protein, lipid, niacin, pantothenic acid, pyridoxine, folic acid, cobalamin, potassium, phosphorus, zinc, and magnesium intake values (p

Ribeiro, Marcia Machado Cunha; Araújo, Melissa Luciana de; Netto, Michele Pereira; Cunha, Lucas Maciel

2011-03-01

126

Pharmacokinetics of Daily Daptomycin in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy.  

UK PubMed Central (United Kingdom)

Background: The optimal daptomycin dosing regimen for critically ill patients undergoing continuous renal replacement therapy (CRRT) has still to be established. Methods: Daptomycin pharmacokinetics was determined in 9 patients after administration of 6 mg/kg/day over 5 days. Results: At steady state, which was reached by day 3, the area under the curve over 24 h (AUC24h) was 667.4 ± 356.6 mg·h/l, and the maximum concentration (Cmax) was 66.9 ±25.3 mg/l. Mean CRRT clearance accounted for 48% (range 32-67%) of total clearance (mean 10.2 ml/min, range 6.1-18 ml/min). Significant correlations were observed between Cmax, minimum concentration (Cmin) and AUC24h (R(2) = 0.91, p < 0.001, and R(2) = 0.94, p < 0.001) and between albumin plasma concentration and free daptomycin (R(2) = 0.7, p = 0.009). Conclusion: No significant accumulation occurred with a daily daptomycin dose of 6 mg/kg in patients undergoing CRRT with an effluent flow rate of >30 ml/kg/h. The quantification of trough concentrations (Cmin) appears to be a good surrogate to estimate AUC24h and to monitor daptomycin treatment in patients undergoing CRRT. © 2013 S. Karger AG, Basel.

Corti N; Rudiger A; Chiesa A; Marti I; Jetter A; Rentsch K; Müller D; Béchir M; Maggiorini M

2013-09-01

127

Comparative study of continuous lateral osteotomy and microperforating osteotomy in patients undergoing primary rhinoplasty  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: Lateral osteotomies play an important role in rhinoplasty and can be performed with different techniques. Objective: To compare the results of narrowing of the nasal dorsum and base through 2 types of lateral osteotomy: continuous and microperforating. Method: We selected 74 patients undergoing rhinoplasty: 37 patients underwent lateral continuous osteotomy and the other 37 underwent microperforating osteotomy, all performed by the same surgeon. We analyzed frontal photography from the pre- and post-operative (6 months) periods, evaluating the width of the nasal dorsum and base. This was a retrospective study. Results and Conclusion: Using Student's t-test, statistical analysis concluded that there was a statistically significant difference in the post-operative narrowing of the nasal dorsum and base following both osteotomy techniques, and there was no statistically significant difference between the 2 techniques.

Diego Sherlon Pizzamiglio1,; Cezar Augusto Sarraf Berger2

2012-01-01

128

Patent Processus Vaginalis in Patients Undergoing continuous Ambulatory Peritoneal Dialysis - Two Cases Confirmed by Radionuclide Peritoneal Scintiscan -  

International Nuclear Information System (INIS)

[en] Continuous ambulatory peritoneal dialysis (CAPD) is a well established method of treating end stage renal failure, and is commonly used as an alternative to hemodialysis. Several complications have been observed. These include catheter malfunction, abdominal and inguinal hernia, and peritonitis. A relatively frequent complication is swelling of external genitalia, due to bowel fluid passing through a patent processus vaginalis. Special diagnostic procedures are necessary to determine the nature of the abnormality and to guide the surgical correction. We reported two cases of patent processus vaginalis in patient on CAPD proved by radionuclide peritonea scintiscan using 99mTc-tin colloid.

1989-01-01

129

Patent Processus Vaginalis in Patients Undergoing continuous Ambulatory Peritoneal Dialysis - Two Cases Confirmed by Radionuclide Peritoneal Scintiscan -  

Energy Technology Data Exchange (ETDEWEB)

Continuous ambulatory peritoneal dialysis (CAPD) is a well established method of treating end stage renal failure, and is commonly used as an alternative to hemodialysis. Several complications have been observed. These include catheter malfunction, abdominal and inguinal hernia, and peritonitis. A relatively frequent complication is swelling of external genitalia, due to bowel fluid passing through a patent processus vaginalis. Special diagnostic procedures are necessary to determine the nature of the abnormality and to guide the surgical correction. We reported two cases of patent processus vaginalis in patient on CAPD proved by radionuclide peritonea scintiscan using {sup 99m}Tc-tin colloid.

Lee, Jae Tae; Son, Sang Kyun; Lee, Kyu Bo; Whang, Kee Suk; Cho, Dong Kyu; Koh, Chul Woo [Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

1989-07-15

130

Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery.  

DEFF Research Database (Denmark)

Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were measured at supine rest, during orthostatic stress, and after walking prior to and 24, 48, and 72 h and 48 h postoperatively compared to preoperatively (P 0.3; HR, P > 0.34) and 12 vs 8 patient; (P = 0.45) experienced a systolic BP decrease > 20 mm Hg post- versus preoperatively. After walking, systolic BP was significantly lower postoperatively compared with preoperatively (P < or = 0.01). Epidural infusion was discontinued in three patients due to either persisting resting or orthostatic hypotension. There was no correlation between ASA classification, intraoperative bleeding, or postoperative dizziness and incidence of orthostatic hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients.

Crawford, M E; MØiniche, S

1996-01-01

131

[Continuous hemodialysis with low blood flow and low dialysate flow in the treatment of acute renal insufficiency].  

UK PubMed Central (United Kingdom)

Slow continuous hemodialysis (SCHD) was performed in 9 patients with oliguric acute renal failure and cardiovascular instability. The vascular access was a Scribner's shunt in 7 patients and a double lumen venous catheter with a BSM22 blood system in 2 patients. Three different dialyzers were tested. The mean urea clearance was 10.8 +/- 1.5 ml/min with the 0.2 m2 polysulfone hollow fiber dialyzer, 14.3 +/- 2.7 ml/min with the 0.5 m2 AN 69 S parallel plate dialyzer and 13.8 +/- 1.8 ml/min with the 0.6 m2 AN 69 hollow fiber dialyzer. The mean dialysate flow rate was 15.6 +/- 1.9 ml/min, 15.2 +/- 0.7 ml/min and 15.1 +/- 1.6 ml/min for the three dialyzers, respectively. A linear relationship was documented for blood urea clearance and dialysate flow rate indicating clearly that low blood flow from 60 to 100 ml per min was appropriate for optimal diffusive transfer. The technic required continuous heparin anticoagulation. Three patients died of causes not related to the SCHD technic. When used in critically ill patients, SCHD is a simple method, suitable for intensive care unit staff with no trained dialysis nurses and allows an adequate control of uremia, fluid removal, acid base homeostasis and parenteral nutrition.

Wynckel A; Toupance O; Melin JP; Lavaud S; Wong T; Chanard J

1990-01-01

132

Distal radial artery pressures predict angiographic result and short-term patency outcome in hemodialysis patients with juxta-anastomotic inflow stenosis of radiocephalic fistula undergoing transradial angioplasty.  

UK PubMed Central (United Kingdom)

Distal radial artery pressure (RAP) was observed to be reduced after transradial percutaneous transluminal angioplasty (PTA) on the juxta-anastomotic venous stenosis of radiocephalic arteriovenous fistula (RCAVF). Distal RAPs are easily obtained from a pressure transducer connected with an introducer retrograde inserted into distal radial artery. The clinical role of distal RAP in the setting of transradial PTA remains unknown. This prospective and observational study aimed to explore the relationship between distal RAPs and clinical outcomes. This study recruited hemodialysis patients with RCAVF juxta-anastomotic venous stenosis undergoing transradial PTA. RAP-related variables and procedural data before PTA (pre-PTA) and after PTA (post-PTA) were analyzed. The study endpoint was dysfunction-driven re-PTA during the 1-year follow-up. Overall, 73 PTAs significantly reduced the mean of systolic RAPs from 159.6?±?41.4 to 108.4?±?41.5?mm Hg; P??0.05). The group with angiographically successful PTAs had a significantly lower mean of post-PTA systolic RAPs compared with that with unsuccessful PTAs (98.4?±?35.4 vs. 128.7?±?46.1?mm Hg; P?=?0.003). The post-PTA systolic RAP may be seen as a predictor for 3-month unassisted patency (AUC?=?0.669; P?=?0.048). In conclusion, this study provides the RAP profile to help guide transradial PTA on RCAVF juxta-anastomotic venous stenosis and predict 3-month unassisted patency in a hemodynamic manner.

Lai CC; Fang HC; Lin CH; Mar GY; Tseng CJ; Liu CP

2013-06-01

133

Microrganismos cariogênicos em pacientes com insuficiência renal crônica em hemodiálise Cariogenic microorganisms in patients with chronic renal failure undergoing hemodialysis therapy  

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Full Text Available Neste estudo comparativo, avaliaram-se a prevalência de cárie, o índice de cálculo, o fluxo salivar e as quantificações de microrganismos cariogênicos na saliva, em pacientes com insuficiência renal crônica submetidos à hemodiálise e em indivíduos normais, pareados quanto a idade e sexo. Não houve diferença significante entre os grupos em relação aos índices CPOD e CPOS, ao fluxo de saliva total estimulada ou às contagens de estreptococos mutans e lactobacilos em meios seletivos. Notável foi a verificação da grande necessidade de tratamento odontológico e de instruções para o controle de placa pelos pacientes. Estes apresentaram índices de superfícies e dentes cariados e perdidos significantemente maiores, índices de superfícies e dentes restaurados significantemente menores e índice de cálculo significantemente maior do que os indivíduos normais, demonstrando a necessidade da realização de um programa preventivo e curativo para esse grupo de pacientes especiais.Prevalence of dental caries, calculus index, stimulated salivary flow rate and levels of cariogenic microorganisms in saliva of patients with chronic renal failure undergoing hemodialysis were compared to those of normal subjects matched as to age and sex. No significant difference was detected regarding to DMF indexes, whole saliva flow or mutans streptococci and lactobacilli levels. However, when compared to the controls, patients showed a great need for dental treatment and dental plaque control instruction. They had higher indexes of decayed and missing surfaces and teeth; their filled surfaces and teeth indexes were lower and their calculus index was higher, demonstrating the necessity of a preventive and curative program to these special patients.

Mitsue FUJIMAKI; Odila Pereira da Silva ROSA; Sérgio Aparecido TORRES

1998-01-01

134

Effects of vitamin D3 on selected biochemical parameters of nutritional status, inflammation, and cardiovascular disease in patients undergoing long?term hemodialysis  

Directory of Open Access Journals (Sweden)

Full Text Available INTRODUCTION: Vitamin D3 has diverse biological effects extending beyond the maintenance of calcium and phosphorus homeostasis and ensuring the proper functioning of the body. OBJECTIVES: This study evaluated the levels of vitamin D3 and its association with nutritional status, immunological activity, and selected markers of cardiovascular disease in patients on long?term hemodialysis (HD). PATIENTS AND METHODS: We measured 25?hydroxyvitamin D3 (25(OH)D3) levels in a group of 84 patients (mean age, 65 years; average time on dialysis, 32.5 months) and investigated correlations between 25(OH)D3 levels and the following parameters: albumin, body mass index, hemoglobin (Hb), interleukin 6 (IL?6), interleukin 10, C?reactive protein, asymmetric dimethylarginine (ADMA), N?terminal pro?B?type natriuretic peptide (NT?proBNP), and comorbidity score. RESULTS: A mean 25(OH)D3 level was 15.4 ±7.2 ng/ml and only 5% of patients had 25(OH)D3 levels above the normal value of 30 ng/ml. There was no statistically significant difference in 25(OH)D3 levels between women and men (P = 0.06). A negative correlation was observed between 25(OH)D3 and IL?6 (R = –0.31, P = 0.009) and ADMA (R = –0.26, P = 0.03), as well as a positive correlation between 25(OH)D3 and Hb (R= 0.21, P = 0.05). There was no association between 25(OH)D3 levels and nutritional status. CONCLUSIONS: A significant vitamin D3 deficiency observed in the majority of patients undergoing long?term HD contributes to the development of chronic inflammation, anemia, and indirectly, to endothelial cell injury.

Anna Bednarek?Skublewska; Agata Smole?; Andrzej Jaroszy?ski; Wojciech Za?uska; Andrzej Ksi??ek

2010-01-01

135

Changes in Plasma Kynurenic Acid Concentration in Septic Shock Patients Undergoing Continuous Veno-Venous Haemofiltration.  

UK PubMed Central (United Kingdom)

Kynurenic acid (KYNA) is one of the end products of tryptophan metabolism. The aim of this study was to analyse plasma KYNA concentration in septic shock patients (SSP) with acute kidney injury (AKI) undergoing continuous veno-venous haemofiltration (CVVH). Changes in KYNA content were compared to alterations in the levels of procalcitonin (PCT), C-reactive protein and lactate. Adult SSP with AKI were examined. Measurements were conducted at seven time points: before beginning CVVH and at 6, 12, 24, 48, 72 and 96 h after the beginning of CVVH. Based on clinical outcomes, the data were analysed separately for survivors and non-survivors. Twenty-seven patients were studied. CVVH was associated with reduced plasma KYNA concentration only in survivors. Plasma KYNA concentration correlated with the levels of lactate and PCT only in survivors. (1) CVVH reduced plasma KYNA concentration only in survivors; (2) lack of this reduction may predict fatal outcomes in SSP.

Dabrowski W; Kocki T; Pilat J; Parada-Turska J; Malbrain ML

2013-09-01

136

Aluminum concentrations in serum, dialysate, urine and bone among patients undergoing continuous ambulatory peritoneal dialysis (CAPD)  

DEFF Research Database (Denmark)

Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations in the dialysate and urine were 9.1 +/- 4.1 micrograms/l and 52.5 +/- 47.3 micrograms/l, respectively. Bone Al concentration was 21.0 +/- 14.9 ppm and correlated significantly with concentrations of Al in serum (p less than 0.01) and dialysate (p less than 0.01). A mass transfer (MT) from the patients to the dialysate was observed in all patients (-44.0 +/- 28.8 micrograms/24 h). There was a highly significant correlation between peritoneal Al MT and serum Al (p less than 0.001), actual Al consumption (p less than 0.05) and bone Al concentration (p less than 0.005) supporting the existence of an overflow phenomenon. Despite very low Al levels in the dialysate, patients are at risk of elevated Al levels in the serum, dialysate, urine and bone because of consumption of Al-containing phosphate binders.

Joffe, P; Olsen, F

1989-01-01

137

Pharmacokinetic evaluation of voriconazole treatment in critically ill patients undergoing continuous venovenous hemofiltration.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Voriconazole represents an essential part of antimicrobial therapy in critically ill patients. The aim of this study was to exclude a significant alteration in voriconazole pharmacokinetics in critically ill patients undergoing continuous venovenous hemofiltration (CVVH). METHODS: Six patients dependent on CVVH with evidence of an invasive mycotic infection treated with intravenous voriconazole at the standard dosing regimen were investigated. The total serum concentration of voriconazole in arterial blood and the concentration in ultrafiltrate were measured by reverse-phase high-performance liquid chromatography with ultraviolet detection. The authors profiled a 5-point pharmacokinetic concentration-time curve during the 12-hour standard maintenance dosing interval and derived the basic pharmacokinetic parameters. RESULTS: The serum voriconazole concentration did not decrease <1.0 mg/L at any time point, and the mean was 4.3 ± 2.6 mg/L and the median (range) 3.6 (9.0) mg/L. The sieving coefficient of the drug did not exceed 0.30 in any patient (0.22 ± 0.08). The mean serum AUC0-12, the mean total clearance, and the mean clearance via CVVH were 53.52 ± 29.97 mg·h/L [the median (range) of 57.74 (62.34) mg·h/L], 0.11 ± 0.07 L·h-1·kg-1, and 0.007 ± 0.003 L·h-1·kg-1, respectively. The clearance by the CVVH method ranged from 4% to 20% of the total drug clearance. The disposition of voriconazole was not compromised. The mean elimination half-life was 27.58 ± 35.82 hours [the median of 13.10 (92.21) hours], and the mean distribution volume value was 3.28 ± 3.10 L/kg [the median of 2.01 (8.10) L/kg]. Marked variability in serum concentrations, elimination half-life, distribution volume, and total clearance was seen. Half of the patients showed some drug accumulation. CONCLUSIONS: The clearance of voriconazole by CVVH is not clinically significant. In view of this finding, voriconazole dose adjustment in patients undergoing the standard method of CVVH is not required. However, the observed potential for an unpredictable voriconazole accumulation suggests the usefulness for monitoring its levels in critically ill patients.

Radej J; Krouzecky A; Stehlik P; Sykora R; Chvojka J; Karvunidis T; Novak I; Matejovic M

2011-08-01

138

[A flow divider which permits, during hemodialysis, the continuous collection of a representative sample of dialysate  

UK PubMed Central (United Kingdom)

Dialysis efficiency is evaluated by the measurement of transfer of urea as well as of other important solutes such as sodium, potassium, phosphates etc. from the blood to the dialysate. These determinations are usually made by using clearances, but, because of the internal dynamics in the blood itself, reliable measurements taken in this way are impossible for most of the solutes of interest. Our system avoids these difficulties and provides accurate results. A reference method requires the determination of the volume and the concentration of the effluent dialysate. This is used in research work, but for obvious reasons, it is not suitable to a daily clinical context. Several authors proposed a system based on a pump, in order to sample continuously a fraction of the dialysate. However, they have to assume a constant flow of the latter. The system described here has the advantage of collecting a representative sample of the whole dialysate regardless of flow and concentrations variations during dialysis. It is suitable to a clinical context, easy to use and silent.

Fellay G; Gabriel JP

1994-01-01

139

Scintigraphic diagnosis of infectious complications in renal failure patients undergoing hemodialysis, continuous ambulatory peritoneal dialysis or renal transplant  

International Nuclear Information System (INIS)

Patients with end-stage renal disease have two therapeutic options, dialysis and renal transplantation. Infectious complications occurring in such patients will not only condition the effectiveness of such treatments, but are among the main causes of morbidity and mortality in such cases. Knowledge of the advantages and limitations of nuclear techniques is essential for management of these conditions. (author)

2007-04-13

140

Scintigraphic diagnosis of infectious complications in renal failure patients undergoing hemodialysis, continuous ambulatory peritoneal dialysis or renal transplant  

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Patients with end-stage renal disease have two therapeutic options, dialysis and renal transplantation. Infectious complications occurring in such patients will not only condition the effectiveness of such treatments, but are among the main causes of morbidity and mortality in such cases. Knowledge of the advantages and limitations of nuclear techniques is essential for management of these conditions. (author)

Garcia Vicente, Ana Maria; Ruiz Solis, Sebastian; Soriano Castrejon, Angel; Poblete Garcia, Victor Manuel; Talavera Rubio, Maria del Prado; Rodado Marina, Sonia; Cortes Romera, Montserrat [Ciudad Real General Hospital (Spain). Dept. of Nuclear Medicine

2005-10-15

 
 
 
 
141

[Hyperthyroidism and hemodialysis  

UK PubMed Central (United Kingdom)

We present the case, clinical following and successful therapy of a patient undergoing maintenance hemodialysis that presents hyperthyroidism secondary to Jod Basedow phenomenon associated to multinodular goitre previous. This case is an unusual complication for subjects in regular hemodialysis (in the bibliography revised only three cases were described in the past years) and of difficulty therapeutic management being our limited experience. In our patient, the antiseptic application with iodo solutions in the arteriovenous fistula could be representing the main cause for the hyperthyroidism. Conventional carbimazole doses keep controlling the thyroid hyper-function. Afterwards the definitive treatment with radioiodine was a safe and effective method for a long-term control.

Martín Hernández T; Torres Cuadro A; Gijón Trigueros A; Lorenzo Carrero J

1995-08-01

142

The comparison of antibody response to influenza vaccination in continuous ambulatory peritoneal dialysis, hemodialysis and renal transplantation patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: The immune system in renal transplant (Tx), Continuous Ambulatory Peritoneal Dialysis (CAPD) and hemodialysis (HD) patients have been suppressed and antibody response to vaccination is weaker than that of the normal population. Additionally immune response to vaccination also differs from each other in aforementioned three groups resulting from different levels immunosuppression. In the present study, detection of antibody response to influenza vaccine as an indicator of the level of immunity in Tx, CAPD and HD patients was aimed PATIENTS AND METHODS: Forty-eight patients (17 Tx, 16 CAPD and 15 HD) and 10 healthy adults, as a control group were enrolled into the study. Purified, split-virus, commercial trivalent influenza vaccine (VAXIGRIP--Pasteur Merieux Connaught, single dose of 0.5 ml into the deltoid muscle) containing 15 microg of each hemagglutinin of A/Johannesburg/82/96 (H1N1), A/Nachang/933/95 (H3N2) and B/Harbin/07/94 (B) strains were administered to all subjects. Serum samples were collected before and 1 month after vaccination to determine antibody titers. Hemagglutination-inhibition test (HI) was applied for determination of antibody response. The antibody response against each strain was measured separately. In addition to measurement of antibody response, increments in antibody titer (n-fold increase in titer), proportion of patients with protective antibody levels and seroconversion levels were taken into account. Wilcoxon paired 2 test and Mann-Whitney U test were applied for statistical analysis. p < 0.05 was accepted as significance level. RESULTS: Significant increases in antibody titers for all three antigens were observed in the study groups after vaccination (p = 0.001). However, the increase in titer of H3N2 was lower in Tx, CAPD and HD patients than that of the control group (1.0-2.0 vs 5.00) (p = 0.01). The proportion of protective antibody titers and seroconvertions were increased after vaccination in all subjects. Proportions of patients with protective antibody titers after vaccination were lower in Tx, CAPD and HD groups in comparison to control group. CONCLUSION: Although antibody titers in Tx, CAPD and HD patients presented significant increases after vaccination, the proportions of patients with protective antibody titers were lower in comparison to control group. Tx, CAPD and HD patients should be vaccinated every year to be able avoid potential morbidity and mortality of the influenza infection. Trial of high dose vaccination protocols may be useful to increase the proportion of patients with protective antibody levels.

Cavdar C; Sayan M; Sifil A; Artuk C; Yilmaz N; Bahar H; Camsari T

2003-01-01

143

Effect of aspirin continuation on blood loss and postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection.  

UK PubMed Central (United Kingdom)

No consensus exists whether to continue or withdraw aspirin therapy perioperatively in patients undergoing major laparoscopic abdominal surgery. To investigate whether preoperative continuation of aspirin therapy increases blood loss and associated morbidity during laparoscopic cholecystectomy and colorectal cancer resection, we compared duration of surgical procedures, amount of intraoperative blood loss, rate of blood transfusion, length of postoperative stay, rate of conversion to open surgery, and reoperation within 48 hours between patients with and without aspirin therapy preoperatively. Twenty-nine of 270 patients who underwent laparoscopic cholecystectomy and 23 of 218 patients who underwent laparoscopic colorectal cancer resection, respectively, were on aspirin therapy. We found no significant difference in the investigated outcome between groups with the exception of longer surgical duration of laparoscopic cholecystectomy in aspirin-treated patients. Although underpowered, above findings may suggest that aspirin continuation is unlikely to increase blood loss or postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection.

Ono K; Idani H; Hidaka H; Kusudo K; Koyama Y; Taguchi S

2013-02-01

144

Helicobacter Pylori IgG Antibodies in Association with Secondary Hyperparathyroidism in End-stage Renal Failure Patients Undergoing Regular Hemodialysis  

Directory of Open Access Journals (Sweden)

Full Text Available The aim of present study was the assessment of relationships between PTH abnormalities and the parameter of Helicobacter pylori (H. pylori) infection as expressed by concentration of IgG antibodies against H. pylori. The study was carried out on 44 (F = 17, M = 27) stable hemodialysis (HD) patients with upper gastrointestinal symptoms. A significant positive correlations of H. pylori IgG antibody titers with serum iPTH and phosphorus also a significant inverse correlation of H. pylori IgG antibody titers with serum alkalin phosphatase was found. It is known that hyperparathyroidism is connected with stimulation of gastrin synthesis as well with increased acidity of gastric juice. Hypergastrinaemia induced stimulation of gastrin synthesis and resultant increased acidity of gastric juice could intensify the H. pylori infection in hemodialysis patients. We strongly propose to more study on the association of secondary hyperparathyroidism with H. pylori infection, because both dyspeptic symptoms and secondary hyperparathyroidism are quite common in chronic hemodialysis patients and in the meantime needs more attention toward control of high levels of parathormone in HD patients.

Hamid Nasri; Azar Baradaran

2006-01-01

145

Alterações ungueais nos pacientes portadores de insuficiência renal crônica em hemodiálise Nail disorders in patients with chronic renal failure undergoing hemodialysis  

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Full Text Available FUNDAMENTOS: A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD), e compará-los com uma amostra pareada da população geral. MÉTODOS: Realizado um estudo caso- controle, pareado por gênero e idade, onde 2 grupos foram estudados com relação às alterações ungueais presentes. RESULTADOS: 86% dos pacientes em HD e 75% do grupo controle tiveram, pelo menos, uma alteração ungueal.Ausência de lúnula (62,9%) e unha meio a meio (14,4%) as alterações foram estatisticamente relevantes no grupo HD, em relação ao grupo controle (p BACKGROUND: Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. OBJECTIVES: To evaluate the spectrum and the frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. METHODS: A case-controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. RESULTS: At least one nail disorder was found in 86% of the hemodialysis patients and in 75% of subjects in the control group. Absent lunula (62.9%) and half and half nails (14.4%) were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p < 0.05). Longitudinal striae were more common in the control group compared to the hemodialysis group (24.1%). CONCLUSIONS: Absent lunula and half and half nails were the most common nail disorders found in patients on hemodialysis, corroborating the findings of previous studies. Longitudinal striae were more common in the control group and future studies may clarify whether structural abnormalities such as absent lunula may be related to this finding.

Marcos Antonio Rodrigues Martinez; Carla Lobato Gregório; Vanessa Pedrassi dos Santos; Ronaldo Roberto Bérgamo; Carlos D'Apparecida Santos Machado Filho

2010-01-01

146

Clinical study of cerebral infarction in hemodialysis patients  

International Nuclear Information System (INIS)

[en] Stroke is one of the leading causes of death in patients undergoing chronic dialysis. However, few clinical studies have so far examined stroke, especially brain infarction, under such conditions. We retrospectively evaluated the clinical features and risk factors for brain infarction in 33 patients undergoing hemodialysis (hemodialysis, 29 patients; continuous ambulatory peritoneal dialysis, 4 patients; male:female ratio, 25:8) between May 2003 and August 2006. The mean age was 68.5±10.9 (mean±standard deviation (SD)) years. The basal renal diseases were chronic glomerulonephritis (n=16), diabetes mellitus (n=10) and other diseases (n=7). The mean duration of maintenance dialysis before the onset of stroke was 5.6±5.2 years. All 33 patients developed brain infarction, including the atherothrombotic (n=13), lacunar (n=9) and cardioembolic (n=11) types. The complications included a high frequency of hypertension (79%) in all groups, diabetes mellitus (36%) and atrial fibrillation (21%). Four of the patients, 2 with lacunar and 2 with atherothrombotic infarction, developed brain infarction within 3 hours after hemodialysis. Hemodynamic changes might have caused the infarction in these patients. The proportion of patients with a modified Rankin Scale grade of 4-6 at discharge was 42%, and the mortality rate was high (15%). The prognosis of brain infarction was poorer in patients with hemodialysis than in those without. (author)

2007-01-01

147

Alterações ungueais nos pacientes portadores de insuficiência renal crônica em hemodiálise/ Nail disorders in patients with chronic renal failure undergoing hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese FUNDAMENTOS: A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD), e compará-los com uma amostra pareada da população geral. MÉTODOS: Re (more) alizado um estudo caso- controle, pareado por gênero e idade, onde 2 grupos foram estudados com relação às alterações ungueais presentes. RESULTADOS: 86% dos pacientes em HD e 75% do grupo controle tiveram, pelo menos, uma alteração ungueal.Ausência de lúnula (62,9%) e unha meio a meio (14,4%) as alterações foram estatisticamente relevantes no grupo HD, em relação ao grupo controle (p Abstract in english BACKGROUND: Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. OBJECTIVES: To evaluate the spectrum and the frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. METHODS: A case (more) -controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. RESULTS: At least one nail disorder was found in 86% of the hemodialysis patients and in 75% of subjects in the control group. Absent lunula (62.9%) and half and half nails (14.4%) were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p

Martinez, Marcos Antonio Rodrigues; Gregório, Carla Lobato; Santos, Vanessa Pedrassi dos; Bérgamo, Ronaldo Roberto; Machado Filho, Carlos D'Apparecida Santos

2010-06-01

148

Association between abnormal myocardial fatty acid metabolism and cardiac-derived death among patients undergoing hemodialysis: results from a cohort study in Japan.  

UK PubMed Central (United Kingdom)

BACKGROUND: Detecting myocardial ischemia in hemodialysis patients is crucial given the high incidence of silent ischemia and the high cardiovascular mortality rates. Abnormal myocardial fatty acid metabolism as determined by imaging with (123)I-labeled BMIPP (?-methyl iodophenyl-pentadecanoic acid) might be associated with cardiac-derived death in hemodialysis patients. STUDY DESIGN: Prospective observational study. SETTING & PARTICIPANTS: Asymptomatic hemodialysis patients with one or more cardiovascular risk factors, but without known coronary artery disease, were followed up for 3 years at 48 Japanese hospitals (406 men, 271 women; mean age, 64 years). PREDICTOR: Baseline BMIPP summed scores semiquantified using a 17-segment 5-point system (normal, 0; absent, 4). OUTCOMES: Cardiac-derived death, including cardiac and sudden death. MEASUREMENTS: HRs were estimated using a Cox model for associations between BMIPP summed scores and cardiac-derived death, adjusting for potential confounders of age, sex, body mass index, dialysis duration, and cardiovascular risk factors. RESULTS: Rates of all-cause mortality and cardiac-derived death were 18.5% and 6.8%, respectively. Cardiac-derived death (acute myocardial infarction [n = 10], congestive heart failure [n = 13], arrhythmia [n = 2], valvular heart disease [n = 1], and sudden death [n = 20]) accounted for 36.8% of all-cause deaths. Cardiac-derived death (n = 46) was associated with age, history of heart failure, and BMIPP summed scores of 4 or higher (HR, 2.9; P < 0.001). Three-year cardiac-derived death-free survival rates were 95.7%, 90.6%, and 78.8% when BMIPP summed scores were 3 or lower, 4-8, and 9 or higher, respectively. BMIPP summed score also was a predictor of all-cause death (HR, 1.6; P = 0.009). LIMITATIONS: Sudden death of unknown cause was considered to have been cardiac derived, although a coronary origin was not confirmed. CONCLUSIONS: Abnormal myocardial fatty acid metabolism is associated with cardiac-derived death in hemodialysis patients. BMIPP single-proton emission computed tomography appears clinically useful for predicting cardiac-derived death in this population.

Moroi M; Tamaki N; Nishimura M; Haze K; Nishimura T; Kusano E; Akiba T; Sugimoto T; Hase H; Hara K; Nakata T; Kumita S; Nagai Y; Hashimoto A; Momose M; Miyakoda K; Hasebe N; Kikuchi K

2013-03-01

149

Should we continue to drain the pylorus in patients undergoing an esophagectomy?  

Science.gov (United States)

A systematic review of the literature was performed to assess the necessity of a pyloric drainage procedure during an esophagectomy with gastric conduit reconstruction. Earlier data recommend performing a pyloric drainage procedure for all esophagectomies; however, recent studies have questioned this. A thorough literature search (January 2001-November 2011) was performed using the terms esophagectomy, pyloroplasty, pyloromyotomy, botulinum toxin, and pyloric drainage. Only studies that compared patient outcome after undergoing an esophagectomy with a pyloric drainage procedure with those undergoing an esophagectomy without a pyloric drainage procedure were selected. Only four studies, comprising 668 patients in total, were identified that compared patient outcome after undergoing an esophagectomy with or without a pyloric drainage procedure, and two additional meta-analyses were identified and selected for discussion. All studies were retrospective, and because of the heterogeneity of studies, patient demographics, reporting, and statistical analysis of patient outcome, pooling of data and meta-analysis could not be performed. Careful analysis demonstrated that pyloric drainage procedure was associated with a non-significant trend for delayed gastric emptying and biliary reflux, while not affecting the incidence of dumping. No correlation was determined between a pyloric drainage procedure and anastomotic leaks, postoperative pulmonary complications, length of hospital stay, and overall perioperative morbidity. While there are risks associated with a pyloric drainage procedure and data exist supporting its omission during an esophagectomy, no good conclusion can be drawn from the current literature. Larger multi-institutional, prospective studies are required to definitively answer this question. PMID:23442059

Gaur, P; Swanson, S J

2013-02-26

150

Hemodialysis and water quality.  

UK PubMed Central (United Kingdom)

Over 383,900 individuals in the U.S. undergo maintenance hemodialysis that exposes them to water, primarily in the form of dialysate. The quality of water and associated dialysis solutions have been implicated in adverse patient outcomes and is therefore critical. The Association for the Advancement of Medical Instrumentation has published both standards and recommended practices that address both water and the dialyzing solutions. Some of these recommendations have been adopted into Federal Regulations by the Centers for Medicare and Medicaid Services as part of the Conditions for Coverage, which includes limits on specific contaminants within water used for dialysis, dialysate, and substitution fluids. Chemical, bacterial, and endotoxin contaminants are health threats to dialysis patients, as shown by the continued episodic nature of outbreaks since the 1960s causing at least 592 cases and 16 deaths in the U.S. The importance of the dialysis water distribution system, current standards and recommendations, acceptable monitoring methods, a review of chemical, bacterial, and endotoxin outbreaks, and infection control programs are discussed.

Coulliette AD; Arduino MJ

2013-07-01

151

Hemodialysis and water quality.  

Science.gov (United States)

Over 383,900 individuals in the U.S. undergo maintenance hemodialysis that exposes them to water, primarily in the form of dialysate. The quality of water and associated dialysis solutions have been implicated in adverse patient outcomes and is therefore critical. The Association for the Advancement of Medical Instrumentation has published both standards and recommended practices that address both water and the dialyzing solutions. Some of these recommendations have been adopted into Federal Regulations by the Centers for Medicare and Medicaid Services as part of the Conditions for Coverage, which includes limits on specific contaminants within water used for dialysis, dialysate, and substitution fluids. Chemical, bacterial, and endotoxin contaminants are health threats to dialysis patients, as shown by the continued episodic nature of outbreaks since the 1960s causing at least 592 cases and 16 deaths in the U.S. The importance of the dialysis water distribution system, current standards and recommendations, acceptable monitoring methods, a review of chemical, bacterial, and endotoxin outbreaks, and infection control programs are discussed. PMID:23859187

Coulliette, Angela D; Arduino, Matthew J

152

Prevalencia de hipertensión arterial y algunos factores de riesgos en pacientes en hemodiálisis Prevalence of hypertension and some risk factors in patients undergoing hemodialysis  

Directory of Open Access Journals (Sweden)

Full Text Available Fundamentación: La enfermedad cardiovascular constituye la principal causa de mortalidad en los pacientes en hemodiálisis y el principal predictor es la hipertensión arterial antes que la dislipemia y el consumo de tabaco. Objetivo: describir la prevalencia de hipertensión arterial y sus factores de riesgos en pacientes hemodializados. Método: se realizó un estudio descriptivo, transversal en 22 pacientes con insuficiencia renal crónica, terminal en hemodiálisis del Hospital General Augusto César Sandino de junio a diciembre de 2009. Se estudiaron las variables sociodemográficas, clínicas y del estilo de vida y su relación con la presencia de hipertensión arterial. Se utilizó la técnica estadística de análisis de distribución de frecuencias para categoría de variables, además, se empleó el test de independencia para probar la hipótesis nula de asociación entre las variables; precisándose un nivel de significación á = 0.05. Resultados: la edad promedio fue de 53 años con un tiempo medio previo en hemodiálisis de 57 meses. Entre las principales causas por las cuales llegaron al tratamiento depurador los pacientes estuvieron las no relacionadas a la diabetes mellitus en el 86,4 %. En 14 pacientes, que representa el (63,6 %), se recogía la historia de hipertensión arterial prediálisis y en hemodiálisis. El análisis multivariado mostró que la hipertensión estaba asociada con la edad avanzada, el tiempo de vida media en hemodiálisis y la presencia de diabetes mellitus. Conclusiones: la hipertensión es altamente prevalente entre los pacientes en hemodiálisis crónica y está asociada a la hipervolemia, el envejecimiento y la diabetes mellitus.Background: The cardiovascular diseases constitutes the main one of cause of mortality in patient in hemodialysis and the main one predict is the hypertension still before that the dislipemia and the consumption of tobacco. Objective: Describe the prevalence and risk factors of hypertension among patients on chronic hemodialysis. Methods: A transversal descriptive study was carried out in 22 patients with chronic kidney diseases in the nephrological service of Augusto Cesar Sandino Teaching Hospital of Pinar del Rio City, since June to December, 2009. Variables such as: age, etiology of the chronic renal failure, time elapsed in hemodialysis were included in the study. Information was gathered through surveys and from the morbimortality book of the nephrology unit. The statistical analysis of frequency distribution was used for each category of variables. The independence test was also used to test the association of variable null hypothesis. The level of significance was set at á = 0.05. Results: The age average went of 53 years with a half prior time in hemodialysis of 57 months. Among the main causes by which they arrived at the processing purifier the patient were the done not relate to the diabetes mellitus in the 86, 4 %. In 14 patients (63, 6%) history was collected of hypertension prediálisis and in hemodialysis. The analysis multivariado showed that the hypertension was associated with the age advanced, the average time of life in hypertension and the presence of diabetes mellitus. Conclusions: The hypertension is highly prevalence among patient in hypertension chronic and this associate to the hipervolemia, the hypertension and the diabetes mellitus.

Nadienka Rodríguez Ramos; Juan Miguel Rubio Cala; Osniel Bencomo Rodríguez; Rosa Ángela Alfonso Pérez; Julio Cesar Camero Machín

2010-01-01

153

Prevalencia de hipertensión arterial y algunos factores de riesgos en pacientes en hemodiálisis/ Prevalence of hypertension and some risk factors in patients undergoing hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Fundamentación: La enfermedad cardiovascular constituye la principal causa de mortalidad en los pacientes en hemodiálisis y el principal predictor es la hipertensión arterial antes que la dislipemia y el consumo de tabaco. Objetivo: describir la prevalencia de hipertensión arterial y sus factores de riesgos en pacientes hemodializados. Método: se realizó un estudio descriptivo, transversal en 22 pacientes con insuficiencia renal crónica, terminal en hemodiálisis d (more) el Hospital General Augusto César Sandino de junio a diciembre de 2009. Se estudiaron las variables sociodemográficas, clínicas y del estilo de vida y su relación con la presencia de hipertensión arterial. Se utilizó la técnica estadística de análisis de distribución de frecuencias para categoría de variables, además, se empleó el test de independencia para probar la hipótesis nula de asociación entre las variables; precisándose un nivel de significación á = 0.05. Resultados: la edad promedio fue de 53 años con un tiempo medio previo en hemodiálisis de 57 meses. Entre las principales causas por las cuales llegaron al tratamiento depurador los pacientes estuvieron las no relacionadas a la diabetes mellitus en el 86,4 %. En 14 pacientes, que representa el (63,6 %), se recogía la historia de hipertensión arterial prediálisis y en hemodiálisis. El análisis multivariado mostró que la hipertensión estaba asociada con la edad avanzada, el tiempo de vida media en hemodiálisis y la presencia de diabetes mellitus. Conclusiones: la hipertensión es altamente prevalente entre los pacientes en hemodiálisis crónica y está asociada a la hipervolemia, el envejecimiento y la diabetes mellitus. Abstract in english Background: The cardiovascular diseases constitutes the main one of cause of mortality in patient in hemodialysis and the main one predict is the hypertension still before that the dislipemia and the consumption of tobacco. Objective: Describe the prevalence and risk factors of hypertension among patients on chronic hemodialysis. Methods: A transversal descriptive study was carried out in 22 patients with chronic kidney diseases in the nephrological service of Augusto Ces (more) ar Sandino Teaching Hospital of Pinar del Rio City, since June to December, 2009. Variables such as: age, etiology of the chronic renal failure, time elapsed in hemodialysis were included in the study. Information was gathered through surveys and from the morbimortality book of the nephrology unit. The statistical analysis of frequency distribution was used for each category of variables. The independence test was also used to test the association of variable null hypothesis. The level of significance was set at á = 0.05. Results: The age average went of 53 years with a half prior time in hemodialysis of 57 months. Among the main causes by which they arrived at the processing purifier the patient were the done not relate to the diabetes mellitus in the 86, 4 %. In 14 patients (63, 6%) history was collected of hypertension prediálisis and in hemodialysis. The analysis multivariado showed that the hypertension was associated with the age advanced, the average time of life in hypertension and the presence of diabetes mellitus. Conclusions: The hypertension is highly prevalence among patient in hypertension chronic and this associate to the hipervolemia, the hypertension and the diabetes mellitus.

Rodríguez Ramos, Nadienka; Rubio Cala, Juan Miguel; Bencomo Rodríguez, Osniel; Alfonso Pérez, Rosa Ángela; Camero Machín, Julio Cesar

2010-12-01

154

Water treatment for hemodialysis--updated to include the latest AAMI standards for dialysate (RD52: 2004) continuing.  

UK PubMed Central (United Kingdom)

While nurses may not routinely service the water treatment system or mix the dialysate, they are responsible for understanding all the clinical ramifications of water and dialysate for HD and helping to piece together the entire treatment picture. Although historically the water treatment system has been in the technicians' domain, knowing the technical aspects is important in order for the entire team to work together toward the patients' ultimate well being. This article describes the composition of water treatment systems for hemodialysis as well as the monitoring and testing necessary to assure that both water and dialysate are safe for patient use.

Amato RL

2005-03-01

155

Continuous intraoperative TEE monitoring for a child with Fontan pathway undergoing post spinal fusion.  

Science.gov (United States)

The following case report describes a very challenging surgical case where the use of intraoperative, continuous TEE monitoring in the prone position was crucial for the anesthetic management (diagnosis and treatment) of a patient with single ventricle physiology. The use of TEE monitoring enabled the anesthesia team to continuously assess hemodynamic stability and respond immediately to hypotension and bradycardia in our patient, thereby providing optimal anesthetic care of the intraoperative spinal fusion patient with Fontan physiology. PMID:23833861

Farid, Ibrahim S; Reddy, Abelash; Lewis, Judith; Kendrick, Elizabeth J

2013-02-01

156

Continuous intraoperative TEE monitoring for a child with Fontan pathway undergoing post spinal fusion.  

UK PubMed Central (United Kingdom)

The following case report describes a very challenging surgical case where the use of intraoperative, continuous TEE monitoring in the prone position was crucial for the anesthetic management (diagnosis and treatment) of a patient with single ventricle physiology. The use of TEE monitoring enabled the anesthesia team to continuously assess hemodynamic stability and respond immediately to hypotension and bradycardia in our patient, thereby providing optimal anesthetic care of the intraoperative spinal fusion patient with Fontan physiology.

Farid IS; Reddy A; Lewis J; Kendrick EJ

2013-02-01

157

Dissecting aortic aneurysm in maintenance hemodialysis patients.  

Science.gov (United States)

The dissecting aortic aneurysm (DAA) is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively. PMID:19861869

Ounissi, M; Goucha, R; Hedri, H; Hamida, F Ben; Abderrahim, E; El Younsi, F; Abdallah, T Ben; Maiz, H Ben; Kheder, A

2009-11-01

158

Potassium balances in maintenance hemodialysis.  

UK PubMed Central (United Kingdom)

Potassium is abundant in the ICF compartment in the body and its excretion primarily depends on renal (about 90%), and to a lesser extent (about 10%) on colonic excretion. Total body potassium approximated to 50mmol/kg body weight and 2% of total body potassium is in the ECF compartment and 98% of it in the intracellular compartment.Dyskalemia is a frequent electrolyte imbalance observed among the maintenance hemodialysis patients. In case of hyperkalemia, it is frequently "a silent and a potential life threatening electrolyte imbalance" among patients with ESRD under maintenance hemodialysis. The prevalence of hyperkalemia in maintenance HD patients was reported to be about 8.7-10%. Mortality related to the hyperkalemia has been shown to be about 3.1/1,000 patient-years and about 24% of patients with HD required emergency hemodialysis due to severe hyperkalemia. In contrast to the hyperkalemia, much less attention has been paid to the hypokalemia in hemodialysis patients because of the low prevalence under maintenance hemodialysis patients. Severe hypokalemia in the hemodialysis patients usually was resulted from low potassium intake (malnutrition), chronic diarrhea, mineralocorticoid use, and imprudent use of K-exchange resins. Recently, the numbers of the new patients with advanced chronic kidney disease undergoing maintenance hemodialysis are tremendously increasing worldwide. However, the life expectancy of these patients is still much lower than that of the general population. The causes of excess mortality in these patients seem to various, but dyskalemia is a common cause among the patients with ESRD undergoing hemodialysis.

Choi HY; Ha SK

2013-06-01

159

HEMODIALYSIS MEMBRANES: PAST, PRESENT AND FUTURE TRENDS  

Directory of Open Access Journals (Sweden)

Full Text Available Renal failure is one of the major health problems faced by many people all over the world. These patients choose either transplantation procedure or undergo hemodialysis. Approximately 28% people suffer from renal failures worldwide, among which a quarter are very critical. Patients who opt for hemodialysis have to undergo it regularly. The membranes used in hemodialysis are very vital. The first ever polymer used asan artificial hemodialysis membrane was collodion, which is a derivative of cellulose- trinitrate. This was the leading element for further research and applications in this field. Later collodion was replaced by cellophane and cuprophane since they had better performance and mechanical stability than the collodion. The major disadvantage of this was their less hemocompatiblity as they were made from unmodified cellulose. Nowadays the modified cellulose membrane comes with high-flux modification and thus very effective in many therapy like the hemodiafiltration and the hemofiltration. The success of hemodialysis is highly dependent on the membrane used.

Gautham A; Muhammed Javad M; Murugan Manavalan; Mansoor Ani Najeeb

2013-01-01

160

Pharmacokinetics of imipenem-cilastatin in critically ill patients undergoing continuous venovenous hemofiltration.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The pharmacokinetics of imipenem-cilastatin were investigated in 12 critically ill patients with acute renal failure (ARF) managed by continuous veno-venous hemofiltration (CVVH) while receiving a fixed combination of 500 mg of imipenem-cilastatin intravenously three or four times daily. No adverse ...

Tegeder, I; Bremer, F; Oelkers, R; Schobel, H; Schüttler, J; Brune, K; Geisslinger, G

 
 
 
 
161

Combined peritoneography and computerized tomography for evaluating abdominal complications in patients undergoing continuous peritoneal dialysis  

International Nuclear Information System (INIS)

[en] Continuous ambulatory peritoneal dialysis (CAPD) is a generally well-tolerated treatment. However, some patients exhibit such complications as to prevent the continuation of treatment. Peritonitis is the major problem, but the continuation of treatment may also be undermined by different complications, such as peritoneal leakage, hernia, catheter malfunctioning, and scrotal-penile edema; a careful investigation of the patient is always needed in such cases. From November 1985 to February 1990, we examined 20 patients, who had presented with different types of complications in the course of dialysis. Peritoneography demonstrated 3 cases of abdominal hernias, 2 cases of patency of the peritoneal-vaginal duct, and 2 cases of catheter obstruction. Peritoneal CT allowed the identification of leakage in 3 patients, while the combined use of the two techniques showed adhesions or pathologic peritoneal recesses in 7 cases. In 3 patients normal patterns were observed. Peritoneography, especially if combined with CT, can carry out a double function, that is in both the screening and choice of the subjects to the destine to peritoneal dialysis, and in therapeutics, to evaluate complications. Moreover, the technique is extremely reliable thanks to both its simple execution and lack of disadvantages

1991-01-01

162

[Usefulness of a noncontact continuous tympanic thermometer in patients undergoing cardiac surgery using an artificial heart-lung machine].  

UK PubMed Central (United Kingdom)

BACKGROUND: Most of the thermometers used during operations are invasive and non-hygienic. The usefulness of a noncontact continuous tympanic thermometer under general anesthesia has been reported. We evaluated the usefulness of a noncontact continuous tympanic thermometer in patients undergoing cardiac surgery using an artificial heart-lung machine. METHODS: Twenty patients scheduled to undergo cardiac surgery using an artificial heart-lung machine were selected for this study. After induction of general anesthesia, thermistor probes were inserted into the rectum and esophagus for measurements of rectal and esophageal temperatures, respectively. A noncontact continuous tympanic thermometer was inserted into the ear canal on the right side. These temperatures were monitored and recorded at one-minute intervals. Regression analysis and Bland-Altman analysis were used to compare the data (tympanic/rectal temperatures) with esophageal temperature as a core temperature. RESULTS: Tympanic temperature showed a good correlation with esophageal temperature (r=0.983, P<0.05). Rectal temperature also showed a good correlation with esophageal temperature (r=0.923, P<0.05), but the coefficient of correlation was low compared to that of tympanic temperature. The mean difference between tympanic temperature and esophageal temperature was -0.022 degrees C, and standard deviation (SD) was 0.395 degrees C. The mean difference between rectal temperature and esophageal temperature was -0.299 degrees C, and standard deviation (SD) was 0.838 degrees C. CONCLUSIONS: A noncontact continuous tympanic thermometer is useful for measurement of core temperature during cardiac surgery using an artificial heart-lung machine.

Yamagishi A; Toyama Y; Tobise F; Ichimiya T; Iwasaki H

2012-08-01

163

Anti-Toxoplasma gondii antibodies in hemodialysis patients receiving long-term hemodialysis therapy in Turkey.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Toxoplasma is a globally distributed pathogen for humans and animals. In situations of immunodeficiency, Toxoplasma gondii (T. gondii) emerges as a life-threatening infection. Toxoplasma gondii is transmitted parenterally, flourish in state immunosuppression and, most toxoplasma infections are asymptomatic. In the present study, we aimed to investigate the prevalence of anti-T. gondii antibodies in hemodialysis patients with chronic renal failure. We undertook a prospective study of our maintenance hemodialysis patients to determine whether these sources posed a risk for transmission of T. gondii. METHODS: This study was carried out on patients undergoing regular hemodialysis in the dialysis units (Hemodialysis Center of Antakya State Hospital, Emir Hemodialysis Center and Antakya Hemodialysis Center, Hatay, Turkey) between January 2004 and June 2004. Two hundred and fifty-five hemodialysis patients and 50 healthy controls were studied for the prevalence of anti-T. gondii antibodies by enzyme-linked immunosorbent assay. RESULTS: Anti-immunoglobulin G (IgG) and immunoglobulin M (IgM) T. gondii antibodies positivity were found to be 195 (76.5%) of the 255 hemodialysis patients and 24 (48%) of the 50 control subjects. The difference between them was statistically significant (p<0.05). In addition, an increase of the seropositivity rate was detected with increasing length of time on hemodialysis treatment, indicating a statistically significant difference between these 2 parameters (p<0.05). CONCLUSION: These findings confirm a high prevalence of toxoplasma infection in hemodialysis patients. These patients are a risk group for toxoplasma infection. Moreover, it is recommended that hemodialysis patients who are susceptible to toxoplasma infections should be identified by T. gondii IgG and IgM specific serological tests. Therefore, patients undergoing hemodialysis should be screened for toxoplasma before dialysis to prevent the dissemination of this infection through the hemodialysis procedure.

Ocak S; Duran N; Eskiocak AF; Aytac H

2005-09-01

164

Original paper Helicobacter pylori IgG antibodies in association with secondary hyperparathyroidism in end-stage renal failure patients undergoing regular hemodialysis  

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Full Text Available Helicobacter pylori (H. pylori) has been shown to play an important role in the development of gastritis and gastric ulcer. Excess parathyroid hormone (PTH) has long been considered detrimental to the health of patients with end-stage renal disease. PTH has been implicated as a multisystem uremic toxin, and hyperparathyroidism can be a debilitating complication in dialyzed patients. The aim of our study was the assessment of relationships between PTH abnormalities and concentration of IgG antibodies against H. pylori. The study included 44 (F=17, M=27) stable hemodialysis (HD) patients with upper gastrointestinal symptoms. Significant positive correlations between H. pylori IgG antibody titers with serum iPTH and phosphorus and significant inverse correlation of H. Pylori IgG antibody titers with serum alkalin phosphatase were found. Hyperparathyroidism is related with stimulation of gastrin synthesis as well with increased acidity of gastric juice. Hypergastrinaemia induced stimulation of gastrin synthesis and resultant increased acidity of gastric juice could intensify the H. pylori infection in HD patients. Further studies on the association of secondary hyperparathyroidism with helicobacter pylori infection are necessary, because both dyspeptic symptoms and secondary hyperparathyroidism are quite common in HD patients and in the meantime, more attention toward control of high levels of parathormone in HD patients is needed.

Azar Baradaran; Hamid Nasri

2005-01-01

165

Pharmacokinetic assessment of peramivir in a hospitalized adult undergoing continuous venovenous hemofiltration.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To report a sieving coefficient for peramivir in a patient receiving continuous venovenous hemofiltration (CVVH). CASE SUMMARY: An 18-year-old male presented with chills, myalgias, and dyspnea and was hospitalized. Nasal secretions were positive for influenza by rapid antigen test at an outside facility and oseltamivir was commenced. Oral absorption was predicted to be unreliable, and intravenous peramivir was accessed as an emergency investigational new drug applicaiton (eIND). CVVH was initiated after the development of acute renal failure, with blood samples collected to determine peramivir concentrations. DISCUSSION: Peramivir, an intravenous investigational neuraminidase inhibitor with activity against influenza viruses, has limited data for dosing in the setting of CVVH. A single patient received 600 mg of peramivir intravenously and had blood and ultrafiltrate concentrations measured serially. A sieving coefficient of approximately 0.9 was identified. CONCLUSIONS: Peramivir is well cleared by CVVH, and drug exposure is potentially predictable based on flow rates. Further study is necessary.

Scheetz MH; Griffith MM; Ghossein C; Hollister AS; Ison MG

2011-12-01

166

Effect of Addition of Magnesium Sulphate and Fentanyl to Ropivacaine Continuous Femoral Nerve Block in Patients Undergoing Elective Total Knee Replacement  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This prospective double blinded study was designed to compare the effect of magnesium or fentanyl addition to ropivacaine in continuous femoral nerve block in patients undergoing elective total knee replacement under general anesthesia. Sixty patients undergoing elective TKR under general anesth...

Md. Ashraf Abd Elmawgoud; Ahmed Badawy; Samaa Abu Elkassem; Doaa Rashwan

167

Mortality, mortality patterns of hemodialysis (HD) patients and conscious level as predictor for mortality among patients undergoing HD in Punjab, Pakistan  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Despite recent therapeutic advances, mortality remains high among patients with stage five chronic kidney diseases maintained on hemodialysis (HD). The excess mortality, largely attributable to atherosclerotic cardiovascular disease (ASCVD), remains significant even after controlling for age, diabetes, and hypertension. These factors contributing to the excessive mortality yielding very low survival of patients treated with HD. The first year crude mortality rates among HD patients were 6.6% in Japan, 15.6% in Europe, and 21.7% in the US. Hence US supposed to be the worst in mortality while in Pakistan, such studies were very rare and there is no information regarding HD patients.Methods: Retrospective analysis of 234 patients was performed. Mortality, its patterns and risks were calculated. Patients of end stage renal disease (ESRD) maintained on HD for more than three months were included in the study. Index method, log rank test, and cox proportional hazard modeling were applied to analyze the data.Results: Majority of patients were males (mean: 50.7 yrs). Crude death rate of HD patients in the first year was 35% and in 4 year cohort was 40.6%. Mortality was more likely to occur in male as compared to female. Age specific death rate was high in age category 55-64. Age and gender specific death rates were also high in male population. Significant role of conscious level that is, drowsiness and comma were observed yielding high mortality. Patients with drowsy condition show high risk of mortality.Conclusions: The mortality rates of HD patients are high in Pakistan. Patient condition is one of the major factors involved in mortality. Deaths were more likely to occur in males. Serious attention required while dealing HD patients.

Iqbal S; Anees M; Khawaja AR; Rizvi SNB

2013-01-01

168

An evaluation of ciprofloxacin pharmacokinetics in critically ill patients undergoing continuous veno-venous haemodiafiltration  

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Full Text Available Abstract Background The study aimed to investigate the pharmacokinetics of intravenous ciprofloxacin and the adequacy of 400 mg every 12 hours in critically ill Intensive Care Unit (ICU) patients on continuous veno-venous haemodiafiltration (CVVHDF) with particular reference to the effect of achieved flow rates on drug clearance. Methods This was an open prospective study conducted in the intensive care unit and research unit of a university teaching hospital. The study population was seven critically ill patients with sepsis requiring CVVHDF. Blood and ultrafiltrate samples were collected and assayed for ciprofloxacin by High Performance Liquid Chromatography (HPLC) to calculate the model independent pharmacokinetic parameters; total body clearance (TBC), half-life (t1/2) and volume of distribution (Vd). CVVHDF was performed at prescribed dialysate rates of 1 or 2 L/hr and ultrafiltration rate of 2 L/hr. The blood flow rate was 200 ml/min, achieved using a Gambro blood pump and Hospal AN69HF haemofilter. Results Seventeen profiles were obtained. CVVHDF resulted in a median ciprofloxacin t1/2 of 13.8 (range 5.15-39.4) hr, median TBC of 9.90 (range 3.10-13.2) L/hr, a median Vdss of 125 (range 79.5-554) L, a CVVHDF clearance of 2.47+/-0.29 L/hr and a clearance of creatinine (Clcr) of 2.66+/-0.25 L/hr. Thus CVVHDF, at an average flow rate of ~3.5 L/hr, was responsible for removing 26% of ciprofloxacin cleared. At the dose rate of 400 mg every 12 hr, the median estimated Cpmax/MIC and AUC0-24/MIC ratios were 10.3 and 161 respectively (for a MIC of 0.5 mg/L) and exceed the proposed criteria of >10 for Cpmax/MIC and > 100 for AUC0-24/MIC. There was a suggestion towards increased ciprofloxacin clearance by CVVHDF with increasing effluent flow rate. Conclusions Given the growing microbial resistance to ciprofloxacin our results suggest that a dose rate of 400 mg every 12 hr, may be necessary to achieve the desired pharmacokinetic - pharmacodynamic (PK-PD) goals in patients on CVVHDF, however an extended interval may be required if there is concomitant hepatic impairment. A correlation between ciprofloxacin clearance due to CVVHDF and creatinine clearance by the filter was observed (r2 = 0.76), providing a useful clinical surrogate marker for ciprofloxacin clearance within the range studied. Trial Registration Current Controlled Trials ISRCTN52722850

Spooner Almath M; Deegan Catherine; D'Arcy Deirdre M; Gowing Caitriona M; Donnelly Maria B; Corrigan Owen I

2011-01-01

169

Avaliação da qualidade de vida em idosos submetidos ao tratamento hemodialítico Evaluación de la calidad de vida en personas mayores sometidos a hemodiálisis Evaluation of quality of life in elderly undergoing hemodialysis  

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Full Text Available A hemodiálise afeta não só aspectos físicos, como psicológicos e sociais, com repercussão na vida pessoal e familiar. Considerando que no Brasil está ocorrendo um aumento da população idosa, esta pesquisa objetivou avaliar a qualidade de vida dos idosos com insuficiência renal crônica, submetidos ao tratamento hemodialítico. Trata-se de uma pesquisa quantitativa, de caráter descritivo exploratório, com idosos de um serviço especializado em hemodiálise de Guarapuava, Paraná. Os dados foram coletados entre maio a junho de 2010, através de um instrumento estruturado e, após, submetidos ao programa estatístico Statistica 7.1. Analisando os domínios do questionário, o maior escore diz respeito ao domínio social (70,42) e o menor, ao domínio físico (49,37). Assim, a qualidade de vida desses idosos apresentou-se baixa, com variações de acordo com o domínio analisado. Pesquisas voltadas à avaliação de qualidade de vida são relevantes e instrumentalizam a prática diária do cuidado.Hemodiálisis afecta aspectos física y psicológica y social, con repercusiones en la vida personal y familiar. Mientras que en Brasil está experimentando un aumento de la población de edad avanzada, este estudio tuvo como objetivo evaluar la calidad de vida de los pacientes ancianos con insuficiencia renal crónica sometidos a hemodiálisis. Se trata de un estudio cuantitativo, exploratorio descriptivo con pacientes ancianos en un centro especializado en hemodiálisis Guarapuava, Paraná, Brasil. Los datos fueron recogidos entre mayo y junio de 2010 a través de un instrumento estructurado y, después someterse el programa estadístico Statistica 7.1. Analizar los dominios del cuestionario, la puntuación más alta con respecto al ámbito social (70,42) y menor dominio físico (49,37). Lo tanto, la calidad de vida de estos ancianos tenían ser bajo, con variaciones según ámbito analizado. La investigación destinada a evaluar la calidad de vida son relevantes e instrumentalizar la práctica diaria de atención.Hemodialysis affects not only physical, and psychological and social, with repercussions on personal and family life. Whereas in Brazil is experiencing a increase in the elderly population, this study aimed to evaluate the quality of life of elderly patients with chronic renal failure undergoing hemodialysis. This is a quantitative, descriptive exploratory study with elderly patients at a facility specializing in hemodialysis Guarapuava, Paraná, Brazil. Data were collected between May and June 2010 through a structured instrument and, after undergoing the statistical program Statistica 7.1. Analyzing the domains of the questionnaire, the highest score with respect to the social domain (70.42) and the lowest physical domain (49.37). Thus, the quality of life of these elderly had to be low, with variations according to the analyzed field. Research aimed at assessing quality of life are relevant and instrumentalize daily practice of care.

Angélica Yukari Takemoto; Patrícia Okubo; João Bedendo; Lígia Carreira

2011-01-01

170

Comparison of continuous, stat, and intermittent cardiac output measurements in patients undergoing minimally invasive direct coronary artery bypass surgery.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare intermittent cardiac output (ICO) with continuous cardiac output (CCO) and stat cardiac output (SCO) measurements in patients undergoing minimally invasive direct coronary artery bypass (MIDCAB) surgery. DESIGN: Prospective, clinical study. SETTING: Single, tertiary referral center. PARTICIPANTS: Twenty adult patients undergoing off-pump MIDCAB surgery from January through June 2000. INTERVENTIONS: Each patient had a 7.5F 5-lumen pulmonary artery thermodilution catheter (CCO catheter, Baxter Healthcare Corporation, Irvine, CA) inserted for measurement of cardiac output (CO). ICO, CCO, and SCO were compared at 10 predefined time points. RESULTS: A total of 400 data pairs for CO were obtained. ICO values ranged from 1.8 to 8.4 L/min; CCO, 1.9 to 7.5 L/min; and SCO, 2.25 to 6.35 L/min. Correlation between ICO and CCO was significant (correlation coefficient, r = 0.78, p < 0.001), accompanied by a bias of -0.095 L/min and precision of 0.729 L/min. Similarly, the correlation between ICO and SCO was significant (r = 0.79, p < 0.001), accompanied by good accuracy (bias, 0.084 L/min) and precision (0.843 L/min). There were statistically significant decreases in mean arterial pressure, CO, cardiac index, stroke volume, stroke volume index, and left and right ventricular stroke work indices during anastomosis of the left internal mammary artery to left anterior descending artery. These parameters returned to baseline preinduction values 1 minute after completion of the anastomosis. CONCLUSION: Excellent correlation, accuracy, and precision were found among the 3 methods of measuring CO in patients undergoing MIDCAB surgery. Further studies are needed to assess their accuracy in multivessel off-pump coronary artery bypass graft surgery and in patients with poor left ventricular function.

Singh A; Juneja R; Mehta Y; Trehan N

2002-04-01

171

Should nicorandil infusion be adapted in dialysis-dependent patients undergoing continuous renal replacement therapy after cardiac surgery?  

UK PubMed Central (United Kingdom)

In this report, we studied whether plasma concentration of nicorandil is maintained effectively and safely in dialysis-dependent patients with stage 5 chronic kidney disease (CKD5D) undergoing continuous renal replacement therapy (CRRT). Participants consisted of 10 patients undergoing CRRT after cardiac surgery. CRRT was performed with an effluent flow rate of either 600?mL/h (low-flow group; n?=?5) or 1800?mL/h (high-flow group; n?=?5). Nicorandil was infused intravenously at 0.1?mg/kg/h for more than 15?h starting 8?h before and 7?h after the start of CRRT. Plasma nicorandil concentrations were measured from arterial blood lines 1?h before and 7?h after CRRT initiation. Nicorandil clearance by CRRT was also calculated 1?h after CRRT initiation. Nicorandil plasma concentrations before and 7?h after CRRT initiation were 68.0?ng/mL and 74.6?ng/mL, respectively. Nicorandil clearance 1?h after CRRT initiation was 20.2?mL/min. Increasing the effluent flow rate from 600?mL/h to 1800?mL/h tended to increase nicorandil clearance. When nicorandil was infused intravenously during CRRT at 0.1?mg/kg/h in patients with CKD5D, plasma nicorandil concentrations were maintained within an effective concentration range.

Yasuda N; Goto K; Shitomi R; Ohchi Y; Abe T; Yamamoto S; Hidaka S; Noguchi T

2013-03-01

172

Depressed mood and poor quality of life in male patients with chronic renal failure undergoing hemodialysis/ Comportamento depressivo e má qualidade de vida em homens com insuficiência renal crônica submetidos à hemodiálise  

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Full Text Available Abstract in portuguese OBJETIVO: Avaliar o estado de humor e a qualidade de vida de homens em tratamento hemodialítico, correlacionar as alterações observadas no humor com os diferentes domínios do questionário de qualidade de vida. MÉTODO: Foram incluídos 47 homens em tratamento hemodialítico estável há mais de seis meses. Foram aplicadas a Escala de Hamilton de depressão e o Kidney Disease Quality of Life Questionnaire, questionário de qualidade de vida relacionado à saúde, em s (more) ua forma traduzida e adaptada para a língua portuguesa. RESULTADOS: A média da idade dos pacientes era 39,4 ± 8,9 anos. Na avaliação pela Escala de Hamilton, observou-se em 32 (68,1%) pacientes a presença de depressão. Encontramos correlação negativa significativa entre os resultados obtidos na escala de Hamilton e os seguintes parâmetros das dimensões específicas do Kidney Disease Quality of Life Questionnaire: lista de sintomas e problemas (rs = -0,399; p = 0,005), qualidade da interação social (rs = -0,433; p = 0,002) e sono (rs = -0,585; p Abstract in english OBJECTIVE: To assess mood and quality of life in male hemodialysis patients, and to correlate mood swings with the different domains of the quality of life questionnaire. METHOD: Forty-seven male patients undergoing regular hemodialysis for more than six months were included in the study. The Hamilton Rating Scale for Depression and the Kidney Disease Quality of Life Questionnaire, in a version translated into and adapted to Portuguese, were used. RESULTS: The patients' a (more) ge was 39.4 ± 8.9 years (median ± SD). Depression was observed in 32 (68.1%) patients according to the Hamilton Rating Scale for Depression. A significant negative correlation was found between the results from the Hamilton Rating Scale for Depression and the following parameters of the specific dimensions of the Kidney Disease Quality of Life Questionnaire: list of symptoms and problems (rs = -0.399; p = 0.005), quality of social interaction (rs = -0.433; p = 0.002), and quality of sleep (rs = -0.585; p

Garcia, Thales Weber; Veiga, Joel Paulo Russomano; Motta, Lucilia Domingues Casulari da; Moura, Flávio José Dutra de; Casulari, Luiz Augusto

2010-12-01

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Cognitive function among hemodialysis patients in Japan  

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Abstract Background Over 290,000 patients are undergoing hemodialysis (HD) in Japan. With old age, the odds of undergoing HD treatment sharply increase, as does the prevalence of cognitive impairment. The aim of the present work was to assess cognitive impairment in HD patients and ...

Odagiri Gen; Sugawara Norio; Kikuchi Atsuhiro; Takahashi Ippei; Umeda Takashi; Saitoh Hisao; Yasui-Furukori Norio

174

Depression in hemodialysis patients  

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[en] To measure the frequency of depression and its risk factors in patients under going hemodialysis. It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1/sup st/ January 2006 to 30/sup th/ April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory- II (BDI-II; adapted in Urdu) was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers (Anti HCV and HbsAg). Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) for correlation of psychological variables with clinical, hematological and biochemical parameters. Eighty nine patients were enrolled which included fifty two (58.4%) were male and seventy seven (86.5%) were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 +- 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty (56.1%) were moderately to severely depressed and there was no gender difference in the prevalence of depression. Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters. (author)

2008-01-01

175

Self cannulation for home hemodialysis: strategies for success.  

UK PubMed Central (United Kingdom)

Self-cannulation is a technique that allows patients on hemodialysis to place the needles into their own vascular access, a fistula, or graft for the purpose of hemodialysis. This practice helps to empower individuals having to undergo hemodialysis with the opportunity to be active participants in their own care. It also reduces anxiety of needles and increases familiarity of the vascular access, thereby reducing the risk of infiltration and infection because only one person is performing the cannulation.

Donato-Moore S

2013-01-01

176

Hiperpigmentação cutânea em pacientes com insuficiência renal crônica em hemodiálise infectados pelo vírus da hepatite C Increased skin pigmentation in patients with chronic renal failure undergoing hemodialysis infected with the hepatitis C virus  

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Full Text Available OBJETIVO: A hiperpigmentação cutânea é comumente encontrada em pacientes portadores de insuficiência renal crônica (IRC), sendo também uma das manifestações mais evidentes da Porfiria Cutânea Tarda (PCT). Essa doença, que tem sido relatada em pacientes em hemodiálise (HD), tem como um dos fatores precipitantes a infecção pelo vírus da hepatite C (HCV). Este estudo tem como objetivo avaliar a prevalência de hiperpigmentação cutânea difusa em pacientes com IRC infectados pelo HCV. MÉTODOS: Foi desenvolvido um estudo transversal com 47 pacientes (idade média de 50,35 ± 15,16 anos, 31 homens e 16 mulheres) que estavam realizando hemodiálise na Unidade de Diálise do Hospital de Clínicas de Porto Alegre. Os pacientes foram divididos em dois grupos: grupo 1, anti-HCV positivos (n=17), e grupo 2, anti-HCV negativos (n=30). RESULTADOS: A prevalência de pacientes com hiperpigmentação cutânea relacionada a HD foi de 36,2% (n=17). Havia 10 pacientes (58,8 %) no grupo 1 e sete pacientes (23,3%) no grupo 2 (Razão de Risco de 2,52 e Intervalo de Confiança de 95% de 1,18 a 5,4; pBACKGROUND: Skin pigmentation is commonly found in patients with chronic renal failure (CRF). This symptom is also one of the most evident features of Porphyria Cutanea Tarda (PCT). Hepatitis C virus (HCV) is an important precipitating agent of this disease, which has been described in patients undergoing hemodialysis (HD). In this paper, we intend to evaluate the prevalence of difuse skin hyperpigmentation in patients with CRF infected with the HCV. METHODS: We developed a transversal study with 47 patients (mean age 50,35 + 15,16 years; 31 men and 16 women) who were on hemodialysis in march of 2001 at the Unit of Dialysis of Hospital de Clínicas de Porto Alegre. Patients were divided in two groups: group 1, anti-HCV positives (n=17), and group 2, anti-HCV negatives (n=30). RESULTS: The prevalence of skin hyperpigmentation related to HD was 36,2% (n=17). There were 10 patients (58,8%) in group 1 and 7 (23,3%) in group 2 (Odds Ratio of 2,52 and 95% Confidence Interval of 1,18-5,4; p<0,05). Among patients who have undergone HD for until 36 months (n=24), 6 were anti-HCV positive and 3 of tham (50%) mentioned skin pigmentation (OR of 9,0 and 95%CI of 1,1-71,0; p<0,05). Patients from group 2 who referenced the symptom have been on HD for a longer period than those who did not (63,85 + 11,9 vs. 29,3 + 4,71 months; p<0,05). CONCLUSIONS: HCV infection was associated with increased skin hyperpigmentation in patients with CRF undergoing HD. Time on treatment was also associated with this signal.

Humberto Kukhyun Choi; Fernando Saldanha Thomé; Tobias Orlandini; Elvino Barros

2003-01-01

177

Short daily hemodialysis is associated with lower plasma FGF23 levels when compared with conventional hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: The utilization of short-term daily hemodialysis has increased over the last few years, but little is known on its effects on the control of serum phosphate and fibroblast growth factor 23 (FGF23) levels. METHODS: We therefore performed a cross-sectional study to compare FGF23 levels as well as other biochemical variables between 24 patients undergoing short daily hemodialysis using the NxStage System® and 54 patients treated with conventional in-center hemodialysis. FGF23 levels were measured using the second-generation Immutopics® C-terminal assay. RESULTS: Short daily hemodialysis patients were younger than patients on conventional hemodialysis but there were no differences between groups in the duration of end-stage renal disease nor in the number of patients with residual renal function. A greater number of short daily hemodialysis patients received vitamin D sterol therapy than did conventional in-center hemodialysis patients while there were no differences in the use of different phosphate binders and calcimimetic therapy between groups. Overall serum calcium, phosphorus and intact parathyroid hormone levels were similar between groups. While serum phosphorus levels correlated with FGF23 concentrations in each group separately [r = 0.522 (P < 0.01) and r = 0.42 (P < 0.01) in short daily and conventional in-center hemodialysis, respectively], FGF23 levels were lower [823 RU/mL (263, 2169)] in the patients receiving short daily hemodialysis than in patients treated with conventional hemodialysis [2521 RU/mL (909, 5556)] (P < 0.01 between groups). CONCLUSIONS: These findings demonstrate that FGF23 levels are significantly lower in short daily hemodialysis patients and suggest that FGF23 levels may be a more sensitive biomarker of cumulative phosphate burden than single or multiple serum phosphorus determinations in patients treated with hemodialysis.

Zaritsky J; Rastogi A; Fischmann G; Yan J; Kleinman K; Chow G; Gales B; Salusky IB; Wesseling-Perry K

2013-09-01

178

[Hemodialysis and complement (author's transl)].  

UK PubMed Central (United Kingdom)

After observing alterations in the activity of the serum complement in patients undergoing periodic hemodialysis, the authors performed a preliminary study to determine repeatedly the activity of C3, C4, and CH50 in 44 patients. They discovered a consistent drop in C3 and CH50 while C4 remained normal. An attempt to explain these findings with information from the literature offered no more than a hypothesis for further study. While the possibility of a decline in the synthesis of the complement factors cannot be disregarded, the authors believe it is much more probable that they are consumed at a rate higher than normal. Since the C4 factor does not appear to be involved, activation is probably along the alternative pathway. Defective synthesis cannot be attributed to liver disease because the latter is not always present and because there is no relationship between C3 levels and levels of albumin or the presence of hepatopathy. The literature was reviewed for data that might support the idea that the complements in these patients are activated continuously by some process in connection with dialysis, by chemical products employed for to clean the machines, by commonly administered drugs, etc. Because so few data could be found on the subject, the authors consider that is necessary to study these mechanisms and their repercussions over a longer period of time.

González Alvarez MT; Aubia J; Mirapeix E; López Pedret J; Revert L

1979-04-01

179

BLOODSTREAM INFECTION DUE TO STREPTOCOCCUS DYSGALACTIAE SUBSP EQUISIMILIS IN A HEMODIALYSIS PATIENT  

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Full Text Available Catheter-related bacteremia is a frequent complication in patients undergoing hemodialysis. We report the first case of catheter-related bacteremia with Streptococcus dysgalactiae subsp equisimilis in a patient on hemodialysis. The organism was isolated from both the hemodialysis catheter and blood of the patient. Although the hemodialysis cathether was removed and ceftriaxone was given, the patient died of a subarachnoidal bleeding complicating end-stage renal disease.

Duygu Perçin; Bülent Tokgöz; Altay Atalay; Cengiz Uta?

2012-01-01

180

Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents.  

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In this paper, we described the symptoms and treatment of a patient with diabetic nephropathy accompanied by spontaneous retroperitoneal hemorrhage after hemodialysis. An elderly female patient with diabetic nephropathy presented with severe pain, numbness, and an increasing swelling in the left hip and left thigh after six sessions of hemodialysis involving the use of an antiplatelet drug and an anticoagulant agent. Her hemoglobin decreased to 46 g/L. An abdominal ultrasound showed a hematoma in the left retroperitoneal space, and computed tomography (CT) findings revealed a 6 cm × 8 cm × 10 cm hematoma in the left psoas muscle. After aggressive supportive therapy [the administration of packed red blood cell transfusion, carbazochrome sodium sulfonate injection, and continuous venovenous hemofiltration (CVVH)], the patient's vital signs stabilized and her hemoglobin increased to 86 g/L. Repeat CT showed that the hematoma had been partially absorbed after two weeks. Eventually, the patient was discharged with stable vital signs. Physicians should be aware of the possibility of spontaneous retroperitoneal hemorrhage, particularly in patients with diabetic nephropathy undergoing hemodialysis involving the use of anticoagulant agents. PMID:22556180

Fan, Wen-xing; Deng, Zheng-xu; Liu, Fang; Liu, Rong-bo; He, Ling; Amrit, Bogati; Zang, Li; Li, Jing-wen; Liu, Xian-rong; Huang, Song-min; Fu, Ping

2012-05-01

 
 
 
 
181

Spontaneous retroperitoneal hemorrhage after hemodialysis involving anticoagulant agents.  

UK PubMed Central (United Kingdom)

In this paper, we described the symptoms and treatment of a patient with diabetic nephropathy accompanied by spontaneous retroperitoneal hemorrhage after hemodialysis. An elderly female patient with diabetic nephropathy presented with severe pain, numbness, and an increasing swelling in the left hip and left thigh after six sessions of hemodialysis involving the use of an antiplatelet drug and an anticoagulant agent. Her hemoglobin decreased to 46 g/L. An abdominal ultrasound showed a hematoma in the left retroperitoneal space, and computed tomography (CT) findings revealed a 6 cm × 8 cm × 10 cm hematoma in the left psoas muscle. After aggressive supportive therapy [the administration of packed red blood cell transfusion, carbazochrome sodium sulfonate injection, and continuous venovenous hemofiltration (CVVH)], the patient's vital signs stabilized and her hemoglobin increased to 86 g/L. Repeat CT showed that the hematoma had been partially absorbed after two weeks. Eventually, the patient was discharged with stable vital signs. Physicians should be aware of the possibility of spontaneous retroperitoneal hemorrhage, particularly in patients with diabetic nephropathy undergoing hemodialysis involving the use of anticoagulant agents.

Fan WX; Deng ZX; Liu F; Liu RB; He L; Amrit B; Zang L; Li JW; Liu XR; Huang SM; Fu P

2012-05-01

182

Dialysis-related amyloidosis of the hip joints in long-term hemodialysis patients. MRI findings of hip joints in twelve female hemodialysis patients  

International Nuclear Information System (INIS)

We report a female with amyloid arthropathy of the hip joints. She was a 67-year-old woman who had been treated by hemodialysis for 22 years. She had demonstrated a 5-month history of continuous low-grade fever and pain in her left hip and she was finally unable to walk by herself. Findings on X-ray films and MRI of the hip joints suggested avascular necrosis in both femur heads. To palliate symptoms, bipolar surgery on the left hip joint was performed. Pathological examination of bone tissue specimen demonstrated that there was some , ?2-microglobulin (?2-MG)-related amyloid accumulation in the femur head. Based on this clinical experience, we performed MRI screening for amyloid lesions of the hip joints in another 11 asymptomatic female patients undergoing hemodialysis for 20 years or more. Cystic lesions of the hip joints were observed in 8 patients, amyloid arthropathy in 2 patients, and fluid trapped in the joint in 1 patient. Patients with amyloidosis had significantly lower serum ?2-MG levels than patients without amyloidosis (28.6 mg/L versus 41.4 mg/L; p=0.0339). Our findings show that dialysis-related amyloidosis of the hip joints is one of the potential and significant problems in female patients on long-term hemodialysis therapy. It may be important to screen for this pathological condition in long-term hemodialysis patients. (author)

2007-01-01

183

Removal of dabigatran by hemodialysis.  

UK PubMed Central (United Kingdom)

Dabigatran is a newly available oral direct thrombin inhibitor approved for anticoagulation therapy to prevent strokes in patients with nonvalvular atrial fibrillation. Unlike warfarin, dabigatran's observed therapeutic window and minimal drug-to-drug interaction suggest that invasive laboratory testing and dose adjustment is not necessary. In circumstances of excessive anticoagulation, such as overdoses, decreased kidney function, or instances of significant bleeding, reversing dabigatran's effects may be necessary. Unlike warfarin, no rapid-acting antidote to reverse the effects of dabigatran is known. However, hemodialysis has been suggested as a method of removing dabigatran and thereby reducing its anticoagulant effect. We describe a case in which hemodialysis was used in an attempt to remove dabigatran in a patient with excessive anticoagulation from dabigatran and severe intracranial hemorrhage. Serial dabigatran levels suggested that hemodialysis removed the drug. However, given the large volume of distribution of dabigatran in the terminal phase of elimination, a rebound in drug level was noted. We suggest that a longer duration of therapy or more continuous modality of hemodialysis may be needed in conjunction with the initial hemodialysis treatment of dabigatran coagulopathy.

Chang DN; Dager WE; Chin AI

2013-03-01

184

Coping religioso/espiritual em pessoas com doença renal crônica em tratamento hemodialítico Coping religioso/espiritual en personas con enfermedad renal crónica en tratamiento por hemodiálisis Religious/spiritual coping in people with chronic kidney disease undergoing hemodialysis  

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Full Text Available O estudo tem como objetivo investigar o uso do coping religioso/espiritual em pacientes com doença renal crônica em hemodiálise. A investigação ocorreu em uma clínica de hemodiálise, por meio de entrevista utilizando um questionário sociodemográfico e a escala de coping religioso/espiritual. Para análise dos dados, foram empregados a estatística descritiva e o teste coeficiente de correlação de Sperman, a análise de variância e o modelo de regressão linear múltipla. Foram entrevistados 123 indivíduos, dos quais 79,6% apresentaram escore alto para o coping religioso/espiritual e nenhum deles apresentou os escores baixos e irrisórios. As variáveis que influenciaram no comportamento do coping religioso/espiritual foram: sexo, faixa etária, tempo de tratamento, renda familiar e prática religiosa. Conclui-se que os pacientes em estudo utilizam de modo positivo o coping religioso/espiritual como estratégia de enfrentamento da doença, destacando-se as mulheres, com renda familiar maior e que frequentam semanalmente a igreja.El estudio objetiva investigar el uso del coping religioso/espiritual en pacientes con enfermedad renal crónica en hemodiálisis. Investigación realizada en clínica de hemodiálisis, mediante entrevista, utilizándose cuestionario sociodemográfico y la escala de coping religioso/espiritual. Se utilizó estadística descriptiva, pruebas de coeficiente de correlación de Spearman, el análisis de varianza y el modelo de regresión lineal múltiple para el análisis de los datos. Fueron entrevistados 123 individuos, de los cuales 76,9% presentaban puntaje alto para coping religioso/espiritual, ninguno de ellos expresando puntajes bajos o irrisorios. Las variables que influyeron en el comportamiento del coping religioso/espiritual fueron: sexo, faja etaria, tiempo de tratamiento, renta familiar y práctica religiosa. Se concluye en que los pacientes estudiados utilizan de modo positivo el coping religioso/espiritual como estrategia de enfrentamiento a la enfermedad, destacándose las mujeres con renta familiar mayor y que frecuentan semanalmente la iglesia.The objective of the present study is to investigate the use of religious/spiritual coping mechanisms in patients with chronic kidney disease undergoing hemodialysis, by means of interviews using a sociodemographic questionnaire and the religious/spiritual coping scale. Data analysis was performed using descriptive statistics and multiple linear regression. A total of 123 individuals were interviewed, 79.6% of whom presented a high score for religious/spiritual coping and none of whom presented low or irrelevant scores. The variables that affected the religious/spiritual coping behavior were: gender, age group, treatment time, family income, and religious practice. In conclusion, the participants used religious/spiritual coping mechanisms as a strategy to cope with the disease, particularly women with a higher family income who attend church every week.

Carolina Costa Valcanti; Érika de Cássia Lopes Chaves; Ana Cláudia Mesquita; Denismar Alves Nogueira; Emília Campos de Carvalho

2012-01-01

185

Pharmacometric characterization of dabigatran hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Hemodialysis has been shown to be a useful method of decreasing dabigatran plasma levels in situations that require rapid elimination of this thrombin inhibitor. However, there is currently no clinical recommendation for the accelerated/optimized elimination of dabigatran via hemodialysis (e.g., flow rates, filter type, duration of dialysis). OBJECTIVES: The primary objective of the present work was to characterize, via pharmacometric methods, the effects of different blood flow rates in hemodialysis on the pharmacokinetics of dabigatran, using data from a dedicated phase I dialysis study of end-stage renal disease (ESRD) patients. In addition, the effects of various clinically relevant hemodialysis settings were evaluated by simulation to assess their potential use in non-ESRD situations. METHODS: Seven patients with ESRD were investigated in an open-label, fixed-sequence, two-period comparison trial. A population pharmacokinetic model was developed to fit the data and then used for various simulations. Data analyses were performed using NONMEM(®), Berkeley Madonna, or SAS. RESULTS: The pharmacokinetics of dabigatran were best described by a two-compartment model with first-order absorption and a lag time. In addition to total body clearance in ESRD subjects, a first-order dialysis clearance was implemented which was greater than zero during hemodialysis and zero during the interdialytic periods. The relationship between the dialysis clearance and the blood flow rate was best described by the Michaels function. Simulations showed that varying clinically relevant dialysis settings such as filter properties or flow rates had only minor effects. Dialysis duration had the strongest impact on dabigatran plasma concentration. The observed geometric mean redistribution effect after hemodialysis was low (<16 %). The final model was successfully evaluated through the prediction of plasma concentrations from a case report undergoing dialysis. CONCLUSIONS: This analysis allowed the influences of various hemodialysis parameters on the dabigatran plasma concentration to be predicted in detail for the first time. Dialysis duration was identified as having the strongest impact on the reduction in dabigatran plasma concentration. The model developed here can potentially serve as a tool to provide guidance when considering the use of hemodialysis in patients who have received dabigatran.

Liesenfeld KH; Staab A; Härtter S; Formella S; Clemens A; Lehr T

2013-06-01

186

Pharmacokinetics of caspofungin in critically ill patients on continuous renal replacement therapy.  

UK PubMed Central (United Kingdom)

Caspofungin pharmacokinetics was assessed in 27 critically ill patients, including 7 on continuous venovenous hemofiltration (CVVH), 8 on continuous venovenous hemodialysis (CVVHD), and 13 not requiring continuous renal replacement therapy (CRRT). Caspofungin exposure during CRRT was very similar to that of the control group and comparable to that in healthy volunteers. Caspofungin clearance by CRRT was very low. Therefore, the standard dosage of caspofungin is probably adequate for critically ill patients undergoing CVVH or CVVHD.

Weiler S; Seger C; Pfisterer H; Stienecke E; Stippler F; Welte R; Joannidis M; Griesmacher A; Bellmann R

2013-08-01

187

Pharmacokinetics of caspofungin in critically ill patients on continuous renal replacement therapy.  

Science.gov (United States)

Caspofungin pharmacokinetics was assessed in 27 critically ill patients, including 7 on continuous venovenous hemofiltration (CVVH), 8 on continuous venovenous hemodialysis (CVVHD), and 13 not requiring continuous renal replacement therapy (CRRT). Caspofungin exposure during CRRT was very similar to that of the control group and comparable to that in healthy volunteers. Caspofungin clearance by CRRT was very low. Therefore, the standard dosage of caspofungin is probably adequate for critically ill patients undergoing CVVH or CVVHD. PMID:23733471

Weiler, Stefan; Seger, Christoph; Pfisterer, Hartwig; Stienecke, Eva; Stippler, Florian; Welte, René; Joannidis, Michael; Griesmacher, Andrea; Bellmann, Romuald

2013-06-03

188

Headache associated with hemodialysis  

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Full Text Available INTRODUCTION Hemodialysis (HD) is one of the most accessible methods for the treatment of the growing number of patients suffering from terminal-stage renal insufficiency. Although headache is the most frequently encountered neurological symptom during HD, there are few studies reporting its prevalence and clinical features. OBJECTIVE The objective of this study was to examine the frequency, demographic and clinical features of headache during HD, and to compare these parameters among patients with and without headache. METHOD The study involved 126 patients (48 female and 78 male) with chronic renal failure on regular HD for at least six months, at the Dialysis Unit of Nephrology Department, Kruševac. All patients were inquired about their possible problems with headache using the standardized questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders, second edition, published in 2004 (ICHD-II). Subsequently, the patients were clinically evaluated and patients with headaches were further sub classified by a neurologist with special interest in headache disorders. Patients with headache were compared to the patients without headache regarding age, sex, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure, and serum values of the most important blood parameters such as sodium, potassium, urea and creatinine. In the group of patients with headache we analyzed the characteristics of specific headache type according to ICHD-II classification. We also analyzed the most important clinical features of hemodialysis headache (HDH). RESULTS In the group of 126 evaluated patients, 41 (32.5%) patients had headaches. There were no statistically significant differences between the patients with headaches and those without headaches regarding sex, age, BMI, duration of HD, causes of end-stage renal disease, arterial blood pressure, red blood cell count, serum concentration of hemoglobin, blood urea nitrogen, creatinine, glucose, MCHC, total protein, sodium and potassium. Fourteen patients (34% of those with headaches) experienced headache during the HD session and were sub classified as HDH using diagnostic criteria of the International Headache Society. Tension type headache (41% of those with headaches) and migraine without aura (10%) were most common in the primary headache group and headache due to arterial hypertension (7%) was the most prevalent among the secondary headaches. Although there were some common clinical characteristics, we could not find a unifying clinical pattern in the patients with HDH. CONCLUSION Hemodialysis headache is the most common headache in patients undergoing hemodialysis, and despite some common symptoms, it does not appear to be uniform in its clinical characteristics.

Niki? Petar M.; Zidverc-Trajkovi? Jasna; Andri? Branislav R.; ?uri? Marija; Stojimirovi? Biljana B.

2008-01-01

189

Substance P and intensity of pruritus in hemodialysis and peritoneal dialysis patients.  

UK PubMed Central (United Kingdom)

Background Uremic pruritus is a common complication in patients undergoing dialysis. The pathophysiological mechanisms of pruritus in patients with end-stage renal disease remain unknown. Neuropeptides, including substance P, are postulated to play an important role in the pathogenesis of pruritus. The aim of this study was to evaluate the role of substance P in uremic pruritus in patients on hemodialysis and peritoneal dialysis. Material and Methods We included 197 patients with end-stage renal disease: 54 on continuous ambulatory peritoneal dialysis and 143 on hemodialysis. Substance P, calcium, phosphorus, iron, ferritin, CRP, albumin, hemoglobin, Ca × P product, and iPTH level were determined in all participants. The correlation between these parameters and self-reported itching was evaluated in patients on hemodialysis in comparison with peritoneal dialysis patients. Results The incidence of itching was similar in hemodialysis and peritoneal dialysis patients. No differences in substance P level between the 2 groups were found. There was no correlation between substance P level and the incidence or intensity of pruritus in dialyzed patients. Conclusions This study demonstrates that substance P does not play any important role in pruritus in hemodialysed and peritoneal dialyzed patients. However, further studies are necessary to assess the exact role of neuropeptides in uremic pruritus.

Snit M; Gawlik R; L?cka-Ga?dzik B; Ku?niewicz R; Dwornicki M; Owczarek A; Walaszczyk M; Grabiec P; Grzeszczak W

2013-01-01

190

Substance P and intensity of pruritus in hemodialysis and peritoneal dialysis patients  

Science.gov (United States)

Background Uremic pruritus is a common complication in patients undergoing dialysis. The pathophysiological mechanisms of pruritus in patients with end-stage renal disease remain unknown. Neuropeptides, including substance P, are postulated to play an important role in the pathogenesis of pruritus. The aim of this study was to evaluate the role of substance P in uremic pruritus in patients on hemodialysis and peritoneal dialysis. Material/Methods We included 197 patients with end-stage renal disease: 54 on continuous ambulatory peritoneal dialysis and 143 on hemodialysis. Substance P, calcium, phosphorus, iron, ferritin, CRP, albumin, hemoglobin, Ca × P product, and iPTH level were determined in all participants. The correlation between these parameters and self-reported itching was evaluated in patients on hemodialysis in comparison with peritoneal dialysis patients. Results The incidence of itching was similar in hemodialysis and peritoneal dialysis patients. No differences in substance P level between the 2 groups were found. There was no correlation between substance P level and the incidence or intensity of pruritus in dialyzed patients. Conclusions This study demonstrates that substance P does not play any important role in pruritus in hemodialysed and peritoneal dialyzed patients. However, further studies are necessary to assess the exact role of neuropeptides in uremic pruritus.

OEnit, Miroslaw; Gawlik, Radoslaw; Lacka-GaYdzik, Beata; KuYniewicz, Roman; Dwornicki, Marek; Owczarek, Aleksander; Walaszczyk, Malgorzata; Grabiec, Piotr; Grzeszczak, Wladyslaw

2013-01-01

191

Peritonitis by Scedosporium apiospermum in a patient undergoing continuous ambulatory peritoneal dialysis Peritonite por Scedosporium apiospermum em paciente sob diálise peritoneal ambulatorial continuada  

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Full Text Available A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection.É relatado caso de peritonite por Scedosporium apiospermum em menino sob diálise peritoneal ambulatorial continuada. O achado de formas teciduais sugestivas do fungo acelerou o diagnóstico da infecção.

Luiz Carlos SEVERO; Flávio de Mattos OLIVEIRA; Clotilde Druck GARCIA; Anelise UHLMANN; Alberto Thomaz LONDERO

1999-01-01

192

Hemodialysis Dose and Adequacy  

Science.gov (United States)

... Titles : Kidney Failure Series : Hemodialysis Dose and Adequacy Hemodialysis Dose and Adequacy On this page: What is ... patient is getting good clearance. Increase Time on Dialysis The other way to improve the Kt in ...

193

Vascular Access for Hemodialysis  

Science.gov (United States)

... Kidney Failure Series : Vascular Access for Hemodialysis Vascular Access for Hemodialysis On this page: What is an ... Top ] What is a venous catheter for temporary access? If your kidney disease has progressed quickly, you ...

194

Hemodialysis patients' perception from nurses' role in their adjustment with hemodialysis: A qualitative study  

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Full Text Available Introduction: Chronic renal failure disease and its conservative treatment (hemodialysis) result in several physical, psychic, and social problems in hemodialysis patients. In health care system, nurses by their supportive behavior have an essential role to help the patients for adjustment with the problems. This study was performed to explain the perception and experience of hemodialysis patients from nurses' role in adjustment with hemodialysis.Materials and Methods: This study was conducted with qualitative research approach and content analysis method. The participants were 16 patients in the hemodialysis ward of hospitals affiliated to Semnan University of Medical Sciences. Purposive sampling was employed and continued up to data saturation. Unstructured interviews were the main method for data collection. All interviews were recorded and then transcribed verbatim. The data were analyzed by using qualitative content analysis and constant comparative method.Results: During content analysis process, three themes emerged including: (1) extremely effort for comforting patient, (2) responsible accountability to patient's questions, and (3) kindly behavior and friendly relationship with patient. The themes indicated the nature and dimensions of patients' perception from nurses' role to help them for adjustment with hemodialysis.Conclusion: The patients' experiences showed that the appropriate supportive behavior of nurses has an important role in their comfort, security, and trust, as well as accelerating adjustment with hemodialysis. The results help the nurses to be aware more from the importance of their supportive role in helping patients for adjustment with hemodialysis.

Mohammad Reza Asgari; Eesa Mohammadi; Masoud Fallahi Khoshknab; Mohammad Reza Tamadon

2011-01-01

195

Doença arterial coronariana subclínica em pacientes com Diabetes Mellitus tipo 1 em hemodiálise Enfermedad arterial coronaria subclínica en pacientes con Diabetes Mellitus tipo 1 en hemodiálisis Subclinical coronary artery disease in patients with type 1 Diabetes Mellitus undergoing hemodialysis  

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Full Text Available FUNDAMENTO: A aterosclerose ocorre mais cedo em pacientes com diabetes mellitus tipo 1 (DM-1) e a doença arterial coronariana (DAC) constitui a mais importante causa de morte. OBJETIVO: Avaliar a prevalência e as características anatômicas da DAC em pacientes com DM-1 e insuficiência renal crônica, submetidos à diálise. MÉTODOS: Este é um estudo descritivo de 20 pacientes com DM-1 submetidos à diálise sem DAC conhecida. A DAC foi avaliada através de angiografia coronariana quantitativa (ACQ) e ultra-som intravascular (USIV). A ACQ foi realizada em todas as lesões >30%, visualmente Todos os segmentos proximais de 18 mm das artérias coronárias foram analisados por USIV. Todos os outros segmentos coronarianos com estenose >30% também foram analisados. RESULTADOS: A angiografia detectou 29 lesões >30% em 15 pacientes (75%). Onze (55%) das lesões eram >50% e 10 (50%) >70%. Treze pacientes tiveram as 3 principais artérias avaliadas pelo USIV. A aterosclerose estava presente em todos os pacientes e em todos os 51 segmentos proximais de 18 mm analisados. Esses segmentos significam que a medida do diâmetro dos vasos apresentava-se significantemente maior no USIV do que na ACQ, em todos os vasos. As imagens do ISIV de 25 (86,2%) das 29 lesões >30% foram obtidas. Placas fibróticas eram comuns (48%) e 60% apresentavam remodelamento intermediário de vasos. CONCLUSÃO: A DAC estava presente em todos os vasos de todos os pacientes com diabete tipo 1 submetidos a hemodiálise. Esses achados estão de acordo com outros estudos de autópsia, angiografia e USIV. Além disso, eles indicam a necessidade de estudos adicionais epidemiológicos e de imagem, para um melhor entendimento e tratamento de uma condição clínica complexa e grave que afeta jovens indivíduos.FUNDAMENTO: La aterosclerosis ocurre más temprano en pacientes con diabetes mellitus tipo 1 (DM-1) y la enfermedad arterial coronaria (EAC) constituye la más importante causa de muerte. OBJETIVO: Evaluar la prevalencia y las características anatómicas de la EAC en pacientes con DM-1 e insuficiencia renal crónica, sometidos a diálisis. MÉTODOS: Este es un estudio descriptivo de 20 pacientes con DM-1 sometidos a diálisis sin EAC conocida. La EAC se evaluó mediante angiografía coronaria cuantitativa (ACC) y ultrasonido intravascular (IVUS). La ACC se realizó en todas las lesiones >30%, se llevó a cabo el análisis visual por IVUS en todos los segmentos proximales de 18 mm de las arterias coronarias. También se analizaron todos los otros segmentos coronarios con estenosis >30%. RESULTADOS: La angiografía detectó 29 lesiones >30% en 15 pacientes (75%). Once (55%) de las lesiones eran >50% y 10 (50%) >70%. Trece pacientes tuvieron las tres arterias principales evaluadas por el IVUS. La aterosclerosis estaba presente en todos los pacientes y en todos los 51 segmentos proximales de 18 mm analizados. Esos segmentos significan que la medición del diámetro de los vasos resultaba significantemente mayor en el IVUS que en la ACC, en todos los vasos. De las imágenes del IVUS se obtuvieron 25 (86,2%) de las 29 lesiones >30%. Placas fibróticas eran comunes (48%) y el 60% presentaban remodelamiento intermediario de vasos. CONCLUSIÓN: La EAC estaba presente en todos los vasos de todos los pacientes con diabetes tipo 1 sometidos a hemodiálisis. Esos hallazgos están de acuerdo con otros estudios de autopsia, angiografía e IVUS. Además de ello, indican la necesidad de estudios adicionales epidemiológicos y de imagen, para una mejor comprensión y tratamiento de una condición clínica compleja y severa que afecta a jóvenes individuos.BACKGROUND: In patients with type 1 diabetes mellitus, atherosclerosis occurs earlier in life and coronary artery disease (CAD) constitutes the major cause of death. OBJECTIVE: Evaluate the prevalence and anatomic characteristics of coronary artery disease (CAD) in type 1 diabetic patients with chronic renal failure undergoing hemodialysis. METHODS: This is a descriptive study of 20 patients with type

Dinaldo Cavalcanti de Oliveira; Fabio Sandoli de Brito Junior; Rosley Weber Alvarenga Fernandes; João Roberto de Sa; Valter Correia de Lima

2009-01-01

196

Vivências dos homens submetidos à hemodiálise acerca de sua sexualidade/ Experiencias de los hombres sometidos a hemodiálisis acerca de su sexualidad/ Experience of men undergoing hemodialysis about their sexuality  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Objetivo: Conhecer as vivências dos pacientes masculinos submetidos à hemodiálise acerca de sua sexualidade. Metodologia: Trata-se de uma investigação exploratória, descritiva, com abordagem qualitativa. Os sujeitos da pesquisa, realizada no primeiro semestre de 2004, foram oito pacientes masculinos que estavam em tratamento hemodialítico. O instrumento de coleta foi a entrevista semiestruturada, utilizando a análise categórica. Como cenário da pesquisa, um serv (more) iço de nefrologia, de um município da Região Sul do Brasil. Resultados: A partir da análise emergiram as seguintes categorias: Aspectos físicos e emocionais acerca do tratamento; As vivências dos pacientes renais crônicos acerca de sua sexualidade; As estratégias para lidar com as limitações relacionadas à sexualidade e A sexualidade dos pacientes renais crônicos após a hemodiálise. Discussão: O desgaste e o cansaço físico foram atribuídos ao tratamento hemodialítico. A vivência dos pacientes renais crônicos acerca de sua sexualidade está intimamente ligada à relação sexual saudável, tanto no biológico quanto no emocional. Os pacientes que buscam estratégias a fim de minimizar ou até mesmo resolver problemas relativos com sua sexualidade, em decorrência da condição crônica, enfrentam com maior facilidade os obstáculos vivenciados. Os sujeitos apresentaram modificações a respeito da sexualidade, no entanto, percebe-se a busca dos pacientes por estratégias que amenizem e até mesmo restabeleçam suas necessidades sexuais, dentro da dimensão biopsicológica. Considerações finais: Este estudo é relevante, pois existe necessidade de capacitar profissionais para trabalharem com a sexualidade humana, percebendo o paciente renal crônico sob uma visão holística.Palavras-chave: insuficiência renal crônica; diálise renal; enfermagem; sexualidade. Abstract in spanish Objetivo: Conocer las experiencias de los pacientes masculinos sometidos a hemodiálisis acerca de su sexualidad. Metodología: Se trata de una investigación exploratoria, descriptiva, con enfoque cualitativo. Los sujetos de la investigación, realizada en el primer semestre de 2004, fueron ocho pacientes masculinos que se encontraban en tratamiento de hemodiálisis. El instrumento de compilación de datos fue una entrevista semiestructurada, utilizando el análisis cate (more) górico. El escenario de investigación fue un servicio de nefrología ubicado en un municipio de la Región Sur de Brasil. Resultados: A partir del análisis surgieron las siguientes categorías: Aspectos físicos y emocionales acerca del tratamiento; las vivencias de los pacientes renales crónicos acerca de su sexualidad; Las estrategias para lidiar con las limitaciones relacionadas con la sexualidad y la sexualidad de los pacientes renales crónicos después de la hemodiálisis. Discusión: El desgaste y el cansancio físico se atribuyeron al tratamiento de hemodiálisis. La experiencia de los pacientes renales crónicos acerca de su sexualidad está íntimamente vinculado con la relación sexual saludables tanto a nivel biológico como emocional. Los pacientes que buscan estrategias dirigidas a minimizar o incluso resolver problemas relativos a su sexualidad, como resultado de la condición crónica, enfrentan con mayor facilidad los obstáculos a los que hacen frente. Los sujetos presentaron modificaciones con respecto a la sexualidad, sin embargo, se percibe la búsqueda de los pacientes por estrategias que amenicen e incluso restablezcan sus necesidades sexuales, dentro de la dimensión bio-sicológica. Consideraciones finales: Este estudio es pertinente, ya que existe la necesidad de capacitar profesionales para que trabajen con la sexualidad humana, percibiendo al paciente renal crónico bajo una visión holística. Abstract in english Objective: To study the experiences of male patients undergoing hemodialysis about their sexuality. Methodology: This is an exploratory, descriptive research with a qualitative approach. The

Fonseca Rodrigues, Denilson; Schwartz, Eda; Santana, Maria da Gloria; Vestena Zillmer, Juliana Graciela; da Costa Viegas, Aline; Pozza dos Santos, Bianca; Lopes Leal Borda, Daiane; Felipette Lima, Juyane

2011-12-01

197

Vivências dos homens submetidos à hemodiálise acerca de sua sexualidade Experiencias de los hombres sometidos a hemodiálisis acerca de su sexualidad Experience of men undergoing hemodialysis about their sexuality  

Directory of Open Access Journals (Sweden)

Full Text Available Objetivo: Conhecer as vivências dos pacientes masculinos submetidos à hemodiálise acerca de sua sexualidade. Metodologia: Trata-se de uma investigação exploratória, descritiva, com abordagem qualitativa. Os sujeitos da pesquisa, realizada no primeiro semestre de 2004, foram oito pacientes masculinos que estavam em tratamento hemodialítico. O instrumento de coleta foi a entrevista semiestruturada, utilizando a análise categórica. Como cenário da pesquisa, um serviço de nefrologia, de um município da Região Sul do Brasil. Resultados: A partir da análise emergiram as seguintes categorias: Aspectos físicos e emocionais acerca do tratamento; As vivências dos pacientes renais crônicos acerca de sua sexualidade; As estratégias para lidar com as limitações relacionadas à sexualidade e A sexualidade dos pacientes renais crônicos após a hemodiálise. Discussão: O desgaste e o cansaço físico foram atribuídos ao tratamento hemodialítico. A vivência dos pacientes renais crônicos acerca de sua sexualidade está intimamente ligada à relação sexual saudável, tanto no biológico quanto no emocional. Os pacientes que buscam estratégias a fim de minimizar ou até mesmo resolver problemas relativos com sua sexualidade, em decorrência da condição crônica, enfrentam com maior facilidade os obstáculos vivenciados. Os sujeitos apresentaram modificações a respeito da sexualidade, no entanto, percebe-se a busca dos pacientes por estratégias que amenizem e até mesmo restabeleçam suas necessidades sexuais, dentro da dimensão biopsicológica. Considerações finais: Este estudo é relevante, pois existe necessidade de capacitar profissionais para trabalharem com a sexualidade humana, percebendo o paciente renal crônico sob uma visão holística.Palavras-chave: insuficiência renal crônica; diálise renal; enfermagem; sexualidade.Objetivo: Conocer las experiencias de los pacientes masculinos sometidos a hemodiálisis acerca de su sexualidad. Metodología: Se trata de una investigación exploratoria, descriptiva, con enfoque cualitativo. Los sujetos de la investigación, realizada en el primer semestre de 2004, fueron ocho pacientes masculinos que se encontraban en tratamiento de hemodiálisis. El instrumento de compilación de datos fue una entrevista semiestructurada, utilizando el análisis categórico. El escenario de investigación fue un servicio de nefrología ubicado en un municipio de la Región Sur de Brasil. Resultados: A partir del análisis surgieron las siguientes categorías: Aspectos físicos y emocionales acerca del tratamiento; las vivencias de los pacientes renales crónicos acerca de su sexualidad; Las estrategias para lidiar con las limitaciones relacionadas con la sexualidad y la sexualidad de los pacientes renales crónicos después de la hemodiálisis. Discusión: El desgaste y el cansancio físico se atribuyeron al tratamiento de hemodiálisis. La experiencia de los pacientes renales crónicos acerca de su sexualidad está íntimamente vinculado con la relación sexual saludables tanto a nivel biológico como emocional. Los pacientes que buscan estrategias dirigidas a minimizar o incluso resolver problemas relativos a su sexualidad, como resultado de la condición crónica, enfrentan con mayor facilidad los obstáculos a los que hacen frente. Los sujetos presentaron modificaciones con respecto a la sexualidad, sin embargo, se percibe la búsqueda de los pacientes por estrategias que amenicen e incluso restablezcan sus necesidades sexuales, dentro de la dimensión bio-sicológica. Consideraciones finales: Este estudio es pertinente, ya que existe la necesidad de capacitar profesionales para que trabajen con la sexualidad humana, percibiendo al paciente renal crónico bajo una visión holística.Objective: To study the experiences of male patients undergoing hemodialysis about their sexuality. Methodology: This is an exploratory, descriptive research with a qualitative approach. The research was conducted in the first half of 2004, and the subjects were eight ma

Denilson Fonseca Rodrigues; Eda Schwartz; Maria da Gloria Santana; Juliana Graciela Vestena Zillmer; Aline da Costa Viegas; Bianca Pozza dos Santos; Daiane Lopes Leal Borda; Juyane Felipette Lima

2011-01-01

198

No inhibitor development after continuous infusion of factor concentrates in subjects with bleeding disorders undergoing surgery: a prospective study.  

UK PubMed Central (United Kingdom)

Inhibitor development against von Willebrand factor, factor VIII or factor IX is one of the most severe complications of treating patients with von Willebrand's disease (VWD), haemophilia A or haemophilia B respectively. Continuous infusion of factor concentrate has been implicated as a risk factor for inhibitor development. This prospective study investigated inhibitor development after continuous infusion of factor concentrate for surgical procedures in subjects with VWD or a severe form of haemophilia (factor activity <1%). Observations were made on the occurrence of inhibitor formation, adverse events and virus seroconversions. Main inclusion criteria comprised a negative history of inhibitors to replacement factor concentrate, ? 50 exposure days to factor concentrate and anticipated surgery requiring replacement factor coverage for ? 3 days. Therapy began with a bolus dose of 30-50 IU kg(-1) body weight of factor concentrate followed by continuous infusion with 3-4 IU kg(-1) h(-1) . Continuous infusion dose of factor concentrate was adjusted based on factor levels measured at least once daily. In 46 subjects included in the study to date, no inhibitors have been identified at discharge or follow-up (3-4 weeks after surgery), and no thrombotic events or postoperative wound infections occurred. All subjects underwent surgery without major blood loss, and hemostatic efficacy was generally rated 'excellent'. The results of the current study are promising, although the number of subjects is too small to make a definitive statement about the incidence of inhibitor development during continuous infusion of factor concentrate. Therefore, this study will be continued.

Auerswald G; Bade A; Haubold K; Overberg D; Masurat S; Moorthi C

2013-05-01

199

Heparin-induced thrombocytopenia in a hemodialysis patient treated with fondaparinux: nephrologists between two fires.  

UK PubMed Central (United Kingdom)

Heparin-induced thrombocytopenia (HIT) is caused by heparin exposure and presents with reduced platelet count. Patients undergoing hemodialysis (HD) treatment have increased risk of developing HIT due to prolonged exposure to unfractionated heparin or low-molecular weight heparin. We report a 79-year-old male patient with end-stage renal disease who developed type-II HIT during maintenance HD. Platelet count of the patient decreased gradually and antiplatelet factor IV antibody was found to be positive. The patient was treated with fondaparinux and continued heparin-free HD. Unfortunately, despite favorable initial response without any thrombotic episodes, the patient died due to severe sepsis complicated by gastrointestinal hemorrhage.

Solak Y; Demircioglu S; Polat I; Biyik Z; Gaipov A; Acar K; Turk S

2013-04-01

200

[Antibiotic dose adjustment in the treatment of MRSA infections in patients with acute renal failure undergoing continuous renal replacement therapies].  

UK PubMed Central (United Kingdom)

Acute renal failure is frequent in critically ill patients. In those patients who need renal replacement therapy, continuous techniques are an alternative to intermittent haemodialysis. Critically ill patients often have an infection, which can lead to sepsis and renal failure. An early and adequate antibiotic treatment at correct dosage is extremely important. Methicillin resistant Staphylococcus aureus (MRSA) is a frequent nosocomial pathogen that causes a high rate of morbidity and mortality in critically ill patients. Many antibiotics are easily removed by continuous renal replacement therapies (CRRT) leading to a high risk of under dosing and therapeutic failure or resistance breakthrough. The objective of this review is to assess the clinical evidence on the pharmacokinetics and dosage recommendations of the main antibiotic groups used in MRSA treatment in patients treated with CRRT.

Carcelero E; Soy D

2012-05-01

 
 
 
 
201

Robustness of System-Filter Separation for the Feedback Control of a Quantum Harmonic Oscillator Undergoing Continuous Position Measurement  

CERN Document Server

We consider the effects of experimental imperfections on the problem of estimation-based feedback control of a trapped particle under continuous position measurement. These limitations violate the assumption that the estimator (i.e. filter) accurately models the underlying system, thus requiring a separate analysis of the system and filter dynamics. We quantify the parameter regimes for stable cooling, and show that the control scheme is robust to detector inefficiency, time delay, technical noise, and miscalibrated parameters. We apply these results to the specific context of a weakly interacting Bose-Einstein condensate (BEC). Given that this system has previously been shown to be less stable than a feedback-cooled BEC with strong interatomic interactions, this result shows that reasonable experimental imperfections do not limit the feasibility of cooling a BEC by continuous measurement and feedback.

Szigeti, Stuart S; Hush, Michael R; Carvalho, Andre R R; Hope, Joseph J

2012-01-01

202

Thrombocytopenia in the setting of hemodialysis using biocompatible membranes.  

UK PubMed Central (United Kingdom)

Thrombocytopenia is a known potential side effect of hemodialysis, however, it is rarely seen in patients who undergo hemodialysis using biocompatible membranes. This case demonstrates hemodialysis-associated thrombocytopenia with use of biocompatible dialysis membranes that expose blood directly to polysulfone. The thrombocytopenia resolved in this patient when the dialysis membrane was changed to a biocompatible model with a polyethylene glycol barrier layer preventing direct interaction between patient blood and polysulfone. The calculated Naranjo ADR score of 9 indicates a highly probable adverse reaction.

Muir KB; Packer CD

2012-01-01

203

Continuous cerebrovascular reactivity monitoring and autoregulation monitoring identify similar lower limits of autoregulation in patients undergoing cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Cerebrovascular autoregulation can be monitored with a moving linear correlation of blood pressure to cerebral blood flow velocity (mean velocity index, Mx) during cardiopulmonary bypass (CPB). Vascular reactivity can be monitored with a moving linear correlation of blood pressure to cerebral blood volume trended with near-infrared spectroscopy (hemoglobin volume index, HVx). We hypothesized that the lower limits of autoregulation (LLA) and the optimal blood pressure (ABPopt) associated with the most active autoregulation could be determined by HVx in patients undergoing CPB. METHODS: Adult patients (n = 109) who underwent CPB for cardiac surgery had monitoring of both autoregulation (Mx) and vascular reactivity (HVx). Individual curves of Mx and HVx were constructed by placing each in 5 mmHg bins. The LLA and ABPopt for each subject were then identified by both methods and compared for agreement by correlation analysis and Bland-Altman. RESULTS: The average LLA defined by Mx compared to HVx were comparable (66±13 and 66±12 mmHg). Correlation between the LLA defined by Mx and HVx was significant (Pearson r = 0.2867; P = 0.0068). The average ABPopt with the most robust autoregulation by Mx was comparable to HVx (75±11 and 74±13 mmHg) with significant correlation (Pearson r = 0.5915; P < or =0.0001). DISCUSSION: Autoregulation and vascular reactivity monitoring are expected to be distinct, as flow and volume have different phasic relationships to pressure when cerebrovascular autoregulation is active. However, the two metrics have good agreement when identifying the LLA and optimal blood pressure in patients during CPB.

Blaine Easley R; Kibler KK; Brady KM; Joshi B; Ono M; Brown C; Hogue CW

2013-05-01

204

Anesthetic management and renal function in pediatric patients undergoing cytoreductive surgery with continuous hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin.  

UK PubMed Central (United Kingdom)

BACKGROUND: Extensive tumor implants secondary to sarcoma, sarcomatosis, or mesothelioma in children is rare. We conducted the first phase 1 trial of escalating doses of cisplatin during hyperthermic intraperitoneal chemotherapy (HIPEC) in children with sarcomatosis. The most devastating complication of cisplatin therapy is nephrotoxicity. Here we present the anesthetic management and analysis of the impact of intraoperative fluid management on the incidence of renal failure. METHODS: Of the 10 patients under 18 years of age who underwent HIPEC in the context of our phase 1 trial, six patients were under the age of 10 years. We reviewed the anesthetic management, intraoperative fluid and blood administration, and postoperative renal function in these patients. RESULTS: The average age and weight were 6 years and 20.9 kg, respectively. To avoid renal toxicity, urine output was maintained at an average of 3 ml/kg/h. Crystalloid and colloid were transfused at an average rate of 9 ml/kg/h. Percentage increase in creatinine postoperatively varied from 33 to 500 %. Volume of fluid administered did not correlate with percentage increase in creatinine. All patients had a temporary increase in their serum creatinine, but none required dialysis. CONCLUSIONS: Fluid administration at an average rate of 9 ml/kg/h was required to maintain satisfactory urine output. This rate of intraoperative fluid administration is similar to what is provided to adult HIPEC patients. There was no significant correlation in the volume or type of fluid delivered and the increase in serum creatinine. More studies are needed to determine optimal fluid management in children undergoing HIPEC with cisplatin.

Owusu-Agyemang P; Arunkumar R; Green H; Hurst D; Landoski K; Hayes-Jordan A

2012-08-01

205

Variables associated with circuit life span in critically ill patients undergoing continuous renal replacement therapy: a prospective observational study.  

Science.gov (United States)

One of the greatest problems in performing continuous renal replacement therapy (CRRT) is premature coagulation of the circuit. The aim of the current study was to monitor the circuit function prospectively and analyze patient-related variables that may affect circuit life. Critically ill patients admitted to the intensive care unit of a tertiary hospital between August 2010 and August 2011 receiving continuous veno-venous hemofiltration (CVVH) with systemic heparin anticoagulation were prospectively studied. Variables including body temperature, blood pH value, ionized calcium level, activated partial thromboplastin time (aPTT), prothrombin time (PT), platelet count, and heparin dose were collected and analyzed for their association with circuit life span. Fifty-four patients treated by CVVH were included, with 255 filters. The filter life was 29.7 ± 13.4 hours (mean ± standard deviation [SD]). Circuits with longer survival time appeared to have lower body temperature (37.80 ± 1.14 vs. 36.36 ± 1.09; p< 0.05), lower levels of serum ionized calcium (0.80 vs. 1.29; p< 0.05), and to be more acidic (7.233 vs. 7.377; p< 0.05). Cox regression showed that pH value and ionized calcium levels were significantly associated with circuit life. Other variables of hematocrit, albumin levels, platelet count, aPTT, PT, or dose of heparin were not significantly associated with circuit life. PMID:22210650

Zhang, Zhongheng; Ni, Hongying; Lu, Baolong

206

Variables associated with circuit life span in critically ill patients undergoing continuous renal replacement therapy: a prospective observational study.  

UK PubMed Central (United Kingdom)

One of the greatest problems in performing continuous renal replacement therapy (CRRT) is premature coagulation of the circuit. The aim of the current study was to monitor the circuit function prospectively and analyze patient-related variables that may affect circuit life. Critically ill patients admitted to the intensive care unit of a tertiary hospital between August 2010 and August 2011 receiving continuous veno-venous hemofiltration (CVVH) with systemic heparin anticoagulation were prospectively studied. Variables including body temperature, blood pH value, ionized calcium level, activated partial thromboplastin time (aPTT), prothrombin time (PT), platelet count, and heparin dose were collected and analyzed for their association with circuit life span. Fifty-four patients treated by CVVH were included, with 255 filters. The filter life was 29.7 ± 13.4 hours (mean ± standard deviation [SD]). Circuits with longer survival time appeared to have lower body temperature (37.80 ± 1.14 vs. 36.36 ± 1.09; p< 0.05), lower levels of serum ionized calcium (0.80 vs. 1.29; p< 0.05), and to be more acidic (7.233 vs. 7.377; p< 0.05). Cox regression showed that pH value and ionized calcium levels were significantly associated with circuit life. Other variables of hematocrit, albumin levels, platelet count, aPTT, PT, or dose of heparin were not significantly associated with circuit life.

Zhang Z; Ni H; Lu B

2012-01-01

207

Evaluation of a Continuing Professional Development program for first year student pharmacists undergoing an Introductory Pharmacy Practice Experience  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives: The purpose of the study was to evaluate a live and online training program for first year pharmacy students in implementing Continuing Professional Development (CPD) principles (Reflect, Plan, Act, and Evaluate), writing SMART learning objectives, and documenting learning activities prior to and during a hospital introductory professional practice experience.Design: Cohort Study. Setting: Introductory professional practice experience. Participants: First year (PY1) students at the University of North Carolina Eshelman School of Pharmacy. Intervention: Live training or online training to introduce the concept of Continuing Professional Development in practice. Main Outcomes: Implementation of CPD principles through 1) completed pre-rotation education action plans with specific, measurable, achievable, relevant and time-bound (SMART) learning objectives; and 2) completed learning activity worksheets post-rotation indicating stimuli for learning, resources used and accomplished learning. objectives; and 3) documented suggestions and content feedback for future lectures and pharmaceutical care lab experiences. Results: Out of the whole cohort (N=154), 14 (87.5%) live (in person) trainees and 122 (88%) online trainees submitted an education action plan. Objectives were scored using a rubric on a scale of 1-5. A rating of 5 means “satisfactory”, 3 means “work in progress” and 1 means “unacceptable”. There were significant differences between the mean live trainee scores and the mean online trainee scores for the following respective section comparisons: Specific 4.7 versus 3.29 (p<0.001); Measurable 3.9 versus 2.05 (p<0.001); number of objectives 3.6 versus 4.6 (p<0.001); and average grade 92.9 versus 77.7 (p<0.001). Of the 396 learning activity worksheets reviewed, 75% selected discussion with peers and/or health providers as a stimulus for learning. Students reported spending an average of 50.2 hours completing the learning objectives. All of the pre-stated objectives were fulfilled completely or partially. Conclusion: Live trainees performed significantly better than online trainees in writing SMART learning objectives. With focused training, students are more capable of implementing principles of CPD.

Toyin Tofade, MS, PharmD, BCPS, CPCC, Pharmacotherapy Director, Wake Area Health Education Center and Clinical Associate Professor, Division of Pharmacy Practice and Experiential Education; Brianna Franklin, student, fourth professional year; Bennett Noell, student, fourth professional year 1; Kim Leadon, MEd, Clinical Assistant Professor and Director of Experiential Education, Division of Pharmacy Practice and Experiential Education

2011-01-01

208

Evaluation of the estimated continuous cardiac output monitoring system in adults and children undergoing kidney transplant surgery: a pilot study.  

UK PubMed Central (United Kingdom)

Evaluation of the estimated continuous cardiac output (esCCO) allows non-invasive and continuous assessment of cardiac output. However, the applicability of this approach in children has not been assessed thus far. We compared the correlation coefficient, bias, standard deviation (SD), and the lower and upper 95 % limits of agreement for esCCO and dye densitography-cardiac output (DDG-CO) measurements by pulse dye densitometry (PDD) in adults and children. On the basis of these assessments, we aimed to examine whether esCCO can be used in pediatric patients. DDG-CO was measured by pulse dye densitometry (PDD) using indocyanine green. Modified-pulse wave transit time, obtained using pulse oximetry and electrocardiography, was used to measure esCCO. Correlations between DDG-CO and esCCO in adults and children were analyzed using regression analysis with the least squares method. Differences between the two correlation coefficients were statistically analyzed using a correlation coefficient test. Bland-Altman plots were used to evaluate bias and SD for DDG-CO and esCCO in both adults and children, and 95 % limits of agreement (bias ± 1.96 SD) and percentage error (1.96 SD/mean DDG-CO) were calculated and compared. The average age of the adult patients (n = 10) was 39.3 ± 12.1 years, while the average age of the pediatric patients (n = 7) was 9.4 ± 3.1 years (p < 0.001). For adults, the correlation coefficient was 0.756; bias, -0.258 L/min; SD, 1.583 L/min; lower and upper 95 % limits of agreement for DDG-CO and esCCO, -3.360 and 2.844 L/min, respectively; and percentage error, 42.7 %. For children, the corresponding values were 0.904; -0.270; 0.908; -2.051 and 1.510 L/min, respectively; and 35.7 %. Due to the high percentage error values, we could not establish a correlation between esCCO and DDG-CO. However, the 95 % limits of agreement and percentage error were better in children than in adults. Due to the high percentage error, we could not confirm a correlation between esCCO and DDG-CO. However, the agreement between esCCO and DDG-CO seems to be higher in children than in adults. These results suggest that esCCO can also be used in children. Future studies with bigger study populations will be required to further investigate these conclusions.

Terada T; Maemura Y; Yoshida A; Muto R; Ochiai R

2013-08-01

209

Population pharmacokinetics of piperacillin and tazobactam in critically ill patients undergoing continuous renal replacement therapy: application to pharmacokinetic/pharmacodynamic analysis.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To evaluate the pharmacokinetics of piperacillin/tazobactam in critically ill patients undergoing continuous renal replacement therapy (CRRT) and to assess the success of the therapy against susceptible bacteria. PATIENTS AND METHODS: Sixteen patients undergoing CRRT with different degrees of renal function were included in the study. Blood and ultrafiltrate samples were drawn after administration of piperacillin/tazobactam (4/0.5 g) every 4, 6 or 8 h. The data were analysed by a population approach using NONMEM 7.2. The probability of target attainment (PTA) of maintaining free piperacillin levels above the MIC during the entire dosing interval was estimated by simulation of intermittent and continuous infusions. RESULTS: The pharmacokinetics of piperacillin and tazobactam were best described by two-compartment models where the elimination of both drugs was conditioned by renal [dependent on creatinine clearance (CLCR)], non-renal and extracorporeal clearances. A 20 min infusion of piperacillin/tazobactam administered every 6 h provided high PTAs against MICs ?32 mg/L in patients with severe renal failure. In patients with normal or moderate renal function PTAs ?90% were only obtained up to MICs ?8 mg/L with short infusions. However, simulating continuous infusion, higher probabilities of success were obtained against MICs of 32 and 16 mg/L when CLCR was 50 and 100 mL/min, respectively. CONCLUSIONS: Population pharmacokinetic models have been developed and validated for piperacillin and tazobactam. Based on the pharmacokinetic/pharmacodynamic analysis, dosing recommendations are given considering the residual renal function of the patient and the MIC for the isolated bacteria.

Asín-Prieto E; Rodríguez-Gascón A; Trocóniz IF; Soraluce A; Maynar J; Sánchez-Izquierdo JA; Isla A

2013-08-01

210

Extending the benefits of early mobility to critically ill patients undergoing continuous renal replacement therapy: the Michigan experience.  

UK PubMed Central (United Kingdom)

Evidence to support improved outcomes with early ambulation is strong in medical literature. Yet, critically ill continuous renal replacement therapy (CRRT) patients remain tethered to their beds by devices delivering supportive therapy. The University of Michigan Adult CRRT Committee identified this deficiency and sought to change it. There was no guidance in the literature to support mobilizing this population; therefore, we reviewed literature from devices with similar technological profiles. Revision of our institutional mobility protocol for the CRRT population included a simple safety acronym, ASK. The acronym addresses appropriate candidacy; secured, appropriate access; and potential device and patient complications as a memorable aid to help nursing staff determine whether their CRRT patients are candidates for early mobility. After implementing our CRRT mobility standard, a preliminary study of 109 CRRT patients and a review of incident reports related to CRRT demonstrated no significant adverse patient events or falls and no access complications related to mobility. This deliberate intervention allows CRRT patients to safely engage in mobility activities to improve this population's outcomes. A simple mobility protocol and safety acronym partnered with strong clinical leadership has permitted the University of Michigan to add CRRT patients to the body of early mobility literature.

Talley CL; Wonnacott RO; Schuette JK; Jamieson J; Heung M

2013-01-01

211

The protein equivalent of nitrogen appearance in critically ill acute renal failure patients undergoing continuous renal replacement therapy.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the nutritional status of critically ill patients with acute renal failure on continuous renal replacement therapy (CRRT) and their protein needs by estimating the protein equivalent of nitrogen appearance (PNA). DESIGN: Prospective, observational study. SETTING: A 74-bed intensive care unit in a single tertiary care hospital. PATIENTS: Twenty-five consecutive critically ill patients with acute renal failure on CRRT. METHODS: The patients were studied over a period of 24 hours, at initiation on CRRT. The nutritional status was assessed by anthropometry and bioimpedance analysis. The PNA was estimated using the Bergstrom equation and PNA was normalized to body weight. RESULTS: The mean age was 58.2 +/- 17 years and 20 (80%) were male. The mean weight was 67 +/- 12 kg, body mass index was 25 +/- 3.5 kg/m(2), and triceps and subscapular skin fold thickness were 13 +/- 4.6 mm and 15 +/- 2.5 mm, respectively. Bioimpedance studies showed that the total body water was increased at 61.7 +/- 5.5% and body fat was 31.8 +/- 5.4%. The PNA was 103 +/- 35 g/day and normalized PNA was 1.57 +/- 0.4 g/kg/day. The mean protein intake was 0.56 +/- 0.38 g/kg/day, resulting in mean net negative protein balance of 1.0 +/- 0.6 g/kg/day. CONCLUSIONS: Malnutrition was uncommon in patients with acute renal failure at the time of initiation on CRRT, but their total body water was increased. They exhibited hypercatabolism and the mean normalized PNA was 1.57 g/kg/day. A large negative nitrogen balance was observed in them, since their protein intake was suboptimal.

Ganesan MV; Annigeri RA; Shankar B; Rao BS; Prakash KC; Seshadri R; Mani MK

2009-03-01

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[Effect of interleukin-10 level and human leukocyte antigen-DR expression as prognostic predictors in critically ill patients undergoing continuous renal replacement therapy].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To inquire into interleukin-10 (IL--10) level and monocyte expression of human leukocyte antigen--DR (HLA--DR) are predictors of infection and prognosis in critically ill patients undergoing continuous renal replacement therapy (CRRT). METHODS: A total of 43 critically ill patients undergoing continuous veno-venous hemofiltration (CVVH) were recruited from the intensive care unit (ICU). Anti--coagulated blood was obtained at 1 day before and 4 days after undergoing CVVH, and plasma IL--10 level (enzyme linked immunosorbent assay) and HLA--DR expression (flow cytometry) were determined. Thirty healthy subjects were enrolled as controls. In addition, the correlation between IL--10 and acute physiology and chronic health evaluation II (APACHEII) score was assessed. RESULTS: (1)Altogether, 7 patients died among a total of 43 critically ill patients, the mortality was 16.3%. Eighteen patients had negative cultures during the study (group I), and 19 patients had positive cultures (group II), and in 6 patients positive bacterial culture appeared 72 hours after the beginning of the treatment (group III). (2) The IL--10 level (ng/L) was higher in patients than in healthy subjects [23.46 (46.71) vs. 0.32 (0.45), P < 0.01]. Compared with group I, the levels of IL--10 in group II and III were higher significantly [40.20 (46.44), 41.78 (49.63) vs. 7.33 (21.05), both P < 0.05]. Continuous observation revealed that IL--10 rapidly lowered in group I after treatment [4.50 (7.44) vs. 7.33 (21.05), P < 0.05], while there was no apparent change in patients of other two groups. It was found that IL--10 was significant positive correlation with the APACHEII score (r = 0.71, P < 0.01).(3) HLA--DR was lower in patients than in healthy individuals [21.65% (25.62%) vs. 90.39% (9.80%), P < 0.01]. After CVVH, HLA--DR expression was obviously increased in group I [64.95% (35.03%) vs. 32.45% (45.03%), P < 0.01]. However, there were no significant changes in the other two groups. The patients who died had persistent and extremely low HLA--DR expression. CONCLUSIONS: (1)A significant discriminative power of IL--10 levels in predicting disease severity was found among the patients receiving CRRT, and persistently high IL--10 level predicts poor prognosis. (2) Persistently low monocyte HLA--DR expression may indicate concomitant or impending infection in patients receiving CRRT.

Fu LJ; Yu C; Gong DH; Ji DX; Liu ZH

2012-03-01

213

Music for Hemodialysis patients  

DEFF Research Database (Denmark)

Music for hemodialysis patients Background Patients starting a new regimen of dialysis often experience anxiety and other psychological disturbances. They struggle with the unknown situation, feelings of uncertainty and on top of that, a high level of sophisticated technological equipment. Music is known from literature to influence and dampen anxiety and tension and has been used for millennia in the treatment of illness. Here we report a study on the influence of music on patients undergoing dialysis and whether music has a potential for lowering discomfort in patients during first-time dialysis.   Purpose To investigate whether music can reduce feelings of anxiety, tension and restlessness in patients new to dialysis treatment and make them more relaxed during the treatment.   Method Twenty patients aged 42-84 were selected for participation in the study, which took place over two separate dialysis treatments. A crossover design was chosen and patients split in two groups. Group one would listen to music during the first treatment but not the second time. Group two would listen to music during the second treatment but not the first. Questionnaires and a special audio and music program created by the Danish composer Niels Eje were used.   Results This study shows that patients undergoing their first dialysis can have a positive experience and lower level of discomfort from listening to music during dialysis. Analysis of the questionnaire showed that patients listening to music were unaffected by alarms given by the machine during dialysis. The musical genre used in the study was well suited for patients undergoing first-time dialysis, as 80% (n=16) of the patients were pleased with the music. Although this is only a preliminary study with a limited number of patients, it shows an indication of music having a positive effect on patient anxiety and tension during their first dialysis treatment. As a direct consequence, the department has purchased a music player for use both by patients undergoing first-time dialysis and by more experienced patients in dialysis showing anxiety during treatment. These results will be published in relevant professional connections.    

Gross, B; Ketema Wassie, F

214

Enfermedad renal quística adquirida que simula una poliquistosis renal del adulto en un paciente en hemodiálisis crónica Acquired cystic kidney disease mimicking adult polycystic kidney disease in a patient undergoing chronic hemodialysis  

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Full Text Available Se presentó la evolución clínica de un paciente de 59 años de edad en hemodiálisis desde el año 1994, que llega a la insuficiencia renal crónica (IRC) terminal por la vía aparente de la hipertensión arterial, que luego de 11 años en el proceder dialítico desarrolla un aumento de tamaño de los riñones con grandes quistes, cuyo aspecto en la ecografía y en la tomografía es indistinguible de una poliquistosis renal dominante del adulto.The clinical evolution of a 59-year-old patient on hemodialysis since 1994 that apparently reaches the end-stage chronic kidney failure (CKF) by arterial hypertension is presented. After 11 years under the dialytic procedure, it is observed an increase of the size of the kidneys with large cysts, whose aspect in the echography and in the tomography is undistinguishable from an adult dominant polycystic kidney disease.

Yanet Parodis López; Betsy Llerena Ferrer; Orestes Benítez Llanes; Christian Leyva; Alexis Pérez Rodríguez; Midiala Suárez

2006-01-01

215

Effect of Addition of Magnesium Sulphate and Fentanyl to Ropivacaine Continuous Femoral Nerve Block in Patients Undergoing Elective Total Knee Replacement  

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Full Text Available This prospective double blinded study was designed to compare the effect of magnesium or fentanyl addition to ropivacaine in continuous femoral nerve block in patients undergoing elective total knee replacement under general anesthesia. Sixty patients undergoing elective TKR under general anesthesia, were randomly allocated into three equal groups, Group (R): given 30 mL Ropivacaine 0.2%. Group (R+F): given 30 mL Ropivacaine 0.2% and 4 ?g mL-1 fentanyl. Group (R+M): given 30 mL Ropivacaine 0.2% and 50 mg mL-1 of magnesium sulphate, through femoral catheter. The following parameters were evaluated: (1) demographic data of the patients and duration of the surgery, (2) intraoperative and postoperative hemodynamics, (3) intraoperative fentanyl requirements, (4) the severity of postoperative pain for 24 h, (5) time to first request of analgesia and (6) amount of postoperative morphine consumed in 0-6, 6-12, 12-18, 18-24 and 0-24 h, postoperatively. There were no difference among the three groups as regards the demographic data, the duration of the surgery, the pre and postoperative hemodynamics, the total intraoperative fentanyl consumption and the VAS during the 1st postoperative hour. The postoperative pain showed significant lower values in groups (R+F) and (R+M) compared to group (R) when measured at 6, 12, 18 and 24 postoperative hours. The time for the first postoperative request for analgesia was statistically longer in the (R+M) group and (R+F) group compared with group (R). The postoperative morphine consumption was statistically lower in groups (R+F) and (R+M) compared to group (R) but insignificant between groups (R+F) and (R+M). The admixture of magnesium sulphate or fentanyl to ropivacaine for continuous femoral nerve block provided a significant prolongation of postoperative analgesia than ropivacaine alone.

Md. Ashraf Abd Elmawgoud; Ahmed Badawy; Samaa Abu Elkassem; Doaa Rashwan

2008-01-01

216

Challenges in blood pressure measurement in patients treated with maintenance hemodialysis.  

UK PubMed Central (United Kingdom)

The association between blood pressure and cardiovascular outcomes in patients undergoing hemodialysis remains controversial. This may relate in part to the technique and device used and the timing of the blood pressure measurement in relation to the hemodialysis procedure. Emerging evidence indicates that standardized hemodialysis unit blood pressure measurements or measurements obtained at home, either by the patient or using an ambulatory blood pressure monitor, may offer advantages over routine hemodialysis unit blood pressure measurements for determining cardiovascular risk and treatment. This review discusses the available evidence and implications for clinicians and clinical trials.

Roberts MA; Pilmore HL; Tonkin AM; Garg AX; Pascoe EM; Badve SV; Cass A; Ierino FL; Hawley CM

2012-09-01

217

Hepatitis C virus infection in hemodialysis patients in Maracaibo, Venezuela.  

UK PubMed Central (United Kingdom)

Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.

Monsalve-Castillo F; Gómez-Gamboa L; Chacín-Bonilla L; Porto-Espinoza L; Costa-León L

2012-01-01

218

Hepatitis C virus infection in hemodialysis patients in Maracaibo, Venezuela.  

Science.gov (United States)

Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit. PMID:22370755

Monsalve-Castillo, Francisca; Gómez-Gamboa, Liliana; Chacín-Bonilla, Leonor; Porto-Espinoza, Leticia; Costa-León, Luciana

219

Intraoperative Continuous Norepinephrine Infusion Combined with Restrictive Deferred Hydration Significantly Reduces the Need for Blood Transfusion in Patients Undergoing Open Radical Cystectomy: Results of a Prospective Randomised Trial.  

UK PubMed Central (United Kingdom)

BACKGROUND: Open radical cystectomy (ORC) is associated with substantial blood loss and a high incidence of perioperative blood transfusions. Strategies to reduce blood loss and blood transfusion are warranted. OBJECTIVE: To determine whether continuous norepinephrine administration combined with intraoperative restrictive hydration with Ringer's maleate solution can reduce blood loss and the need for blood transfusion. DESIGN, SETTING, AND PARTICIPANTS: This was a double-blind, randomised, parallel-group, single-centre trial including 166 consecutive patients undergoing ORC with urinary diversion (UD). Exclusion criteria were severe hepatic or renal dysfunction, congestive heart failure, and contraindications to epidural analgesia. INTERVENTION: Patients were randomly allocated to continuous norepinephrine administration starting with 2?g/kg per hour combined with 1ml/kg per hour until the bladder was removed, then to 3ml/kg per hour of Ringer's maleate solution (norepinephrine/low-volume group) or 6ml/kg per hour of Ringer's maleate solution throughout surgery (control group). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Intraoperative blood loss and the percentage of patients requiring blood transfusions perioperatively were assessed. Data were analysed using nonparametric statistical models. RESULTS AND LIMITATIONS: Total median blood loss was 800ml (range: 300-1700) in the norepinephrine/low-volume group versus 1200ml (range: 400-2800) in the control group (p<0.0001). In the norepinephrine/low-volume group, 27 of 83 patients (33%) required an average of 1.8 U (±0.8) of packed red blood cells (PRBCs). In the control group, 50 of 83 patients (60%) required an average of 2.9 U (±2.1) of PRBCs during hospitalisation (relative risk: 0.54; 95% confidence interval [CI], 0.38-0.77; p=0.0006). The absolute reduction in transfusion rate throughout hospitalisation was 28% (95% CI, 12-45). In this study, surgery was performed by three high-volume surgeons using a standardised technique, so whether these significant results are reproducible in other centres needs to be shown. CONCLUSIONS: Continuous norepinephrine administration combined with restrictive hydration significantly reduces intraoperative blood loss, the rate of blood transfusions, and the number of PRBC units required per patient undergoing ORC with UD.

Wuethrich PY; Studer UE; Thalmann GN; Burkhard FC

2013-08-01

220

Nutritional Assessment of Hemodialysis Patients  

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Full Text Available The objective of this study was to evaluate the nutrition status of chronic renal failure (CRF) patients. The study was carried out in 61 CRF patients (29 males and 32 females) who had been undergoing Maintenance Hemodialysis (MH). The mean intake of energy was 19.4±6.8 kcal/kg/day. Notably 95.1% of patients had energy intake below the recommendations for hemodialysis patients (HP) (30-35 kcal/kg/day). The mean intake of dietary protein was 0.8±0.4 g/kg/day which was substantially less than the recommended intake for hemodialysis patients (HP) (1.2-1.4 g/kg/day). About 82% of patients had the protein intake below 1.2 g/kg/day. The intake of calcium, phosphorus, iron, vitamin C, vitamin B6, folate and vitamin B12 was also inadequate. Most of patients had intake of these nutrients below the recommendations. The mean serum albumin level was 3.37±6.5 g dL-1 which was substantially less than normal range. Moreover, 60% of patients had a serum albumin level of less than 3.5 g dL-1. The mean hemoglobin concentration was 11.4 g dL-1 with 48% of patients had hemoglobin concentrations below normal levels; meanwhile 46% of patients had hematocrit value below 30%. In conclusion, malnutrition is common in HP and high percent of HP in Saudi Arabia are at high risk mortality and morbidity. It seem important to take some responsible and effective steps to correct the malnutrition of HP. Increasing the intake of energy, protein and other nutrients, especially, calcium, iron, folate, vitamin B12, vitamin B6 and vitamin C is recommended for HP.

Ali A. Alshatwi; Agdir Alshmary; Abdrohman Al-Khalifa

2007-01-01

 
 
 
 
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Aspectos nutricionais e epidemiológicos de pacientes com doença renal crônica submetidos a tratamento hemodialítico no Brasil, 2010 Nutritional and epidemiological aspects of patients with chronic renal failure undergoing hemodialysis from Brazil, 2010  

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Full Text Available INTRODUÇÃO: O Comitê de Nutrição da Sociedade Brasileira de Nefrologia (SBN) realizou, em 2010, o primeiro Censo Brasileiro de Nutrição em pacientes em Hemodiálise. Dados multicêntricos contribuem para o desenvolvimento de condutas clínicas e intervenção nutricional. OBJETIVO: Descrever aspectos nutricionais e epidemiológicos de pacientes em hemodiálise. MÉTODO: Estudo transversal em 36 clínicas de diálise, 2.622 participantes selecionados aleatoriamente. Foram coletados: registros sociodemográficos, clínicos, bioquímicos e antropométricos. RESULTADOS: Dos pacientes, 60,45% era da região Sudeste, 13,53% Nordeste, 12,81% Sul, 10,33% Centro-Oeste e 2,86% Norte. Cerca de 58% eram homens e 63,1% tinham menos de 60 anos. Casados ou em união estável, 58,5% deles. Aproximadamente 80% dependia do Sistema Único de Saúde. O tabagismo apresentou diferença entre sexo e idade. As etiologias presuntivas foram nefroesclerose hipertensiva 26,4%, nefropatia diabética 24,6%, causas desconhecidas/não diagnosticadas 19,9%, glomerulopatias 13,6% e outros 11,2%. A hipertensão arterial e o Diabetes Mellitus acometiam aproximadamente 30% dos pacientes, principalmente aqueles acima de 60 anos. O Índice de Massa Corporal não diferiu entre sexos, embora tenha diferido entre grupos etários e quando utilizados critérios de avaliação distintos. A média de circunferência da cintura de homens e mulheres foi, respectivamente, 90,5 cm e 88,0 cm. O perfil lipídico não diferiu entre às faixas etárias, porém, houve diferenças entre sexos. Os valores de albumina estiveram menores nas mulheres e em pacientes com idade superior a 60 anos. CONCLUSÃO: O estudo caracterizou os pacientes em hemodiálise no Brasil em 2010, podendo subsidiar novos estudos para acompanhamento de transições nutricionais e epidemiológicas da população.INTRODUCTION: The Nutrition Committee of the Brazilian Society of Nephrology (SBN) held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention. OBJECTIVE: To describe epidemiological and nutritional aspects of hemodialysis patients. METHOD: Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected. RESULTS: 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%), Diabetic Nephropathy (24.6%), unknown/undiagnosed causes (19.9%), Glomerulopathies (13.6%) and others (11.2%). Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years. CONCLUSION: This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.

Bárbara Margareth Menardi Biavo; Carmen Tzanno-Martins; Lucas Maciel Cunha; Melissa Luciana de Araujo; Márcia Machado Cunha Ribeiro; Anita Sachs; Clarissa Baia Bargas Uezima; Sérgio Antonio Draibe; Cibele Isaac Saad Rodrigues; Elvino José Guardão Barros

2012-01-01

222

Clinical evaluation of the flotrac/vigileo™ system for continuous cardiac output monitoring in patients undergoing regional anesthesia for elective cesarean section: a pilot study  

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Full Text Available BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo™ system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo™ system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A prospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements), after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia), at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis. RESULTS: There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P < 0.01). Importantly, stroke volume variation increased immediately after newborn delivery (P < 0.001) and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time. DISCUSSION AND CONCLUSIONS: No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia.

José Otavio Costa Auler Junior; Marcelo L.A. Torres; Mônica M. Cardoso; Thais C Tebaldi; André P. Schmidt; Mario M. Kondo; Marcelo Zugaib

2010-01-01

223

Xerostomia in patients on chronic hemodialysis.  

UK PubMed Central (United Kingdom)

Xerostomia is the subjective feeling of a dry mouth, which is relatively common in patients on chronic hemodialysis. Xerostomia can be caused by reduced salivary flow secondary to atrophy and fibrosis of the salivary glands, use of certain medications, restriction of fluid intake and old age. In patients undergoing hemodialysis, xerostomia is associated with the following problems: difficulties in chewing, swallowing, tasting and speaking; increased risk of oral disease, including lesions of the mucosa, gingiva and tongue; bacterial and fungal infections, such as candidiasis, dental caries and periodontal disease; interdialytic weight gain resulting from increased fluid intake; and a reduction in quality of life. Unfortunately, no effective treatment exists for xerostomia in patients on chronic hemodialysis. The stimulation of salivary glands by mechanical means (such as chewing gum) or pharmacological agents (such as pilocarpine and angiotensin-converting-enzyme inhibitors, the latter alone or in combination with angiotensin-receptor blockers), as well as saliva substitutes, are all ineffective, or effective only in the short term. Xerostomia remains a frustrating symptom for patients on hemodialysis, and further efforts should be made to find an effective treatment for it in the near future.

Bossola M; Tazza L

2012-03-01

224

Optimal nutrition in hemodialysis patients.  

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Protein-energy wasting (PEW) is highly prevalent in patients undergoing maintenance hemodialysis (MHD). It is important to note that there is a robust association between the extent of PEW and the risk of hospitalization and death in these patients, regardless of the nutritional marker used. The multiple etiologies of PEW in advanced kidney disease are still being elucidated. Apart from the multiple mechanisms that might lead to PEW, it appears that the common pathway for all of the derangements is related to exaggerated protein degradation along with decreased protein synthesis. The hemodialysis procedure per se is an important contributor to this process. Metabolic and hormonal derangements such as acidosis, inflammation, and resistance to anabolic properties of insulin resistance and growth hormone are all implicated for the development of PEW in MHD patients. Appropriate management of MHD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition should be attempted in patients who cannot efficiently use the gastrointestinal tract. Other anabolic strategies such as exercise, anabolic hormones, anti-inflammatory therapies, and appetite stimulants can be considered as complementary therapies in suitable patients.

Ikizler TA

2013-03-01

225

The Effect of Acupressure on Quality of Sleep in Hemodialysis Patients  

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Full Text Available Sleep disorders are the most prevalent complaints in hemodialysis patients. Treatments such as Air Way Positive Pressure and medicines frequently are not available or may have side effects. Acupressure is a non-invasive method from traditional Chinese medicine. The effectiveness of this method in treatment of sleep disorders has been proved in some studies. The aim of this study is to research the effect of Acupressure on quality of sleep in hemodialysis patients. This study was a randomized clinical trial; conducted at Razi hospital on a sample of 62 hemodialysis patients who had complains from sleep disorders. The sample were randomized into experimental and control groups. The experimental group received acupressure 3 times per week while undergoing dialysis for 4 weeks. The control group only received unit routine care. Quality of life was measured using Pittsburgh Sleep Quality Index (PSQI) before and after intervention. In order to record the pattern of quality of sleep the sleep log were used. Statistical analysis was done by Chi-square, T-test, Mann-Withney and Wilcoxone test. Findings on quality of life showed statistically significant differences between experimental and control groups based on PSQI. Domain of subjective quality of life (p = 0.042), time needed to falling sleep (p = 0.007), sleep duration (p = 0.017), habitual sleep efficiency (p = 0.001), sleep disorders (p = 0.024), daily performance disorders (p = 0.002) and overall score (p = 0.001) were improved in experimental group compared to control group. Moreover, sleep log demonstrated the decrease in nighttime waking and increase in quality of sleep that started from the first week of intervention and continued up to one week after intervention. This study confirmed the previously published studies which showed the effect of acupressure on improving the quality of sleep in hemodialysis patients. This treatment could be used as a non-invasive method for treatment of sleep disorders in these patients.

Eisa Nasiri; Mehdi Raei; Javad Vatani; Razieh Khajeh- Kazemi

2011-01-01

226

Anterior chamber depth during hemodialysis  

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Background Exacerbation of chronic glaucoma or acute glaucoma is occasionally observed in patients undergoing hemodialysis (HD) because of anterior chamber depth changes during this therapy. Purpose To evaluate anterior chamber depth and axial length in patients during HD sessions. Methods A total of 67 eyes of 35 patients were prospectively enrolled. Axial length and anterior chamber depth were measured using ultrasonic biometry, and these measures were evaluated at three different times during HD sessions. Body weight and blood pressure pre- and post-HD were also measured. Results There was no difference in the axial length between the three measurements (P = 0.241). We observed a significantly decreased anterior chamber depth (P = 0.002) during HD sessions. Conclusion Our results support the idea that there is a change in anterior chamber depth in HD sessions.

Gracitelli, Carolina Pelegrini Barbosa; Stefanini, Francisco Rosa; Penha, Fernando; Goes, Miguel Angelo; Draibe, Sergio Antonio; Canziani, Maria Eugenia; Junior, Augusto Paranhos

2013-01-01

227

Destructive spondyloarthropathy in hemodialysis patients  

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A destructive spondyloarthropathy is reported in four patients undergoing maintenance hemodialysis for chronic renal disease. In a separate investigation a controlled, prospective radiographic study of the cervical spine revealed this spondyloarthropathy in 4 (15%) of 26 long-term dialysis patients. A single disk level was involved in three patients, and two disc levels were involved in one patient. This spondyloarthropathy correlated with the duration of dialysis but not with the radiographic evidence of renal osteodystrophy or severity of laboratory abnormalities associated with hyperparathyroidism. Three of these four patients also had discovertebral erosions or destruction involving the lumbar spine. Cervical spine flexion views revealed evidence of ligamentous laxity or instability in three (12%) dialysis patients, all with vertebral resorption and disc space narrowing. It is postulated that this instability may contribute to the development of cervical discovertebral lesions or be a secondary manifestation of disc destruction. (orig.).

1988-01-01

228

Clinical evaluation of the flotrac/vigileo? system for continuous cardiac output monitoring in patients undergoing regional anesthesia for elective cesarean section: a pilot study  

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Full Text Available Abstract in english BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo? system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo? system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A p (more) rospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements), after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia), at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis. RESULTS: There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P

Auler Junior, José Otavio Costa; Torres, Marcelo L.A.; Cardoso, Mônica M.; Tebaldi, Thais C; Schmidt, André P.; Kondo, Mario M.; Zugaib, Marcelo

2010-06-01

229

Carboplatin Pharmacokinetics in a Patient Receiving Hemodialysis.  

UK PubMed Central (United Kingdom)

With refinements and advances in hemodialysis techniques, survival for patients with end-stage renal disease has improved significantly. To our knowledge, however, no prospective trials have been performed in patients receiving hemodialysis who are also diagnosed with cancer and are candidates for chemotherapy. We describe a 73-year-old man who was diagnosed with high-grade neuroendocrine carcinoma, metastatic to the bone and lymph nodes, and was undergoing hemodialysis. Although cisplatin is more commonly used in the treatment of metastatic neuroendocrine cancers, it may not be the best option in patients who suffer from renal insufficiency. Carboplatin is a second-generation, nonnephrotoxic platinum analog that can be hemodialyzed, although no formal guidelines are available regarding the dosing for patients receiving hemodialysis. This case describes a patient who was treated with five cycles of combination carboplatin 115 mg/m(2) on day 1 and etoposide 50 mg/m(2) on day 1 and day 3 of a 28-day cycle. Dialysis was performed for 3.5 hours starting 90 minutes after completion of carboplatin on day 1. Pharmacokinetic assessments were performed at 1, 2, 4, and 12 hours after chemotherapy infusion on day 1 of cycle 1. Total carboplatin concentrations in plasma and platinum ultrafiltrate were measured. The plasma concentration of free platinum at the end of the infusion was 31,000 ng/ml, and the area under the plasma concentration-time curve was 2.9 minute·mg/ml. No significant carboplatin-related toxicities were reported. This case report indicates that carboplatin can be safely administered in patients receiving hemodialysis.

Fong MK; Fetterly GJ Jr; McDougald LJ; Iyer RV

2013-09-01

230

NUTRITIONAL STATUS AND FOOD INSECURITY IN HEMODIALYSIS PATIENTS  

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Objective: The purpose of this study was to determine if a relationship exists between nutrition status, and food security of patients on hemodialysis (HD). Design: A descriptive, correlation study. Setting: This study consisted of HD patients undergoing treatment at three northeast Louisiana dial...

231

Sildenafil citrate can improve erectile dysfunction among chronic hemodialysis patients  

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Erectile dysfunction (ED) is common among patients with end-stage renal disease (ESRD), who undergo hemodialysis (HD). The aim of this study was to evaluate the safety and effectiveness of sildenafil in male HD patients with ED. Twenty-seven HD patients were recruited for this prospective, randomize...

Ghafari, A.; Farshid, B.; Afshari, A. T.; Sepehrvand, N.; Rikhtegar, E.; Ghasemi, K.; Hatami, S.

232

Rising burden of Hepatitis C Virus in hemodialysis patients  

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Abstract Aim High prevalence of Hepatitis C virus (HCV) has been reported among the dialysis patients throughout the world. No serious efforts were taken to investigate HCV in patients undergoing hemodialysis (HD) treatment who are at great increased risk to HCV. HCV genotypes are i...

Khan Sanaullah; Attaullah Sobia; Ali Ijaz; Ayaz Sultan; Naseemullah; Khan Shahid; Siraj Sami; Khan Jabbar

233

Age and Dialysis Adequacy in Maintenance Hemodialysis Patients  

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Full Text Available Aim: The issue of optimal dialysis dose and frequency has been a central topic in the delivery of dialysis treatment. We aimed to consider the effects of age on some hemodialysis parameters specially dialysis adequacy by urea reduction rate (URR) and to compare these parameters between diabetics and non diabetic HD(hemodialysis) patients. Material and Method: Patients with end-stage renal disease (ESRD), undergoing maintenance hemodialysis treatment were considered. The urea reduction rate and body mass index were calculated. Results: The total patients were 60 (F=21 M=39), consisting of 44 non diabetic hemodialysis patients (F=15 M=29), and 16 diabetic hemodialysis patients (F=6 M=10). A significant difference of dialysis adequacy between non-diabetics and diabetics was observed with lower values in diabetic group and a significant difference of dialysis adequacy and creatinine was observed in patients, with ages below and more than 50 years old with lower values in older patients. A significant negative correlation of age with dialysis adequacy in total hemodialysis patients and a significant negative correlation of age with serum creatinine were observed. Discussion: The negative effect of age on dialysis adequacy needs more attention to this aspect  to reduce the dialysis complications which is frequently observed in older patients.

Hamid Nasri

2013-01-01

234

Association of Serum Homocysteine with Anemia in Maintenance Hemodialysis Patients  

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Full Text Available To investigate the relationship between homocysteine level and anemia in maintenance hemodialysis patients, a cross-sectional study that was conducted on patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis treatment. The study was carried out on 39 (F=15 M=24) stable hemodialysis HD patients. Mean ages of patients were 46?18 years. The length of the time patients had been on hemodialysis was 30?35 months (median: 18 months). The value of serum homocysteine of all patients was 5?2 ?mol/L (median : 4.5 ?mol/L). Mean?SD of hemoglobin and hematocrit level of all patients were 9?2 g/dl (median : 9 g/dl), and 28?6% median: 29% respectively. In this study, we assessed for the first time the positive relation of serum homocysteine with anemia in patients on maintenance hemodialysis. In addition, in male HD patients a significant positive correlation of serum homocysteine with serum ferritin and a significant inverse correlation of serum homocysteine with serum total iron binding capacity (TIBC) were seen. It is possible that the high levels of serum homocysteine in some conditions may increases the micro inflammatory state of uremia in hemodialysis patients and had a role in intensification of anemia. In the meantime more research needs to confirm our conclusion.

M.D. Hamid Nasri; M.D. Azar Baradaran

2005-01-01

235

Successful Treatment of Small-Cell Lung Cancer With Irinotecan in a Hemodialysis Patient With End-Stage Renal Disease  

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The prognosis of patients with end-stage renal disease has improved with advances in hemodialysis techniques. However, many patients who undergo hemodialysis suffer from various types of cancer. Limited data is available to guide clinical management of these patients who may have impaired renal func...

Kim, Dong Min; Kim, Hyun Lee; Chung, Choon Hae; Park, Chi Young

236

Nutritional status of zinc and activity superoxide dismutase in chronic renal patients undergoing hemodialysis Estado nutricional del zinc y actividad de la enzima superóxido dismutasa en pacientes con enfermedad renal crónica en hemodiálisis  

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Full Text Available Introduction: Chronic kidney disease promotes changes in the zinc nutritional status and in the antioxidant defense system. This study assessed the relationship between the parameters of the zinc nutritional status and the activity of superoxide dismutase in patients with chronic renal failure who are receiving hemodialysis. Methods: 134 individuals, aged between 18 and 85 years, were divided into two groups: case group (hemodialyzed patients, n = 63) and control group (n = 71). Zinc concentrations in plasma and erythrocytes were determined using the flame atomic absorption spectrophotometry technique. The activity of superoxide dismutase enzyme was determined according to Ransod kit. Results: The mean values of plasma zinc were 62.02 ± 13.59 ?g/dL and 65.58 ± 8.88 ?g/dL, and for erythrocytary zinc the values were 54.52 ± 22.82 ?gZn/gHb and 48.01 ± 15.08 ?gZn/gHb for the chronic renal patients and the control group, respectively. The activity of superoxide dismutase was significantly lower in patients when compared with the control group (p Introducción: La enfermedad renal crónica produce cambios en el estado nutricional del zinc y en el sistema de defensa antioxidante. Por lo tanto, este estudio investigó la relación entre parámetros del estado nutricional del zinc y la actividad de la enzima superóxido dismutase en pacientes con enfermedad renal crónica en hemodiálisis. Métodos: Se incluyeron 134 personas, de 20 a 59 años de edad que fueron divididos en dos grupos: grupo caso (pacientes en hemodiálisis, n = 63) y grupo control (n = 71). El zinc plasmático y eritrocitario fueron analizados según el método de espectrofotometría de absorción atómica. La actividad de la enzima superóxido dismutasa fue analizada de acuerdo con Kit Ransod. Resultados: Los valores medios de zinc plasmatico fueron 62,02 ± 13,59 ?g/dL y 65,58 ± 8,88 ?g/dL y los valores de zinc eritrocitario fueron 54,52 ± 22,82 ?gZn/gHb y 48,01 ± 15,08 ?gZn/gHb, en los pacientes en hemodialisis y en el grupo control, respectivamente. La actividad de la superoxido dismutasa fue significantemente inferior en los pacientes que en controles (p < 0,05). Conclusiones: La actividad de la superóxido dismutasa en pacientes con enfermedad renal crónica en hemodiálisis, que es influenciada por la concentración del zinc, fue significantemente inferior. Hubo una respuesta inadecuada por la enzima al estrés oxidativo en pacientes en hemodiálisis.

R. C. Noleto Magalhães; C. Guedes Borges de Araujo; V. Batista de Sousa Lima; J. Machado Moita Neto; N. do Nascimento Nogueira; D. do Nascimento Marreiro

2011-01-01

237

Nutritional status of zinc and activity superoxide dismutase in chronic renal patients undergoing hemodialysis/ Estado nutricional del zinc y actividad de la enzima superóxido dismutasa en pacientes con enfermedad renal crónica en hemodiálisis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Introducción: La enfermedad renal crónica produce cambios en el estado nutricional del zinc y en el sistema de defensa antioxidante. Por lo tanto, este estudio investigó la relación entre parámetros del estado nutricional del zinc y la actividad de la enzima superóxido dismutase en pacientes con enfermedad renal crónica en hemodiálisis. Métodos: Se incluyeron 134 personas, de 20 a 59 años de edad que fueron divididos en dos grupos: grupo caso (pacientes en hemod (more) iálisis, n = 63) y grupo control (n = 71). El zinc plasmático y eritrocitario fueron analizados según el método de espectrofotometría de absorción atómica. La actividad de la enzima superóxido dismutasa fue analizada de acuerdo con Kit Ransod. Resultados: Los valores medios de zinc plasmatico fueron 62,02 ± 13,59 ?g/dL y 65,58 ± 8,88 ?g/dL y los valores de zinc eritrocitario fueron 54,52 ± 22,82 ?gZn/gHb y 48,01 ± 15,08 ?gZn/gHb, en los pacientes en hemodialisis y en el grupo control, respectivamente. La actividad de la superoxido dismutasa fue significantemente inferior en los pacientes que en controles (p Abstract in english Introduction: Chronic kidney disease promotes changes in the zinc nutritional status and in the antioxidant defense system. This study assessed the relationship between the parameters of the zinc nutritional status and the activity of superoxide dismutase in patients with chronic renal failure who are receiving hemodialysis. Methods: 134 individuals, aged between 18 and 85 years, were divided into two groups: case group (hemodialyzed patients, n = 63) and control group (n (more) = 71). Zinc concentrations in plasma and erythrocytes were determined using the flame atomic absorption spectrophotometry technique. The activity of superoxide dismutase enzyme was determined according to Ransod kit. Results: The mean values of plasma zinc were 62.02 ± 13.59 ?g/dL and 65.58 ± 8.88 ?g/dL, and for erythrocytary zinc the values were 54.52 ± 22.82 ?gZn/gHb and 48.01 ± 15.08 ?gZn/gHb for the chronic renal patients and the control group, respectively. The activity of superoxide dismutase was significantly lower in patients when compared with the control group (p

Noleto Magalhães, R. C.; Guedes Borges de Araujo, C.; Batista de Sousa Lima, V.; Machado Moita Neto, J.; do Nascimento Nogueira, N.; do Nascimento Marreiro, D.

2011-12-01

238

Prevalência de infecção latente por Mycobacterium tuberculosis e risco de infecção em pacientes com insuficiência renal crônica em hemodiálise em um centro de referência no Brasil/ Prevalence of latent tuberculosis infection and risk of infection in patients with chronic kidney disease undergoing hemodialysis in a referral center in Brazil  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: Determinar a prevalência da infecção latente por Mycobacterium tuberculosis (ILMT) e o risco de infecção em pacientes com insuficiência renal crônica em um centro de hemodiálise. MÉTODOS: Foram incluídos no estudo 307 pacientes com insuficiência renal crônica em tratamento hemodialítico no Instituto Mineiro de Nefrologia, na cidade de Belo Horizonte (MG). Todos os pacientes foram submetidos a testes tuberculínicos (TTs). O efeito booster e a virage (more) m tuberculínica foram avaliados. Se o primeiro TT (TT1) era negativo, um segundo (TT2) era realizado 1-3 semanas após o TT1 para investigar o efeito booster. Se o TT2 também era negativo, um terceiro (TT3) era realizado um ano após o TT2 para identificar a viragem tuberculínica. RESULTADOS: A prevalência da ILMT, quando considerado o ponto de corte de 5 mm de enduração, foi de 22,2% no TT1, com incremento de 11,2% no TT2. A prevalência da ILMT, quando considerado o ponto de corte de enduração de 10 mm, foi de 28,5% no TT1, com incremento de 9,4% no TT2. Um aumento significativo da prevalência da ILMT foi observado entre TT1 e TT2 (efeito booster) e entre TT2 e TT3 (p Abstract in english OBJECTIVE: To determine the prevalence of latent tuberculosis infection (LTBI) and the risk of infection in patients with chronic kidney disease treated at a hemodialysis center. METHODS: We included 307 patients with chronic kidney disease undergoing hemodialysis at the Mineiro Institute of Nephrology, located in the city of Belo Horizonte, Brazil. All of the patients were submitted to tuberculin skin tests (TSTs). We investigated the booster effect and TST conversion. I (more) f the initial TST (TST1) was negative, a second TST (TST2) was performed 1-3 weeks later in order to investigate the booster effect. If TST2 was also negative, a third TST (TST3) was performed one year after TST2 in order to determine whether there was TST conversion. RESULTS: When we adopted a cut-off induration of 5 mm, the prevalence of LTBI was 22.2% on TST1, increasing by 11.2% on TST2. When we adopted a cut-off induration of 10 mm, the prevalence of LTBI was 28.5% on TST1, increasing by 9.4% on TST2. The prevalence of LTBI increased significantly from TST1 to TST2 (booster effect), as well as from TST2 to TST3 (p

Fonseca, Jane Corrêa; Caiaffa, Waleska Teixeira; Abreu, Mery Natali Silva; Farah, Katia de Paula; Carvalho, Wânia da Silva; Miranda, Silvana Spindola de

2013-04-01

239

Evaluación a largo plazo de la respuesta inmunológica a la vacuna de la hepatitis B en 136 pacientes en hemodiálisis/ Long-term evaluation of inmune response to hepatitis b vaccine in 136 patients undergoing hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish La respuesta inmunitaria a la vacuna de la hepatitis B (HB) está impedida en los pacientes en hemodiálisis (HD), y la persistencia de la inmunidad, la eficacia de la revacunación y la periodicidad de la realización de controles serológicos no están bien definidas. Presentamos la experiencia de un protocolo de vacunación de la HB con tres dosis intramusculares de 40 µg de vacuna recombinante (Engerix®-B) en un grupo de 136 pacientes atendidos en una unidad de HD a (more) lo largo de 18 años. Se realizaron controles anuales de anticuerpos anti-HB en todos los pacientes, y semestrales en 31; y se administraba anualmente una dosis doble de vacuna a los pacientes que no respondían o cuando los niveles de anticuerpos descendían por debajo de 10 UI/ml. Setenta y cuatro pacientes (54,4%) presentaron seroconversión, mientras que 62 pacientes no respondieron. La edad de los pacientes era superior en el grupo de no respondedores, pero no se observaron diferencias en el sexo ni en la etiología de la enfermedad renal. Un 32% de los pacientes respondedores perdió la memoria inmunológica al primer año de la vacunación, y tan sólo un 18% de los pacientes permaneció inmunizado a los seis años. El título de anticuerpos inmediatamente después de completar la vacunación fue predictor del mantenimiento de la memoria inmunológica: un 75% de los pacientes con títulos de anticuerpos >1.000 UI/ml mantuvo la seroprotección a los tres años en comparación con un 47% con títulos entre 100-999 (p = 0,08), y un 34% con títulos entre 11-99 (p = 0,02). La administración de dosis de refuerzo fue efectiva en un 24% de los pacientes no respondedores, y un 69% mantenía la respuesta inmunológica al final del primer año. Las dosis de refuerzo repetidas en pacientes no respondedores a una primera dosis consiguieron nuevas seroconversiones en un 19,6% de los pacientes. La práctica de controles semestrales podría haber permitido administrar dosis de recuerdo antes del período anual en un 16% de los pacientes respondedores. En conclusión, nuestros resultados demuestran que un protocolo de vacunación de la HB con un seguimiento serológico regular y dosis de refuerzo sucesivas consigue una aceptable seroprotección en los pacientes en hemodiálisis. Abstract in english Hemodialysis (HD) patients have an impaired response to hepatitis B (HB) vaccines, and the persistence of immunity, the efficacy of revaccination and the periodicity of postvaccination testing are not well defined. We present the experience during 18 years in an outpatient dialysis center of 136 HD patients who completed a HB vaccination program consisting in 3 doses of 40 µg intramuscular recombinant B vaccine (Engerix-B). In all patients anti-HBs titers were determined (more) annually and in 31 patients every 6 months. Nonresponders patients and responders patients that lost their antibodies (

Pin, M.; Compte, M.T.; Angelet, P.; Gállego, C.; Gutiérrez, C.; Martínez Vea, A.

2009-01-01

240

The experience and self-management of fatigue in patients on hemodialysis.  

UK PubMed Central (United Kingdom)

Fatigue is a common and debilitating symptom for adult patients with end stage renal disease on hemodialysis, and has been associated with decreased survival and quality of life. Patients on hemodialysis must find ways to manage their fatigue and mitigate its effects on their lives. The purpose of this qualitative descriptive work was to describe the experience and self-management of fatigue in patients on incenter hemodialysis. Several themes were identified which included the nature of fatigue, management of fatigue, consequences of fatigue, and factors associated with fatigue. This information will be valuable to nephrology nurses as they continue to care for and educate patients on hemodialysis.

Horigan AE; Schneider SM; Docherty S; Barroso J

2013-03-01

 
 
 
 
241

Quantitative microbiological monitoring of hemodialysis fluids: evaluation of methods and demonstration of lack of test relevance in single-pass hemodialysis machines with automatic dialysate proportioning with reverse osmosis-treated tap water.  

UK PubMed Central (United Kingdom)

Two methods for estimating the quantity of microorganisms present in hemodialysis fluid, a blood agar surface-spread plate method and a total-count water tester device impregnated with modified standard plate count agar (Millipore Corp., Bedford, Mass.), were evaluated. Both methods exhibited comparable precision; however, colony counts obtained with the total-count water tester were consistently and unacceptably low. The need for routine quantitative microbiological monitoring of hemodialysis fluids such as that recommended by the American Public Health Association was not supported by the results of this study. Such testing was not of value in predicting untoward reactions for patients undergoing hemodialysis, nor did quantitative testing of hemodialysis fluids identify the buildup of potentially hazardous levels of contamination within hemodialysis systems. Finally, the kinds of organisms found in hemodialysis systems, i.e., gram-negative water-borne bacilli, were elucidated.

Doern GV; Brogden BE; DiFederico JD; Earls JE; Quinn ML

1982-12-01

242

Severe hypermagnesemia presenting with abnormal electrocardiographic findings similar to those of hyperkalemia in a child undergoing peritoneal dialysis  

Science.gov (United States)

In this report, we present a pediatric case of severe symptomatic hypermagnesemia resulting from the use of magnesium oxide as a laxative in a child undergoing continuous cyclic peritoneal dialysis for end-stage renal disease. The patient showed abnormal electrocardiography (ECG) findings, such as tall T waves, a widened QRS complex, and irregular conduction, which were initially misdiagnosed as hyperkalemia; later, the correct diagnosis of hypermagnesemia was obtained. Emergent hemodialysis successfully returned the serum magnesium concentration to normal without complications. When abnormal ECG changes are detected in patients with renal failure, hypermagnesemia should be considered.

Jhang, Won Kyoung; Lee, Yoon Jung; Kim, Young A; Park, Seong Jong

2013-01-01

243

Severe hypermagnesemia presenting with abnormal electrocardiographic findings similar to those of hyperkalemia in a child undergoing peritoneal dialysis.  

UK PubMed Central (United Kingdom)

In this report, we present a pediatric case of severe symptomatic hypermagnesemia resulting from the use of magnesium oxide as a laxative in a child undergoing continuous cyclic peritoneal dialysis for end-stage renal disease. The patient showed abnormal electrocardiography (ECG) findings, such as tall T waves, a widened QRS complex, and irregular conduction, which were initially misdiagnosed as hyperkalemia; later, the correct diagnosis of hypermagnesemia was obtained. Emergent hemodialysis successfully returned the serum magnesium concentration to normal without complications. When abnormal ECG changes are detected in patients with renal failure, hypermagnesemia should be considered.

Jhang WK; Lee YJ; Kim YA; Park SJ; Park YS

2013-07-01

244

Surgical management of pseudoaneurysm complicating arteriovenous fistula for hemodialysis.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To report surgical experience in pseudoaneurysm (PA) repair of arteriovenous fistula (AVF) for renal hemodialysis. METHODS: Twenty patients undergoing PA repair of AVF for renal hemodialysis were treated in Central Hospital Conde S. Januario of Macao. Sixteen patients had PAs of AVF in upper extremities, 4 in lower extremities. All patients were treated with surgical therapy. RESULTS: All operations were finished without death. One patient suffered from acute thrombosis, recovered without any complication through instant thrombectomy. One patient with postoperative incision bleeding recovered after low molecular weight heparin was ceased. And one AVF could not be mature six weeks later, was recovered after ligation of branch vein. And one patient died due to recurrent cerebral infarction. CONCLUSION: Surgical repair is the best choice for PA of AVF for renal hemodialysis.

Zheng YH; Liu CW; Guan H; Gan HB; Kuok U; Li CL; Zhang J; In DC; Rui F

2007-09-01

245

Pressure changes within a chronic subdural hematoma during hemodialysis.  

UK PubMed Central (United Kingdom)

Spontaneous intracranial hemorrhage is not an infrequent complication of systemic anticoagulation, as occurs in hemodialysis. The neurological symptoms of subdural hematoma may be similar to those of dialysis disequilibrium. The pressure within a subdural fluid collection was monitored in a patient undergoing hemodialysis. The patient was known to become unresponsive during previous dialysis treatments. The initial pressure within the subdural cavity was measured to be -10.0 cm H2O prior to dialysis. The pressure within the collection decreased to a minimum value of -19.4 cm H2O during dialysis and stabilized at -16.4 cm H2O at the termination of dialysis. The neurological status changed subjectively during the procedure, with the patient becoming unresponsive to verbal stimuli as the intracranial pressure reached a minimum. These findings represent a syndrome similar to aliquorrhea, or low cerebrospinal fluid pressure within an otherwise asymptomatic subdural hematoma. Previously only increased intracranial pressure has been reported with hemodialysis.

Kopitnik TA Jr; de Andrade R Jr; Gold MA; Nugent GR

1989-10-01

246

Avaliação do nível de esperança de vida de idosos renais crônicos em hemodiálise Evaluación del nivel de esperanza de vida de ancianos con enfermedad renal crónica en hemodiálisis The evaluation of the level of hope of elderly chronic kidney disease patients undergoing hemodialysis  

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Full Text Available O presente estudo teve por objetivo avaliar o nível de esperança dos idosos renais crônicos em hemodiálise, por meio da Escala de Esperança de Herth (EEH). Trata-se de um estudo descritivo transversal, realizado em uma Unidade de Terapia Renal Substitutiva do interior do estado de São Paulo. A amostra foi composta por 50 idosos em tratamento hemodialítico. Após o consentimento em participar da pesquisa, realizou-se entrevistas individuais com os referidos idosos aplicando-se um instrumento de caracterização e a Escala de Esperança de Herth. Todos os preceitos éticos foram respeitados (protocolo 512/2009). Quanto aos resultados, houve predomínio do sexo masculino (60%) e idade média de 70,20 (±6,1) anos. O escore médio obtido com a aplicação da Escala de Esperança de Herth foi de 36,20 (±2,90). Conclui-se que em comparação com o estudo brasileiro de validação da Escala de Esperança de Herth, o nível de esperança dos sujeitos do presente estudo foi mais baixo, indicando a necessidade de intervenção sobre esse sentimento.Se objetivó evaluar el nivel de esperanza de vida de ancianos con enfermedad renal crónica en hemodiálisis, mediante Escala de Esperanza de Herth (EEH). Estudio descriptivo, transversal, realizado en Unidad de Terapia Renal Sustitutiva del interior del estado de São Paulo. Muestra compuesta por 50 ancianos en tratamiento de hemodiálisis. Con consentimiento para participar en la investigación, se realizaron entrevistas individuales con los sujetos, aplicándose un instrumento de caracterización y la Escala de Esperanza de Herth. Fueron respetados todos los preceptos éticos (protocolo 512/2009). Los resultados mostraron predominio del sexo masculino (60%), edad promedio de 70,20 años (±6,1). El puntaje promedio obtenido con EEH fue 36,20 (±2,90). En comparación con el estudio brasileño de validación de la EEH, el nivel de esperanza de vida de los sujetos de este estudio fue más bajo, indicando la necesidad de intervención sobre tal sentimiento.The objective of the present study was to evaluate the level of hope of elderly chronic kidney disease patients undergoing hemodialysis, using the Herth Hope Scale (HHS). This cross-sectional descriptive study was performed at a Renal Replacement Therapy Unit located in upstate São Paulo. The sample consisted of 50 elderly patients currently undergoing hemodialysis treatment. After obtaining the participants' consent to participate, individual interviews were performed with the elderly individuals, utilizing a characterization instrument and the Herth Hope Scale. All of the ethical premises were complied with (protocol 512/2009). Regarding the results, most participants were male (60%) and their mean age was 70.20 (±6.1) years. The mean score on the Herth Hope Scale was 36.20 (±2.90). In conclusion, compared with the Brazilian study regarding the validation of the Herth Hope Scale, the subjects' level of hope was lower, thus indicating a need to intervene regarding this feeling.

Fabiana de Souza Orlandi; Barbara Garbelotti Pepino; Sofia Cristina Iost Pavarini; Damiana Aparecida dos Santos; Marisa Silvana Zazzetta de Mendiondo

2012-01-01

247

Avaliação do nível de esperança de vida de idosos renais crônicos em hemodiálise/ The evaluation of the level of hope of elderly chronic kidney disease patients undergoing hemodialysis/ Evaluación del nivel de esperanza de vida de ancianos con enfermedad renal crónica en hemodiálisis  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O presente estudo teve por objetivo avaliar o nível de esperança dos idosos renais crônicos em hemodiálise, por meio da Escala de Esperança de Herth (EEH). Trata-se de um estudo descritivo transversal, realizado em uma Unidade de Terapia Renal Substitutiva do interior do estado de São Paulo. A amostra foi composta por 50 idosos em tratamento hemodialítico. Após o consentimento em participar da pesquisa, realizou-se entrevistas individuais com os referidos idosos a (more) plicando-se um instrumento de caracterização e a Escala de Esperança de Herth. Todos os preceitos éticos foram respeitados (protocolo 512/2009). Quanto aos resultados, houve predomínio do sexo masculino (60%) e idade média de 70,20 (±6,1) anos. O escore médio obtido com a aplicação da Escala de Esperança de Herth foi de 36,20 (±2,90). Conclui-se que em comparação com o estudo brasileiro de validação da Escala de Esperança de Herth, o nível de esperança dos sujeitos do presente estudo foi mais baixo, indicando a necessidade de intervenção sobre esse sentimento. Abstract in spanish Se objetivó evaluar el nivel de esperanza de vida de ancianos con enfermedad renal crónica en hemodiálisis, mediante Escala de Esperanza de Herth (EEH). Estudio descriptivo, transversal, realizado en Unidad de Terapia Renal Sustitutiva del interior del estado de São Paulo. Muestra compuesta por 50 ancianos en tratamiento de hemodiálisis. Con consentimiento para participar en la investigación, se realizaron entrevistas individuales con los sujetos, aplicándose un in (more) strumento de caracterización y la Escala de Esperanza de Herth. Fueron respetados todos los preceptos éticos (protocolo 512/2009). Los resultados mostraron predominio del sexo masculino (60%), edad promedio de 70,20 años (±6,1). El puntaje promedio obtenido con EEH fue 36,20 (±2,90). En comparación con el estudio brasileño de validación de la EEH, el nivel de esperanza de vida de los sujetos de este estudio fue más bajo, indicando la necesidad de intervención sobre tal sentimiento. Abstract in english The objective of the present study was to evaluate the level of hope of elderly chronic kidney disease patients undergoing hemodialysis, using the Herth Hope Scale (HHS). This cross-sectional descriptive study was performed at a Renal Replacement Therapy Unit located in upstate São Paulo. The sample consisted of 50 elderly patients currently undergoing hemodialysis treatment. After obtaining the participants' consent to participate, individual interviews were performed w (more) ith the elderly individuals, utilizing a characterization instrument and the Herth Hope Scale. All of the ethical premises were complied with (protocol 512/2009). Regarding the results, most participants were male (60%) and their mean age was 70.20 (±6.1) years. The mean score on the Herth Hope Scale was 36.20 (±2.90). In conclusion, compared with the Brazilian study regarding the validation of the Herth Hope Scale, the subjects' level of hope was lower, thus indicating a need to intervene regarding this feeling.

Orlandi, Fabiana de Souza; Pepino, Barbara Garbelotti; Pavarini, Sofia Cristina Iost; Santos, Damiana Aparecida dos; Mendiondo, Marisa Silvana Zazzetta de

2012-08-01

248

Headache associated with hemodialysis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

INTRODUCTION Hemodialysis (HD) is one of the most accessible methods for the treatment of the growing number of patients suffering from terminal-stage renal insufficiency. Although headache is the most frequently encountered neurological symptom during HD, there are few studies reporting its prevale...

Niki? Petar M.; Zidverc-Trajkovi? Jasna; Andri? Branislav R.; ?uri? Marija; Stojimirovi? Biljana B.

249

Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients.  

Science.gov (United States)

Infections cause significant morbidity and mortality in patients undergoing hemodialysis. Bloodstream infections (BSIs) are particularly problematic, accounting for a substantial number of hospitalizations in these patients. Hospitalizations for BSI and other vascular access infections appear to have increased dramatically in hemodialysis patients since 1993. These infections frequently are related to central venous catheter (CVC) use for dialysis access. Regional initiatives that have shown successful decreases in catheter-related BSIs in hospitalized patients have generated interest in replicating this success in outpatient hemodialysis populations. Several interventions have been effective in preventing BSIs in the hemodialysis setting. Avoiding the use of CVCs in favor of access types with lower associated BSI risk is among the most important. When CVCs are used, adherence to evidence-based catheter insertion and maintenance practices can positively influence BSI rates. In addition, facility-level surveillance to detect BSIs and stimulate examination of vascular access use and care practices is essential to a comprehensive approach to prevention. This article describes the current epidemiology of BSIs in hemodialysis patients and effective prevention strategies to decrease the incidence of these devastating infections. PMID:20554361

Patel, Priti R; Kallen, Alexander J; Arduino, Matthew J

2010-06-15

250

Echocardiographic parameters as cardiovascular event predictors in hemodialysis patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Patients with chronic kidney disease (CKD) on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established in literature. OBJECTIVE: To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis. METHODS: Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them. RESULTS: Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD), ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005) and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042) were independent risk factors for cardiovascular events. CONCLUSION: Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.

Siqueira TM; Ferreira PA; Monteiro Júnior Fd; Salgado Filho N; Ferreira Ade S; Santos Neto ED; Souza FL; Cardoso Pde T

2012-08-01

251

Prevalence of occult hepatitis B virus infection in hemodialysis patients.  

UK PubMed Central (United Kingdom)

BACKGROUND/AIMS: The prevalence of occult HBV infection depends on the prevalence of HBV infection in the general population. Hemodialysis patients are at increased risk for HBV infection. The aim of this study was to determine the prevalence of occult HBV infection in hemodialysis patients. METHODS: Total of 98 patients undergoing hemodialysis in CHA Bundang Medical Center (Seongnam, Korea) were included. Liver function tests and analysis of HBsAg, anti-HBs, anti-HBc and anti-HCV were performed. HBV DNA testing was conducted by using two specific quantitative methods. RESULTS: HBsAg was detected in 4 of 98 patients (4.1%), and they were excluded. Among 94 patients with HBsAg negative and anti-HCV negative, one (1.1%) patient with the TaqMan PCR test and 3 (3.2%) patients with the COBAS Amplicor HBV test were positive for HBV DNA. One patient was positive in both methods. Two patients were positive for both anti-HBs and anti-HBc and one patient was negative for both anti-HBs and anti-HBc. CONCLUSIONS: The present study showed the prevalence of occult HBV infection in HBsAg negative and anti-HCV negative patients on hemodialysis at our center was 3.2%. Because there is possibility of HBV transmission in HBsAg negative patients on hemodialysis, more attention should be given to prevent HBV transmission.

Yoo JH; Hwang SG; Yang DH; Son MS; Kwon CI; Ko KH; Hong SP; Park PW; Rim KS

2013-04-01

252

Health-Related Quality of Life in a Sample of Iranian Patients on Hemodialysis  

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Full Text Available Introduction. This study evaluated the health-related quality of life (HRQOL) in a sample of Iranian patients undergoing maintenance hemodialysis. The data were compared with the HRQOL for the Iranian general population. Materials and Methods. Two-hundred and fifty patients undergoing hemodialysis were included using a convenience sampling approach in a cross-sectional study. Data collection was performed using a Persian translation of the Short Form-36 questionnaire in combination with demographic and clinically related questions. The collected data were analyzed using a logistic regression model with physical and mental summary scales as dependent variables. Results. The patients’ mean Short Form-36 scores were significantly lower than those obtained for the general population for all scales. Patients with longer duration of being on hemodialysis, poor adherence to treatment, higher body mass index, and comorbidity diseases suffered from a poorer physical health. Poor mental health was associated with a lower level of education, longer duration of hemodialysis, lower economic status, a lower degree of knowledge on disease, and comorbidity diseases. Conclusions. This study affirms the fact that patients undergoing hemodialysis suffer from poor HRQOL. In comparison with data from other studies from Asian and European countries, this sample of Iranian patients on hemodialysis had a lower HRQOL, a discrepancy that might be due to differences in life style, socioeconomic status, the general level of education of the patients, as well as physician-patient communication.

Amir H Pakpour; Mohsen Saffari; Mir Saeed Yekaninejad; Davood Panahi; Adrian P Harrison; Stig Molsted

2010-01-01

253

Effects of inspiratory muscle training in hemodialysis patients.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function. OBJECTIVE: To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functional capacity in patients with chronic kidney failure undergoing hemodialysis. METHOD: Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40% of PImax and weekly frequency of three alternate days. RESULTS: A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values. CONCLUSION: The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.

Silva VG; Amaral C; Monteiro MB; Nascimento DM; Boschetti JR

2011-03-01

254

5-year mortality in hemodialysis patients: a single center study in Tripoli.  

UK PubMed Central (United Kingdom)

To investigate the 5-year mortality of patients undergoing maintenance hemo-dialysis (HD) at Al-Shat center Tripoli, we reviewed during June 2007 the records of all the HD patients initiated on HD from Jun 2000 and Jan 2002. There were 124 patients in the study, 77 males (63.6%) and 47 (36.4%) females, with a mean age of 49 +/- 14 years. Diabetic nephropathy (DN) was the underlying kidney disease in 34 (27.4%) patients. After 5 years; 3 patients were transferred to other centers, 18 (14.9%) patients underwent kidney transplan-tation. Out of the 103 patients who continued on hemodialysis, 53 (51.4%) expired during the 5-year follow-up. Mortality was associated with older age (p 50 years) and DN (p< 0.002 and OR of 3.9). Mortality rate in diabetics was 74.1% and significantly associated with male sex (p< 0.0067 and OR of 2.4), older age (p< 0.004), presence of hypertension (p< 0.003 and OR of 3.9), type 1 diabetes (OR 1.6), and elevated mean body weight (p< 0.046). Mortality was also relatively higher in black patients (OR of 2.0) and smokers (OR of 1.39). In conclusion, the overall 5- year mortality for dialysis patients was elevated and higher in the diabetics.

Buargub MA

2008-03-01

255

5-year Mortality in Hemodialysis Patients: A Single Center Study in Tripoli  

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Full Text Available To investigate the 5-year mortality of patients undergoing maintenance hemo-dialysis (HD) at Al-Shat center Tripoli, we reviewed during June 2007 the records of all the HD patients initiated on HD from Jun 2000 and Jan 2002.There were 124 patients in the study, 77 males (63.6%) and 47 (36.4%) females, with a mean age of 49 ± 14 years. Diabetic nephropathy (DN) was the underlying kidney disease in 34 (27.4%) patients. After 5 years; 3 patients were transferred to other centers, 18 (14.9%) patients underwent kidney transplan-tation. Out of the 103 patients who continued on hemodialysis, 53 (51.4%) expired during the 5-year follow-up. Mortality was associated with older age (p 50 years) and DN (p< 0.002 and OR of 3.9). Mortality rate in diabetics was 74.1% and significantly associated with male sex (p< 0.0067 and OR of 2.4), older age (p< 0.004), presence of hypertension (p< 0.003 and OR of 3.9), type 1 diabetes (OR 1.6), and elevated mean body weight (p< 0.046). Mortality was also relatively higher in black patients (OR of 2.0) and smokers (OR of 1.39). In conclusion, the overall 5- year mortality for dialysis patients was elevated and higher in the diabetics.

Buargub Mahdia

2008-01-01

256

Extended hemodialysis in acute kidney injury.  

UK PubMed Central (United Kingdom)

About 10% of patients in the intensive care unit which develop acute renal failure will depend on renal replacement therapy. Although there are no data showing reduction in mortality when compared with intermittent therapy, continuous therapies provide higher cumulative doses of dialysis and greater hemodynamic stability. However, have high costs and are not available in many centers. In this context the Extended Hemodialysis gaining ground in clinical practice because it combines the hemodynamic tolerability, slow and sustained solute control and effective doses of continuous dialysis therapies associated with reduced costs and logistics facilities of intermittent therapy.

Custodio FB; de Lima EQ

2013-04-01

257

Evaluation of Bone Mineral Density in Hemodialysis Patients  

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Full Text Available Objective: Low bone mass in end-stage renal disease patients, especially those undergoing hemodialysis, can lead to serious health problems such as fragility fractures and may have negative impact on their quality of life. The aim of this study was to determine bone mineral density (BMD) in a group of hemodialysis patients and to evaluate its relationship with several clinical parameters and markers of biochemical bone turnover.Materials and Methods: Thirty hemodialysis patients, with a mean age of 49.7±16.0 years, were included in the study. The BMD was measured at the lumbar spine (L2-L4) and at the proximal femur by dual-energy X-ray absorptiometry (DXA). Markers of biochemical bone turnover such as calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (iPTH), plasma bicarbonate, blood pH, serum albumin, and hematocrit levels were measured before the hemodialysis session. Results: The mean T-scores at lumbar spine and femur neck were -1.6±0.8 and -2.6±1.1, respectively. According to the World Health Organization criteria based on BMD T-score at lumbar spine, 7% of patients were osteoporotic, 60% osteopenic, and 33% normal. On the other hand, at femur neck, the results were 50% osteoporotic, 40% osteopenic, and 10% normal. No significant differences were observed in age, duration of hemodialysis and iPTH levels between the patients with or without osteoporosis at femur neck. No correlation was found between BMD at both sites and age, duration of hemodialysis, serum calcium, phosphorus, alkaline phosphatase and iPTH levels. There were no statistically significant differences in BMD and biochemical markers of bone turnover between sexes. Conclusion: In this study, we showed that 53% of the patients undergoing hemodialysis have osteoporosis, especially at femur neck. Thus, we suggest regular monitoring of the femur neck BMD in order to improve bone health of the chronic hemodialysis patients. Turk J Phys Med Rehab 2010;56:62-6.

Oya Özdemir; Mukadder Ay?e Bilgiç

2010-01-01

258

Cost Analysis of Private Hemodialysis Centers in Turkey  

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Full Text Available Chronic kidney disease is a worldwide public health problem. There is a continuing increase in the prevalence of patients on renal replacement therapies which causes an enormous economic burden to the healthcare system. Center hemodialysis is the most common type of renal replacement therapy in patients with end-stage renal disease. The aim of this study was to assess the cost of hemodialysis in private hemodialysis centers in Turkey. The study included a total of 296 centers with patient numbers between 51 and 150. The total number of patients treated in these centers was 26,659. The mean cost per hemodialysis session was calculated as 163.5 TL whereas the prices reimbursed by the Social Security Institution was 145 TL per session. This gap has the potential to cause serious problems considering the continuing rise in the number of hemodialysis patients. The healthcare authorities should search for solutions to decrease the expenses and an optimal price for reimbursement should be determined.

Mehtap TATAR; Gülpembe ERG?N; Tevfik ECDER

2013-01-01

259

Pulmonary ventilation during hemodialysis.  

Science.gov (United States)

During hemodialysis a decrease in pulmonary ventilation has been reported. The elimination of CO2 across the dialyzer has been suggested as the cause of the pulmonary hypoventilation. Our purpose was to analyze the factors that could have influenced the pulmonary ventilation of 7 patients with chronic renal failure during hemodialysis, performed against an acetate dialysate with constant addition of CO2, bubbling into the dialysis bath. In spite of the large volume of CO2 mainly as bicarbonate, eliminated across the dialyzer there was no significant decrease of ventilation. The values of pH in the venous line were extremely low and the values of PvCO2 were artificially maintained around 35.0 mm Hg. Thus, the total CO2 delivered to the lungs, but mainly the levels of pH and PCO2 in the venous line play an important role in the control of pulmonary ventilation of these patients. PMID:6817152

Romaldini, H; Stabile, C; Faro, S; Lopes Dos Santos, M; Ramos, O L; Ratto, O R

1982-01-01

260

Hepatitis C virus screening and management of seroconversions in hemodialysis facilities.  

UK PubMed Central (United Kingdom)

Over the past two decades, healthcare-associated exposure has increasingly been proved to be a means of hepatitis C virus (HCV) transmission, especially in hemodialysis facilities. The prevalence of HCV among hemodialysis patients is known to be several times greater than that of the general population of the United States, and chronic HCV infection is associated with significant morbidity and mortality among these patients. During 2008-2011, HCV infection outbreaks were identified in multiple US hemodialysis facilities, resulting in at least 46 new HCV infections among hemodialysis patients. These outbreaks, linked to infection control breaches, also highlight the failure of some facilities to follow established guidelines for routine HCV antibody (anti-HCV) screening and response to new HCV infection among hemodialysis patients. Current national guidelines recommend screening of hemodialysis patients for anti-HCV on facility admission and, for susceptible patients, on a semiannual basis. Here, we seek to underscore the importance of compliance with national recommendations for anti-HCV screening of hemodialysis patients and actions to be taken in the event of possible HCV transmission within a hemodialysis facility. These include general steps to ensure that: hemodialysis patients are routinely screened for anti-HCV to facilitate early detection of new infections; newly infected patients are informed of the change in their HCV status and undergo clinical evaluation; and public health officials are notified of new HCV infections in a timely manner. We then focus on the need to assess infection control practices at the facility, with particular attention given to safe handling of injectable medications, hand hygiene and disinfection practices. ?In the absence of a vaccine, routine screening and adherence to standard infection control practices will remain the key strategies for preventing HCV transmission in hemodialysis units.

Mbaeyi C; Thompson ND

2013-07-01

 
 
 
 
261

ORIGINAL PAPER Pulmonary artery pressure in association with serum parathormone in maintenance hemodialysis patients  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: There are several potential explanations for the development of PH in patients with stable hemodialysis patients. Hormonal and metabolic derangement associated with end-stage renal failure might lead to pulmonary arterial vasoconstriction and an increase of the pulmonary vascular resistance. The aim of this study was to consider the association of pulmonary artery pressure (PAP) with serum parathormone in end-stage renal disease (ESRD) patients under regular hemodialysis treatment. Material and methods: This cross-sectional study was conducted on patients with end-stage renal disease undergoing maintenance hemodialysis treatment through an arteriovenous fistula which was created on the hand, and with acetate basis dialysate and polysulfone membranes. For all patients serum intact parathormone (iPTH) was measured. For assessment of pulmonary artery pressure, all patients were subjected to two-dimensional and doppler echocardiographic studies that were done for the patients after their hemodialysis sessions. Results: The study comprised 102 patients (F=46, M=56) consisting of 73 non diabetic hemodialysis patients (F=33, M=40), and 29 diabetic hemodialysis patients (F=13, M=16). The duration of hemodialysis was 17.8±29 months. The mean ±SD of serum iPTH of total patients was 338±306 pg/ml. The mean ±SD of pulmonary artery systolic pressure (PAP) was 41.5±12.6 mmHg. A significant positive correlation of PAP with the dosage (r=0.36, p=0.001) and duration of hemodialysis (r=0.35, p<0.001) was seen, also a significant positive correlation of pulmonary artery systolic pressure with serum intact parathormone (iPTH) in hemodialysis patients was found. Conclusions: A significant positive correlation of serum intact parathormone with pulmonary artery pressure, which is a new aspect of uncontrolled secondary hyperparathyroidism implies the need for a better control of poorly controlled hyperparathyroidism disease in hemodialysis patients.

Hamid Nasri

2006-01-01

262

Consequences of Frequent Hemodialysis: Comparison to Conventional Hemodialysis and Transplantation  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The average life expectancy of a person on hemodialysis is less than 3 years and hasn't changed in 20 years. The Hemodialysis (HEMO) trial, a randomized trial to determine whether increasing urea removal to the maximum practical degree through a 3-times-a-week schedule, showed no difference in morta...

Stokes, John B.

263

The effects of hemodialysis and peritoneal dialysis on serum homocysteine and C-reactive protein levels  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVES: In this study, we aimed to investigate plasma homocysteine (Hcy) and serum C-reactive protein (CRP) levels in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, and the relation among them.

Ali Borazan; Selim Aydemir; Mehmet Sert; Ahmet Yilmaz

1992-01-01

264

Chlorine dioxide and hemodialysis  

Energy Technology Data Exchange (ETDEWEB)

Because it has little or no tendency to generate carcinogenic trihalomethanes such as chloroform, chlorine dioxide is an attractive alternative to chlorine for drinking water disinfection. There are, however, concerns about its acute toxicity, and the toxic effects of its by-products, chlorite and chlorate. The human experience with chlorine dioxide in both controlled, prospective studies and in actual use situations in community water supplies have as yet failed to reveal adverse health effects. The EPA has recommended standards of 0.06 mg/L for chlorine dioxide and standards of 0.007 mg/L for chlorite and chlorate in drinking water. Among groups who may be at special risk from oxychlorines in drinking water are patients who must undergro chronic extracorporeal hemodialysis. Although even units for home hemodialysis are supposed to be equipped with devices which effectively remove oxychlorines, there is a always a possibility of operator error or equipment failure. When the equipment is adequately maintained, it is likely that dialysis patients will have more intensive exposures from drinking water than from dialysis fluids despite the much larger volumes of water that are involved in dialysis. This paper discusses a hemodialysis and the standards and effects of oxychlorines. 90 refs., 2 tabs.

Smith, R.P. (Dartmouth Coll., Hanover, NH (USA). Dept. of Pharmacology and Toxicology)

1989-05-01

265

Continuous warfarin versus periprocedural dabigatran to reduce stroke and systemic embolism in patients undergoing catheter ablation for atrial fibrillation or left atrial flutter.  

UK PubMed Central (United Kingdom)

PURPOSE: Left atrial catheter ablation for patients with atrial fibrillation (AF) requires periprocedural anticoagulation to minimize thromboembolic complications. High rates of major bleeding complications using dabigatran etexilate for periprocedural anticoagulation have been reported, raising concerns regarding its safety during left atrial catheter ablation. We sought to evaluate the safety and efficacy of a dabigatran use strategy versus warfarin, at a single high-volume AF ablation center. METHODS: We performed a retrospective analysis on consecutive patients undergoing left atrial ablation at Vanderbilt Medical Center from January 2011 through August 2012 with a minimum follow-up of 3 months. Patient cohorts were divided into two groups, those utilizing dabigatran etexilate pre- and post-ablation and those undergoing ablation on dose-adjusted warfarin, with or without low-molecular-weight heparin bridging. Dabigatran was held 24-30 h pre-procedure and restarted 4-6 h after hemostasis was achieved. We evaluated all thromboembolic and bleeding complications at 3 months post-ablation. RESULTS: A total of 254 patients underwent left atrial catheter ablation for atrial fibrillation or left atrial flutter. Periprocedural anticoagulation utilized dabigatran in 122 patients and warfarin in 135 patients. Three late thromboembolic complications occurred in the dabigatran group (2.5 %), compared with one (0.7 %) in the warfarin group (p?=?0.28). The dabigatran group had similar minor bleeding (2.5 vs. 7.4 %, p?=?0.07), major bleeding (1.6 vs. 0.7 %, p?=?0.51), and composite of bleeding and thromboembolic complications (6.6 vs. 8.9 %, p?=?0.49) when compared to warfarin. There were no acute thromboembolic complications in either group (<24 h post-ablation). CONCLUSIONS: In patients undergoing left atrial catheter ablation for AF or left atrial flutter, use of periprocedural dabigatran etexilate provides a safe and effective anticoagulation strategy compared to warfarin. A prospective randomized study is warranted.

Kaiser DW; Streur MM; Nagarakanti R; Whalen SP; Ellis CR

2013-09-01

266

Continuous Renal Replacement Therapy  

Directory of Open Access Journals (Sweden)

Full Text Available It is a mode of renal replacement therapy for hemodynamically unstable ;fluid overloaded; catabolic septic patients and finds its application in management of acute renal failure especially in the critical care /intensive care unit setting. The popularity of ?slow continuous therapies? for the treatment of critically ill patients with renal failure is increasing. The techniques most commonly used are slow continuous hemodialysis and hemodiafiltration. Slow continuous hemofiltration and slow continuous ultrafiltration also are commonly used.

Dr. Manish Chaturvedi

2004-01-01

267

Nosocomial infective endocarditis in Hemodialysis  

International Nuclear Information System (INIS)

There is an increased risk of infective endocarditis catheterization usedfor Hemodialysis. We report a case of a young man who had endocarditissecondary to the use of a permanent jugular catheter for hemodialysis. Bloodcultures were repeatedly negative, but vegetations were seen on the tricuspidvalve on echocardiography. A high index of suspicion is recommended for thisserious complication. (author)

2002-01-01

268

The influence of metabolic syndrome on hemodialysis access patency.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The natural history of patients with metabolic syndrome (MetS) undergoing hemodialysis access placement is unknown. MetS has previously been found as a risk factor for poor outcomes for vascular surgery patients undergoing other interventions. The aim of this is study is to describe the outcomes of MetS patients undergoing primary hemodialysis access placement. METHODS: The medical records of the 187 patients who underwent hemodialysis access placement between 1999 and 2009 at the Veterans Administration Connecticut Healthcare System were reviewed. Survival, primary patency, and secondary patency were evaluated using the Gehan-Breslow test for survival. MetS was defined as the presence of three or more of the following: blood pressure?130/90 mm Hg; triglycerides?150 mg/dL; high-density lipoprotein?50 mg/dL for women and ?40 mg/dL for men; body mass index?30 kg/m2; or fasting blood glucose?110 mg/dL. RESULTS: Of the 187 patients who underwent hemodialysis access placement, 115 (61%) were identified to have MetS. The distribution of MetS factors among all patients was hypertension in 98%, diabetes in 58%, elevated triclyceride in 39%, decreased high-density lipoprotein in 60%, elevated body mass index in 36%, and 39% were currently receiving hemodialysis. Patients were a mean age of 66 years. The median length of follow-up was 4.2 years. The forearm was site of fistula placement in 53%; no difference existed between groups (MetS, 57%; no MetS, 50%; P=.388). The median time to primary failure was 0.46 years for all patients (MetS, 0.555 years; no MetS, 0.436 years; P=.255). Secondary patency was 50% at 1.18 years for all patients (no MetS, 1.94 years; MetS, 0.72 years; P=.024). Median survival duration for all patients was 4.15 years (no MetS, 5.07 years; MetS, 3.63 years; P=.019). CONCLUSIONS: MetS is prevalent among patients undergoing hemodialysis access placement. Patients with MetS have equivalent primary patency rates; however, their survival and cumulative patency rates are significantly lower than in patients without MetS. Patients with MetS form a high-risk group that needs intensive surveillance protocols.

Protack CD; Jain A; Vasilas P; Dardik A

2012-12-01

269

[Perinatal complications in patients with chronic renal insufficiency on hemodialysis].  

UK PubMed Central (United Kingdom)

BACKGROUND: Pregnant patients with chronic renal insufficiency treated with hemodialysis experience adverse perinatal results. OBJECTIVE: To compare perinatal complications of patients with chronic renal insufficiency undergoing hemodialysis who become pregnant vs. the complications of women with chronic renal insufficiency not undergoing dialysis but who then require dialysis during gestation. PATIENTS AND METHOD: Transversal and retrospective study that included three patients with chronic renal insufficiency on chronic hemodialysis who became pregnant (group A) and three patients with chronic renal insufficiency without hemodialysis at the time of conception but who required dialysis during gestation (group B). Perinatal results were compared. Statistical analysis was performed with measures of central tendency and dispersion and Student t-test. RESULTS: Group A had 25 sessions vs. group B with 29 hemodialysis sessions (p = 0.88). Maternal complications were anemia 100% (six cases), Cesarean delivery 83.3% (group A 2 cases vs. group B 2 cases), preeclampsia 50% (group A 2 cases vs. group B 1 case), uncontrolled hypertension 50% (group A 2 cases vs. group B 1 case), preterm delivery 50% (group A 2 cases vs. group B 1 case), transfusion 33.3% (group A 2 cases), polyhydramnios 33.3% (group A 1 case vs. group B 1 case) and abortion 16.6% (group A 1 case). Fetal complications included fetal loss 16.6% (group A 1 case), neonatal mortality 33.3% (group A 1 cases vs. group B 1 case), prematurity 50% (group A2 cases vs. group B 1 case), fetal distress 50% (group A 1 case vs. group B 2 cases), respiratory failure 33.3% (group A 2 cases) and fetal growth restriction 16.6% (group A 1 case). CONCLUSION: Frequency of perinatal complications is elevated in both groups.

Vázquez-Rodríguez JG; del Angel-García G

2010-09-01

270

Oxidative stress and lipoperoxides in patients undergoing hemodialysis treatment.  

Czech Academy of Sciences Publication Activity Database

. Elsevier. Ro?. 144, ?. 1 (1999), s. 41-42. ISSN 0021-9150.[Congress of the European Atherosclerosis Society /71./. 26.05.1999-29.05.1999, Athens]Výzkumný zám?r: CEZ:A17/98:Z5-004-9-iiKód oboru RIV: EC - Imunologie

Soška, V.; Lojek, AntonínG; ?íž, Milan; Sobotová, D.

271

The role of hemodialysis machines dedication in reducing Hepatitis C transmission in the dialysis setting in Iran: A multicenter prospective interventional study  

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Abstract Background Hepatitis C virus (HCV) infection is a significant problem among patients undergoing maintenance hemodialysis (HD). We conducted a prospective multi-center study to evaluate the effect of dialysis machine separation on the spread of HCV infection. Methods<...

Shamshirsaz Alireza; Kamgar Mohammad; Bekheirnia Mir; Ayazi Farzam; Hashemi Seyed; Bouzari Navid; Habibzadeh Mohammad

272

Racial differences in survival among hemodialysis patients after coronary artery bypass grafting.  

Science.gov (United States)

The aim of this study was to examine racial differences in long-term survival among hemodialysis patients after coronary artery bypass grafting (CABG). To our knowledge this has not been previously addressed in the literature. Black and white hemodialysis patients undergoing first-time, isolated CABG procedures between 1992 and 2011 were compared. Survival probabilities were computed using the Kaplan-Meier product-limit method and stratified by race. Hazard ratios (HR) and 95% confidence intervals (CI) were computed using a Cox regression model. A total of 207 (2%) patients were on hemodialysis at the time of CABG. White (n = 80) hemodialysis patients had significantly decreased 5-year survival compared with black (n = 127) patients (adjusted HR = 1.9, 95% CI = 1.2-2.8). Our finding provides useful outcome information for surgeons, primary care providers, and their patients. PMID:24018839

Efird, Jimmy T; O'Neal, Wesley T; Bolin, Paul; Davies, Stephen W; O'Neal, Jason B; Anderson, Curtis A; Ferguson, T Bruce; Chitwood, W Randolph; Kypson, Alan P

2013-09-06

273

Longitudinal study of leptin levels in chronic hemodialysis patients  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The influence of serum leptin levels on nutritional status and survival in chronic hemodialysis patients remained to be elucidated. We conducted a prospective longitudinal study of leptin levels and nutritional parameters to determine whether changes of serum leptin levels modify nutritional status and survival in a cohort of prevalent hemodialysis patients. Methods Leptin, dietary energy and protein intake, biochemical markers of nutrition and body composition (anthropometry and bioimpedance analysis) were measured at baseline and at 6, 12, 18 and 24 months following enrollment, in 101 prevalent hemodialysis patients (37% women) with a mean age of 64.6 ± 11.5 years. Observation of this cohort was continued over 2 additional years. Changes in repeated measures were evaluated, with adjustment for baseline differences in demographic and clinical parameters. Results Significant reduction of leptin levels with time were observed (linear estimate: -2.5010 ± 0.57 ng/ml/2y; p Conclusions Thus leptin levels reflect fat mass depots, rather than independently contributing to uremic anorexia or modifying nutritional status and/or survival in chronic hemodialysis patients. The importance of such information is high if leptin is contemplated as a potential therapeutic target in hemodialysis patients.

Beberashvili Ilia; Sinuani Inna; Azar Ada; Yasur Hila; Feldman Leonid; Averbukh Zhan; Weissgarten Joshua

2011-01-01

274

Topical Capsaicin Therapy for Uremic Pruritus in Patients on Hemodialysis  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. Pruritus is one of the common problems in patients on hemodialysis. There are several causes for pruritus, and different treatment modalities are applied to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in patients on hemodialysis.Materials and Methods. This randomized double-blinded cross-over clinical trial was performed on 34 patients on hemodialysis with uremic pruritus. The patients were divided into 2 groups, one group received capsaicin 0.03% and the other, placebo, for 4 weeks. Treatment was stopped for 2 weeks as washout period and continued as a cross-over technique. Pruritus scores were analyzed and compared.Results. Thirty-four patients on long-term hemodialysis, 14 men and 20 women with a mean age of 57.0 ± 18.6 years were studied. The mean of pruritus score before capsaicin treatment was 15.9 ± 6.3, which was reduced to 6.4 ± 3.9, 4.7 ± 3.1, 3.2 ± 2.9, and 2.5 ± 2.5 on weeks 1 to 4, respectively (P Conclusions. Capsaicin is a new safe and effective topical treatment for hemodialysis-induced pruritus in patients with end-stage renal disease.

Atieh Makhlough; Shahram Ala; Zohreh Haj-Heydari; Zahra Kashi; Alireza Bari

2010-01-01

275

Removal of cimetidine by peritoneal dialysis, hemodialysis, and charcoal hemoperfusion.  

UK PubMed Central (United Kingdom)

Dialysis clearance of cimetidine in patients receiving peritoneal dialysis, hemodialysis, and hemoperfusion was compared in stable and seriously ill patients. Two methods of determining dialysis clearance were employed, one of which was the method employed for cimetidine previously in the literature. Cimetidine clearance was lowest for peritoneal dialysis (5 ml/min), intermediate for hemodialysis (28 ml/min), and greatest for hemoperfusion (85 ml/min). Using both methods to calculate dialysis clearance, we found that cimetidine clearance during dialysis has been overestimated. In addition, pharmacokinetic analysis revealed that peritoneal and hemodialysis apparently removed cimetidine from the central compartment only, whereas hemoperfusion apparently removed drug from the peripheral compartment as well. A possible mechanism to explain this difference is based on the observation that hemodynamic changes occur during hemodialysis that may not be seen during hemoperfusion. No dosage adjustment need be made when patients receiving cimetidine undergo any form of dialysis; hemoperfusion may be of some benefit in removing drug from the central as well as tissue compartments in an acute overdose situation.

Pizzella KM; Moore MC; Schultz RW; Walshe J; Schentag JJ

1980-01-01

276

Experience of Iranian persons receiving hemodialysis: a descriptive, exploratory study.  

UK PubMed Central (United Kingdom)

Patients living with end-stage renal disease experience different levels of physical and psychological disability that can impact on the type and level of social interaction in which they engage with others. The researchers concurrently collected and thematically analyzed the interview data that were generated from 21 participants who were undergoing hemodialysis in Iran. Four major themes were constructed from the analysis of the transcripts: living with fatigue; changes in self-image; patients' dependency on the device, place, and time of hemodialysis; and hiding the disease. The results from this study showed that the patients who were living with hemodialysis in Iran experienced altered social interactions with others. The culture of Iran resulted in the participants trying to hide their disease from others, which led to social avoidance, thus reducing the participants' social interactions with others. It is recommended that nurses include a comprehensive assessment of the social interactions of persons who are receiving hemodialysis in their overall nursing assessment and that this is reviewed on a regular basis.

Kazemi M; Nasrabadi AN; Hasanpour M; Hassankhani H; Mills J

2011-03-01

277

Effect of aromatherapy on pruritus relief in hemodialysis patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Pruritus is one of the commonest problems in patients with end-stage renal failure undergoing hemodialysis. Pruritus is an irritating symptom which can directly affect the life quality of patients with chronic renal failure. However, available treatments have failed to relieve the symptom and kidney transplant remains the definite treatment of the problem. A recently proposed treatment for pruritus is the use of complementary medicine. Thus, the aim of this research is to study the effect of aromatherapy on pruritus relief in hemodialysis patients. METHODS: The study is a pre- and post-clinical trial, carried out in dialysis centers of Isfahan University of Medical Sciences in 2009. Sample was performed using convenient sampling method and the participants were selected from among the patient who received hemodialysis three times a week for 3-5 hours and had pruritus scores above 3. All the participants received seven minutes of hand massage in the non-fistulated hand with 3-5 ml of lavender, mint, and tea tree oils at 5% concentration for six sessions (two weeks). The data of the study were analyzed using descriptive and inferential statistics by SPSS software, version 16. RESULTS: Twenty patients with end-stage renal failure who had pruritus fulfilled the course of the study. Data analysis indicated that aromatherapy significantly relieved pruritus (p < 0.05). CONCLUSIONS: Aromatherapy can significantly relieve pruritus in hemodialysis patients.

Shahgholian N; Dehghan M; Mortazavi M; Gholami F; Valiani M

2010-01-01

278

[A pilot study on physical training of patients in hemodialysis].  

UK PubMed Central (United Kingdom)

BACKGROUND: Exercise training during the dialytical procedure may have positive cardiovascular effects and prevent or revert muscle wasting in patients undergoing chronic hemodialysis. AIM: To evaluate the effects of an exercise training program in patients undergoing chronic hemodialysis. MATERIAL AND METHODS: Fifteen patients on chronic hemodialysis aged 21 to 69 years (three females) were included in the study. Nine of these were included in an exercise training program. During 16 weeks, exercise sessions were carried out during each dialytical procedure that included a warm-up period, aerobic exercises done using standing cycles, and resistance exercises, performed using Thera-Band(®) elastic bands and loops. Borg scale was used to control the intensity of training. At baseline and at the end of the study, a blood sample prior and after the dialytical procedure was obtained to measure C reactive protein, tumor necrosis factor ? and interleukin 6. Quadriceps muscle strength, six minutes' walk and quality of life using the SF-36 questionnaire, were also measured. RESULTS: Four experimental subjects did not complete the study period, two that withdrew before starting, one due to problems with the venous access and one that decided to withdraw after 1 month of training. Among the five patients that finished the training period, significant improvements in the six minutes' walk and quadriceps strength were observed in the experimental group. No significant changes were observed among controls. No changes were observed in either group in C reactive protein, tumor necrosis factor and interleukin 6 levels or quality of life. CONCLUSIONS: Among patients undergoing chronic hemodialysis exercise training improves endurance and muscle strength.

Oliveros R MS; Avendaño M; Bunout D; Hirsch S; De La Maza MP; Pedreros C; Müller H

2011-08-01

279

Referral pattern of hemodialysis patients to nephrologists  

International Nuclear Information System (INIS)

To determine the referral pattern of dialysis patients to nephrologists and the effects of late referral on clinical, hematological and biochemical parameters in patients presenting for the first-time to dialysis center. This study was conducted on all patients of end stage renal diseases presenting for the first-time for undergoing hemodialysis at our center. Patients with acute renal failure were excluded from the study. At presentation, a history was taken from all the patients regarding seeking of nephrology services and referral pattern. Early and late referral was defined as the time of first referral or admission to a nephrologists greater or less than six months respectively before initiation of hemodialysis. All the patients were examined and their blood sample was drawn at the same time for routine hematological, biochemical parameters (urea, creatinine, serum potassium, calcium, phosphate and albumin) and viral markers (Anti HCV and HbsAg). In this study, 248 patients were enrolled, amongst them, 131 (52.8%) were male and 117 (47.2%) were female. Major causes of renal failure were diabetes mellitus, chronic glomerulonephritis and hypertension. Most of the patients were euvolemic and hypertensive. Sixty percent of patients were having very high urea (>200 mg/dl) and creatinine (>8.0 mg/dl). Most of the patients, 226 (91.1%), were anemic (Hemoglobin

2007-01-01

280

Uremic pruritus in chronic hemodialysis patients.  

UK PubMed Central (United Kingdom)

Skin itching (pruritus) affects 50%-90% of patients undergoing peritoneal dialysis or hemodialysis and the symptoms range from localized and mild to generalized and severe. Among the dermatological abnormalities associated with end-stage renal disease, pruritus is the most prevalent. Of all systemic disorders, uremia is the most important cause of pruritus. The mechanism underlying uremic pruritus is poorly understood: secondary hyperparathyroidism, divalent-ion abnormalities, histamine, allergic sensitization, proliferation of skin mast cells, iron-deficiency anemia, neuropathy and neurological changes, or a combination of these have been hypothesized. Severe pruritus not only affects the quality of life but is also associated with poor outcome in chronic hemodialysis patients. No specific, effective treatment is currently available for uremic pruritus. Further studies are necessary to evaluate the long-term efficacy and safety of a novel kappa-opioid agonist, nalfurafine. Early diagnosis and treatment of uremic pruritus focusing on general strategies that include the optimization of dialysis dose, erythropoiesis-stimulating agents, and management of secondary hyperparathyroidism is recommended.

Narita I; Iguchi S; Omori K; Gejyo F

2008-03-01

 
 
 
 
281

Uremic pruritus in chronic hemodialysis patients.  

Science.gov (United States)

Skin itching (pruritus) affects 50%-90% of patients undergoing peritoneal dialysis or hemodialysis and the symptoms range from localized and mild to generalized and severe. Among the dermatological abnormalities associated with end-stage renal disease, pruritus is the most prevalent. Of all systemic disorders, uremia is the most important cause of pruritus. The mechanism underlying uremic pruritus is poorly understood: secondary hyperparathyroidism, divalent-ion abnormalities, histamine, allergic sensitization, proliferation of skin mast cells, iron-deficiency anemia, neuropathy and neurological changes, or a combination of these have been hypothesized. Severe pruritus not only affects the quality of life but is also associated with poor outcome in chronic hemodialysis patients. No specific, effective treatment is currently available for uremic pruritus. Further studies are necessary to evaluate the long-term efficacy and safety of a novel kappa-opioid agonist, nalfurafine. Early diagnosis and treatment of uremic pruritus focusing on general strategies that include the optimization of dialysis dose, erythropoiesis-stimulating agents, and management of secondary hyperparathyroidism is recommended. PMID:18446709

Narita, Ichiei; Iguchi, Seitaro; Omori, Kentaro; Gejyo, Fumitake

282

Assessment of Adequacy of Dialysis in Patients Undergoing Dialysis With Bicarbonate Solution  

Directory of Open Access Journals (Sweden)

Full Text Available Background & Aim: Hemodialysis is a common replacement therapy for patients with ESRD, worldwide. Effective and adequate hemodialysis can improve quality of life and reduce complications of renal failure. Enhancing quality of dialysis results in reducing the complications and mortality rate in patients with chronic renal failure. The aim of this study was to assess the adequacy of dialysis in patients undergoing dialysis with Bicarbonate solution in hemodialysis ward of a hospital in Sary.Methods & Materials: This cross-sectional study was conducted on 50 patients admitted in the hemodialysis ward with chronic renal failure diagnosis. A researcher-made questionnaire was used to gather data. The KT/V formula was used to assess the adequacy of hemodialysis. The URR common characteristic was also measured. Data were analyzed using statistical tests.Results: The mean age of patients was 54.76±12.55 years. The mean of KT/V and URR were 0.26±0.92 and 0.47±0.09, respectively. The kt/v ratio was lower than 1.2 in 85.2% of the patients; and the URR was lower than 65% in 97.8% of the patients.Conclusion: The hemodialysis adequacy was low in 85.2% of the patients in the hospital and the hemodialysis efficacy indicators were lower than the standard measures. Assessment to find the reasons of low efficacy of hemodialysis is recommended.

Raheleh Mohseni; Ehteram Sadat Ilali

2011-01-01

283

The effect of high-flux hemodialysis on hemoglobin concentrations in patients with CKD: results of the MINOXIS study.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Hemodialysis treatment induces markers of inflammation and oxidative stress, which could affect hemoglobin levels and the response to erythropoietin use. This study sought to determine whether high-flux dialysis would help improve markers of renal anemia, inflammation, and oxidative stress compared with low-flux dialysis. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS: In a prospective, controlled study, 221 patients undergoing maintenance hemodialysis and receiving darbepoetin-alfa treatment (mean age, 66 years; 55% male) from 19 centers were screened in a 20-week run-in period of low-flux hemodialysis with a synthetic dialysis membrane. Thereafter, 166 patients were enrolled and randomly assigned to receive a synthetic high-flux membrane or to continue on low-flux dialysis for 52 weeks. Data on myeloperoxidase, oxidized LDL, high-sensitivity C-reactive protein, and the Malnutrition Inflammation Score were collected at baseline and after 52 weeks; routine laboratory data, such as hemoglobin, ferritin, and albumin, and the use of darbepoetin-alfa, were also measured in the run-in period. Results After 52 weeks, the low-flux and the high-flux groups did not differ with respect to hemoglobin (mean ± SD, 11.7±0.9 g/dl versus 11.7±1.1 g/dl; P=0.62) or use of darbepoetin-alfa (mean dosage ± SD, 29.8±24.8 ?g/wk versus 26.0±31.1 ?g/wk; P=0.85). Markers of inflammation, oxidative stress, or nutritional status also did not differ between groups. CONCLUSION: Over 1 year, high-flux dialysis had no superior effects on hemoglobin levels or markers of inflammation, oxidative stress, and nutritional status. These data do not support the hypothesis that enhanced convective toxin removal would improve patient outcome.

Schneider A; Drechsler C; Krane V; Krieter DH; Scharnagl H; Schneider MP; Wanner C

2012-01-01

284

Alleviation of sleep apnea in patients with chronic renal failure by nocturnal cycler-assisted peritoneal dialysis compared with conventional continuous ambulatory peritoneal dialysis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Nocturnal hemodialysis has been shown to improve sleep apnea in patients who receive conventional hemodialysis. It was hypothesized that nocturnal peritoneal dialysis (NPD) also is effective in correcting sleep apnea in patients who receive continuous ambulatory PD (CAPD). Overnight polysomnography ...

Tang, SCW; Lam, B; Ku, PP; Leung, WS; Chu, CM; Ho, YW; Ip, MSM; Lai, KN

285

ADIPONECTIN LEVELS AND ATHEROSCLEROTIC RISK FACTORS IN CHILDREN ON HEMODIALYSIS  

International Nuclear Information System (INIS)

Atherosclerotic cardiovascular disease (ACVD) is the major cause of mortality in patients with end stage renal disease (ESRD) treated with hemodialysis (HD), even in children. Adiponectin (ADPN) is an adipocyte derived plasma protein having anti-atherogenic properties. ADPN levels are elevated in ESRD but it has been reported that ESRD patients with low plasma ADPN levels have a high risk of cardiovascular death. The aim of this study is to evaluate the relation between ADPN and atherosclerotic risk factors in children on hemodialysis.Twenty-eight children (17 boys and 11girls) with a mean age of 10.6 ± 3.34 years undergoing hemodialysis (HD) for a mean period of 11.96 ± 8.32 months (ranged from 6 to 36 months) and 10 healthy age and sex matched control subjects were enrolled in this study. The acute effect of a hemodialysis session on serum ADPN and other atherosclerotic risk factors , including blood pressure, serum lipids, C-reactive protein (CRP) and tumor necrosis factor-? (TNF-?) were assessed by comparison of pre- and post-hemodialysis determinations. Serum levels of ADPN and TNF-? were measured by enzyme linked immunosorbant assay (ELISA) while CRP was measured by the semi-quantitative latex agglutination assay.The data showed that serum ADPN levels were twice higher in the HD group as compared to the control subjects. Concerning the atherosclerotic risk factors, TNF-?, CRP and triglycerides levels showed significant elevation in the HD group. Meanwhile, serum albumin, cholesterol and phosphorus levels showed significant decreases. The linear regression analysis showed that adiponectin was negatively correlated with glomerular filtration rate (GFR) (r = -0.68,P

2008-01-01

286

Prospective randomized comparison of ultrasound-guided and neurostimulation techniques for continuous interscalene brachial plexus block in patients undergoing coracoacromial ligament repair.  

UK PubMed Central (United Kingdom)

BACKGROUND: There are few data comparing the onset time of interscalene brachial plexus block performed using ultrasound (US) guidance or nerve stimulation (NS) technique for elective coracoacromial ligament repair. METHODS: Fifty ASA I-III patients were randomly allocated to receive a continuous interscalene brachial plexus block with 20 ml of 1% ropivacaine with either NS or US guidance. The time of block performance, number of skin punctures and needle redirections, inadvertent vascular punctures, and procedure-related pain scores were recorded. The onsets of sensory and motor blocks in the distribution of radial, axillary, and musculocutaneous nerves were blindly assessed every 5 min until 30 min from the end of local anaesthetic (LA) injection. Intraoperative fentanyl, general anaesthesia (GA) requirements, postoperative pain scores, LA consumption, and patients' requirements for subcutaneous morphine during the first 24 h were compared. RESULTS: Block onset times were similar. The time to complete the block and the number of skin punctures and vascular punctures were significantly lower in Group US. There were no differences in needle redirections, incidence of paraesthesiae, intraoperative fentanyl consumption, and requirements for GA or postoperative morphine. The US group required significantly less LA only at 16 h after surgery and had lower pain scores at rest at 24 h after surgery. CONCLUSIONS: Block onset times and success rate were similar whether NS or US was used, although US guidance allowed shorter procedural times, fewer needle punctures, and fewer vascular punctures.

Danelli G; Bonarelli S; Tognú A; Ghisi D; Fanelli A; Biondini S; Moschini E; Fanelli G

2012-06-01

287

Impact of hemodialysis on P-wave amplitude, duration, and dispersion  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Atrial fibrillation (AF) is a frequent arrhythmia in patients undergoing hemodialysis (HD). P wave duration (PWdu) and P wave dispersion (PWdi) have been shown to be predictors of emerging AF in different clinical conditions. We sought to study the impact of HD on PWdu, PWdi, and P wave amplitude in...

Drighil, Abdenasser; Madias, John E; Mosalami, Hanane El; Badaoui, Nadia El; Mouine, Bahija; Fadili, Wafae; Ramdani, Beenyouness

288

5-year Mortality in Hemodialysis Patients: A Single Center Study in Tripoli  

Digital Repository Infrastructure Vision for European Research (DRIVER)

To investigate the 5-year mortality of patients undergoing maintenance hemo-dialysis (HD) at Al-Shat center Tripoli, we reviewed during June 2007 the records of all the HD patients initiated on HD from Jun 2000 and Jan 2002.There were 124 patients in the study, 77 males (63.6%) and 47 (36.4&#...

Buargub Mahdia

289

Social adaptability and substance abuse: Predictors of depression among hemodialysis patients?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Several aspects linked to social are involved in the onset of depressive feelings. We aimed to find out if social adaptability and substance abuse predict depression among end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Methods

Santos Paulo Roberto; Arcanjo Francisco Plácido Nogueira

290

Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in Al-Hasa Region of Saudi Arabia  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The prevalence of anti-HCV antibodies among hemodialysis (HD) patients was studied at King Fahad Hospital, Hofuf, Saudi Arabia. The records of 189 patients undergoing HD were reviewed. The overall prevalence of anti-HCV antibodies was 43.9%. Anti-HCV antibody prevalence was more common among ...

Saxena Anil; Panhotra B; Naguib Mohamed; Aboras Mohammed; Sundaram D; Venkateshappa C; Khan Wahid

291

Supplementary dose after hemodialysis.  

UK PubMed Central (United Kingdom)

It is the aim of this paper to review in tabulated form the supplementary dose of drugs required after hemodialysis and to discuss the basic pharmacokinetics of these drugs in the presence of reduced renal function. This review is intended to point out practical aspects of clinical nephrology, It refers to data available from the literature. The descriptions of pharmacokinetics focus on the amount of drug in the body. The fraction of this amount removed by dialysis is replaced by the supplementary dose to maintain effective drug action. The rebound phenomenon affecting plasma drug levels after dialysis renders the calculation of the supplementary dose difficult. Linear extrapolation from plasma drug concentrations measured 6-12 h or more after dialysis may offer a solution to this problem.

Keller F; Offermann G; Lode H

1982-01-01

292

Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients.  

Science.gov (United States)

Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States; the prevalence in maintenance hemodialysis patients substantially exceeds that in the general population. In hemodialysis patients, HCV infection has been associated with increased occurrence of cirrhosis and hepatocellular carcinoma and increased mortality. Injection drug use and receipt of blood transfusions before 1992 has accounted for most prevalent HCV infections in the United States. However, HCV transmission among patients undergoing hemodialysis has been documented frequently. Outbreak investigations have implicated lapses in infection control practices as the cause of HCV infections. Preventing these infections is an emerging priority for renal care providers, public health agencies, and regulators. Adherence to recommended infection control practices is effective in preventing HCV transmission in hemodialysis facilities. In addition, adoption of routine screening to facilitate the detection of incident HCV infections and hemodialysis-related transmission is an essential component of patient safety and infection prevention efforts. This article describes the current epidemiology of HCV infection in US maintenance hemodialysis patients and prevention practices to decrease its incidence and transmission. PMID:20570422

Patel, Priti R; Thompson, Nicola D; Kallen, Alexander J; Arduino, Matthew J

2010-06-08

293

The Role of Various Filters in Hypoxemia Levels of Hemodialysis Patients  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: One of the main complications of hemodialysis in patients with chronic renal failure is hypoxemia which is related to several factors including the type of filter. The aim of this study was to evaluate the hypoxemia levels in patients undergoing hemodialysis with focus on the type of filter. Methods: In a crossover clinical trial, 29 patients from emodialysis ward of Fatemieh hospital were enrolled in the study. The patients were randomly divided in two groups (allocation). First group was hemodialyzed using Polysulfone filters while the second group was hemodialyzed by Hemoph an filters for one month. After a period of 24 hours washout, filter was changed and hemodialysis was done for another month. Arterial blood O2 saturation at different times, before and after hemodialysis was determined and amount of decrement was measured and compared in both groups. Results: Mean decrease in the arterial blood O2 saturation during 5, 30, 60 and 120 minutes after initiation of hemodialysis was higher in Hemophan filter than Polysulfone filter (p<0.001). In both groups, peak of decreasing levels were 30 and 60 minutes after initiation of hemodialysis. Conclusion: As use of polysulfone filters causes lesser decrease in arterial blood oxygen saturation, it is recommended in igh risk, especially cardiopulmonary disease patients

F Malek; J Toussy; MR Tamadon; Sh Mousavi; M Malek; M Ghaderi

2008-01-01

294

Pruritus in hemodialysis patients  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Pruritus is one of the most bothersome symptoms in patients on maintenance hemodialysis (HD), however little progress is seen in our understanding of its pathogenesis. The aim of this study was to evaluate the frequency of pruritus in HD patients in Tehran, Iran, and to correlate its presence and intensity with relevant clinical and laboratory parameters. Methods One hundred sixty-seven patients on maintenance HD at three out-patient HD units were enrolled in the study. Itch intensity was scored as mild, moderate and severe. Some relevant clinical and laboratory parameters (age, sex, xerosis, presence of neuropathy, duration of dialysis, history of atopy and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone [PTH] and alkaline phosphatase) were evaluated. Results Pruritus was found in 41.9% of patients. The intensity of itching was mild, moderate and severe, in 51.4%, 11.4% and 37.7% of patients, respectively. In 22 patients (31.4%) pruritus intensified during and after dialysis. There was no significant difference in the serum levels of creatinine, blood urea nitrogen, calcium, phosphorus, alkaline phosphatase, PTH and hematocrit between patients with and without pruritus. Age, sex, xerosis, underlying renal disease, history of atopy and duration of haemodialysis were not significantly different between the two groups. However, neuropathy was significantly more common in the pruritic group (63.8% versus 42.1%) (pv = 0.006). Conclusion Clinical neuropathy was the only significant finding in the pruritic group in our study. This finding justifies further research on nerve function and neurotransmitters in hemodialysis patients and the introduction of new drugs targeting neuropathy.

Akhyani Maryam; Ganji Mohammad-Reza; Samadi Nasrin; Khamesan Behnaz; Daneshpazhooh Maryam

2005-01-01

295

Pramlintide improved measures of glycemic control and body weight in patients with type 1 diabetes mellitus undergoing continuous subcutaneous insulin infusion therapy.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the safety and efficacy of the addition of pramlintide to continuous subcutaneous insulin infusion (CSII) therapy in patients with type 1 diabetes mellitus (T1DM). RESEARCH DESIGN AND METHODS: We conducted a post hoc analysis of 2 studies: a 29-week, multicenter, randomized, double-blind, placebo-controlled trial (referred to as RCT) (pramlintide, n = 82; placebo, n = 73) and an open-ended, multicenter, open-label, single-arm, observational study (referred to as clinical practice trial) (n = 150), which assessed the addition of pramlintide to CSII therapy in patients with T1DM. Pramlintide was initiated at 15 ?g and titrated to 30 or 60 ?g with major meals. The mealtime insulin dose was reduced by 30% to 50% at initiation, and then adjusted to optimize glycemic control. Endpoints at 29 weeks (RCT) and 6 months (clinical practice trial) included change in glycated hemoglobin (HbA1c) level, insulin dose, body weight, pre- and postprandial blood glucose level, and tolerability and safety. RESULTS: In both studies, mean baseline age was approximately 42 years, duration of diabetes was 20 to 24 years, and HbA1c level was approximately 8%. Pramlintide reduced blood glucose excursions and improved the percentage of recorded postprandial blood glucose levels < 180 mg/dL. Mean (± standard deviation) reduction in HbA1c level in the clinical practice trial was -0.3% ± 0.1% (P < 0.0001), and in the RCT was similar between pramlintide- and placebo-treated patients (-0.4% ± 0.1% and -0.3% ± 0.1%, respectively). Glycemic improvements were accomplished, with reductions in mealtime insulin doses (RCT: pramlintide, -23.8% ± 5.2%; placebo, -3.2% ± 4.1%; P < 0.0005; clinical practice trial: -27.5% ± 2.9%; P < 0.0001) and body weight (RCT: pramlintide, -2.2 kg ± 0.5 kg; placebo, +1.4 kg ± 0.3 kg; P < 0.0001; clinical practice trial: -3.2 kg ± 0.4 kg; P < 0.0001). Short-lived nausea, primarily mild to moderate in intensity, was the most common adverse event associated with pramlintide therapy. Severe hypoglycemic events occurred at a rate of 0.56 and 0.34 events per patient-year in pramlintide- and placebo-treated patients, respectively, in the RCT, and at a rate of 0.12 events per patient-year in the clinical practice trial. CONCLUSION: Addition of pramlintide to CSII therapy was safe and effective in patients with T1DM. Pramlintide should be considered for patients who are not able to optimize glycemic control with CSII therapy alone, particularly those with difficulty controlling postprandial blood glucose levels and/or body weight. Trial registration: www.ClinicalTrials.gov identifiers: NCT00042458, NCT00108004.

Herrmann K; Frias JP; Edelman SV; Lutz K; Shan K; Chen S; Maggs D; Kolterman OG

2013-05-01

296

Duplex ultrasound volumetric flow analysis before and after ?hemodialysis in patients with brachio-cephalic fistulae.  

UK PubMed Central (United Kingdom)

Purpose: The United Kingdom Renal Association recommends duplex ultrasound to monitor arteriovenous fistula (AVF) flow rates during surveillance. Significant flow rate changes should prompt further investigation or treatment to avoid a failing fistula. Hemodialysis is known to alter the hemorrheologic and physiologic factors with a potential impact on measured flow rates. The aim of this study was to determine the difference in flow rate measured with duplex ultrasound before and after a single hemodialysis session in patients with brachial-cephalic fistulae.Methods: Patients with brachial-cephalic AVFs in our dialysis populations who were undergoing regular hemodialysis without recent intervention (less than six weeks) were invited to participate. Flow measurements were made pre-and post-hemodialysis using a Zonare ultrasound machine. The vascular scientist was always blinded to the pre-hemodialysis flow.Results: A total of 157 patients were identified with brachial-cephalic fistulae. Following exclusions, 119 patients were eligible. However, a further 58 were excluded because they declined or did not attend leaving 61 patients in the study. Paired t test showed a statistically significant reduction in flow rate of 105 mL/min (P=0.026) post-hemodialysis which equates to a -6.9% change in flow (95% C.I. -12.7 to -0.8%). Bland-Altman analysis showed limits of flow rate agreement between -599 mL/min and +810 mL/min (+/-1.96 s.d.).Conclusions: Whilst we have shown a statistically significant change in flow rate post-hemodialysis, this is small and should be taken in the context of previously accepted interobserver variability. Therefore, the practical and financial considerations of implementing an AVF surveillance programme are likely to outweigh the minimal benefit of consistency that would be enabled by strict protocol of pre-hemodialysis flow measurements.

Chowdhury S; Goss D; Mistry H; Stephenson MA; Seed P; Deane C; Valenti D

2013-05-01

297

Human herpesvirus 8 shedding in the mouth and blood of hemodialysis patients.  

Science.gov (United States)

In Saudi Arabia, the prevalence of transplantation-associated Kaposi's sarcoma (KS) is high, and there is disparity in the prevalence rates of human herpesvirus 8 (HHV-8) infection between patients with renal disease and the general population. It was hypothesized that oral HHV-8 transmission among patients undergoing hemodialysis treatment contributes to the high prevalence of infection in renal disease patients. The detection rates of anti-HHV8-IgG in plasma and HHV-8-DNA in CD45(+)-peripheral blood cells of 72 hemodialysis patients were compared first with those of 178 blood donors and 60 pregnant women. Between the hemodialysis patients and the apparently healthy people sampled, the detection rate of anti-HHV-8-IgG was 16.7% versus 0.4% (P?undergoing hemodialysis. The amount of virus shed into saliva ranged between 8,600 and 119,562,500 (mean: 24,009,360) genome-equivalents/ml among the five patients in whom oral HHV-8 DNA was detected. Finally, HHV-8-subgenomic sequencing was conducted which showed that orally shed HHV-8 in four patients belonged to genotype C2, and in one patient to genotypes A1 and C2. HHV-8 shed in the mouth of hemodialysis patients may be extensive and diverse. Oral fluid in addition to blood is thus a likely vehicle for transmission of HHV-8, possibly contributing to the high risk of HHV-8 infection in patients undergoing hemodialysis and to KS following immunosuppression after renal transplantation. PMID:22431028

Al-Otaibi, Lubna M; Moles, David R; Porter, Stephen R; Teo, Chong-Gee

2012-05-01

298

Human herpesvirus 8 shedding in the mouth and blood of hemodialysis patients.  

UK PubMed Central (United Kingdom)

In Saudi Arabia, the prevalence of transplantation-associated Kaposi's sarcoma (KS) is high, and there is disparity in the prevalence rates of human herpesvirus 8 (HHV-8) infection between patients with renal disease and the general population. It was hypothesized that oral HHV-8 transmission among patients undergoing hemodialysis treatment contributes to the high prevalence of infection in renal disease patients. The detection rates of anti-HHV8-IgG in plasma and HHV-8-DNA in CD45(+)-peripheral blood cells of 72 hemodialysis patients were compared first with those of 178 blood donors and 60 pregnant women. Between the hemodialysis patients and the apparently healthy people sampled, the detection rate of anti-HHV-8-IgG was 16.7% versus 0.4% (P?undergoing hemodialysis. The amount of virus shed into saliva ranged between 8,600 and 119,562,500 (mean: 24,009,360) genome-equivalents/ml among the five patients in whom oral HHV-8 DNA was detected. Finally, HHV-8-subgenomic sequencing was conducted which showed that orally shed HHV-8 in four patients belonged to genotype C2, and in one patient to genotypes A1 and C2. HHV-8 shed in the mouth of hemodialysis patients may be extensive and diverse. Oral fluid in addition to blood is thus a likely vehicle for transmission of HHV-8, possibly contributing to the high risk of HHV-8 infection in patients undergoing hemodialysis and to KS following immunosuppression after renal transplantation.

Al-Otaibi LM; Moles DR; Porter SR; Teo CG

2012-05-01

299

Rising burden of Hepatitis C Virus in hemodialysis patients  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Aim High prevalence of Hepatitis C virus (HCV) has been reported among the dialysis patients throughout the world. No serious efforts were taken to investigate HCV in patients undergoing hemodialysis (HD) treatment who are at great increased risk to HCV. HCV genotypes are important in the study of epidemiology, pathogenesis and reaction to antiviral therapy. This study was performed to investigate the prevalence of active HCV infection, HCV genotypes and to assess risk factors associated with HCV genotype infection in HD patients of Khyber Pakhtunkhwa as well as comparing this prevalence data with past studies in Pakistan. Methods Polymerase chain reaction was performed for HCV RNA detection and genotyping in 384 HD patients. The data obtained was compared with available past studies from Pakistan. Results Anti HCV antibodies were observed in 112 (29.2%), of whom 90 (80.4%) were HCV RNA positive. In rest of the anti HCV negative patients, HCV RNA was detected in 16 (5.9%) patients. The dominant HCV genotypes in HCV infected HD patients were found to be 3a (n = 36), 3b (n = 20), 1a (n = 16), 2a (n = 10), 2b (n = 2), 1b (n = 4), 4a (n = 2), untypeable (n = 10) and mixed (n = 12) genotype. Conclusion This study suggesting that i) the prevalence of HCV does not differentiate between past and present infection and continued to be elevated ii) HD patients may be a risk for HCV due to the involvement of multiple routes of infections especially poor blood screening of transfused blood and low standard of dialysis procedures in Pakistan and iii) need to apply infection control practice.

Khan Sanaullah; Attaullah Sobia; Ali Ijaz; Ayaz Sultan; Naseemullah; Khan Shahid; Siraj Sami; Khan Jabbar

2011-01-01

300

The strategy of performing non-prophylactic hemodialysis therapy after administration of contrast media in renal insufficiency patients  

International Nuclear Information System (INIS)

Acute renal failure induced by contrast media is an important problem in renal insufficiency patients. Prophylactic hemodialysis is usually undertaken after the administration of radiocontrast media. However, we decided to cease giving prophylactic hemodialysis from February, 2002 in line with the guidelines regarding dialysis and contrast media administration provided by the European Society of Urogenital Radiology. We reported our policy at the doctor's meeting of hemodialysis therapy and at the meeting of clinical engineering technologists which were held in Okinawa. After the presentation, a questionnaire survey in 28 hospitals was undertaken by telephone. In all the hospitals, prophylactic hemodialysis after the administration of radiocontrast media was still being continued, with the exception of one hospital. We need to enlighten medical staff that the strategy of performing hemodialysis immediately after the administration of contrast media in patients with reduced renal function does not diminish the rate of radiocontrast media-induced nephropathy. (author)

2007-01-01

 
 
 
 
301

High mortality in orthotopic liver transplant recipients who require hemodialysis.  

UK PubMed Central (United Kingdom)

Acute renal failure is a significant risk factor for death in patients with liver failure. The goal of this study was to analyze the impact of peri-transplant dialysis on the long-term mortality of liver transplant recipients. We performed a single-center, retrospective cohort study of 743 adult liver transplants; patients who received first liver transplants were divided into four groups: those who received more than one dialysis treatment (hemodialysis [HD], continuous veno-venous hemodialysis [CVVH]) pre-orthotopic liver transplantation (OLT), post OLT, pre- and post OLT, and those not dialyzed. There was no statistically significant difference in the mean survival time for patients who were not dialyzed or dialyzed only pre-OLT. Mean survival times were markedly reduced in patients dialyzed post OLT or both pre- and post OLT compared with those never dialyzed. Mortality risk in a Cox proportional hazards model correlated with hemodialysis post OLT, intra-operative vasopressin or neosynephrine, donor age >50 yr, Cr >1.5 mg/dL at transplant, and need for subsequent retransplant. Risk of post-OLT dialysis was correlated with pre-OLT dialysis, intra-operative levophed, pre-OLT diabetes, African American race, pre-OLT Cr >1.5, and male gender. We conclude that renal failure requiring hemodialysis post liver transplant, irrespective of pre-transplant dialysis status, is a profound risk factor for death in liver transplant recipients.

Zand MS; Orloff MS; Abt P; Patel S; Tsoulfas G; Kashyap R; Jain A; Safadjou S; Bozorgzadeh A

2011-03-01

302

High mortality in orthotopic liver transplant recipients who require hemodialysis.  

Science.gov (United States)

Acute renal failure is a significant risk factor for death in patients with liver failure. The goal of this study was to analyze the impact of peri-transplant dialysis on the long-term mortality of liver transplant recipients. We performed a single-center, retrospective cohort study of 743 adult liver transplants; patients who received first liver transplants were divided into four groups: those who received more than one dialysis treatment (hemodialysis [HD], continuous veno-venous hemodialysis [CVVH]) pre-orthotopic liver transplantation (OLT), post OLT, pre- and post OLT, and those not dialyzed. There was no statistically significant difference in the mean survival time for patients who were not dialyzed or dialyzed only pre-OLT. Mean survival times were markedly reduced in patients dialyzed post OLT or both pre- and post OLT compared with those never dialyzed. Mortality risk in a Cox proportional hazards model correlated with hemodialysis post OLT, intra-operative vasopressin or neosynephrine, donor age >50 yr, Cr >1.5 mg/dL at transplant, and need for subsequent retransplant. Risk of post-OLT dialysis was correlated with pre-OLT dialysis, intra-operative levophed, pre-OLT diabetes, African American race, pre-OLT Cr >1.5, and male gender. We conclude that renal failure requiring hemodialysis post liver transplant, irrespective of pre-transplant dialysis status, is a profound risk factor for death in liver transplant recipients. PMID:20331690

Zand, Martin S; Orloff, Mark S; Abt, Peter; Patel, Siddharth; Tsoulfas, George; Kashyap, Randeep; Jain, Ashok; Safadjou, Saman; Bozorgzadeh, Adel

303

Olfactory function improves following hemodialysis.  

UK PubMed Central (United Kingdom)

Olfactory function has been shown to be affected in chronic kidney disease; however, studies are contradictory and little is known on the effects of dialysis. To resolve these issues we tested olfactory function in 24 healthy controls and in 28 patients with chronic kidney disease receiving hemodialysis (20 patients) or peritoneal dialysis (the other 8). As assays for olfactory function we measured smell identification, n-butanol and acetic acid thresholds, Kt/V urea, percentage reduced urea, and weights before and after dialysis. Olfactory function was also self-rated by the participants. Compared to healthy controls, predialysis olfactory function was moderately but significantly decreased in the two dialysis groups, with hemodialysis patients being more affected. Patients self-rated olfactory function similar to that of healthy controls, suggesting that patients are unaware of the olfactory decrease. Olfactory function was significantly improved by one hemodialysis session. Neither body mass index, total volume loss, nor any other dialysis parameter correlated with olfactory function or its restitution following hemodialysis. The observed pattern of improvement suggests underlying mixed peripheral and central mechanisms. Thus, olfactory dysfunction in patients with chronic kidney disease is readily reversible by hemodialysis.

Landis BN; Marangon N; Saudan P; Hugentobler M; Giger R; Martin PY; Lacroix JS

2011-10-01

304

Current status and standards for establishment of hemodialysis units in Korea.  

UK PubMed Central (United Kingdom)

The number of hemodialysis patients and dialysis facilities is increasing each year, but there are no surveillance programs validating that the services and equipment of each hemodialysis unit meet specified safety and quality standards. There is a concern that excessive competition and illegal activities committed by some dialysis facilities may violate patients' right to health. Contrastingly, developed countries often have their own survey program to provide initial certification and monitoring to ensure that these clinics continue to meet basic requirements. Because hemodialysis units provide renal replacement therapy to critical patients suffering from severe chronic renal failure, appropriate legal regulation is important for the provision of initial certification and maintenance of facility, equipment, and human resource quality. Therefore, several standards providing minimum requirements for the area of hemodialysis unit, equipment for emergency care, physician and nurse staffs, water purification and quality management are urgently needed.

Lee YK; Kim K; Kim DJ

2013-05-01

305

Technical aspects of home hemodialysis.  

UK PubMed Central (United Kingdom)

Home hemodialysis (HHD) has proved to be a useful form of renal replacement therapy. The economic advantage of HHD is well established and interest in it is renewed. Once it has been decided to establish a HHD program, a well developed strategic plan is required. This should address financial and logistical issues and establish policies that will address responsi-bilities of both patients and HD centers. The recruitment of patients is facilitated by ensuring that all incident patients have early access to an education program describing all forms of renal replacement therapy that the regional renal program provides. Patients and members of the pre-dialysis education program should understand the selection process criteria in advance. Once the assessment is completed and the patient agrees to the proceedings, a plan of action should be esta-blished for enrolling the patient into the program and initiating training. Patients' education pro-gram should take into consideration principles of adult learning. When choosing dialysis equip-ment for home use, the needs and preferences of the patients should be respected. As a rule of thumb, the equipment should be simple to use, yet still provide adequate and reliable therapy. De-ciding where to set up and position the HHD equipment is important. Installation of HHD ma-chine at home requires a continuous supply of accessories. Before establishing a HHD program, commitment of the dialysis center to provide and maintain the infrastructure of the program is mandatory. The estimated patients suitable for HHD are less than 15% of all prospective dialysis patients. Generally, those who are have greatly improved quality of life and by using modalities such as nocturnal and daily dialysis can have improved physical well-being with considerable potential cost savings.

Alhomayeed B; Lindsay RM

2009-03-01

306

Feasible isolated liver transplantation for a cirrhotic patient on chronic hemodialysis.  

UK PubMed Central (United Kingdom)

End-stage liver and kidney disease (ELKD) is an indication for deceased donor simultaneous liver-kidney transplantation. Although a few cases of living donor liver-kidney transplantation have been reported, the invasiveness remains to be discussed. Living donor liver transplantation (LDLT) is an alternative choice for ELKD, but has never been reported. Here, we report a case of successful LDLT for a patient with ELKD on hemodialysis. The patient was a 63-year-old male and had decompensated hepatitis C cirrhosis with seronegativity for hepatitis C virus. He had non-diabetic end-stage renal failure and had been on hemodialysis for 3 years. He was in good general condition except for hepatic and renal failure. The living donor was his 58-year-old healthy wife. A right lobe graft was transplanted to the recipient under continuous hemodiafiltration (CHDF) and extracorporeal veno-venous bypass. CHDF was continued until postoperative day 4, at which point CHDF was converted to hemodialysis. His posttransplant course was good and he was discharged on postoperative day 36. To the best of our knowledge, this is the first report of LDLT for a patient on chronic hemodialysis. Therefore, being on hemodialysis is not a contraindication for LDLT. LDLT is feasible for a patient with ELKD on hemodialysis.

Morita K; Shirabe K; Yoshizumi T; Ikegami T; Masuda T; Hashimoto N; Mano Y; Miyata T; Soejima Y; Maehara Y

2013-05-01

307

High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients.  

UK PubMed Central (United Kingdom)

Retrospective studies suggest that online hemodiafiltration (OL-HDF) may reduce the risk of mortality compared with standard hemodialysis in patients with ESRD. We conducted a multicenter, open-label, randomized controlled trial in which we assigned 906 chronic hemodialysis patients either to continue hemodialysis (n=450) or to switch to high-efficiency postdilution OL-HDF (n=456). The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular mortality, all-cause hospitalization, treatment tolerability, and laboratory data. Compared with patients who continued on hemodialysis, those assigned to OL-HDF had a 30% lower risk of all-cause mortality (hazard ratio [HR], 0.70; 95% confidence interval [95% CI], 0.53-0.92; P=0.01), a 33% lower risk of cardiovascular mortality (HR, 0.67; 95% CI, 0.44-1.02; P=0.06), and a 55% lower risk of infection-related mortality (HR, 0.45; 95% CI, 0.21-0.96; P=0.03). The estimated number needed to treat suggested that switching eight patients from hemodialysis to OL-HDF may prevent one annual death. The incidence rates of dialysis sessions complicated by hypotension and of all-cause hospitalization were lower in patients assigned to OL-HDF. In conclusion, high-efficiency postdilution OL-HDF reduces all-cause mortality compared with conventional hemodialysis.

Maduell F; Moreso F; Pons M; Ramos R; Mora-Macià J; Carreras J; Soler J; Torres F; Campistol JM; Martinez-Castelao A

2013-02-01

308

Variable pulmonary manifestations in hemodialysis patients  

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A wide variety of pulmonary disorders related to hemodialysis or pre-existing renal disease occurs in hemodialysis patients. The disorders may be classified as 1) pulmonary abnormalities associated with chronic renal failures; 2) pulmonary complications arising during hemodialysis; 3) pulmonary infection; or 4) pulmonary-renal syndrome. An awareness of the various possible pulmonary disorders arising in hemodialysis patients may be helpful for the proper and timely management of such patients. We describe and illustrate various radiographic and CT findings of variable pulmonary disorders in hemodialysis patients.

Kim, Yoo Kyung; Shim, Sung Shine; Shin, Jung Hee; Choi, Gyu Bock [Ewha Womans University College of Medicine, Seoul (Korea, Republic of); Lee, Kyung Soo; Yi, Chin A [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Oh, Yu Whan [Korea University College of Medicine, Seoul (Korea, Republic of)

2003-08-01

309

Variable pulmonary manifestations in hemodialysis patients  

International Nuclear Information System (INIS)

A wide variety of pulmonary disorders related to hemodialysis or pre-existing renal disease occurs in hemodialysis patients. The disorders may be classified as 1) pulmonary abnormalities associated with chronic renal failures; 2) pulmonary complications arising during hemodialysis; 3) pulmonary infection; or 4) pulmonary-renal syndrome. An awareness of the various possible pulmonary disorders arising in hemodialysis patients may be helpful for the proper and timely management of such patients. We describe and illustrate various radiographic and CT findings of variable pulmonary disorders in hemodialysis patients.

2003-01-01

310

Perceptions of incorporating spirituality into their care: a phenomenological study of female patients on hemodialysis.  

UK PubMed Central (United Kingdom)

This phenomenological study was aimed at understanding how women with end stage renal disease undergoing hemodialysis want nurses to address their spirituality. Interviews were conducted with 16 women from outpatient hemodialysis centers in a large Midwestern city. Eighty-three significant statements yielded meanings representing four theme clusters, highlighting how these women prefer nurses to incorporate spirituality into their care: (a) displaying genuine caring, (b) building relationships and connectedness, (c) initiating spiritual dialogue, and (d) mobilizing spiritual resources. Participants expressed that nephrology nurses are uniquely positioned to understand their individualized spiritual needs and implement spiritual care.

Tanyi RA; Werner JS; Recine AC; Sperstad RA

2006-09-01

311

Negotiating living with an arteriovenous fistula for hemodialysis.  

UK PubMed Central (United Kingdom)

The purpose of this study was to examine how clients with end stage renal disease on hemodialysis negotiate living with an arteriovenous fistula. A fistula is the preferred access for hemodialysis, and clients must continually monitor and protect their fistula. In this qualitative, ethnographic study, data were collected during fieldwork and semistructured interviews. Constructivism and a cultural negotiation model provided frameworks for the study. Fourteen clients were interviewed; interviews lasted 1.5 to 4 hours. Results revealed new insights into informants'perspectives and experiences with a vascular access. The overarching theme was vulnerability, and underlying themes were body awareness, dependency, mistrust, and stigma. The response to vulnerability was to be continually vigilant and assertive to protect the holistic self Stigma of the vascular access was an important issue for informants and evoked the greatest emotional responses.

Richard CJ; Engebretson J

2010-07-01

312

Pulmonary Artery Pressure in Maintenance Hemodialysis Patients  

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Full Text Available To consider the prevalence of pulmonary artery pressure in End-stage Renal Disease (ESRD) patients, a study was conducted on maintenance of hemodialysis patients and a group of normal subjects. For assessment of pulmonary artery pressure all participants were subjected to two-dimensional and doppler echocardiographic studies that for patients were done after their hemodialysis session. In this study a significant difference of Pulmonary Artery Systolic Pressure (PASP) between patients and normal subjects with more values in hemodialysis patients was seen. A significant positive correlation of pulmonary artery pressure with age of control group and also significant positive correlation of pulmonary artery pressure with age of hemodialysis group were found. A significant positive correlation of PASP with duration and dosages of hemodialysis treatment were seen too. A high prevalence of pulmonary hypertension in hemodialysis needs more attention to this aspect of hemodialysis patients because pulmonary hypertension is a disease with poor prognosis.

M.D. Hamid Nasri; M.D. Shahin Shirani; M.D. Azar Baradaran

2006-01-01

313

[Workload during hemodialysis sessions].  

UK PubMed Central (United Kingdom)

In recent years, the population of dialysis patients has become frailer and older. Patients present with more comorbid conditions and experience more complications during their follow-up. The aim of the present study is to describe the workload of the dialysis center during hemodialysis sessions and determine whether comorbidities are associated with increased workload. We conducted a retrospective multicentric study on a sample population of 123 patients selected from a dialysis population within a regional network. We described hospitalizations and HD sessions during a 1-year follow-up. We collected data on 19 prescriptions and events occurring during HD sessions. We described two HD care profiles (easy and difficult) and looked for variables linked with these profiles. We found that age more or equal to 60 years, elevated C-reactive protein and HD catheters are associated with difficult HD care. Surprisingly, apart from heart failure, comorbidities were not linked to greater workload during HD sessions. The development of HD care profiles should be helpful in early detection of frailer patients. This could have concrete applications such as better allocation of human and material resources and better training for the dialysis staff.

Peters NO; Cridlig J; Loos-Ayav C; Kessler M; Frimat L

2010-11-01

314

Paricalcitol reduces oxidative stress and inflammation in hemodialysis patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Treatment with selective vitamin D receptor activators such as paricalcitol have been shown to exert an anti-inflammatory effect in patients on hemodialysis, in addition to their action on mineral metabolism and independently of parathyroid hormone (PTH) levels. The objective of this study was to evaluate the additional antioxidant capacity of paricalcitol in a clinical setting. METHODS: The study included 19 patients with renal disease on hemodialysis, of whom peripheral blood was obtained for analysis at baseline and three months after starting intravenous paricalcitol treatment. The following oxidizing and inflammatory markers were quantified: malondialdehyde (MDA), nitrites and carbonyl groups, indoleamine 2,3-dioxygenase (IDO), tumor necrosis factor alfa (TNF-?), interleukin-6 (IL-6), interleukin-18 (IL-18) and C-reactive protein (CRP). Of the antioxidants and anti-inflammatory markers, superoxide dismutase (SOD), catalase, reduced glutathione (GSH), thioredoxin, and interleukin-10 (IL-10) levels were obtained. RESULTS: Baseline levels of oxidation markers MDA, nitric oxide and protein carbonyl groups significantly decreased after three months on paricalcitol treatment, while levels of GSH, thioredoxin, catalase and SOD activity significantly increased. After paricalcitol treatment, levels of the inflammatory markers CRP, TNF-?, IL-6 and IL-18 were significantly reduced in serum and the level of anti-inflammatory cytokine IL-10 was increased. CONCLUSIONS: In renal patients undergoing hemodialysis, paricalcitol treatment significantly reduces oxidative stress and inflammation, two well known factors leading to cardiovascular damage.

Izquierdo MJ; Cavia M; Muñiz P; de Francisco AL; Arias M; Santos J; Abaigar P

2012-01-01

315

Paricalcitol reduces oxidative stress and inflammation in hemodialysis patients  

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Full Text Available ABSTRACT Background Treatment with selective vitamin D receptor activators such as paricalcitol have been shown to exert an anti-inflammatory effect in patients on hemodialysis, in addition to their action on mineral metabolism and independently of parathyroid hormone (PTH) levels. The objective of this study was to evaluate the additional antioxidant capacity of paricalcitol in a clinical setting. Methods The study included 19 patients with renal disease on hemodialysis, of whom peripheral blood was obtained for analysis at baseline and three months after starting intravenous paricalcitol treatment. The following oxidizing and inflammatory markers were quantified: malondialdehyde (MDA), nitrites and carbonyl groups, indoleamine 2,3-dioxygenase (IDO), tumor necrosis factor alfa (TNF-?), interleukin-6 (IL-6), interleukin-18 (IL-18) and C-reactive protein (CRP). Of the antioxidants and anti-inflammatory markers, superoxide dismutase (SOD), catalase, reduced glutathione (GSH), thioredoxin, and interleukin-10 (IL-10) levels were obtained. Results Baseline levels of oxidation markers MDA, nitric oxide and protein carbonyl groups significantly decreased after three months on paricalcitol treatment, while levels of GSH, thioredoxin, catalase and SOD activity significantly increased. After paricalcitol treatment, levels of the inflammatory markers CRP, TNF-?, IL-6 and IL-18 were significantly reduced in serum and the level of anti-inflammatory cytokine IL-10 was increased. Conclusions In renal patients undergoing hemodialysis, paricalcitol treatment significantly reduces oxidative stress and inflammation, two well known factors leading to cardiovascular damage.

Izquierdo María; Cavia Mónica; Muñiz Pilar; de Francisco Angel LM; Arias Manuel; Santos Javier; Abaigar Pedro

2012-01-01

316

Pressure changes within a chronic subdural hematoma during hemodialysis.  

Science.gov (United States)

Spontaneous intracranial hemorrhage is not an infrequent complication of systemic anticoagulation, as occurs in hemodialysis. The neurological symptoms of subdural hematoma may be similar to those of dialysis disequilibrium. The pressure within a subdural fluid collection was monitored in a patient undergoing hemodialysis. The patient was known to become unresponsive during previous dialysis treatments. The initial pressure within the subdural cavity was measured to be -10.0 cm H2O prior to dialysis. The pressure within the collection decreased to a minimum value of -19.4 cm H2O during dialysis and stabilized at -16.4 cm H2O at the termination of dialysis. The neurological status changed subjectively during the procedure, with the patient becoming unresponsive to verbal stimuli as the intracranial pressure reached a minimum. These findings represent a syndrome similar to aliquorrhea, or low cerebrospinal fluid pressure within an otherwise asymptomatic subdural hematoma. Previously only increased intracranial pressure has been reported with hemodialysis. PMID:2781460

Kopitnik, T A; de Andrade, R; Gold, M A; Nugent, G R

1989-10-01

317

Serum cholesterol binding reserve and high density lipoprotein cholesterol in patients on maintenance hemodialysis.  

UK PubMed Central (United Kingdom)

Serum cholesterol binding reserve (SCBR, the capacity of the serum to solubilize additional cholesterol), high density lipoprotein cholesterol (HDL . Ch) and serum levels of cholesterol and triglycerides were measured in 53 chronically uremic patients (40 men and 13 women) undergoing maintenance hemodialysis. The values were compared with those of controls (149 men and 28 women) matched for serum lipid levels. Hypertriglyceridemia and decreased HDL . Ch were observed among the patients, confirming previous reports. SCBR values of the patients were not significantly different from those of controls except in a small subgroup of uremic diabeties, whose SCBR values were markedly decreased. There was a positive correlation between SCBR and the duration for which the patients had been maintained by hemodialysis. The results suggest that patients with higher SCBR values have a better prospect for surviving long duration of hemodialysis.

Perez GO; Hsia SL; Christakis G; Burr J

1980-09-01

318

Calcified Plaques in Carotid and Femoral Arteries in Association with Left Ventricular Hypertrophy and Ejection Fraction in Hemodialy-sis Patients  

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Full Text Available Background/Objectives: Two principal cardiovascular findings in end-stage renal disease (ESRD) patients who undergo hemodialy-sis are left ventricular hypertrophy (LVH) and arterial disease due to rapidly progressive atherosclerotic vascular disease that can be characterized by arterial plaques. In this study we studied the relationship of LVH and ejection fraction with carotid and femoral artery plaques in ESRD patients undergoing hemodialysis. Materials and Methods: Sixty-one ESRD patients who underwent maintenance hemodialysis (F=23, M=38) were considered. There were 50 non-diabetic hemodialysis patients (F=20, M=30) and 11 diabetic hemodialysis patients (F=3, M=8). For all the subjects echocardiography and B-mode ultrasonographic assessment of carotid-femoral arteries for plaque occurrence were performed. Results: In this study there was a positive correlation between LVH and the duration of hemodialysis treatment; and also a significant asso-ciation between LVH and plaque score. Positive correlation was also demonstrated between hypertension and plaque score. Also an inverse correlation of plaque score with LV ejection fraction was noted. Moreover, the association of plaque score with diabetes mellitus was positive. Conclusion: The present study signifies the cardiac and vascular adaptation secondary to ESRD and demonstrates the potential contribution of structural and functional alteration in the large arteries to the pathogenesis of left ventricular hypertrophy, which requires more attention in hemodi-alysis patients.

"A. Baradaran; H. Nasri "

2004-01-01

319

Hemodialysis through persistent left superior vena cava  

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Full Text Available We report a case of end stage renal disease patient who displayed a persistent left superior vena cava (PLSVC) after placement of hemodialysis (HD) catheter through left internal jugular vein, as revealed by routine post-procedure X-ray chest. The diagnosis of PLSVC was confirmed by arterial blood gas, two-dimensional echocardiography, computed tomography thorax and angiographic examination. This anomaly is rather rare; few studies on safety of PLSVC for HD have been reported. The catheter was uneventfully used for HD for 2 months with careful continuous monitoring and removed after arteriovenous fistula was successfully cannulated. Physicians who place HD catheters in the left jugular/subclavian vein should be aware of the existence of PLSVC.

Kute V; Vanikar A; Gumber M; Shah P; Goplani K; Trivedi H

2011-01-01

320

Hospitalization for initiation of maintenance hemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Recent data on complications of hemodialysis (HD) is lacking. With advancement in dialysis technology the incidence of complications such as dialysis disequilibrium syndrome (DDS) has decreased. Notwithstanding these improvements many patients with end-stage renal disease (ESRD) continue to be hospitalized solely for initiation of hemodialysis. This study was undertaken to assess if such admissions are justified and also to determine incidence and predictors of complications of HD during initiation. METHODS: Medical records of adult patients (>18 years) initiated on maintenance hemodialysis from January 1st, 1998 through December 31st, 2000 at our institution were reviewed. The demographics of the patients, cause of renal failure, creatinine clearance, type of vascular access, comorbidities, serum chemistries, ultrafiltration (UF) rate and indications for initiating dialysis were noted. Intradialytic complications were retrieved from the dialysis flow sheets. RESULTS: Of the 240 patients reviewed, 18.3% developed complications during initiation of dialysis, and none was severe. Hypotension and leg cramps were the most frequent complications. The patients who developed hypotension and cramps were significantly older than those with no complications, 57.7 +/- 14.9 (mean +/- SD) years versus 52.3 +/- 14.8 years, respectively (p = 0.02). The increment of age significantly influenced the complication rate [odds ratio (OR): 1.03, 95% confidence interval (CI) 1.01-1.05 (p = 0.03)], and so did hematocrit (HCT) (OR: 1.07, 95% CI 1.01-1.13). Multivariate analysis using age and hematocrit as continuous variables revealed that the older patients with anemia had a significantly higher risk of developing HD related complications than younger patients with anemia (OR: 1.05, 95% CI 1.01-1.09 at HCT of 24%, and OR: 1.03, 95% CI 1.00-1.06 at HCT 27%). When patients were stratified by hematocrit level, older patients with hematocrit <27% had higher risk of complications and the risk increased with increasing age [complication rate (HCT <27%): age <40 = 0%, age 40-64 = 11.7%, age >65 = 25%, p < 0.016]. CONCLUSION: Although very few, hypotension and muscle cramps were the main complications during initiation of HD. Older patients with anemia are prone for these complications although no physician intervention was necessary. Hospitalization solely for initiation of maintenance dialysis is not necessary and the additional cost from such admissions cannot be justified.

Agraharkar M; Martinez MA; Kuo YF; Ahuja TS

2004-01-01

 
 
 
 
321

Effect of maintenance hemodialysis on diastolic left ventricular function in end-stage renal disease  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english PURPOSE: To analyze the effect of maintenance hemodialysis on left ventricular diastolic function in patients with end-stage renal disease. METHODS: Study population consisted of 42 patients with end-stage renal disease. Before an arteriovenous fistula was surgically created, the patients were evaluated by conventional and Doppler echocardiography and Doppler tissue imaging. Then, the patients undergoing hemodialysis treatment when the arteriovenous fistula was compleated (more) . After the first hemodialysis session (mean 76.14 ± 11.37 days) the second echocardiographic evaluations were performed. RESULTS: Mean age was 58 ± 13 years and 21 (%50) of the patients were female. After maintenance hemodialysis treatment; peak early (E) and peak late (A) diastolic mitral inflow velocities and E/A ratio were not significantly change however the deceleration time of E wave and left atrial diameter were significantly increased. Also there was no change in the early (Em) and late (Am) diastolic myocardial velocities and Em/Am ratios of lateral and septal walls of left ventricular. E/Em ratio was decreased insignificantly. Pulmonary vein velocities and right ventricular functions are remained almost unchanged after hemodialysis treatment. DISCUSSION: The acute and long-term effect of hemodialysis on left ventricular diastolic function is unclearly. Patients with end-stage renal disease treatment with hemodialysis via arteriovenous fistula experience a variety of hemodynamic and metabolic abnormalities that predispose to alterations in left and right ventricular functions. The present study showed that left ventricular diastolic function except left atrial diameter and right ventricular functions were not significantly change, however left ventricular systolic functions were impaired after maintenance hemodialysis treatment in patients with end-stage renal disease. CONCLUSION: It has been suggested that echocardiographic parameters are useful markers for evaluation of left ventricular and right ventricular functions in patients with end-stage renal disease. However, in patients with endstage renal disease treated with hemodialysis, repeated assessment of echocardiographic examinations to observe serial changes in left and right ventricular functions are not yet well established. In this study, we showed that acute changes of volume status and electrolytes and autonomic regulation by hemodialysis session did not affect left ventricular diastolic and right ventricular functions in a relatively long term.

Duran, Mustafa; Unal, Aydin; Inanc, Mehmet Tugrul; Esin, Fatma; Yilmaz, Yucel; Ornek, Ender

2010-01-01

322

Effect of maintenance hemodialysis on diastolic left ventricular function in end-stage renal disease  

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Full Text Available PURPOSE: To analyze the effect of maintenance hemodialysis on left ventricular diastolic function in patients with end-stage renal disease. METHODS: Study population consisted of 42 patients with end-stage renal disease. Before an arteriovenous fistula was surgically created, the patients were evaluated by conventional and Doppler echocardiography and Doppler tissue imaging. Then, the patients undergoing hemodialysis treatment when the arteriovenous fistula was compleated. After the first hemodialysis session (mean 76.14 ± 11.37 days) the second echocardiographic evaluations were performed. RESULTS: Mean age was 58 ± 13 years and 21 (%50) of the patients were female. After maintenance hemodialysis treatment; peak early (E) and peak late (A) diastolic mitral inflow velocities and E/A ratio were not significantly change however the deceleration time of E wave and left atrial diameter were significantly increased. Also there was no change in the early (Em) and late (Am) diastolic myocardial velocities and Em/Am ratios of lateral and septal walls of left ventricular. E/Em ratio was decreased insignificantly. Pulmonary vein velocities and right ventricular functions are remained almost unchanged after hemodialysis treatment. DISCUSSION: The acute and long-term effect of hemodialysis on left ventricular diastolic function is unclearly. Patients with end-stage renal disease treatment with hemodialysis via arteriovenous fistula experience a variety of hemodynamic and metabolic abnormalities that predispose to alterations in left and right ventricular functions. The present study showed that left ventricular diastolic function except left atrial diameter and right ventricular functions were not significantly change, however left ventricular systolic functions were impaired after maintenance hemodialysis treatment in patients with end-stage renal disease. CONCLUSION: It has been suggested that echocardiographic parameters are useful markers for evaluation of left ventricular and right ventricular functions in patients with end-stage renal disease. However, in patients with endstage renal disease treated with hemodialysis, repeated assessment of echocardiographic examinations to observe serial changes in left and right ventricular functions are not yet well established. In this study, we showed that acute changes of volume status and electrolytes and autonomic regulation by hemodialysis session did not affect left ventricular diastolic and right ventricular functions in a relatively long term.

Mustafa Duran; Aydin Unal; Mehmet Tugrul Inanc; Fatma Esin; Yucel Yilmaz; Ender Ornek

2010-01-01

323

Sleep disorders in hemodialysis patients  

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The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni-versity, Egypt over 4-...

Sabry Alaa; Abo-Zenah Hamdy; Wafa Ehab; Mahmoud Khaled; El-Dahshan Khaled; Hassan Ahmed; Abbas Tarek; Saleh Abd El-Baset

324

Survey the seroprevalence of CMV among hemodialysis patients in Urmia, Iran.  

UK PubMed Central (United Kingdom)

Cytomegalovirus (CMV) causes infection in immunocompromised, transplant recipients and those who received blood transfusion frequently. Risk factors for primary CMV infection are blood transfusion (including clotting factors, etc), recipients of infected transplants, hemo-dialysis and the frequency of dialysis in a week. This study aimed at determining the prevalence of cytomegalovirus (CMV) antibodies in end-stage renal disease (ESRD) patients who undergo hemodialysis. A cross-sectional study of hemodialysis patients in Urmia, Iran was undertaken in 2007. Sera of 84 Hemodialysis patients were investigated for CMV-specific immunoglobulin G (IgG). Forty-four (52%) patients were males. 65 patients (77.4%) were anti-CMV IgG positive and 6 (7.1%) were anti-CMV IgM positive. There was no relationship between the antibody titer and dialysis duration, or frequency of HD in a week. In conclusion, we recommend that every patient who has undergone hemodialysis receive blood products free of CMV if CMV negative to reduce the incidence and prevalence of CMV among HD patients.

Sepehrvand N; Khameneh ZR; Eslamloo HR

2010-03-01

325

Survey the seroprevalence of CMV among hemodialysis patients in Urmia, Iran  

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Full Text Available Cytomegalovirus (CMV) causes infection in immunocompromised, transplant reci-pients and those who received blood transfusion frequently. Risk factors for primary CMV infec-tion are blood transfusion (including clotting factors, etc), recipients of infected transplants, hemo-dialysis and the frequency of dialysis in a week. This study aimed at determining the prevalence of cytomegalovirus (CMV) antibodies in end-stage renal disease (ESRD) patients who undergo hemodialysis. A cross-sectional study of hemodialysis patients in Urmia, Iran was undertaken in 2007. Sera of 84 Hemodialysis patients were investigated for CMV-specific immunoglobulin G (IgG). Forty-four (52%) patients were males. 65 patients (77.4%) were anti-CMV IgG positive and 6 (7.1%) were anti-CMV IgM positive. There was no relationship between the antibody titer and dialysis duration, or frequency of HD in a week. In conclusion, we recommend that every patient who has undergone hemodialysis receive blood products free of CMV if CMV negative to reduce the incidence and prevalence of CMV among HD patients.

Sepehrvand Nariman; Khameneh Zakieh; Eslamloo Hamid-Reza

2010-01-01

326

Nalfurafine hydrochloride: a new drug for the treatment of uremic pruritus in hemodialysis patients.  

Science.gov (United States)

Uremic pruritus in hemodialysis patients is intractable and no effective treatments have been established yet. Although the precise mechanism of the pruritus is still unclear, accumulating evidence suggests that activation of the micro-opioid receptors may induce pruritus in hemodialysis patients. On the other hand, activation of kappa-opioid receptors is known to control or inhibit the signals activated through micro-opioid receptors; therefore, it was expected that kappa-opioid receptor agonists would be able to reduce pruritus in patients undergoing hemodialysis. Nalfurafine hydrochloride is a novel derivative of the opioid receptor antagonist naltrexone. Nalfurafine hydrochloride is a selective kappa-opioid receptor agonist and has a potent antipruritic effect on various types of pruritus through central kappa-opioid receptor activation in non-clinical pharmacological studies. Moreover, clinical studies have demonstrated that nalfurafine hydrochloride possesses efficacy and safety in hemodialysis patients with uremic pruritus. In this review, we provide a detailed description of the activity of nalfurafine hydrochloride using published data of in vitro, in vivo nonclinical pharmacological and clinical studies in hemodialysis patients with uremic pruritus. PMID:19584962

Nakao, Kaoru; Mochizuki, Hidenori

2009-05-01

327

Nalfurafine hydrochloride: a new drug for the treatment of uremic pruritus in hemodialysis patients.  

UK PubMed Central (United Kingdom)

Uremic pruritus in hemodialysis patients is intractable and no effective treatments have been established yet. Although the precise mechanism of the pruritus is still unclear, accumulating evidence suggests that activation of the micro-opioid receptors may induce pruritus in hemodialysis patients. On the other hand, activation of kappa-opioid receptors is known to control or inhibit the signals activated through micro-opioid receptors; therefore, it was expected that kappa-opioid receptor agonists would be able to reduce pruritus in patients undergoing hemodialysis. Nalfurafine hydrochloride is a novel derivative of the opioid receptor antagonist naltrexone. Nalfurafine hydrochloride is a selective kappa-opioid receptor agonist and has a potent antipruritic effect on various types of pruritus through central kappa-opioid receptor activation in non-clinical pharmacological studies. Moreover, clinical studies have demonstrated that nalfurafine hydrochloride possesses efficacy and safety in hemodialysis patients with uremic pruritus. In this review, we provide a detailed description of the activity of nalfurafine hydrochloride using published data of in vitro, in vivo nonclinical pharmacological and clinical studies in hemodialysis patients with uremic pruritus.

Nakao K; Mochizuki H

2009-05-01

328

ORIGINAL PAPER Erythropoietin therapy in chronic renal failure patients prior to hemodialysis  

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Full Text Available The human recombinant erythropoietin (hrEpo) is crucial in anemia treatment options in chronic renal failure patients undergoing regular hemodialysis therapy. However, the clinical characteristics of erythropoietin treatment prior to hemodialysis have not been thoroughly studied. This study was aimed to analyze in retrospective manner the results of hrEpo therapy in chronic renal failure prior to hemodialysis. The study included 42 patients (26 males and 16 females, 42.4±3.7 yrs old) with mean serum creatinine 305±32 µmol/l, whose anemia and iron homeostasis parameters were carefully assessed. HrEpo improved both the general state of the patients and the life quality, it decreased cardiovascular complications and the mortality of patients prior to hemodialysis therapy. Iron supplementation during erythropoietin therapy was required, in the majority of patients oral iron was sufficient. The application of human recombinant erythropoietin prior to hemodialysis is a safe option, it does not accelerate the progression of chronic renal failure, only in a small number of patients moderate increase of blood pressure was noted that could have been effectively managed with the modification of doses of hypotensive pharmacotherapy.

Jacek Rysz; Piotr Bartnicki; Robert A. Stolarek

2005-01-01

329

Association of Serum Leptin with Various Biochemical Parameters of Bone Turnover in Maintenance Hemodialysis Patients  

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Full Text Available Leptin is a small peptide hormone that is mainly but not exclusively, produced in adipose tissue. leptin is cleared principally by the kidney. Serum leptin concentrations and bone mass are directly related. This cross-sectional study was conducted on patients with end-stage renal disease (ESRD), who were undergoing maintenance hemodialysis. Serum calcium, phosphorus, predialysis serum creatinine, blood urea nitrogen and also alkaline phosphatase (ALP) and also intact serum PTH (iPTH) and serum Leptin were measured too. In this study a significant difference of serum leptin between males and females of diabetic patients with more values in females was seen. In all patients a significant positive correlation of logarithm of serum leptin with logarithm of serum iPTH and a significant positive correlation of serum leptin and BMI in were found. In male hemodialysis patients a near significant and inverse correlation of serum ALP with serum leptin was seen, moreover in female hemodialysis patients a near significant inverse correlation of serum leptin with serum phosphorus and also a significant inverse correlation of serum leptin with CaXP products were found too. In hemodialysis patients serum leptin affects bone activity and need further investigation this aspect of hemodialysis patients.

Hamid Nasri M.D.

2006-01-01

330

Clinical factors associated with serum copper levels and potential effect of sevelamer in hemodialysis patients.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Copper is an essential mineral nutrient for humans. Serum copper levels of hemodialysis patients are higher than those of healthy subjects, but it remains to be elucidated whether increased serum copper may have harmful effects. In addition, a recent in vitro study has shown that sevelamer can adsorb copper. In the present study, we searched for clinical factors associated with serum copper levels in hemodialysis patients. METHODS: This cross-sectional study included patients undergoing hemodialysis for more than 6 months. In these patients, we statistically tested associations between serum copper levels and other parameters, including nutritional markers, lipid profiles, oxidative stress, inflammation, and sevelamer administration. RESULTS: Among 48 patients (male/female = 28:20, age 71 ± 10 years, hemodialysis duration 84 ± 72 months), sevelamer hydrochloride was administered in 39 patients (81.3 %). In univariate analysis, serum copper levels showed significant positive correlations with serum levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-sensitivity C-reactive protein (hs-CRP), and malondialdehyde modified-LDL and negative correlations with plasma total homocysteine levels and the administered dose of sevelamer. In multivariate analysis, serum levels of LDL-cholesterol and hs-CRP were found to be independent determinants of serum copper levels. CONCLUSION: We found that serum copper levels were independently associated with dyslipidemia and inflammation in hemodialysis patients, but the pathogenic roles of copper remain to be elucidated. In addition, potential effect of sevelamer on serum copper levels should be examined in appropriately designed studies.

Ikee R; Tsunoda M; Sasaki N; Sato N; Hashimoto N

2013-06-01

331

Reducing bloodstream infections in an outpatient hemodialysis center--New Jersey, 2008-2011.  

UK PubMed Central (United Kingdom)

Patients undergoing hemodialysis are at risk for bloodstream infections (BSIs), and preventing these infections in this high-risk population is a national priority. During 2008, an estimated 37,000 BSIs related to central lines occurred among hemodialysis patients in the United States. This is almost as many as the estimated 41,000 central line-associated BSIs that occurred during 2009 among patients in critical-care units and wards of acute-care hospitals. In 2009, to decrease BSI incidence in a New Jersey outpatient hemodialysis center, a package of interventions was instituted, beginning with participation in a national collaborative BSI prevention program and augmented by a social and behavioral change process to enlist staff members in infection prevention. Rates of BSIs related to the patient's vascular access (i.e., access-related BSIs [ARBs]) were evaluated in the preintervention and postintervention periods. The incidence of all ARBs decreased from 2.04 per 100 patient-months preintervention to 0.75 (p=0.03) after initiating program interventions and to 0.24 (p<0.01) after adding a behavioral change intervention. Only one ARB occurred during the last 12 postintervention months. At this hemodialysis facility, participating in a collaborative prevention program along with implementation of a behavioral change strategy was associated with a large decrease in ARBs. Other outpatient hemodialysis facilities also might reduce ARBs by adopting similar approaches to prevention.

2012-03-01

332

Estudo comparativo de osteotomias nasais laterais contínua e por microperfuração em pacientes submetidos à rinoplastia primária/ Comparative study of continuous lateral osteotomy and microperforating osteotomy in patients undergoing primary rhinoplasty  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese INTRODUÇÃO: As osteotomias laterais têm papel importante na rinoplastia e podem ser realizadas através de diferentes técnicas. OBJETIVO:Este trabalho visa comparar o resultado final de estreitamento do dorso e base nasal por meio de dois tipos de osteotomia laterais, via microperfuração e contínua. MÉTODO: Foram selecionados 74 pacientes submetidos à rinoplastia, em Curitiba, 37 pacientes tiveram osteotomia lateral realizada por microperfuração e os outros 37 (more) por osteotomia contínua, todos pelo mesmo cirurgião. Analisados fotografias frontais, pré-operatórias e pós-operatórias de 6 meses, avaliando a largura do dorso e base nasal. Estudo retrospectivo. RESULTADOS E CONCLUSÃO: Por meio de análise estatística t de Student, concluímos que, em ambas as técnicas de osteotomia lateral há uma diferença estatística significativa no estreitamento do dorso e base nasal pós-operatório e não há diferença estatística entre os dois tipos de osteotomias. Abstract in english INTRODUCTION: Lateral osteotomies play an important role in rhinoplasty and can be performed with different techniques. OBJECTIVE: To compare the results of narrowing of the nasal dorsum and base through 2 types of lateral osteotomy: continuous and microperforating. METHOD: We selected 74 patients undergoing rhinoplasty: 37 patients underwent lateral continuous osteotomy and the other 37 underwent microperforating osteotomy, all performed by the same surgeon. We analyzed (more) frontal photography from the pre- and post-operative (6 months) periods, evaluating the width of the nasal dorsum and base. This was a retrospective study. RESULTS AND CONCLUSION: Using Student's t-test, statistical analysis concluded that there was a statistically significant difference in the post-operative narrowing of the nasal dorsum and base following both osteotomy techniques, and there was no statistically significant difference between the 2 techniques.

Pizzamiglio, Diego Sherlon; Berger, Cezar Augusto Sarraf

2012-09-01

333

Does more frequent hemodialysis provide dietary freedom?  

UK PubMed Central (United Kingdom)

Proponents of more frequent hemodialysis have suggested that this modality may improve nutritional status. A review of trials performed in the past 10 years was carried out to substantiate this claim. Three daily hemodialysis trials and 5 nocturnal hemodialysis trials were identified. More frequent hemodialysis did not appear to consistently improve serum albumin levels, weight after dialysis, protein catabolic rate, or protein or energy intake as measured by food diaries, except in 1 study with an average duration of conventional dialysis of 9.8 years before patients were switched to short daily hemodialysis and a mean follow-up of 39 months. There was an improvement in serum phosphorus levels and a decline in the use of phosphate binders, particularly in participants who received nocturnal hemodialysis. Thus, most short-term studies of more frequent dialysis do not show significant benefits in improving nutritional status. Nutritional benefits may accrue with longer follow-up or long-term dialysis, or both.

Rocco MV

2013-05-01

334

Objectives and Design of the Hemodialysis Fistula Maturation Study.  

UK PubMed Central (United Kingdom)

BACKGROUND: A large proportion of newly created arteriovenous fistulas cannot be used for dialysis because they fail to mature adequately to support the hemodialysis blood circuit. The Hemodialysis Fistula Maturation (HFM) Study was designed to elucidate clinical and biological factors associated with fistula maturation outcomes. STUDY DESIGN: Multicenter prospective cohort study. SETTING & PARTICIPANTS: Approximately 600 patients undergoing creation of a new hemodialysis fistula will be enrolled at 7 centers in the United States and followed up for as long as 4 years. PREDICTORS: Clinical, anatomical, biological, and process-of-care attributes identified pre-, intra-, or postoperatively. OUTCOMES: The primary outcome is unassisted clinical maturation, defined as successful use of the fistula for dialysis for 4 weeks without maturation-enhancing procedures. Secondary outcomes include assisted clinical maturation, ultrasound-based anatomical maturation, fistula procedures, fistula abandonment, and central venous catheter use. MEASUREMENTS: Preoperative ultrasound arterial and venous mapping, flow-mediated and nitroglycerin-mediated brachial artery dilation, arterial pulse wave velocity, and venous distensibility; intraoperative vein tissue collection for histopathologic and molecular analyses; postoperative ultrasounds at 1 day, 2 weeks, 6 weeks, and prior to fistula intervention and initial cannulation. RESULTS: Assuming complete data, no covariate adjustment, and unassisted clinical maturation of 50%, there will be 80% power to detect ORs of 1.83 and 1.61 for dichotomous predictor variables with exposure prevalences of 20% and 50%, respectively. LIMITATIONS: Exclusion of 2-stage transposition fistulas limits generalizability. The requirement for study visits may result in a cohort that is healthier than the overall population of patients undergoing fistula creation. CONCLUSIONS: The HFM Study will be of sufficient size and scope to: (1) evaluate a broad range of mechanistic hypotheses, (2) identify clinical practices associated with maturation outcomes, (3) assess the predictive utility of early indicators of fistula outcome, and (4) establish targets for novel therapeutic interventions to improve fistula maturation.

Dember LM; Imrey PB; Beck GJ; Cheung AK; Himmelfarb J; Huber TS; Kusek JW; Roy-Chaudhury P; Vazquez MA; Alpers CE; Robbin ML; Vita JA; Greene T; Gassman JJ; Feldman HI

2013-08-01

335

Methemoglobinemia in critically ill patients during extended hemodialysis and simultaneous disinfection of the hospital water supply.  

UK PubMed Central (United Kingdom)

INTRODUCTION: To evaluate the cause of methemoglobinemia in patients undergoing extended daily hemodialysis/hemodiafiltration we analyzed the relationship between methemoglobinemia and the water disinfection schedule of the hospital. METHODS: We reviewed all arterial blood gas analyses, obtained over a one-year period, in patients undergoing extended hemodialysis/hemodiafiltration, and compared the methemoglobin concentrations obtained on the days when the water supply was disinfected, using a hydrogen peroxide/silver ion preparation, with data measured on disinfection-free days. RESULTS: The evaluation of 706 measurements revealed a maximum methemoglobin fraction of 1.0 (0.8; 1.2) % (median and 25th; 75th percentiles) during hemodialysis/hemodiafiltration on the disinfection-free days. The methemoglobin fraction increased to 5.9 (1.3; 8.4) % with a maximal value of 12.2% on the days of water disinfection (P < 0.001 compared to disinfection-free days). Spot checks on hydrogen peroxide concentrations in the water supply, the permeate, and the dialysate, using a semi-quantitative test, demonstrated levels between 10 and 25 mg/l during water disinfection. CONCLUSIONS: Our results demonstrate that even a regular hospital water disinfection technique can be associated with significant methemoglobinemia during extended hemodialysis. Clinicians should be aware of this potential hazard.

Bek MJ; Laule S; Reichert-Jünger C; Holtkamp R; Wiesner M; Keyl C

2009-01-01

336

Cutaneous manifestations in patients with chronic kidney disease on maintenance hemodialysis.  

UK PubMed Central (United Kingdom)

Cutaneous disorders can precede or follow the initiation of hemodialysis treatment. We evaluated the prevalence of various dermatological manifestations in patients undergoing hemodialysis at least twice a week for minimum of three months at our center. Patients were excluded if they were undergoing hemodialysis less than twice a week or on hemodialysis secondary to ESRD following graft dysfunction. One hundred and forty-three patients were evaluated. Among them, there were 113 male and 30 females. Among the skin changes, pruritus accounted for 56%, Xerosis was observed in 52%, Diffuse blackish hyper pigmentation was seen in 40%. Skin infections was seen in 53% of patients, of these fungal, bacterial and viral infections were 27.2%, 14.6%, and 11.2%, respectively. Kyrle's disease was observed only in 6.9%. Other skin manifestations include eczema 4.8%, psoriasis 2.7%, and drug rash 2.1%. Nail changes were observed in 46 patients of whom 27 patients had onychomycosis. Other changes include discoloration, onycholysis, and splinter hemorrhages. Hair changes were observed in 21.7%. Mucosal changes were seen in 27.3%. In our study, pruritus, xerosis, and pigmentation were higher among skin changes. Recognition and management of some of these dermatological manifestations vastly reduce the morbidity and improve the quality of life.

Kolla PK; Desai M; Pathapati RM; Mastan Valli B; Pentyala S; Madhusudhan Reddy G; Vijaya Mohan Rao A

2012-01-01

337

Cutaneous Manifestations in Patients with Chronic Kidney Disease on Maintenance Hemodialysis  

Science.gov (United States)

Cutaneous disorders can precede or follow the initiation of hemodialysis treatment. We evaluated the prevalence of various dermatological manifestations in patients undergoing hemodialysis at least twice a week for minimum of three months at our center. Patients were excluded if they were undergoing hemodialysis less than twice a week or on hemodialysis secondary to ESRD following graft dysfunction. One hundred and forty-three patients were evaluated. Among them, there were 113 male and 30 females. Among the skin changes, pruritus accounted for 56%, Xerosis was observed in 52%, Diffuse blackish hyper pigmentation was seen in 40%. Skin infections was seen in 53% of patients, of these fungal, bacterial and viral infections were 27.2%, 14.6%, and 11.2%, respectively. Kyrle's disease was observed only in 6.9%. Other skin manifestations include eczema 4.8%, psoriasis 2.7%, and drug rash 2.1%. Nail changes were observed in 46 patients of whom 27 patients had onychomycosis. Other changes include discoloration, onycholysis, and splinter hemorrhages. Hair changes were observed in 21.7%. Mucosal changes were seen in 27.3%. In our study, pruritus, xerosis, and pigmentation were higher among skin changes. Recognition and management of some of these dermatological manifestations vastly reduce the morbidity and improve the quality of life.

Kolla, Praveen Kumar; Desai, Madhav; Pathapati, Ram Mohan; Mastan Valli, B.; Pentyala, Suneetha; Madhusudhan Reddy, G.; Vijaya Mohan Rao, A.

2012-01-01

338

Medication adherence in Greek hemodialysis patients: the contribution of depression and health cognitions.  

UK PubMed Central (United Kingdom)

BACKGROUND: Several studies have shown that non-adherence is a common and increasing problem among individuals with chronic illnesses, including hemodialysis patients. PURPOSE: The present study aimed to investigate the influence of depression and health cognitions on medication adherence among patients undergoing hemodialysis. METHOD: A sample of 168 participants was recruited from six general hospitals in the broader area of Athens, consisting of patients undergoing in-center hemodialysis. Measurements were conducted with the following instruments: the Medication Adherence Rating Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Multidimensional Health Locus of Control (MHLC) scale. RESULTS: The results indicated that medication adherence was associated positively with the dimensions of internal and doctor-attributed health locus of control, measured by the MHLC. It was also related negatively to depression, measured by the CES-D. CONCLUSIONS: The present study demonstrates the importance of depression in understanding the medication adherence of hemodialysis patients, as well as the contribution of heath cognitions.

Theofilou P

2013-06-01

339

Interpersonal psychosocial factors associated with underreported dietary energy intake in hemodialysis patients.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To examine the association between degree of underreporting energy intake and psychosocial (including interpersonal and personal) factors among hemodialysis patients in Japan. DESIGN: We conducted a cross-sectional study. Predictors of difference were identified using multiple linear regression analysis. SETTING: Study was conducted at a public hospital and a dialysis clinic in a single district in northeast Honshu, Japan. SUBJECTS: Participants were hemodialysis outpatients. Patients aged more than 20 years and undergoing treatment for end-stage renal disease for at least 6 months were included. Exclusion criteria were diagnosis of depression, a mental disease, or dementia. MAIN OUTCOME: The outcome measure was the difference in reported energy intake defined by the differences between a brief administered dietary history questionnaire and diet record stratified by standardized weight. RESULTS: Seventy patients undergoing hemodialysis participated (44 men [62.9%] and 26 women [37.1%]). Of these, 54.3% underreported energy intake (by >10%). Sex (male) and employment status (employed) were statistically associated with energy intake underreporting. A lower score of dialysis staff encouragement was associated with greater energy intake underreporting (? coefficient = 3.89 kcal/standardized weight, 95% confidence interval: 0.89 to 6.90; P = .012). CONCLUSION: Degree of underreporting energy intake is significantly associated with interpersonal psychosocial factors among hemodialysis patients in Japan. The interpersonal relationship with encouragement by the dialysis staff is important in improving the accuracy of reporting energy intake among dialysis patients.

Yokoyama Y; Sasaki S; Suzukamo Y; Yamazaki S; Takegami M; Kakudate N; Hasegawa T; Haga M; Kawaguchi T; Moriya T; Hotta O; Fukuhara S

2013-01-01

340

Depression in Chronic Kidney Disease and Hemodialysis Patients  

Directory of Open Access Journals (Sweden)

Full Text Available Depression is the most common psychiatric condition in Chronic Kidney Disease (CKD), but there are few studies that analyzed this condition in patients in different phases of disease. This article aims to evaluated depression in CKD patients, comparing patients in different phases of disease. Methods: We evaluated 134 patients with CKD submitted to conservative ambulatory treatment, and 36 patients with end-stage renal disease undergoing hemodialysis (HD). To evaluate depression, we used the Beck Depression Inventory (BDI), and the Beck Depression Inventory—SF (BDI-SF), a subscale that allows evaluate only the cognitive aspects of depression. Functional capacity was evaluated using the Karnofsky Performance Scale, and clinical and sociodemographic variables were also investigated. Results: Using BDI, depression was identified in 37.3% of patients in conservative treatment and in 41.6% in HD patients (p > 0.05). This percentage reduced when the BDI-SF was used, to 11.1% in conservative CKD patients and 13.8% in HD patients (p > 0.05). Depression was associated with marital status, professional activity, income, comorbidities and functional capacity. Discussion: We observed high prevalence of depression in patients with CKD undergoing conservative or hemodialysis treatment. Depression was associated with some clinical and sociodemografic variables and with functional capacity.

C. P. Andrade; R. C. Sesso

2012-01-01

 
 
 
 
341

Are the complications of arteriovenous fistulas associated with an abnormal ankle-brachial index in hemodialysis patients?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The peripheral artery disease is frequent among patients undergoing hemodialysis much more than in the general population. The ankle-brachial index (AB!) is a potent tool to screen this pathology. We analysed the relationship between ABI abnormal values and arteriovenous fistulas (AVF) complications...

Xhignesse, Patricia; Saint-Remy, Annie; Dubois, Bernard; Philips, Jean-Christophe; Krzesinski, Jean-Marie

342

Cardiovascular effects of home intensive hemodialysis.  

UK PubMed Central (United Kingdom)

Cardiovascular mortality remains the leading cause of death in patients with end-stage renal disease. Frequent home hemodialysis in the form of short daily hemodialysis and nocturnal home hemodialysis has been suggested to correct multiple cardiovascular surrogate endpoints in observational and randomized controlled studies. This review discusses recent advances of intensive hemodialysis on important cardiovascular outcomes including blood pressure control and cardiovascular geometry and function. Its impact on calcium-phosphate metabolism and anemia management as they relate to cardiovascular outcomes are highlighted.

Chan CT

2009-05-01

343

Melatonin improves sleep quality in hemodialysis patients.  

UK PubMed Central (United Kingdom)

Disturbed sleep is common in end-stage renal disease (ESRD). Exogenous melatonin has somniferous properties in normal subjects and can improve sleep quality (SQ) in several clinical conditions. Recent studies have shown that melatonin may play a role in improving sleep in patients undergoing dialysis. The goal of the present study was to assess the effect of exogenous melatonin administration on SQ improvement in daytime hemodialysis patients. Lipid profile and the required dose of erythropoietin (EPO) are also reported as secondary outcomes. In a 6-week randomized, double-blind cross-over clinical trial, 3 mg melatonin or placebo was administered to 68 patients at bedtime. A 72-h washout preceded the switch from melatonin to placebo, or vice versa. SQ was assessed by the Pittsburgh sleep quality index (PSQI). Sixty-eight patients completed the study protocol and were included in the final analysis. Melatonin treatment significantly improved the global PSQI scores (P < 0.001), particularly subjective SQ (P < 0.001), sleep efficiency (P = 0.005) and sleep duration (P < 0.001). No differences in sleep latency and daytime sleepiness were observed. Melatonin also increased the high-density lipoprotein (HDL) cholesterol (P = 0.003). The need for EPO prescription decreased after melatonin treatment (P < 0.001). We conclude that melatonin can improve sleep in ESRD. The modest increase in HDL cholesterol and decrease in the EPO requirement are other benefits associated with this treatment.

Edalat-Nejad M; Haqhverdi F; Hossein-Tabar T; Ahmadian M

2013-07-01

344

Urea biosensor for hemodialysis monitoring  

Energy Technology Data Exchange (ETDEWEB)

This research discloses an electrochemical sensor capable of detecting and quantifying urea in fluids resulting from hemodialysis procedures. The sensor is based upon measurement of the pH change produced in an aqueous environment by the products of the enzyme-catalyzed hydrolysis of urea. The sensor may be fabricated using methods amenable to mass fabrication, resulting in low-cost sensors and thus providing the potential for disposable use. In a typical application, the sensor could be used in treatment centers, in conjunction with an appropriate electronics/computer system, in order to determine the hemodialysis endpoint. The sensor can also be utilized to allow at-home testing to determine if dialysis was necessary. Such a home monitor is similar, in principle, to devices used for blood glucose testing by diabetics, and would require a blood droplet sample by using a finger prick. 9 figs.

Glass, R.S.