Noninvasive continuous monitoring of digital pulse waves during hemodialysis

DEFF Research Database (Denmark)

Burkert, Antje; Scholze, Alexandra; Tepel, Martin

2009-01-01

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, investiga...

Efficiency of acidemia correction on intermittent versus continuous hemodialysis in acute methanol poisoning

Czech Academy of Sciences Publication Activity Database

Zakharov, S.; Pelclová, D.; Navrátil, Tomáš; Běláček, J.; Latta, J.; Písař, M.; Rulíšek, J.; Lepš, J.; Zídek, P.; Kučera, C.; Boček, R.; Mazur, M.; Belik, Z.; Chalupa, J.; Talafa, V.; Kodras, K.; Nalos, D.; Sedlak, C.; Šenkyřík, M.; Šmíd, J.; Šálek, T.; Roberts, D. M.; Hovda, K. E.

2017-01-01

Roč. 55, č. 2 (2017), s. 123-132 ISSN 1556-3650 Institutional support: RVO:61388955 Keywords : Acidemia * continuous veno-venous hemodialysis * extended daily hemodialysis * intermittent hemodialysis * metabolic acidosis * methanol poisoning Subject RIV: CF - Physical ; Theoretical Chemistry OBOR OECD: Physical chemistry Impact factor: 3.677, year: 2016

Dietary Quality and Adherence to Dietary Recommendations in Patients Undergoing Hemodialysis.

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Luis, Desiree; Zlatkis, Karyn; Comenge, Beatriz; García, Zoraida; Navarro, Juan F; Lorenzo, Victor; Carrero, Juan Jesús

2016-05-01

The multiple dietary restrictions recommended to hemodialysis patients may be difficult to achieve and, at the same time, may result in nutritional deficiencies rendering a poor dietary quality. We here assess the dietary quality and adherence to renal-specific guideline recommendations among hemodialysis patients from a single center in Canary Islands, Spain. Cross-sectional study, including 91 patients undergoing maintenance hemodialysis. Clinical data and 3-day dietary records were collected. We compared patient's reported nutrients intake with guideline recommendations. We also evaluated their alignment with current American Heart Association dietary guidelines for cardiovascular prevention. Seventy-seven percent and 50% of patients consumed less than the recommended daily energy and protein, respectively. Although half of the patients met the recommendations for dietary fat intake, this was accounted by an excess of saturated fat in 92% of them. Only 22% consumed sufficient fiber. A very small proportion of patients (less than 50%) met the requirements for vitamins and other micronutrients. Insufficient dietary intake was observed in most patients for all vitamins except for cobalamin. Similarly, inadequate dietary intake was observed for many minerals, by both excess (phosphorus, calcium, sodium, and potassium) and defect (magnesium). Most patients met the recommendations for iron and zinc in their diets. A large proportion of hemodialysis patients at our center did not meet current renal-specific dietary recommendations. The quality of the diet was considered poor and proatherogenic according to American Heart Association guidelines. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations.

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Chirakarnjanakorn, Srisakul; Navaneethan, Sankar D; Francis, Gary S; Tang, W H Wilson

2017-04-01

Patients undergoing maintenance hemodialysis develop both structural and functional cardiovascular abnormalities. Despite improvement of dialysis technology, cardiovascular mortality of this population remains high. The pathophysiological mechanisms of these changes are complex and not well understood. It has been postulated that several non-traditional, uremic-related risk factors, especially the long-term uremic state, which may affect the cardiovascular system. There are many cardiovascular changes that occur in chronic kidney disease including left ventricular hypertrophy, myocardial fibrosis, microvascular disease, accelerated atherosclerosis and arteriosclerosis. These structural and functional changes in patients receiving chronic dialysis make them more susceptible to myocardial ischemia. Hemodialysis itself may adversely affect the cardiovascular system due to non-physiologic fluid removal, leading to hemodynamic instability and initiation of systemic inflammation. In the past decade there has been growing awareness that pathophysiological mechanisms cause cardiovascular dysfunction in patients on chronic dialysis, and there are now pharmacological and non-pharmacological therapies that may improve the poor quality of life and high mortality rate that these patients experience. Copyright © 2017 Elsevier B.V. All rights reserved.

Progressive exhaustion: A qualitative study on the experiences of Iranian family caregivers regarding patients undergoing hemodialysis

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Shahriar Salehitali

2018-04-01

Full Text Available Objective: The aim of this study was to explore the burden of care for patients undergoing hemodialysis from the experiences of family caregivers. Methods: In this qualitative study, a content analysis approach was used for data collection and analysis. Participants were 16 family caregivers selected through purposive sampling from four medical education centers affiliated with Ahvaz Jundishapur University of Medical Sciences, Iran. Semi-structured interviews were held to collect data. Results: Four categories were developed as follows: ‘care challenges’, ‘psychological vulnerabilities’, ‘the chronic nature of care ’and “care in the shade”. The categories led to the development of the main theme of ‘progressive exhaustion’ experienced by the family caregivers during the provision of care to patients undergoing hemodialysis. Conclusion: Family caregivers have a significant role in the process of patient care, and this role leads them to progressive exhaustion; therefore, the overall health of the caregivers should be taken into account and more attention should be paid to their quality of life, social welfare, and satisfaction level. Keywords: Family caregivers, Hemodialysis, Progressive exhaustion, Qualitative study

Evaluation of pulmonary function in renal transplant recipients and chronic renal failure patients undergoing maintenance hemodialysis

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Mohamed E. Abdalla

2013-01-01

Conclusion: There is impairment of lung function in patients with CRF undergoing hemodialysis. The main changes are small airway obstruction, reduction in carbon monoxide transfer and diminished 6MWT that were not completely improved in the kidney transplant patients.

Comparing the effects of relaxation technique and inhalation aromatherapy on fatigue in patients undergoing hemodialysis.

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Hassanzadeh, Mohammadali; Kiani, Fatemeh; Bouya, Salehoddin; Zarei, Mohammad

2018-05-01

This study aimed to compare the effects of relaxation techniques on fatigue in hemodialysis patients. This clinical trial study was conducted on 105 hemodialysis patients. The subjects were categorized into three groups as: relaxation, aromatherapy and control. In the relaxation group, Benson muscle relaxation techniques were employed; in the aromatherapy group, the inhalation of two drops of 5% lavender essential oil used and the control group only received regular healthcare actions. Data collected by using brief fatigue inventory, before and after the intervention. Results of the current study indicated significant differences in the mean of changes in fatigue scores before and after the intervention between the relaxation and aromatherapy groups, but the difference was insignificant in the control group. Aromatherapy with lavender essential oil can decrease the level of fatigue in the patients undergoing hemodialysis compared to Benson relaxation techniques. Copyright © 2018 Elsevier Ltd. All rights reserved.

Hemodialysis-related headache.

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Sav, Murat Yusuf; Sav, Tansu; Senocak, Elif; Sav, Nadide Melike

2014-10-01

Headache is one of the most frequently encountered neurological symptoms during hemodialysis. According to International Classification of Headache criteria dialysis-related headache was defined as the headache occurring during hemodialysis with no specific characteristic. It resolves spontaneously within 72 hours after the hemodialysis session ends. There are few studies in the literature investigating the clinical features of dialysis headache. The pathophysiology of hemodialysis-related headache is not known, but various triggering factors have been identified, including changes in blood pressure, serum sodium and magnesium levels during hemodialysis sessions, caffeine deprivation and stress. The aim of this article is to evaluate and analyze features of headache in patients undergoing hemodialysis. © 2014 International Society for Hemodialysis.

Is Nottingham Health Profile a reliable tool to measure quality of life of Filipinos with chronic kidney diseases undergoing hemodialysis.

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Chuku, Chika Lawson; Valdez, Josephine R; Ajonuma, Louis Chukwuemeka

2010-12-01

The quality of life (QOL) of hemodialysis patients is often compromised and many tools have been developed to assess the health-related QOL of chronic kidney disease (CKD) patients undergoing hemodialysis. However, no such tool is currently in use in the Philippines. The objective of this study is to determine if Nottingham Health Profile (NHP) can be a useful tool in the Philippines. Eighty patients undergoing hemodialysis in the dialysis unit of our hospital were enrolled for this study. Sixty-nine patients completed the study. Comparative analysis revealed significant difference in social isolation with favorable result for the Filipino patients. Other measures correlate well although with differences that were not statistically significant. NHP can be successfully applied as a standard QOL tool in the Philippines. However, it should be translated into Filipino to avoid language difficulty. NHP may be recommended for QOL determination in other developing countries.

Comparison of Dosage Requirement of Erythropoietin Stimulating Agent (ESA in Maintenance of Hemoglobin Concentration in patients undergoing twice weekly versus thrice weekly Hemodialysis in Pakistani Population

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Osama Kunwer Naveed

2018-03-01

Full Text Available Anemia is one of the major complications of patients with chronic kidney disease (CKD undergoing hemodialysis (HD and is associated with left ventricular hypertrophy and also increases morbidity and mortality. Anemia in patients with CKD can be due to two major reasons; iron deficiency or erythropoietin insufficiency. Erythropoietin Stimulating Agent (ESAs administration is the mainstay in treating anemia if the patient is iron sufficient. However, higher doses of ESAs have been associated with increased cerebrovascular and cardiovascular events. We conducted this study to see how much erythropoietin is required in our setting in iron sufficient patients to maintain hemoglobin(Hb  level and the effect of dialysis frequency on ESA doses.  Methods and Findings: A cross-sectional study was conducted at the Department of Nephrology at Ziauddin University Hospital. Patients’ charts were reviewed for Hb levels and doses of ESA to maintain Hb between 10-12 mg/dl. Patients were excluded if they had iron deficiency, malignancy, were on immunosuppressive agents, had renal transplant, and with Hb >12 mg/dl or <10 mg/dl and their ferritin levels, transferrin saturation, hemoglobin concentration, frequency of hemodialysis and ESA dosage were monitored. We also compared these variables between patients undergoing hemodialysis thrice weekly with those undergoing hemodialysis twice a week. A total of 105 patients were analyzed. 24 were excluded as they did not match the inclusion criteria. 81 patients were included in the study. 36 (44.4% were males and 45 (55.6% were females. Mean age of the patient was 56.47 ± 11.72 years. The average dose of ESA was 106.91 ± 61.47 for patients undergoing hemodialysis thrice weekly and 183.94 ± 116.71 for patients undergoing hemodialysis twice a week. Significant difference was found to exist between dosage of patients undergoing thrice weekly dialysis versus twice weekly dialysis(p=<0.001.  Our study has limitations

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

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El-Nakib GA

2013-08-01

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-α (TNF-α, 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-α, 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

Hope and spirituality among patients with chronic kidney disease undergoing hemodialysis: a correlational study

OpenAIRE

Ottaviani, Ana Carolina; Souza, Érica Nestor; Drago, Natália de Camargo; Mendiondo, Marisa Silvana Zazzetta de; Pavarini, Sofia Cristina Iost; Orlandi, Fabiana de Souza

2014-01-01

OBJECTIVE: to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis.METHOD: this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through individual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS).RESULTS: the average HHI score was 38.06 (±...

Theoretical overview of clinical and pharmacological aspects of the use of etelcalcetide in diabetic patients undergoing hemodialysis

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Ye J

2018-04-01

Full Text Available Jianzhen Ye,1 Guangrui Deng,1 Feng Gao2 1Department of Endocrinology, Huangzhou District People’s Hospital, Huanggang, People’s Republic of China; 2Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China Abstract: Etelcalcetide is the first intravenous calcimimetic agent authorized for the treatment of secondary hyperparathyroidism (sHPT in patients undergoing hemodialysis in Europe, the US, and Japan. The relationship between sHPT and diabetes resides on complex, bidirectional effects and largely unknown homeostatic mechanisms. Although 30% or more patients with end-stage renal disease are diabetics and about the same percentage of those patients suffer from sHPT associated with hemodialysis, no data on the specificities of the use of etelcalcetide in such patients are available yet. Regarding pharmacokinetic interactions, etelcalcetide may compete with oral hypoglycemics recommended for use in patients undergoing hemodialysis and insulins detemir and degludec, causing unexpected hypocalcemia or hypoglycemia. More importantly, hypocalcemia, a common side effect of etelcalcetide, may cause decompensation of preexisting cardiac insufficiency in diabetic patients or worsen dialysis-related hypotension and lead to hypotension-related cardiac events, such as myocardial ischemia. In diabetic patients, hypocalcemia may lead to dangerous ventricular arrhythmias, as both insulin-related hypoglycemia and hemodialysis prolong QT interval. Patients with diabetes, therefore, should be strictly monitored for hypocalcemia and associated effects. Due to an altered parathormone activity in this patient group, plasma calcium should be the preferred indicator of etelcalcetide effects. Until more clinical experience with etelcalcetide is available, the clinicians should be cautious when using this calcimimetic in patients with diabetes. Keywords: glucose intolerance

Evaluation of biocompatibility of the membrane of cellulose acetate in dogs with acute renal failure undergoing hemodialysis

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Andre Marcelo Conceição Meneses

2014-12-01

Full Text Available ABSTRACT. Meneses A.M.C., Saito M.E., Moraes C.C.G., Souza N.F., Bastos R.K.G., Luz M.A., Seixas L.S., Melchert A. & Caramori J.C.T. [Evaluation of biocompatibility of the membrane of cellulose acetate in dogs with acute renal failure undergoing hemodialysis.] Avaliação da biocompatibilidade da membrana de acetato de celulose em cães com insuficiência renal aguda submetidos à hemodiálise. Revista Brasileira de Medicina Veterinária, 36(4:362-366, 2014. Instituto da saúde e Produção Animal na Amazônia, Universidade Federal Rural da Amazônia, Avenida Presidente Tancredo Neves, 2501, Montese, Belém, PA 66077-530, Brasil. E-mail: andre.meneses@ufra.edu.br In order to evaluate the biocompatibility of the membrane of cellulose acetate in dogs with acute renal failure (ARF, undergoing hemodialysis, were used two groups, one consisting of eight normal dogs and the other by eight dogs with ARF induced by gentamicin. Each animal underwent five hemodialysis sessions, with intervals of 24 hours between each one. A significant reduction in urea and creatinine, whereas the other biochemical values were not different between groups, as well as blood pressure, red cell count, white blood cell count and activated clotting time. High levels of TNF-α was found in sick animals, with no detection of this cytokine in normal animals.

Clinical variables, lifestyle and coping in hemodialysis.

Science.gov (United States)

Comelis Bertolin, Daniela

2016-10-01

To verify the relationship between coping strategies of people with chronic kidney disease undergoing hemodialysis and their clinical variables and lifestyle habits. It was developed a cross-sectional study that used the Coping Strategies Inventory of Folkman and Lazarus and a semi-structured questionnaire for collecting clinical variables and lifestyles of patients undergoing hemodialysis in the Urology and Nephrology Institute of São Jose do Rio Preto-SP (Brazil). Participants were 107 adults undergoing hemodialysis, with an average age of 51 years; 62.4% were men. The main causes of chronic kidney disease were chronic glomerulonephritis, diabetes mellitus, undetermined cause and hypertension. The most reported coping strategies were focused on emotion. There were greater coping scores among people who had diabetes, those who had leisure and those who referred religion. People who exercised and those who had undergone renal transplantation had more positive coping. Clinical variables of people undergoing hemodialysis can be sources of stress, and lifestyle habits are associated with coping strategies to mitigate the effects of stress. Copyright© by the Universidad de Antioquia.

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

Science.gov (United States)

Maeshima, Keisuke; Torigoe, Masataka; Iwakura, Mikako; Yamanaka, Kunitoshi; Ishii, Koji

2015-01-01

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.

Intensive Home Hemodialysis: An Eye at the Past Looking for the Hemodialysis of the Future.

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Naso, Agostino; Scaparrotta, Giuseppe; Naso, Elena; Calò, Lorenzo A

2015-09-01

Multiple observational studies along with a limited number of randomized clinical trials suggest that intensive hemodialysis (IHD) not only improves outcomes for uremic patients undergoing chronic dialysis but does so with a more favorable cost/benefit ratio compared with conventional hemodialysis. As a result of this, there has been a rapid increase in the interest in home hemodialysis (HHD) as HHD represents the easiest means of implementing IHD. While HHD has generated increased interest given its association with better outcomes/reduced hospitalizations, there are very few randomized controlled trials comparing HHD with other hemodialysis methods. Reported HHD-associated increased survival benefits compared with in-center hemodialysis are from uncontrolled studies, which raise patient selection bias as underlying the differences found. Thus, while HHD draws increasing attention, studies that pay careful attention to the psychosocial, demographic, and clinical factors associated with patients selected to undergo HHD will be needed to ultimately demonstrate its benefits, clarify the clinical applications, and determine the limits of IHD use in dialysis patients. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Reversible primary hypothyroidism in Japanese patients undergoing maintenance hemodialysis.

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Sanai, T; Inoue, T; Okamura, K; Sato, K; Yamamoto, K; Abe, T; Node, K; Tsuruya, K; Iida, M

2008-02-01

The presence or absence of hypothyroidism was assessed in 152 consecutive Japanese patients with end-stage renal disease on hemodialysis. Eight patients who had undergone treatment for thyroid disease before starting hemodialysis therapy, and 3 patients with amyloidosis due to rheumatoid arthritis were excluded. Of the remaining 141 hemodialysis patients, 14 (9.9%) (9 males and 5 females, aged 69.1 A+/- 8.8 years with a mean duration of hemodialysis of 69 A+/- 51 months) were in a hypothyroid state, defined as a thyroid-stimulating hormone (TSH) level > 5 mU/l. Antithyroid peroxidase antibodies were positive in only 1 of the 14 patients, while antithyroglobulin antibodies were negative in all of these patients. After iodide restriction, the serum TSH level decreased in all the patients from a mean of 16.49 A+/- 22.80 to 4.44 A+/- 3.35 mU/l after 1 month, 4.25 A+/- 2.24 mU/l after 2 months and 3.97 A+/- 2.22 mU/l after 3 months. The 3 months of iodide restriction were also associated with decreases in systolic blood pressure (142 A+/- 19 to 125 A+/- 16 mmHg, p patients on hemodialysis. Retention of excess iodide may be the mechanism responsible for reversible hypothyroidism rather than immunological perturbations. It is, therefore, recommended to attempt iodide restriction before starting l-thyroxine replacement therapy.

Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation: A Competing-Risk Analysis of a Nationwide Cohort.

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Shih, Chia-Jen; Ou, Shuo-Ming; Chao, Pei-Wen; Kuo, Shu-Chen; Lee, Yi-Jung; Yang, Chih-Yu; Tarng, Der-Cherng; Lin, Chih-Ching; Huang, Po-Hsun; Li, Szu-Yuan; Chen, Yung-Tai

2016-01-19

Whether oral anticoagulant use should be considered in patients undergoing hemodialysis with atrial fibrillation (AF) remains controversial because of the uncertainty regarding risk-benefit assessments. The purpose of this study was to investigate the risk of ischemic stroke in patients undergoing hemodialysis with new-onset AF, in comparison with those without arrhythmia. This nationwide, population-based, propensity score-matched cohort study used data from Taiwan's National Health Insurance Research Database during 1998 to 2011 for patients on hemodialysis with new-onset nonvalvular AF and matched subjects without arrhythmia. The clinical end points were ischemic stroke (fatal or nonfatal), all-cause death, and other serious adverse cardiovascular events. In comparison with the matched cohort, patients with AF (n=6772) had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.13-1.43), all-cause death (aHR, 1.59; 95% CI, 1.52-1.67), in-hospital cardiovascular death (aHR, 1.83; 95% CI, 1.71-1.94), myocardial infarction (aHR, 1.33; 95% CI, 1.17-1.51), and hospitalization for heart failure (aHR, 1.90; 95% CI, 1.76-2.05). After considering in-hospital death as a competing risk, AF significantly increased the risk of heart failure (HR, 1.56; 95% CI, 1.45-1.68), but not those of ischemic stroke and myocardial infarction. Additionally, the predictive value of the CHA2DS2-VASc score for ischemic stroke was diminished in the competing-risk model. The risk of stroke was only modestly higher in patients undergoing hemodialysis with new-onset AF than in those without AF, and it became insignificant when accounting for the competing risk of in-hospital death. © 2015 American Heart Association, Inc.

Effect of hemodialysis on leflunomide plasma concentrations.

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Beaman, Jasmine M; Hackett, L Peter; Luxton, Grant; Illett, Kenneth F

2002-01-01

To report on the influence of hemodialysis on the disposition of leflunomide in a woman with end-stage renal disease. A 65-year-old white woman with a history of diabetes, end-stage renal disease, rheumatoid arthritis, vasculitis, and leg ulcers was admitted to the hospital with a flare in the symptoms of joint pain and vasculitis. Prior to admission, she had been treated for rheumatoid arthritis with methotrexate 7.5 mg once a week. Due to adverse effects from methotrexate and continuing painful joints, leflunomide was considered as a therapeutic alternative. A loading dose of 100 mg was followed two days later by a daily dose of 10 mg. The active metabolite of leflunomide (A771726) was measured before and after hemodialysis and between hemodialysis sessions over a period of 80 days. Pre- and post-hemodialysis concentrations were compared for 17 sessions during this time. Based on the initial measured concentrations, the leflunomide dose was increased to 20 mg/d for several weeks before being reduced to 15 mg due to elevated liver enzymes. Although renal pathways are responsible in part for excretion of A771726, the concentrations achieved in this patient at doses of 10-20 mg/d were at the low end of the range reported in the literature. It was shown that pre- and post-hemodialysis concentrations of A771726 did not differ significantly. Thus, the low concentrations of A771726 were not a result of the hemodialysis. Steady-state concentrations of A771726 in plasma were not affected by hemodialysis or renal impairment. Reduction of the dose of leflunomide in patients with chronic renal failure undergoing hemodialysis does not appear to be required.

[Bioimpedance vector analysis as a tool for the determination and adjustment of dry weight in patients undergoing hemodialysis].

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Atilano-Carsi, Ximena; Miguel, José Luis; Martínez Ara, Jorge; Sánchez Villanueva, Rafael; González García, Elena; Selgas Gutiérrez, Rafael

2015-05-01

Overhydration in hemodialysis patients is associated with cardiovascular mortality. Adequate removal of liquids and achievement of dry weight is one of the main goals of therapy. So far there are no clinical or laboratory parameters that are reliable, simple and affordable for its determination. The bioelectrical impedance vector analysis (BIVE) is a tool that allows identifying and monitoring hydration status, so the aim of this study was to use BIVE to adjust the intensity of ultrafiltration and achieve dry weight in hemodialysis patients. We studied 26 patients on hemodialysis, which were performed monthly measurements of bioelectrical impedance for four months. Corresponding vectors were plotted to know in an individual way the state of hydration, according to which the dry weight was adjusted when necessary. Dry weight adjustment was performed in 13 patients, 7 of which required increase and 6 decrease of dry weight. The displacement of vectors on the ellipses corresponded to the type of intervention made. Dry weight was reached in 84.6% of patients at the end of the study with a significant decrease in mean arterial blood pressure and an increase in phase angle in the group of decrease of dry weight. Bioelectrical impedance vector analysis is an useful tool for adjusting the dry weight in patients undergoing hemodialysis. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

[Factors that influence treatment adherence in chronic disease patients undergoing hemodialysis].

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Maldaner, Cláudia Regina; Beuter, Margrid; Brondani, Cecília Maria; Budó, Maria de Lourdes Denardin; Pauletto, Macilene Regina

2008-12-01

The following bibliographical research wanted to identify the main factors that influence adherence to treatment in chronic disease. The study focused on patients undergoing hemodialysis, as well as on the support nurses require for the promotion of health education among individuals with low treatment adherence. The identification of bibliographical sources was conducted at Health Virtual Library and Scientific Electronic Library Online (SciELO) data bases. Some printed magazines were also used. The results indicated nine factors influencing treatment adherence or non-adherence: team trust, support nets, educational level; accepting disease, treatment side effects, lack of access to medicines, long-term treatment, complex therapeutic approach, and lack of symptoms. It is advisable that nurses take into account these factors when dealing with chronic-disease patients that present low treatment adherence, getting family and multidisciplinary team support seeking treatment adherence.

ASSOSIATION BETWEEN PARAMETERS OF MINERAL BONE METABOLISM AND SURVIVAL IN PATIENTS UNDERGOING CHRONIC HEMODIALYSIS

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Branislav Apostolović

2015-12-01

Full Text Available Beside the traditional risk factors which have an effect on cardiovascular diseases, hemodialysis patients are exposed to metabolic factors, such as malnutrition, microinflammation and oxidative stress, along with mineral bone disorder. The aim of this study was to determine a three-year survival in patients undergoing chronic hemodialysis and to analyse correlation with parameters of mineral bone metabolism. During the three-year follow-up 186 patients were included, of which 115 men (61.83% and 71 women, with a mean age 61.47±12.42. The exact date and the direct cause of death were recorded and mineral bone metabolism parameters were analysed. Out of 67 dead patients, 33 (49.25% died from cardiovascular cause. Out of the total number of deaths in our study, only 11.9% of patients had a target PTH values. Patients with PTH>600 pg/ml are exposed to an increased risk from the overall mortality (RR=0.48, 95% CI (0.24-0.95, p=0.04, but also from cardiovascular mortality (RR=0.34, 95% CI (0.12-0.93, p=0.034 compared to patients with normal serum PTH. These patients have a statistically significant higher serum phosphorus in comparison with patients with normal PTH levels (1.72±0.42 vs. 1.39±0.36, p=0.032. Phosphorus above 2.10 mmol/L increases the relative risk for the overall mortality rate by 60% (RR=0.59, 95% CI (0.35-0.89, p=0.049. In our study, 2-fold higher risk of all-cause mortality (RR=2.00, 95% CI (0.92-4.36, p=0.048, and even 3-fold higher risk of cardiovascular mortality (RR=3.03, 95% CI (0.71-1.29, p=0.039 were found in patients with CaxP levels above 4.50 mmol2/L2. Three-year mortality rate of patients undergoing hemodialysis was 36.02%, while half of the patients died from cardiovascular disease. Patients with hyperparathyroidism and elevated calcium phosphorus product are at the highest risk, both for all-cause and cardiovascular mortality. Patients with hyperphosphatemia are at higher risk for all-cause mortality.

Pharmacokinetics of amikacin during hemodialysis and peritoneal dialysis

DEFF Research Database (Denmark)

Regeur, L; Colding, H; Jensen, H

1977-01-01

The pharmacokinetics of amikacin were examined in six bilaterally nephrectomized patients undergoing hemodialysis and in four patients with a minimal residual renal function undergoing peritoneal dialysis. The mean elimination half-life before the dialysis was 86.5 h in the anephric patients and 44...... renal function. During hemodialysis the half-life decreased to less than 10% (5.6 h) of the pretreatment value. The effectiveness of peritoneal dialysis was less as the half-life decreased to only about 30% (17.9 h) of the pretreatment value. During the dialyses a significant correlation between...... the half-life of amikacin and the decrease in blood urea and serum creatinine was demonstrated. The pharmacokinetic data were used to make dosage regimen recommendations for the treatment of patients undergoing intermittent hemodialysis or peritoneal dialysis....

Elastase, α1-Proteinase Inhibitor, and Interleukin-8 in Children and Young Adults with End-Stage Kidney Disease Undergoing Continuous Ambulatory Peritoneal Dialysis

OpenAIRE

Polańska, Bożena; Augustyniak, Daria; Makulska, Irena; Niemczuk, Maria; Jankowski, Adam; Zwolińska, Danuta

2013-01-01

Peritoneal dialysis is one of the main modality of treatment in end-stage kidney diseases (ESKD) in children. In our previous work in chronic kidney disease patients, in pre-dialyzed period and on hemodialysis, the neutrophils were highly activated. The aim of this study was to assess an inflammatory condition and neutrophil activation in ESKD patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Thirteen CAPD patients without infection, both sexes, aged 2.5–24 years, and grou...

Role of saliva in the caries experience and calculus formation of young patients undergoing hemodialysis.

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Andrade, Marcia Rejane Thomas Canabarro; Salazar, Sabrina Loren Almeida; de Sá, Leandro Figueira Reis; Portela, Maristela; Ferreira-Pereira, Antonio; Soares, Rosangela Maria Araújo; Leão, Anna Thereza Thomé; Primo, Laura Guimarães

2015-11-01

The aims of this study were to investigate the caries experience, periodontal status, oral hygiene habits, and salivary parameters of children and adolescents undergoing hemodialysis (HD) and to compare them with their healthy counterparts. Fifty-two HD patients were matched for age, sex, ethnicity, and social class with 52 healthy subjects for analysis of the number of decayed, missing and filled teeth, plaque and gingival index, dental calculus accumulation, measurements of pocket depth, clinical attachment level, gingival recession, and bleeding on probing. Stimulated saliva samples were collected to assess salivary flow rate, pH and buffer capacity, and salivary concentrations of calcium, phosphate, and urea by colorimetric method. HD patients had lower dental caries (p = 0.004), greater plaque and calculus accumulation (p = 0.001), and reported flossing less often than the controls (p = 0.013). Regarding salivary analysis, HD patients showed significantly higher values of pH, buffer capacity, and salivary urea concentration when compared to the controls (p = 0.001). HD patients had lower caries experience, higher accumulation of dental plaque, and calculus deposition than their healthy counterparts, probably due to the differences found in their salivary biochemical parameters. A significant number of children and adolescents undergoing hemodialysis are candidates for kidney transplantation and should receive complete pre-transplant dental exams and dental treatment. Our results open the way for the development of an individualized dental protocol for these patients with preventive measures and treatment of the poor oral health in HD patients.

Complementary Therapies for Pain Among Individuals Receiving Hemodialysis: A Systematic Review.

Science.gov (United States)

Zins, Savannah; Gross, Cynthia R; Huff, Edwin D; Hooke, Mary Catherine

2018-01-01

Pain is a major problem for individuals undergoing hemodialysis and can lead to decreased quality of life when ineffectively managed. Pain is often reported as burdensome; thus, nurses must learn effective, nonpharmacological adjuncts to help care for symptomatic patients. The purpose of this review was to identify non-pharmacologic complementary therapies and evaluate their effectiveness in minimizing pain among individuals undergoing hemodialysis. Multiple complementary interventions were identified, and several reduced pain, but evidence is qualified by limitations in study methods. Complementary therapies have the potential to reduce pain among individuals undergoing hemodialysis; however, more research is needed. Copyright© by the American Nephrology Nurses Association.

Analytical and Finite Element Modeling of Nanomembranes for Miniaturized, Continuous Hemodialysis

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Tucker Burgin

2015-12-01

Full Text Available Hemodialysis involves large, periodic treatment doses using large-area membranes. If the permeability of dialysis membranes could be increased, it would reduce the necessary dialyzer size and could enable a wearable device that administers a continuous, low dose treatment of chronic kidney disease. This paper explores the application of ultrathin silicon membranes to this purpose, by way of analytical and finite element models of diffusive and convective transport of plasma solutes during hemodialysis, which we show to be predictive of experimental results. A proof-of-concept miniature nanomembrane dialyzer design is then proposed and analytically predicted to clear uremic toxins at near-ideal levels, as measured by several markers of dialysis adequacy. This work suggests the feasibility of miniature nanomembrane-based dialyzers that achieve therapeutic levels of uremic toxin clearance for patients with kidney failure.

The efficacy of mupirocin ointment and chlorhexidine body scrubs in the eradication of nasal carriage of Staphylococcus aureus among patients undergoing long-term hemodialysis

NARCIS (Netherlands)

C. Watanakunakorn; J. Brandt; P. Durkin; S. Santore; B. Bota; C. J. Stahl

1992-01-01

textabstractPatients undergoing long-term hemodialysis have a high prevalence of Staphylococcus aureus nasal carriage, which may lead to serious infections. Mupirocin ointment has been used intranasally to eradicate S. aureus carriage in health human volunteers and health care workers.

Health-related quality of life in a sample of iranian patients on hemodialysis

DEFF Research Database (Denmark)

Pakpour, Amir H.; Saffari, Mohsen; Yekaninejad, Mir Saeed

2010-01-01

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......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...... 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 Language of Coping: Understanding Filipino Geriatric Patients' Hemodialysis Lived Experiences

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de Guzman, Allan B.; Chy, Mark Anthony S.; Concepcion, April Faye P.; Conferido, Alvin John C.; Coretico, Kristine I.

2009-01-01

The majority of patients with chronic kidney disease (CKD) are undergoing maintenance hemodialysis. Hemodialysis is a process of removing metabolic waste, other poisons, and excess fluids from the blood and replacing essential blood constituents through a dialysis machine. With hemodialysis causing stress not only to physical status but also to…

Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study.

Science.gov (United States)

Yamada, Shunsuke; Taniguchi, Masatomo; Tokumoto, Masanori; Yoshitomi, Ryota; Yoshida, Hisako; Tatsumoto, Narihito; Hirakata, Hideki; Fujimi, Satoru; Kitazono, Takanari; Tsuruya, Kazuhiko

2017-08-01

Hemodialysis patients are at increased risk for bone fracture and sarcopenia. There is close interplay between skeletal muscle and bone. However, it is still unclear whether lower skeletal muscle mass increases the risk for bone fracture. Cross-sectional study and prospective longitudinal cohort study. An independent cohort of 78 hemodialysis patients in the cross-sectional study and 3,030 prevalent patients undergoing maintenance hemodialysis prospectively followed up for 4 years. Skeletal muscle mass measured by bioelectrical impedance analysis (BIA) and modified creatinine index, an estimate of skeletal muscle mass based on age, sex, Kt/V for urea, and serum creatinine level. Bone fracture at any site. In the cross-sectional study, modified creatinine index was significantly correlated with skeletal muscle mass measured by BIA. During a median follow-up of 3.9 years, 140 patients had bone fracture. When patients were divided into sex-specific quartiles based on modified creatinine index, risk for bone fracture estimated by a Fine-Gray proportional subdistribution hazards model with all-cause death as a competing risk was significantly higher in the lower modified creatinine index quartiles (Q1 and Q2) compared to the highest modified creatinine index quartile (Q4) as the reference value in both sexes (multivariable-adjusted HRs for men were 7.81 [95% CI, 2.63-23.26], 5.48 [95% CI, 2.08-14.40], 2.24 [95% CI, 0.72-7.00], and 1.00 [P for trend creatinine index; no data for residual kidney function and fracture sites and causes. Modified creatinine index was correlated with skeletal muscle mass measured by BIA. Lower modified creatinine index was associated with increased risk for bone fracture in male and female hemodialysis patients. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

A modified version of the Greek Simplified Medication Adherence Questionnaire for hemodialysis patients

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Victoria Alikari

2017-05-01

Full Text Available Non-adherence to the therapeutic regimen is an increasingly growing problem especially among patients undergoing hemodialysis. The aim of this study was to modify the Greek version of Simplified Medication Adherence Questionnaire (GR-SMAQ for patients undergoing hemodialysis (GR-SMAQ-HD and explore its validity and reliability. Between June 2016 and November 2016 a group of patients undergoing hemodialysis (N=107 completed the Greek version of SMAQ. The study was carried out in three Dialysis Units of Hospitals of Athens and Peloponnese region, Greece. The form of GR-SMAQ was modified specifically for renal patients while four additional items were added so as the tool study all aspects of adherence to hemodialysis regimen. Construct validity was checked through exploratory factor analysis with principal Component Analysis with the Equamax method. Test-retest reliability and internal consistency were tested. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up at 5%. The Greek version of SMAQ for patients undergoing hemodialysis includes eight questions. Three factors emerged from factor analysis. Cronbach’s α coefficient was 0.742 for the whole scale and for each subscale was for Medication Adherence 0.75, for Attendance at hemodialysis session 0.856 and for Diet/Fluid restriction was 0.717. The total mean score was 6.29 (±1.82. GR-SMAQ-HD is a reliable and valuable tool that can be used by hemodialysis nurses and students of nursing for detection of adherence levels in clinical practice.

A comparison of the effect of alcohol and povidone-iodine mixture with alcohol after povidon-iodine in prevention of vascular access inflammation in patients undergoing hemodialysis

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Bazzi A

2014-11-01

Full Text Available Background and Objective: The quality of hemodialysis can be promoted through reducing vascular access complications in these patients. One of the crucial roles of nurses in hemodialysis wards is reducing inflammation and infection of the vascular access. This study was conducted to compare the incidence of inflammation around the vascular access area in patients undergoing hemodialysis between two antiseptic methods of alcohol after povidone-iodine and the combination of alcohol and povidone-iodine. Materials and Method: This clinical trial was performed under the supervision of Mashhad University of Medical Sciences, Iran, after gaining ethical committee approval in 2014. In the present study, 100 participants were selected by convenience sampling method and randomly divided into three groups of combination of alcohol and povidone-iodine (n = 37, alcohol after using povidone-iodine (n = 32, and control group (n = 31. In the intervention groups 1 and 2, vascular access was disinfected using a combination of alcohol and povidone-iodine and alcohol after povidone-iodine, respectively. In the control group, vascular access was disinfected using the method of the related ward. Patients were fully observed for phlebitis occurrence for 12 hemodialysis sessions (1 month. Vascular access was controlled using the Iranian Nurses Association's phlebitis criteria. Data were analyzed using chi-square, ANOVA test, and Fisher's exact test in SPSS version 16. Results: The incidence rate of inflammation in the combination of alcohol and povidone-iodine, alcohol after povidone-iodine, and control groups, respectively, were 46%, 87.9%, and 100%. The incidence rate of inflammation was significantly lower in the combination of alcohol and povidone-iodine compared to the alcohol after povidone-iodine group (P < 0.001. However, no significant differences existed between the alcohol after povidone-iodine and control group. Conclusion: The combination of alcohol and

The influence of spirituality and religiousness on suicide risk and mental health of patients undergoing hemodialysis.

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Loureiro, Ana Catarina Tavares; de Rezende Coelho, Maria Carlota; Coutinho, Felipe Bigesca; Borges, Luiz Henrique; Lucchetti, Giancarlo

2018-01-01

Despite the large amount of literature assessing how spiritual and religious beliefs have an impact on mental health and suicide risk in various groups of patients, few studies have investigated patients with chronic kidney disease (CKD). The purpose of this study is to investigate whether spirituality and religiousness (S/R) are associated with the presence of suicide risk as well as whether those beliefs are also associated with the presence of mental health problems in patients undergoing hemodialysis. Cross-sectional study carried out in three Brazilian dialysis units involving hemodialysis patients. The study assessed religiousness (Duke Religion Index); spiritual well-being (FACIT-Sp 12); mental health - depression and anxiety (Mini International Neuropsychiatric Interview-MINI); and risk of suicide (MINI). For analysis, adjusted logistic regression models were applied. A total of 264 (80.7%) patients were included, 17.8% presented suicide risk, 14.0% presented current major depressive episode, and 14.7% presented generalized anxiety disorder. Concerning spiritual well-being (FACIT-Sp 12), the subscale of "Meaning" was associated with lower risk of suicide, depression, and anxiety. The subscale "Peace" was associated with lower depression and anxiety, whereas the subscale "Faith" was associated with lower suicide risk and depression. Religiousness measures were not associated with the study outcomes. Spiritual beliefs were associated with lower suicide risk and better mental health among hemodialysis patients. Factors related to spiritual well-being, such as "meaning", "peace" and "faith" were more associated with the outcomes studied than religious involvement. Further studies are needed to replicate our findings in different cultural and religious settings. Copyright © 2017 Elsevier Inc. All rights reserved.

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

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Zaritsky, Joshua; Rastogi, Anjay; Fischmann, George; Yan, Jieshi; Kleinman, Kenneth; Chow, Georgina; Gales, Barbara; Salusky, Isidro B; Wesseling-Perry, Katherine

2014-02-01

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. 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. 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). 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.

Factors associated with mortality in a population with acute kidney injury undergoing hemodialysis in Peru

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Percy Herrera-Añazco

Full Text Available Abstract Introduction: Patients with acute kidney injury (AKI in developing countries are described in a profile of young age, with less comorbidities, with unifactorial, and with a lower mortality compared to patients in developed countries. Objective: To assess mortality in patients with acute kidney injury undergoing hemodialysis (HD and its associated factors in a developing country setting. Methods: Retrospective study. Demographic, clinical, and mortality variables were collected from patients who presented AKI and underwent HD between January 2014 and December 2015 at a national reference hospital in Lima, Peru. Risk ratios (RR and 95% confidence intervals (95%CI were estimated through Poisson regressions. Results: Data from 72 patients with AKI that underwent HD were analyzed, 66.7% of them were 8.9 mg/dL. The adjusted analysis showed that having had a creatinine level of > 8.9 mg/dL, compared to a creatinine level of < 5.2 mg/dL at the time of initiating HD, was associated with 74% less probability of death. Conclusion: Four out of every ten AKI patients undergoing HD die. Higher levels of creatinine were associated with lower probability of mortality.

Long-term bicycle riding ameliorates the depression of the patients undergoing hemodialysis by affecting the levels of interleukin-6 and interleukin-18

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Zhao C

2016-12-01

improves the quality of life and ameliorates the depression severity of the patients undergoing hemodialysis by affecting the levels of IL-6 and IL-18. Bicycle riding is a potential way for the depression therapy of the patients with chronic hemodialysis. Keywords: aerobic exercise, depression, hemodialysis patients

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)

Suzuki, Hitoe; Shibuya, Asuka; Ando, Minoru; Akiba, Takashi; Nitta, Kosaku

2007-01-01

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 , β 2 -microglobulin (β 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 β 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)

Variables associated with lung congestion as assessed by chest ultrasound in diabetics undergoing hemodialysis

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Paulo Roberto Santos

Full Text Available Abstract Introduction: Ultrasound is an emerging method for assessing lung congestion but is still seldom used. Lung congestion is an important risk of cardiac events and death in end-stage renal disease (ESRD patients on hemodialysis (HD. Objective: We investigated possible variables associated with lung congestion among diabetics with ESRD on HD, using chest ultrasound to detect extracellular lung water. Methods: We studied 73 patients with diabetes as the primary cause of ESRD, undergoing regular HD. Lung congestion was assessed by counting the number of B lines detected by chest ultrasound. Hydration status was assessed by bioimpedance analysis and cardiac function by echocardiography. The collapse index of the inferior vena cava (IVC was measured by ultrasonography. All patients were classified according to NYHA score. Correlations of the number of B lines with continuous variables and comparisons regarding the number of B lines according to categorical variables were performed. Multivariate linear regression was used to test the variables as independent predictors of the number of B lines. Results: None of the variables related to hydration status and cardiac function were associated with the number of B lines. In the multivariate analysis, only the IVC collapse index (b = 45.038; p < 0.001 and NYHA classes (b = 13.995; p = 0.006 were independent predictors of the number of B lines. Conclusion: Clinical evaluation based on NYHA score and measurement of the collapsed IVC index were found to be more reliable than bioimpedance analysis to predict lung congestion.

Dissecting aortic aneurysm in maintenance hemodialysis patients

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Ounissi M

2009-01-01

Full Text Available 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.

[Adherence to pharmacological treatment in adult patients undergoing hemodialysis].

Science.gov (United States)

Sgnaolin, Vanessa; Figueiredo, Ana Elizabeth Prado Lima

2012-06-01

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. To identify compliance with pharmacological treatment of patients on hemodialysis and the main factors related to it we used the Adherence Scale. Observational, descriptive and cross-sectional study. Interviews were conducted to collect socioeconomic, pharmacological data, as well as those regarding self-reported adherence to drug. 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). 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.

The relationship between spiritual well-being and stress coping strategies in hemodialysis patients

OpenAIRE

Zahra Taheri-Kharameh

2016-01-01

Background and Objectives: Spiritual well-being has been recognized as an important resource to cope with illness and life stresses. The aim of this study is to determine the Spiritual well-being status as well as stress coping strategies in hemodialysis patients. Methods: This descriptive-analysis study included 95 randomly selected patients undergoing treatments with hemodialysis in hemodialysis centers of Qom hospitals. Data collection instruments were the Spiritual Well-Being Scale an...

Warfarin Use in Patients With Atrial Fibrillation Undergoing Hemodialysis: A Nationwide Population-Based Study.

Science.gov (United States)

Yoon, Chang-Yun; Noh, Juhwan; Jhee, Jong Hyun; Chang, Tae Ik; Kang, Ea Wha; Kee, Youn Kyung; Kim, Hyoungnae; Park, Seohyun; Yun, Hae-Ryong; Jung, Su-Young; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Kang, Shin-Wook; Kim, Changsoo; Yoo, Tae-Hyun

2017-09-01

The aim of this study is to elucidate the effects of warfarin use in patients with atrial fibrillation undergoing dialysis using a population-based Korean registry. Data were extracted from the Health Insurance Review and Assessment Service, which is a nationwide, mandatory social insurance database of all Korean citizens enrolled in the National Health Information Service between 2009 and 2013. Thromboembolic and hemorrhagic outcomes were analyzed according to warfarin use. Overall and propensity score-matched cohorts were analyzed by Cox proportional hazards models. Among 9974 hemodialysis patients with atrial fibrillation, the mean age was 66.6±12.2 years, 5806 (58.2%) were men, and 2921 (29.3%) used warfarin. After propensity score matching to adjust for all described baseline differences, 5548 subjects remained, and differences in baseline variables were distributed equally between warfarin users and nonusers. During a mean follow-up duration of 15.9±11.1 months, ischemic and hemorrhagic stroke occurred in 678 (6.8%) and 227 (2.3%) patients, respectively. In a multiple Cox model, warfarin use was significantly associated with an increased risk of hemorrhagic stroke (hazard ratio, 1.44; 95% confidence interval, 1.09-1.91; P =0.010) in the overall cohort. Furthermore, a significant relationship between warfarin use and hemorrhagic stroke was found in propensity-matched subjects (hazard ratio, 1.56; 95% confidence interval, 1.10-2.22; P =0.013). However, the ratios for ischemic stroke were not significantly different in either the propensity-matched (hazard ratio, 0.95; 95% confidence interval, 0.78-1.15; P =0.569) or overall cohort (hazard ratio, 1.06; 95% confidence interval, 0.90-1.26; P =0.470). Our findings suggest that warfarin should be used carefully in hemodialysis patients, given the higher risk of hemorrhagic events and the lack of ability to prevent thromboembolic complications. © 2017 American Heart Association, Inc.

21 CFR 876.5665 - Water purification system for hemodialysis.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Water purification system for hemodialysis. 876... SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5665 Water purification system for hemodialysis. (a) Identification. A water purification system for hemodialysis is a...

Efficacy and safety of teneligliptin in addition to insulin therapy in type 2 diabetes mellitus patients on hemodialysis evaluated by continuous glucose monitoring.

Science.gov (United States)

Yajima, Takahiro; Yajima, Kumiko; Hayashi, Makoto; Takahashi, Hiroshi; Yasuda, Keigo

2016-12-01

Appropriate glycemic control without hypoglycemia is important in patients with type 2 diabetes on hemodialysis. Teneligliptin, a novel dipeptidyl peptidase-4 inhibitor, can be used without dose adjustment for these patients. Using continuous glucose monitoring (CGM), we evaluated the efficacy and safety of adding teneligliptin to insulin therapy. Twenty-one type 2 diabetes mellitus patients on hemodialysis treated with insulin were enrolled. After the adjustment of insulin dose, their blood glucose level was monitored by CGM. Insulin dose was reduced after teneligliptin administration. The median total daily insulin dose significantly reduced from 18 (9-24)U to 6 (0-14)U (p1). Maximum, mean, and standard deviation of blood glucose level on the hemodialysis and non-hemodialysis days did not change after teneligliptin administration. However, minimum blood glucose level was significantly elevated on the hemodialysis day after teneligliptin administration (from 3.9±1.0mmol/L to 4.4±0.9mmol/L, p=0.040). The incidence of asymptomatic hypoglycemia on the hemodialysis day detected by CGM significantly decreased from 38.1% to 19.0% (p=0.049). Teneligliptin may contribute toward reducing the total daily insulin dose and preventing hypoglycemic events on the hemodialysis day in type 2 diabetes mellitus patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Influence of Uncertainty and Uncertainty Appraisal on Self-management in Hemodialysis Patients].

Science.gov (United States)

Jang, Hyung Suk; Lee, Chang Suk; Yang, Young Hee

2015-04-01

This study was done to examine the relation of uncertainty, uncertainty appraisal, and self-management in patients undergoing hemodialysis, and to identify factors influencing self-management. A convenience sample of 92 patients receiving hemodialysis was selected. Data were collected using a structured questionnaire and medical records. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlations and multiple regression analysis with the SPSS/WIN 20.0 program. The participants showed a moderate level of uncertainty with the highest score being for ambiguity among the four uncertainty subdomains. Scores for uncertainty danger or opportunity appraisals were under the mid points. The participants were found to perform a high level of self-management such as diet control, management of arteriovenous fistula, exercise, medication, physical management, measurements of body weight and blood pressure, and social activity. The self-management of participants undergoing hemodialysis showed a significant relationship with uncertainty and uncertainty appraisal. The significant factors influencing self-management were uncertainty, uncertainty opportunity appraisal, hemodialysis duration, and having a spouse. These variables explained 32.8% of the variance in self-management. The results suggest that intervention programs to reduce the level of uncertainty and to increase the level of uncertainty opportunity appraisal among patients would improve the self-management of hemodialysis patients.

Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning

Science.gov (United States)

Zakharov, Sergey; Pelclova, Daniela; Navratil, Tomas; Belacek, Jaromir; Kurcova, Ivana; Komzak, Ondrej; Salek, Tomas; Latta, Jiri; Turek, Radovan; Bocek, Robert; Kucera, Cyril; Hubacek, Jaroslav A; Fenclova, Zdenka; Petrik, Vit; Cermak, Martin; Hovda, Knut Erik

2014-01-01

During an outbreak of methanol poisonings in the Czech Republic in 2012, we were able to study methanol and formate elimination half-lives during intermittent hemodialysis (IHD) and continuous veno-venous hemodialysis/hemodiafiltration (CVVHD/HDF) and the relative impact of dialysate and blood flow rates on elimination. Data were obtained from 11 IHD and 13 CVVHD/HDF patients. Serum methanol and formate concentrations were measured by gas chromatography and an enzymatic method. The groups were relatively comparable, but the CVVHD/HDF group was significantly more acidotic (mean pH 6.9 vs. 7.1 IHD). The mean elimination half-life of methanol was 3.7 and formate 1.6 h with IHD, versus 8.1 and 3.6 h, respectively, with CVVHD/HDF (both significant). The 54% greater reduction in methanol and 56% reduction in formate elimination half-life during IHD resulted from the higher blood and dialysate flow rates. Increased blood and dialysate flow on the CVVHD/HDF also increased elimination significantly. Thus, IHD is superior to CVVHD/HDF for more rapid methanol and formate elimination, and if CVVHD/HDF is the only treatment available then elimination is greater with greater blood and dialysate flow rates. PMID:24621917

Rocuronium-sugammadex use for electroconvulsive therapy in a hemodialysis patient: a case report.

Science.gov (United States)

Kurita, Shigeaki; Moriwaki, Katsuyuki; Shiroyama, Kazuhisa; Sanuki, Mikako; Toyota, Yukari; Takebayashi, Minoru

2016-01-01

Recently, rocuronium with subsequent use of sugammadex was proposed for electroconvulsive therapy (ECT) as an alternative to succinylcholine. Because sugammadex is cleared via the kidney with no metabolism, it is unknown that rocuronium-sugammadex use is safe in hemodialysis patients who received ECT. In this case report, we used rocuronium with subsequent administration of sugammadex in a 69-year-old female, hemodialysis patient, scheduled for ten ECT sessions for severe major depression. In the initial eight sessions, we tested the feasibility of rocuronium-sugammadex use for ECT. During the series of four ECT sessions, we measured plasma concentrations for the sum of sugammadex and sugammadex-rocuronium complex and observed whether possible residual sugammadex affected muscle relaxation during subsequent sessions of ECT. The results showed the feasibility of rocuronium-sugammadex use as muscle relaxants for ECT in patients undergoing hemodialysis. However, an accumulation of sugammadex did occur even after two sessions of hemodialysis, and residual sugammadex decreased the effect of the rocuronium given in the subsequent ECT sessions. Rocuronium-sugammadex was successfully utilized as muscle relaxants for ECT in this patient. Our experience in this case may indicate that if succinylcholine is contraindicated, rocuronium-sugammadex can be an alternative method for muscle relaxation during ECT in patients undergoing hemodialysis. When this rocuronium-sugammadex procedure is used, the effect of residual sugammadex after hemodialysis on the subsequently administered rocuronium should be considered.

[Suicide attempt by means of phenobarbital overdose. Effective treatment with continuous veno-venous hemodialysis].

Science.gov (United States)

Ruhe, M; Grautoff, S; Kähler, J; Pohle, T

2016-03-01

A 68-year-old woman tried to commit suicide using phenobarbital, which was initially prescribed for her dog that suffered from seizures. At admission she was unconscious and ventilated. Five days of intensive care therapy did not improve her state of consciousness. Subsequent continuous veno-venous hemodialysis accelerated the elimination of phenobarbital compared to endogenous elimination by a factor of five. The patient survived without sequelae. Detailed history taking and well-timed indication for dialysis were crucial.

Hope and spirituality among patients with chronic kidney disease undergoing hemodialysis: a correlational study

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Ana Carolina Ottaviani

2014-04-01

Full Text Available OBJECTIVE: to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis.METHOD: this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through individual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI, and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS.RESULTS: the average HHI score was 38.06 (±4.32 while the average PP-RSS score was 3.67 (±0.62 for "beliefs" and 3.21 (±0.53 for "hope/optimism". Spearman's coefficient indicated there was a moderate positive correlation between the HHI and PP-RSS dimensions of "beliefs" (r=0.430; p<0.001 and "hope/optimism" (r=0.376; p<0.001.CONCLUSION: Since a relationship between the sense of hope and spirituality of patients with chronic kidney disease was found, these constructs should be taken into account at the time health professionals deliver care to help patients coping with the disease and treatment.

[A case of Poncet's disease (tuberculous rheumatism) in a patient with chronic renal failure undergoing hemodialysis therapy].

Science.gov (United States)

Miki, Yusuke; Fujita, Yoshiro; Kawai, Ryosuke; Danbara, Atsushi; Ueno, Yukio; Ito, Yasuhiko

2003-10-01

A 78-year-old man who was undergoing hemodialysis therapy was admitted to our hospital because of sore throat, remittent cervical lymphadenopathy, and polyarthritis over the preceding 4 weeks. On admission, he had bilateral cervical lymphadenopathy. He complained of arthralgia associated with tenderness, warmth and swelling of both elbows, left side wrist and left shoulder joint. The C-reactive protein level on admission was 15.3 mg/dl. Rheumatoid factor, antinuclear antibodies, tuberculin skin test and blood culture were negative. Joint fluid was not aspirated. Radiographs of the joints did not reveal any abnormalities. Acid-fast bacilli were demonstrated in the smear of the cervical lymph node with a fluorochrome rhodamine-auramine stain. Mycobacterium tuberculosis DNA was identified by polymerase chain reaction. We found the presence of caseating granuloma on the biopsy specimens and M.tuberculosis was detected from culture. At that point, we diagnosed this patient as having tuberculous lymphadenitis. His general symptoms resolved rapidly after starting with a three-drug regimen consisting of isoniazid, rifampin and pyrazinamide. His polyarthritis also improved dramatically. Finally we considered that his polyarthritis was tuberculous rheumatism, also called Poncet's disease. Poncet's disease is characterized by sterile polyarthritis during active tuberculosis infection. It is considered a reactive arthritis, which is a different entity from tuberculous arthritis. Although this is a rare disease, we should be aware of it in hemodialysis patient clinics, because the incidence of tuberculosis infection has been reported to be increasing in patients with end-stage renal failure.

Relationship between ABO blood groups and von Willebrand factor, ADAMTS13 and factor VIII in patients undergoing hemodialysis.

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Rios, Danyelle R A; Fernandes, Ana Paula; Figueiredo, Roberta C; Guimarães, Daniela A M; Ferreira, Cláudia N; Simões E Silva, Ana C; Carvalho, Maria G; Gomes, Karina B; Dusse, Luci Maria Sant' Ana

2012-05-01

Several studies have demonstrated that non-O blood groups subjects present an increased VTE risk as compared to those carrying O blood group. The aim of this study was to investigate the ABO blood groups influence on factor VIII (FVIII) activity, von Willebrand factor (VWF), and ADAMTS13 plasma levels in patients undergoing hemodialysis (HD). Patients undergoing HD (N=195) and 80 healthy subjects (control group) were eligible for this cross-sectional study. The ABO blood group phenotyping was performed by the reverse technique. FVIII activity was measured through coagulometric method, and VWF and ADAMTS13 antigens were assessed by ELISA. FVIII activity and VWF levels were significantly higher and ADAMTS13 levels was decreased in HD patients, as compared to healthy subjects (P blood groups showed a significant increase in FVIII activity (P = 0.001) and VWF levels (P blood group. However, no significant difference was observed in ADAMTS13 levels (P = 0.767). In the control group, increased in FVIII activity (P = 0.001) and VWF levels (P = 0.002) and decreased in ADAMTS13 levels (P = 0.005) were observed in subjects carrying non-O blood groups as compared to carriers of O blood group.Our data confirmed that ABO blood group is an important risk factor for increased procoagulant factors in plasma, as FVIII and VWF. Admitting the possible role of kidneys in ADAMTS13 synthesis or on its metabolism, HD patients were not able to increase ADAMTS13 levels in order to compensate the increase of VWF levels mediated by ABO blood groups. Considering that non-O blood groups constitute a risk factor for thrombosis, it is reasonable to admit that A, B and AB HD patients need a careful and continuous follow-up in order to minimize thrombotic events.

The effect of education of health-promoting behaviors on lifestyle in hemodialysis patients

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Seyed Reza Borzou

2016-06-01

Full Text Available Today improve lifestyle and health promotion is a basic requirement for human society and the need for more tangible factor in the increase in chronic diseases such as chronic kidney disease and hemodialysis process is followed. As life expectancy increases, due to the importance of promoting behavior change. The aim of this study was to evaluate the effect of health promoting behaviors was on the lifestyle of patients undergoing hemodialysis. In this study, 70 patients undergoing hemodialysis training centers - medical Hamadan were selected. That is because Hamedan only two dialysis centers, randomly one of them was selected as a test group and a control group. Of the patients referred to the center for sampling in each group 35 patients were studied. For groups of six 30-minute sessions on an individual basis during hemodialysis, held over three weeks in a row. Data analysis using descriptive statistics and statistical tests of Kolmogorov - Smirnov, T and T were analyzed with SPSS version 16. In the experimental group, health-promoting lifestyle scores before and after intervention showed significant statistical differences (001 / 0 < p. The mean scores of health-promoting lifestyle intervention and control groups after the intervention, there was a significant difference (p<0.05. Teaching with an emphasis on health-promoting behaviors, hemodialysis patients was improved lifestyle. Develop and implement training programs to improve lifestyle behaviors and health promoting effective step is hemodialysis patients.

Preferences of patients undergoing hemodialysis – results from a questionnaire-based study with 4,518 patients

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Janssen IM

2015-06-01

Full Text Available Inger Miriam Janssen,1 Ansgar Gerhardus,2,3 Gero D von Gersdorff,4 Conrad August Baldamus,4 Mathias Schaller,4 Claudia Barth,5 Fueloep Scheibler6 1Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany; 2Department for Health Services Research, University of Bremen, Bremen, Germany; 3Health Sciences Bremen, University of Bremen, Bremen, Germany; 4Department of Internal Medicine II, University Hospital of Cologne, Cologne, Germany; 5KfH Kuratorium fuer Dialyse und Nierentransplantation e.V., Neu-Isenburg, Germany; 6Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Cologne, Germany Background: Chronic kidney disease is an increasing health problem worldwide and in its final stage (stage V can only be treated by renal replacement therapy, mostly hemodialysis. Hemodialysis has a major influence on the everyday life of patients and many patients report dissatisfaction with treatment. Little is known about which aspects of treatment are considered important by hemodialysis patients. The objective of this study was to rate the relative importance of different outcomes for hemodialysis patients and to analyze whether the relative importance differed among subgroups of patients.Patients and methods: Within the framework of a yearly questionnaire which is distributed among patients receiving hemodialysis by the largest hemodialysis provider in Germany, we assessed the relative importance of 23 outcomes as rated on a discrete visual analog scale. Descriptive statistics were used to rank the outcomes. Subgroup analyses were performed using Mann–Whitney U or Kruskal–Wallis tests.Results: Questionnaires of 4,518 hemodialysis patients were included in the analysis. The three most important outcomes were safety of treatment, health-related quality of life, and satisfaction with care. Further important outcomes were hospital stays, accompanying symptoms, hemodialysis

The Impact of Abdominal Fat Levels on All-Cause Mortality Risk in Patients Undergoing Hemodialysis

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Takahiro Yajima

2018-04-01

Full Text Available Although an increased body mass index is associated with lower mortality in patients undergoing hemodialysis (HD, known as the “obesity paradox,” the relationship of abdominal fat levels with all-cause mortality has rarely been studied. We investigated the impact of computed-tomography-measured abdominal fat levels (visceral fat area (VFA and subcutaneous fat area (SFA on all-cause mortality in this population. A total of 201 patients undergoing HD were enrolled and cross-classified by VFA and SFA levels according to each cutoff point, VFA of 78.7 cm2 and SFA of 93.2 cm2, based on the receiver operator characteristic (ROC curve as following; group 1 (G1: lower VFA and lower SFA, G2: higher VFA and lower SFA, G3: lower VFA and higher SFA, G4: higher VFA and higher SFA. During a median follow-up of 4.3 years, 67 patients died. Kaplan–Meier analysis revealed 10-year survival rates of 29.0%, 50.0%, 62.6%, and 72.4% in G1, G2, G3, and G4 (p < 0.0001, respectively. The adjusted hazard ratio was 0.30 (95% confidence interval [CI] 0.05–1.09, p = 0.070 for G2 vs. G1, 0.37 (95% CI 0.18–0.76, p = 0.0065 for G3 vs. G1, and 0.21 (95% CI 0.07–0.62, p = 0.0035 for G4 vs. G1, respectively. In conclusion, combined SFA and VFA levels were negatively associated with risks for all-cause mortality in patients undergoing HD. These results are a manifestation of the “obesity paradox.”

[Assessment of periodontal condition of kidney patients in hemodialysis].

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Souza, Cláudia Régia Dias de; Libério, Silvana Amado; Guerra, Rosane Nassar Meireles; Monteiro, Silvio; Silveira, Ericka Janine Dantas da; Pereira, Antonio Luiz Amaral

2005-01-01

Thirty patients undergoing hemodialysis were evaluated for their periodontal condition through plaque, calculus and gingival indexes; PSR and IgA present in the saliva were also appraised in order to determine the periodontal condition of patients presenting chronic kidney disease. Results obtained demonstrated that in the studied group the plaque, calculus and gingival indexes were high. With regard to these patients' requirement to undergo periodontal treatment, most patients submitted to hemodialysis needed better oral hygiene, in addition to supra and sub gingival scraping and topic application of fluor (code 2). As to the IgA amount present in the saliva, only three patients showed a low density. Patients presenting chronic kidney disease disclosed a tendency for greater bacterial plaque concentration, high formation of dental calculus suggesting the need for periodontal treatment comprising supra and sub gingival scraping.

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

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

2010-09-01

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.

Hepatitis C virus infection in hemodialysis patients in Maracaibo, Venezuela

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Francisca Monsalve-Castillo

2012-02-01

Full Text Available 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.

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

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Vázquez-Rodríguez, Juan Gustavo; del Angel-García, Guadalupe

2010-09-01

Pregnant patients with chronic renal insufficiency treated with hemodialysis experience adverse perinatal results. 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. 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. 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). Frequency of perinatal complications is elevated in both groups.

Factors associated with low bone mass in the hemodialysis patients – a cross-sectional correlation study

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Huang Guey-Shiun

2009-06-01

Full Text Available Abstract Background Low bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis. It can lead to serious bone health problems such as fragility fractures. The purpose of this study is to investigate the risk factors of low bone mass in the hemodialysis patients. Methods Sixty-three subjects on hemodialysis for at least 6 months were recruited from a single center for this cross-sectional study. We collected data by questionnaire survey and medical records review. All subjects underwent a bone mineral density (BMD assay with dual-energy x-ray absorptiometry at the lumbar spine and right hip. Data were statistically analyzed by means of descriptive analysis, independent t test and one way analysis of variance for continuous variables, Pearson product-moment correlation to explore the correlated factors of BMD, and stepwise multiple linear regression to identify the predictors of low bone mass. Results Using WHO criteria as a cutoff point, fifty-one subjects (81% had a T-score lower than -1, of them 8 subjects (13% had osteoporosis with the femoral neck most commonly affected. Regarding risk factors, age, serum alkaline phosphatase (ALP level, and intact parathyroid hormone (iPTH level had significant negative correlations with the femoral neck and lumbar spine BMD. On the other hand, serum albumin level, effective exercise time, and body weight (BW had significant positive correlations with the femoral neck and lumbar spine BMD. Age, effective exercise time, and serum albumin level significantly predicted the femoral neck BMD (R2 × 0.25, whereas BW and the ALP level significantly predicted the lumbar spine BMD (R2 × 0.20. Conclusion This study showed that advanced age, low BW, low serum albumin level, and high ALP and iPTH levels were associated with a low bone mass in the hemodialysis patients. We suggest that regular monitoring of the femoral neck BMD, maintaining an adequate serum albumin level and BW

The effect of foot massage on night sleep quality in hemodialysis patients

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farhad Ariamanesh

2015-05-01

Full Text Available Background : Studies have shown, about 20 to 80 percent of hemodialysis patients have sleep problems that can lead to reduction of their quality of life. With regard to high number of hemodialysis patients in the present age, promoting the level of their health issues are deemed important. In this regared, the purpose of this research was to determine the effect of foot massage on night sleeping in hemodialysis patients. Materials and Methods: This experimental clinical trial design, was conducted on 80 hemodialysis patients, admitted to the hemodialysis wards of Shahid Rahimi and Shohada hospitals of Khorramabad city in 2014. Data gathering was done by Pittsburg questionnaire and Sleep Log, by which the sleep condition of the subjects was assessed before and after the night of massage therapy. The treatment was Stroke Foot Massage, carried out during dialysis for 10 minutes, three times a week, for four consecutive weeks. Results: Changes in the Pittsburg questionnaire score indicated that, using foot massage can improve sleep quality of hemodialysis patients and sleep hours increased and generally sleep condition was progressively improving each week than the week before (p<0/001. Conclusion: According to the results of this study, foot massage has a favorable impact on sleep quality in hemodialysis patients undergoing hemodialysis and can be applied and trained as a useful method to improve sleep quality of patients in hemodialysis wards.

Cytokine Signature in End-Stage Renal Disease Patients on Hemodialysis

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Danyelle Romana Alves Rios

2017-01-01

Full Text Available Hemodialysis is a modality of blood filtration in which accumulated toxins and water are removed from the body. This treatment is indicated for patients at the end stage of renal disease. Vascular access complications are responsible for 20–25% of all hospitalizations in dialyzed patients. The occurrence of thrombosis in the vascular access is a serious problem that may severely compromise or even make the hemodialysis impossible, which is vital for the patient. The aim of this study was to investigate inflammatory profile in patients undergoing hemodialysis as well as the association between these alterations and vascular access thrombosis. A total of 195 patients undergoing hemodialysis have been evaluated; of which, 149 patients had not experienced vascular access thrombosis (group I and 46 patients had previously presented this complication (group II. Plasma levels of cytokines including interleukin (IL- 2, IL-4, IL-5, IL-10, TNF-α, and IFN-γ were measured by cytometric bead array. Our results showed that patients with previous thrombotic events (group II had higher levels of the IL-2, IL-4, IL-5, and IFN-γ when compared to those in group I. Furthermore, a different cytokine signature was detected in dialyzed patients according to previous occurrences or not of thrombotic events, suggesting that elevated levels of T-helper 1 and T-helper 2 cytokines might, at least in part, contribute to this complication.

Knowledge and Practice of Hemodialysis Amongst Dialysis Nurses.

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Manandhar, Dhiraj Narayan; Chhetri, Pramod Kumar; Poudel, Prakash; Baidya, Samir Keshari; Agrawaal, Krishna Kumar

2017-01-01

Dialysis nurses should have a good knowledge regarding hemodialysis treatment. The status of Nepalese dialysis nurses on this aspect is unknown. This study was done to assess the knowledge and practice on different aspects of the hemodialysis treatment. We distributed validated questionnaires to the participants in a biannual conference in Kathmandu on 24th September as most of the dialysis nurses attend the event. We calculated mean and standard deviation for continuous variables and frequencies and percentage for the responses and compared counseling with different parameters. Total 94 out of 116 participants who were giving care to dialysis patients were in the study. Total 39 (42%) received formal nursing training in hemodialysis and 71 (78%) respondents always counseled patients regarding fluid intake. A total of 37 (96%) trained nurses always counseled the importance of regular dialysis. Seventy-six (81.7%) respondents did counseling on vaccination against Hepatitis B. Counseling on vaccination against influenza and pneumococcus was 47 (50%). When comparing educational status, respondents below bachelor level did more frequent counseling than level above (P=0.03). All the respondents knew the importance of hand washing and BP monitoring during hemodialysis. Ninety-one (96.7%) respondents knew how to deal with BP changes during hemodialysis. Seventy-three (77.6%) respondents were very confident on managing complications. Only 31 (33%) respondents knew how to deal with patients on continuous ambulatory peritoneal dialysis. Dialysis nurses have knowledge on basic procedures of hemodialysis but there is a space for improvement in dealing with complications to provide quality service to hemodialysis patients.

Depression in hemodialysis patients

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Anees, M.; Barki, H.; Masood, M.

2008-01-01

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)

Soluble transferrin receptor as a marker of erythropoiesis in patients undergoing high-flux hemodialysis

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Pei Yin

2017-11-01

Full Text Available Anemia is a common complication in chronic kidney disease (CKD patients receiving hemodialysis. The effect of high-flux dialysis (HFD on anemia remains unclear. This prospective study aimed to evaluate the effect of HFD on anemia, and the potential of soluble transferrin receptor (sTfR as a marker of iron status and erythropoiesis in CKD patients on hemodialysis. Forty patients, who switched from conventional low-flux dialysis to HFD for 12 months, were enrolled in this study. The levels of sTfR, hemoglobin (Hb, iron, and nutritional markers, as well as the dose of recombinant human erythropoietin (rhEPO and use of chalybeate were determined at 0, 2, 6, and 12 months after starting HFD. HFD significantly increased the hemoglobin level and reduced sTfR level in CKD patients (p < 0.05. In addition, significant decreasing linear trends were observed for rhEPO dosage and chalybeate use (p < 0.05. The level of sTfR was positively correlated with the percentage of reticulocytes (RET%, rhEPO dose, and chalybeate use, while it was negatively correlated with Hb levels and total iron-binding capacity results (all p < 0.05. A univariate generalized estimating equation (GEE model showed that the Hb level, RET%, rhEPO dose, and chalybeate use were the variables associated with sTfR levels. A multivariate GEE model showed that the time points when hemodialysis was performed were the variables associated significantly with sTfR levels. Overall, our findings suggest that HFD can effectively improve renal anemia in hemodialysis patients, and sTfR could be used as a marker of erythropoiesis in HFD patients.

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

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Santos Paulo

2012-08-01

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.

The effects of lavender aromatherapy on pain following needle insertion into a fistula in hemodialysis patients.

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Bagheri-Nesami, Masoumeh; Espahbodi, Fatemeh; Nikkhah, Attieh; Shorofi, Seyed Afshin; Charati, Jamshid Yazdani

2014-02-01

This study sought to determine the effects of lavender aromatherapy on pain following needle insertion into a fistula in patients undergoing hemodialysis. This is a randomized controlled clinical trial in which 92 patients undergoing hemodialysis with arteriovenous fistulas were randomly divided into two groups. The experimental-group patients inhaled lavender essence with a concentration of 10% for 5 min during 3 hemodialysis sessions, while the control-group patients received aromatherapy free of lavender essence. The mean VAS pain intensity score in the experimental and control groups before the intervention was 3.78 ± 0.24 and 4.16 ± 0.32, respectively (p = 0.35). The mean VAS pain intensity score in the experimental and control groups after three aromatherapy sessions was 2.36 ± 0.25 and 3.43 ± 0.31, respectively (p = 0.009). Lavender aromatherapy may be an effective technique to reduce pain following needle insertion into a fistula in hemodialysis patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

Hypotension due to Chemotherapy in a Patient with Small Cell Lung Cancer and Lambert-Eaton Myasthenic Syndrome Undergoing Hemodialysis: A First Case Report

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Taiji Kuwata

2012-01-01

Full Text Available We present the first case of small cell lung cancer with Lambert-Eaton myasthenic syndrome during hemodialysis (HD. A 72-year-old male patient receiving HD experienced progressive muscle weakness. He was diagnosed with small cell lung cancer with Lambert-Eaton myasthenic syndrome due to an increased serum level of anti-voltage-gated calcium channel antibody and aspiration cytology on endobronchial ultrasonography for the swelling of a subcarinal lymph node. He received chemotherapy consisting of carboplatin (300 mg/m2 and etoposide (50 mg/m2, to which he had a partial response. However, the second therapy course could not be administered because of the unexpected development of severe hematological adverse events, which also prevented him from undergoing further HD. This case indicates that caution should be taken when using chemotherapy for such patients because of hypotension due to chemotherapy, with which it is impossible to undergo HD.

Hemodialysis decreases serum brain-derived neurotrophic factor concentration in humans.

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Zoladz, Jerzy A; Śmigielski, Michał; Majerczak, Joanna; Nowak, Łukasz R; Zapart-Bukowska, Justyna; Smoleński, Olgierd; Kulpa, Jan; Duda, Krzysztof; Drzewińska, Joanna; Bartosz, Grzegorz

2012-12-01

In the present study we have evaluated the effect of a single hemodialysis session on the brain-derived neurotrophic factor levels in plasma [BDNF](pl) and in serum [BDNF](s) as well as on the plasma isoprostanes concentration [F(2) isoprostanes](pl), plasma total antioxidant capacity (TAC) and plasma cortisol levels in chronic kidney disease patients. Twenty male patients (age 69.8 ± 2.9 years (mean ± SE)) with end-stage renal disease undergoing maintenance hemodialysis on regular dialysis treatment for 15-71 months participated in this study. A single hemodialysis session, lasting 4.2 ± 0.1 h, resulted in a decrease (P = 0.014) in [BDNF](s) by ~42 % (2,574 ± 322 vs. 1,492 ± 327 pg ml(-1)). This was accompanied by an increase (P 0.05) in [BDNF](pl) and the platelets count were observed after a single dialysis session. Furthermore, basal [BDNF](s) in the chronic kidney disease patients was significantly lower (P = 0.03) when compared to the age-matched control group (n = 23). We have concluded that the observed decrease in serum BDNF level after hemodialysis accompanied by elevated [F(2)-Isoprostanes](pl) and decreased plasma TAC might be caused by enhanced oxidative stress induced by hemodialysis.

Bacteremic infection in hemodialysis.

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Nsouli, K A; Lazarus, M; Schoenbaum, S C; Gottlieb, M N; Lowrie, E G; Shocair, M

1979-11-01

This is a retrospective study of 133 episodes of bacteremic infection in 112 hemodialysis patients. The frequency of bacteremic infection was 9.5% in patients with chronic renal failure and 10.9% in patients with acute renal failure. In patients with acute renal failure, pneumonia and intra-abdominal abscess were the most frequent sources of septicemia. Sepsis was usually due to Gram-negative organisms and mortality was high. In patients with chronic renal failure, infection of the shunt or fistula was the most common cause, was frequently due to Staphylococcus organism, and had a more favorable survival rate. Gram-negative septicemia from a nonaccess source in patients with chronic renal failure was associated with a higher mortality. Bacterial endocarditis and septic pulmonary emboli occurred in 3.6% of septic episodes and 0.35% of patients at risk and had very low mortality. A low threshold for obtaining blood cultures and early antibiotic treatment are believed to be important in the treatment of bacteremic infections in patients undergoing long-term hemodialysis.

Circulating IGF-binding protein 7 (IGFBP7 levels are elevated in patients with endometriosis or undergoing diabetic hemodialysis

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Sasajima Koji

2008-11-01

Full Text Available Abstract Background Insulin-like growth factor-binding protein-7 (IGFBP7 is a secretory protein with a molecular mass of approximately 30 kDa. It is abundantly expressed in the uterine endometrium during the secretory phase of the menstrual cycle. Decreased IGFBP7 expression has been observed in some cancers and leiomyomata. Methods To determine whether serum IGFBP7 levels reflect changes in uterine IGFBP7 expression in humans during the menstrual cycle, and to examine whether serum IGFBP7 levels are altered in patients with various disorders, we developed a novel, dual-antibody sandwich enzyme-linked immunosorbent assay (ELISA. Firstly, concentrations of IGFBP7 released into the medium were determined in cultured endometrial stromal and glandular cells. Blood samples were collected from women who had normal menstrual cycles and who had been diagnosed with endometriosis. Serum from hemodialysis patients and gastrointestinal cancers was also used to determine the IGFBP7 levels. Results Using this new ELISA, we demonstrated that cultured uterine cells secrete IGFBP7 into the medium. Patients with endometriosis and those with type II diabetes mellitus undergoing hemodialysis had significantly higher serum concentrations of IGFBP7 than the relevant control subjects. There were no differences in serum IGFBP7 levels in women at different stages of the menstrual cycle. Furthermore, serum IGFBP7 levels in patients with colorectal, esophageal, or endometrial cancer were not different than normal healthy subjects. Conclusion Our observations suggest that IGFBP7 is associated with the pathophysiology of endometriosis and diabetes mellitus, and that serum IGFBP7 levels do not reflect enhanced uterine expression of IGFBP7 mRNA during the menstrual cycle.

Pulmonary hypertenstion ad leading factor in patients undergoing dialysis

International Nuclear Information System (INIS)

Rehman, I.U.; Sumera, A.; Idrees, M.K.; Tanweer, A.

2014-01-01

Objective: To determine the frequency and leading factors of pulmonary hypertension among chronic hemodialysis patients. Study Design: Case series. Place and Duration of Study: Hemodialysis Unit, Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, from September 2011 to March 2012. Methodology: Patients of either gender aged between 16 to 60 years of age undergoing hemodialysis for at least 3 months not having pre-existing valvular heart disease, chronic lung disease or connective tissue disorder were included. Pulmonary hypertension was prospectively estimated by Doppler echocardiogram on patients undergoing dialysis. Pulmonary artery pressure was calculated on the post-dialysis day and leading factors were compared between patients with and without pulmonary hypertension. Results: A total of 178 patients were included in study with male to female ratio120/58 (2.06:1). The mean age was 33.84 +- 11.9 years. The mean duration of hemodialysis was 23.85 +- 22.48 months. Pulmonary hypertension was found in 76 (42.7%) patients. Out of the studied factors, low serum albumin ( 3.4 mg/dl, p = 0.01) was found to be statistically significant in patients with pulmonary hypertension. Conclusion: Pulmonary hypertension was frequently present in dialysis population (42.7%). This subset of patients had significantly lower albumin levels in serum. More research is needed in its pathogenesis to arrest its course. (author)

Comparison the effect of lidocaine gel and inhalation of lavender aromatherapy on pain score of arteriovenous fistula puncture in hemodialysis patients

OpenAIRE

Abbaszadeh

2015-01-01

Introduction: patients undergoing hemodialysis repetitively experience pain and anxiety related to arterivenous fistula (AVF) punctures. Using of appropriate methods of pain relief in these patients is very important. The purpose of this study was to compare the effect of lidocaine gel and inhalation of lavender aromatherapy on pain intensity of arterivenous fistula puncture in hemodialysis patients. Methods: In this before and after clinical trial study, 40 hemodialysis patients were sele...

The use of D-penicillamine in patients with rheumatoid arthritis undergoing hemodialysis.

Science.gov (United States)

Matthey, F; Perrett, D; Greenwood, R N; Baker, L R

1986-05-01

D-penicillamine and its major metabolites cysteine-penicillamine disulphide (CP) and penicillamine disulphide (P2) concentrations were measured in plasma from a hemodialysis patient with rheumatoid arthritis. CP and P2 alone were measured in plasma and a plasma ultrafiltrate from a second patient. On penicillamine 250 mg thrice weekly taken after dialysis pre-dialysis penicillamine concentrations were in the range 5.9-9.9 mumol/l. CP and P2 concentrations remained stable (range 139-197 mumol/l and 10-20 mumol/l) over 5 weeks and were of the same order as previously found in patients with normal renal function on higher doses of the drug. On penicillamine 250 mg daily concentrations of metabolites CP and P2 reach 193 mumol/l and 59.2 mumol/l after 2 and 3 weeks respectively. Concentration of metabolites fell by about half and of penicillamine by about a third after dialysis. Concentration of metabolites in ultrafiltrate were on average 75% lower than in plasma. Penicillamine 250 mg thrice weekly given after dialysis appears to be an appropriate dose for hemodialysis patients with rheumatoid arthritis.

Interventions to improve hemodialysis adherence: a systematic review of randomized-controlled trials.

Science.gov (United States)

Matteson, Michelle L; Russell, Cynthia

2010-10-01

Over 485,000 people in the United States have chronic kidney disease, a progressive kidney disease that may lead to hemodialysis. Hemodialysis involves a complex regimen of treatment, medication, fluid, and diet management. In 2005, over 312,000 patients were undergoing hemodialysis in the United States. Dialysis nonadherence rates range from 8.5% to 86%. Dialysis therapy treatment nonadherence, including treatment, medication, fluid, and diet nonadherence, significantly increases the risk of morbidity and mortality. The purpose of this paper is to systematically review randomized-controlled trial intervention studies designed to increase treatment, medication, fluid, and diet adherence in adult hemodialysis patients. A search of Cumulative Index of Nursing and Allied Health Literature (CINAHL) (1982 to May 2008), MEDLINE (1950 to May 2008), PsycINFO (1806 to May 2008), and all Evidence-Based Medicine (EBM) Reviews (Cochran DSR, ACP Journal Club, DARE, and CCTR) was conducted to identify randomized-controlled studies that tested the efficacy of interventions to improve adherence in adult hemodialysis patients. Eight randomized-controlled trials met criteria for inclusion. Six of the 8 studies found statistically significant improvement in adherence with the intervention. Of these 6 intervention studies, all studies had a cognitive component, with 3 studies utilizing cognitive/behavioral intervention strategies. Based on this systematic review, interventions utilizing a cognitive or cognitive/behavioral component appear to show the most promise for future study. © 2010 The Authors. Hemodialysis International © 2010 International Society for Hemodialysis.

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

International Nuclear Information System (INIS)

Ghasemi, A.; Shafiee, M.; Rowghani, K.

2008-01-01

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<0.01). Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than increased serum nitric oxide levels may be involved in hemodialysis hypotension in this group of patients. (author)

Hemodialysis and water quality.

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Coulliette, Angela D; Arduino, Matthew J

2013-01-01

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. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

LOW OXYGENATION STATUS INCREASES NAUSEA-VOMITING INCIDENCE IN HEMODIALYSIS PATIENTS

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Cornelia DY Nekada

2017-08-01

Full Text Available Background and Objective: Data from Indonesia Basic Health Research (2013 states that the chronic renal failure in Indonesia is increasing, especially in Yogyakarta with the prevalence of chronic renal failure of 0,3%. If the patients of chronic renal failure are in End Stage Renal Disease (ESRD, the kidney needs replacement therapy to help its function. This therapy is called Continuous Renal Replacement Therapy (CRRT or Hemodialysis (HD. Hemodialysis therapy may influence to the imbalance of oxyhemoglobin in the blood. Patients undergoing hemodialysis may experience intradialytic nausea and vomiting. The objective of this study is to identify whether there is a relationship between pre-dialysis oxygenation status through oxygen saturation (SpO2 and respiratory rate (RR examination and the intradialytic nausea-vomiting occurrence. Method: This research is a comparative research with analytical cross sectional design. This research was conducted in hemodialysis room in Public Hospital of Panembahan Senopati Bantul. The subject of the research was taken using total sampling, by paying attention to research ethics. The total research subjects are 183 respondents. The researchers measured the oxygen saturation and patients’ respiratory rate and examined the intradialytic nausea and vomiting complaints. Result: The analysis result of Fisher’s exact in this research shows p value of 0,000 both in bivariate analysis of oxygen saturation to the nausea and vomiting occurrence and in bivariate analysis of the respiratory rate to the nausea and vomiting occurrence. The multivariate analysis employing regression logistic shows that the OR of oxygen saturation is 73,57, this means that the measurement of the abnormal oxygen saturation has the chance of seventy three times more to the nausea and vomiting occurrence, if compared to the patients with normal oxygen saturation. Conclusion and Suggestion: Intradialytic nausea and vomiting is one of the causes

Test-retest reliability and minimal detectable change scores for sit-to-stand-to-sit tests, the six-minute walk test, the one-leg heel-rise test, and handgrip strength in people undergoing hemodialysis.

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Segura-Ortí, Eva; Martínez-Olmos, Francisco José

2011-08-01

Determining the relative and absolute reliability of outcomes of physical performance tests for people undergoing hemodialysis is necessary to discriminate between the true effects of exercise interventions and the inherent variability of this cohort. The aims of this study were to assess the relative reliability of sit-to-stand-to-sit tests (the STS-10, which measures the time [in seconds] required to complete 10 full stands from a sitting position, and the STS-60, which measures the number of repetitions achieved in 60 seconds), the Six-Minute Walk Test (6MWT), the one-leg heel-rise test, and the handgrip strength test and to calculate minimal detectable change (MDC) scores in people undergoing hemodialysis. This study was a prospective, nonexperimental investigation. Thirty-nine people undergoing hemodialysis at 2 clinics in Spain were contacted. Study participants performed the STS-10 (n=37), the STS-60 (n=37), and the 6MWT (n=36). At one of the settings, the participants also performed the one-leg heel-rise test (n=21) and the handgrip strength test (n=12) on both the right and the left sides. Participants attended 2 testing sessions 1 to 2 weeks apart. High intraclass correlation coefficients (≥.88) were found for all tests, suggesting good relative reliability. The MDC scores at 90% confidence intervals were as follows: 8.4 seconds for the STS-10, 4 repetitions for the STS-60, 66.3 m for the 6MWT, 3.4 kg for handgrip strength (force-generating capacity), 3.7 repetitions for the one-leg heel-rise test with the right leg, and 5.2 repetitions for the one-leg heel-rise test with the left leg. Limitations A limited sample of patients was used in this study. The STS-16, STS-60, 6MWT, one-leg heel rise test, and handgrip strength test are reliable outcome measures. The MDC scores at 90% confidence intervals for these tests will help to determine whether a change is due to error or to an intervention.

Anthropometric Indicators Predict Metabolic Syndrome Diagnosis in Maintenance Hemodialysis Patients.

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Vogt, Barbara Perez; Ponce, Daniela; Caramori, Jacqueline Costa Teixeira

2016-06-01

Obesity has been considered the key in metabolic syndrome (MetS) development, and fat accumulation may be responsible for the occurrence of metabolic abnormalities in hemodialysis patients. The use of gold-standard methods to evaluate obesity is limited, and anthropometric measures may be the simplest methods. However, no study has investigated the association between anthropometric indexes and MetS in these patients. Therefore, the aim was to determine which anthropometric indexes had the best association and prediction for MetS in patients undergoing hemodialysis. Cross-sectional study that included patients older than 18 years, undergoing hemodialysis for at least 3 months. Patients with liver disease and cancer or those receiving corticosteroids or antiretroviral therapy were excluded. Diagnostic criteria from Harmonizing Metabolic Syndrome were used for the diagnosis of MetS. Anthropometric indexes evaluated were body mass index (BMI); percent standard of triceps skinfold thickness and of middle arm muscle circumference; waist circumference (WC); sagittal abdominal diameter; neck circumference; waist-to-hip, waist-to-thigh, and waist-to-height ratios; sagittal index; conicity index; and body fat percentage. Ninety-eight patients were included, 54.1% male, and mean age was 57.8 ± 12.9 years. The prevalence of MetS was 74.5%. Individuals with MetS had increased accumulation of abdominal fat and general obesity. Waist-to-height ratio was the variable independently associated with MetS diagnosis (odds ratio, 1.21; 95% confidence interval, 1.09-1.34; P < .01) and that better predicts MetS, followed by WC and BMI (area under the curve of 0.840, 0.836, and 0.798, respectively, P < .01). Waist-to-height ratio was the best anthropometric predictor of MetS in maintenance hemodialysis patients. © 2015 American Society for Parenteral and Enteral Nutrition.

Intermittent hemodialysis is superior to continuous veno-venous hemodialysis/hemodiafiltration to eliminate methanol and formate during treatment for methanol poisoning

Czech Academy of Sciences Publication Activity Database

Zakharov, S.; Pelclová, D.; Navrátil, Tomáš; Běláček, J.; Kurcová, I.; Komzák, O.; Šálek, T.; Latta, J.; Turek, R.; Boček, R.; Kučera, C.; Hubáček, J. A.; Fenclová, Z.; Petřík, V.; Čermák, M.; Hovda, K. E.

2014-01-01

Roč. 86, č. 1 (2014), s. 199-207 ISSN 0085-2538 Institutional support: RVO:61388955 Keywords : Intermittent hemodialysis * hemodiafiltration * methanol poisonings Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 8.563, year: 2014

Recurrent Hypoglycemia in a Hemodialysis Patient Related to Propoxyphene Treatment

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Hui-Ting Lee

2007-07-01

Full Text Available There are various etiologies for hypoglycemia in patients with chronic renal failure, and its pathogenesis is complex. Concomitant use of medications is the most common cause. We report a rare case of an 82-year-old woman with type 2 diabetes mellitus in end-stage renal disease undergoing maintenance hemodialysis, who experienced recurrent symptomatic hypoglycemia during treatment with propoxyphene for pain relief. Hypoglycemia occurred simultaneously with elevated levels of serum immunoreactive insulin and C-peptide. After discontinuing propoxyphene, hypoglycemia mitigated and the level of insulin returned to normal range. Our case reminds us that propoxyphene-induced hypoglycemia should not be ignored, especially in hemodialysis patients with cold sweats, agitation and depressed consciousness.

Effect of hemodialysis on intraocular lens power calculation.

Science.gov (United States)

Çalışkan, Sinan; Çelikay, Osman; Biçer, Tolga; Aylı, Mehmet Deniz; Gürdal, Canan

2016-01-01

To evaluate changes in ocular biometric parameters after hemodialysis (HD) in patients with end-stage renal disease (ESRD). Forty eyes of 40 patients undergoing HD were included in this cross-sectional study. Keratometry (K) readings, white-to-white (WTW) distance, central corneal thickness (CCT), anterior chamber depth (ACD), pupil diameter, lens thickness (LT), axial length (AL), and intraocular lens (IOL) power calculation were measured with Lenstar LS 900 (Haag Streit AG, Koeniz, Switzerland) before and after hemodialysis. Intraocular pressure (IOP) was measured with a non-contact tonometer (Tonopachy NT-530P, Nidek Co., LTD, Tokyo, Japan). Main outcomes were changes in biometric parameters after HD. Reliability of the measurements (intraclass correlation coefficients (ICCs)) and the effect size (Cohen's d) were also calculated. Mean difference in AL before and after HD was -0.041 ± 0.022 mm with ICCs > 0.90 (p  0.90 (p = 0.041 and Cohen's d = 0.20). Hemodialysis had no significant effect on K readings, WTW distance, CCT, ACD, LT, or IOP. Axial length and pupil diameter increase after HD with small effect size, while HD does not significantly affect IOL power calculations.

Health-related quality of life in patients undergoing hemodialysis

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Miljanović Gora

2018-01-01

Full Text Available Background/Aim. Chronic renal disease is one of the growing problems all over the world. Health-related quality of life (HRQoL is an important indicator for those with a chronic disease, such as chronic renal disease, because it may serve as predictor of mortality and hospitalization. The aim of this study was to assess HRQoL in patients on chronic maintenance hemodialysis (HD, and compare it with patients suffering from hypertension (HTA, and normal controls of the same age and gender (C. Methods. The study enrolled 224 males and females older than 18 years: 67 in the HD group, 78 in the HTA group, and 79 in the C group. HRQoL was assessed in all groups using 15-D questionnaire. Results. Significantly higher level of education was recorded in the HD group compared to other two groups. In the HD group there were significantly less employed persons (9% and significantly more retired (67.2%. All groups were similar regarding an average monthly income and marital status. We found significantly lower total HRQoL score in patients in the HD group, compared to normal controls (0.78 ± 0.16 vs. 0.89 ± 0.10 in the HTA and 0.95 ± 0.06 in the C group as well as specific scores in almost all investigated domains, except in speech, eating and mental functions. Patients in the HD and HTA groups had similar self-reported quality of life in additional 3 domains: hearing, elimination and distress, while the HD group reported significantly lower scores in remaining 9 domains: mobility, vision, breathing, sleeping, usual activities, discomfort and symptoms, depression, vitality and sexual activity. Patients in the HTA group had significantly lower scores than normal controls in 8 domains (hearing, sleeping, elimination, usual activities, discomfort and symptoms, depression, distress and vitality as well as in total quality of life, while in remaining 4 domains there was no significant difference (mobility, vision, breathing, sexual activity. Conclusion. Both

Partial response to cinacalcet treatment in a patient with secondary hyperparathyroidism undergoing hemodialysis: a case report

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Conzo Giovanni

2012-12-01

Full Text Available Abstract Introduction In the treatment of secondary hyperparathyroidism of chronic kidney disease, calcimimetics - allosteric modulators of the calcium-sensing receptor - inhibit glandular hyperplasia and significantly reduce circulating parathyroid hormone levels. They have a major impact on the management of secondary hyperparathyroidism. Case presentation We present the clinical case of a 41-year-old Caucasian man undergoing chronic hemodialysis, who had a parathyroidectomy to treat severe secondary hyperparathyroidism resistant to cinacalcet treatment. Preoperatively, 24 months after high-dose cinacalcet hydrochloride, we observed a persistently elevated intact parathyroid hormone serum level, and detected clear parathyroid gland hyperplasia regression on ultrasound. We performed a three-gland parathyroidectomy, which was assumed to be total, associated with a hemithyroidectomy. Our patient then entered a hypoparathyroid state. A histopathological examination showed that the removed parathyroid glands were of small size, with a total weight of 1g, associated with a multifocal small papillary thyroid cancer. Conclusion In the management of secondary hyperparathyroidism, cinacalcet hydrochloride effectively reduces total parathyroid gland hyperplasia. However, a persisting elevated intact parathyroid hormone serum level may be observed, demonstrating that reduced parathyroid hyperplastic tissue may still be associated with severe secondary hyperparathyroidism. Even if calcimimetics are very effective in secondary hyperparathyroidism treatment, further studies are necessary for a better understanding of their actions.

Effect of High-Cutoff Hemodialysis vs Conventional Hemodialysis on Hemodialysis Independence Among Patients With Myeloma Cast Nephropathy: A Randomized Clinical Trial.

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Bridoux, Frank; Carron, Pierre-Louis; Pegourie, Brigitte; Alamartine, Eric; Augeul-Meunier, Karine; Karras, Alexandre; Joly, Bertrand; Peraldi, Marie-Noëlle; Arnulf, Bertrand; Vigneau, Cécile; Lamy, Thierry; Wynckel, Alain; Kolb, Brigitte; Royer, Bruno; Rabot, Nolwenn; Benboubker, Lotfi; Combe, Christian; Jaccard, Arnaud; Moulin, Bruno; Knebelmann, Bertrand; Chevret, Sylvie; Fermand, Jean-Paul

2017-12-05

Cast nephropathy is the main cause of acute kidney injury in multiple myeloma and persistent reduction in kidney function strongly affects prognosis. Strategies to rapidly remove nephrotoxic serum-free light chains combined with novel antimyeloma agents have not been evaluated prospectively. To compare the hemodialysis independence rate among patients newly diagnosed with myeloma cast nephropathy treated with hemodialysis using a high-cutoff dialyzer (with very large membrane pores and high permeability to immunoglobulin light chains) or a conventional high-flux dialyzer (with small pores and lower permeability). Randomized clinical trial involving 98 patients with biopsy-proven myeloma cast nephropathy requiring hemodialysis treated at 48 French centers between July 2011 and June 2016; the final date of follow-up was June 29, 2016. Intensive hemodialysis (eight 5-hour sessions over 10 days) with either a high-cutoff dialyzer (46 patients) or a conventional high-flux dialyzer (48 patients). All patients received the same chemotherapy regimen of bortezomib and dexamethasone. Primary end point was hemodialysis independence at 3 months; secondary end points: hemodialysis independence rates at 6 and 12 months, hemodialysis- and chemotherapy-related adverse events, and death. Among 98 randomized patients, 94 (96%) (median age, 68.8 years [interquartile range, 61.2-75.3 years]; 45% women) were included in the modified intent-to-treat analysis. The hemodialysis independence rate at 3 months was 41.3% (n = 19) in the high-cutoff hemodialysis group vs 33.3% (n = 16) in the conventional hemodialysis group (between-group difference, 8.0% [95% CI, -12.0% to 27.9%], P = .42); at 6 months, the rate was 56.5% (n = 26) vs 35.4% (n = 17), respectively (between-group difference, 21.1% [95% CI, 0.9% to 41.3%], P = .04); and at 12 months, the rate was 60.9% (n = 28) vs 37.5% (n = 18) (between-group difference, 23.4% [95% CI, 3.2% to 43.5%], P = .02

Associations of fractalkine receptor (CX3CR1) and CCR5 gene variants with hypertension, diabetes and atherosclerosis in chronic renal failure patients undergoing hemodialysis.

Science.gov (United States)

Bagci, Binnur; Bagci, Gokhan; Huzmeli, Can; Sezgin, Ilhan; Ozdemir, Ozturk

2016-07-01

We aimed to investigate the associations of fractalkine receptor (CX3CR1) V249I, T280M and CCR5-59029 A/G gene polymorphisms in chronic renal failure (CRF) subjects undergoing hemodialysis and to evaluate possible associations of these polymorphisms with hypertension (HT), diabetes mellitus (DM) and atherosclerosis (AS). A total of 225 CRF subjects undergoing hemodialysis and 201 healthy controls were enrolled in the study. CRF subjects were divided into three major subgroups according to comorbidities including HT (n = 127), DM (n = 65) and AS (n = 33). Genotyping was done using polymerase chain reaction-restriction fragment length polymorphism method. The II genotype and I allele frequencies of CX3CR1 V249I polymorphism were found significantly more frequent in CRF subjects, CRF subjects with DM and CRF subjects with AS compared with controls (p < 0.05 for all comparisons). G allele frequency of CCR5 polymorphism was found significantly more prevalent in CRF subjects with DM than that of controls. Further, GG genotype and G allele frequencies of CCR5 polymorphism were significantly more prevalent in CRF subjects with AS compared with controls (p < 0.05). We also explored these polymorphisms among CRF subjects with and without following comorbidities: HT, DM, AS. We found significant association between CRF subjects with HT and without HT in terms of genotype and allele frequencies of V249I polymorphism (p < 0.05). CX3CR1 T280M polymorphism was not found significantly different in none of the comparisons. These data demonstrate possible associations between CX3CR1 V249I and CCR5-59029 A/G polymorphisms and/or HT, DM and AS in CRF subjects.

Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients

OpenAIRE

Bo Kyung Sohn; Yun Kyu Oh; Jung-Seok Choi; Jiyoun Song; Ahyoung Lim; Jung Pyo Lee; Jung Nam An; Hee-Jeong Choi; Jae Yeon Hwang; Hee-Yeon Jung; Jun-Young Lee; Chun Soo Lim

2018-01-01

Background : Many patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) experience depression. Depression influences patient quality of life (QOL), dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT) program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers. Methods : We conducted group CBT over a 12-week period...

Longitudinal study of leptin levels in chronic hemodialysis patients

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Averbukh Zhan

2011-06-01

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.

Mortality Risk for Women on Chronic Hemodialysis Differs by Age

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Manish M Sood

2014-06-01

Full Text Available Background: Previous reports have demonstrated similar survival for men and women on hemodialysis, despite women's increased survival in the general population. Objectives: To examine the effect of age on mortality in women undergoing chronic hemodialysis. Design: A retrospective cohort study using an administrative data registry, the Canadian Organ Replacement Registry (CORR from Jan. 2001 and Dec. 2009. Setting: Canada. Patients: 28,971 (Women 11,792 (40.7%, Men 17,179 (59.3% incident chronic hemodialysis patients who survived greater than 90 days on dialysis. Measurements: All-cause mortality. Methods: Cox proportional hazards and competing risks models were employed to determine the independent association between sex, age and likelihood of all-cause mortality with renal transplantation as the competing outcome. Results: During the study period, 6060 (51.4% of women and 8650 (50.4% of men initiating dialysis died. Younger women experienced higher mortality (Age 85: Women 66%, Men 70.2%, HR 0.83 95% CI 0.71–0.97 compared to men. This relationship persisted after accounting for the competing risk of transplantation. Limitations: The cause of death was unknown. Conclusions: Women's survival on chronic hemodialysis varies by age compared to men with a significantly higher mortality in women younger than 45 years old and lower mortality in woman older than 75 years of age.

Comparison of multiple fluid status assessment methods in patients on chronic hemodialysis.

Science.gov (United States)

Alexiadis, Giannis; Panagoutsos, Stelios; Roumeliotis, Stefanos; Stibiris, Ilias; Markos, Angelos; Kantartzi, Konstantia; Passadakis, Ploumis

2017-03-01

Control of hydration status is an important constituent of adequate and efficient hemodialysis (HD) treatment. Nevertheless, there are no precise clinical indices for early recognition of small changes in fluid status of patients undergoing chronic hemodialysis therapy. This study aimed to evaluate and compare the widely used and reliable method of indexed inferior vena cava diameter (IVCDi) with established and more recently available techniques (bioelectrical impedance analysis [BIA], continuous blood volume monitoring [Crit-line], and the B-line score [BLS] with lung ultrasonography) for estimating the hydration status of patients on HD. Fifty-three patients undergoing chronic HD thrice weekly were included in the study. Evaluation of hydration status methods (IVCDi, BLS, BIA, and Crit-line) was performed thrice weekly before and after HD. Receiver operating characteristic curve analysis was performed to evaluate the discriminative power of (methods) the BLS, BIA, and Crit-line for predicting over- and underhydration of patients, as determined by the reference method, IVCDi. BLS showed the most promising results in predicting overhydration, as determined by IVCDi, compared with BIA and Crit-line and presented a sensitivity of 77% and specificity of 74%. The accuracy of the BLS was higher than that of BIA (0.81 vs. 0.71, p = 0.032) and Crit-line (0.61, p = 0.001). BLS also showed more promising results in predicting underhydration, as determined by IVCDi, than BIA and Crit-line and presented a sensitivity of 78% and a specificity of 73%. The accuracy of the BLS was higher than that of BIA (0.83 vs. 0.76, p = 0.035) and Crit-line (0.50, p < 0.001). The BLS is a useful and easily performed technique that has recently become available for accurate evaluation of dry weight and fluid status in patients with end-stage renal disease undergoing chronic HD. This method might help recognize asymptomatic lung congestion in these patients.

[Auto-dialysis: an 11-year experience of a hemodialysis center in France].

Science.gov (United States)

Montagnac, R; Schillinger, F

1996-03-30

Report 11 years of experience with self-managed hemodialysis in patients medically apt for extra-hospital dialysis and living close enough to small outpatient hemodialysis units to become totally self-sufficient. Among the 276 patients with chronic renal failure managed at the hemodialysis center at the Troyes hospital during the 11-year study period from 1984 through 1994, self-managed hemodialysis at small outpatient units was initiated in 127 (46%). None of these 127 patients required medical assistance or specific care during dialysis sessions. At initial hospital admission, only 60/127 (47%) were totally self-sufficient: 52 (41%) were later graft recipients; and 21 (16.5%) had to return to the hospital for a medical or surgical condition incompatible with extra-hospital care but all of these 21 patients remained self-sufficient. Extra-hospital hemodialysis in units close to the patients residence offers patients a better quality of life, even when medical assistance is required. All patients who require hemodialysis can thus be treated at lower cost without compromising quality of treatment. Perfect self-sufficiency may not be a goal in itself, but self-managed hemodialysis can be a very useful technique for patients without major medical problems. Continuing contact with the organizing hemodialysis center guarantees the safety of the system.

A fresh look into the pathophysiology of ischemia-induced complications in patients with chronic kidney disease undergoing hemodialysis

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Honore PM

2015-03-01

Full Text Available Patrick M Honore,1 Rita Jacobs,1 Elisabeth De Waele,1 Viola Van Gorp,1 Jouke De Regt,1 Olivier Joannes-Boyau,2 Willem Boer,3 Herbert D Spapen1 1Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; 2Intensive Care Unit, Haut Leveque University Hospital of Bordeaux, University of Bordeaux 2, Pessac, France; 3Intensive Care Department, Ziekenhuis Oost Limburg, Genk, Belgium Abstract: Recent case reports of acute esophageal necrosis in patients with chronic kidney disease (CKD undergoing hemodialysis encouraged us to look beyond hypoperfusion/ischemia as a sole explanation for this dramatic complication. At least three intriguing pathways, ie, accumulation of protein-bound toxins, endotoxin translocation, and altered mucosal defense mechanisms, have been proposed to explain the inherent susceptibility of CKD patients to developing ischemia-related and cardiovascular events. Interestingly, all the proposed pathways can be potentially antagonized or attenuated. At present, however, it is not known whether one pathway predominates or if any interaction exists between these pathways. More solid experimental and clinical data are warranted to acquire a better insight into the complex pathogenesis of CKD-associated ischemia. Keywords: chronic kidney disease, ischemia, pathophysiology, cardiovascular events

The relationship between coping with stress and employment in patients receiving maintenance hemodialysis.

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Takaki, Jiro; Yano, Eiji

2006-07-01

The goal of this study was to assess the relationship between emotion- and task-oriented coping (EOC/TOC) with stress and employment in patients undergoing maintenance hemodialysis. Individuals aged 18 to 64 yr who had uremia and had been undergoing hemodialysis regularly for at least three months were evaluated according to sociodemographic and clinical factors. Work status was defined using the most recent International Labour Organization definitions. Patients were requested to complete the following questionnaires: the Japanese version of the Coping Inventory for Stressful Situations, the Short Form-36 Health Survey, an item on itchiness, the Self-Efficacy on Health-Related Behavior Scale, the Japanese version of the Health Locus of Control Scale, the Social Support Scale, and the Japanese version of the Hospital Anxiety and Depression Scale. A total of 317 individuals participated in this study. Among men, age, physical functioning, EOC, and depression differed significantly (pTOC was not significantly associated with employment in either sex. Multiple logistic regression analyses, including possible confounders, indicated that when EOC increased by 10 points, the associated adjusted odds ratio of an unemployed or economically inactive status changed by 1.48 (95% confidence interval, 1.04-2.11; p=0.030) in men and by 1.88 (95% confidence interval, 1.02-3.46; p=0.042) in women. These results suggest that EOC is associated with employment in patients receiving maintenance hemodialysis.

Effects of frequent hemodialysis on perceived caregiver burden in the Frequent Hemodialysis Network trials.

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Suri, Rita S; Larive, Brett; Hall, Yoshio; Kimmel, Paul L; Kliger, Alan S; Levin, Nathan; Tamura, Manjula Kurella; Chertow, Glenn M

2014-05-01

Patients receiving hemodialysis often perceive their caregivers are overburdened. We hypothesize that increasing hemodialysis frequency would result in higher patient perceptions of burden on their unpaid caregivers. In two separate trials, 245 patients were randomized to receive in-center daily hemodialysis (6 days/week) or conventional hemodialysis (3 days/week) while 87 patients were randomized to receive home nocturnal hemodialysis (6 nights/week) or home conventional hemodialysis for 12 months. Changes in overall mean scores over time in the 10-question Cousineau perceived burden scale were compared. In total, 173 of 245 (70%) and 80 of 87 (92%) randomized patients in the Daily and Nocturnal Trials, respectively, reported having an unpaid caregiver at baseline or during follow-up. Relative to in-center conventional dialysis, the 12-month change in mean perceived burden score with in-center daily hemodialysis was -2.1 (95% confidence interval, -9.4 to +5.3; P=0.58). Relative to home conventional dialysis, the 12-month change in mean perceived burden score with home nocturnal dialysis was +6.1 (95% confidence interval, -0.8 to +13.1; P=0.08). After multiple imputation for missing data in the Nocturnal Trial, the relative difference between home nocturnal and home conventional hemodialysis was +9.4 (95% confidence interval, +0.55 to +18.3; P=0.04). In the Nocturnal Trial, changes in perceived burden were inversely correlated with adherence to dialysis treatments (Pearson r=-0.35; P=0.02). Relative to conventional hemodialysis, in-center daily hemodialysis did not result in higher perceptions of caregiver burden. There was a trend to higher perceived caregiver burden among patients randomized to home nocturnal hemodialysis. These findings may have implications for the adoption of and adherence to frequent nocturnal hemodialysis.

Assessment of Adequacy of Dialysis in Patients under Continuous Hemodialysis in Kamkar and Hazrat Vali Asr Hospitals, State of Qom, 2006

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S. M. Mousavi Movahed

2007-07-01

Full Text Available Background and objectivesHemodialysis is one of the therapeutic modalities of the end stage renal disease (ESRD. As inadequate dialysis is considered a risk factor leading to higher morbidity and mortality, determination of adequacy of dialysis is necessary. This study was conducted to determine adequacy of dialysis in continuous hemodialysis patients in Kamkar and Hazrat Vali Asr Hospitals in the state of Qom, Iran.Methods This cross sectional descriptive-analytic study was conducted in 2006. The study variables were age, gender, height, weight and duration of dialysis. Data were collected by a questionnaire and URR, dKt/V, eKt/V and pKt/V were calculated. For statistical analysis, t-test, Fisher’s exact test and Pearson correlation were employed. Results Of 238 patients, 51.7% and 48.3% were males and females respectively. The average age was 55.27 ± 16.79 years. Mean values of dKt/V, eKt/V, pKt/V and URR were 1.03 ± 0.232, 0.89 ± 0.196, 1.18 ± 0.254, and 57.46 ± 8.42 respectively. The percent of adequate dialysis in eKt/V, pKt/V and URR were 26.5%, 44.5% and 21% respectively. The mean age of insufficient eKt/V group was higher than adequate eKt/V group and t test showed a significant statistical correlation. Fisher’s exact test showed a significant correlation between adequate eKt/V and female gender, and also between eKt/V and URR. But chi-square test did not show a significant correlation between eKt/V and underling disease.Conclusion We found that hemodialysis is inadequate in a high number of patients. Further studies with larger sample numbers are recommended to determine the underlying cause of this inadequacy. Keywords: Hemodialysis, Dialysis, End Stage Renal Disease

Relationship between serum total bilirubin levels and mortality in uremia patients undergoing long-term hemodialysis: A nationwide cohort study.

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Su, Hui-Hsien; Kao, Chia-Man; Lin, Yi-Chun; Lin, Yen-Chung; Kao, Chih-Chin; Chen, Hsi-Hsien; Hsu, Chih-Cheng; Chen, Kuan-Chou; Peng, Chiung-Chi; Wu, Mai-Szu

2017-10-01

Previous studies show that serum bilirubin has potent antioxidant effect and is associated with protection from kidney damage and reduce cardiovascular events. The aim of this study was to examine the association of serum total bilirubin level and mortality in uremia patients who underwent hemodialysis. This is a nationwide retrospective long-term cohort study. Patients were registered in the Taiwan Renal Registry Data System (TWRDS) from 2005 to 2012. A total of 115,535 hemodialysis patients were surveyed and those with valid baseline total bilirubin (TB) data were enrolled. All-cause mortality was the primary outcome. A total of 47,650 hemodialysis patients followed for 27.6 ± 12 months, were divided into 3 groups according to different baseline serum total bilirubin levels (0.1-0.3, 0.3-0.7, 0.7-1.2 mg/dL). Mean age was 61.4 ± 13.6 years, 50% were male, 13% were hepatitis B carriers, and 20% were hepatitis C carriers. Primary outcome was the 3-year mortality. The TB level 0.7-1.2 mg/dL group had high mortality, statistically significant hazard ratio of mortality was 1.14 (crude HR, 95% 1.07-1.20, p bilirubin on hemodialysis patients are needed. Copyright © 2017 Elsevier B.V. All rights reserved.

Potential impact of renin-angiotensin system inhibitors and calcium channel blockers on plasma high-molecular-weight adiponectin levels in hemodialysis patients

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Nakagawa, Naoki; Yao, Naoyuki; Hirayama, Tomoya

2011-01-01

Although metabolic syndrome confers an increased risk of cardiovascular disease in the general population, little is known about the alteration of abdominal adiposity and its association with adipocytokines in hemodialysis patients. We investigated the plasma high-molecular-weight (HMW) adiponectin level and its relationship to visceral fat area (VFA) and various markers of atherosclerosis in hemodialysis patients. In a cross-sectional study, conventional cardiovascular risk factors, plasma total and HMW adiponectin, the number of components of the metabolic syndrome and, using computed tomography, the distribution of abdominal adiposity were assessed in 144 hemodialysis patients (90 men and 54 women; mean age, 60.7 years) and 30 age- and sex-matched patients with chronic kidney disease (CKD). Plasma HMW adiponectin levels in hemodialysis patients were significantly higher than those in patients with CKD, negatively associated with VFA and serum triglycerides and positively associated with plasma total adiponectin, as well as the HMW-to-total adiponectin ratio in men and women (all P<0.05) in a simple regression analysis. In a multiple regression analysis, VFA was a significant determinant of HMW adiponectin in hemodialysis patients. Furthermore, after adjustment for classical risk factors, HMW adiponectin levels were significantly higher in patients undergoing treatment with renin-angiotensin system inhibitors or calcium channel blockers compared with patients not undergoing such treatment. This study shows that plasma HMW adiponectin levels were negatively associated with VFA and positively associated with treatment with blockade of the renin-angiotensin system and of the calcium channel. Therefore, these drugs might be effective for improving adipocytokine-related metabolic abnormalities in hemodialysis patients. (author)

A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis

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Abdolamir Atapour

2016-01-01

Full Text Available Over the years, there has been a steady increase in the number of patients requiring dialysis. However, no consensus exists between choosing either hemodialysis (HD or peritoneal dialysis (PD as the preferred method of dialysis for patients. In this study, we have compared the quality of life of the patients undergoing either HD or PD. This cross-sectional study was performed in the dialysis center of the Noor and Saint Ali Asghar University Hospital in Isfahan, Iran in 2012. Forty-six patients who underwent PD (28 males and 18 females and 46 similar patients undergoing HD (26 males and 20 females were compared. A standardized Persian version of the short form-36 (SF-36 tool was used to assess the quality of life and to assess the quality of dialysis weekly Kt/V in patients undergoing PD and single random Kt/V sampling in HD patients were assessed. Patients undergoing PD reported higher scores in physical functioning. The lowest scores in both groups were reported in mental health section. In physical functioning section, physical role functioning section and overall score of the SF-36 tool, PD patients reported significantly higher scores compared to the HD patients (P <0.05. There was no significant difference between the qualities of the dialysis in the two patient groups. Aspects of quality of life such as physical functioning, physical role functioning, bodily pain, general health perceptions, and overall score were significantly different between the two groups. If these results are substantiated by subsequent longitudinal studies, then the choice of dialysis could be better guided in patients by the quality of life issues.

The Effect of Stress Management Training on Hope in Hemodialysis Patients.

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Poorgholami, Farzad; Abdollahifard, Sareh; Zamani, Marzieh; Kargar Jahromi, Marzieh; Badiyepeyma Jahromi, Zohreh

2015-11-18

Chronic renal failure exposes patients to the risk of several complications, which will affect every aspect of patient's life, and eventually his hope. This study aims to determine the effect of stress management group training on hope in hemodialysis patients. In this quasi-experimental single-blind study, 50 patients with renal failure undergoing hemodialysis at Motahari Hospital in Jahrom were randomly divided into stress management training and control groups. Sampling was purposive, and patients in stress management training group received 60-minute in-person training by the researcher (in groups of 5 to 8 patients) before dialysis, over 5 sessions, lasting 8 weeks, and a researcher-made training booklet was made available to them in the first session. Patients in the control group received routine training given to all patients in hemodialysis department. Patients' hope was recorded before and after intervention. Data collection tools included demographic details form, checklist of problems of hemodialysis patients and Miller hope scale (MHS). Data were analyzed in SPSS-18, using Chi-square, one-way analysis of variance, and paired t-test. Fifty patients were studied in two groups of 25 each. No significant difference was observed between the two groups in terms of age, gender, or hope before intervention. After 8 weeks of training, hope reduced from 95.92±12.63 to 91.16±11.06 (P=0.404) in the control group, and increased from 97.24±11.16 to 170.96±7.99 (P=0.001) in the stress management training group. Significant differences were observed between the two groups in hope scores after the intervention. Stress management training by nurses significantly increased hope in hemodialysis patients. This low cost intervention can be used to improve hope in hemodialysis patients.

Hypoxia and oxidative stress markers in pediatric patients undergoing hemodialysis: cross section study

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Hamed Enas A

2012-10-01

Full Text Available Abstract Background Tissue injury due to hypoxia and/or free radicals is common in a variety of disease processes. This cross-sectional study aimed to investigate effect of chronic kidney diseases (CKD and hemodialysis (HD on hypoxia and oxidative stress biomarkers. Methods Forty pediatric patients with CKD on HD and 20 healthy children were recruited. Plasma hypoxia induced factor-1α (HIF-1α, vascular endothelial growth factor (VEGF were measured by specific ELISA kits while, total antioxidant capacity (TAC, total peroxide (TPX, pyruvate and lactate by enzymatic/chemical colorimetric methods. Oxidative stress index (OSI and lactate/pyruvate (L/P ratio were calculated. Results TAC was significantly lower while TPX, OSI and VEGF were higher in patients at before- and after-dialysis session than controls. Lactate and HIF-1α levels were significantly higher at before-dialysis session than controls. Before dialysis, TAC and L/P ratio were lower than after-dialysis. In before-dialysis session, VEGF correlated positively with pyruvate, HIF-1α and OSI correlated positively with TPX, but, negatively with TAC. In after-dialysis session, HIF-1α correlated negatively with TPX and OSI; while, OSI correlated positively with TPX. Conclusions CKD patients succumb considerable tissue hypoxia with oxidative stress. Hemodialysis ameliorated hypoxia but lowered antioxidants as evidenced by decreased levels of HIF-1α and TAC at before- compared to after-dialysis levels.

In-center hemodialysis attendance: patient perceptions of risks, barriers, and recommendations.

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Chenitz, Kara B; Fernando, Michael; Shea, Judy A

2014-04-01

Missed hemodialysis treatments lead to increased morbidity and mortality in the end-stage renal disease population. Little is known about why patients have difficulty attending their scheduled in-center dialysis treatments. Semistructured interviews with 15 adherent and 15 nonadherent hemodialysis patients were conducted to determine patients' attitudes about dialysis, health beliefs and risk perception regarding missed treatments, barriers and facilitators to hemodialysis attendance, and recommendations to improve the system to facilitate dialysis attendance. Average time on dialysis was 2.5 years for the nonadherent group and 7.3 years in the adherent group. In both groups, patients felt that dialysis is life-saving and a necessity. A substantial number of patients in both groups understood that missing hemodialysis treatments is dangerous and several patients could clearly communicate the risk of skipping. The most common barriers to hemodialysis were inadequate or unreliable transportation (mentioned in both groups) and a lack of motivation to get to dialysis or that dialysis is not a priority (typically mentioned by the nonadherent group). Facilitators to hemodialysis attendance included explanations from the health care team regarding the risk of skipping and relationships with other dialysis patients. Patient recommendations to improve dialysis attendance included continued education about the risk of poor attendance and more accessible transportation. Patients did not feel that home dialysis would improve adherence. Hemodialysis patients must adhere to a complex and burdensome regimen. Through the elucidation of barriers and facilitators to hemodialysis attendance and through specific patient recommendations, at least three interventions may be further investigated to improve hemodialysis attendance: Improvement of the transportation system, education and supportive encouragement from the health care team, and peer support mentorship. © 2014 International

Modulation of Myostatin/Hepatocyte Growth Factor Balance by Different Hemodialysis Modalities.

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Esposito, Pasquale; La Porta, Edoardo; Calatroni, Marta; Grignano, Maria Antonietta; Milanesi, Samantha; Verzola, Daniela; Battaglia, Yuri; Gregorini, Marilena; Libetta, Carmelo; Garibotto, Giacomo; Rampino, Teresa

2017-01-01

Background. In this study we investigated the relevance of myostatin and Hepatocyte Growth Factor (HGF) in patients undergoing hemodialysis HD and the influence of different HD modalities on their levels. Methods. We performed a prospective crossover study in which HD patients were randomized to undergo 3-month treatment periods with bicarbonate hemodialysis (BHD) followed by online hemodiafiltration (HDF). Clinical data, laboratory parameters, and myostatin and HGF serum levels were collected and compared. Results. Ten patients and six controls (C) were evaluated. In any experimental condition myostatin and HGF levels were higher in HD than in C. At enrollment and after BHD there were not significant correlations, whereas at the end of the HDF treatment period myostatin and HGF were inversely correlated ( r   -0.65, p myostatin serum levels inversely correlated with transferrin ( r   -0.73, p myostatin levels significantly decreased (6.3 ± 4.1 versus 4.3 ± 3.1 ng/ml, p myostatin levels and myostatin/HGF balance by the use of different HD modalities might represent a novel approach to the prevention and treatment of HD-related muscle wasting syndrome.

A case of scrub typhus requiring maintenance hemodialysis

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Dae-Yeon Kim

2013-12-01

Full Text Available Renal failure caused by scrub typhus is known to be reversible. In most cases, renal function is almost fully restored after appropriate antibiotic treatment. A 71-year-old man was diagnosed with scrub typhus complicated by renal failure. A renal biopsy revealed histopathologic findings consistent with acute tubulointerstitial nephritis. Renal function did not improve 18 months after discharge and the patient required continuous hemodialysis. Although severe renal failure requiring dialysis is a rare complication of scrub typhus, we describe a case of scrub typhus requiring maintenance hemodialysis. To the best of our knowledge, this is the first such report.

Destructive spondyloarthropathy in hemodialysis patients

International Nuclear Information System (INIS)

Orzincolo, C.; Ghedini, M.; Cardona, P.; Bedani, P.L.; Scutellari, P. N.

1991-01-01

Destructive spondyloarthropathy (DSA) has been observed in patients undergoing long-term hemodialysis. The pathophysiology of this condition is still unknown, but there is evidence that amyloid depositions play an important role in its development. Despite several reports, the radiological evolution of these lesions is poorly known. The authors report the results of the radiographic follow-up (12-18 months) of 9 cases (7 female and 2 male patients; age 63±6 years) hemodilized for over 60 months (mean: 126±33). In 7 cases. radiographic patterns of destructive arthropathy were seen in peripheral joints as well. X-ray pictures demonstrated: 1) increased erosion of vertebral end plates (in all cases); 2) increased narrowing of invertebral spaces (in 5 cases); 3) increased collapse of vertebral bodies (in 5 cases); 4) increased malalignment of the involved segments (in 4 cases). In 3 autopsied cases β 2 -microglobulin amyloid depositions were found in disc and ligamentous paravertebral tissue. These results confirm that: 1) DSA is progressive in longterm hemodialysis patients; 2) radiographic evolution is often very quick; 3) the cervical spine is the most frequently involved location and the one where lesions are quickest to develop; 4) severe malalignament of the involved spine may be present, with subsequent neurological complications

Predictive Factors of One-Year Mortality in a Cohort of Patients Undergoing Urgent-Start Hemodialysis.

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Luciene P Magalhães

Full Text Available Chronic kidney disease (CKD affects 10-15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality.We studied 424 patients who were admitted to our service between 01/2006 and 12/2012 and were followed for 1 year. We analyzed vascular access, risk factors linked to cardiovascular disease (CVD and mineral and bone disease associated with CKD (CKD-MBD, and clinical events that occurred during the follow-up period. Factors that influenced patient survival were evaluated by Cox regression analysis.The patient mean age was 50 ± 18 years, and 58.7% of them were male. Hypertension was the main cause of primary CKD (31.8%. Major risk factors were smoking (19.6%, dyslipidemia (48.8%, and CVD (41%. Upon admission, most patients had no vascular access for hemodialysis (89.4%. Biochemical results showed that most patients were anemic with high C-reactive protein levels, hypocalcemia, hyperphosphatemia, elevated parathyroid hormone and decreased 25-hydroxy vitamin D. At the end of one year, 60 patients died (14.1%. These patients were significantly older, had a lower percentage of arteriovenous fistula in one year, and low levels of 25-hydroxy vitamin D.The combined evaluation of clinical and biochemical parameters and risk factors revealed that the mortality in urgent-start dialysis is associated with older age and low levels of vitamin D deficiency. A lack of a permanent hemodialysis access after one year was also a risk factor for mortality in this population.

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

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Henning, Bernhard F; Holzhausen, Helge; Tepel, Martin

2010-01-01

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 measure...

DNA damage in hemodialysis patients with chronic kidney disease; a test of the role of diabetes mellitus; a comet assay investigation.

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Mamur, Sevcan; Unal, Fatma; Altok, Kadriye; Deger, Serpil Muge; Yuzbasioglu, Deniz

2016-04-01

The incidence of chronic kidney disease (CKD) is increasing rapidly. Diabetes mellitus (DM) is the most important cause of CKD. We studied the possible role of DM in CKD patients with respect to DNA damage, as assessed by the comet assay in 60 CKD patients (with or without DM) undergoing hemodialysis and in 26 controls. Effects of other factors, such as age, sex, hypertension, duration of hemodialysis, body mass index (BMI), and levels of hemoglobin (HB), intact parathormone (iPTH), and ferritin (FER), were also examined. Primary DNA damage measured by the comet assay was significantly higher in CKD patients than in controls. Among CKD patients, the following correlations were observed. (1) There was no difference in comet tail length or tail intensity between diabetic and non-diabetic individuals. (2) Age, sex, hemoglobin, hypertension, duration of hemodialysis, and ferritin levels affected neither tail length nor intensity. (3) BMI values above 25kg/m(2) and iPTH levels above 300pg/ml were associated with significantly greater comet tail length. Our results indicate that primary DNA damage is increased in CKD patients undergoing hemodialysis, compared to controls; however, DM had no additional effect. Copyright © 2016. Published by Elsevier B.V.

Characterizing the continuously acquired cardiovascular time series during hemodialysis, using median hybrid filter preprocessing noise reduction.

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Wilson, Scott; Bowyer, Andrea; Harrap, Stephen B

2015-01-01

The clinical characterization of cardiovascular dynamics during hemodialysis (HD) has important pathophysiological implications in terms of diagnostic, cardiovascular risk assessment, and treatment efficacy perspectives. Currently the diagnosis of significant intradialytic systolic blood pressure (SBP) changes among HD patients is imprecise and opportunistic, reliant upon the presence of hypotensive symptoms in conjunction with coincident but isolated noninvasive brachial cuff blood pressure (NIBP) readings. Considering hemodynamic variables as a time series makes a continuous recording approach more desirable than intermittent measures; however, in the clinical environment, the data signal is susceptible to corruption due to both impulsive and Gaussian-type noise. Signal preprocessing is an attractive solution to this problem. Prospectively collected continuous noninvasive SBP data over the short-break intradialytic period in ten patients was preprocessed using a novel median hybrid filter (MHF) algorithm and compared with 50 time-coincident pairs of intradialytic NIBP measures from routine HD practice. The median hybrid preprocessing technique for continuously acquired cardiovascular data yielded a dynamic regression without significant noise and artifact, suitable for high-level profiling of time-dependent SBP behavior. Signal accuracy is highly comparable with standard NIBP measurement, with the added clinical benefit of dynamic real-time hemodynamic information.

FUNCTIONAL STATUS IN PATIENTS WITH CHRONIC KIDNEY DISEASE BEING TREATED WITH HEMODIALYSIS IN PKU MUHAMMADIYAH HOSPITAL, YOGYAKARTA, INDONESIA

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Adiyati Mardiyah

2017-08-01

Full Text Available Background: Hemodialysis process is useful for patients with end-stage renal disease. However, this is a situation of abject dependence on a machine, a procedure and a group of qualified medical professionals for the rest of their lives that may influence their functional status. Objective: This study aims to describe the functional status of patients with chronic kidney disease undergoing hemodialysis. Method: This was a descriptive study with cross-sectional design, which conducted in the PKU Muhammadiyah Hospital Yogyakarta on March 2017. There were 78 patients selected using purposive sampling. Functional status was measured using SF-36 questionnaire. Descriptive statistic was performed for data analysis Result:. The total average of functional status level was 42.92, with Physical Component Scale (PCS of 42.31 and Mental Component Scale (MCS of 45.78. Conclusion: There were functional deficiencies in both physical and mental status in patients with CKD undergoing hemodialysis. Thus, it is suggested that pharmacological management of these patients need stringent monitoring on part of the psychiatrist to deal with mental health problems, and the interdisciplinary team need to do great efforts to improve functional status and quality of life of patients with CKD.

A qualitative approach of psychosocial adaptation process in patients undergoing long-term hemodialysis.

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Lin, Chun-Chih; Han, Chin-Yen; Pan, I-Ju

2015-03-01

Professional hemodialysis (HD) nursing tends to be task-oriented and lack consideration of the client's viewpoint. This study aims to interpret the process of psychosocial adaptation to dealing with HD in people with end-stage renal disease (ESRD). A grounded theory guided this study. Theoretical sampling included 15 people receiving HD at the HD center of a hospital from July to November 2010. Participants received an information sheet in writing, a verbal invitation, and informed consent forms before interviews were conducted. A constant comparative data analysis was analyzed using open, axial and selective coding. The computer software ATLAS.ti assisted data management. Credibility, transferability, dependability, and confirmability ensured the rigor of study process. This study identified "adopting life with hemodialysis", which captures the process of the psychosocial adaptation in people with ESRD as one transformation. Four categories that evolved from "adopting HD life" are (a) slipping into, (b) restricted to a renal world, (c) losing self control, and (d) stuck in an endless process. The findings of this investigation indicate the multidimensional requirements of people receiving maintenance dialysis, with an emphasis on the deficiency in psychosocial and emotional care. The study's findings contribute to clinical practice by increasing the understanding of the experience of chronic HD treatment from the recipient's viewpoint. The better our understanding, the better the care provided will meet the needs of the people receiving HD. Copyright © 2015. Published by Elsevier B.V.

Critical Evaluation of Blood Volume Measurements during Hemodialysis

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Dasselaar, Judith J.; van der Sande, Frank M.; Franssen, Casper F. M.

2012-01-01

Devices that continuously measure relative blood volume (RBV) changes during hemodialysis (HD) are increasingly used for the prevention of dialysis hypotension and fine-tuning of dry weight. However, RBV measurements are subject to various limitations. First, RBV devices provide information on

Association of Secondary Hyperparathyroidism with Coronary Artery Disease in Patients on Regular Hemodialysis

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Azar BARADARAN

2011-12-01

Full Text Available Objective: To understand the association of parathormone excess due to secondary hyperparathyroidism and hyperphosphatemia with coronary artery disease, a study was designed on a group of stable hemodialysis (HD patients. Methods: This cross-sectional study was carried out on patients undergoing maintenance HD. Blood samples were collected after overnight fasting for serum calcium, phosphorus, and intact serum parathormone (iPTH. The presence of cardiac chest pain was confirmed through the complaint of heart burn or epigastric pain, retrosternal discomfort and chest compression was confirmed by symmetrical depressed T wave at that time on a 12-lead ECG by means of a 12-channel and also reliving the pain after taking sublingual Trinitroglycerine pearls (TNG. Results: A sample of 36 stable HD patients was investigated. The mean age of patients was 46.5±17 years. The length of the time patients have been on hemodialysis were 32± 36 months (Median = 19 months. About 21% of patients had chest pain. Mean±SD of intact PTH of patients was 434±455 pg/ml (Median = 309 pg/ml. In this study, there was a significant difference of hemodialysis duration (p = 0.009, hemodialysis amount (p = 0.029 and also serum phosphorus (p = 0.013 between patients with and without cardiac chest pain. There was also a significant difference of iPTH (p = 0.026 between male hemodialysis patients with and without cardiac chest pain. Conclusion: Our data supported the importance of better control of serum phosphorus and also treatment of parathormone excess as the responsible factors promoting the coronary artery disease in hemodialysis patients.

The association of sociodemographic factors and needs of hemodialysis patients according to Maslow's hierarchy of needs.

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Shih, Chiung-Yu; Huang, Chiu-Ya; Huang, Mei-Lun; Chen, Chyong-Mei; Tang, Fu-In

2018-05-18

To explore the association between the sociodemographic factors and the needs of patients undergoing hemodialysis in Taiwan. Concomitant discomfort, including physical and mental aspects, affects the patients' quality of life and their willingness to undergo hemodialysis. Maslow's hierarchy of needs is a well-known tool to assess different levels of human needs. We conducted a small-scale cross-sectional observational study using a structured needs assessment questionnaire on 159 patients from the Taipei Veterans General Hospital hemodialysis unit. The overall mean scores of physical, mental, spiritual, other needs, and needs in relation to medical staff care were 4.0±0.8, 3.2±0.8, 2.7±1.0, 3.1±0.9, and 4.1±0.7, respectively. The results showed that the patients' highest need was in relation to medical staff care, followed by physical needs. Further analysis showed that patients who are still employed during the treatment process have higher mental, spiritual, and other needs. Patient who are financially supported by their family have higher physical needs. Patients taken cared of by paid caregivers have lower spiritual needs and other needs. This is also the same with patients who are religious as opposed to those who are non-religious. Patients who have attained tertiary education have higher other needs compared to patients who have only achieved up to primary or secondary education. The study is the first in Taiwan to identify and quantify the needs of patients undergoing hemodialysis. When the needs of the patients are identified in relation to their sociodemographic factors, the medical staff can give the appropriate treatment in order to meet the needs and improve the patients' well-being. Healthcare providers should not only focus on the patients' physiological needs, but should determine and address their other needs in various aspects in order to improve the quality and efficacy of the dialysis care process. This article is protected by copyright

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

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Crawford, M E; Møiniche, S; Orbæk, Janne

1996-01-01

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...... 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....

The effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among hemodialysis patients.

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Shahgholian, Nahid; Jazi, Shahrzad Khojandi; Karimian, Jahangir; Valiani, Mahboubeh

2016-01-01

Restless leg syndrome prevalence is high among the patients undergoing hemodialysis. Due to several side effects of medicational treatments, the patients prefer non-medicational methods. Therefore, the present study aimed to investigate the effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among patients undergoing hemodialysis. This study is a randomized clinical trial that was done on 90 qualified patients undergoing hemodialysis in selected hospitals of Isfahan, who were diagnosed with restless leg syndrome through standard restless leg syndrome questionnaire. They were randomly assigned by random number table to three groups: Reflexology, stretching exercises, and control groups through random allocation. Foot reflexology and stretching exercises were conducted three times a week for 30-40 min within straight 4 weeks. Data analysis was performed by SPSS version 18 using descriptive and inferential statistical analyses [one-way analysis of variance (ANOVA), paired t-test, and least significant difference (LSD) post hoc test]. There was a significant difference in the mean scores of restless leg syndrome severity between reflexology and stretching exercises groups, compared to control (P reflexology and stretching exercises groups compared to the control group (P reflexology massage and stretching exercises groups. Our obtained results showed that reflexology and stretching exercises can reduce the severity of restless leg syndrome. These two methods of treatment are recommended to the patients.

Influence of hemodialysis on the mean blood flow velocity in the middle cerebral artery.

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Stefanidis, I; Bach, R; Mertens, P R; Liakopoulos, V; Liapi, G; Mann, H; Heintz, B

2005-08-01

Several effects of hemodialysis, including hemoconcentration, alterations of hemostasis or hemorheology and endothelial activation, could potentially interfere with cerebral blood flow (CBF) regulation. These treatment-specific changes may also be crucial for the enhanced incidence of stroke in uremic patients. Nevertheless, the influence of hemodialysis on CBF has not been yet adequately studied. We registered mean blood flow velocity (MFV) in the middle cerebral artery (MCA) during hemodialysis treatment in order to evaluate its contribution on CBF changes. Transcranial Doppler ultrasonography (TCD) of the MCA was performed continuously during hemodialysis treatment in 18 stable patients (10 males and 8 females, mean age 62 +/- 11 years) with end-stage renal disease of various origin. Blood pressure (mmHg), heart rate (/min), ultrafiltration volume (ml), BV changes (deltaBV by hemoglobinometry, %), arterial blood gases (pO2, blood oxygen content, pCO2), hemostasis activation (thrombin-antithrombin III complex, ELISA) and fibrinogen (Clauss) were measured simultaneously at the beginning of treatment and every hour thereafter. Before the hemodialysis session the MFV in the MCA was within normal range (57.5 +/- 13.0 cm/s, ref. 60 +/- 12) and was mainly dependent on the patients' age (r = -0.697, p delta%MFV) were interrelated to the ultrafiltration volume (r = -0.486, p delta%acO2, r = -0.420, p delta%fibrinogen, r = 0.244, p < 0.05). A significant continuous decrease of the MFV in the MCA was observed during hemodialysis treatment, which inversely correlated both with ultrafiltration volume, BV changes and changes of plasma fibrinogen. The ultrafiltration-induced hemoconcentration with concomitant rise of hematocrit and oxygen transport capacity, may partly explain the alterations in the cerebral MFV observed during hemodialysis.

Prognostic study of cardiac events in Japanese high risk hemodialysis patients using I-BMIPP-SPECT: B-SAFE study design.

Science.gov (United States)

Hasebe, Naoyuki; Moroi, Masao; Nishimura, Masato; Hara, Kazuhiro; Hase, Hiroki; Hashimoto, Akiyoshi; Kumita, Shinichiro; Haze, Kazuo; Momose, Mitsuru; Nagai, Yoji; Sugimoto, Tokuichiro; Kusano, Eiji; Akiba, Takashi; Nakata, Tomoaki; Nishimura, Tsunehiko; Tamaki, Nagara; Kikuchi, Kenjiro

2008-12-01

Cardiovascular disease is the leading cause of morbidity and mortality in patients undergoing hemodialysis. Such patients frequently develop complications such as asymptomatic coronary artery disease (CAD). Accordingly, CAD must ideally be diagnosed at an early stage to improve prognosis. Although myocardial perfusion single photon emission computed tomography (SPECT) is valuable for diagnosing CAD, the stress test is not always applicable to patients on hemodialysis. Thus, we proposed a multicenter, prospective cohort study called "B-SAFE" to investigate the applicability of resting (123)I-labeled beta-methyl-iodophenylpentadecanoic acid ((123)I-BMIPP)-SPECT will be used to diagnose cardiac disease and evaluate the prognosis of hemodialysis patients by imaging myocardial fatty acid metabolism. B-SAFE began enrolling patients from June 2006 at 48 facilities. We performed (123)I-BMIPP-SPECT on 702 hemodialysis patients with risk factors for CAD until 30 November 2007 and plan to follow up for three years. The primary endpoints will be cardiac death and sudden death. This study should end in 2010.

Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury

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Anton Lund

2017-01-01

Full Text Available Dialysis disequilibrium syndrome (DDS is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension. CT of the brain showed diffuse cerebral edema. CRRT was discontinued, sedation was increased, and hypertonic saline was administered, upon which ICP normalized. Due to persistent hyperkalemia and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered.

Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury.

Science.gov (United States)

Lund, Anton; Damholt, Mette B; Strange, Ditte G; Kelsen, Jesper; Møller-Sørensen, Hasse; Møller, Kirsten

2017-01-01

Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT) revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP) monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT) was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension. CT of the brain showed diffuse cerebral edema. CRRT was discontinued, sedation was increased, and hypertonic saline was administered, upon which ICP normalized. Due to persistent hyperkalemia and overhydration, ultrafiltration and intermittent hemodialysis were performed separately on day 4 with a small dialyzer, low blood and dialysate flow, and high dialysate sodium content. During subsequent treatments, isolated ultrafiltration was well tolerated, whereas hemodialysis was associated with increased ICP necessitating frequent pauses or early cessation of dialysis. In patients at risk of DDS, hemodialysis should be performed with utmost care and continuous monitoring of ICP should be considered.

Sexual dysfunction in women with ESRD requiring hemodialysis.

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Strippoli, Giovanni F M; Vecchio, Mariacristina; Palmer, Suetonia; De Berardis, Giorgia; Craig, Jonathan; Lucisano, Giuseppe; Johnson, David; Pellegrini, Fabio; Nicolucci, Antonio; Sciancalepore, Michela; Saglimbene, Valeria; Gargano, Letizia; Bonifati, Carmen; Ruospo, Marinella; Navaneethan, Sankar D; Montinaro, Vincenzo; Stroumza, Paul; Zsom, Marianna; Torok, Mariatta; Celia, Eduardo; Gelfman, Ruben; Bednarek-Skublewska, Anna; Dulawa, Jan; Graziano, Giusi; Gentile, Giorgio; Ferrari, Juan Nin; Santoro, Antonio; Zucchelli, Annalisa; Triolo, Giorgio; Maffei, Stefano; Hegbrant, Jörgen; Wollheim, Charlotta; De Cosmo, Salvatore; Manfreda, Valeria M

2012-06-01

The few existing studies of sexual dysfunction in women on hemodialysis are limited by small sample size. This large, cross-sectional study evaluated the prevalence and correlates of female sexual dysfunction in advanced kidney disease. DESIGN, SETTING, PARTICIPANTS, METHODS: A total of 1472 women with ESRD undergoing hemodialysis were recruited to a multinational, cross-sectional study conducted within a collaborative dialysis network in Europe and South America. Sexual dysfunction was identified by the Female Sexual Function Index. Correlates of self-reported sexual dysfunction were identified by regression analyses. Of the 1472 women, 659 completed questionnaires (45%). More than half (362 of 659 [55%]) lived with a partner, and 232 of 659 (35%) reported being sexually active. Of these 659 respondents, 555 (84%) reported sexual dysfunction. Women with a partner (282 of 362 [78%]) were less likely to report sexual dysfunction than those without a partner (273 of 297 [92%]) (Psymptoms, less education, menopause, diabetes, and diuretic therapy. Nearly all women who were not wait-listed for a kidney transplant and were living without a partner (249 of 260 [96%]) reported sexual dysfunction. More than half (128 of 232 [55%]) of sexually active women reported sexual dysfunction, associated with age, depressive symptoms, menopause, low serum albumin, and diuretic therapy. This descriptive study suggests most women on hemodialysis experience sexual problems. Additional research on the relevance of sexual dysfunction to symptom burden and quality of life in these women is needed.

Variable pulmonary manifestations in hemodialysis patients

International Nuclear Information System (INIS)

Kim, Yoo Kyung; Shim, Sung Shine; Shin, Jung Hee; Choi, Gyu Bock; Lee, Kyung Soo; Yi, Chin A; Oh, Yu Whan

2003-01-01

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

A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study

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Ashima Sharma

Full Text Available ABSTRACT BACKGROUND: The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD patients. DESIGN AND SETTING: Prospective study in tertiary-level care center. METHODS: Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS: The patients’ average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94% and hypoalbuminemia (72% were common. Diabetes mellitus (68%, hypertension (34% and coronary artery disease (18% were major comorbidities. Forty-five patients (90% had been on hemodialysis for six months to three years. The patients’ pre-dialysis mean forced vital capacity (FVC and forced expiratory volume in 1 second (FEV1 were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P 0.05. The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05. The mean peak expiratory flow was below normal (43.8 ± 30.7% and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05. Males and females showed similar directions of change after hemodialysis. CONCLUSIONS: Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.

Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients - The CORDIAL Study

International Nuclear Information System (INIS)

Burmeister, Jayme Eduardo; Mosmann, Camila Borges; Costa, Veridiana Borges; Saraiva, Ramiro Tubino; Grandi, Renata Rech; Bastos, Juliano Peixoto; Gonçalves, Luiz Felipe; Rosito, Guido Aranha

2014-01-01

There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. All patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33). Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries

Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients - The CORDIAL Study

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Burmeister, Jayme Eduardo, E-mail: jb.nefro@gmail.com [Universidade Federal de Ciências da Saúde de Porto Alegre - Programa de Pós-graduação em Ciências da Saúde, Porto Alegre, RS (Brazil); Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil); Mosmann, Camila Borges [Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil); Costa, Veridiana Borges [Universidade Federal de Ciências da Saúde de Porto Alegre - Faculdade de Medicina, Porto Alegre, RS (Brazil); Saraiva, Ramiro Tubino; Grandi, Renata Rech; Bastos, Juliano Peixoto [Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil); Gonçalves, Luiz Felipe [Universidade Federal do Rio Grande do Sul - Faculdade de Medicina, Porto Alegre, RS (Brazil); Hospital Mãe de Deus - Departamento de Nefrologia, Porto Alegre, RS (Brazil); Rosito, Guido Aranha [Universidade Federal de Ciências da Saúde de Porto Alegre - Programa de Pós-graduação em Ciências da Saúde, Porto Alegre, RS (Brazil); Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil)

2014-05-15

There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. All patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33). Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries.

Factors associated with the quality of life of adults subjected to hemodialysis in a city in northeast Brazil.

Science.gov (United States)

Cavalcante, Milady Cutrim Vieira; Lamy, Zeni Carvalho; Lamy Filho, Fernando; França, Ana Karina Teixeira da Cunha; dos Santos, Alcione Miranda; Thomaz, Erika Bárbara Abreu Fonseca; da Silva, Antonio Augusto Moura; Salgado Filho, Natalino

2013-01-01

There is a known association between low scores for quality of life (QOL) and higher rates of hospitalization, mortality in hemodialysis vascular access catheter, older age, lack of regular occupation, presence of comorbidities and hypoalbuminemia. There is still no agreement about the influence of sex, educational level, socioeconomic status and treatment time on the worst levels of QOL. Identify socioeconomic, demographic, clinical, nutritional and laboratory factors associated with worse QOL in adults undergoing hemodialysis in Sao Luís, Maranhão, Brazil. A cross-sectional study which evaluated the QOL of patients with chronic renal disease, aged 20-59 years, undergoing hemodialysis. Two instruments were used: the Kidney Disease Quality of Life -Short Form 1.3 (KDQOL-SF™ 1.3) and a questionnaire on socioeconomic, demographic, clinical, nutritional and laboratory data. The reliability of KDQOL-SF™ 1.3 was assessed by Cronbach's alpha. For the multivariable analysis a Poisson regression model with robust adjustment of the standard error was used. The reliability assessment of KDQOL-SF™ 1.3 showed a Cronbach's alpha test greater than 0.8 in all areas. The areas with the worst levels of QOL were "work situation", "burden of kidney disease", "patient satisfaction", "physical function" and "general health". Having less than 8 years of schooling, coming from the countryside and having cardiovascular disease were associated to the areas with the worst levels of QOL. KDQOL-SF™ 1.3 is a reliable instrument to measure quality of life of hemodialysis patients. Demographic and clinical conditions can negatively influence QOL in chronic renal failure patients.

Music for Hemodialysis patients

DEFF Research Database (Denmark)

Gross, B; Ketema Wassie, F; Agnholt, Hanne

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...

Headache associated with hemodialysis

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Nikić Petar M.

2008-01-01

, 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.

Home hemodialysis

DEFF Research Database (Denmark)

Agar, John W; Perkins, Anthony; Heaf, James G

2015-01-01

We describe the infrastructure that is necessary for hemodialysis in the home focusing on physical requirements, the organization of plumbing and water, and the key features that should guide the selection of machines that are suitable for home use.......We describe the infrastructure that is necessary for hemodialysis in the home focusing on physical requirements, the organization of plumbing and water, and the key features that should guide the selection of machines that are suitable for home use....

Dental Health of Patients Undergoing Hemodialysis (A Study

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Vinay Mohan

2011-01-01

Full Text Available The primary purpose of this study was to determine the oral manifestations of patients undergoing dialysis. Two subgroups of the population were studied: (1 Those who have been on dialysis for less than one year, (2 those who have been on dialysis for more than one year. Two dental indices–periodontal index and decayed, missing, filled index were used to identify periodontal status, dental canes activity. Data were compiled and analyzed by using the unpaired t-test. Results suggested that 100% (n = 26 of the patients undergoing dialysis presented with some form of periodontal disease (mean value = 2.24, standard deviation = 1.33. Majority of the patients displayed either established periodontal disease (57.6% or the beginning of periodontal disease (38 4%. Approximately, 70% of the patients had high decayed, missing, filled index (mean value = 6.19, standard deviation = 6.40. Findings led to the conclusion that patients on dialysis need comprehensive professional oral care and self-care instructions. The source of infection in oral cavity can cause variety of systemic diseases, causing morbidity and mortality in these immune-suppressed patients.

Incremental short daily home hemodialysis: a case series.

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Toth-Manikowski, Stephanie M; Mullangi, Surekha; Hwang, Seungyoung; Shafi, Tariq

2017-07-05

Patients starting dialysis often have substantial residual kidney function. Incremental hemodialysis provides a hemodialysis prescription that supplements patients' residual kidney function while maintaining total (residual + dialysis) urea clearance (standard Kt/Vurea) targets. We describe our experience with incremental hemodialysis in patients using NxStage System One for home hemodialysis. From 2011 to 2015, we initiated 5 incident hemodialysis patients on an incremental home hemodialysis regimen. The biochemical parameters of all patients remained stable on the incremental hemodialysis regimen and they consistently achieved standard Kt/Vurea targets. Of the two patients with follow-up >6 months, residual kidney function was preserved for ≥2 years. Importantly, the patients were able to transition to home hemodialysis without automatically requiring 5 sessions per week at the outset and gradually increased the number of treatments and/or dialysate volume as the residual kidney function declined. An incremental home hemodialysis regimen can be safely prescribed and may improve acceptability of home hemodialysis. Reducing hemodialysis frequency by even one treatment per week can reduce the number of fistula or graft cannulations or catheter connections by >100 per year, an important consideration for patient well-being, access longevity, and access-related infections. The incremental hemodialysis approach, supported by national guidelines, can be considered for all home hemodialysis patients with residual kidney function.

Challenges of hemodialysis in Vietnam: experience from the first standardized district dialysis unit in Ho Chi Minh City

OpenAIRE

Duong, Cuong Minh; Olszyna, Dariusz Piotr; Nguyen, Phong Duy; McLaws, Mary-Louise

2015-01-01

Background Hemodialysis is an increasingly common treatment in Vietnam as the diagnosis of end stage renal disease continues to rise. To provide appropriate hemodialysis treatment for end-stage renal disease patients, we conducted a 1-year cross-sectional study to measure the prevalence of bloodborne infection and factors associated with non-compliant behaviors in hemodialysis patients. Methods One hundred forty-two patients were tested for hepatitis B virus (HBV) surface antigen and hepatiti...

Nutrition and hydration status improve with exercise training using stationary cycling during hemodialysis (HD) in patients with end-stage renal disease (ESRD).

Science.gov (United States)

Załuska, Alicja; Załuska, Wojciech T; Bednarek-Skublewska, Anna; Ksiazek, Andrzej

2002-01-01

Patients with end-stage renal disease (ESRD) undergoing hemodialysis and peritoneal dialysis are functionally limited as a consequence of their physical, emotional, and social problems. Exercise intolerance is a major problem in chronic renal failure. Stationary cycle training during hemodialysis is recommended as safe, effective, and practical in ESRD patients treated on hemodialysis. The aim of the present study was to evaluate the effect of cycling exercises in 10 HD patients during 6-month period (including each of dialysis sessions) on nutrition, dialysis adequacy, and fluid parameters as measured by biochemical, and bioimpedance parameters. A significant increase in serum albumin concentration, Kt/V, and nPCR, and decrease in serum CRP have been observed after 6 months of regular stationary cycling during hemodialysis. Relative changes (pre-post HD) in extracellular water compartment and ECW/TBW ratio have significantly increased after 6 months of observation period.

Angiotensin Converting-Enzyme Inhibitors, Angiotensin Receptor Blockers, and Calcium Channel Blockers Are Associated with Prolonged Vascular Access Patency in Uremic Patients Undergoing Hemodialysis.

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Fu-An Chen

Full Text Available Vascular access failure is a huge burden for patients undergoing hemodialysis. Many efforts have been made to maintain vascular access patency, including pharmacotherapy. Angiotensin converting enzyme inhibitor (ACE-I, angiotensin receptor blocker (ARB, and calcium channel blocker (CCB are known for their antihypertensive and cardio-protective effects, however, their effects on long-term vascular access patency are still inconclusive.We retrospectively enrolled patients commencing maintenance hemodialysis between January 1, 2000, and December 31, 2006 by using National Health Insurance Research Database in Taiwan. Primary patency was defined as the date of first arteriovenous fistula (AVF or arteriovenous graft (AVG creation to the time of access thrombosis or any intervention aimed to maintain or re-establish vascular access patency. Cox proportional hazards models were used to adjust the influences of patient characteristics, co-morbidities and medications.Total 42244 patients were enrolled in this study, 37771 (89.4% used AVF, 4473 (10.6% used AVG as their first long term dialysis access. ACE-I, ARB, and CCB use were all associated with prolonged primary patency of AVF [hazard ratio (HR 0.586, 95% confidence interval (CI 0.557-0.616 for ACE-I use; HR 0.532, CI 0.508-0.556 for ARB use; HR 0.485, CI 0.470-0.501 for CCB use] and AVG (HR 0.557, CI 0.482-0.643 for ACE-I use, HR 0.536, CI 0.467-0.614 for ARB use, HR 0.482, CI 0.442-0.526 for CCB use.In our analysis, ACE-I, ARB, and CCB were strongly associated with prolonged primary patency of both AVF and AVG. Further prospective randomized studies are still warranted to prove the causality.

Hemodialysis: stressors and coping strategies.

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Ahmad, Muayyad M; Al Nazly, Eman K

2015-01-01

End-stage renal disease (ESRD) is an irreversible and life-threatening condition. In Jordan, the number of ESRD patients treated with hemodialysis is on the rise. Identifying stressors and coping strategies used by patients with ESRD may help nurses and health care providers to gain a clearer understanding of the condition of these patients and thus institute effective care planning. The purpose of this study was to identify stressors perceived by Jordanian patients on hemodialysis, and the coping strategies used by them. A convenience sample of 131 Jordanian men and women was recruited from outpatients' dialysis units in four hospitals. Stressors perceived by participants on hemodialysis and the coping strategies were measured using Hemodialysis Stressor Scale, and Ways of Coping Scale-Revised. Findings showed that patients on hemodialysis psychosocial stressors scores mean was higher than the physiological stressors mean. Positive reappraisal coping strategy had the highest mean among the coping strategies and the lowest mean was accepting responsibility. Attention should be focused towards the psychosocial stressors of patients on hemodialysis and also helping patients utilize the coping strategies that help to alleviate the stressors. The most used coping strategy was positive reappraisal strategy which includes faith and prayer.

Characterizing the continuously acquired cardiovascular time series during hemodialysis, using median hybrid filter preprocessing noise reduction

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Wilson S

2015-01-01

Full Text Available Scott Wilson,1,2 Andrea Bowyer,3 Stephen B Harrap4 1Department of Renal Medicine, The Alfred Hospital, 2Baker IDI, Melbourne, 3Department of Anaesthesia, Royal Melbourne Hospital, 4University of Melbourne, Parkville, VIC, Australia Abstract: The clinical characterization of cardiovascular dynamics during hemodialysis (HD has important pathophysiological implications in terms of diagnostic, cardiovascular risk assessment, and treatment efficacy perspectives. Currently the diagnosis of significant intradialytic systolic blood pressure (SBP changes among HD patients is imprecise and opportunistic, reliant upon the presence of hypotensive symptoms in conjunction with coincident but isolated noninvasive brachial cuff blood pressure (NIBP readings. Considering hemodynamic variables as a time series makes a continuous recording approach more desirable than intermittent measures; however, in the clinical environment, the data signal is susceptible to corruption due to both impulsive and Gaussian-type noise. Signal preprocessing is an attractive solution to this problem. Prospectively collected continuous noninvasive SBP data over the short-break intradialytic period in ten patients was preprocessed using a novel median hybrid filter (MHF algorithm and compared with 50 time-coincident pairs of intradialytic NIBP measures from routine HD practice. The median hybrid preprocessing technique for continuously acquired cardiovascular data yielded a dynamic regression without significant noise and artifact, suitable for high-level profiling of time-dependent SBP behavior. Signal accuracy is highly comparable with standard NIBP measurement, with the added clinical benefit of dynamic real-time hemodynamic information. Keywords: continuous monitoring, blood pressure

Role of resilience and social support in alleviating depression in patients receiving maintenance hemodialysis

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Liu YM

2018-03-01

Full Text Available Yueh-Min Liu,1 Hong-Jer Chang,2 Ru-Hwa Wang,3 Li-King Yang,4 Kuo-Cheng Lu,4 Yi-Chou Hou4 1Department of Nursing, Ching Kuo Institute of Management and Health, Taiwan; 2Graduate Institute of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan; 3Department of Nursing, Fu-Jen Catholic University, New Taipei City, Taiwan; 4Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan Background: Patients who undergo hemodialysis encounter challenges including role changes, physical degeneration, and difficulty in performing activities of daily living (ADLs and self-care. These challenges deteriorate their physiological and psychosocial conditions, resulting in depression. High resilience (RES and social support can alleviate stress and depression. This study evaluated the importance of RES and social support in managing depression in elderly patients undergoing maintenance hemodialysis (HD. Patients and methods: In this descriptive, correlational study, 194 older patients undergoing HD were enrolled from the HD centers of three hospitals in northern Taiwan. The Barthel ADL Index, RES scale, Inventory of Socially Supportive Behavior, and Beck Depression Inventory-II were used. Hierarchical regression analysis was applied to evaluate the interaction of RES and social support with illness severity, demographics, and ADLs. Results: Of the total participants, 45.9% experienced depressive symptoms. Demographic analysis showed that men and those with high educational level and income and financial independence had less depression (p<0.01. Patients with a higher Barthel Index (n=103, RES scale (n=33, and social support (n=113 showed less depressive symptoms (p<0.01. We found a significant negative correlation between depressive symptoms and social support (r=-0.506, p<0.01 and RES (r=-0.743, p<0.01. Hierarchical regression analysis showed

Vapocoolant Spray vs Lidocaine/Prilocaine Cream for Reducing the Pain of Venipuncture in Hemodialysis Patients: A Randomized, Placebo-Controlled, Crossover Study

OpenAIRE

?elik, G?lperi; ?zbek, Orhan; Y?lmaz, M?mtaz; Duman, Ipek; ?zbek, Seda; Apiliogullari, Seza

2011-01-01

Objective: Patients undergoing hemodialysis are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula. This study was designed to measure pain associated with venepuncture during AVF cannulation and to compare the effectiveness of ethyl chloride vapocoolant spray, topical eutectic mixture of local anesthetics (EMLA) cream and placebo in controlling pain caused by venepuncture of arteriovenous fistula patients undergoing chronic hemodial...

Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients.

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Sohn, Bo Kyung; Oh, Yun Kyu; Choi, Jung-Seok; Song, Jiyoun; Lim, Ahyoung; Lee, Jung Pyo; An, Jung Nam; Choi, Hee-Jeong; Hwang, Jae Yeon; Jung, Hee-Yeon; Lee, Jun-Young; Lim, Chun Soo

2018-03-01

Many patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) experience depression. Depression influences patient quality of life (QOL), dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT) program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers. We conducted group CBT over a 12-week period with seven ESRD patients undergoing HD and suffering from depression. QOL, mood, anxiety, and perceived stress were measured at baseline and at weeks 8 and 12 using the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF), the Beck Depression Inventory II (BDI-II), the Hamilton Rating Scale for Depression (HAM-D), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). Biochemical markers were measured at baseline and after 12 weeks. The Temperament and Character Inventory was performed to assess patient characteristics before starting group CBT. The seven patients showed significant improvement in QOL, mood, anxiety, and perceived stress after 12 weeks of group CBT. WHOQOL-BREF and the self-rating scales, BDI-II and BAI, showed continuous improvement across the 12-week period. HAM-D scores showed significant improvement by week 8; PSS showed significant improvement after week 8. Serum creatinine levels also improved significantly following the 12 week period. In this pilot study, a CBT program which included mindfulness meditation enhanced overall mental health and biochemical marker levels in ESRD patients undergoing HD.

Modulation of Myostatin/Hepatocyte Growth Factor Balance by Different Hemodialysis Modalities

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Pasquale Esposito

2017-01-01

Full Text Available Background. In this study we investigated the relevance of myostatin and Hepatocyte Growth Factor (HGF in patients undergoing hemodialysis HD and the influence of different HD modalities on their levels. Methods. We performed a prospective crossover study in which HD patients were randomized to undergo 3-month treatment periods with bicarbonate hemodialysis (BHD followed by online hemodiafiltration (HDF. Clinical data, laboratory parameters, and myostatin and HGF serum levels were collected and compared. Results. Ten patients and six controls (C were evaluated. In any experimental condition myostatin and HGF levels were higher in HD than in C. At enrollment and after BHD there were not significant correlations, whereas at the end of the HDF treatment period myostatin and HGF were inversely correlated (r  -0.65, p<0.05, myostatin serum levels inversely correlated with transferrin (r  -0.73, p<0.05, and HGF levels that resulted positively correlated with BMI (r 0.67, p<0.05. Moving from BHD to HDF, clinical and laboratory parameters were unchanged, as well as serum HGF, whereas myostatin levels significantly decreased (6.3 ± 4.1 versus 4.3 ± 3.1 ng/ml, p<0.05. Conclusions. Modulation of myostatin levels and myostatin/HGF balance by the use of different HD modalities might represent a novel approach to the prevention and treatment of HD-related muscle wasting syndrome.

Changes in Plasma Copeptin Levels during Hemodialysis: Are the Physiological Stimuli Active in Hemodialysis Patients?

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Esmée M Ettema

Full Text Available Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP, are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli for copeptin release, i.e. plasma osmolality, blood volume and mean arterial pressure (MAP, are operational in hemodialysis patients.One hundred and eight prevalent, stable hemodialysis patients on a thrice-weekly dialysis schedule were studied during hemodialysis with constant ultrafiltration rate and dialysate conductivity in this observational study. Plasma levels of copeptin, sodium, MAP, and blood volume were measured before, during and after hemodialysis. Multivariate analysis was used to determine the association between copeptin (dependent variable and the physiological stimuli plasma sodium, MAP, excess weight as well as NT-pro-BNP immediately prior to dialysis and between copeptin and changes of plasma sodium, MAP and blood volume with correction for age, sex and diabetes during dialysis treatment.Patients were 63 ± 15.6 years old and 65% were male. Median dialysis vintage was 1.6 years (IQR 0.7-4.0. Twenty-three percent of the patients had diabetes and 82% had hypertension. Median predialysis copeptin levels were 141.5 pmol/L (IQR 91.0-244.8 pmol/L. Neither predialysis plasma sodium levels, nor NT-proBNP levels, nor MAP were associated with predialysis copeptin levels. During hemodialysis, copeptin levels rose significantly (p<0.01 to 163.0 pmol/L (96.0-296.0 pmol/L. Decreases in blood volume and MAP were associated with increases in copeptin levels during dialysis, whereas there was no significant association between the change in plasma sodium levels and the change in copeptin levels.Plasma copeptin levels are elevated predialysis and increase further during hemodialysis. Volume stimuli, i.e. decreases in MAP and blood volume, rather than osmotic

Best possible medication history for hemodialysis patients obtained by a pharmacy technician.

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Leung, Marianna; Jung, Joanne; Lau, Wynnie; Kiaii, Mercedeh; Jung, Beverly

2009-09-01

Outpatients undergoing hemodialysis are at high risk for adverse drug events. Limited resources make it challenging for pharmacists to routinely obtain a best possible medication history (BPMH). The primary objective was to determine whether, for patients undergoing hemodialysis, a pharmacy technician has the skills to obtain a BPMH that would allow a pharmacist to identify drug-related problems. The secondary objectives were to determine the number and types of medication discrepancies and drug-related problems identified and the time required by the technician to complete the BPMH. All patients treated in the hemodialysis unit during the study period were included, except for those who required an interpreter or were unable to participate in an in-person interview. A single technician was taught how to interview patients according to a structured format. For each patient, the technician's BMPH was verified by a pharmacist. The agreement rate between technician and pharmacists was determined, along with the number and types of discrepancies and drug-related problems identified. The technician interviewed 99 patients. Of the 1334 medication orders reviewed, the technician and pharmacists agreed on all but 15 (agreement rate 98.9%). A total of 358 medication discrepancies were noted for 93 patients (3.8 discrepancies per patient). Of these, 210 (59%) were undocumented intentional discrepancies, and 148 (41%) were unintentional discrepancies (most commonly errors of commission). Of the 135 drug-related problems identified, the majority involved dosing problems or nonadherence. The technician required an average of 17 min for each interview. An adequately trained technician was capable of interviewing patients to create a BPMH. A variety of medication discrepancies and drug-related problems were identified. Generation of a BPMH by a technician is a useful approach allowing pharmacists to identify drug-related problems.

[Atypical retinitis pigmentosa in Laurence-Moon-Biedl-Bardet syndrome. Report of a case of chronic renal insufficiency under periodic hemodialysis treatment].

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Bianco, G; Carlesimo, S C; Mazzarrino, R; Palestini, M

1993-03-01

A case of Laurence-Moon-Biedl-Bardet syndrome in a patient undergoing hemodialysis is reported. The principal characteristics of this congenital syndrome are described. A possible pathogenetic mechanism of the atypical form of retinitis pigmentosa (sine pigmento) is discussed.

Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients.

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Weinhandl, Eric D; Nieman, Kimberly M; Gilbertson, David T; Collins, Allan J

2015-01-01

Cardiovascular disease is a common cause of hospitalization in dialysis patients. Daily hemodialysis improves some parameters of cardiovascular function, but whether it associates with lower hospitalization risk is unclear. Observational cohort study using US Renal Data System data. Medicare-enrolled daily (5 or 6 sessions weekly) home hemodialysis (HHD) patients initiating NxStage System One use from January 1, 2006, through December 31, 2009, and contemporary thrice-weekly in-center hemodialysis patients, matched 5 to 1. Daily HHD or thrice-weekly in-center hemodialysis. All-cause and cause-specific hospital admissions, hospital readmissions, and hospital days assessed from Medicare Part A claims. For 3,480 daily HHD and 17,400 thrice-weekly in-center hemodialysis patients in intention-to-treat analysis, the HR of all-cause admission for daily HHD versus in-center hemodialysis was 1.01 (95%CI, 0.98-1.03). Cause-specific admission HRs were 0.89 (95%CI, 0.86-0.93) for cardiovascular disease, 1.18 (95%CI, 1.13-1.23) for infection, 1.01 (95%CI, 0.93-1.09) for vascular access dysfunction, and 1.02 (95%CI, 0.99-1.06) for other morbidity. Regarding cardiovascular disease, first admission and readmission HRs for daily HHD versus in-center hemodialysis were 0.91 and 0.87, respectively. Regarding infection, first admission and readmission HRs were 1.35 and 1.03, respectively. Protective associations of daily HHD with heart failure and hypertensive disease were most pronounced, as were adverse associations of daily HHD with bacteremia/sepsis, cardiac infection, osteomyelitis, and vascular access infection. Results may be confounded by unmeasured factors, including vascular access type; information about dialysis frequency, duration, and dose was lacking; causes of admission may be misclassified; results may not apply to patients without Medicare coverage. All-cause hospitalization risk was similar in daily HHD and thrice-weekly in-center hemodialysis patients. However

Dialyzability of gadodiamide in hemodialysis patients

International Nuclear Information System (INIS)

Saitoh, Tomoya; Tanaka, Yoshiaki; Kuno, Tsutomu; Nagura, Yuji; Hayasaka, Kazumasa

2006-01-01

The aim of this study was to evaluate the contrast enhancement, pharmacokinetics, dialyzability, and safety of gadodiamide in patients on hemodialysis. Thirteen hemodialysis patients with abdominal disease were examined after receiving intravenous gadodiamide (0.1 mmol/kg body weight) by magnetic resonance imaging (MRI) and were dialyzed at 1, 3, 5, and 8 days. Blood samples were obtained immediately before, during, and at the end of the first hemodialysis session and immediately before and at the end of the next three sessions. The complete blood count, blood biochemistry, β 2 -microglobulin, and gadolinium were measured. Dialysis of urea, creatinine, and gadolinium during the first hemodialysis session was assessed. Precontrast and postcontrast MRI and Gd-enhanced MR angiography (MRA) images were reviewed and visually evaluated by two radiologists; their evaluation was based on consensus. Gadodiamide did not cause any changes in renal function. An average of 73.8%, 92.4%, and 98.9% of the gadodiamide dose was eliminated by the end of the first, second, and third hemodialysis sessions, respectively. The average half-time of gadodiamide was 1.93 h (SD 0.55). The mean clearance of gadodiamide during hemodialysis was 63.5 ml/min (SD 21.9). There were no side effects related to the injection of gadodiamide. In all cases, diagnosable MRI and MRA images were obtained after gadodiamide injection in the hemodialysis patients. In hemodialysis patients, gadodiamide achieves diagnosable images. It is dialyzable and can be used safely without measures to increase excretion. (author)

Validity and reliability of short form-12 questionnaire in Iranian hemodialysis patients

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Pakpour, Amir H.; Nourozi, Saeedeh; Mølsted, Stig

2011-01-01

INTRODUCTION: The aim of the study was to assess the validity and reliability of the SF-12 questionnaire in a sample of Iranian patients undergoing hemodialysis. MATERIALS AND METHODS: One hundred and forty-four hemodialysis patients were included from dialysis centers in Zanjan, Iran, and were...... asked to complete the SF-12 and SF-36 questionnaires. An initial test-retest reliability evaluation was performed on a sample of 70 patients from the total group, with a retest interval of 14 days. Reliability was estimated by internal consistency and validity was assessed using known-group comparisons...... and construct validity on the patient group as a whole. A linear regression analysis was used to assess any variation in the physical component summary and mental component summary scores of the SF-36 with the respective component summary scores of the SF-12. In addition, the factor structure...

Incremental short daily home hemodialysis: a case series

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Toth-Manikowski, Stephanie M.; Mullangi, Surekha; Hwang, Seungyoung; Shafi, Tariq

2017-01-01

Background Patients starting dialysis often have substantial residual kidney function. Incremental hemodialysis provides a hemodialysis prescription that supplements patients? residual kidney function while maintaining total (residual + dialysis) urea clearance (standard Kt/Vurea) targets. We describe our experience with incremental hemodialysis in patients using NxStage System One for home hemodialysis. Case presentation From 2011 to 2015, we initiated 5 incident hemodialysis patients on an ...

Idiopathic erythrocytosis in a patient on chronic hemodialysis

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Dong Hyun Lee

2015-03-01

Full Text Available A 78-year-old man on hemodialysis presented to our hospital with erythrocytosis. He had started hemodialysis 4 years previously, with a hemoglobin level of 9.8 g/dL, and was administered erythropoiesis stimulating agents and ferrous sulfate. Two years previously, his hemoglobin level increased to 14.5 g/dL and the treatment for anemia was discontinued. He continued hemodialysis thrice weekly; however, the hemoglobin level had increased to 17.0 g/dL at the time of presenting to our hospital. His serum erythropoietin level was 31.4 mIU/mL (range, 3.7–31.5 mIU/mL, carboxyhemoglobin level was 0.6% (range, 0–1.5%, and oxygen saturation in ambient air was 95.4%. The JAK2 V617F mutation was not observed and other bone marrow abnormalities were not identified. The patient was diagnosed with bladder cancer and a transurethral resection was performed. Eight months after the treatment of bladder cancer, his hemoglobin level was 15.1 g/dL, and he was diagnosed with idiopathic erythrocytosis.

Infliximab treatment in a patient with rheumatoid arthritis on hemodialysis.

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Singh, Ranju; Cuchacovich, Raquel; Huang, Wenqun; Espinoza, Luis R

2002-03-01

We describe a 60-year-old woman with active rheumatoid arthritis (RA) and endstage renal disease secondary to hypertensive nephrosclerosis undergoing hemodialysis. She had tried multiple antirheumatic medications; however, their usefulness was limited due to toxic side effects or lack of efficacy. She was then treated with chimeric antitumor necrosis factor monoclonal antibody (infliximab), which resulted in immediate improvement in clinical and laboratory measures. After about 2 years of therapy, no side effects have been observed. This report expands the spectrum of infliximab to include RA patients with renal insufficiency.

Stent tunnel technique to save thrombosed native hemodialysis fistula with extensive venous aneurysm

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Rabellino M

2017-07-01

Full Text Available Martin Rabellino,1 Guillermo J Rosa-Diez,2 Sergio A Shinzato,1 Pablo Rodriguez,1 Oscar A Peralta,1 Maria S Crucelegui,2 Rosario Luxardo,2 Agustina Heredia-Martinez,2 Mariela I Bedini-Rocca,2 Ricardo D García-Mónaco1 1Department of Angiography and Endovascular Therapy, 2Department of Nephrology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Introduction and purpose: The increasing number of patients undergoing hemodialysis and the limited number of access sites have resulted in an increasing number of techniques to maintain vascular access for hemodialysis. Thrombosed arteriovenous (AV fistulas with large venous aneurysms have poor treatment results, with both endovascular and surgical techniques, leading to a high rate of definitive AV access loss. The purpose of this study was to review the feasibility and initial results of this novel endovascular treatment of thrombosed AV fistulas with large venous aneurysms.Materials and methods: A novel endovascular treatment technique of inserting nitinol auto-expandable uncovered stents stretching through the whole puncture site area, thus creating a tunnel inside the thrombus, was retrospectively analyzed and described.Results: A total of 17 stents were placed in 10 hemodialysis fistulas, with a mean venous coverage length of 17.8 cm. In all the cases, 100% technical success was achieved, with complete restoration of blood flow in all patients. There were no procedure-related complications. The mean follow-up was 167 days (range 60–420 days, with a primary and assisted patency of 80% and 100%, respectively. No multiple trans-stent struts-related complications were observed. Three stent fractures were diagnosed with plain films at the site of puncture without consequence in the venous access permeability.Conclusion: The “stent tunnel technique” is a feasible, safe and effective alternative to salvage native hemodialysis access, thus extending the function of the venous access with

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

International Nuclear Information System (INIS)

Hokama, Sanehiro; Oda, Masami; Kadekawa, Katsumi

2007-01-01

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)

Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients

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Maria Isabel da Conceição Dias Fernandes

2015-12-01

Full Text Available Objective: to evaluate the accuracy of the defining characteristics of the excess fluid volume nursing diagnosis of NANDA International, in patients undergoing hemodialysis. Method: this was a study of diagnostic accuracy, with a cross-sectional design, performed in two stages. The first, involving 100 patients from a dialysis clinic and a university hospital in northeastern Brazil, investigated the presence and absence of the defining characteristics of excess fluid volume. In the second step, these characteristics were evaluated by diagnostic nurses, who judged the presence or absence of the diagnosis. To analyze the measures of accuracy, sensitivity, specificity, and positive and negative predictive values were calculated. Approval was given by the Research Ethics Committee under authorization No. 148.428. Results: the most sensitive indicator was edema and most specific were pulmonary congestion, adventitious breath sounds and restlessness. Conclusion: the more accurate defining characteristics, considered valid for the diagnostic inference of excess fluid volume in patients undergoing hemodialysis were edema, pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the presence of these, the nurse may safely assume the presence of the diagnosis studied.

Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis.

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Hall, Rasheeda K; Myers, Evan R; Rosas, Sylvia E; O'Hare, Ann M; Colón-Emeric, Cathleen S

2017-06-07

Although arteriovenous fistulas have been found to be the most cost-effective form of hemodialysis access, the relative benefits of placing an arteriovenous fistula versus an arteriovenous graft seem to be least certain for older adults and when placed preemptively. However, older adults' life expectancy is heterogeneous, and most patients do not undergo permanent access creation until after dialysis initiation. We evaluated cost-effectiveness of arteriovenous fistula placement after dialysis initiation in older adults as a function of age and life expectancy. Using a hypothetical cohort of patients on incident hemodialysis with central venous catheters, we constructed Markov models of three treatment options: ( 1 ) arteriovenous fistula placement, ( 2 ) arteriovenous graft placement, or ( 3 ) continued catheter use. Costs, utilities, and transitional probabilities were derived from existing literature. Probabilistic sensitivity analyses were performed by age group (65-69, 70-74, 75-79, 80-84, and 85-89 years old) and quartile of life expectancy. Costs, quality-adjusted life-months, and incremental cost-effectiveness ratios were evaluated for up to 5 years. The arteriovenous fistula option was cost effective compared with continued catheter use for all age and life expectancy groups, except for 85-89 year olds in the lowest life expectancy quartile. The arteriovenous fistula option was more cost effective than the arteriovenous graft option for all quartiles of life expectancy among the 65- to 69-year-old age group. For older age groups, differences in cost-effectiveness between the strategies were attenuated, and the arteriovenous fistula option tended to only be cost effective in patients with life expectancy >2 years. For groups for which the arteriovenous fistula option was not cost saving, the cost to gain one quality-adjusted life-month ranged from $2294 to $14,042. Among older adults, the cost-effectiveness of an arteriovenous fistula placed within the first

Hemodialysis Self-management Intervention Randomized Trial (HED-SMART): A Practical Low-Intensity Intervention to Improve Adherence and Clinical Markers in Patients Receiving Hemodialysis.

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Griva, Konstadina; Nandakumar, Mooppil; Ng, Jo-An H; Lam, Kevin F Y; McBain, Hayley; Newman, Stanton P

2018-03-01

Poor adherence to treatment is common in hemodialysis patients. However, effective interventions for adherence in this population are lacking. Small studies of behavioral interventions have yielded improvements, but clinical effectiveness and long-term effects are unclear. Multicenter parallel (1:1) design, blinded cluster-randomized controlled trial. Patients undergoing maintenance hemodialysis enrolled in 14 dialysis centers. Dialysis shifts of eligible patients were randomly assigned to either an interactive and targeted self-management training program (HED-SMART; intervention; n=134) or usual care (control; n=101). HED-SMART, developed using the principles of problem solving and social learning theory, was delivered in a group format by health care professionals over 4 sessions. Serum potassium and phosphate concentrations, interdialytic weight gains (IDWGs), self-reported adherence, and self-management skills at 1 week, 3 months, and 9 months postintervention. 235 participants were enrolled in the study (response rate, 44.2%), and 82.1% completed the protocol. IDWG was significantly lowered across all 3 assessments relative to baseline (Pmanagement skills, and self-efficacy at all time points. Low proportion of patients with diabetes. HED-SMART provides an effective and practical model for improving health in hemodialysis patients. The observed improvements in clinical markers and self-report adherence, if maintained at the longer follow-up, could significantly reduce end-stage renal disease-related complications. Given the feasibility of this kind of program, it has strong potential for supplementing usual care. Registered at ISRCTN with study number ISRCTN31434033. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Using controlled attenuation parameter combined with ultrasound to survey non-alcoholic fatty liver disease in hemodialysis patients: A prospective cohort study.

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Yi-Hao Yen

Full Text Available Controlled attenuation parameter (CAP is a non-invasive method for measuring hepatic steatosis (HS. Non-alcoholic fatty liver disease (NAFLD is closely related to cardiovascular diseases (CVDs. CVDs are the leading cause of morbidity and mortality in hemodialysis patients. The aim of this study was to investigate the prevalence of NAFLD in hemodialysis patients.We prospectively enrolled patients undergoing chronic hemodialysis, as well as patients with normal renal function who served as controls. The control group patients were referred by an endocrinologist to be tested for NAFLD; most of these patients had diabetes, hypertension, or dyslipidemia. We excluded those with excess alcohol intake, use of drugs known to induce HS, chronic viral hepatitis, or CAP failure. CAP ≥ 238 dB/m was used as a cutoff suggesting HS. An increased liver kidney contrast, as defined by ultrasound, was used to make the diagnosis of HS.Three hundred and forty-three hemodialysis patients and 252 control group patients were enrolled. Among the hemodialysis patients, 192 (56.0% had CAP- or ultrasound-identified HS compared with 91 (26.5% who only had ultrasound-identified HS (P<0.001. Among the control group patients, 212 (84.1% had CAP- or ultrasound-identified HS compared with 180 (71.4% who only had ultrasound-identified HS (P<0.001.The prevalence of NAFLD in the hemodialysis patients was 56%. The number of diagnoses of NAFLD made by using CAP combined with ultrasound was more than 2 times the number made with ultrasound alone in the hemodialysis patients. Therefore, we suggest the use of CAP combined with ultrasound to screen for NAFLD in hemodialysis patients.

Hemodialysis Catheters: How to Keep Yours Working Well

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... for specific treatment recommendations. Print Email Read related articles Home Hemodialysis Nocturnal Hemodialysis What Is Dry Weight Nutrition and Hemodialysis The Buttonhole Technique The National Kidney ...

Left ventricular diastolic dysfunction in chronic renal failure patients on chronic hemodialysis in Dr. Cipto-Mangunkusumo Hospital : the association with left ventricular mass

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Idrus Alwi

2006-06-01

Full Text Available Fourty three patients with chronic renal failure undergoing chronic hemodialysis in Division of Nephrology and Hypertension, Faculty of Medicine, University of Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, since October 2003 until February 2004, were examined for echocardiography (2-D, M-mode, Doppler imaging.Diastolic dysfunction was found in 58.1 % of chronic renal failure patients on hemodialysis. There was no significant difference between left ventricular mass in the group with or without left ventricular diastolic dysfunction. (Med J Indones 2006; 15:105-8Keywords: Left ventricular mass, diastolic function, chronic renal failure, hemodyalisis

Radiology of the kidneys in patients under maintenance hemodialysis

International Nuclear Information System (INIS)

Bahner, M.L.; Kaick, G. van; Bommer, J.; Sommerer, C.

1999-01-01

The kidneys of patients with chronic renal failure undergoing maintenance hemodialysis may show different variances or complications. Most common are secondarily acquired renal cysts, which my be found in as many as 92% of patients after 8 years of hemodialysis. Single (in 12.5% of patients) or multiple (8.3%) cysts with bleeding are common; additionally, hematuria or ruptured cysts may be found. Bleeding into cysts is more common in patients with autosomal dominant polycystic kidney disease. Due to the decreasing urinary production development of kidney stones is very uncommon, but calcification in or around cysts can be found in 71% of patients. Kidney tumors occur 41 times more often in patients with chronic renal failure than in patients without kidney disease. We detected tumors in 4.2% of our patients on long-term dialysis. Diagnostic differentiation of the relatively slow growing and fairly late metastasizing malignant tumors from adenomas is not possible. Nevertheless, we screen our patients every 3-4 years. Computed tomography is superior to ultrasonography for this purpose, because ultrasonography lacks the necessary sensitivity in this group of patients. (orig.) [de

Radioablative therapy with Iodine-131 on a patient with thyroid cancer and chronic renal failure in hemodialysis first experience in Peru

International Nuclear Information System (INIS)

Apaza Veliz, D. G.; Herrera Vera, R. D.; Cardenas Abarca, C. A.; Oporto Gonzales, C. A.; Aguilar Ramírez, C.; Urquizo Baldomero, R. M.; Vega Ramírez, J. L.

2016-01-01

The Iodine-131 (I-131) is a radioisotope used as a standard treatment for radioablation of thyroid remnants. Among thyroid cancer patients, the ones undergoing hemodialysis represent a specific group. The dose of I-131 is given orally to these patients, part of it is absorbed by the thyroid remnants and the rest of it, largely not incorporated, is excreted primarily by renal excretion. The use of a high dose of radioactivity in the process, and the inability of excretion, represents a high risk of exposure to the patient, medical staff and hemodialysis equipment. This work describes the procedure applied on the radioablation therapy for thyroid cancer while receiving hemodialysis, minimizing the risks for the patient and the staff involved. This clinical procedure will establish the dosimetric measures, a plan on radiation protection and a treatment protocol for this specific type of patients.

Radioablative therapy with Iodine-131 on a patient with thyroid cancer and chronic renal failure in hemodialysis first experience in Peru

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Apaza Veliz, D. G., E-mail: dgav02@gmail.com [Hospital Nacional Carlos Alberto Seguin Escobedo, Servicio de Medicina Nuclear, Arequipa, Perú, Universidad Nacional de San Agustín de Arequipa, Escuela de Física, Arequipa (Peru); Herrera Vera, R. D.; Cardenas Abarca, C. A.; Oporto Gonzales, C. A.; Aguilar Ramírez, C.; Urquizo Baldomero, R. M. [Hospital Nacional Carlos Alberto Seguin Escobedo, Servicio de Medicina Nuclear, Arequipa (Peru); Vega Ramírez, J. L. [Universidad Nacional de San Agustín de Arequipa, Escuela de Física, Arequipa (Peru)

2016-07-07

The Iodine-131 (I-131) is a radioisotope used as a standard treatment for radioablation of thyroid remnants. Among thyroid cancer patients, the ones undergoing hemodialysis represent a specific group. The dose of I-131 is given orally to these patients, part of it is absorbed by the thyroid remnants and the rest of it, largely not incorporated, is excreted primarily by renal excretion. The use of a high dose of radioactivity in the process, and the inability of excretion, represents a high risk of exposure to the patient, medical staff and hemodialysis equipment. This work describes the procedure applied on the radioablation therapy for thyroid cancer while receiving hemodialysis, minimizing the risks for the patient and the staff involved. This clinical procedure will establish the dosimetric measures, a plan on radiation protection and a treatment protocol for this specific type of patients.

Radioablative therapy with Iodine-131 on a patient with thyroid cancer and chronic renal failure in hemodialysis first experience in Peru

Science.gov (United States)

Apaza Veliz, D. G.; Herrera Vera, R. D.; Cardenas Abarca, C. A.; Oporto Gonzales, C. A.; Aguilar Ramírez, C.; Vega Ramírez, J. L.; Urquizo Baldomero, R. M.

2016-07-01

The Iodine-131 (I-131) is a radioisotope used as a standard treatment for radioablation of thyroid remnants. Among thyroid cancer patients, the ones undergoing hemodialysis represent a specific group. The dose of I-131 is given orally to these patients, part of it is absorbed by the thyroid remnants and the rest of it, largely not incorporated, is excreted primarily by renal excretion. The use of a high dose of radioactivity in the process, and the inability of excretion, represents a high risk of exposure to the patient, medical staff and hemodialysis equipment. This work describes the procedure applied on the radioablation therapy for thyroid cancer while receiving hemodialysis, minimizing the risks for the patient and the staff involved. This clinical procedure will establish the dosimetric measures, a plan on radiation protection and a treatment protocol for this specific type of patients.

Refusal of hemodialysis by hospitalized chronic kidney disease patients in Pakistan.

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Shafi, Salman Tahir; Saleem, Mohammad; Anjum, Roshina; Abdullah, Wajid; Shafi, Tahir

2018-01-01

In Pakistan, patients with chronic kidney disease (CKD) are commonly diagnosed at a late stage. There is little information about the refusal of hemodialysis by hospitalized CKD patients who need hemodialysis (HD) and reasons for acceptance and refusal among these patients. All patients with Stage V CKD who had medical indications to undergo HD and were hospitalized at a tertiary care facility over a six-month period were invited to participate in this study. Patients were surveyed regarding acceptance or refusing of HD and reasons for their decisions. Demographic, socioeconomic, and clinical characteristics of patients were compared between patients who accepted or refused HD. A total of 125 patients were included in the study. The mean age of the patients was 47.9 ±12.1 years. The mean duration of diagnosis of CKD was 2.5 ± 0.6 months. Of all patients, 72 (57.6%) agreed to do HD and 53 (42.4%) refused HD. Patients with arteriovenous fistula in place (27.1 vs. 9.1%, P 0.02) and those in the middle- or higher-income group (64.4% vs. 38.6%, p = 0.03) were more willing to undergo HD. Trust in doctor's advice (86.1%) was the most common reason for acceptance of HD. Frequency of HD per week (52.8%), lifelong and permanent nature of HD (50.9%), advice by family members or friends (37.7%), perception of poor quality of life on HD (35.8%), and fear of HD needles and complications during HD (33.9%) were the most common reasons for refusal. Refusal of HD is common among hospitalized CKD patients with medical indications to undergo HD, especially in lower income group.

The relationship between spiritual well-being and stress coping strategies in hemodialysis patients

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Zahra Taheri-Kharameh

2016-12-01

Full Text Available Background and Objectives: Spiritual well-being has been recognized as an important resource to cope with illness and life stresses. The aim of this study is to determine the Spiritual well-being status as well as stress coping strategies in hemodialysis patients. Methods: This descriptive-analysis study included 95 randomly selected patients undergoing treatments with hemodialysis in hemodialysis centers of Qom hospitals. Data collection instruments were the Spiritual Well-Being Scale and Jalowiec Coping Scale Data were analyzed via SPSS 16 software, by using descriptive statistics, Pearson correlation coefficient and independent t-test. Results: The mean and standard deviation score of spiritual well-being of patients were 91.98±15.09 while the mean and standard deviation of existential and religious well-being were 50.76±8.06 and 41.22±8.91, respectively. 52.6% got scores higher than the average score in spiritual well-being. The most common coping strategies in patients were Evasive and Supportant copings. Spiritual well-being and problem-oriented coping strategies had a significant positive correlation (r = 0.41, p = 0.008. But there was no significant relationship between spiritual well-being and emotion-focused coping strategies. Conclusion: Results showed that hemodialysis patients mostly use emotion-oriented strategies when facing disease and treatment’s challenges. There was a positive relation between spiritual well-being and problem-oriented coping strategies; therefore, in order to increase levels of coping with the disease, the care plan should be written with an emphasis on patients' spiritual needs.

Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients

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Bo Kyung Sohn

2018-03-01

Full Text Available Background : Many patients with end-stage renal disease (ESRD undergoing hemodialysis (HD experience depression. Depression influences patient quality of life (QOL, dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers. Methods : We conducted group CBT over a 12-week period with seven ESRD patients undergoing HD and suffering from depression. QOL, mood, anxiety, and perceived stress were measured at baseline and at weeks 8 and 12 using the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF, the Beck Depression Inventory II (BDI-II, the Hamilton Rating Scale for Depression (HAM-D, the Beck Anxiety Inventory (BAI, and the Perceived Stress Scale (PSS. Biochemical markers were measured at baseline and after 12 weeks. The Temperament and Character Inventory was performed to assess patient characteristics before starting group CBT. Results : The seven patients showed significant improvement in QOL, mood, anxiety, and perceived stress after 12 weeks of group CBT. WHOQOL-BREF and the self-rating scales, BDI-II and BAI, showed continuous improvement across the 12-week period. HAM-D scores showed significant improvement by week 8; PSS showed significant improvement after week 8. Serum creatinine levels also improved significantly following the 12 week period. Conclusion : In this pilot study, a CBT program which included mindfulness meditation enhanced overall mental health and biochemical marker levels in ESRD patients undergoing HD.

Changes in Plasma Copeptin Levels during Hemodialysis : Are the Physiological Stimuli Active in Hemodialysis Patients?

NARCIS (Netherlands)

Ettema, Esmee M.; Kuipers, Johanna; Assa, Solmaz; Bakker, Stephan J. L.; Groen, Henk; Westerhuis, Ralf; Gaillard, Carlo A. J. M.; Gansevoort, Ron T.; Franssen, Casper F. M.

2015-01-01

Objectives Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP), are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli

Association between vascular calcification scores on plain radiographs and fatty acid contents of erythrocyte membrane in hemodialysis patients.

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Son, Young K; Lee, Su M; Kim, Seong E; Kim, Ki H; Lee, Seon Y; Bae, Hae R; Han, Jin Y; Park, Yongsoon; An, Won S

2012-01-01

Vascular calcification (VC) scores determined by using simple plain radiographic films are known to be associated with coronary artery disease and mortality in patients undergoing hemodialysis (HD). Omega-3 fatty acid (FA) has been shown to reduce ectopic calcifications in an animal model, and it has also been shown that erythrocyte membrane omega-3 FA content is an independent discriminator of coronary artery disease. The present study was designed to demonstrate relations between VC scores and erythrocyte membrane FA contents in patients undergoing HD. A cross-sectional study was carried out. The study was carried out at an outpatient hemodialysis unit at Dong-A University Hospital, Busan, Republic of Korea. A total of 31 patients undergoing HD were recruited. Patients with significant malnutrition, a short duration of dialysis (acid and docosahexaenoic acid were not found to be related with VC on simple plain radiographic films. However, erythrocyte membrane contents of oleic acid and total monounsaturated FA (MUFA) were significantly higher in patients with significant VC scores. Furthermore, erythrocyte membrane contents of MUFA and oleic acid were found to be negatively associated with high-density lipoprotein cholesterol level and positively associated with triglyceride level. Erythrocyte membrane contents of MUFA and oleic acid were found to be associated with VC scores determined using plain radiographs and with dyslipidemia in patients undergoing HD. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Resistance to erythropoiesis stimulating agents in patients treated with online hemodiafiltration and ultrapure low-flux hemodialysis: Results from a randomized controlled trial (CONTRAST)

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N.C. van der Weerd (Neelke); C.H. den Hoedt (Claire); P.J. Blankestijn (Peter); M.L. Bots (Michiel); M.A. van den Dorpel (Marinus); R. Lévesque (Renée); A.H.A. Mazairac (Albert); M.J. Nubé (Menso); E. Lars Penne; P.M. ter Wee (Piet); M.P.C. Grooteman (Muriel)

2014-01-01

textabstractResistance to erythropoiesis stimulating agents (ESA) is common in patients undergoing chronic hemodialysis (HD) treatment. ESA responsiveness might be improved by enhanced clearance of uremic toxins of middle molecular weight, as can be obtained by hemodiafiltration (HDF). In this

The effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among hemodialysis patients

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Nahid Shahgholian

2016-01-01

Full Text Available Background: Restless leg syndrome prevalence is high among the patients undergoing hemodialysis. Due to several side effects of medicational treatments, the patients prefer non-medicational methods. Therefore, the present study aimed to investigate the effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among patients undergoing hemodialysis. Materials and Methods: This study is a randomized clinical trial that was done on 90 qualified patients undergoing hemodialysis in selected hospitals of Isfahan, who were diagnosed with restless leg syndrome through standard restless leg syndrome questionnaire. They were randomly assigned by random number table to three groups: Reflexology, stretching exercises, and control groups through random allocation. Foot reflexology and stretching exercises were conducted three times a week for 30–40 min within straight 4 weeks. Data analysis was performed by SPSS version 18 using descriptive and inferential statistical analyses [one-way analysis of variance (ANOVA, paired t-test, and least significant difference (LSD post hoc test]. Results: There was a significant difference in the mean scores of restless leg syndrome severity between reflexology and stretching exercises groups, compared to control (P < 0.001, but there was no significant difference between the two study groups (P < 0.001. Changes in the mean score of restless leg syndrome severity were significantly higher in reflexology and stretching exercises groups compared to the control group (P < 0.001, but it showed no significant difference between reflexology massage and stretching exercises groups. Conclusions: Our obtained results showed that reflexology and stretching exercises can reduce the severity of restless leg syndrome. These two methods of treatment are recommended to the patients.

Restless legs syndrome in hemodialysis patients

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Shahram Rafie

2016-01-01

Full Text Available Restless legs syndrome (RLS is a neurological disorder characterized by uncomfortable sensation of paresthesia in legs that subsequently causes involuntary and continuous movement of the lower limbs, especially at rest. Its prevalence in hemodialysis is more than that in the general population. Different risk factors have been suggested for RLS. We studied the prevalence and risk factors of RLS in 137 hemodialysis patients followed up at our center. The patients completed at least three months on dialysis and fulfilled four criteria for the diagnosis of RLS. We compared the patients with and without RLS, and the odds ratios (ORs were estimated by the logistic regression models. The prevalence of RLS was 36.5% in the study patients. Among the variables, diabetes was the only predicting factor for the development of RLS. The diabetic patients may be afflicted with RLS 2.25 times more than the non-diabetics. Women developed severe RLS 5.23 times more than men. Neurodegeneration, decrease in dopamine level, higher total oxidant status, and neuropathy in diabetic patients may explain the RLS symptoms.

A comparative study of renal care in Brazil and Mexico: hemodialysis treatment from the perspective of ESRD sufferers.

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Mercado-Martinez, Francisco J; da Silva, Denise Guerreiro V; Correa-Mauricio, Mauricio E

2017-04-01

Renal replacement therapy is the indicated treatment for individuals with chronic kidney disease (CKD) to survive. However, not all sick people have access to the same treatment. This study compares renal care in two developing countries with different health systems. Specifically, it explores hemodialysis treatment from the perspective of low-income individuals. A qualitative, comparative study was performed in Brazil and Mexico. Using purposive sampling, the research was based on open-ended interviews with nineteen participants with kidney failure undergoing hemodialysis treatment in public hospitals and ten relatives. According to our results, Brazilian participants perceived hemodialysis care as satisfactory because of health personnel courtesy as well as free access to dialysis treatment, prescription drugs, hospitalization and transportation. However, they reported deficiencies in the care they were receiving due to shortages of specialists, prescription drugs, laboratory tests and transportation. Mexican participants, in contrast, highlighted the catastrophic costs of medical care because they had no free access to renal therapy, nor adequate financial resources. Our findings suggest that low-income Brazilian CKD sufferers experience renal care differently, as they are more satisfied and face less obstacles with hemodialysis compared with those of Mexico. More studies on the topic are needed. © 2016 John Wiley & Sons Ltd.

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

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

2007-01-01

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.

Resistance to erythropoiesis stimulating agents in patients treated with online hemodiafiltration and ultrapure low-flux hemodialysis: results from a randomized controlled trial (CONTRAST)

NARCIS (Netherlands)

Weerd, N.C. van der; Hoedt, C.H. den; Blankestijn, P.J.; Bots, M.L.; Dorpel, M.A. van den; Levesque, R.; Mazairac, A.H.; Nube, M.J.; Penne, E.L.; Wee, P.M. ter; Grooteman, M.P.; Hamersvelt, H.W. van; et al.,

2014-01-01

Resistance to erythropoiesis stimulating agents (ESA) is common in patients undergoing chronic hemodialysis (HD) treatment. ESA responsiveness might be improved by enhanced clearance of uremic toxins of middle molecular weight, as can be obtained by hemodiafiltration (HDF). In this analysis of the

The Effect of the Type of Hemodialysis Buffer on the QTc Interval in Patients on Chronic Hemodialysis

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Reza Hekmat

2009-03-01

Full Text Available Background: Identifying the sources of variation in QTc measurementsis important for preventing arrhythmias during and afterhemodialysis. The present study was designed to determine thecorrelation between the type of hemodialysis buffer and thechanges in QTc interval in patients on chronic hemodialysis.Methods: Fifty-nine patients on chronic hemodialysis whoreferred in winter 2007 to hemodialysis centers of Ghaem andHashemi Nejad hospitals, in Mashhad, Iran, were divided intotwo groups according to their last dialysate buffer: acetate orbicarbonate. Electrocardiography, arterial blood gas parameters,serum K+, Na+, ionized calcium, and albumin levels weremeasured prior to and after hemodialysis in all patients.Results: All arterial blood gas parameters and serum electrolytesconcentrations were increased except K+ levels that weresignificantly decreased with hemodialysis. PCO2 and QTc intervalswere slightly increased in all patients, however thisincrease was not statistically significant. We found that thetype of dialysate affected the QTc interval, HCO3, base excess,base excess of extra cellular fluid, and base bufferchanges with no effect on ionized calcium, pH, PCO2, andserum albumin concentration. QTc interval was prolonged byusing bicarbonate and shortened by using acetate dialysatebuffer. We found no correlation between the variations of QTcinterval and serum electrolytes or arterial blood gas parametersin either group.Conclusion: Bicarbonate buffer use in hemodialysis prolongedQTc interval and acetate buffer shortened it. This effectis independent of serum electrolytes and pH changes duringhemodialysis. The effect of bicarbonate buffer is probablydue to more tolerability of ultra filtration, more effectiveedema reduction and augmented body electro-conductivity.

Ultrasound Thrombolysis in Hemodialysis Access: In Vitro Investigation

International Nuclear Information System (INIS)

Wildberger, Joachim Ernst; Schmitz-Rode, Thomas; Haage, Patrick; Pfeffer, Joachim; Ruebben, Alexander; Guenther, Rolf W.

2001-01-01

Purpose: To evaluate the effectiveness of ultrasound thrombolysis in occluded hemodialysis access shunts using an in vitro model.Methods: Thrombosed hemodialysis accesses were simulated by clotted bovine blood in a flow model (silicone tubing; inner diameters 4, 6, and 9 mm). After retrograde and antegrade sheath placement (7 Fr), mechanical thrombolysis was performed using an ultrasound probe (Acolysis, Angiosonics, Morrisville, NC, USA). The tip of the device measured 2.2 mm in diameter. During sonication, the catheter was moved slowly back and forth using an over-the-wire system. Thirty complete occlusions [tubing diameters 4 mm (n = 12), 6 mm (n = 12), 9 mm (n = 6)] were treated. Initial thrombus weights were 3.5 (± 0.76) g, 7.7 (± 1.74) g, and 19.4 (± 2.27) g for the three diameters. Maximum sonication time was 15 min for each probe.Results: With this device, we were able to restore a continuous lumen in all 12 occluded 4∼mm silicone tubes. No wall-adherent thrombi remained after sonication for 3.5-9.6 min. In hemodialysis access models with diameters of 6 mm, thrombus fragments persisted in 25% (3/12 accesses). These were located in the medial portion of the access loop and near to the puncture sites. However, flow was re-established after 5.0-13.0 min of treatment in all settings. Mechanical dissolution of thrombus material failed in five of six access models with diameters of 9 mm, even though ultrasound energy was applied for the maximum of 15 min.Conclusion: In a clotted hemodialysis shunt model, successful ultrasound thrombolysis was limited to small access diameters and small amounts of thrombus

Frequent hemodialysis in children.

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Warady, Bradley A; Fischbach, Michel; Geary, Denis; Goldstein, Stuart L

2007-07-01

Frequent hemodialysis is currently conducted in a limited number of pediatric dialysis centers. However, the preliminary experience with children who have undergone procedures such as "daily" intensive hemodiafiltration and nocturnal hemodialysis has been positive, with the allowance for unrestricted diets and fluid intake, the lack of need for phosphate binders, excellent metabolic and blood pressure control, and, in the case of hemodiafiltration, excellent growth. The provision of frequent daily hemodialysis with the NxStage System has also recently been introduced to pediatrics. An overview about what is currently understood regarding the technical and clinical application of these approaches to therapy for children with end-stage renal disease form the basis for this article and highlight the impact of the procedures to date and the need for additional experience and collaborative data collection.

Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction

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Felipe Jose Skupien

2014-03-01

Full Text Available It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL, few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.

Is proBNP a Reliable Marker for the Evaluation of Fluid Load in Patients Undergoing Continuous Renal Replacement Therapy?

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Seher Erdogan

2016-11-01

Full Text Available Aim: Pro-B type natriuretic peptide (proBNP has been defined as a volume marker in hemodialysis patients. In the present study we aimed to evaluate the role of serum proBNP levels to indicate fluid load in patients undergoing continuous renal replacement therapy (CRRT due to overhydration. Material and Method: Patients who were admitted to a tertiary 7-bed pediatric intensive care unit and underwent CRRT due to overhydration were included in the study. Results: The study was conducted with 15 girls (53.6% and 13 boys (46.4%. The mean age was 61.46±56.13 months (range, 2-183 months; the mean CRRT administration time was 20.8±14.9 hours (range, 5-60 hours; and the mean percentage of fluid extracted from the body was 8.43 ± 4.51% (range, 2.5-20%. CRRT was administered to 12 patients because of fluid overload (42.9% and to 12 (57.1% because of fluid load accompanied by uremia.. There was a statistically significant difference between body weight, urea, and creatinine levels of patients before and after treatment (p= 0.001. The mean proBNP level was 23.306 ± 13.943 pg/mL immediately before CRRT and the mean proBNP after CRRT was 22.178 ± 15.473 pg/mL. There was no statistically significant difference between the initial and final proBNP levels (p= 0.756. With the exception of serum sodium levels, there was no correlation between the final proBNP levels and body weight, urea, and creatinine (p>0.05. Similarly, there was also no correlation between initial proBNP levels and fluid load (p= 0.602 or between the percentage of extracted fluid and final proBNP levels (p= 0.155. Discussion: There was no significant correlation between the fluid load and initial proBNP levels or with the extracted fluid percentage and final proBNP levels in patients undergoing CRRT because of fluid overload.In conclusion, no appropriate marker was determined to evaluate cumulative fluid load and the extracted liquid volume.

The Effect of High-Flux Hemodialysis on Hemoglobin Concentrations in Patients with CKD: Results of the MINOXIS Study

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Schneider, Andreas; Drechsler, Christiane; Krane, Vera; Krieter, Detlef H.; Scharnagl, Hubert; Schneider, Markus P.; Wanner, Christoph

2012-01-01

Summary 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 μg/wk versus 26.0±31.1 μg/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. PMID:22096040

Use of the anion gap and intermittent hemodialysis following continuous hemodiafiltration in extremely high dose acute-on-chronic lithium poisoning: A case report.

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Komaru, Yohei; Inokuchi, Ryota; Ueda, Yoshihiro; Nangaku, Masaomi; Doi, Kent

2018-01-01

A 35-year-old woman intentionally took 40,000 mg of lithium carbonate, and she was transferred to our hospital with nausea, vomiting, and diarrhea. She was diagnosed as having bipolar disorder 10 years ago and was receiving oral lithium therapy. Blood test results on arrival were remarkable for a negative anion gap of -2.1 and later, the serum lithium level turned out to be as high as 15.4 mEq/L. Intubation was required because of disrupted consciousness, and continuous hemodiafiltration (CHDF) was immediately started in the intensive care unit to obtain constant removal of lithium. After adding intermittent hemodialysis (IHD) twice during the daytime to accelerate the lithium clearance, CHDF became unnecessary on day 4, and she was extubated on day 6 with complete recovery of consciousness. Close monitoring of the patient data showed recovery of the decreased anion gap as indicator of the serum lithium level reduction. On day 36, she was discharged without any complication and sequela. The current case highlighted the effective use of CHDF between IHD sessions to prevent the rebound elevation of lithium and the role of the anion gap as a surrogate marker of serum lithium concentration during the treatment. © 2017 International Society for Hemodialysis.

Referral pattern of hemodialysis patients to nephrologists

International Nuclear Information System (INIS)

Anees, M.; Mumtaz, A.; Nazir, M.; Ibrahim, M.; Kausar, T.

2007-01-01

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 <11gm/dl) and 224 (90%) were hypoalbuminemic (serum albumin < 4gm/dl) on first presentation. Majority of patients were hyperkalemic, 139 (56.0%), hypocalcemic, 168 (67.7%) and serum phosphate level was high in only 117 (47%) patients. All the patients presented in emergency room to nephrologists at very late stage (100% late referral), when disease was very much advanced. All of them did not have permanent vascular access for hemodialysis on first presentation to dialysis center. Reasons for late referral were non-availability of nephrologists and nephrology services, non-renal doctors biased, unawareness and

Thyroid hormone concentrations in dialysate during hemodialysis in children

International Nuclear Information System (INIS)

Waters, W.; Bulla, M.; Buschsieweke, U.; Kutzim, H.; Koeln Univ.

1981-01-01

Thyroxine (T4) concentration in dialysate in the course of hemodialysis was determined in 15 children. Concentrations were measured by a modified radioimmunoassay. During hemodialysis there was a slight increase in T4 concentration. At the end of hemodialysis T4 concentration was about 50% higher than soon after the onset of hemodialysis. The loss of T4 into dialysate during hemodialysis was 19.2 μg; the loss of T3 was less than 75 ng. The amount of the daily loss of thyroid hormones into dialysate was found to be in the range of normal urinary excretion. The lowering of serum thyroid hormone concentrations in children on hemodialysis cannot be explained by the loss of these hormones into dialysate. (orig.) [de

Hemodialysis patients' preferences for the management of secondary hyperparathyroidism.

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Hauber, Brett; Caloyeras, John; Posner, Joshua; Brommage, Deborah; Belozeroff, Vasily; Cooper, Kerry

2017-07-28

Patient engagement and patient-centered care are critical in optimally managing patients with end-stage renal disease (ESRD). Understanding patient preferences is a key element of patient-centered care and shared decision making. The objective of this study was to elicit patients' preferences for the treatment of secondary hyperparathyroidism (SHPT) associated with ESRD using a discrete-choice experiment survey. Clinical literature, nephrologist input, patient-education resources, and a patient focus group informed development of the survey instrument, which was qualitatively pretested before its administration to a broader sample of patients. The National Kidney Foundation invited individuals in the United States with ESRD who were undergoing hemodialysis to participate in the survey. Respondents chose among three hypothetical SHPT treatment alternatives (two medical alternatives and surgery) in each of a series of questions, which were defined by attributes of efficacy (effect on laboratory values and symptoms), safety, tolerability, mode of administration, and cost. The survey instrument included a best-worst scaling exercise to quantify the relative bother of the individual attributes of surgery. Random-parameters logit models were used to evaluate the conditional relative importance of the attributes. A total of 200 patients with ESRD completed the survey. The treatment attributes that were most important to the respondents were whether a treatment was a medication or surgery and out-of-pocket cost. Patients had statistically significant preferences for efficacy attributes related to symptom management and laboratory values, but placed less importance on the attributes related to mode of administration and side effects. The most bothersome attribute of surgery was the risk of surgical mortality. Patients with ESRD and SHPT who are undergoing hemodialysis understand SHPT and have clear and measurable treatment preferences. These results may help inform

Monitoring of arrhythmia and sudden death in a hemodialysis population: The CRASH-ILR Study.

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Paul R Roberts

Full Text Available It has been suggested that sudden cardiac death (SCD contributes around 50% of cardiovascular and 27% of all-cause mortality in hemodialysis patients. The true burden of arrhythmias and arrhythmic deaths in this population, however, remains poorly characterised. Cardio Renal Arrhythmia Study in Hemodialysis (CRASH-ILR is a prospective, implantable loop recorder single centre study of 30 established hemodialysis patients and one of the first to provide long-term ambulatory ECG monitoring.30 patients (60% male aged 68±12 years receiving hemodialysis for 45±40 months with varied etiology (diabetes 37%, hypertension 23% and left ventricular ejection fraction (LVEF 55±8% received a Reveal XT implantable loop recorder (Medtronic, USA between August 2011 and October 2014. ECG data from loop recorders were transmitted at each hemodialysis session using a remote monitoring system. Primary outcome was SCD or implantation of a (tachy or bradyarrhythmia controlling device and secondary outcome, the development of arrhythmia necessitating medical intervention.During 379,512 hours of continuous ECG monitoring (mean 12,648±9,024 hours/patient, there were 8 deaths-2 SCD and 6 due to generalised deterioration/sepsis. 5 (20% patients had a primary outcome event (2 SCD, 3 pacemaker implantations for bradyarrhythmia. 10 (33% patients reached an arrhythmic primary or secondary end point. Median event free survival for any arrhythmia was 2.6 years (95% confidence intervals 1.6-3.6 years.The findings confirm the high mortality rate seen in hemodialysis populations and contrary to initial expectations, bradyarrhythmias emerged as a common and potentially significant arrhythmic event.

Post-operative bilateral continuous ultrasound-guided transversus abdominis plane block versus continuous local anaesthetic wound infusion in patients undergoing abdominoplasty

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Eman Ramadan Salama

2018-01-01

Full Text Available Background and Aims: Transversus abdominis plane (TAP block and continuous local anaesthetic wound infusion are used as part of multimodal analgesia to treat postoperative pain after lower abdominal surgeries. The aim of this randomised controlled study was to assess the efficacy of the two techniques and compare the two in patients undergoing abdominoplasty. Methods: Ninety female patients undergoing abdominoplasty were allocated to receive continuous wound infusion with saline (control group, GC, n = 30, continuous bilateral TAP block with 0.25% levobupivacaine (group GT, n = 30, or continuous wound infusion with 0.25% levobupivacaine (group GW, n = 30. The primary end-point was morphine requirement in the first 48 h. Numerical rating scale (NRS at rest and during movement, time to first morphine dose and time to first ambulation were recorded. Results: Morphine requirement in the first 48 h was significantly higher in GC than GW and GT (61.9 ± 12.8, 21.5 ± 9.5, and 18.9 ± 8.1 mg, respectively; P = 0.001, but GW and GT were comparable (P = 0.259. NRS was significantly higher in GC during movement in the first 24 h. GW and GT showed significantly longer time to first morphine dose (6.5 ± 1.7 and 8.9 ± 1.4 h, respectively, vs. 1.2 ± 0.3 h in GC and significantly shorter time to first ambulation (7.8 ± 3.1 and 6.9 ± 3.4 h, respectively, vs. 13.2 ± 4.9 h in GC (P = 0.001. Conclusion: Continuous bilateral ultrasound-guided TAP block and continuous local anaesthetic wound infusion significantly decreased total morphine consumption in the first 48 h compared to placebo; however, both treatment techniques were comparable.

Nosocomial infective endocarditis in Hemodialysis

International Nuclear Information System (INIS)

Bhat, A.W.; Solangi, S.; Murtada, O.

2002-01-01

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)

Serum Anti-Hbs-Ag in Stable Hemodialysis Patients and its Relationship with Various Demographic and Biochemical Data

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Azar BARADARAN

2010-12-01

Full Text Available Introduction: To evaluate the relationship between various biochemical, nutritional and demographic factors with immune response to hepatitis B vaccine in maintenance hemodialysis (HD patients. Material and Methods: A retro-prospective study was carried out on 68 patients undergoing maintenance hemodialysis .Patients were vaccinated against hepatitis B virus with an intramuscular hepatitis B vaccination schedule, 40 micrograms at 0, 1, and 6 months. We also selected 32 age matched normal healthy persons who had vaccinated against hepatitis B previously to compare the antibody production with HD patients. Results: The value of serum antibody level against hepatitis B surface antigen ( HBs in hemodialisis patients and healthy persons were 35±55(median=5.5 and 135±71 (median=175 mIU/ml respectively. There was a significant deference between mean serum antibody level against HBs antigen of hemodialysis patients and normal subjects (p<0.001, there were not any significant differences of antibody production against HBs antigen between males and females or diabetic and non diabetics. There were no correlation between serum antibody level against HBs-Ag and serum albumin and also with body mass index. There were not significant correlation between anti-HBs antibody level and age, amounts of hemodialysis, duration of dialysis, dialysis adequacy, serum ferritin level and serum lipids. There were not also significant correlation between anti-HBs antibody level and serum parathormone, calcium, phosphorus, serum hemoglobin and hematocrit level. Conclusion: In this study, there was not significant correlation between serum antibody level against hepatitis B surface antigen and various nutritional and demographic factors of patients under regular hemodialysis.

Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients.

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Rymarz, Aleksandra; Gibińska, Julia; Zajbt, Maria; Piechota, Wiesław; Niemczyk, Stanisław

2018-11-01

Nutritional status has a significant impact on the outcomes in the dialysis population. The aim of this study was to evaluate the association between body composition and a one-year survival of hemodialysis patients. Forty-eight patients with chronic kidney disease stage V treated with hemodialysis for more than three months were included. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care). Blood samples for serum creatinine, serum albumin, serum prealbumin, high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), insulin-like growth factor 1(IGF-1) concentrations were taken before the midweek dialysis session. Over the course of a one-year observation, seven patients died. We observed a significantly lower lean tissue index (LTI) (p = .013) and higher IL-6 (p = .032) and hsCRP levels (p = .011) among the patients who died. The remaining biochemical markers did not differ between these two groups. Kapplan-Meier analysis revealed a worse survival rate in patients with sarcopenia (lower than the 10th percentile for their age and gender) in comparison with those with normal LTI. However, it was not of statistical significance (p = .055). LTI inversely correlated with age and IL-6 and positively with IGF-1. Sarcopenia defined as decreased LTI, is a relatively common condition among patients undergoing maintenance hemodialysis, it can also be associated with a lower one-year survival rate. Decreased lean tissue mass can be associated with old age, lower IGF-1 levels and higher IL-6 levels. Body composition assessment may provide prognostic data for hemodialysis patients.

Cutaneous manifestations in patients with chronic renal failure on hemodialysis

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Udayakumar P

2006-01-01

Full Text Available Background: Chronic renal failure (CRF presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. Aim: The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF undergoing hemodialysis. Methods: One hundred patients with CRF on hemodialysis were examined for cutaneous changes. Results: Eighty-two per cent patients complained of some skin problem. However, on examination, all patients had at least one skin lesion attributable to CRF. The most prevalent finding was xerosis (79%, followed by pallor (60%, pruritus (53% and cutaneous pigmentation (43%. Other cutaneous manifestations included Kyrle′s disease (21%; fungal (30%, bacterial (13% and viral (12% infections; uremic frost (3%; purpura (9%; gynecomastia (1%; and dermatitis (2%. The nail changes included half and half nail (21%, koilonychia (18%, onychomycosis (19%, subungual hyperkeratosis (12%, onycholysis (10%, splinter hemorrhages (5%, Mees′ lines (7%, Muehrcke′s lines (5% and Beau′s lines (2%. Hair changes included sparse body hair (30%, sparse scalp hair (11% and brittle and lusterless hair (16%. Oral changes included macroglossia with teeth markings (35%, xerostomia (31%, ulcerative stomatitis (29%, angular cheilitis (12% and uremic breath (8%. Some rare manifestations of CRF like uremic frost, gynecomastia and pseudo-Kaposi′s sarcoma were also observed. Conclusions: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. The commonest are xerosis and pruritus and the early recognition of cutaneous signs can relieve suffering and decrease morbidity.

Insomnia and limb pain in hemodialysis patients: What is the share of restless leg syndrome?

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Majid Malaki; Fakhr Sadat Mortazavi; Sussan Moazemi; Maryam Shoaran

2012-01-01

Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, ...

Increased Cerebral Water Content in Hemodialysis Patients

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Reetz, Kathrin; Abbas, Zaheer; Eitner, Frank; Gross, Theresa; Schulz, Jörg Bernhard; Floege, Jürgen; Shah, N. J.; Costa, Ana Sofia; Gras, Vincent; Tiffin-Richards, Frances; Mirzazade, Shahram; Holschbach, Bernhard; Frank, Rolf Dario; Vassiliadou, Athina; Krüger, Thilo

2015-01-01

Little information is available on the impact of hemodialysis on cerebral water homeostasis and its distribution in chronic kidney disease. We used a neuropsychological test battery, structural magnetic resonance imaging (MRI) and a novel technique for quantitative measurement of localized water content using 3T MRI to investigate ten hemodialysis patients (HD) on a dialysis-free day and after hemodialysis (2.4±2.2 hours), and a matched healthy control group with the same time interval. Neuro...

Association Between Changes in CMS Reimbursement Policy and Drug Labels for Erythrocyte-Stimulating Agents With Outcomes for Older Patients Undergoing Hemodialysis Covered by Fee-for-Service Medicare.

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Wang, Cunlin; Kane, Robert; Levenson, Mark; Kelman, Jeffrey; Wernecke, Michael; Lee, Joo-Yeon; Kozlowski, Steven; Dekmezian, Carmen; Zhang, Zhiwei; Thompson, Aliza; Smith, Kimberly; Wu, Yu-Te; Wei, Yuqin; Chillarige, Yoganand; Ryan, Qin; Worrall, Chris; MaCurdy, Thomas E; Graham, David J

2016-12-01

In 2011, the US Centers for Medicare & Medicaid Services (CMS) changed its reimbursement policy for hemodialysis to a bundled comprehensive payment system that included the cost of erythrocyte-stimulating agents (ESAs). Also in 2011, the US Food and Drug Administration revised the drug label for ESAs, recommending more conservative dosing in patients with chronic kidney disease. In response to concerns that these measures could have adverse effects on patient care and outcomes, the CMS and the FDA initiated a collaboration to assess the effect. To assess the effects of the changes in reimbursement policy and the ESA drug label on patients who underwent incident hemodialysis. For this retrospective cohort study, patients 66 years or older who had undergone incident hemodialysis, and were enrolled in Medicare parts A, B, or D for at least 12 months prior to hemodialysis initiation between January 1, 2008, and December 31, 2013, were recruited from hemodialysis centers across the United States. Patients were divided into 2 cohorts based on their date of hemodialysis initiation and followed: January 1, 2008, to December 31, 2009, for the prepolicy cohort and July 1, 2011, to June 30, 2013, for the postpolicy cohort, with the exclusion of January 1, 2010, to June 30, 2011, as a transition period. Changes in CMS reimbursement policy for dialysis and the FDA label for ESAs. Major adverse cardiovascular events (MACEs), including acute myocardial infarction (AMI), stroke, and all-cause mortality; hospitalized congestive heart failure (H-CHF); venous thromboembolism; and red blood cell transfusions. Secondary outcomes included evaluating effects on black and other patient subgroups. Baseline characteristics of the 69 718 incident hemodialysis patients were similar between cohorts. Compared with the prepolicy period, the risk of MACE, death, H-CHF, and venous thromboembolism were similar in the postpolicy period, and the risk of stroke decreased (hazard ratio [HR], 0.77; 95

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

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Moroi, Masao; Tamaki, Nagara; Nishimura, Masato; Haze, Kazuo; Nishimura, Tsunehiko; Kusano, Eiji; Akiba, Takashi; Sugimoto, Tokuichiro; Hase, Hiroki; Hara, Kazuhiro; Nakata, Tomoaki; Kumita, Shinichiro; Nagai, Yoji; Hashimoto, Akiyoshi; Momose, Mitsuru; Miyakoda, Keiko; Hasebe, Naoyuki; Kikuchi, Kenjiro

2013-03-01

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 (β-methyl iodophenyl-pentadecanoic acid) might be associated with cardiac-derived death in hemodialysis patients. Prospective observational study. 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). Baseline BMIPP summed scores semiquantified using a 17-segment 5-point system (normal, 0; absent, 4). Cardiac-derived death, including cardiac and sudden death. 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. 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 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). Sudden death of unknown cause was considered to have been cardiac derived, although a coronary origin was not confirmed. 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

Use of hemodialysis in meprobamate overdosage.

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Lobo, P I; Spyker, D; Surratt, P; Westervelt, F B

1977-02-01

A case of meprobamate overdosage successfully treated with hemodialysis is described. The patient was admitted 4 hours after an overdosage of meprobamate (30-40 g) deeply unconscious, hypotensive, in respiratory failure and with a serum meprobamate level of 50 mg/100 ml. Hemodialysis was instituted using a Gambro parallel flow dialyzer and a portable re-circulating dialyzate delivery system (Redy, CCi Life Systems). Meprobamate removal with hemodialysis was 672+/-167 mg/hr with a corresponding clearance of 61.97+/-9.9 ml/min. Drug removal with forced diuresis was 177+/-23.4 mg/hr. Metabolic degradation of the drug was approximately 482 mg/hr with a plasma disappearance rate of 5.2%/hr. No drug could be detected in the dialyzate fluid after its passage through the Redy re-circulating dialyzate system. Because of the rapidity of metabolic degradation of meprobamate, we feel that hemodialysis should be reserved for severe clinical intoxication and either compromised normal excretory routes or progressive clinical deterioration.

Assessment of Adequacy of Dialysis in Patients under Continuous Hemodialysis in Kamkar and Hazrat Vali Asr Hospitals, State of Qom, 2006

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S.M Mousavi Movahed

2012-05-01

Full Text Available

Background and objectives

Hemodialysis is one of the therapeutic modalities of the end stage renal disease (ESRD. As inadequate dialysis is considered a risk factor leading to higher morbidity and mortality, determination of adequacy of dialysis is necessary. This study was conducted to determine adequacy of dialysis in continuous hemodialysis patients in Kamkar and Hazrat Vali Asr Hospitals in the state of Qom, Iran.

Methods

 This cross sectional descriptive-analytic study was conducted in 2006. The study variables were age, gender, height, weight and duration of dialysis. Data were collected by a questionnaire and URR, dKt/V, eKt/V and pKt/V were calculated. For statistical analysis, t-test, Fisher’s exact test and Pearson correlation were employed.

Results

 Of 238 patients, 51.7% and 48.3% were males and females respectively. The average age was 55.27 ± 16.79 years. Mean values of dKt/V, eKt/V, pKt/V and URR were 1.03 ± 0.232, 0.89 ± 0.196, 1.18 ± 0.254, and 57.46 ± 8.42 respectively. The percent of adequate dialysis in eKt/V, pKt/V and URR were 26.5%, 44.5% and 21% respectively. The mean age of insufficient eKt/V group was higher than adequate eKt/V group and t test showed a significant statistical correlation. Fisher’s exact test showed a significant correlation between adequate eKt/V and female gender, and also between eKt/V and URR. But chi-square test did not show a significant correlation between eKt/V and underling disease.

Conclusion

 We found that hemodialysis is inadequate in a high number of patients. Further studies with larger sample numbers are recommended to determine the underlying cause of this inadequacy.

Insomnia and limb pain in hemodialysis patients: What is the share of restless leg syndrome?

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Majid Malaki

2012-01-01

Full Text Available Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, serum phosphorous, ionized calcium, iron and ferritin levels. These variables between patients with insomnia and those with normal sleep were evaluated by independent "t" test. Without considering the etiology or pathogenesis of insomnia, we evaluated the occurrence of insomnia and limb pain in these patients, and specifically, restless leg syndrome. Insomnia and limb pain were common in dialytic patients. 46% of patients had insomnia. 91% of sleepless group had limb pain as a persistent, annoying complaint. Limb pain was not seen in groups with a normal sleep pattern. Restless leg syndrome was found in 8% of total cases (2 out of 26 and 17% among the insomnia group (2 out of 12. In spite of high incidence of insomnia among patients undergoing regular hemodialysis, role of RLS is trivial. There is a strong relationship between hemoglobin levels and duration of renal replacement therapy to insomnia occurrence.

Insomnia and limb pain in hemodialysis patients: what is the share of restless leg syndrome?

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Malaki, Majid; Mortazavi, Fakhr Sadat; Moazemi, Sussan; Shoaran, Maryam

2012-01-01

Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, serum phosphorous, ionized calcium, iron and ferritin levels. These variables between patients with insomnia and those with normal sleep were evaluated by independent "t" test. Without considering the etiology or pathogenesis of insomnia, we evaluated the occurrence of insomnia and limb pain in these patients, and specifically, restless leg syndrome. Insomnia and limb pain were common in dialytic patients. 46% of patients had insomnia. 91% of sleepless group had limb pain as a persistent, annoying complaint. Limb pain was not seen in groups with a normal sleep pattern. Restless leg syndrome was found in 8% of total cases (2 out of 26) and 17% among the insomnia group (2 out of 12). In spite of high incidence of insomnia among patients undergoing regular hemodialysis, role of RLS is trivial. There is a strong relationship between hemoglobin levels and duration of renal replacement therapy to insomnia occurrence.

Nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in hemodialysis patients

International Nuclear Information System (INIS)

Gao Peizhu; Ding Wenbin; Ming Zhibing; Sun Juyun

2010-01-01

Objective: To summarize the experience of the nursing care of indwelling catheter thrombolysis for acute thrombosis in the arteriovenous fistula in eight hemodialysis patients. Methods: After breaking thrombus through indwelling catheter, both bolus injection and micro-pump continuous infusion of urokinase was employed in eight hemodialysis patients with acute thrombosis in the arteriovenous fistula. The necessary nursing measures were carried out to assist the whole therapeutic procedure. Results: All the patients could well cooperate with the procedure of indwelling catheter thrombolysis and urokinase infusion. The reopening rate of the obstructed fistula was 100%. Conclusion: Indwelling catheter thrombolysis with urokinase infusion is a simple, effective and safe treatment for acute thrombosis in the arteriovenous fistula in hemodialysis patients. In order to obtain optimal results, necessary nursing measures must be carried out. (authors)

Association of lean body mass with nutritional parameters and mortality in hemodialysis patients: A long-term follow-up clinical study.

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Zhou, Dong Chi; Yang, Xiu Hong; Zhan, Xiao Li; Gu, Yan Hong; Guo, Li Li; Jin, Hui Min

2018-06-01

This study aimed to evaluate the correlation between lean body mass (LBM) and nutritional status in hemodialysis (HD) patients to better predict their long-term prognosis. Anthropometric body measurements and biochemical parameters were recorded from 222 patients on maintenance hemodialysis (MHD) at the Shanghai Pudong Hospital Hemodialysis Center. LBM was calculated using the serum creatinine index (LBM-SCR), mid-arm muscle circumference (LBM-MAMC), and dominant-arm hand-grip strength (LBM-HGS). Patient mortality and hospitalization were observed after 24 months. LBMs measured from LBM-SCR and LBM-MAMC were associated with sex, body mass index (BMI), serum albumin, and serum creatinine (SCR) ( p LBM evaluation, low LBM was shown to be associated with a higher mortality in patients undergoing HD ( p LBM-SCR and LBM-HGS are strongly associated with hospitalization and mortality in HD patients, indicating LBM is an important factor in prediction of outcomes in those patients. LBM is associated with nutritional parameters in HD patients, and LBM-SCR, HGS, and MAMC are simple approaches for accurately predicting the patient's risk of hospitalization and/or death.

Serum trypsin inhibitory capacity in hemodialysis patients

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Hashemi, Mohammad; Mehrabifar, Hamid; Homayooni, Fatemeh; Naderi, Mohammad; Montazerifar, Farzaneh; Ghavami, Saeid

2009-01-01

It has been established that overproduction of reactive oxygen species (ROS) occurs during hemodialysis causing oxidation of proteins. Alpha-1-antitrypsin is the major circulating anti-protease which contains methionine in the active site. The aim of the present study was to measure the level of serum trypsin inhibitory capacity (sTIC) in hemodialysis patients. This case-control study was performed in 52 hemodialysis patients and 49 healthy controls. sTIC was measured by enzymatic assay. The sTIC was significantly (P< 0.001) lower in hemodialysis patients (1.87 + - 0.67 micron mol/min/mL) than healthy controls (2.83 + - 0.44 micron mol/min/L). Reduction of sTIC may be due to the oxidation of methionine residue in the reactive site of alpha-1 antitrypsin. (author)

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

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Schmid H

2009-06-01

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.

The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency.

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Zhai, Hongxia; Li, Liang; Yin, Yaxin; Zhang, Jinjin; Chen, Haiwei; Liu, Runmei; Xia, Yun-feng

2016-01-01

The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1 g 3/day × 3 days and slow intravenous input sodium chloride 1000 ∼1500 mL 3-12 h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4 h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251 umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.

Severe Valproic Acid Intoxication Responding to Hemodialysis

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Ali Ertuğ Arslanköylü

2017-08-01

Full Text Available Valproic acid is a commonly used antiepileptic drug which causes intoxication easily due to its narrow therapeutic window. Here, we present a child with valproic acid poisoning who responded to hemodialysis. A 14-year-old male patient with epilepsy and mental motor retardation was admitted to the pediatric intensive care unit due to valproic acid intoxication. Plasma valproic acid level was 710 µg/mL. The patient’s vital signs were stable and a decrease was observed in the valproic acid and ammonia levels with supportive treatment at the beginning. On the third day of the admission, hemodynamic and mental status of the patient deteriorated, plasma ammonia and lactate levels elevated, thus, we decided to perform hemodialysis. After hemodialysis, the patient’s hemodynamic status and mental function improved in conjunction with the reduction in valproic acid, ammonia and lactate levels. Thus he was transferred to the pediatric ward. Hemodialysis may be considered an effective treatment choice for severe valproic acid intoxication. Here, it was shown that hemodialysis may also be effective in patients with deteriorated general status under supportive treatment in the late phase of valproic acid intoxication.

Proteomic Investigations into Hemodialysis Therapy

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Mario Bonomini

2015-12-01

Full Text Available The retention of a number of solutes that may cause adverse biochemical/biological effects, called uremic toxins, characterizes uremic syndrome. Uremia therapy is based on renal replacement therapy, hemodialysis being the most commonly used modality. The membrane contained in the hemodialyzer represents the ultimate determinant of the success and quality of hemodialysis therapy. Membrane’s performance can be evaluated in terms of removal efficiency for unwanted solutes and excess fluid, and minimization of negative interactions between the membrane material and blood components that define the membrane’s bio(incompatibility. Given the high concentration of plasma proteins and the complexity of structural functional relationships of this class of molecules, the performance of a membrane is highly influenced by its interaction with the plasma protein repertoire. Proteomic investigations have been increasingly applied to describe the protein uremic milieu, to compare the blood purification efficiency of different dialyzer membranes or different extracorporeal techniques, and to evaluate the adsorption of plasma proteins onto hemodialysis membranes. In this article, we aim to highlight investigations in the hemodialysis setting making use of recent developments in proteomic technologies. Examples are presented of why proteomics may be helpful to nephrology and may possibly affect future directions in renal research.

Proteomic Investigations into Hemodialysis Therapy

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Bonomini, Mario; Sirolli, Vittorio; Pieroni, Luisa; Felaco, Paolo; Amoroso, Luigi; Urbani, Andrea

2015-01-01

The retention of a number of solutes that may cause adverse biochemical/biological effects, called uremic toxins, characterizes uremic syndrome. Uremia therapy is based on renal replacement therapy, hemodialysis being the most commonly used modality. The membrane contained in the hemodialyzer represents the ultimate determinant of the success and quality of hemodialysis therapy. Membrane’s performance can be evaluated in terms of removal efficiency for unwanted solutes and excess fluid, and minimization of negative interactions between the membrane material and blood components that define the membrane’s bio(in)compatibility. Given the high concentration of plasma proteins and the complexity of structural functional relationships of this class of molecules, the performance of a membrane is highly influenced by its interaction with the plasma protein repertoire. Proteomic investigations have been increasingly applied to describe the protein uremic milieu, to compare the blood purification efficiency of different dialyzer membranes or different extracorporeal techniques, and to evaluate the adsorption of plasma proteins onto hemodialysis membranes. In this article, we aim to highlight investigations in the hemodialysis setting making use of recent developments in proteomic technologies. Examples are presented of why proteomics may be helpful to nephrology and may possibly affect future directions in renal research. PMID:26690416

Blood Transfusion, Serum Ferritin, and Iron in Hemodialysis Patients in Africa

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Kouegnigan Rerambiah, Leonard; Essola Rerambiah, Laurence; Mbourou Etomba, Armel; Mouguiama, Rose Marlène; Issanga, Phanie Brunelle; Biyoghe, Axel Sydney; Batchilili, Batchelili; Akone Assembe, Sylvestre; Djoba Siawaya, Joel Fleury

2015-01-01

Background and Objectives. There is no data analyzing the outcome of blood transfusions and oral iron therapy in patients with kidneys failure in sub-Saharan Africa. The present study aimed to fill that gap and assess the value of ferritin in the diagnosis of iron overload and deficiency. Design. From January to February 2012, we prospectively studied 85 hemodialysis patients (78% of males and 22% of females aged 20 to 79 years) attending the Gabonese National Hemodialysis Centre. Results. Correlation studies showed (a) a strong positive linear relationship between the number of blood transfusions and high serum ferritin in hemodialysis patient (Spearman r : 0.74; P value: 0.0001); (b) a weak association between the number of blood transfusions and serum iron concentrations (Spearman r : 0.32; P value: 0.04); (c) a weak association between serum ferritin and serum iron (Spearman r : 0.32; P value: 0.003). Also, the strength of agreement beyond chance between the levels of ferritin and iron in the serum was poor (κ = 0.14). The prevalence of iron overload was 10.6%, whereas the prevalence of iron deficiency was 2.3%, comparing (1) patients with a maximum of one transfusion not on iron therapy; (2) patients with a maximum of one transfusion on iron therapy; (3) polytransfused patients not on iron therapy; and (4) polytransfused patients on oral iron therapy. The “Kruskal-Wallis test” showed that ferritin levels varied significantly between the groups (P value: 0.0001). Conclusion. Serum ferritin is not reliable as a marker of iron overload. For patients undergoing regular transfusion we recommend routine serum ferritin measurement and yearly measurement of LIC. PMID:25685597

Assessment of Nutritional Status of Nepalese Hemodialysis Patients by Anthropometric Examinations and Modified Quantitative Subjective Global Assessment

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Arun Sedhain

2015-01-01

Full Text Available Objective To assess the nutritional status of patients on maintenance hemodialysis by using modified quantitative subjective global assessment (MQSGA and anthropometric measurements. Method We Conducted a cross sectional descriptive analytical study to assess the nutritional status of fifty four patients with chronic kidney disease undergoing maintenance hemodialysis by using MQSGA and different anthropometric and laboratory measurements like body mass index (BMI, mid-arm circumference (MAC, mid-arm muscle circumference (MAMC, triceps skin fold (TSF and biceps skin fold (BSF, serum albumin, C-reactive protein (CRP and lipid profile in a government tertiary hospital at Kathmandu, Nepal. Results Based on MQSGA criteria, 66.7% of the patients suffered from mild to moderate malnutrition and 33.3% were well nourished. None of the patients were severely malnourished. CRP was positive in 56.3% patients. Serum albumin, MAC and BMI were (mean + SD 4.0 + 0.3 mg/dl, 22 + 2.6 cm and 19.6 ± 3.2 kg/m 2 respectively. MQSGA showed negative correlation with MAC ( r = −0.563; P = < 0.001, BMI ( r = −0.448; P = < 0.001, MAMC ( r = −0.506; P = < .0001, TSF ( r = −0.483; P = < .0002, and BSF ( r = −0.508; P = < 0.0001. Negative correlation of MQSGA was also found with total cholesterol, triglyceride, LDL cholesterol and HDL cholesterol without any statistical significance. Conclusion Mild to moderate malnutrition was found to be present in two thirds of the patients undergoing hemodialysis. Anthropometric measurements like BMI, MAC, MAMC, BSF and TSF were negatively correlated with MQSGA. Anthropometric and laboratory assessment tools could be used for nutritional assessment as they are relatively easier, cheaper and practical markers of nutritional status.

Is incremental hemodialysis ready to return on the scene? From empiricism to kinetic modelling.

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Basile, Carlo; Casino, Francesco Gaetano; Kalantar-Zadeh, Kamyar

2017-08-01

Most people who make the transition to maintenance dialysis therapy are treated with a fixed dose thrice-weekly hemodialysis regimen without considering their residual kidney function (RKF). The RKF provides effective and naturally continuous clearance of both small and middle molecules, plays a major role in metabolic homeostasis, nutritional status, and cardiovascular health, and aids in fluid management. The RKF is associated with better patient survival and greater health-related quality of life, although these effects may be confounded by patient comorbidities. Preservation of the RKF requires a careful approach, including regular monitoring, avoidance of nephrotoxins, gentle control of blood pressure to avoid intradialytic hypotension, and an individualized dialysis prescription including the consideration of incremental hemodialysis. There is currently no standardized method for applying incremental hemodialysis in practice. Infrequent (once- to twice-weekly) hemodialysis regimens are often used arbitrarily, without knowing which patients would benefit the most from them or how to escalate the dialysis dose as RKF declines over time. The recently heightened interest in incremental hemodialysis has been hindered by the current limitations of the urea kinetic models (UKM) which tend to overestimate the dialysis dose required in the presence of substantial RKF. This is due to an erroneous extrapolation of the equivalence between renal urea clearance (Kru) and dialyser urea clearance (Kd), correctly assumed by the UKM, to the clinical domain. In this context, each ml/min of Kd clears the urea from the blood just as 1 ml/min of Kru does. By no means should such kinetic equivalence imply that 1 ml/min of Kd is clinically equivalent to 1 ml/min of urea clearance provided by the native kidneys. A recent paper by Casino and Basile suggested a variable target model (VTM) as opposed to the fixed model, because the VTM gives more clinical weight to the RKF and allows

Evaluation of individual quality of life among hemodialysis patients: nominated themes using SEIQoL-adapted.

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Matlabi, Hossein; Ahmadzadeh, Sharareh

2017-01-01

Quality of life (QoL) has become an important issue for patients with chronic renal failure diseases who are permanently undergoing hemodialysis. In this study, an adapted schedule for the evaluation of individual quality of life (SEIQoL-adapted) was used to evaluate QoL among hemodialysis patients, to explore their views about the most important aspects of life satisfaction. A multiple approach design and convenience sampling were applied to recruit 53 patients from a hemodialysis unit in Iran. Data were collected through structured interviews and then analyzed using conventional content analysis. A total score for QoL was calculated using scale guideline. The most important aspects of life were health, family, financial status, living conditions, leisure activities, relationships and socializing, religious and spiritual issues, medical knowledge, and therapies or treatments. The calculated mean QoL score was 66.2, indicating a relatively high life satisfaction. Males had higher QoL scores than females in both married and single groups. Moreover, the relationships between the QoL scores and education, job and marital status were not statistically significant. The SEIQoL-adapted revealed reasonable lay definitions of QoL in a group of patients following chronic renal failure. The patients' views of the aspects of life could be used by health policy makers, clinicians, and caregivers as a reliable guide to the most important priorities for treatment and medical interventions.

Prolonged hypophosphatemia following parathyroidectomy in chronic hemodialysis patients

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Eda Altun

2015-01-01

Full Text Available Secondary hyperparathyroidism (SHPT is a common problem in patients with end-stage renal disease. In cases with severe and resistant SHPT, surgical parathyroidectomy (PTX is recommended. Hungry bone syndrome (HBS following surgical PTX is most often associated with hypocalcemia and hypophosphatemia. The mechanisms for the HBS are not clear, and a method for its prevention has not been established. We present three hemodialysis patients with persistant hypophosphatemia after PTX. In our parathyroidectomized patients, hypocalcemia could be corrected with calcium and vitamin D treatment, but hypophosphatemia continued for eight months in one patient and in two other patients until the last visit (10 and 2 months, respectively. Predisposing factors such as old age, diabetes mellitus and parathyroid adenoma were not found in our patients. All three patients were younger (<35 years old and anuric. Hemodialysis durations were seven, three and two years. In summary, HBS presented with hypocalcemia, and especially hypophosphatemia cannot be developed uncommonly and may persist for a long time following PTX in HD patients.

Biofeedback systems and adaptive control hemodialysis treatment

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Azar Ahmad

2008-01-01

Full Text Available On-line monitoring devices to control functions such as volume, body temperature, and ultrafiltration, were considered more toys than real tools for routine clinical application. However, bio-feedback blood volume controlled hemodialysis (HD is now possible in routine dialysis, allowing the delivery of a more physiologically acceptable treatment. This system has proved to reduce the incidence of intra-HD hypotension episodes significantly. Ionic dialysance and the patient′s plasma conductivity can be calculated easily from on-line measurements at two different steps of dialysate conductivity. A bio-feedback system has been devised to calculate the patient′s plasma conductivity and modulate the conductivity of the dialysate continuously in order to achieve a desired end-dialysis patient plasma conductivity corresponding to a desired end-dialysis plasma sodium concentration. Another bio-feedback system can control the body tempe-rature by measuring it at the arterial and venous lines of the extra-corporeal circuit, and then modulating the dialysate temperature in order to stabilize the patients′ temperature at constant values that result in improved intra-HD cardiovascular stability. The module can also be used to quantify vascular access recirculation. Finally, the simultaneous computer control of ultrafiltration has proven the most effective means for automatic blood pressure stabilization during hemo-dialysis treatment. The application of fuzzy logic in the blood-pressure-guided biofeedback con-trol of ultrafiltration during hemodialysis is able to minimize HD-induced hypotension. In con-clusion, online monitoring and adaptive control of the patient during the dialysis session using the bio-feedback systems is expected to render the process of renal replacement therapy more physiological and less eventful.

Influence of combination hemodialysis/hemoperfusion against score of depression in regular hemodialysis patients

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Permatasari, T. D.; Thamrin, A.; Hanum, H.

2018-03-01

Patients with chronic kidney disease, have a higher risk for psychological distress such as anxiety, depression and cognitive decline. Combination of Hemodialysis (HD)/hemoperfusion (HP) regularly able to eliminate uremic toxin with mild-to-large molecular weight better. HD/HP can remove metabolites, toxin, and pathogenic factors and regulate the water, electrolyte and acid-base balance to improve the quality of patient’s sleep and appetite also reduces itching of the skin, which in turn improve the quality and life expectancy. This research was a cross sectional research with a pre-experimental design conducted from July to September 2015 with 17 regular hemodialysis patients as samples. Inclusion criteria were regular hemodialysis patients and willingly participated in the research. The assessmentwas conducted using BDI to assess depression. To obtained the results, data were analyzed using T-Test and showed that that the average BDI score before the combination of HD/HP 18.59±9 to 8.18±2.83 after the combination (p<0.001). In conclusion, combination HD/HP can lower depression scores in patients with regular HD.

Blood Transfusions in Dogs and Cats Receiving Hemodialysis: 230 Cases (June 1997-September 2012).

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Langston, C; Cook, A; Eatroff, A; Mitelberg, E; Chalhoub, S

2017-03-01

Multiple factors exist that contribute to anemia in dogs and cats receiving hemodialysis, can necessitate transfusion. To describe blood product usage in dogs and cats with acute and chronic kidney disease that were treated with intermittent hemodialysis to determine risk factors associated with the requirement for blood product transfusion. 83 cats and 147 dogs undergoing renal replacement therapy at the Animal Medical Center for acute or chronic kidney disease. Retrospective medical record review of all dogs and cats receiving renal replacement therapy for kidney disease, from June 1997 through September 2012. Blood products (whole blood, packed RBCs, or stromal-free hemoglobin) were administered to 87% of cats and 32% of dogs. The number of dialysis treatments was associated with the requirement for transfusion in cats (adjusted OR 2.21, 95% CI 1.13, 4.32), but not in dogs (adjusted OR 0.98, 95% CI 0.95, 1.03). Administration of a blood product was associated with a higher likelihood of death in dogs (OR 3.198, 95% CI 1.352, 7.565; P = .0098), but not in cats (OR 1.527, 95% CI 0.5404, 4.317, P = .2). Veterinary hospitals with a hemodialysis unit should have reliable and rapid access to safe blood products in order to meet the needs of dogs and cats receiving dialysis. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

The role of secondary hyperparathyroidism in left ventricular hypertrophy of patients under chronic hemodialysis

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Randon R.B.

2005-01-01

Full Text Available End-stage renal disease (ESRD patients frequently develop structural cardiac abnormalities, particularly left ventricular hypertrophy (LVH. The mechanisms involved in these processes are not completely understood. In the present study, we evaluated a possible association between parathyroid hormone (PTH levels and left ventricular mass (LVM in patients with ESRD. Stable uremic patients on intermittent hemodialysis treatment were evaluated by standard two-dimensional echocardiography and their sera were analyzed for intact PTH. Forty-one patients (mean age 45 years, range 18 to 61 years, 61% males, who had been on hemodialysis for 3 to 186 months, were evaluated. Patients were stratified into 3 groups according to serum PTH: low levels (280 pg/ml; group III = 21 patients. A positive statistically significant association between LVM index and PTH was identified (r = 0.34; P = 0.03, Pearson's correlation coefficient in the sample as a whole. In subgroup analyses, we did not observe significant associations in the low and intermediate PTH groups; nevertheless, PTH and LVM index were correlated in patients with high PTH levels (r = 0.62; P = 0.003. LVM index was also inversely associated with hemoglobin (r = -0.34; P = 0.03. In multivariate analysis, after adjustment for age, hemoglobin, body mass index, and blood pressure, the only independent predictor of LVM index was PTH level. Therefore, PTH is an independent predictor of LVH in patients undergoing chronic hemodialysis. Secondary hyperparathyroidism may contribute to the elevated cardiovascular morbidity associated with LVH in ESRD.

Designing a model to minimize inequities in hemodialysis facilities distribution

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Teresa M. Salgado

2011-11-01

Full Text Available Portugal has an uneven, city-centered bias in the distribution of hemodialysis centers found to contribute to health care inequities. A model has been developed with the aim of minimizing access inequity through the identification of the best possible localization of new hemodialysis facilities. The model was designed under the assumption that individuals from different geographic areas, ceteris paribus, present the same likelihood of requiring hemodialysis in the future. Distances to reach the closest hemodialysis facility were calculated for every municipality lacking one. Regions were scored by aggregating weights of the “individual burden”, defined as the burden for an individual living in a region lacking a hemodialysis center to reach one as often as needed, and the “population burden”, defined as the burden for the total population living in such a region. The model revealed that the average travelling distance for inhabitants in municipalities without a hemodialysis center is 32 km and that 145,551 inhabitants (1.5% live more than 60 min away from a hemodialysis center, while 1,393,770 (13.8% live 30-60 min away. Multivariate analysis showed that the current localization of hemodialysis facilities is associated with major urban areas. The model developed recommends 12 locations for establishing hemodialysis centers that would result in drastically reduced travel for 34 other municipalities, leaving only six (34,800 people with over 60 min of travel. The application of this model should facilitate the planning of future hemodialysis services as it takes into consideration the potential impact of travel time for individuals in need of dialysis, as well as the logistic arrangements required to transport all patients with end-stage renal disease. The model is applicable in any country and health care planners can opt to weigh these two elements differently in the model according to their priorities.

Hemodialysis, plea of availability versus adequecy gezira experience

African Journals Online (AJOL)

Methods: Pre and post hemodialysis blood sample were obtained from the study ... duration of hemodialysis session, increase blood flow rate and dialysate flow rate. ... renal replacement therapy (peritoneal dialysis and renal transplantations).

Association of conjunctival and corneal calcification with vascular calcification among hepatitis-C-seropositive hemodialysis patients.

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AbouSeif, Khaled; Sany, Dawlat; Elshahawy, Yasser; Seddik, Ayman; Rahman, Khedr; Gaber, Moustapha

2016-01-01

Disorders associated with the hepatitis C virus (HCV) have been reported including cardiovascular, metabolic, and central nervous system diseases. Since chronic HCV infections may be curable, their identification as causal contributors to cardiovascular risk could offer new perspectives in the prevention of cardiovascular disease. The aim of this study is to investigate the association between HCV and aortic arch calcification (AAC) and corneal and conjunctival calcification (CCC) in maintenance hemodialysis (MHD) patients; further, we assessed the correlation of CCC with vascular calcification. A total of 100 patients undergoing hemodialysis (HD) in our hospital were included in this study. Patients underwent a complete ocular examination including intraocular pressure, and CCC was looked for by slit lamp and fundoscopy. CCC was graded according to modified Porter and Crombie classification system described by Tokuyama et al. Helical computerized tomographic chest examination was used to evaluate the grading of AAC. Demographic, hematological, biochemical, and dialysis-related data were obtained. There was significant difference between seropositive (n = 51) and seronegative patients (n = 49) regarding grading of AAC and CCC (P <0.001). Significant positive correlation was found between grading of CCC, AAC, age (P <0.001), duration on HD (P <0.001), HCV-antibody positivity (P <0.001), serum calcium level (P <0.001), serum phosphorus level (P <0.001), calcium × phosphorus product (P <0.001), and i-parathormone level (P < 0.001). In addition, CCC grading positively correlated with AAC. Our results suggest that patients undergoing HD infected with the HCV have high degree of CCC, AAC, and mineral metabolism disorder. The strong correlation between CCC and AAC indicates that CCC evaluation is an easy, fast, non-invasive method, and might be used as an indirect indicator to detect vascular calcification in patients undergoing MHD.

Association of conjunctival and corneal calcification with vascular calcification among hepatitis-C-seropositive hemodialysis patients

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Khaled AbouSeif

2016-01-01

Full Text Available Disorders associated with the hepatitis C virus (HCV have been reported including cardiovascular, metabolic, and central nervous system diseases. Since chronic HCV infections may be curable, their identification as causal contributors to cardiovascular risk could offer new perspectives in the prevention of cardiovascular disease. The aim of this study is to investigate the association between HCV and aortic arch calcification (AAC and corneal and conjunctival calcification (CCC in maintenance hemodialysis (MHD patients; further, we assessed the correlation of CCC with vascular calcification. A total of 100 patients undergoing hemodialysis (HD in our hospital were included in this study. Patients underwent a complete ocular examination including intraocular pressure, and CCC was looked for by slit lamp and fundoscopy. CCC was graded according to modified Porter and Crombie classification system described by Tokuyama et al. Helical computerized tomographic chest examination was used to evaluate the grading of AAC. Demographic, hematological, biochemical, and dialysis-related data were obtained. There was significant difference between seropositive (n = 51 and seronegative patients (n = 49 regarding grading of AAC and CCC (P <0.001. Significant positive correlation was found between grading of CCC, AAC, age (P <0.001, duration on HD (P <0.001, HCV-antibody positivity (P <0.001, serum calcium level (P <0.001, serum phosphorus level (P <0.001, calcium × phosphorus product (P <0.001, and i-parathormone level (P < 0.001. In addition, CCC grading positively correlated with AAC. Our results suggest that patients undergoing HD infected with the HCV have high degree of CCC, AAC, and mineral metabolism disorder. The strong correlation between CCC and AAC indicates that CCC evaluation is an easy, fast, non-invasive method, and might be used as an indirect indicator to detect vascular calcification in patients undergoing MHD.

Pruritus in hemodialysis patients: Results from Fresenius dyalisis center, Banja Luka, Bosnia and Herzegovina

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Zoran Vrucinic

2015-07-01

Full Text Available Introduction: Uremic pruritus (UP is a common and distressing complication of end-stage renal disease (ESRD. Aglobal cross-sectional study of 18,000 hemodialysis patientsreported a 42% prevalence of moderate or extreme UP, which was strongly associated with sleep disturbance, depression, impaired quality of life, and mortality. Pruritus is commonly encountered in individuals with end-stage renal disease (ESRD on hemodialysis (HD. Materials and Methods: This cross-sectional study was performed in order to find out the prevalence of pruritus in patients on regular maintenance hemodialysis (HD as well as to analyze its relationship to age, sex of the patient, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose, parameters in the beggining of the study and six months after. The data were analyzed by descriptive statistics- Wilcoxon Signed Rank Test and Chi-square test with Yates correction factor. Results: Sixty and two patients with ESRD (age ranging from 31 to 87years free from systemic, skin or psychiatric disorders and other secondary causes attributable to pruritis, undergoing maintenance HD (duration on HD 4-348months; mean 86.97 and median 79,5months at Fresenius dialysis center, Banja Luka, Bosnia and Herzegovina were evaluated for pruritus. Pruritus has been discovered in 21 out of 34males (54,8% and 6 out of 28females (22,2%. Our study as many others showed that pruritus is very common (45.2% in HD patients. Applying c2 test with Yates correction factor is highly statistically significant (c2 = 8.003, p = 0.005 by gender. Research of the gender revealed that pruritus appeared more in men analysis. There were no significant differences between other measured markers: to age, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose in patients with pruritus and in patients without pruritus. Conclusions:This first cross-sectional study

Evaluation of obesity in hemodialysis patients-relationship between visceral fat obesity and lipometabolism

International Nuclear Information System (INIS)

Tsushima, Megumi; Terayama, Yuriko; Fukuhara, Youko; Yamaya, Kanemitsu; Mizuno, Hiroshi; Saitoh, Hisao; Mikuni, Tsuneyasu; Momose, Akishi; Funyu, Tomihisa

2006-01-01

Due to various metabolic disorders, especially dyslipidemia, in patients undergoing dialysis, the prevailing reference values of indices for determining obesity may differ from those used in the general population. To clarify visceral fat levels indicating obesity in dialysis patients, we analyzed indices for determining obesity and lipid profiles, and compared the data between dialysis patients and control subjects with normal renal function. This study was conduced in 75 hemodialysis patients (HD group) aged 61.0 y on average and 58 control subjects (control group) aged 44.5 y on average. We calculated body mass index (BMI), waist circumference at the umbilical level (W), waist-height ratio (W/Ht) and evaluated visceral and subcutaneous fat areas using computed tomography (CT) at the level of the umbilicus. In addition, we measured postprandial total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) in the serum and calculated the ratios, (TC-HDL-C)/HDL-C and TG/TC. Visceral fat area, (TC-HDL-C)/HDL-C and TG/TC in HD group were 58.1 cm 2 , 2.31 and 0.74, which were significantly higher than those in the control group (37.4 cm 2 , 1.95 and 0.52), respectively. A significant positive correlation was found between visceral fat area and BMI, W, and W/Ht in both groups. In control subjects, visceral fat area was highly correlated with (TC-HDL-C)/HDL-C (r=0.532, p less than 0.0001), and with TG/TC (r=0.286, p=0.0296). In contrast, visceral fat area in hemodialysis patients was highly correlated with (TC-HDL-C)/HDL-C (r=0.397, p=0.0004), and with TG/TC (r=0.568, p less than 0.0001). Our study demonstrated that visceral fat accumulation in hemodialysis patients increased irrespective of BMI, and the standard criteria for obesity using BMI would be unsuitable. Furthermore, we identified a novel indicator, non-fasting TG/TC, which seems to indicate visceral fat obesity in hemodialysis patients. (author)

Evaluation of obesity in hemodialysis patients-relationship between visceral fat obesity and lipometabolism

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Tsushima, Megumi; Terayama, Yuriko; Fukuhara, Youko; Yamaya, Kanemitsu; Mizuno, Hiroshi; Saitoh, Hisao; Mikuni, Tsuneyasu; Momose, Akishi; Funyu, Tomihisa [Oyokyo Kidney Research Inst., Hirosaki, Aomori (Japan)

2006-07-15

Due to various metabolic disorders, especially dyslipidemia, in patients undergoing dialysis, the prevailing reference values of indices for determining obesity may differ from those used in the general population. To clarify visceral fat levels indicating obesity in dialysis patients, we analyzed indices for determining obesity and lipid profiles, and compared the data between dialysis patients and control subjects with normal renal function. This study was conduced in 75 hemodialysis patients (HD group) aged 61.0 y on average and 58 control subjects (control group) aged 44.5 y on average. We calculated body mass index (BMI), waist circumference at the umbilical level (W), waist-height ratio (W/Ht) and evaluated visceral and subcutaneous fat areas using computed tomography (CT) at the level of the umbilicus. In addition, we measured postprandial total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) in the serum and calculated the ratios, (TC-HDL-C)/HDL-C and TG/TC. Visceral fat area, (TC-HDL-C)/HDL-C and TG/TC in HD group were 58.1 cm{sup 2}, 2.31 and 0.74, which were significantly higher than those in the control group (37.4 cm{sup 2}, 1.95 and 0.52), respectively. A significant positive correlation was found between visceral fat area and BMI, W, and W/Ht in both groups. In control subjects, visceral fat area was highly correlated with (TC-HDL-C)/HDL-C (r=0.532, p less than 0.0001), and with TG/TC (r=0.286, p=0.0296). In contrast, visceral fat area in hemodialysis patients was highly correlated with (TC-HDL-C)/HDL-C (r=0.397, p=0.0004), and with TG/TC (r=0.568, p less than 0.0001). Our study demonstrated that visceral fat accumulation in hemodialysis patients increased irrespective of BMI, and the standard criteria for obesity using BMI would be unsuitable. Furthermore, we identified a novel indicator, non-fasting TG/TC, which seems to indicate visceral fat obesity in hemodialysis patients. (author)

Are PTH levels related to oxidative stress and inflammation in chronic kidney disease patients on hemodialysis?

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Marcel Jaqueto

Full Text Available Abstract Introduction: Patients at end stage renal disease have higher levels of inflammation and oxidative stress than the general population. Many factors contribute to these issues, and the parathyroid hormone (PTH is also implicated. Objective: The study was conducted in order to assess the relationship between PTH levels and inflammation and oxidative stress in hemodialysis patients. Methods: Cross-sectional study with patients of two hemodialysis facilities in Londrina, Brazil. Patients with other conditions known to generate oxidative stress and inflammation were excluded. Blood levels of PTH and biochemical parameters of inflammation (interleukins 1 and 6, tumor necrosis factor-alpha and oxidative stress (total plasma antioxidant capacity, malonic dialdehyde, lipid hydroperoxidation, advanced oxidation protein products, quantification of nitric oxide metabolites, and 8-isoprostane were measured before a dialysis session. Then, we made correlation analyses between PTH levels - either as the continuous variable or categorized into tertiles-, and inflammatory and oxidative stress biomarkers. Results: PTH did not show any correlation with the tested inflammation and oxidative stress parameters, nor as continuous variable neither as categorical variable. Conclusion: In this descriptive study, the results suggest that the inflammation and oxidative stress of hemodialysis patients probably arise from mechanisms other than secondary hyperparathyroidism.

Orofacial Disorders of Patients with End Stage Renal Disease Undergoing Haemodialysis

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Yohana Gowara

2015-05-01

Full Text Available Several orofacial disorders in patients with end stage renal disease (ESRD undergoing hemodialysis have been reported. However, up to the present, particularly in Indonesia, such data still limited. Objective: the purpose of this study was to assess the orofacial disorders in patients with ESDR undergoing hemodialysis at Cipto Mangunkusumo Hospital, Indonesia. Methods: The study was conducted through observation using a cross-sectional design. The subjects were selected by consecutive sampling. Ninety-three patients fulfilled the inclusion criteria and enrolled in this study. They participated in the structural interview-using questionnaire assessing subjective complaints; clinical examinations; and salivary measurements. Results: Xerostomia (82.8% dysgeusia (66.7%, metal taste (57%, perioral anesthesia (24.7% were the common symptoms. Clinical findings consisted of tongue coating (100%, calculus deposits (97.8%, pallor of oral mucous (94.6%, sialosis (75.3%, uremic odor (40,9%, haemorrhagic spot (39.8%, angular cheilitis (37.7%, gingival bleeding (15.1%, and oral candidiasis (3.2% were also found. Salivary changes showed the increase of salivary viscosity (86%, pH (80.6%, buffer capacity (76.3% whereas decrease of mucous hydration level (79.6% and the flow rates of unstimulated (22.6% and stimulated (31.2% whole saliva were observed. Conclusion: The findings of orofacial disorders required attention and further comprehensive management to enhance the quality of life of patients with ESDR.DOI: 10.14693/jdi.v21i3.262

Quality Assurance Audit of Technique Failure and 90-Day Mortality after Program Discharge in a Canadian Home Hemodialysis Program.

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Shah, Nikhil; Reintjes, Frances; Courtney, Mark; Klarenbach, Scott W; Ye, Feng; Schick-Makaroff, Kara; Jindal, Kailash; Pauly, Robert P

2017-07-24

Little is known about patients exiting home hemodialysis. We sought to characterize the reasons, clinical characteristics, and pre-exit health care team interactions of patients on home hemodialysis who died or underwent modality conversion (negative disposition) compared with prevalent patients and those who were transplanted (positive disposition). We conducted an audit of all consecutive patients incident to home hemodialysis from January of 2010 to December of 2014 as part of ongoing quality assurance. Records were reviewed for the 6 months before exit, and vital statistics were assessed up to 90 days postexit. Ninety-four patients completed training; 25 (27%) received a transplant, 11 (12%) died, and 23 (25%) were transferred to in-center hemodialysis. Compared with the positive disposition group, patients in the negative disposition group had a longer mean dialysis vintage (3.15 [SD=4.98] versus 1.06 [SD=1.16] years; P =0.003) and were performing conventional versus a more intensive hemodialysis prescription (23 of 34 versus 23 of 60; P <0.01). In the 6 months before exit, the negative disposition group had significantly more in-center respite dialysis sessions, had more and longer hospitalizations, and required more on-call care team support in terms of phone calls and drop-in visits (each P <0.05). The most common reason for modality conversion was medical instability in 15 of 23 (65%) followed by caregiver or care partner burnout in three of 23 (13%) each. The 90-day mortality among patients undergoing modality conversion was 26%. Over a 6-year period, approximately one third of patients exited the program due to death or modality conversion. Patients who die or transfer to another modality have significantly higher health care resource utilization ( e.g. , hospitalization, respite treatments, nursing time, etc. ). Copyright © 2017 by the American Society of Nephrology.

The Effect of Interdialytic Combined Resistance and Aerobic Exercise Training on Health Related Outcomes in Chronic Hemodialysis Patients: The Tunisian Randomized Controlled Study

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Bechir Frih

2017-05-01

Full Text Available Background: Tunisia has the highest prevalence of hemodialysis patients compared to the other countries in North Africa. Dialysis centers rarely offer an exercise program to prevent physiological and psychological dialysis therapy-related alterations in chronic hemodialysis patients.Aim: To examine the effect of combined endurance-resistance training program on physiological and psychological outcomes in patients undergoing hemodialysis.Methods: We designed a single blinded, randomized, controlled study for a period of 4 months. Patients were randomized to intervention group or control group. Intervention group patients received 4 training sessions per week, held on non-hemodialysis days for a period of 4 months, whereas control group patients continued their regular lifestyle practice without direct intervention from the personnel of this investigation. Patients were evaluated at baseline (initial assessment and after the four-month study period (final assessment by the same investigator blinded to treatment group assignment using physical, physiological, and psychological measurements.Results: Compared with control group, intervention group showed significant improvement in physical performance during the sit-to-stand-to-sit tests (STS-10: −16.2%, ES = −1.65; STS-60: +23.43%, ES = 1.18, handgrip force task (+23.54%, ES = 1.16, timed up and go test (−13.86%, ES = −1.13, and 6-min walk test (+15.94%, ES = 2.09. Likewise, mini nutritional assessment long form scores after intervention period were significantly higher in the intervention group compared to the control group (ES = 1.43. Physical and mental component scores of SF-36 questionnaire increased significantly in the intervention group (ES = 1.10 and ES = 2.06, respectively, whereas hospital anxiety and depression scale scores decreased significantly (ES = −1.65 and ES = −2.72, respectively. Regarding biological parameters, intervention group displayed improvement in systolic

Post-marketing surveillance study of the safety and efficacy of nalfurafine hydrochloride (Remitch® capsules 2.5 μg in 3,762 hemodialysis patients with intractable pruritus

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Kozono H

2018-01-01

Full Text Available Hideki Kozono,* Hiroshi Yoshitani,* Ryoko Nakano* Pharmaceutical and Medical Device Vigilance Department, Toray Industries, Inc., Tokyo, Japan *The authors contributed equally to this work Background: Intractable pruritus in hemodialysis patients can significantly decrease their quality of life and is also associated with poor vital prognosis. Although combined multiple causes of intractable pruritus in these patients have been identified, no existing treatments are proven to be sufficiently effective. We conducted a post-marketing surveillance to follow-up and assess the safety and efficacy of nalfurafine, a selective κ-opioid receptor agonist, for the treatment of intractable pruritus in patients undergoing hemodialysis. Patients and methods: Hemodialysis patients with intractable pruritus from institutions in Japan who received oral nalfurafine hydrochloride between January 2010 and December 2013 were enrolled in the surveillance. Surveillance was completed in July 2015. Safety data during 1 year after nalfurafine treatment onset, and efficacy data of nalfurafine evaluating the first 12-week treatment period and the following period until 1 year after the initial dose of nalfurafine (using global assessment of the itch improvement by the physician, Visual Analog Scale, and the Shiratori’s severity scores were collected and analyzed. Results: In total, 3,762 patients were analyzed for safety. Adverse drug reactions were experienced by 402/3,762 (10.69% patients. The most frequent adverse drug reactions were insomnia (127/3,762 [3.38%] patients, constipation (34 [0.90%], somnolence (32 [0.85%], dizziness (23 [0.61%], nausea (13 [0.35%], and malaise (9 [0.24%]. No patients developed dependence on nalfurafine. Nalfurafine was effective in 82.50% (2,880/3,491 of patients during the first 12 weeks and in 84.95% (2,167/2,551 on treatment during the subsequent period until 1 year after nalfurafine treatment initiation. Statistically significant

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop.

Science.gov (United States)

Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C; O'Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny I; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C

2017-01-01

Evidence-informed decision making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient centered. The Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis therapy. Key stakeholders including 8 patients/caregivers and 47 health professionals (nephrologists, policymakers, industry, and researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations, flexibility to consider evolving priorities over time, deconstruction of language and meaning for conceptual consistency and clarity, understanding of potential overlap and associations between outcomes, and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive, and validated outcome measures that could be used in clinical care (quality indicators) and trials (including pragmatic trials) and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment and improved patient outcomes. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Establishing Core Outcome Domains in Hemodialysis: Report of the Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Consensus Workshop

Science.gov (United States)

Tong, Allison; Manns, Braden; Hemmelgarn, Brenda; Wheeler, David C.; Evangelidis, Nicole; Tugwell, Peter; Crowe, Sally; Van Biesen, Wim; Winkelmayer, Wolfgang C.; O’Donoghue, Donal; Tam-Tham, Helen; Shen, Jenny; Pinter, Jule; Larkins, Nicholas; Youssouf, Sajeda; Mandayam, Sreedhar; Ju, Angela; Craig, Jonathan C.

2017-01-01

Evidence-informed decision-making in clinical care and policy in nephrology is undermined by trials that selectively report a large number of heterogeneous outcomes, many of which are not patient-centered. The Standardized Outcomes in Nephrology−Hemodialysis (SONG-HD) Initiative convened an international consensus workshop on November 7, 2015, to discuss the identification and implementation of a potential core outcome set for all trials in hemodialysis. The purpose of this article is to report qualitative analyses of the workshop discussions, describing the key aspects to consider when establishing core outcomes in trials involving patients on hemodialysis. Key stakeholders including eight patients/caregivers and 47 health professionals (nephrologists, policy makers, industry, researchers) attended the workshop. Attendees suggested that identifying core outcomes required equitable stakeholder engagement to ensure relevance across patient populations; flexibility to consider evolving priorities over time; deconstruction of language and meaning for conceptual consistency and clarity; understanding of potential overlap and associations between outcomes; and an assessment of applicability to the range of interventions in hemodialysis. For implementation, they proposed that core outcomes must have simple, inexpensive and validated outcome measures that could be used in clinical care (quality ndicators) and trials (including pragmatic trials), and endorsement by regulatory agencies. Integrating these recommendations may foster acceptance and optimize the uptake and translation of core outcomes in hemodialysis, leading to more informative research, for better treatment, and improved patient outcomes. PMID:27497527

Effect of Hemodialysis on Left and Right Ventricular Volume and Function

International Nuclear Information System (INIS)

Han, Jin Suk; Koh, Chang Soon

1985-01-01

With the improvement of hemodialysis, the course of thc discase in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate: reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (carly and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodialysis, 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe du to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.

Effect of Hemodialysis on Left and Right Ventricular Volume and Function

Energy Technology Data Exchange (ETDEWEB)

Han, Jin Suk; Koh, Chang Soon [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1985-09-15

With the improvement of hemodialysis, the course of thc discase in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate: reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (carly and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodialysis, 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe du to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.

Survival with Three-Times Weekly In-Center Nocturnal Versus Conventional Hemodialysis

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Xu, Jianglin; Suri, Rita S.; Nesrallah, Gihad; Lindsay, Robert; Garg, Amit X.; Lester, Keith; Ofsthun, Norma; Lazarus, Michael; Hakim, Raymond M.

2012-01-01

Whether the duration of hemodialysis treatments improves outcomes remains controversial. Here, we evaluated survival and clinical changes associated with converting from conventional hemodialysis (mean=3.75 h/treatment) to in-center nocturnal hemodialysis (mean=7.85 h/treatment). All 959 consecutive patients who initiated nocturnal hemodialysis for the first time in 77 Fresenius Medical Care facilities during 2006 and 2007 were eligible. We used Cox models to compare risk for mortality during 2 years of follow-up in a 1:3 propensity score–matched cohort of 746 nocturnal and 2062 control patients on conventional hemodialysis. Two-year mortality was 19% among nocturnal hemodialysis patients compared with 27% among conventional patients. Nocturnal hemodialysis associated with a 25% reduction in the risk for death after adjustment for age, body mass index, and dialysis vintage (hazard ratio=0.75, 95% confidence interval=0.61–0.91, P=0.004). With respect to clinical features, interdialytic weight gain, albumin, hemoglobin, dialysis dose, and calcium increased on nocturnal therapy, whereas postdialysis weight, predialysis systolic blood pressure, ultrafiltration rate, phosphorus, and white blood cell count declined (all P<0.001). In summary, notwithstanding the possibility of residual selection bias, conversion to treatment with nocturnal hemodialysis associates with favorable clinical features, laboratory biomarkers, and improved survival compared with propensity score–matched controls. The potential impact of extended treatment time on clinical outcomes while maintaining a three times per week hemodialysis schedule requires evaluation in future clinical trials. PMID:22362905

[Effects of midodrine on symptomatic hypotension during hemodialysis].

Science.gov (United States)

Cotera, Alejandro; Alvo, Miriam; Sanhueza, María Eugenia; Elgueta, Leticia; Gormaz, Juan Pablo; Ibáñez, Carlos; Cuadra, Cristián

2002-09-01

Hypotension occurs in 20% of hemodialysis procedures. To study the effects of midodrine on hypotension during hemodialysis. Ten patients on chronic hemodialysis and with a history of hypotension during the procedure, were studied. They received midodrine 10 mg per os or placebo during 5 dialytic procedures each, in a double blind cross over design. Blood pressure levels prior to dialysis were similar during the midodrine or placebo administration periods. During dialysis, systolic blood pressure fell 19.3 +/- 28 mmHg with midodrine and 23.4 +/- 28 mmHg with placebo. Diastolic blood pressure fell 7.3 +/- 11.5 mmHg with midodrine and 11.1 +/- 12 mmHg with placebo. The reduction in median arterial pressure was also less pronounced with midodrine. Midodrine lessens the fall in arterial pressure during hemodialysis, in patients with symptomatic hypotension.

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

DEFF Research Database (Denmark)

Joffe, P; Olsen, F; Heaf, J G

1989-01-01

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 d...

Clinical Performance of a Salivary Amylase Activity Monitor During Hemodialysis Treatment

Directory of Open Access Journals (Sweden)

Masaru Shimazaki

2008-01-01

Full Text Available The hemodialysis procedure is thought to be a physical stressor in the majority of hemodialyzed patients. Previous studies suggest that elevated salivary amylase level may correlate with increased plasma norepinephrine level under psychological and physical stress conditions. In this study, we investigated biological stress reactivity during hemodialysis treatment using salivary amylase activity as a biomarker. Seven patients (male/female = 5/2, age:67.7+ /− 5.9 years who had been receiving regular 4 h hemodialysis were recruited. Salivary amylase activity was measured using a portable analyzer every hour during the hemodialysis session. Salivary amylase activity was shown to be relatively stable and constant throughout hemodialysis, whereas there were significant changes in systolic blood pressure and pulse rate associated with blood volume reduction. Our results show that hemodialysis treatment per se dose not affect salivary amylase activity.

Effect of Treatment Education Based on the Roy Adaptation Model on Adjustment of Hemodialysis Patients.

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Kacaroglu Vicdan, Ayse; Gulseven Karabacak, Bilgi

2016-01-01

The Roy Adaptation Model examines the individual in 4 fields: physiological mode, self-concept mode, role function mode, and interdependence mode. Hemodialysis treatment is associated with the Roy Adaptation Model as it involves fields that might be needed by the individual with chronic renal disease. This research was conducted as randomized controlled experiment with the aim of determining the effect of the education given in accordance with the Roy Adaptation Model on physiological, psychological, and social adaptation of individuals undergoing hemodialysis treatment. This was a random controlled experimental study. The study was conducted at a dialysis center in Konya-Aksehir in Turkey between July 1 and December 31, 2012. The sample was composed of 82 individuals-41 experimental and 41 control. In the second interview, there was a decrease in the systolic blood pressures and body weights of the experimental group, an increase in the scores of functional performance and self-respect, and a decrease in the scores of psychosocial adaptation. In the control group, on the other hand, there was a decrease in the scores of self-respect and an increase in the scores of psychosocial adaptation. The 2 groups were compared in terms of adaptation variables and a difference was determined on behalf of the experimental group. The training that was provided and evaluated for individuals receiving hemodialysis according to 4 modes of the Roy Adaptation Model increased physical, psychological, and social adaptation.

Using Medical-Device Wearable to Improve Hemodialysis Patient’s Live and Access the Holistic Health

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Chen, W. L.; Wu, C.-C.; Kan, C. D.

2017-06-01

The increasing incidence of end-stage renal disease (ESRD) is the major burden to health budgets and a threat to public health worldwide. For many years, Taiwan has been ranked the first in the world for the number of hemodialysis patients. For solving the above-mentioned circumstance, we demonstrate the project, here, which goal is to construct the holistic health for hemodialysis patient. The project is to design a wearable medicine-device which can simultaneously measure and monitor the vital sign, including heart rate (HR), pulse oximetry (SPO2), continuous non-invasive blood pressure (c-NIBP), and total body water (TBW), of hemodialysis patient. By aid of the device we design, hemodialysis patients will get better health care than before. This device comprises three techniques. The first is named “Using phonoangiography technique to early detect the dysfunction of arteriovenous access by arteriovenous access (AVA) stenosis detector”. The stenosis detector based on autoregressive model was employed to simultaneously estimate the status of AVA life cycle and to tract changes in frequency spectra. It helps hemodialysis patients to early detect the dysfunction of AVA and alarms them to make a return visit. The second technique is named “Physiological detecting device for wearable medical device and encoding algorithm development”. The feature of the second technique is to optimize the prognosis by analyzing physiological signals, including water content index, pulse oximetry, and blood pressure in the meanwhile. The third technique is named “Intelligent and smart tourniquet”. This technique aims to preclude AVA dysfunction caused by inappropriate hemostasis.

Hepatitis C Is Less Aggressive in Hemodialysis Patients than in Nonuremic Patients

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Trevizoli, Jose Eduardo; de Paula Menezes, Raissa; Ribeiro Velasco, Lara Franciele; Amorim, Regina; de Carvalho, Mauro Birche; Mendes, Liliana Sampaio; Neto, Columbano Junqueira; de Deus Macedo, José Roberto; de Assis, Francisco; Neves, Rocha

2008-01-01

Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function. Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection. Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P = 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio = 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001). Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV. PMID:18650408

Erectile Dysfunction in Males on Hemodialysis

International Nuclear Information System (INIS)

Haider, E.; Iftikhar, R.; Ghazanfar, A.; Afzal, M.; Mir, A. W.; Mansoor, K.; Taj, R.; Samiullah, R.

2013-01-01

Objective: The determine the frequency of erectile dysfunction in males on hemodialysis. Study Design: Descriptive study. Place and duration: Hemodialysis unit, Combined Military Hospital Kharian from October 2011 to April 2012. Patients and Methods: A total of 150 married male patients of end stage renal disease (ESRD) on hemodialysis were included in the study. Patients with cognitive and/or communication deficits and on hemodialysis for less than 06 months were excluded from the study. Erectile dysfunction (ED) was assessed using International Index of Erectile Function-5 (IIEF-5). Frequency of erectile dysfunction (ED) was analyzed using Statistical Package for Social Sciences (SPSS) version 17. Results: Mean age of the patients were 52.89 = 8.25 years. Mean duration of hemodialysis was 34 +- 9.62 months. The underlying etiology of end stage renal disease were diabetic nephropathy 69(46%), hypertensive nephropathy 51(34%), obstructive nephropathy 18(12%), glomerulonephritis 9(6%), autosomal polycystic kidney disease 3(2%). Mean IIEF-5 score was 13.29 +- 6.38. The frequency of erectile dysfunction was 74%. The majority of the patients, 73(48.7%) had moderate erectile dysfunction, while 24 (16%) had severe and 14 (9.3%) had mild erectile dysfunction. Out of total 150 patients enrolled, 39 (26%) patients had no erectile dysfunction. Conclusion: ED is a highly prevalent problem in men with ESRD. Physicians are urged to recognize the high prevalence of erection problems in men with ESRD and proactively question all patients regarding their sexual function. This will not only improve the recognition of this condition among these patients but also improve the quality of life after adequate treatment. (author)

Estimation of parameters biokinetics from the resolution of a model compartment for I-131. Application to a patient with thyroid carcinoma hemodialysis

International Nuclear Information System (INIS)

Garcia, R.; Jimenez Feltstrom, D.; Luis dimon, F. J.; Sanchez Carmona, G.; Herrador Cordoba, M.

2013-01-01

This work aims to define a biokinetic model for the I-131, and solve it for different conditions of the patient or person affected (normal, with cancer of the thyroid or hyperthyroid). Solve the model in the case of a patient treated with I-131 for ablation of thyroid remnants with undergoing renal insufficiency and hemodialysis . Get the parameters Biokinetic this model for different situations. (Author)

Tinzaparin is safe and effective in the management of hemodialysis catheter thrombosis.

LENUS (Irish Health Repository)

Quinlan, Catherine

2012-08-27

Children on hemodialysis are at increased risk of thrombosis, especially when dialyzed via a central venous catheter (CVC); there are limited published data regarding the safety and efficacy of tinzaparin in this group. We conducted a retrospective chart review of all children in the National Pediatric Hemodialysis Centre for Ireland diagnosed with a CVC thrombus and treated with subcutaneous tinzaparin over a 10 year period. Seven children were treated with subcutaneous tinzaparin for 10 CVC thrombi. Tinzaparin was commenced at 175 IU\\/kg\\/day and the dose was titrated by measuring anti-factor Xa levels, aiming for levels of 0.3-1.0 IU\\/ml. Treatment was continued until resolution of the CVC thrombus. Restoration of normal flows during dialysis occurred within 3 days in all patients. There were no episodes of bleeding and all children tolerated the treatment well.

Proteomic Profiling in Early Venous Stenosis Formation in a Porcine Model of Hemodialysis Graft

Science.gov (United States)

Misra, Sanjay; Fu, Alex A.; Puggioni, Alessandra; Glockner, James F.; McKusick, Michael A.; Bjarnason, Haraldur; Mukhopadhyay, Debabrata

2009-01-01

PURPOSE To use proteomic analysis to identify up- and downregulated proteins in early venous stenosis formation in a porcine model of hemodialysis graft failure. MATERIALS AND METHODS Pigs had chronic renal insufficiency created by subtotal renal infarction caused by renal artery embolization. Arteriovenous polytetrafluoroethylene grafts were placed 28 days later and the animals were killed after a further 3 days (n = 4), 7 days (n = 4), or 14 days (n = 4). Proteomic analysis with isotope-coded affinity tags and multidimensional liquid chromatography followed by tandem mass spectrometry was performed on the venous stenosis and control vessels. Expression of proteins was further confirmed by Western blot analysis. The blood urea nitrogen (BUN) and creatinine levels were determined before renal artery embolization and at the time of graft placement. RESULTS At graft placement, mean BUN and creatinine levels were significantly higher than before embolization (P < .05). Six proteins were identified that were common to all four animals at the same time point. Five proteins (α-fetoprotein, fetuin A, macrophage migration inhibitory factor, pyruvate dehydrogenase E1 component, and lactoferrin) were upregulated and one protein (decorin) was downregulated. Expression of macrophage migration inhibitory factor, α-fetoprotein, and lactoferrin was further validated with Western blotting. By day 14, lactoferrin and fetuin-A expression were increased significantly in early venous stenosis formation. CONCLUSIONS Significantly increased expression of lactoferrin and fetuin-A were observed in early venous stenosis by day 14. Understanding the role of lactoferrin and fetuin-A in hemodialysis vascular access failure could help in improving outcomes in patients undergoing hemodialysis. PMID:19028119

Impact of neuromuscular electrical stimulation on functional capacity of patients with chronic kidney disease on hemodialysis.

Science.gov (United States)

Roxo, Renata Spósito; Xavier, Vivian Bertoni; Miorin, Luiz Antônio; Magalhães, Andrea Olivares; Sens, Yvoty Alves Dos Santos; Alves, Vera Lúcia Dos Santos

2016-01-01

Literature shows that patients undergoing hemodialysis present poor physical conditioning and low tolerance to exercise. They may also suffer from respiratory dysfunctions. The purpose of this study was to evaluate the effects of neuromuscular electrical stimulation on pulmonary function and functional capacity of patients with chronic kidney disease on hemodialysis. Forty adult patients with chronic kidney disease on hemodialysis were prospectively studied and randomized into two groups (control n = 20 and treatment n = 20). The treatment group underwent bilateral femoral quadriceps muscles electrical stimulation for 30 minutes during hemodialysis, three times per week, for two months. The patients were evaluated by pulmonary function test, maximum respiratory pressures, maximum one-repetition test, and six-minute walk test (6MWT), before and after the treatment protocol. The treatment group presented increased maximum inspiratory (MIP) (p = 0.02) and expiratory pressures (MEP) (p grupos (controle n = 20 e tratamento n = 20). O grupo tratamento realizou protocolo com estimulação elétrica neuromuscular em quadríceps femoral por 30 minutos durante a hemodiálise, três vezes por semana, durante dois meses. Todos pacientes realizaram espirometria, pressões respiratórias máximas, teste de uma repetição máxima e teste da caminhada dos seis minutos (TC6), antes e após o período de acompanhamento. O grupo tratamento apresentou aumento da pressão inspiratória máxima com p = 0,02 na comparação entre grupos e p grupo de tratamento com p grupo controle. A estimulação elétrica neuromuscular teve impacto positivo sobre a função pulmonar e a capacidade funcional levando ao melhor desempenho físico em pacientes em hemodiálise.

The mothers' experiences in the pediatrics hemodialysis unit.

Science.gov (United States)

Mieto, Fernanda Stella Risseto; Bousso, Regina Szylit

2014-01-01

The need for hemodialysis exerts a deep impact on the lives of children and adolescents with end-stage kidney chronic failure and their mothers, who predominantly assume the care related to treatment. The hemodialysis requires that the mother accompanies the child during sessions at least three times a week and, since it is not a healing practice, they also experience the waiting for a kidney transplant, attributing different meanings to this experience. To understand what it means for the mothers to accompany the child in a Pediatric Hemodialysis Unit and to construct a theoretical model representing this experience. The Symbolic Interactionism was adopted as a theoretical model and the Grounded Theory as a methodological framework. Data were collected through interviews with 11 mothers. The comparative analysis of the data enabled the identification of two phenomena that compose the experience: "Seeing the child´s life being sucked by the hemodialysis machine" expresses the experiences of the mothers that generates new demands to comprehend the new health conditions of their children and "Giving new meaning to the dependence of the hemodialysis machine" that represents the strategies employed to endure the experience. The relationship of these phenomena allowed the identification of the main category: "Having the mother's life imprisoned by the hemodialysis machine", from which we propose a new theoretical model. The results of the study allow us to provide a theoretical ground for planning an assistance that meets the real needs of the mothers, identifying aspects that require intervention.

[Safe and effective administration of carboplatin-based chemotherapy in a patient undergoing hemodialysis with cancer of unknown primary by monitoring observed AUC of carboplatin-a case report].

Science.gov (United States)

Kondo, Masahiro; Kuroda, Junko; Ikai, Yoshitomo; Hayashi, Rumiko; Uegaki, Shiori; Yoshida, Tatsuya; Yoshida, Atsuhiro; Komatsu, Hirokazu; Kimura, Kazunori

2012-11-01

Here we report a case of successful treatment with combination chemotherapy of carboplatin(CBDCA)and paclitaxel for a patient undergoing hemodialysis(HD)with cancer of unknown primary, conducted by monitoring the observed AUC of ultrafilterable CBDCA. CBDCA was administered at a dose of 125 mg on day 1 in each course, an amount which had been calculated by the Calvert formula(GFR: 0, target AUC: 5). HD was started at a point in time one hour after the completion of each CBDCA administration, and performed for 5 hours in each course. Blood samples were collected during the first 3 courses of chemotherapy to measure the plasma concentration of free-platinum. The observed AUCs(o-AUC)of CBDCA in the first, second and third courses were 3. 03, 3. 44 and 3. 50mg·min/mL, respectively. The o-AUC in the first course was lower than that in the second course. The o-AUC in the second course was nearly equal to that in the third course, while each o-AUC was below the target AUC(t-AUC). Partial response was achieved after two courses of the CBDCA and paclitaxel combination chemotherapy, with adverse events of Grade 3 neutropenia and Grade 3 peripheral neuropathy observed in each course after the second course of chemotherapy. o-AUC of CBDCA administered to HD patients can not only be below t-AUC, as in this case, but also oppositely above t-AUC in cases with different doses of CBDCA or HD settings. Our results suggest that the monitoring of o-AUC of CBDCA is useful when practicing CBDCA-based chemotherapy safely and effectively in cancer patients undergoing HD.

Blastocystis sp. and other intestinal parasites in hemodialysis patients.

Science.gov (United States)

Kulik, Rose Anne; Falavigna, Dina Lúcia Morais; Nishi, Letícia; Araujo, Silvana Marques

2008-08-01

Chronic renal insufficiency disease (CRI) leads to uremia in hemodialysis patients and induces a state of immunodepression that results in higher frequencies of infections and diarrhea. Hemodialysis patients resident in the city of Campo Mourão, Paraná, Brazil were analyzed from April 2006 through September 2007 for Blastocystis sp. and other intestinal parasites and for associated diarrhea. Fecal samples from 86 hemodialysis patients and 146 healthy (reference) persons were examined by standard methods for detecting ova, larvae and cysts, which included preservation in 10% formalin and the Kinyoun method. Thirty-three hemodialysis patients (45.1%) and 36 reference individuals (25.7%) were found to be parasitized. The differences in the percentages of parasitism and polyparasitism between the reference group and the chronic renal patients was significant (p= 0.0318 and 0.0019, respectively). Blastocystis sp. (18%-20.1%), Endolimax nana (14%-16.3%), Cryptosporidium sp. (4%-4.7%) and Entamoeba coli (4%-4.7%) were the most frequent protozoa found in the hemodialysis patients. Parasitism was not significantly associated with diarrhea (p=0.9947) or with decreased white blood cell counts (p=0.7046) in these individuals. Because parasitic infections may be an important comorbidity factor in hemodialysis patients, we suggest that parasitological stool examinations, especially for Blastocystis sp. and Cryptosporidium sp., be included in routine medical follow-up examinations of these patients.

Blastocystis sp. and other intestinal parasites in hemodialysis patients

Directory of Open Access Journals (Sweden)

Rose Anne Kulik

Full Text Available Chronic renal insufficiency disease (CRI leads to uremia in hemodialysis patients and induces a state of immunodepression that results in higher frequencies of infections and diarrhea. Hemodialysis patients resident in the city of Campo Mourão, Paraná, Brazil were analyzed from April 2006 through September 2007 for Blastocystis sp. and other intestinal parasites and for associated diarrhea. Fecal samples from 86 hemodialysis patients and 146 healthy (reference persons were examined by standard methods for detecting ova, larvae and cysts, which included preservation in 10% formalin and the Kinyoun method. Thirty-three hemodialysis patients (45.1% and 36 reference individuals (25.7% were found to be parasitized. The differences in the percentages of parasitism and polyparasitism between the reference group and the chronic renal patients was significant (p= 0.0318 and 0.0019, respectively. Blastocystis sp. (18%-20.1%, Endolimax nana (14%-16.3%, Cryptosporidium sp. (4%-4.7% and Entamoeba coli (4%-4.7% were the most frequent protozoa found in the hemodialysis patients. Parasitism was not significantly associated with diarrhea (p=0.9947 or with decreased white blood cell counts (p=0.7046 in these individuals. Because parasitic infections may be an important comorbidity factor in hemodialysis patients, we suggest that parasitological stool examinations, especially for Blastocystis sp. and Cryptosporidium sp., be included in routine medical follow-up examinations of these patients.

Sleep quality and spiritual well-being in hemodialysis patients.

Science.gov (United States)

Eslami, Ahmad Ali; Rabiei, Leili; Khayri, Freidoon; Rashidi Nooshabadi, Mohammad Reza; Masoudi, Reza

2014-07-01

Sleep disorders are considered as one of the most important problems in hemodialysis patients, making their everyday life a serious hazard. Sleep quality of hemodialysis patients and consequences of sleep disorders on other aspects of health such as spiritual well-being are important issues. This study examined the relationship between spiritual well-being and quality of sleep in hemodialysis patients in Isfahan, Iran. This study was a correlation research, carried out on 190 hemodialysis patients. Data collection Questionnaires included demographic forms, Pittsburgh sleep quality index (PSQI), and Ellison and Paloutzian spiritual well-being scale. Data were analyzed using descriptive and inferential statistics (Pearson correlation and linear regression analysis) at P spiritual health conditions. Pearson correlation test showed significant relationship between the sleep quality items of Pittsburg and spiritual well-being (P spiritual health, family, education, financial status, marital status, occupation, and use of sleep medication, the predictive power of these variables was found 0.417% and prediction of spiritual well-being was more than others (ß = 0.209). Considering bed as one of the most vital physical, mental, and emotional needs, it is very important in mental and spiritual well-being of hemodialysis patients as an influencing factor in mental relaxation and reducing disease tensions. Paying attention to sleep quality and spiritual well-being components of hemodialysis patients in formulating and promoting healthcare programs is recommended.

Skin Perfusion Pressure Is a Prognostic Factor in Hemodialysis Patients

Directory of Open Access Journals (Sweden)

Shingo Hatakeyama

2012-01-01

Full Text Available Peripheral arterial disease (PAD is common in hemodialysis patients and predicts a poor prognosis. We conducted a prospective cohort study to identify risk factors for PAD including skin perfusion pressure (SPP in hemodialysis patients. The cohort included 373 hemodialysis patients among 548 patients who received hemodialysis at Oyokyo Kidney Research Institute, Hirosaki, Japan from August 2008 to December 2010. The endpoints were lower limb survival (peripheral angioplasty or amputation events and overall survival of 2 years. Our results showed that <70 mmHg SPP was a poor prognosis for the lower limb survival and overall survival. We also identified age, history of cardiovascular disease, presence of diabetes mellitus, smoking history, and SPP < 70 mmHg as independent risk factors for lower limb survival and overall survival. Then, we constructed risk criteria using the significantly independent risk factors. We can clearly stratify lower limb survival and overall survival of the hemodialysis patients into 3 groups. Although the observation period is short, we conclude that SPP value has the potential to be a risk factor that predicts both lower limb survival and the prognosis of hemodialysis patients.

Solute kinetics with short-daily home hemodialysis using slow dialysate flow rate.

Science.gov (United States)

Kohn, Orly F; Coe, Fredric L; Ing, Todd S

2010-01-01

"NxStage System One()" is increasingly used for daily home hemodialysis. The ultrapure dialysate volumes are typically between 15 L and 30 L per dialysis, substantially smaller than the volumes used in conventional dialysis. In this study, the impact of the use of low dialysate volumes on the removal rates of solutes of different molecular weights and volumes of distribution was evaluated. Serum measurements before and after dialysis and total dialysate collection were performed over 30 times in 5 functionally anephric patients undergoing short-daily home hemodialysis (6 d/wk) over the course of 8 to 16 months. Measured solutes included beta(2) microglobulin (beta(2)M), phosphorus, urea nitrogen, and potassium. The average spent dialysate volume (dialysate plus ultrafiltrate) was 25.4+/-4.7 L and the dialysis duration was 175+/-15 min. beta(2) microglobulin clearance of the polyethersulfone dialyzer averaged 53+/-14 mL/min. Total beta(2)M recovered in the dialysate was 106+/-42 mg per treatment (n=38). Predialysis serum beta(2)M levels remained stable over the observation period. Phosphorus removal averaged 694+/-343 mg per treatment with a mean predialysis serum phosphorus of 5.2+/-1.8 mg/dL (n=34). Standard Kt/V averaged 2.5+/-0.3 per week and correlated with the dialysate-based weekly Kt/V. Weekly beta(2)M, phosphorus, and urea nitrogen removal in patients dialyzing 6 d/wk with these relatively low dialysate volumes compared favorably with values published for thrice weekly conventional and with short-daily hemodialysis performed with machines using much higher dialysate flow rates. Results of the present study were achieved, however, with an average of 17.5 hours of dialysis per week.

The effect of hemodialysis on balance measurements and risk of fall.

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Erken, Ertugrul; Ozelsancak, Ruya; Sahin, Safak; Yılmaz, Emine Ece; Torun, Dilek; Leblebici, Berrin; Kuyucu, Yunus Emre; Sezer, Siren

2016-10-01

Patients with end-stage renal disease (ESRD) have increased risk of falls and fall-related complications. Other than aging and factors related to chronic kidney disease, treatment of hemodialysis may also contribute to this increased risk. The aim of this study was to demonstrate the impairment of balance after a session of hemodialysis with a quantitative assessment and reveal an increased fall risk that would possibly be related to treatment of hemodialysis for patients on maintenance hemodialysis. Fifty-six patients with ESRD on chronic hemodialysis program and 53 healthy individuals were involved in this study. Fall Index percentages were calculated, and fall risk categories were determined for all patients and healthy controls using Tetrax posturography device (Sunlight Medical Ltd Israel). The patient group was evaluated twice for balance, before and after a routine session of hemodialysis. Fall Index scores of healthy controls were lower than that of ESRD patients (p = 0.001). In the patient group, we found the mean Fall Index to be significantly higher at the post-dialysis assessment compared to the pre-dialysis assessment (p = 0.003). The number of patients with high risk of falling also increased at the post-dialysis assessment yet the difference did not reach significance. Fall Index was correlated with the increase in age only at the pre-dialysis balance measurement (p = 0.038). Patients with better dialysis adequacy had significantly lower Fall Index scores than the others at the pre-dialysis balance measurement (p = 0.004). The difference was not significant at the post-dialysis measurement. In the current study, we evaluated the balance of ESRD patients before and after a routine session of hemodialysis treatment. This is the first study to investigate the effect of hemodialysis on balance, using an electronic posturographic balance system. We found the Fall Index score to be significantly higher after hemodialysis, indicating a negative

21 CFR 876.5860 - High permeability hemodialysis system.

Science.gov (United States)

2010-04-01

... hemodialysis system. (a) Identification. A high permeability hemodialysis system is a device intended for use as an artificial kidney system for the treatment of patients with renal failure, fluid overload, or... system removes toxins or excess fluid from the patient's blood using the principles of convection (via a...

Diffusive Silicon Nanopore Membranes for Hemodialysis Applications.

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Steven Kim

Full Text Available Hemodialysis using hollow-fiber membranes provides life-sustaining treatment for nearly 2 million patients worldwide with end stage renal disease (ESRD. However, patients on hemodialysis have worse long-term outcomes compared to kidney transplant or other chronic illnesses. Additionally, the underlying membrane technology of polymer hollow-fiber membranes has not fundamentally changed in over four decades. Therefore, we have proposed a fundamentally different approach using microelectromechanical systems (MEMS fabrication techniques to create thin-flat sheets of silicon-based membranes for implantable or portable hemodialysis applications. The silicon nanopore membranes (SNM have biomimetic slit-pore geometry and uniform pores size distribution that allow for exceptional permeability and selectivity. A quantitative diffusion model identified structural limits to diffusive solute transport and motivated a new microfabrication technique to create SNM with enhanced diffusive transport. We performed in vitro testing and extracorporeal testing in pigs on prototype membranes with an effective surface area of 2.52 cm2 and 2.02 cm2, respectively. The diffusive clearance was a two-fold improvement in with the new microfabrication technique and was consistent with our mathematical model. These results establish the feasibility of using SNM for hemodialysis applications with additional scale-up.

Diffusive Silicon Nanopore Membranes for Hemodialysis Applications

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Kim, Steven; Feinberg, Benjamin; Kant, Rishi; Chui, Benjamin; Goldman, Ken; Park, Jaehyun; Moses, Willieford; Blaha, Charles; Iqbal, Zohora; Chow, Clarence; Wright, Nathan; Fissell, William H.; Zydney, Andrew; Roy, Shuvo

2016-01-01

Hemodialysis using hollow-fiber membranes provides life-sustaining treatment for nearly 2 million patients worldwide with end stage renal disease (ESRD). However, patients on hemodialysis have worse long-term outcomes compared to kidney transplant or other chronic illnesses. Additionally, the underlying membrane technology of polymer hollow-fiber membranes has not fundamentally changed in over four decades. Therefore, we have proposed a fundamentally different approach using microelectromechanical systems (MEMS) fabrication techniques to create thin-flat sheets of silicon-based membranes for implantable or portable hemodialysis applications. The silicon nanopore membranes (SNM) have biomimetic slit-pore geometry and uniform pores size distribution that allow for exceptional permeability and selectivity. A quantitative diffusion model identified structural limits to diffusive solute transport and motivated a new microfabrication technique to create SNM with enhanced diffusive transport. We performed in vitro testing and extracorporeal testing in pigs on prototype membranes with an effective surface area of 2.52 cm2 and 2.02 cm2, respectively. The diffusive clearance was a two-fold improvement in with the new microfabrication technique and was consistent with our mathematical model. These results establish the feasibility of using SNM for hemodialysis applications with additional scale-up. PMID:27438878

Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis.

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Yuxin Nie

Full Text Available Sudden cardiac death is one of the primary causes of mortality in chronic hemodialysis (HD patients. Prolonged QTc interval is associated with increased rate of sudden cardiac death. The aim of this article is to assess the abnormalities found in electrocardiograms (ECGs, and to explore factors that can influence the QTc interval.A total of 141 conventional HD patients were enrolled in this study. ECG tests were conducted on each patient before a single dialysis session and 15 minutes before the end of dialysis session (at peak stress. Echocardiography tests were conducted before dialysis session began. Blood samples were drawn by phlebotomy immediately before and after the dialysis session.Before dialysis, 93.62% of the patients were in sinus rhythm, and approximately 65% of the patients showed a prolonged QTc interval (i.e., a QTc interval above 440 ms in males and above 460ms in females. A comparison of ECG parameters before dialysis and at peak stress showed increases in heart rate (77.45±11.92 vs. 80.38±14.65 bpm, p = 0.001 and QTc interval (460.05±24.53 ms vs. 470.93±24.92 ms, p<0.001. After dividing patients into two groups according to the QTc interval, lower pre-dialysis serum concentrations of potassium (K+, calcium (Ca2+, phosphorus, calcium* phosphorus (Ca*P, and higher concentrations of plasma brain natriuretic peptide (BNP were found in the group with prolonged QTc intervals. Patients in this group also had a larger left atrial diameter (LAD and a thicker interventricular septum, and they tended to be older than patients in the other group. Then patients were divided into two groups according to ΔQTc (ΔQTc = QTc peak-stress- QTc pre-HD. When analyzing the patients whose QTc intervals were longer at peak stress than before HD, we found that they had higher concentrations of Ca2+ and P5+ and lower concentrations of K+, ferritin, UA, and BNP. They were also more likely to be female. In addition, more cardiac construction

Inpatient Dialysis Unit Project Development: Redesigning Acute Hemodialysis Care.

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Day, Jennifer

2017-01-01

Executive leaders of an acute care hospital performed a market and financial analysis, and created a business plan to establish an inpatient hemodialysis unit operated by the hospital to provide safe, high-quality, evidence-based care to the population of individuals experiencing end stage renal disease (ESRD) within the community. The business plan included a SWOT (Strengths - Weaknesses - Opportunities - Threats) analysis to assess advantages of the hospital providing inpatient hemodialysis services versus outsourcing the services with a contracted agency. The results of the project were a newly constructed tandem hemodialysis room and an operational plan with clearly defined key performance indicators, process improvement initiatives, and financial goals. This article provides an overview of essential components of a business plan to guide the establishment of an inpatient hemodialysis unit. Copyright© by the American Nephrology Nurses Association.

CORRELATION BETWEEN ANTHROPOMETRY, BIOCHEMICAL MARKERS AND SUBJECTIVE GLOBAL ASSESSMENT – DIALYSIS MALNUTRITION SCORE AS PREDICTORS OF NUTRITIONAL STATUS OF THE MAINTENANCE HEMODIALYSIS PATIENTS

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Vanitha Rani N, S. Kavimani, Soundararajan P, Chamundeeswari D, Kannan Gopal

2015-10-01

Full Text Available Background: Protein energy malnutrition is the major cause of poor prognostic outcome in patients on maintenance hemodialysis (MHD. The assessment of nutritional status in patients on maintenance hemodialysis should be done both subjectively and objectively by integrating clinical, biochemical and anthropometric measurements. A study was conducted to assess the possible correlations between the subjective global assessment-dialysis malnutrition score (SGA-DMS, anthropometric measurements, and biochemical parameters in hemodialysis patients. Methods: The study included 90 patients (55 males and 35 females; age range of 25 to 73 years; mean age 52.62 ± 11.7 years undergoing twice/thrice weekly maintenance hemodialysis for six months and above in the dialysis unit of a tertiary care teaching hospital. The MHD patients were assessed by SGA -DMS, anthropometry and biochemical indicators (serum albumin, iron, ferritin and transferrin of nutritional status. Results: According to the SGA-DMS 54.4 % were moderate to severely malnourished, 31% were mild to moderately nourished and 14.4% were well nourished. There was a highly significant negative correlation between SGA –DMS and serum albumin, iron, transferrin; positive correlation between SGA-DMS and ferritin (P<0.0001. Body mass index, upper arm circumferences, and skin fold thickness had a highly significant negative correlation with SGA-DMS (P<0.001, where as the lean body mass, total body water and the fat free mass had a significant negative correlation (P<0.05. Conclusion: SGA-DMS correlated with anthropometric and biochemical parameters that are indicative of nutritional status. SGA –DMS used in conjunction with other objective nutritional assessment methods may be of greater impact in determining nutritional status of hemodialysis patients.

Influence of Frequent Nocturnal Home Hemodialysis on Food Preference

NARCIS (Netherlands)

Ipema, Karin; Franssen, Casper; van der Schans, Cees; Smit, Lianne; Noordman, Sabine; Haisma, Hinke

Objective: Dialysis patients frequently report a change of taste that is reversible after renal transplantation, suggesting that uremic toxins may negatively influence taste. Currently, frequent nocturnal home hemodialysis (NHHD) is the most effective method of hemodialysis, and is associated with

Prognostic value of bone- and vascular-derived molecular biomarkers in hemodialysis and renal transplant patients: a systematic review and meta-analysis.

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Pichler, Gernot; Haller, Maria C; Kainz, Alexander; Wolf, Myles; Redon, Josep; Oberbauer, Rainer

2017-09-01

Patients undergoing hemodialysis and kidney graft recipients are high-risk populations for cardiovascular and all-cause mortality. Fibroblast growth factor 23 (FGF23), osteoprotegerin (OPG), RANK ligand, osteopontin (OPN), Klotho protein and bone morphogenetic protein-7 (BMP-7) are bone- and vascular-derived molecular biomarkers that have been shown to be associated with cardiovascular surrogate end points; however, currently available data on the prognostic value of these biomarkers is inconsistent. The aim of the present study was to conduct a systematic review and meta-analysis in order to summarize the available evidence on the association of molecular biomarkers with mortality in individuals undergoing hemodialysis and renal transplant patients. Two databases (MEDLINE and Embase) were systematically searched. Studies were eligible if the association of biomarker and mortality was reported as time-to-event data [hazard Ratio (HR)] or as effect size with a fixed time of follow-up [odds Ratio (OR)]. Abstracted HRs were converted onto a standard scale of effect and combined using a random effects model. From a total of 1170 studies identified in initial searches, 21 met the inclusion criteria. In hemodialysis patients, comparing the lower third with the upper third of baseline FGF23 distribution, pooled HRs (95% confidence intervals) were 1.94 (1.47, 2.56) for all-cause mortality and 2.4 (1.64, 3.51) for cardiovascular mortality. For the same comparison of baseline OPG distribution, pooled HRs were 1.8 (0.95, 3.39) for all-cause mortality and 2.53 (1.29, 4.94) for cardiovascular mortality. Reported risk estimates of RANK ligand, OPN, Klotho protein and BMP-7 were not suitable for pooling; however, only Klotho protein was significantly related to mortality. For kidney graft recipients, four studies that investigated the relationship of FGF23 and OPG with mortality were identified, all of which reported a significant association. In hemodialysis patients, FGF23 is a

Continuous PECS II block for postoperative analgesia in patients undergoing transapical transcatheter aortic valve implantation.

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Shakuo, Tomoharu; Kakumoto, Shinichi; Kuribayashi, Junya; Oe, Katsunori; Seo, Katsuhiro

2017-01-01

It has been reported that PECS II block can alleviate postoperative pain following transapical transcatheter aortic valve implantation (TA-TAVI). However, the effectiveness of continuous PECS II block with catheterization has not yet been reported on the postoperative pain in patients undergoing TA-TAVI. We experienced two cases of TA-TAVI who received PECS II block with catheterization to manage postoperative pain. In the first case, a bolus injection for intraoperative pain and subsequent catheterization were performed before the implantation. However, the patient developed severe pain postoperatively in spite of the continuous block due to displacement of the catheter. In the second case, a bolus injection and the catheterization for the continuous block were performed before and after the implantation, respectively, which provided high-quality pain control. Continuous PECS II block may be useful to control perioperative pain associated with TA-TAVI. The insertion of the catheter after the implantation could be useful to avoid its displacement during the surgery.

Hepatitis B virus reactivation after treatment for hepatitis C in hemodialysis patients with HBV/HCV coinfection

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Raul Carlos Wahle

2015-09-01

Full Text Available In coinfected HBV/HCV patients, HBV replication is usually suppressed by HCV over the time. No study to date has evaluated the HBV viremia in long-term follow-up after HCV treatment in hemodialysis patients with HBV/HCV coinfection. This study aimed to assess the evolution of HBV viremia after HCV treatment in this special population. Ten hemodialysis patients with HBV/HCV coinfection with dominant HCV infection (HBV lower than 2000 IU/mL and significant fibrosis were treated with interferon-alpha 3 MU 3×/week for 12 months and could be followed for at least 36 months after HCV treatment. Six cases of HBV reactivation (60% during follow-up were observed and 5/6 had been successfully treated for HCV. Patients with HBV reactivation received anti-HBV therapy. Our preliminary findings indicate that treatment of hepatitis C in HBV/HCV coinfected hemodialysis patients may favor HBV reactivation. Thus, continued monitoring of HBV viremia must be recommended and prompt anti-HBV therapy should be implemented.

Amyloid arthropathy of the hip joint: MR demonstration of presumed amyloid lesions in 152 patients with long-term hemodialysis

International Nuclear Information System (INIS)

Otake, S.; Yamana, D.; Tsuruta, Y.; Mizutani, H.; Ohba, S.

1998-01-01

The aim of this study was to determine the spectrum of MR findings of presumed amyloid arthropathy of the hip joints in patients on long-term hemodialysis. We prospectively performed T1- and T2-weighted spin-echo imaging on 152 consecutive patients on hemodialysis. The duration of hemodialysis ranged from 5 months to 24 years, 2 months (mean: 8 years, 8 months). The frequency, location, and signal intensity of bone lesions were assessed. In 12 cases with contrast-enhanced MR examination, enhancement pattern of bone lesions, synovial lesions, and intra-articular lesions were characterized. Bone lesions presumed to be amyloid deposits were identified in 60 patients (39 %). Magnetic resonance imaging revealed that amyloid lesions were more extensive than anticipated by plain radiographs. All bone lesions showed decreased signal intensity on T1-weighted images. On T2-weighted images, bone lesions showed increased signal intensity in 32 patients (54 %), decreased signal intensity in 11 patients (18 %), and both increased and decreased signal intensity in 17 patients (28 %). Following intravenous injection of gadolinium-based contrast, all bone lesions showed moderate enhancement. Synovial thickening could not be identified on T1- and T2-weighted images. However, contrast-enhanced images showed thickened synovial membrane, which could be differentiated from joint fluid. Intra-articular nodules showed decreased or intermediate signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images; the intra-articular nodules were contiguous with subchondral bone lesions. Magnetic resonance imaging is useful for evaluating the distribution and extent of amyloidosis of the hip joints in patients undergoing long-term hemodialysis. (orig.) (orig.)

Myocardial scintigraphy using a fatty acid analogue detects coronary artery disease in hemodialysis patients.

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Nishimura, Masato; Hashimoto, Tetsuya; Kobayashi, Hiroyuki; Fukuda, Toyofumi; Okino, Koji; Yamamoto, Noriyuki; Fujita, Hiroshi; Inoue Tsunehiko Nishimura, Naoto; Ono, Toshihiko

2004-08-01

Coronary artery disease contributes significantly to mortality in end-stage renal disease (ESRD) patients. Single-photon emission computed tomography (SPECT) using an iodinated fatty acid analogue, iodine-123-methyl iodophenylpentadecanoic acid (123I-BMIPP), can assess fatty acid metabolism in the myocardium. We investigated the ability of 123I-BMIPP SPECT to detect coronary artery disease in hemodialysis patients compared with 201thallium chloride (201Tl) SPECT. We prospectively studied 130 ESRD patients undergoing hemodialysis for a mean of 88.6 months (male/female, 77/53; mean age, 63.8 years). Dual SPECT using 123I-BMIPP and 201Tl was performed, followed by coronary angiography. SPECT findings were graded in 17 segments on a five-point scale (0, normal uptake; 4, none) and assessed as a summed score. By coronary angiography, 71.5% of patients (93/130) had significant coronary stenosis (> or =75%), and five patients showed coronary spasm without coronary stenosis. When a BMIPP summed score of 6 or more was defined as abnormal, sensitivity, specificity, and accuracy for detecting coronary artery disease by BMIPP SPECT were 98.0%, 65.6%, and 90.0%, respectively; in contrast, these parameters for detecting coronary artery disease by Tl SPECT were 84.7%, 46.9%, and 75.0%, respectively, when a Tl summed score of 1 or more was defined as abnormal. In receiver operating characteristic analysis, the area under the curve was 0.895 in BMIPP and 0.727 in Tl SPECT, respectively. Resting BMIPP SPECT is superior to Tl SPECT for detecting coronary lesions, and provides safe screening for coronary artery disease among maintenance hemodialysis patients.

Hypersensitivity reactions in patients receiving hemodialysis.

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Butani, Lavjay; Calogiuri, Gianfranco

2017-06-01

To describe hypersensitivity reactions in patients receiving maintenance hemodialysis. PubMed search of articles published during the past 30 years with an emphasis on publications in the past decade. Case reports and review articles describing hypersensitivity reactions in the context of hemodialysis. Pharmacologic agents are the most common identifiable cause of hypersensitivity reactions in patients receiving hemodialysis. These include iron, erythropoietin, and heparin, which can cause anaphylactic or pseudoallergic reactions, and topical antibiotics and anesthetics, which lead to delayed-type hypersensitivity reactions. Many hypersensitivity reactions are triggered by complement activation and increased bradykinin resulting from contact system activation, especially in the context of angiotensin-converting enzyme inhibitor use. Several alternative pharmacologic preparations and dialyzer membranes are available, such that once an etiology for the reaction is established, recurrences can be prevented without affecting the quality of care provided to patients. Although hypersensitivity reactions are uncommon in patients receiving hemodialysis, they can be life-threatening. Moreover, considering the large prevalence of the end-stage renal disease population, the implications of such reactions are enormous. Most reactions are pseudoallergic and not mediated by immunoglobulin E. The multiplicity of potential exposures and the complexity of the environment to which patients on dialysis are exposed make it challenging to identify the precise cause of these reactions. Great diligence is needed to investigate hypersensitivity reactions to avoid recurrence in this high-risk population. Copyright © 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Changes in Left Ventricular Diastolic Function During Hemodialysis Sessions

NARCIS (Netherlands)

Assa, Solmaz; Hummel, Yoran M.; Voors, Adriaan A.; Kuipers, Johanna; Groen, Henk; de Jong, Paul E.; Westerhuis, Ralf; Franssen, Casper F. M.

Background: Left ventricular diastolic dysfunction is common in hemodialysis patients and is associated with worse outcome. Previous studies have shown that diastolic function worsens from pre- to post-dialysis session, but this has not been studied during hemodialysis. We studied the evolution of

[Evaluation of cardiac complications among chronic hemodialysis in Dakar].

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Moustapha, Cissé Mouhamadou; Tall, Lemrabott Ahmed; Maria, Faye; Khodia, Fall; Moustapha, Faye; Fary, Ka El Hadji; Abdou, Niang; Boucar, Diouf

2016-01-01

Hemodialysis is the first extrarenal treatment method that allowed supporting patients in terminal chronic failure in Senegal since 1997. 25 years later, we conducted this study to determine the type and the prevalence of different cardiovascular complications and identify the main cardiovascular risk factors. It is a retrospective study of 4 years. 38 patients treated at least 6 months in hemodialysis and cardiovascular explorations with a front chest x-ray, electrocardiogram and cardiac ultrasound. All patients who have not started hemodialysis, treated less than 6 months in hemodialysis, treaties in peritoneal dialysis or having raised cardiovascular explorations were excluded. For each selected patient, we collected data epidemiological, clinical, paraclinical and evolutionary aspects of cardiovascular complications. 38 patients were included in this study. The average age was 52 years ± 12.85 and the sex ratio H/F of 1.53. Initial nephropathy was dominated by the néphroangiosclérose followed by diabetic nephropathy. Clinically the signs of appeal are marked by the effort dyspnea palpitations, chest pain and physically by the HTA, anemia. Cardiovascular complications were dominated by hypertrophy (LVH) left ventricular, rhythm type of arrhythmia disorders valvular leakage (mitral and tricuspid) and cerebral vascular accident (stroke). The average impact of LVH according the HTA is 81%, by sex of 78.26% for men and 60% for women. At the end of the study, 27 patients were pursuing hemodialysis and 11 had died 6 (54%) of cardiovascular cause. Hemodialysis is a common purification technique in Senegal and its complications remain especially dominated by abuses cardiovascular.

The home hemodialysis hub: physical infrastructure and integrated governance structure.

Science.gov (United States)

Marshall, Mark R; Young, Bessie A; Fox, Sally J; Cleland, Calli J; Walker, Robert J; Masakane, Ikuto; Herold, Aaron M

2015-04-01

An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes. © 2015 International Society for Hemodialysis.

Adherence to treatment, emotional state and quality of life in patients with end-stage renal disease undergoing dialysis

OpenAIRE

García-Llana, Helena; Remor, Eduardo; Selgas, Rafael

2013-01-01

A low rate of adherence to treatment is a widespread problem of great clinical relevance among dialysis patients. The objective of the present study is to determine the relationship between adherence, emotional state (depression, anxiety, and perceived stress), and healthrelated quality of life (HRQOL) in renal patients undergoing dialysis. Method: Two patient groups (30 in hemodialysis and 31 in peritoneal dialysis) participated in this study. We evaluated aspects of adhere...

Sex-specific differences in hemodialysis prevalence and practices and the male-to-female mortality rate: the Dialysis Outcomes and Practice Patterns Study (DOPPS.

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Manfred Hecking

2014-10-01

Full Text Available BACKGROUND: A comprehensive analysis of sex-specific differences in the characteristics, treatment, and outcomes of individuals with end-stage renal disease undergoing dialysis might reveal treatment inequalities and targets to improve sex-specific patient care. Here we describe hemodialysis prevalence and patient characteristics by sex, compare the adult male-to-female mortality rate with data from the general population, and evaluate sex interactions with mortality. METHODS AND FINDINGS: We assessed the Human Mortality Database and 206,374 patients receiving hemodialysis from 12 countries (Australia, Belgium, Canada, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, the UK, and the US participating in the international, prospective Dialysis Outcomes and Practice Patterns Study (DOPPS between June 1996 and March 2012. Among 35,964 sampled DOPPS patients with full data collection, we studied patient characteristics (descriptively and mortality (via Cox regression by sex. In all age groups, more men than women were on hemodialysis (59% versus 41% overall, with large differences observed between countries. The average estimated glomerular filtration rate at hemodialysis initiation was higher in men than women. The male-to-female mortality rate ratio in the general population varied from 1.5 to 2.6 for age groups <75 y, but in hemodialysis patients was close to one. Compared to women, men were younger (mean = 61.9 ± standard deviation 14.6 versus 63.1 ± 14.5 y, were less frequently obese, were more frequently married and recipients of a kidney transplant, more frequently had coronary artery disease, and were less frequently depressed. Interaction analyses showed that the mortality risk associated with several comorbidities and hemodialysis catheter use was lower for men (hazard ratio [HR] = 1.11 than women (HR = 1.33, interaction p<0.001. This study is limited by its inability to establish causality for the observed sex

Middle East respiratory syndrome clinical practice guideline for hemodialysis facilities

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Hayne Cho Park

2017-06-01

Full Text Available The Korean Society of Nephrology participated in the task force team consisting of government authorities and civilian experts to prevent and control the spread of Middle East respiratory syndrome (MERS in 2015. The Korean Society of Nephrology MERS Task Force Team took an immediate action and drafted ‘the clinical recommendation for hemodialysis facilities’ to follow when the first and the only confirmed case was reported in the hemodialysis unit. Owing to the dedicated support from medical doctors, dialysis nurses, and related medical companies, we could prevent further transmission of MERS infection successfully in hemodialysis units. This special report describes the experience of infection control during MERS outbreak in 2015 and summarizes the contents of ‘the clinical practice guideline for hemodialysis facilities dealing with MERS patients’ built upon our previous experience.

The clinical significance and risk factors of anti-platelet factor 4/heparin antibody on maintenance hemodialysis patients: a two-year prospective follow-up.

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Delong Zhao

Full Text Available BACKGROUND: Heparin-induced thrombocytopenia is an immune response mediated by anti-PF4/heparin antibody, which is clinically characterized by thrombocytopenia and thromboembolic events. In this study, a prospective and multi-center clinical investigation 1 determined the positive rate of anti-PF4/heparin antibody in maintenance hemodialysis patients in China, 2 identified the related risk factors, and 3 further explored the effect of the anti-PF4/heparin antibody on bleeding, thromboembolic events, and risk of death in the patients. METHODS: The serum anti-PF4/heparin antibody was measured in 661 patients from nine hemodialysis centers, detected by IgG-specific ELISA and followed by confirmation with excess heparin. Risk factors of these patients were analyzed. Based on a two-year follow-up, the association between the anti-PF4/heparin antibody and bleeding, thromboembolic events, and risk of death in the patients was investigated. RESULTS: 1 The positivity rate of the anti-PF4/heparin antibody in maintenance hemodialysis patients was 5.6%. With diabetes as an independent risk factor, the positivity rate of the anti-PF4/heparin antibody decreased in the patients undergoing weekly dialyses ≥3 times. 2 The positivity rate of the anti-PF4/heparin antibody was not related to the occurrence of clinical thromboembolic events and was not a risk factor for death within two years in maintenance hemodialysis patients. 3 Negativity for the anti-PF4/heparin antibody combined with a reduction of the platelet count or combined with the administration of antiplatelet drugs yielded a significant increase in bleeding events. However, the composite determination of the anti-PF4/heparin antibody and thrombocytopenia, as well as the administration of antiplatelet drugs, was not predictive for the risk of thromboembolic events in the maintenance hemodialysis patients. CONCLUSIONS: A single detection of the anti-PF4/heparin antibody did not predict the occurrence

Central venous obstruction in hemodialysis patients: the usefulness of percutaneous treatment

International Nuclear Information System (INIS)

Kim, Cheol Young; Goo, Dong Erk; Kim, Dae Ho; Hong, Hyun Suk; Lee, Hae Kyoung; Choi, Duk Lin; Yang, Sung Boo; Moon, Chul

2002-01-01

To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. In 100 patients, 107 central venous strictures (56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23,stenosis:28)) were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion was also determined. We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2-and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required

Recurrent symptomatic intraocular pressure spikes during hemodialysis in a patient with unilateral anterior uveitis

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Lim Su-Ho

2013-02-01

Full Text Available Abstract Background The relationship between intraocular pressure (IOP changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery. Case presentation A 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+ in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10–14 mmHg and no painful IOP spikes occurred during hemodialysis over the first postoperative year. Conclusion We present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility.

Pictorial essay: Interventional radiology in the management of hemodialysis vascular access - A single-center experience

International Nuclear Information System (INIS)

Mammen, Suraj; Keshava, Shyamkumar N; Moses, Vinu; Babu, Surendra; Varughese, Santhosh

2012-01-01

Chronic kidney disease (CKD) is a worldwide public health problem and is associated with high morbidity and mortality. The majority of patients with CKD stage 5 (CKD-5), who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically created access sites. Native fistulae are preferred over grafts due to their longevity. More than half of these vital portals for dialysis access will fail over time. Screening procedures to select high-risk patients before thrombosis or stenosis appears have resulted in aggressive management. These patients are referred for angiographic evaluation and/or therapy. We present the patterns of dialysis-related interventions done in our institution

Mitral and aortic valve endocarditis together with mitral cleft developing due to an incorrectly inserted permanent hemodialysis catheter

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Oktay Şenöz

2015-06-01

Full Text Available Infective endocarditis (IE usually affects the right-sided valves in hemodialysis (HD patients. Hemodialysis catheter-related left-sided endocarditis is a very rare condition and has a high mortality. A 58-year-old male patient who had been inserted a permanent HD catheter from the right subclavian vein 6 months ago was admitted with fever and dyspnea. Transesophageal echocardiography (TEE revealed that the HD catheter extended to the left atrium by passing from interatrial septum (IAS. A vegetation in the interatrial septum, aortic valve, which formed a perforation in the mitral valve and leading to severe valve insufficiency was observed. The patient was planned to undergo an operation however he died as a result of impaired hemodynamic stability. Catheter site should be confirmed through an imaging method performed during or after the procedure in order to prevent catheter malposition. A proper antibiotic treatment should be started as soon as a catheter-related endocarditis is detected, a surgical decision should be done in the shortest and the most proper time.

An international observational study suggests that artificial intelligence for clinical decision support optimizes anemia management in hemodialysis patients.

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Barbieri, Carlo; Molina, Manuel; Ponce, Pedro; Tothova, Monika; Cattinelli, Isabella; Ion Titapiccolo, Jasmine; Mari, Flavio; Amato, Claudia; Leipold, Frank; Wehmeyer, Wolfgang; Stuard, Stefano; Stopper, Andrea; Canaud, Bernard

2016-08-01

Managing anemia in hemodialysis patients can be challenging because of competing therapeutic targets and individual variability. Because therapy recommendations provided by a decision support system can benefit both patients and doctors, we evaluated the impact of an artificial intelligence decision support system, the Anemia Control Model (ACM), on anemia outcomes. Based on patient profiles, the ACM was built to recommend suitable erythropoietic-stimulating agent doses. Our retrospective study consisted of a 12-month control phase (standard anemia care), followed by a 12-month observation phase (ACM-guided care) encompassing 752 patients undergoing hemodialysis therapy in 3 NephroCare clinics located in separate countries. The percentage of hemoglobin values on target, the median darbepoetin dose, and individual hemoglobin fluctuation (estimated from the intrapatient hemoglobin standard deviation) were deemed primary outcomes. In the observation phase, median darbepoetin consumption significantly decreased from 0.63 to 0.46 μg/kg/month, whereas on-target hemoglobin values significantly increased from 70.6% to 76.6%, reaching 83.2% when the ACM suggestions were implemented. Moreover, ACM introduction led to a significant decrease in hemoglobin fluctuation (intrapatient standard deviation decreased from 0.95 g/dl to 0.83 g/dl). Thus, ACM support helped improve anemia outcomes of hemodialysis patients, minimizing erythropoietic-stimulating agent use with the potential to reduce the cost of treatment. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.

Total body and regional bone mineral content in hemodialysis patients

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Hagiwara, Satoshi; Aratani, Hideyui; Miki, Takami; Nishizawa, Yoshiki; Okamura, Terue; Koizumi, Yoshiko; Ochi, Hironobu; Morii, Hirotoshi

1994-01-01

Bone mineral content (BMC) in the total body and lumbar spine was evaluated in 126 hemodialysis patients (60 males, 66 females) by dual photon absorptiometry with the Norland DBD 2600. Measurements of: 1) total body BMC divided by lean body mass (BMC TB /LBM), 2) bone mineral density (BMD) of total body, 3) BMD of four regional sections (head, trunk, pelvis, and legs), and 4) BMD of lumbar spine, generally showed a significant decrease in the hemodialysis patients compared to the reference population. However, arm BMD did not show a significant difference between patients and control populations. The z-score of BMC TB /LBM declined significantly throughout the duration of hemodialysis, although that of the lumbar spine BMD did not. It should be noted that the degree of decrease in BMC was more prominent in the total body measurement than in the lumbar spine measurement. There was preferential osteopenia of the total body in the hemodialysis patients. Although the lumbar spine BMD showed a lower value than the control population, the lumbar spine is not the recommended region to monitor the BMD change in hemodialysis patients. (author)

Metabolic syndrome criteria as predictors of insulin resistance, inflammation and mortality in chronic hemodialysis patients.

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Vogt, Barbara Perez; Souza, Priscilla L; Minicucci, Marcos Ferreira; Martin, Luis Cuadrado; Barretti, Pasqual; Caramori, Jacqueline Teixeira

2014-10-01

Abstract Background: Chronic kidney disease (CKD) and metabolic syndrome are characterized by overlapping disorders, including glucose intolerance, hypertension, dyslipidemia, and, in some cases, obesity. However, there are no specific criteria for the diagnosis of metabolic syndrome in CKD. Metabolic syndrome can also be associated with increased risk of mortality. Some traditional risk factors may protect dialysis patients from mortality, known as "reverse epidemiology." Metabolic syndrome might undergo reverse epidemiology. The objectives were to detect differences in frequency and metabolic characteristics associated with three sets of diagnostic criteria for metabolic syndrome, to evaluate the accuracy of insulin resistance (IR) and inflammation to identify patients with metabolic syndrome, and to investigate the effects of metabolic syndrome by three sets of diagnostic criteria on mortality in chronic hemodialysis patients. An observational study was conducted. Diagnostic criteria for metabolic syndrome proposed by National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), International Diabetes Federation (IDF), and Harmonizing the Metabolic Syndrome (HMetS) statement were applied to 98 hemodialysis patients. The prevalence of metabolic syndrome was 51%, 66.3%, and 75.3% according to NCEP ATP III, IDF, and HMetS criteria, respectively. Diagnosis of metabolic syndrome by HMetS was simultaneously capable of revealing both inflammation and IR, whereas NCEP ATP III and IDF criteria were only able to identify IR. Mortality risk increased in the presence of metabolic syndrome regardless of the criteria used. The prevalence of metabolic syndrome in hemodialysis varies according to the diagnostic criteria used. IR and inflammation predict metabolic syndrome only when diagnosed by HMetS criteria. HMetS was the diagnostic criteria that can predict the highest risk of mortality.

Evaluation of individual quality of life among hemodialysis patients: nominated themes using SEIQoL-adapted

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Matlabi H

2016-12-01

Full Text Available Hossein Matlabi, Sharareh Ahmadzadeh Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran Background: Quality of life (QoL has become an important issue for patients with chronic renal failure diseases who are permanently undergoing hemodialysis. In this study, an adapted schedule for the evaluation of individual quality of life (SEIQoL-adapted was used to evaluate QoL among hemodialysis patients, to explore their views about the most important aspects of life satisfaction. Methods and results: A multiple approach design and convenience sampling were applied to recruit 53 patients from a hemodialysis unit in Iran. Data were collected through structured interviews and then analyzed using conventional content analysis. A total score for QoL was calculated using scale guideline. The most important aspects of life were health, family, financial status, living conditions, leisure activities, relationships and socializing, religious and spiritual issues, medical knowledge, and therapies or treatments. The calculated mean QoL score was 66.2, indicating a relatively high life satisfaction. Males had higher QoL scores than females in both married and single groups. Moreover, the relationships between the QoL scores and education, job and marital status were not statistically significant. Conclusion: The SEIQoL-adapted revealed reasonable lay definitions of QoL in a group of patients following chronic renal failure. The patients’ views of the aspects of life could be used by health policy makers, clinicians, and caregivers as a reliable guide to the most important priorities for treatment and medical interventions. Keywords: quality of life, SEIQoL-adapted, renal dialysis

Salt-water imbalance and fluid overload in hemodialysis patients: a pivotal role of corin.

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Ricciardi, Carlo Alberto; Lacquaniti, Antonio; Cernaro, Valeria; Bruzzese, Annamaria; Visconti, Luca; Loddo, Saverio; Santoro, Domenico; Buemi, Michele

2016-08-01

Natriuretic peptides (NP) play a key role in regulation of salt and water balance. Corin, a serine protease which activates NP, plays a key role in regulation of blood pressure and cardiac function. The aim of the study was to evaluate the involvement of corin in renal physiopathology, analyze its levels in dialyzed patients and evaluate its relation with fluid overload and comorbidities such as heart failure and blood hypertension. We studied serum corin in uremic patients (n = 20) undergoing hemodialysis therapy (HD) and in healthy subjects (HS). Corin levels in uremic patients were higher than in HS (p role of corin in kidney diseases and to define its diagnostic and prognostic role.

Methicillin-resistant Staphylococcus aureus nasal carriage among patients receiving hemodialysis in Taiwan: prevalence rate, molecular characterization and de-colonization

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Kang Yu-Chuan

2012-11-01

Full Text Available Abstract Background Staphylococcus aureus, particularly methicillin resistant (MRSA, is a common pathogen among patients receiving hemodialysis. To evaluate nasal carriage, molecular characterization and effectiveness of decolonization of MRSA among patients receiving hemodialysis in Taiwan, we conducted this study. Methods From January to June 2011, two nasal samplings with a 3-month interval were obtained from patients undergoing hemodialysis in a medical center (CGMH, and in a local hospital (YMH and sent for detection of MRSA. For MRSA carriers, decolonization procedures were administered. All patients in CGMH were observed if MRSA infections occurred during the study period. Results A total of 529 nasal specimens (265 from CGMH and 264 from YMH were collected from 296 patients (161 from CGMH and 135 from YMH. 233 patients participated in both surveys. Average one-time point MRSA carriage rate was 3.8%, and the rate was up to 6.9% for those with two-time point surveys. No additional significant factor for MRSA carriage was identified. Seventy percent of the 20 colonizing MRSA isolates, though categorized as healthcare-associated strains epidemiologically, shared common molecular characteristics of the local community-associated strains. Only one of the 20 MRSA-colonized patients failed decolonization and had persistent colonization, while without any intervention, 17 (61% of 28 patients with methicillin-sensitive S. aureus colonization in the first survey had persistent colonization of a genetically indistinguishable strain. Within the study period, two patients (1.24% in CGMH, one with MRSA colonization (9.1%, developed MRSA infection. Conclusion A substantial proportion of patients receiving hemodialysis in Taiwan had MRSA colonization, mostly genetically community strains. Decolonization procedures may effectively eliminate MRSA colonization and might reduce subsequent MRSA infection in these patients.

Nontraditional factors influencing the quality of life of hemodialysis patients

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Diana-Cristina Varela

2014-06-01

Full Text Available Introduction: The prevalence of CKD patients in advanced stages with dialysis requirement continues to grow. A goal for the medical team, the patient and their caregivers is to provide a treatment that offers an impact on the prognosis and quality of life (QOL. Methods: In 100 patients with CKD on hemodialysis, randomized assigned, the quality of life by SF-36 was assessed, it was evaluated the functional capacity using the Karnofsky, ability to perform basic tasks of daily life through the index Barthel, presence of depression using the Beck test, family functioning through family APGAR, cognitive state through Minimental and presence of comorbidities using the Charlson index correlated with the sum of physical components (PCS and mental components (MCS of the SF-36 in patients in two renal units in Medellín and Bogotá, Colombia. Results: A decrease in QOL in the physical components (PCS Mental components (MCS regarding the general population. A significant correlation between low PCS and diabetes mellitus (-16 p=0.008 95% CI 2.49 was found. Low MCS showed relation with PTH (p=0.046 95% CI 0.000-0.014, Karnofsky index (p=0.034 95% CI 0.244 to 5.984 and Beck depression test (p=0.000 95% CI -13.606 to 6.253. Conclusions: The QOL of hemodialysis patients is affected with more impact on PCS, there is significant relationship between MCS with functional status and depression. To improve QOL in hemodialysis patients, non traditionally-measured variables should be measured and monitored and the therapeutic focus should be optimized addressed to physical rehabilitation, nutritional, functional and psychological state.

Clearance of Tc-99m DTPA in hemodialysis and peritoneal dialysis: concise communication

International Nuclear Information System (INIS)

Wainer, E.; Boner, G.; Lubin, E.; Rosenfeld, J.B.

1981-01-01

The clearance of Tc-99m DTPA was studied in 14 patients undergoing hemodialysis (HD) or peritoneal dialysis (PD). Mean Tc-99m DTPA clearance during HD was 37.8% +/- 10.1 of creatinine clearance. Mean Tc-99m DTPA clearance in PD was 65.1% +/- 10.3 of creatinine clearance. Tc-99m DTPA, with a larger molecular weight than that of creatinine, is cleared relatively better during PD than during HD. Thus Tc-99m DTPA may be used in the assessment of the effectiveness of different dialytic treatments for substances of similar molecular weight. In addition, our study shows that clearance of DTPA both in HD and PD is sufficiently high to allow the removal of this chelating agent in patients with renal failure

The source of net ultrafiltration during hemodialysis is mostly the extracellular space regardless of hydration status.

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Jeong, Hyeonju; Lim, Chae-Wan; Choi, Hye-Min; Oh, Dong-Jin

2016-01-01

Fluid shifts are common in patients undergoing chronic hemodialysis (HD) during the intradialytic periods, as several liters of fluid are removed during ultrafiltration (UF). Some patients have experienced frequent intradialytic hypotension (IDH). However, the characteristics of fluid shifts and which fluid space is affected remain controversial. Therefore, we designed this study to evaluate the fluid spaces most affected by UF and to determine whether hydration status influences the fluid shifts during HD. This was a prospective cohort study of 40 patients undergoing HD. We measured the patient's fluid spaces using a whole-body bioimpedance apparatus to evaluate the changes in the fluid spaces before HD and 1-4 hours of HD and 30 minutes after HD. UF achieved during HD by the 40 patients (age, 60.0 ± 5.2 years; 50% men; 50% of patients with diabetes; body weight, 61.3 ± 10.5 kg) was 2.18 ± 0.78 L (measured fluid overload, 2.15 ± 1.24 L). 1) Mean relative reduction of total body water and extracellular water was reduced from the start to the end of HD. 2) However, mean relative reduction of intracellular water was not reduced from the start to the end of HD. 3) No significant differences in fluid shifts were observed according to hydration status. The source of net UF during HD is mostly the extracellular space regardless of hydration status. Thus, IDH may be related to differences in the interstitial fluid shift to the vascular space. © 2015 International Society for Hemodialysis.

Serum leptin level and its significance in chronic renal failure hemodialysis patients

International Nuclear Information System (INIS)

Zhang Yong; You Yuping; Chen Weizhen; Mo Congjian

2003-01-01

To study serum leptin level in chronic renal failure (CRF) hemodialysis patients and the relationship between serum leptin level and residue renal function, body composition, and indices of malnutrition, 31 end-stage CRF hemodialysis patients and 38 healthy people were enrolled. Serum leptin levels were detected by radioimmunoassay. BMI, %Fat and LBM were measured by bioelectrical impedance analysis device. Alb, Chol, Hgb, BUN, SCr and Ccr of the patients were also examined. Results showed that Serum leptin level in end-stage CRF hemodialysis patients was markedly higher than that in healthy controls (P 0.05). Conclusion: Hyperleptinemia existed in end-stage CRF hemodialysis patients and might cause the loss of LBM. The leptin level was not correlated with residue renal function, but it could reflect the fat content. However, serum leptin did not play a significant role in protein malnutrition in end-stage CRF hemodialysis patients

Echocardiographic study of cardiac dysfunction in patients of chronic kidney disease on hemodialysis

International Nuclear Information System (INIS)

Arshi, S.; Butt, G.U.D.; Mian, F.A.

2016-01-01

Objective: The objective of this study was to see echocardiographic findings of cardiac dysfunction in patients of chronic kidney disease (CKD) on hemodialysis. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of nephrology, Pakistan Institute of Medical Sciences. Islamabad from September 2014 to February 2015. Patients and Methods: One hundred patients of either gender were included in this study. Fifty patients of chronic kidney disease stage V on hemodialysis were taken for echocardiography and fifty were normal. Echocardiography was done for cardiac dysfunction. Systolic function was measured by ejection fraction (EF) and fractional shortening (FS). Diastolic function was measured by E/A ratio. Results: Out of 100 patients included in the study, 50 patients were on hemodialysis and 50 were control. Left ventricular end systolic and end diastolic volumes were higher in patients on hemodialysis than controls as well as left atrial enlargement and inter ventricular septum which was statistically significant. Ejection fraction, although normal and fractional shortening decreased in patients on hemodialysis (p<0.05). Diastolic dysfunction was present in 36 patients on hemodialysis, while absent in the control group. Conclusion: Patients with chronic kidney disease on hemodialysis have higher prevalence of cardiac dysfunction. (author)

Pharmacokinetics of Gefitinib in a Patient with Non-Small Cell Lung Cancer Undergoing Continuous Ambulatory Peritoneal Dialysis

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Teppei Yamaguchi

2015-02-01

Full Text Available A 72-year-old man undergoing continuous ambulatory peritoneal dialysis (CAPD for chronic renal failure and who had undergone right upper lobectomy for lung adenocarcinoma (pT2aN0M0 2 years ago was admitted for recurrence of lung cancer presenting as multiple brain metastases. An epidermal growth factor receptor mutation analysis of his lung cancer revealed a deletion of 15 nucleotides (E746-A750 in exon 19. After whole-brain radiotherapy, we started daily administration of 250 mg gefitinib under the continuation of CAPD and performed a pharmacokinetic analysis. We speculated that the plasma concentration of gefitinib reached the steady state at least by day 16 after the start of gefitinib (626.6 ng/ml at trough level. On day 46, the plasma concentration was 538.4 ng/ml at trough level and the concentration in the peritoneal dialysis fluid was 34.6 ng/ml, suggesting that CAPD appeared to have little effect on the pharmacokinetics of gefitinib. During gefitinib therapy, there were no significant adverse events except for grade 2 diarrhea. Gefitinib could be safely administered to a patient undergoing CAPD.

Quality of life/spirituality, religion and personal beliefs of adult and elderly chronic kidney patients under hemodialysis

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Suzana Gabriela Rusa

2014-12-01

Full Text Available OBJECTIVE: to assess the quality of life of chronic kidney patients undergoing hemodialysis, using the WHOQOL-bref and WHOQOL-SRPB.METHOD: a descriptive and cross-sectional study was undertaken at a kidney replacement therapy service in the interior of the state of SP. The 110subjects who complied with the inclusion criteria answered the Subject Characterization Instrument, the WHOQOL-bref and WHOQOL-SRPB.RESULTS: most of the respondents were male (67.27%, with a mean age of 55.65 years, Catholic (55.45%, with unfinished primary education (33.64% and without formal occupation (79.08%. The WHOQOL-bref domains with the highest and lowest mean score were, respectively, "psychological" (µ=74.20 and "physical" (µ=61.14. The WHOQOL-SRPB domains with the highest and lowest mean score were, respectively, "completeness and integration" (µ=4.00 and "faith" (µ=4.40.CONCLUSIONS: the respondents showed high quality of life scores, specifically in the dimensions related to spirituality, religion and personal beliefs. Losses were evidenced in the physical domain of quality of life, possibly due to the changes resulting from the chronic kidney disease and hemodialysis treatment.

Relationship between instantaneous wave-free ratio and fractional flow reserve in patients receiving hemodialysis.

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Morioka, Yuta; Arashi, Hiroyuki; Otsuki, Hisao; Yamaguchi, Junichi; Hagiwara, Nobuhisa

2017-06-22

Instantaneous wave-free ratio (iFR) is a vasodilator-free index and is reported to have a good correlation with fractional flow reserve (FFR). Hemodialysis patients exhibit left ventricular hypertrophy, reduced arterial compliance, and impaired microcirculation. Such a coronary flow condition in these patients may influence the relationship between iFR and FFR. This study assessed the impact of hemodialysis on the relationship between iFR and FFR. The study enrolled 196 patients with 265 stenoses who underwent assessment via iFR, FFR assessment, and right heart catheterization. A good correlation between iFR and FFR was observed in hemodialysis patients. iFR in the hemodialysis group was significantly lower than in the non-hemodialysis group (0.81 ± 0.13 vs. 0.86 ± 0.13, p = 0.005), although no significant difference was found in FFR and percentage diameter stenosis. An iFR value of 0.84 was found to be equivalent to an FFR value of 0.8 in hemodialysis patients, which was lower than the standard predictive iFR range for ischemia. Vasodilator-free assessment by iFR could be beneficial in evaluating intermediate coronary stenosis in patients receiving hemodialysis. However, the threshold for iFR abnormality needs adjustment in hemodialysis patients, and larger clinical trials are required to confirm the results in this specific subset.

Serum alanine aminotransferase levels, hematocrit rate and body weight correlations before and after hemodialysis session

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Edmundo Pessoa Lopes

2009-01-01

Full Text Available PURPOSE: To evaluate alanine aminotransferase levels before and after a hemodialysis session and to correlate these values with the hematocrit rate and weight loss during hemodialysis. PATIENTS AND METHODS: The serum alanine aminotransferase levels, hematocrit rate and body weight were measured and correlated before and after a single hemodialysis session for 146 patients with chronic renal failure. An receiver operating characteristic (ROC curve for the serum alanine aminotransferase levels collected before and after hemodialysis was plotted to identify hepatitis C virus-infected patients. RESULTS: The mean weight loss of the 146 patients during hemodialysis was 5.3% (p < 0.001. The mean alanine aminotransferase levels before and after hemodialysis were 18.8 and 23.9 IU/, respectively, denoting a significant 28.1% increase. An equally significant increase of 16.4% in the hematocrit rate also occurred after hemodialysis. The weight loss was inversely correlated with the rise in both the alanine aminotransferase level (r = 0.3; p < 0.001 and hematocrit rate (r = 0.5; p < 0.001. A direct correlation was found between the rise in alanine aminotransferase levels and the hematocrit during the hemodialysis session (r = 0.4; p < 0.001. Based on the ROC curve, the upper limit of the normal alanine aminotransferase level should be reduced by 40% relative to the upper limit of normal if the blood samples are collected before the hemodialysis session or by 60% if blood samples are collected after the session. CONCLUSION: In the present study, significant elevations in the serum alanine aminotransferase levels and hematocrit rates occurred in parallel to a reduction in body weight after the hemodialysis session. These findings suggest that one of the factors for low alanine aminotransferase levels prior to hemodialysis could be hemodilution in patients with chronic renal failure.

White thrombus formation in blood tubing lines in a chronic hemodialysis unit.

Science.gov (United States)

Watnick, Suzanne; Stooksbury, Michael; Winter, Rolf; Riscoe, Michael; Cohen, David M

2008-03-01

Previous reports have described white particulate matter in banked blood components, but no prior public reports describe such matter in blood tubing during the course of routine in-center hemodialysis. This report describes the events, investigations, and preliminary conclusions associated with the spontaneous formation of adherent white thrombus in the venous and arterial blood lines during routine in-center hemodialysis treatments. Design setting, participants, & measurements: This investigation occurred at the Portland Veterans Administration Medical Center (PVAMC) Hemodialysis Unit from October 2006 through April 2007. Sixty-eight variables regarding demographics, medical history and dialysis treatments were collected on our 34 chronic hemodialysis outpatients. Over a 5-wk interval, 62% (21 of 34) of the chronic hemodialysis patients unexpectedly developed a white precipitate adhering to the lumenal surface of their dialysis blood tubing, with 73 of 580 chronic dialysis treatments exhibiting the phenomenon. Microscopic and biochemical analyses were consistent with white thrombus, formed by an aggregation of platelets and fibrin. An alert was issued and other in-center hemodialysis units noted similar findings. This was remedied by the removal of specific tubing. Both patient-specific and tubing-specific factors may have been operative. Although patient safety was not adversely affected, assessment of clinical and manufacturing variables potentially affecting platelet activation is warranted.

The relationship between emotional intelligence and quality of life hemodialysis patients

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Masoome Shahnavazi

2016-07-01

Full Text Available Hemodialysis treatment methods in patients with chronic kidney failure increase the life span of these patients, but hemodialysis affects all life aspects of patients and diminishes the quality of life patients. The aim of the study was to examine the relationship between emotional intelligence and quality of life for hemodialysis patients . This study was a descriptive – correlational research conducted in 2014 on 98 hemodialysis patients Referred to Hospitals of University Medical Sciences in Iran Iranshahr . The tools used in this study included demographic questionnaire, Cyberia Shrink Emotional Intelligence Questionnaire, and the Kidney Disease Quality of Life-Short Form Questionnaire. After obtaining informed consent, patient completed the questionnaire. Finally, raw data were collected through questionnaires and were analyzed using SPSS16 Software. To investigate the relationships between predictor and criterion variables, Pearson correlation and linear regression analysis were used . The mean age of patients was 33/36 and the majority of participants were male (58.1 percent. In terms of variable of education level, majority of participants had elementary education, and 54.54% of the mean weight of the patients was 41.06 kg. Mean score of life quality was 41.06 ± 15.95 and the mean score of emotional intelligenc e was 43.99 ± 10.50. Pearson correlation coefficient with 99% p robability confidence showed significant positive correlation between the components of emotional intelligence and quality of life in hemodialysis patients (p<0.001 and emotional intelligence with regression coefficient 0.412 predicts 30% of the variance of quality of life in hemodialysis patients . It is recommended for nurses and nursing directors to improve the quality of life hemodialysis patients by training emotional intelligence skills.

Post-angioplasty far infrared radiation therapy improves 1-year angioplasty-free hemodialysis access patency of recurrent obstructive lesions.

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Lai, C-C; Fang, H-C; Mar, G-Y; Liou, J-C; Tseng, C-J; Liu, C-P

2013-12-01

To explore the role of far infrared (FIR) radiation therapy for hemodialysis (HD) access maintenance after percutaneous transluminal angioplasties (PTA). This was a prospective observational study. Eligible patients were those who received repeated PTA with the last PTA successfully performed within 1 week before the study enrollments. Consecutively enrolled patients undergoing successful HD treatments after PTA were randomly assigned to the FIR-radiated group or control group without radiation. FIR-radiated therapy meaning 40-minute radiation at the major lesion site or anastomosed site three times a week was continued until an end-point defined as dysfunction-driven re-PTA or the study end was reached. Of 216 participants analyzed, including 97 with arteriovenous grafts (AVG) (49 FIR-radiated participants and 48 control participants) and 119 with arteriovenous fistulas (AVF) (69 FIR-radiated participants and 50 control participants), the FIR-radiated therapy compared with free-radiated usual therapy significantly enhanced PTA-unassisted patency at 1 year in the AVG subgroup (16.3% vs. 2.1%; p radiated therapy improves PTA-unassisted patency in patients with AVG who have undergone previous PTA. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

TTV as A Risk Factor in Hemodialysis Process

International Nuclear Information System (INIS)

Ibrahim, I.M.

2010-01-01

The association of TTV (transfusion transmitted virus) with both cryptogenic chronic liver diseases and post-transfusion hepatitis has been reported. Hemodialysis patients are at high risk for viral hepatitis due to blood born viral agents. The few data available concerning TTV infection among hemodialysis patients shows a high prevalence. This study was conducted on one hundred patients with end-stage renal disease (ESRD). They were attending the hemodialysis (HD) unit of Naser institute for performing hemodialysis for the first time (as a control group) and the same patients after recurrent HD for at least six months of regular HD (as a HD patient group). Patients and controls were subjected to the following laboratory investigations; 1) TTV DNA detection by PCR. 2) HBs Ag by ELISA technique. 3) HCV Ab by ELISA technique. 4) Liver enzymes include ALT, AST and γGT. The study was done to detect TTV DNA by PCR in hemodialysis patients and to evaluate its clinical impacts, taking into account co-infection with other hepatitis viruses. The results of this work are:- 1- TTV is remarkably prevalent in HD patients. The prevalence of TTV infection in HD Egyptian patients was 45% and 9% in healthy volunteer from the same geographical area. 2- HCV was found to have highly significant association with HD patients while there was no association between HD patients and HBs Ag. 3- TTV infection was not found to be more prevalent in HD patients infected with HCV. 4- Abnormal liver enzymes were uncommon in HD patients infected with TTV alone, in contrast to patients with known hepatotropic viruses such as HCV. 5- TTV did not play a role in liver injury, but it might aggravate liver diseases caused by HCV.

Non-Imaging Acoustical Properties in Monitoring Arteriovenous Hemodialysis Access. A Review

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Anas Mohd Noor

2015-12-01

Full Text Available The limitations of the gold standard angiography technique in arteriovenous access surveillance have opened a gap for researchers to find the best way to monitor this condition with low-cost, non-invasive and continuous bedside monitoring. The phonoangiography technique has been developed prior to these limits. This measurement and monitoring technique, associated with intelligence signal processing, promises better analysis for early detection of hemodialysis access problems, such as stenosis and thrombosis. Some research groups have shown that the phonoangiography technique could identify as many as 20% of vascular diameter changes and also its frequency characteristics due to hemodialysis access problems. The frequency characteristics of these acoustical signals are presented and discussed in detail to understand the association with the stenosis level, blood flows, sensor locations, fundamental frequency bands of normal and abnormal conditions, and also the spectral energy produced. This promising technique could be used in the near future as a tool for pre-diagnosis of arteriovenous access before any further access correction by surgical techniques is required. This paper provides an extensive review of various arteriovenous access monitoring techniques based on non-imaging acoustical properties.

Urea biosensor for hemodialysis monitoring

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Glass, Robert S.

1999-01-01

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.

Optimizing lithium dosing in hemodialysis

DEFF Research Database (Denmark)

Bjarnason, N H; Munkner, R; Kampmann, J P

2006-01-01

We studied a 62-year-old female hemodialysis patient during initiation and maintenance of lithium carbonate therapy. Three different methods were applied to estimate the regimen: a scenario based on volume of distribution (V(d)), a scenario based on glomerular filtration rate (GFR), and a scenario...... estimates. Furthermore, the maintenance dose estimated from the central compartment (V1) led to plasma concentrations within the therapeutic range. Thus, a regimen where 12.2 mmol lithium was given after each hemodialysis session resulted in stable between-dialysis plasma lithium concentrations...... in this patient with no residual kidney function. We did not observe adverse effects related to this regimen, which was monitored from 18 days to 8 months of therapy, and the patient experienced relief from her severe depressive disorder. In conclusion, dialysis patients may be treated with lithium administrated...

Geographical Variations in Blood Pressure Level and Seasonality in Hemodialysis Patients

NARCIS (Netherlands)

Duranton, Flore; Kramer, Anneke; Szwarc, Ilan; Bieber, Brian; Gayrard, Nathalie; Jover, Bernard; Vetromile, Fernando; Massy, Ziad A.; Combe, Christian; Tentori, Francesca; Jager, Kitty J.; Servel, Marie-Françoise; Argilés, Àngel

2018-01-01

Seasons and climate influence the regulation of blood pressure (BP) in the general population and in hemodialysis patients. It is unknown whether this phenomenon varies across the world. Our objective was to estimate BP seasonality in hemodialysis patients from different geographical locations.

Rosuvastatin in diabetic hemodialysis patients

DEFF Research Database (Denmark)

Holdaas, Hallvard; Holme, Ingar; Schmieder, Roland E

2011-01-01

A randomized, placebo-controlled trial in diabetic patients receiving hemodialysis showed no effect of atorvastatin on a composite cardiovascular endpoint, but analysis of the component cardiac endpoints suggested that atorvastatin may significantly reduce risk. Because the AURORA (A Study...

Frequency of nursing care of vascular access in hemodialysis patients

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Iman Taghizade Firoozjayi

2016-03-01

Full Text Available Background: Hemodialysis is a critical treatment method, which depends on the vascular access route. Lack of care for the vascular access route could diminish its efficiency in a short time. Regarding this, the present study aimed to evaluate the frequency of nursing care for vascular access route in the hemodialysis patients. Methods: This cross-sectional study was conducted on 20 nurses and 120 hemodialysis patients, who referred to the Hemodialysis Department of Shahid Beheshti Hospital, Babol, Iran, in 2015. The method of nursing care for vascular access route was evaluated using a researcher-made checklist. The data analysis was performed using the descriptive statistics in the SPSS version 16. Results: In total, 14 cases of nursing care were evaluated, in 100% of which all the caring steps, including wearing gloves and a mask, early bolus injections of heparin, washing the catheter tubing, frequent monitoring of blood pressure, rinsing the catheter tubing, returning the blood to the body after hemodialysis, and sterile covering of the puncture site, were observed. However, some of the other techniques, such as the care related to appropriate pump speed when starting the dialysis machine (81.66%, observance of the needle distance from fistula (75.83%, appropriate placement of catheter (75%, pressing the injection site (54.17%, blood pressure monitoring at the end of dialysis (50%, and change of the needle site between two sessions (27.5%, were not adhered to by the nurses. Conclusion: According to the results of this study, some of the nursing care steps, which are necessary in the beginning and end of the hemodialysis, were not accurately followed by the nurses. It is recommended that constant training courses be held for the nurses in this regard.

Blood leptin levels and erythropoietin requirement in Iranian hemodialysis patients

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Rahimi A

2008-12-01

Full Text Available "nBackground: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer durations of hemodialysis are possible factors contributing to the reduced need for rHuEPO in these patients. The present study is designed to asses the relationship between the plasma levels of leptin and the reduced EPO need. "nMethods: Fifty eligible hemodialysis patients with hemoglobin levels higher than 11 mg/dl were enrolled in the cross-sectional study. The information on age, sex, hemodialysis duration and the cause of renal dysfunction were extracted from the files. The baseline plasma levels of Leptin and albumin were measured. The patients BMI and the weekly need for rHuEPO were also calculated. "nResults: There was no correlation between the weekly need for rHuEPO and sex, BMI, the cause of renal dysfunction and the plasma levels of albumin and leptin; it, however, was related with age and the duration of dialysis. While age negatively influences the weekly need, the duration of dialysis has a positive effect on the need. "nConclusion: The plasma levels of leptin are not directly correlated with the required amounts of rHuEPO, indicating that leptin is not an effective factor in erythropoiesis. Conversely, older age and shorter hemodialysis durations are accompanied by reduced need for rHuEPO.

N-terminal pro brain natriuretic peptide as a cardiac biomarker in Japanese hemodialysis patients.

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Shimizu, Minako; Doi, Shigehiro; Nakashima, Ayumu; Naito, Takayuki; Masaki, Takao

2018-03-01

This study examined the clinical significance of N-terminal pro brain natriuretic peptide level as a cardiac marker in Japanese hemodialysis patients. This was a multicenter cross-sectional study involving 1428 Japanese hemodialysis patients. Ultrasonic cardiography data at post-hemodialysis were obtained from 395 patients. We examined whether serum N-terminal pro brain natriuretic peptide levels were associated with cardiac parameters and assessed cut-off values and investigated factors associated with a reduced ratio of N-terminal pro brain natriuretic peptide levels pre- and post-hemodialysis. Multivariate logistic regression analysis showed that pre- and post-hemodialysis N-terminal pro brain natriuretic peptide levels were associated with left ventricular hypertrophy on electrocardiogram (odds ratio: 3.10; p N-terminal pro brain natriuretic peptide levels were also significantly associated with ejection fraction on urine chorionic gonadotrophin (ultrasonic cardiography; odds ratio: 35.83; p N-terminal pro brain natriuretic peptide reduction ratio during a hemodialysis session correlated with Kt/V, membrane area, membrane type, modality, body weight gain ratio, treatment time, and ultrafiltration rate with multiple linear regression ( R: 0.53; p N-terminal pro brain natriuretic peptide are associated with the presence of left ventricular hypertrophy in this population. The post-hemodialysis N-terminal pro brain natriuretic peptide level is a useful marker for systolic dysfunction.

Comparison of Hemoglobin Levels Before and After Hemodialysis and Their Effects on Erythropoietin Dosing and Cost

OpenAIRE

Sagheb; Fallahzadeh; Moaref; Fallahzadeh; Dormanesh

2016-01-01

Background Hemoglobin levels measured after hemodialysis, as compared to hemoglobin levels measured before hemodialysis, are suggested to be a more accurate reflection of the hemoglobin levels between hemodialysis sessions, and to be a better reference point for adjusting erythropoietin dosing. Objectives The aim of this study was to compare the hemoglobin levels before and after hemodialysis, to calculate the required erythropoie...

Concurrence of Serum Creatinine and Albumin with Lower Risk for Death in Twice-Weekly Hemodialysis Patients

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Wang, Jialin; Streja, Elani; Soohoo, Melissa; Chen, Joline L.T.; Rhee, Connie M.; Kim, Taehee; Molnar, Miklos Z.; Kovesdy, Csaba P.; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar

2016-01-01

Objective Markers of better nutritional status including both higher levels of serum albumin (as a measure of visceral proteins) and creatinine (as a measure of the muscle mass) are associated with lower mortality in conventional (thrice-weekly) hemodialysis patients. However, data for these associations in twice-weekly hemodialysis patients, in whom less frequent hemodialysis may confound nutritional predictors, are lacking. Design, Settings and Subjects We identified 1,113 twice-weekly and matched 4,448 thrice-weekly hemodialysis patients from a large national dialysis cohort of incident hemodialysis patients over 5 years (2007-2011). Mortality risk, adjusted for potential confounders, was examined across two-by-two combinations of serum creatinine (creatinine≥6mg/dl and albumin≥3.5g/dl as reference, patients with creatininecreatinine mortality associations between twice-weekly and thrice-weekly hemodialysis patients (p-for-interaction 0.7667). Conclusions Surrogate markers of higher visceral protein and muscle mass combined may confer greatest survival in both twice-weekly and thrice-weekly hemodialysis patients. PMID:27528412

Pancytopenia after low dose methotrexate therapy in a hemodialysis patient: case report and review of literature.

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Yang, Ching-Ping; Kuo, Mei-Chuan; Guh, Jinn-Yuh; Chen, Hung-Chun

2006-01-01

Methotrexate (MTX) is widely used in the treatment of rheumatoid arthritis (RA) with a side effect of pancytopenia. However, only a few cases of severe pancytopenia caused by low-dose MTX therapy have been reported, and the condition is rarely reported in uremic patients on dialysis therapy. We thereby report a hemodialysis patient who developed severe pancytopenia after oral treatment with low-dose MTX for RA. A 55-year-old woman who had been on regular hemodialysis treatment for 7 yr suffered from RA for 10 yr. She was regularly treated with celecoxib, prednisolone, and sulfasalazine in the past year. Because of the increasing arthralgia, 7.5 mg per week MTX was prescribed 3 months before admission. Stomatitis, fever, general fatigue, multiple skin carbuncles, and easy bruising developed after a cumulative dose of 90 mg. Pancytopenia was found at admission and the nadir of white blood cell count was 250/microL with 28% neutrophils, hematocrit was 22%, and platelet count was 6000/microL. Eosinophil counts increased from 11.5% initially to 26.1% on the sixth admission day. Transfusion with red blood cells and platelets, and appropriate antibiotics and folic acid were prescribed. She continued receiving regular hemodialysis and eventually recovered within 3 weeks.

Transhepatic venous catheters for hemodialysis

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Mohamed El Gharib

2014-06-01

Conclusion: Based on our findings, transhepatic hemodialysis catheters have proven to achieve good long-term functionality. A high level of maintenance is required to preserve patency, although this approach provides remarkably durable access for patients who have otherwise exhausted access options.

Effect of warm footbath with vibration on arteriovenous fistula puncture-related pain in hemodialysis patients

OpenAIRE

Zahra Abbas Ali Madadi; Jalil Azimian; Farzaneh Falahatpishe; Mahmoud Alipour Heidari

2017-01-01

Background: Pain and stress of hemodialysis are experienced by more than 50% of patients who are suffering from renal disease; hence decreasing a part of these adverse effects can be effective on individual’s long term coping with hemodialysis. The current study was done to determine the effect of warm footbath with vibration on arteriovenous fistula puncture-related pain in hemodialysis patients. Methods: This clinical trial was conducted on 31 hemodialysis patients in 2014. The patients ...

Prognostic impact of peritonitis in hemodialysis patients: A national-wide longitudinal study in Taiwan.

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Yueh-An Lu

Full Text Available Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients.This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure.Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%, yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis.The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.

Prognostic impact of peritonitis in hemodialysis patients: A national-wide longitudinal study in Taiwan.

Science.gov (United States)

Lu, Yueh-An; Tu, Kun-Hua; Lee, Cheng-Chia; Wu, Patricia W; Chang, Chee-Jen; Tian, Ya-Chung; Yang, Chih-Wei; Chu, Pao-Hsien

2017-01-01

Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients. This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure. Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis. The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.

Short and long nightly hemodialysis in the United States.

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Lockridge, Robert S; Pipkin, Mary

2008-07-01

When hemodialysis first started in the United States in the 1960s, a large percentage of patients performed their treatments at home. However, because of reimbursement issues, home hemodialysis (HHD) gradually succumbed to an in-center approach and eventually a mindset. Since the introduction of nightly HHD by Uldall and Pierratos in 1993, there has been a resurgence of interest in HHD. This paper describes the different types of home hemodialysis being performed as of December 31, 2007 in this country. Because neither the United States Renal Data System (USRDS) nor the End Stage Renal Disease (ESRD) Networks break down home dialysis into the different modalities, a provider questionnaire was sent out to 2 major providers, a number of mid-level providers and other providers known to do HHD. In addition, a questionnaire was sent out to 3 machine providers to obtain the number of patients using their machine for HHD as of December 31, 2007. The results showed that 91.7% of patients are dialyzing in-center, 7.3% are doing peritoneal dialysis, and 0.7% are doing HHD. Currently about 1% of ESRD patients in the United States are doing home hemodialysis. NxStage, however, has started 1000 patients in the past year on short-daily home hemodialysis. Patients are beginning to understand that there are better options than 3 times a week in-center dialysis. And as a result of the "HEMO Study," nephrologists now believe that longer and more frequent dialysis is a better therapy for ESRD patients. Therefore, promotion of HHD should become a priority for the renal community in the future.

Sudden cardiac death in hemodialysis patients: an in-depth review.

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Green, Darren; Roberts, Paul R; New, David I; Kalra, Philip A

2011-06-01

Sudden cardiac death (SCD) is the leading cause of death in hemodialysis patients, accounting for death in up to one-quarter of this population. Unlike in the general population, coronary artery disease and heart failure often are not the underlying pathologic processes for SCD; accordingly, current risk stratification tools are inadequate when assessing these patients. Factors assuming greater importance in hemodialysis patients may include left ventricular hypertrophy, electrolyte shift, and vascular calcification. Knowledge regarding SCD in hemodialysis patients is insufficient, in part reflecting the lack of an agreed-on definition of SCD in this population, although epidemiologic studies suggest the most common times for SCD to occur are toward the end of the long 72-hour weekend interval between dialysis sessions and in the 12 hours immediately after hemodialysis. Accordingly, it is hypothesized that the dialysis procedure itself may have important implications for SCD. Supporting this is recognition that hemodialysis is associated with both ventricular arrhythmias and dynamic electrocardiographic changes. Importantly, echocardiography and electrocardiography may show changes that are modifiable by alterations to dialysis prescription. The most effective preventative strategy in the general population, implanted cardioverter-defibrillator devices, are less effective in the presence of chronic kidney disease and have not been studied adequately in dialysis patients. Last, many dialysis patients experience SCD despite not fulfilling current criteria for implantation, making appropriate allocation of defibrillators uncertain. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Coping with Treatment-Related Stress: Effects on Patient Adherence in Hemodialysis.

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Christensen, Alan J.; And Others

1995-01-01

Examines the relation of coping to adherence among 57 hemodialysis patients. As predicted, coping efforts involving planful problem solving were associated with more favorable adherence when used in response to stressors involving a relatively controllable aspect of the hemodialysis context. For less controllable stressors, coping efforts…

Increased cerebral water content in hemodialysis patients.

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Kathrin Reetz

Full Text Available Little information is available on the impact of hemodialysis on cerebral water homeostasis and its distribution in chronic kidney disease. We used a neuropsychological test battery, structural magnetic resonance imaging (MRI and a novel technique for quantitative measurement of localized water content using 3T MRI to investigate ten hemodialysis patients (HD on a dialysis-free day and after hemodialysis (2.4±2.2 hours, and a matched healthy control group with the same time interval. Neuropsychological testing revealed mainly attentional and executive cognitive dysfunction in HD. Voxel-based-morphometry showed only marginal alterations in the right inferior medial temporal lobe white matter in HD compared to controls. Marked increases in global brain water content were found in the white matter, specifically in parietal areas, in HD patients compared to controls. Although the global water content in the gray matter did not differ between the two groups, regional increases of brain water content in particular in parieto-temporal gray matter areas were observed in HD patients. No relevant brain hydration changes were revealed before and after hemodialysis. Whereas longer duration of dialysis vintage was associated with increased water content in parieto-temporal-occipital regions, lower intradialytic weight changes were negatively correlated with brain water content in these areas in HD patients. Worse cognitive performance on an attention task correlated with increased hydration in frontal white matter. In conclusion, long-term HD is associated with altered brain tissue water homeostasis mainly in parietal white matter regions, whereas the attentional domain in the cognitive dysfunction profile in HD could be linked to increased frontal white matter water content.

Increased cerebral water content in hemodialysis patients.

Science.gov (United States)

Reetz, Kathrin; Abbas, Zaheer; Costa, Ana Sofia; Gras, Vincent; Tiffin-Richards, Frances; Mirzazade, Shahram; Holschbach, Bernhard; Frank, Rolf Dario; Vassiliadou, Athina; Krüger, Thilo; Eitner, Frank; Gross, Theresa; Schulz, Jörg Bernhard; Floege, Jürgen; Shah, Nadim Jon

2015-01-01

Little information is available on the impact of hemodialysis on cerebral water homeostasis and its distribution in chronic kidney disease. We used a neuropsychological test battery, structural magnetic resonance imaging (MRI) and a novel technique for quantitative measurement of localized water content using 3T MRI to investigate ten hemodialysis patients (HD) on a dialysis-free day and after hemodialysis (2.4±2.2 hours), and a matched healthy control group with the same time interval. Neuropsychological testing revealed mainly attentional and executive cognitive dysfunction in HD. Voxel-based-morphometry showed only marginal alterations in the right inferior medial temporal lobe white matter in HD compared to controls. Marked increases in global brain water content were found in the white matter, specifically in parietal areas, in HD patients compared to controls. Although the global water content in the gray matter did not differ between the two groups, regional increases of brain water content in particular in parieto-temporal gray matter areas were observed in HD patients. No relevant brain hydration changes were revealed before and after hemodialysis. Whereas longer duration of dialysis vintage was associated with increased water content in parieto-temporal-occipital regions, lower intradialytic weight changes were negatively correlated with brain water content in these areas in HD patients. Worse cognitive performance on an attention task correlated with increased hydration in frontal white matter. In conclusion, long-term HD is associated with altered brain tissue water homeostasis mainly in parietal white matter regions, whereas the attentional domain in the cognitive dysfunction profile in HD could be linked to increased frontal white matter water content.

Factors associated with quality of life among hemodialysis patients in Malaysia.

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Nor Baizura Md Yusop

Full Text Available Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90 were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS and Physical Composite Summary (PCS of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0-100, with a higher score indicating better quality of life. Approximately 26 (30% of respondents achieved the body mass index (24 kg/m(2 and more than 80% (n=77 achieved serum albumin level (>35.0 mg/dL recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80% and protein (n=68,75% recommendations. The total score of SF-36 was 54.1 ± 19.2, while the score for the mental and physical components were 45.0 ± 8.6 and 39.6 ± 8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000 and lower serum calcium (p=0.004, while higher blood flow (p=0.000, higher serum creatinine (p=0.000 and lower protein intake (p=0.006 were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality

Factors associated with quality of life among hemodialysis patients in Malaysia.

Science.gov (United States)

Md Yusop, Nor Baizura; Yoke Mun, Chan; Shariff, Zalilah Mohd; Beng Huat, Choo

2013-01-01

Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90) were recruited from Hospital Kuala Lumpur and dialysis centres of the National Kidney Foundation of Malaysia. Data obtained included socio-demography, medical history, hemodialysis treatment and nutritional status. Mental and physical quality of life were measured using the Mental Composite Summary (MCS) and Physical Composite Summary (PCS) of the Short-Form Health Survey 36-items, a generic core of the Kidney Disease Quality of Life Short Form. Two summary measures and total SF-36 was scored as 0-100, with a higher score indicating better quality of life. Approximately 26 (30%) of respondents achieved the body mass index (24 kg/m(2)) and more than 80% (n=77) achieved serum albumin level (>35.0 mg/dL) recommended for hemodialysis patients. The majority of respondents did not meet the energy (n=72, 80%) and protein (n=68,75%) recommendations. The total score of SF-36 was 54.1 ± 19.2, while the score for the mental and physical components were 45.0 ± 8.6 and 39.6 ± 8.6, respectively. Factors associated with a higher MCS score were absence of diabetes mellitus (p=0.000) and lower serum calcium (p=0.004), while higher blood flow (p=0.000), higher serum creatinine (p=0.000) and lower protein intake (p=0.006) were associated with a higher PCS score. To improve the overall quality of life of hemodialysis patients, a multidisciplinary intervention that includes medical, dietetic and psychosocial strategies that address factors associated with mental and physical quality of life are warranted to reduce further health complications and to improve quality of

Mortality risk in hemodialysis patients with increased arterial stiffness is reduced by attainment of classical clinical performance measures

DEFF Research Database (Denmark)

Scholze, Alexandra; Thies, Christina; Cheikhalfraj, Mohamed

2009-01-01

We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness.......We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness....

Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies.

Science.gov (United States)

Saha, Manish; Allon, Michael

2017-02-07

Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence. Copyright © 2017 by the American Society of Nephrology.

The effects of nocturnal compared with conventional hemodialysis on mineral metabolism: A randomized-controlled trial.

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Walsh, Michael; Manns, Braden J; Klarenbach, Scott; Tonelli, Marcello; Hemmelgarn, Brenda; Culleton, Bruce

2010-04-01

Hyperphosphatemia is common among patients receiving dialysis and is associated with increased mortality. Nocturnal hemodialysis (NHD) is a long, slow dialytic modality that may improve hyperphosphatemia and disorders of mineral metabolism. We performed a randomized-controlled trial of NHD compared with conventional hemodialysis (CvHD); in this paper, we report detailed results of mineral metabolism outcomes. Prevalent patients were randomized to receive NHD 5 to 6 nights per week for 6to 10 hours per night or to continue CvHD thrice weekly for 6 months. Oral phosphate binders and vitamin D analogs were adjusted to maintain phosphate, calcium and parathyroid hormone (PTH) levels within recommended targets. Compared with CvHD patients, patients in the NHD group had a significant decrease in serum phosphate over the course of the study (0.49 mmol/L, 95% confidence interval 0.24-0.74; P=0.002) despite a significant reduction in the use of phosphate binders. Sixty-one percent of patients in the NHD group compared with 20% in the CvHD group had a decline in intact PTH (P=0.003). Nocturnal hemodialysis lowers serum phosphate, calcium-phosphate product and requirement for phosphate binders. The effects of NHD on PTH are variable. The impact of these changes on long-term cardiovascular and bone-related outcomes requires further investigation.

Contributions of myocardial scintigraphy in coronary heart disease in chronic hemodialysis: A prospective study of 52 cases

International Nuclear Information System (INIS)

Souli, Jihene

2007-01-01

We propose in this work to assess the prevalence of cardiovascular risk factors in the chronic hemodialysis as well as diagnostic and prognostic performance of myocardial SPECT. We conducted a prospective study over a period of 5 years (1999-2004) assemble 52 chronic hemodialysis patients, 73 pour cent were treated at the hemodialysis unit of the principal Hospital Military - Tunis and 27 pour cent the hemodialysis unit of the polyclinic CNSS El Khadhra. The conventional periodic hemodialysis bicarbonate was the dialysis technique used in all our patients.

Induction of IL-1 during hemodialysis: Transmembrane passage of intact endotoxins (LPS)

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Laude-Sharp, M.; Caroff, M.; Simard, L.; Pusineri, C.; Kazatchkine, M.D.; Haeffner-Cavaillon, N. (INSERM U 28, Hopital Broussais, Paris (France))

1990-12-01

Circulating monocytes of patients undergoing chronic hemodialysis are triggered to produce interleukin-1 (IL-1) in vivo. Intradialytic induction of IL-1 is associated with complement activation in patients dialyzed with first-use cellulose membranes. Chronic stimulation of IL-1 production occurs because of an yet unidentified mechanism in patients dialyzed with high permeability membranes. The present study demonstrates that intact bacterial lipopolysaccharide (LPS) molecules may cross cuprophan, AN69 and polysulfone membranes under in vitro conditions simulating in vivo hemodialysis. The experiments used purified LPS from Neisseria meningitidis and LPS from Pseudomonas testosteroni, a bacterial strain grown out from a clinically used dialysate. LPS were purified to homogeneity and radiolabeled. Transmembrane passage of 3H-labeled LPS was observed within the first five minutes of dialysis. A total of 0.1 to 1% of 3H-labeled LPS were recovered in the dialysate compartment after one hour of dialysis. High amounts of LPS, representing 40 to 70% of the amount originally present in the dialysate, were absorbed onto high permeability membranes. Low amounts of LPS were absorbed onto cuprophan membranes. The amount of LPS absorbed decreased with the concentration of LPS in the dialysate. LPS recovered from the blood compartment exhibited the same molecular weight as that used to contaminate the dialysate. Biochemically detectable transmembrane passage of LPS was not associated with that of material detectable using the limulus amebocyte lysate (LAL) assay. An IL-1-inducing activity was, however, detected in the blood compartment upon dialysis with high permeability membranes, as previously found by others with cuprophan membranes.

Induction of IL-1 during hemodialysis: Transmembrane passage of intact endotoxins (LPS)

International Nuclear Information System (INIS)

Laude-Sharp, M.; Caroff, M.; Simard, L.; Pusineri, C.; Kazatchkine, M.D.; Haeffner-Cavaillon, N.

1990-01-01

Circulating monocytes of patients undergoing chronic hemodialysis are triggered to produce interleukin-1 (IL-1) in vivo. Intradialytic induction of IL-1 is associated with complement activation in patients dialyzed with first-use cellulose membranes. Chronic stimulation of IL-1 production occurs because of an yet unidentified mechanism in patients dialyzed with high permeability membranes. The present study demonstrates that intact bacterial lipopolysaccharide (LPS) molecules may cross cuprophan, AN69 and polysulfone membranes under in vitro conditions simulating in vivo hemodialysis. The experiments used purified LPS from Neisseria meningitidis and LPS from Pseudomonas testosteroni, a bacterial strain grown out from a clinically used dialysate. LPS were purified to homogeneity and radiolabeled. Transmembrane passage of 3H-labeled LPS was observed within the first five minutes of dialysis. A total of 0.1 to 1% of 3H-labeled LPS were recovered in the dialysate compartment after one hour of dialysis. High amounts of LPS, representing 40 to 70% of the amount originally present in the dialysate, were absorbed onto high permeability membranes. Low amounts of LPS were absorbed onto cuprophan membranes. The amount of LPS absorbed decreased with the concentration of LPS in the dialysate. LPS recovered from the blood compartment exhibited the same molecular weight as that used to contaminate the dialysate. Biochemically detectable transmembrane passage of LPS was not associated with that of material detectable using the limulus amebocyte lysate (LAL) assay. An IL-1-inducing activity was, however, detected in the blood compartment upon dialysis with high permeability membranes, as previously found by others with cuprophan membranes

OPCAB in patients on hemodialysis.

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Milani, Rodrigo; Brofman, Paulo Roberto Slud; Souza, José Augusto Moutinho de; Barboza, Laura; Guimarães, Maximiliano Ricardo; Barbosa, Alexandre; Varela, Alexandre Manoel; Ravagnelli, Marcel Rogers; Silva, Francisco Maia da

2007-01-01

To analyze the hospital outcomes of patients, with chronic renal insufficiency in the hemodialysis, submitted to OPCAB. Fifty-one patients with chronic renal insufficiency were submitted to OPCAB. Hemodialysis was performed on the day before and the day after the operation. Myocardial revascularization was performed using LIMA's suture and suction stabilization. Fifty-one patients, with an average of 61.28+/-11.09 years, were analyzed. Thirty patients (58.8%) were female. The predominant functional class was IV in 21 (41.1%) of the patients. The left ventricle ejection fraction was dire in 21 (41.1%) patients. The mean EUROSCORE of this series was 7.65+/-3.83 and the mean number of distal anastomosis was 3.1+/-0.78 per patient. The average time of mechanical ventilation was 3.78+/-4.35 hours and the mean ICU stay was 41.9+/-13.8 hours, while the average hospitalization was 6.5+/-1.31 days. In respect to complications, nine (17.6%) of the patients developed atrial fibrilation, and one (1.9%) patient presented with a case of ischemic stroke but had a good recovery during hospitalization. There were no deaths in this series. Chronic renal patients submitted to hemodialysis were always a high risk population for myocardial revascularization. In this series, the absence of extracorporeal circulation appeared to be safe and efficient in this special subgroup of patients. The operations were performed with low indices of complications, absence of deaths and relatively low stays in the ICU and in hospital.

Hemodialysis Induces an Acute Decline in Cerebral Blood Flow in Elderly Patients

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Polinder-Bos, Harmke; Vállez García, David; Kuipers, Johanna; Elting, Jan Willem J.; Aries, M.J.H.; Krijnen, Wim P.; Groen, Hendrik; Willemsen, Antoon; van Laar, Peter; Strijkert, Fijanne; Luurtsema, Geert; Slart, Riemer; Westerhuis, Ralf; Gansevoort, Ron T.; Gaillard, Carlo A.; Franssen, Casper

The initiation of hemodialysis is associated with an accelerated decline of cognitive function and an increased incidence of cerebrovascular accidents and white matter lesions. Investigators have hypothesized that the repetitive circulatory stress of hemodialysis induces ischemic cerebral injury,

[Evaluation of the impact of a hemodialysis center on environment and local ecology].

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Jabrane, Marouane; Fadili, Wafaa; Kennou, Bouchra; Labaali, Asmaa; Zahlane, Karima; Laouad, Inass

2013-12-01

The prevalence of chronic kidney disease continues to increase worldwide, especially in our country with a consequent increase in patients requiring renal replacement therapy by hemodialysis, either temporarily or for life in the absence of a solid draft kidney transplant in the future. However, hemodialysis and peritoneal dialysis treatment are very expensive, very demanding in resources such as water and electricity and generate a large amount of waste. The objective of our work is to put the item in the environmental aspects of dialysis and its impact on the environment. This is a descriptive cross-sectional study conducted in the department of nephrology dialysis. Our hemodialysis center has 13 generators with a private water treatment (mono osmosis). Our annual water consumption for a single hemodialysis generator for 10hours per day and 6days per week is estimated at 93.6m(3). The production volume of water discharged from the reverse osmosis system (concentrate rejected) is 12m(3)/day (66% of the volume of water treated by reverse osmosis) with physico-chemical and bacteriological parameters remaining in the standards of WHO/FAO irrigation potential. The living water treatment as well as our 13 generators need more than 156 KW/day for work. The waste generated is about 23.5 tons/year, classified as high risk because of the high rates of hepatitis C in our center (48%) and severity of bacterial flora that we have identified in the post-generator dialysate thrown directly into sewers. Our natural resources are valuable especially that we are among the world exposed to water shortages in the near future (Haut-Commissariat des eaux et forêts et à la désertification du Maroc, 2009), which leads us to develop new programs to recycle waste and rejected in order to concentrate the reuse in various areas (irrigation, watering, sanitation, sterilization of surgical instruments), and to encourage the use of solar energy especially in a sunny country like ours

Nutritional Status in Nocturnal Hemodialysis Patients : A Systematic Review with Meta-Analysis

NARCIS (Netherlands)

Ipema, Karin J. R.; Struijk, Simone; van der Velden, Annet; Westerhuis, Ralf; van der Schans, Cees P.; Gaillard, Carlo A. J. M.; Krijnen, Wim P.; Franssen, Casper F. M.

2016-01-01

Background Hemodialysis patients experience an elevated risk of malnutrition associated with increased morbidity and mortality. Nocturnal hemodialysis (NHD) results in more effective removal of waste products and fluids. Therefore, diet and fluid restrictions are less restricted in NHD patients.

Spiritual well-being and quality of life of older adults in hemodialysis.

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Pilger, Calíope; Santos, Renata Ohana Pereira Dos; Lentsck, Maicon Henrique; Marques, Sueli; Kusumota, Luciana

2017-01-01

To analyze the relationship between spiritual well-being, sociodemographic, economic, religious, and health variables and the quality of life of older adults undergoing hemodialysis. This was a cross-sectional and correlational study conducted with 169 older adults undergoing hemodialysis. The researchers conducted interviews to collect sociodemographic, economic, religious, and health data and applied the Spiritual Well-Being Scale (SWBS) and the WHO quality of life assessment (WHOQOL-BREF and WHOQOL-OLD). Most of the older adults attained a moderate level of total spiritual well-being (SWB). In terms of QOL, the psychological domain (66.8; sd=13.9) and social relationships domain (66.8; sd=15.1) presented the highest mean scores. The WHOQOL-BREF domains were positively correlated with the SWB scale, with statistical significance among all domains and subscales except the environmental domain. The QOL of older adults was associated with the construct of SWB, either positively or negatively. Analisar a relação entre o bem-estar espiritual, variáveis sociodemográficas, econômicas, religiosas e de saúde com a qualidade de vida de idosos em tratamento hemodialítico. Estudo transversal e correlacional feito com 169 idosos que realizavam hemodiálise. Foram realizadas entrevistas para caracterização sociodemográfica, econômica, religiosa e de saúde, além de aplicação da Escala de Bem-Estar Espiritual (EBE) e de Qualidade de vida (QV) (WHOQOL- bref e WHOQOL - Old). A maioria dos idosos possuía moderado bem-estar espiritual total (EBE). Com relação à QV, os domínios psicológico (66,8; dp=13,9) e relações sociais (66,8; dp=15,1) apresentaram os maiores escores médios. A correlação dos domínios do WHOQOL- bref com os escores da escala de EBE foi positiva, com significância estatística em todos os domínios e nas subescalas, exceto no domínio meio ambiente. A QV dos idosos está relacionada, seja de forma positiva ou negativa, com o constructo

Hypoalbuminemia is an important risk factor of hypotension during hemodialysis.

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Nakamoto, Hidetomo; Honda, Nobuko; Mimura, Taku; Suzuki, Hiromichi

2006-10-01

Hypotension during hemodialysis (HD) is an important problem in patients on HD. To investigate the risk factors that contribute to the hypotension during HD, we compared background factors of hypotensive (HP) patients during HD. Among 58 patients undergoing HD in Tamura Memorial Hospital, 12 patients could not continue full HD because of hypotension. We compared the data of ultrafiltration volume, cardiothoracic ratio (CTR), total protein (TP), serum albumin, blood urea nitrogen (BUN), serum creatinine, total cholesterol (TC), hemoglobin (Hb), blood glucose (BS), brain natriuretic peptide (BNP), and cardiac function between HP patients (HP group; n=12) and sex- and age-matched control patients (NP group; n=12). There were no significant differences of age, sex, and duration of HD between the 2 groups. Cardiothoracic ratio is bigger and BNP is higher in the HP group compared with the NP group (CTR: HP 55.8+/-2.9% vs. NP 47.7+/-1.1%, p=0.0165; BNP: HP 602+/-171 vs. NP 147+/-38, p=0.0167). Serum albumin in the HP group is significantly lower compared with the NP group (HP 3.2+/-0.1 g/dL vs. NP 3.5+/-0.1 g/dL, p=0.0130). However, there were no significant differences of ultrafiltration rate (UFR), BS, TC, Hb, and cardiac function between the 2 groups. There is a significant negative correlation between changes of systolic blood pressure (delta systolic blood pressure) and serum albumin in these patients (r=-0.598, p=0.0016). From these data, we conclude that hypoalbuminemia is a major risk factor of hypotension during HD.

Alkalosis and Dialytic Clearance of Phosphate Increases Phosphatase Activity: A Hidden Consequence of Hemodialysis.

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Ricardo Villa-Bellosta

Full Text Available Extracellular pyrophosphate is a potent endogenous inhibitor of vascular calcification, which is degraded by alkaline phosphatase (ALP and generated by hydrolysis of ATP via ectonucleotide pyrophosphatase/phosphodiesterase 1 (eNPP1. ALP activity (as routinely measured in clinical practice represents the maximal activity (in ideal conditions, but not the real activity (in normal or physiological conditions. For the first time, the present study investigated extracellular pyrophosphate metabolism during hemodialysis sessions (including its synthesis via eNPP1 and its degradation via ALP in physiological conditions.45 patients in hemodialysis were studied. Physiological ALP activity represents only 4-6% of clinical activity. ALP activity increased post-hemodialysis by 2% under ideal conditions (87.4 ± 3.3 IU/L vs. 89.3 ± 3.6 IU/L and 48% under physiological conditions (3.5 ± 0.2 IU/L vs. 5.2 ± 0.2 IU/L. Pyrophosphate synthesis by ATP hydrolysis remained unaltered post-hemodialysis. Post-hemodialysis plasma pH (7.45 ± 0.02 significantly increased compared with the pre-dialysis pH (7.26 ± 0.02. The slight variation in pH (~0.2 units induced a significant increase in ALP activity (9%. Addition of phosphate in post-hemodialysis plasma significantly decreased ALP activity, although this effect was not observed with the addition of urea. Reduction in phosphate levels and increment in pH were significantly associated with an increase in physiological ALP activity post-hemodialysis. A decrease in plasma pyrophosphate levels (3.3 ± 0.3 μmol/L vs. 1.9 ± 0.1 μmol/L and pyrophosphate/ATP ratio (1.9 ± 0.2 vs. 1.4 ± 0.1 post-hemodialysis was also observed.Extraction of uremic toxins, primarily phosphate and hydrogen ions, dramatically increases the ALP activity under physiological conditions. This hitherto unknown consequence of hemodialysis suggests a reinterpretation of the clinical value of this parameter.

Reengineering hemodialysis for the home environment.

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Treu, Denny

2010-01-01

Denny Treu of NxStage Medical, Inc., who has led the development of six dialysis systems with various companies, reports here on a home hemodialysis system that his company successfully designed specifically for home use.

Managing hyperparathyroidism in hemodialysis: role of etelcalcetide

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Eidman KE

2018-02-01

Full Text Available Keith E Eidman,1 James B Wetmore1,2 1Division of Nephrology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, 2Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA Abstract: Secondary hyperparathyroidism (SHPT is common in patients receiving maintenance hemodialysis and is associated with adverse outcomes. Currently, SHPT is managed by reducing circulating levels of phosphate with oral binders and parathyroid hormone (PTH with vitamin D analogs and/or the calcimimetic cinacalcet. Etelcalcetide, a novel calcimimetic administered intravenously (IV at the end of a hemodialysis treatment session, effectively reduces PTH in clinical trials when given thrice weekly. Additional clinical effects include reductions in circulating levels of phosphate and FGF-23 and an improved profile of markers of bone turnover. However, despite being administered IV, etelcalcetide appears to be associated with rates of nausea and vomiting comparable to those of cinacalcet. Additionally, etelcalcetide, relative to placebo, causes hypocalcemia and prolonged electrocardiographic QT intervals, effects that must be considered when contemplating its use. Etelcalcetide likely has a role in treating hemodialysis patients with uncontrolled SHPT or with hypercalcemia or hyperphosphatemia receiving activated vitamin D compounds. However, its use should be at least partially constrained by consideration of the risk of hypocalcemia and resultant prolonged QT intervals in vulnerable patients. Because of its effectiveness as a PTH-reducing agent administered in the dialysis unit, etelcalcetide represents a potentially promising new therapeutic approach to the often vexing problem of SHPT in hemodialysis patients. However, whether its use is associated with changes in surrogate clinical end points, such as effects on rates of parathyroidectomy, fracture, vascular calcification, or mortality or on quality of life

Prevalence and severity of anemia in pediatric hemodialysis patients, a single center study

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Afshin Azhir

2006-12-01

Full Text Available BACKGROUNDS: This study was conducted to determine the prevalence and severity of anemia in children and adolescents on chronic hemodialysis, and to identify independent predictors of anemia in children on hemodialysis. METHODS: This cross-sectional study was performed between September 2005 and January 2006. The study population consisted of 25 patients aged 7−20 years on chronic hemodialysis from pediatric hemodialysis centers in Isfahan. RESULTS: A total of 22 (88% patients had hemoglobin levels of <11 g/dL (anemic and 12 patients (48% had hemoglobin levels of <8 g/dL (severe anemia. The mean age of these patients was 15.5 ± 3.7 years. Mean time on chronic dialysis was 20.44 ± 15.25 months. Anemia was more common and more severe among children who were on dialysis for less than 6 months. There was an inverse relationship between the severity of anemia and duration of hemodialysis (P = 0.019, r = – 0.465. Nearly all patients were treated with erythropoietin, Children with more severe anemia received slightly higher dose of erythropoietin (P = 0.09, r = 0.202. There was a significant difference between serum albumin values in anemic patients and patients without anemia (P = 0.023. There was a correlation between serum albumin and hemoglobin level (r = 0.511, P = 0.01. Intact PTH levels were >200 pg/ml in 16 patients (66% and >400 pg/ml in 9 patients (37. 5%. There was a reverse correlation between intact PTH level >200 pg/ml and hemoglobin level (r = -0.505, P = 0.046. CONCLUSIONS: The prevalence of anemia in hemodialysis children in Isfahan appears to be higher than that reported in the other studies in spite of extensive use of rHuEPO and iron supplementation. We found this to be especially true for patients new on hemodialysis (less than 6 months and in those with low albumin and severe hyperparathyroidism. KEY WORDS: Hemodialysis, anemia, children.

Spurious hypocalcemia in hemodialysis patients after heparinization. In-vitro formation of calcium soaps.

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Godolphin, W; Cameron, E C; Frohlich, J; Price, J D

1979-02-01

Patients on long-term hemodialysis via arteriovenous fistula received heparin when the fistula needle was inserted, before a sample of blood was obtained for chemical analysis. The resultant release of lipoprotein lipase activity in vivo and continued lipolytic activity in vitro sometimes produced sufficient free fatty acid to precipitate calcium soaps. The consequent spurious hypocalcemia was most frequently observed when the patients had chylomicronemia. This cause of apparent hypocalcemia was eliminated either by immediate analyses of the blood samples or by obtaining samples before systemic heparinization.

Fifty years of hemodialysis access literature: The fifty most cited publications in the medical literature.

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Skripochnik, Edvard; O'Connor, David J; Trestman, Eric B; Lipsitz, Evan C; Scher, Larry A

2018-02-01

Objectives The modern era of hemodialysis access surgery began with the publication in 1966 by Brescia et al. describing the use of a surgically created arteriovenous fistula. Since then, the number of patients on chronic hemodialysis and the number of publications dealing with hemodialysis access have steadily increased. We have chronicled the increase in publications in the medical literature dealing with hemodialysis access by evaluating the characteristics of the 50 most cited articles. Methods We queried the Science Citation Index from the years 1960-2014. Articles were selected based on a subject search and were ranked according to the number of times they were cited in the medical literature. Results The 50 most frequently cited articles were selected for further analysis and the number of annual publications was tracked. The landmark publication by Dr Brescia et al. was unequivocally the most cited article dealing with hemodialysis access (1109 citations). The subject matter of the papers included AV fistula and graft (9), hemodialysis catheter (9), complications and outcomes (24), and other topics (8). Most articles were published in nephrology journals (33), with fewer in surgery (7), medicine (7), and radiology (3) journals. Of the 17 journals represented, Kidney International was the clear leader, publishing 18 articles. There has been an exponential rise in the frequency of publications regarding dialysis access with 42 of 50 analyzed papers being authored after 1990. Conclusion As the number of patients on hemodialysis has increased dramatically over the past five decades, there has been a commensurate increase in the overall number of publications related to hemodialysis access.

Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities

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Hayne Cho Park

2018-03-01

Full Text Available Patients receiving hemodialysis are vulnerable to infectious diseases due to their impaired immunity and high risk of exposure to pathogens. To protect patients, staff, and visitors from potential infections, each hemodialysis unit should establish and follow standard infection control and prevention measures. Therefore, clinical practice guidelines were developed by a working group of nephrologists and infection control specialists to provide evidence-based guidance for dialysis physicians and nurses, with the aim of preventing infection transmission and controlling infection sources in hemodialysis facilities. The areas of infection control covered by these guidelines include standard precautions, isolation strategies, vascular access, water treatment, cleaning/disinfecting/sterilizing, and vaccination. This special report summarizes the key recommendations from the Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities.

International variations and trends in home hemodialysis.

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Agar, John W M

2009-05-01

Home hemodialysis, once a valid, viable dialysis choice, faded as facility-based care was preferentially funded and supported through the 1970s and 1980s. It was simply more comfortable for providers, physicians, and nurses to capture dialysis patients through clinic schedules and clinical protocols. Home patients were unpredictable, out of sight and out of control, trouble, and best avoided. This was so except in Australia and New Zealand where funding and support remained strong for what was seen there as an effective, outcome-rich, and cost-effective modality. The renaissance of home hemodialysis began in Canada when home-based nocturnal dialysis emerged in the 1990s. Home patients soon appreciated the self-determination and re-employment opportunities that overnight dialysis delivered. This article explores the origins, the near demise, the foundations of renewal, and the now-expanding potential of home and nocturnal hemodialysis in regions as diverse as North America, Australia and New Zealand, South East Asia, the United Kingdom, and Finland. Home dialysis fed by cost containment, outcome success, patient acceptance, and new smart equipment has emerged as a bright new modality option. Trainee nephrologists would be wise to take more notice as this near ghost of the past forges an exciting future.

Markers of bone pain in the hemodialysis patients with renal insufficiency

International Nuclear Information System (INIS)

Oka, Fumitoshi; Sagawa, Hitoshi; Yabe, Kinji

1988-01-01

The patients receiving maintenance hemodialysis were divided into two groups in the absence and the presence of bone pain and investigated the markers of bone pain in these patients. These results suggested that the duration of receiving hemodialysis, serum contrations of alkaline phosphatase, osteocalcin and parathyroid hormone became to be the markers of bone pain. (author)

Influence of hemodialysis on the physical activity and motor capacity of patients with chronic renal disease, stage 4-5 (K/DOQI: study synopsis

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Olivier Giannini

2017-11-01

Full Text Available Purpose: Elderly patients who undergo hemodialysis are more fragile than older persons not on dialysis. However, it is not clear if this frailty exists before hemodialysis or if it becomes evident or more acute at the time of beginning a dialysis therapy program. The purpose of this study is to analyze if changes at both the motor and cognitive levels go hand in hand with the beginning of dialysis, and, if this is the case, to identify possible risk factors associated with the functional decline in these patients. Methods: A multicentric prospective pilot observational study was conducted in an ambulatory population with the primary objective to represent the evolution of functional gait capacity in patients before and during hemodialysis treatment, to show gait insecurity during treatment follow-up, if it is present. The secondary objectives are to identify risk factors in the development of gait insecurity, and to measure the prevalence of falls during the follow-up period. Results: The enrolment of patients began in January 2015 and the duration of the data collection will be at least 36 months. In the first 24 months, 19 patients have been included in the study. Preliminary data analysis is not expected before July 2018. Conclusions: The identification of frailty predictors is of major importance in order to identify and target patients at the highest risk of frailty who may be likely to benefit from preventive intervention.

Arrhythmias and hemodialysis: role of potassium and new diagnostic tools.

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Buemi, Michele; Coppolino, Giuseppe; Bolignano, Davide; Sturiale, Alessio; Campo, Susanna; Buemi, Antoine; Crascì, Eleonora; Romeo, Adolfo

2009-01-01

Cardiovascular diseases represent the main causes of death in patients affected by renal failure, and arrhythmias are frequently observed in patients undergoing hemodialysis. Dialytic treatment per se can be considered as an arrhythmogenic stimulus; moreover, uraemic patients are characterized by a "pro-arrhythmic substrate" because of the high prevalence of ischaemic heart disease, left ventricular hypertrophy and autonomic neuropathy. One of the most important pathogenetic element involved in the onset of intra-dialytic arrhythmias is the alteration in electrolytes concentration, particularly calcium and potassium. It may be very useful to monitor the patient's cardiac activity during the whole hemodilaytic session. Nevertheless, the application of an extended intradialytic electrocardiographic monitoring is not simple because of several technical and structural impairments. We tried to overcome these difficulties using Whealthy, a wearable system consisting in a t-shirt composed of conductors and piezoresistive materials, integrated to form fibers and threads connected to tissutal sensors, electrodes, and connectors. ECG and pneumographic impedance signals are acquired by the electrodes in the tissue, and the data are registered by a small computer and transmitted via GPRS or Bluetooth.

Adipokines and nutritional status for patients on maintenance hemodialysis.

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Małgorzewicz, S; Aleksandrowicz-Wrona, E; Owczarzak, A; Debska-Slizień, A; Rutkowski, B; Łysiak-Szydłowska, W

2010-09-01

The aim of this study was to investigate the serum concentration of adipokines, such as leptin, adiponectin, and resistin, and assess its relation to nutritional and inflammatory parameters in both overweight and normal weight patients on maintenance hemodialysis. A total of 36 hemodialysis patients (27 M, 9 F; mean age 55.3 +/- 12 yr.) were examined and 23 additional healthy volunteers were recruited as the control group. The concentrations of leptin, leptin receptor, adiponectin, resistin, IL-6, TNFa and CRP were measured by ELISA. Assessment of nutritional status was determined by the levels of albumin, BMI, percentage of body fat (%F), lean body mass (LBM), and Subjective Global Assessment Score (SGA). According to the SGA 7-points score and the albumin level, 20 patients were of good nutritional status (6-7 points), while 16 patients were mildly malnourished (4-5 points). The concentrations of CRP, resistin, adiponectin, and TNFa were statistically higher in hemodialysis patients than in the control group (p pound 0.05). The adiponectin level was inversely correlated with %F (R Spearman=-0.3; p pound 0.05). The level of leptin was positively correlated with %F as well as with BMI and SGA scores (R Spearman=0.4; p pound 0.05). Although there was no significant difference in the nutritional status between the nonoverweight (BMI 18.5-24.99) and overweight (BMI (3)25.0) groups of patients, in the nonoverweight group there were 12 patients (54.5%) with signs of mild malnutrition compared to 4 malnourished patients (28.5%) in the overweight group. Nonoverweight patients presented significantly lower leptin concentration (12.7 vs 27.8 ug/l) and higher adiponectin level (38.9 vs 32.5 ng/ml) when compared to overweight patients. The levels of IL-6 and TNFa were higher in the nonoverweight group of patients. Overweight patients also had shorter durations of stay in the hemodialysis program (30.5 vs. 87.6 months). The results of our study indicate that lean hemodialysis

Sterilization of heparinized cuprophan hemodialysis membranes

NARCIS (Netherlands)

ten Hoopen, Hermina W.M.; Hinrichs, W.L.J.; Hinrichs, W.L.J.; Engbers, G.H.M.; Feijen, Jan

1996-01-01

The effects of sterilization of dry heparinized Cuprophan hemodialysis membranes by means of ethylene oxide (EtO) exposure, gamma irradiation, or steam on the anticoagulant activity and chemical characteristics of immobilized heparin and the permeability of the membrane were investigated.

Percutaneous treatment of complications occurring during hemodialysis graft recanalization

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Sofocleous, Constantinos T. E-mail: constant@pol.net; Schur, Israel; Koh, Elsie; Hinrichs, Clay; Cooper, Stanley G.; Welber, Adam; Brountzos, Elias; Kelekis, Dimitris

2003-09-01

Introduction/objective: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. Methods and materials: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. Results: Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. Discussions and conclusion: The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.

Effects of hemodialysis on serum fetuin-A levels

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Roman Safranek

2012-06-01

Full Text Available Fetuin-A is a calcification inhibitor, negative acute phase response marker and cardiovascular mortality predictor in hemodialysis patients. Low levels of fetuin-A are associated with malnutrition, inflammation, decreased bone mass density, low-turnover bone and use of high calcium concentration dialysate. Hemodialysis procedure (HD has been shown to decrease fetuin-A levels by 20%, probably due to HD-induced inflammation or acute changes in calcium metabolism. The aim of our study was to investigate effects of HD on serum fetuin-A levels. Forty clinically and hemodynamically stable hemodialysis patients (21 females, 68 (38-85 years underwent routine bicarbonate hemodialysis or hemodiafiltration with polysulfone dialyzer. On consecutive HD dialysis solution with different calcium concentration with/without citric acid was used to assess influence of calcium shifts and parathyroid activity on fetuin-A changes during HD. All other parameters of HD were kept constant. Serum fetuin-A, calcium, phosphorus, iPTH, CRP and other biochemical parameters were measured before and after each HD. Our data show that predialysis serum fetuin-A levels have positive correlation with iPTH levels (p<0.05 and tendency to decrease with higher CRP levels. There was no change in fetuin-A levels during HD: 206 (167.1; 231.9 ug/ml before and 208.9 (170.3; 246.3 ug/ml after HD; respectively. When corrected for haemoconcentration, decrease in fetuin-A was only 2.8% (p<0.05. There was also no difference between effect of hemodialysis and hemodia-filtration procedure. The use of different calcium dialysate concentrations had distinct effect on iPTH levels during and after HD, however, we observed no associated changes in fetuin-A levels. The use of dialysate solution with citric acid had no effect on fetuin-A levels. In conclusion, standard bicarbonate HD with polysulfone dialyser and ultrapure dialysate induces only minor changes in fetuin-A and no changes in hsCRP levels

Views of Japanese patients on the advantages and disadvantages of hemodialysis and peritoneal dialysis.

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Nakamura-Taira, Nanako; Muranaka, Yoshimi; Miwa, Masako; Kin, Seikon; Hirai, Kei

2013-08-01

The preference for dialysis modalities is not well understood in Japan. This study explored the subjective views of Japanese patients undergoing dialysis regarding their treatments. The participants were receiving in-center hemodialysis (CHD) or continuous ambulatory peritoneal dialysis (CAPD). In Study 1, 34 participants (17 CHD and 17 CAPD) were interviewed about the advantages and disadvantages of dialysis modalities. In Study 2, 454 dialysis patients (437 CHD and 17 CAPD) rated the advantages and disadvantages of CHD and CAPD in a cross-sectional survey. Interviews showed that professional care and dialysis-free days were considered as advantages of CHD, while independence, less hospital visits, and flexibility were considered as advantages of CAPD. Disadvantages of CHD included restriction of food and fluids and unpleasant symptoms after each dialysis session. Catheter care was an additional disadvantage of CAPD. Survey showed that the highly ranked advantages were professional care in CHD and less frequent hospital visits in CAPD, while the highly ranked disadvantages were concerns about emergency and time restrictions in CHD, and catheter care and difficulty in soaking in a bath in CAPD. The total scores of advantages and disadvantages showed that CHD patients subjectively rated their own modality better CHD over CAPD, while CAPD patients had the opposite opinion. The results of this study indicate that the factors affecting the decision-making process of Japanese patients are unique to Japanese culture, namely considering the trouble caused to the people around patients (e.g., families, spouses, and/or caregivers).

Serum IL-6 level and associated factors: hemodialysis patients

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Seifi S, Mokhtari A

2008-07-01

Full Text Available "nBackground: The annual amount of mortality in ESRD exceeds the expectation and represents the recent evidences of the inflammation as its etiology. The etiology of inflammation is not clearly known. Chronic inflammation is a dominant occurrence of ESRD which increases the risk of atherosclerosis, malnutrition and peripheral vascular disease. Inflammatory responses are orchestrated by cytokines. Some of the proinflammatory cytokines like IL-6 have a crucial role in this phenomenon. The IL-6 and its receptor activity is up regulated in ESRD patients and the increased level of IL-6 predicts cardiovascular mortality and morbidity in normal and CRF patients. This study devotes itself to determining the serum level of IL-6 and factors affecting it in patients undergoing chronic hemodialysis in Imam Khomeini Hospital which can represent the Iranian Society. By identifying factors affecting the serum level of IL-6 and high-risk patients we can provide treatment possibilities, a decrease in mortality and an improvement in its prognosis. "n"nMethods: In this study 42 patients in Imam Dialysis Center were chosen and their serum IL-6 levels were measured at 2 times at three month interval and at the same time blood sample analysis were done for the following: Alb CPR, Ca, P, PTH, TIBC, Ferritin, TG, Chol, LDL, HDL, Uric Acid, Hb, WBC and urea."n"nResults: The mean serum level of IL-6 in hemodialysis patients was 6.35±4.47pg/ml (minimum: 0.55, maximum: 18.25 with the normal range of 1.3±3.2pg/ml."n"nConclusions: The IL-6 level was higher than normal range in the 52% of the patients. The serum IL-6 level had a significant correlations with CPR, Ferritin, TIBC, WBC and their serum IL-6 level was significantly higher in patients with hypertension, but no significant correlation was observed between other parameters and IL-6

Alfaxalone for maintenance of anaesthesia in ponies undergoing field castration: continuous infusion compared with intravenous boluses.

Science.gov (United States)

Deutsch, Julia; Ekiri, Abel; de Vries, Annemarie

2017-07-01

To compare alfaxalone as continuous intravenous (IV) infusion with intermittent IV injections for maintenance of anaesthesia in ponies undergoing castration. Prospective, randomized, 'blinded' clinical study. A group of 33 entire male Welsh ponies undergoing field castration. After preanaesthetic medication with IV detomidine (10 μg kg -1 ) and butorphanol (0.05 mg kg -1 ), anaesthesia was induced with IV diazepam (0.05 mg kg -1 ) followed by alfaxalone (1 mg kg -1 ). After random allocation, anaesthesia was maintained with either IV alfaxalone 2 mg kg -1  hour -1 (group A; n = 16) or saline administered at equal volume (group S; n = 17). When necessary, additional alfaxalone (0.2 mg kg -1 ) was administered IV. Ponies were breathing room air. Using simple descriptive scales, surgical conditions and anaesthesia recovery were scored. Total amount of alfaxalone, ponies requiring additional alfaxalone and time to administration, time from induction to end of infusion and end of infusion to standing were noted. Indirect arterial blood pressure, pulse and respiratory rates, end-expiratory carbon dioxide partial pressure and arterial haemoglobin oxygen saturation were recorded every 5 minutes. Data were analysed using Student t, Mann-Whitney U and chi-square tests, where appropriate (p < 0.05). Total amount of alfaxalone administered after induction of anaesthesia (0.75 ± 0.27 versus 0.17 ± 0.23 mg kg -1 ; p < 0.0001) and time to standing (14.8 ± 4 versus 11.6 ± 4 minutes; p = 0.044) were higher in group A compared to group S. Ponies requiring additional alfaxalone boluses [four (group A) versus seven (group S)] and other measured variables were similar between groups; five ponies required oxygen supplementation [three (group A) versus two (group S)]. Continuous IV infusion and intermittent administration of alfaxalone provided similar anaesthesia quality and surgical conditions in ponies undergoing field castration. Less alfaxalone

Tolerability and Healthcare Utilization in Maintenance Hemodialysis Patients Undergoing Treatment for Tuberculosis-Related Conditions.

Science.gov (United States)

Hamadah, Abdurrahman M; Beaulieu, Lynn M; Wilson, John W; Aksamit, Timothy R; Gregoire, James R; Williams, Amy W; Dillon, John J; Albright, Robert C; Onuigbo, Macaulay; Iyer, Venkateshwaran K; Hickson, LaTonya J

2016-01-01

The incidence of tuberculosis (TB) in end-stage renal disease is significantly higher than that in the general population. Among those with kidney dysfunction, anti-TB treatment is associated with increased side effects, but the effect on healthcare utilization is unknown. Methods/Aim: To assess patient-reported symptoms, adverse effects and describe changes in healthcare utilization patterns during treatment for TB, we conducted a case series (n = 12) of patients receiving maintenance hemodialysis (HD) from Mayo Clinic Dialysis Services and concurrent drug therapy for TB from January 2002 through May 2014. Healthcare utilization (hospitalizations and emergency department (ED) visits independent of hospital admission) was compared before and during treatment. Patients were treated for latent (n = 7) or active (n = 5) TB. The majority of patients with latent disease were treated with isoniazid (n = 5, 71%), while active-disease patients received a 4-drug regimen. Adverse effects were reported in 83% of patients. Compared to measurements prior to drug initiation, serum albumin and dialysis weights were similar at 3 months. Commonly reported anti-TB drug toxicities were described. More than half (58%) of the patients were hospitalized at least once. No ED or hospital admissions occurred in the period prior to drug therapy, but healthcare utilization increased during treatment in the latent disease group (hospitalization rate per person-month: pre 0 vs. post 1). Among HD patients, anti-TB therapy is associated with frequently reported symptoms and increased healthcare utilization. Among this subset, patients receiving treatment for latent disease may be those with greatest increase in healthcare use. Careful monitoring and early complication detection may help optimize medication adherence and minimize hospitalizations. © 2016 S. Karger AG, Basel.

Impact of Compression Stockings vs. Continuous Positive Airway Pressure on Overnight Fluid Shift and Obstructive Sleep Apnea among Patients on Hemodialysis

Directory of Open Access Journals (Sweden)

Bruno C. Silva

2017-05-01

Full Text Available IntroductionObstructive sleep apnea (OSA is common in edematous states, notably in hemodialysis patients. In this population, overnight fluid shift can play an important role on the pathogenesis of OSA. The effect of compression stockings (CS and continuous positive airway pressure (CPAP on fluid shift is barely known. We compared the effects of CS and CPAP on fluid dynamics in a sample of patients with OSA in hemodialysis, through a randomized crossover study.MethodsEach participant performed polysomnography (PSG at baseline, during CPAP titration, and after 1 week of wearing CS. Neck circumference (NC and segmental bioelectrical impedance were done before and after PSG.ResultsFourteen patients were studied (53 ± 9 years; 57% men; body mass index 29.7 ± 6.8 kg/m2. Apnea–hypopnea index (AHI decreased from 20.8 (14.2; 39.6 at baseline to 7.9 (2.8; 25.4 during CPAP titration and to 16.7 (3.5; 28.9 events/h after wearing CS (CPAP vs. baseline, p = 0.004; CS vs. baseline, p = 0.017; and CPAP vs. CS, p = 0.017. Nocturnal intracellular trunk water was higher after wearing CS in comparison to baseline and CPAP (p = 0.03. CS reduced the fluid accumulated in lower limbs during the day, although not significantly. Overnight fluid shift at baseline, CPAP, and CS was −183 ± 72, −343 ± 220, and −290 ± 213 ml, respectively (p = 0.006. Overnight NC increased at baseline (0.7 ± 0.4 cm, decreased after CPAP (−1.0 ± 0.4 cm, and while wearing CS (−0.4 ± 0.8 cm (CPAP vs. baseline, p < 0.0001; CS vs. baseline, p = 0.001; CPAP vs. CS, p = 0.01.ConclusionCS reduced AHI by avoiding fluid retention in the legs, favoring accumulation of water in the intracellular component of the trunk, thus avoiding fluid shift to reach the neck. CPAP improved OSA by exerting local pressure on upper airway, with no impact on fluid redistribution. CPAP performed significantly better than CS

Heparin-Induced Cardiac Tamponade and Life-Threatening Hyperkalemia in a Patient with Chronic Hemodialysis

Directory of Open Access Journals (Sweden)

Ho-Ming Su

2005-03-01

Full Text Available Heparin, a commonly used anticoagulant agent, is frequently used in patients undergoing hemodialysis. As with most medications, heparin has a significant side effect profile. Two of its most important side effects, major bleeding and hyperkalemia, may be devastating without immediate diagnosis and treatment. Major bleeding such as gastrointestinal, genitourinary or intracranial bleeding is occasionally encountered and rarely neglected. However, heparin-induced cardiac tamponade is rarely encountered and may be easily overlooked. Another side effect, heparin-induced hyperkalemia, an unusual but well-described side effect, is frequently forgotten until life-threatening arrhythmia has occurred. We report a case involving a 40-year-old male patient with uremia, who had received heparin for 10 days for deep vein thrombosis in the left lower extremity. Hemopericardium with cardiac tamponade and life-threatening hyperkalemia were both noted in this patient.

[Treatment of hyperthyroidism with radioiodine during hemodialysis: Report of one case].

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Hurtado, Claudia; Báez, María Soledad; Bate, Anabel; Opazo, Claudio; Troncoso, Mauricio

2017-05-01

Although radioiodine (131-I) can be used as treatment of hyperthyroidism for patients in hemodialysis, its use is limited and the experience is mainly related to differentiated thyroid carcinoma. We report a 58 years old female on hemodialysis with recurrent hyperthyroidism after propylthiouracil treatment. She was successfully treated with 131-I and four months after the intervention her euthyroid state was confirmed. We measured 131-I activity in blood, dialysate liquid and other waste products, as well as patient radiation exposure rates. We found that 131-I elimination was prolonged through time with no major dependence on hemodialysis, as opposed to the elimination of 131-I in patients with thyroid carcinoma. This was probably due to high radiotracer uptake in hyper functioning thyroid tissue. Conversely, radiation content in dialysate wastes or equipment was minimal. Furthermore, the rate of both environmental exposure and exposure of nursing staff in charge of hemodialysis sessions, was minimal and met international security standards. In conclusion, I-131 therapy showed both appropriate effectiveness and safety in this case and may be considered as a suitable treatment alternative to thyroidectomy when antithyroid drugs are unsuccessful.

Non-adherence in patients on chronic hemodialysis: an international comparison study.

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Kugler, Christiane; Maeding, Ilona; Russell, Cynthia L

2011-01-01

Adherence to diet and fluid restrictions by adults on hemodialysis treatment is challenging. This study compared non-adherence (NA) to diet and fluid restrictions between adult US and German hemodialysis patients, and assessed potential predictors for NA. A cross-sectional multicenter comparative study of 456 adult hemodialysis patients was conducted in 12 outpatient-based hemodialysis centers in the United States and Germany. NA was based on self-report using the Dialysis Diet and Fluid Non-adherence Questionnaire (DDFQ). Laboratory marker, interdialytic weight gain (IDWG) and dialysis adequacy (Kt/V) information were obtained from medical records. Mean time on dialysis was 50 months (range 3-336); mean age was 62 years (range 19-91), with the majority of patients (89.7%) being white. Self-reported frequency of NA to diet was 80.4% and to fluid 75.3% in the total sample. The degree of NA to diet and fluid differed significantly, with the US patients (68.1% vs. 61.1%) reporting less NA when compared with German (81.6% vs. 79.0%) patients (phemodialysis patients. Our findings suggest that patient, condition-related, socioeconomic and health care system-related factors may contribute to NA to diet and fluid restrictions.

Incidence of Renal Failure Requiring Hemodialysis Following Transcatheter Aortic Valve Replacement.

Science.gov (United States)

Ladia, Vatsal; Panchal, Hemang B; O׳Neil, Terrence J; Sitwala, Puja; Bhatheja, Samit; Patel, Rakeshkumar; Ramu, Vijay; Mukherjee, Debabrata; Mahmud, Ehtisham; Paul, Timir K

2016-09-01

Studies have shown that iodinated radiocontrast use is associated with acute renal failure especially in the presence of chronic kidney disease and multiple factors modulate this risk. The purpose of this meta-analysis is to compare the incidence of renal failure requiring hemodialysis between transfemoral (TF) and transapical (TA) transcatheter aortic valve replacement using the Edwards valve. The PubMed database was searched from January 2000 through December 2014. A total of 10 studies (n = 2,459) comparing TF (n = 1,268) and TA (n = 1,191) TAVR procedures using the Edwards valve were included. Variables of interest were baseline logistic EuroSCORE, prevalence of diabetes mellitus, hypertension, peripheral arterial disease, chronic kidney disease and amount of contrast used. The primary endpoint was incidence of renal failure requiring hemodialysis. The odds ratio and 95% CI were computed and P renal failure requiring hemodialysis was higher with the Edwards valve. This suggests that the incidence of renal failure requiring hemodialysis after TAVR is associated with baseline comorbidities in the TA-TAVR group rather than the volume of contrast used. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

On pressure: volume relations in hemodialysis

NARCIS (Netherlands)

E.H.Y. Ie (Eric)

2005-01-01

textabstractChapter 1 is a brief introduction to several aspects of cardiovascular pressure-volume relations in dialysis patients. The aims of the thesis are presented. In Chapter 2, an overview is presented of circulatory physiology in hemodialysis (HD) patients. Volume withdrawal by

Chronic obstructive pulmonary disease in patients with end-stage kidney disease on hemodialysis

DEFF Research Database (Denmark)

Plesner, Louis L; Warming, Peder E; Nielsen, Ture L

2016-01-01

The objectives of this study were to assess the prevalence of chronic obstructive pulmonary disease (COPD) in hemodialysis patients with spirometry and to examine the effects of fluid removal by hemodialysis on lung volumes. Patients ≥18 years at two Danish hemodialysis centers were included....... Forced expiratory volume in one second (FEV1 ), forced vital capacity (FVC), and FEV1 /FVC ratio were measured with spirometry before and after hemodialysis. The diagnosis of COPD was based on both the GOLD criteria and the lower limit of normal criteria. There were 372 patients in treatment at the two...... centers, 255 patients (69%) completed spirometry before dialysis and 242 of these (65%) repeated the test after. In the initial test, 117 subjects (46%) had airflow limitation indicative of COPD with GOLD criteria and 103 subjects (40.4%) with lower limit of normal criteria; COPD was previously diagnosed...

The cost of starting and maintaining a large home hemodialysis program.

Science.gov (United States)

Komenda, Paul; Copland, Michael; Makwana, Jay; Djurdjev, Ogdjenka; Sood, Manish M; Levin, Adeera

2010-06-01

Home extended hours hemodialysis improves some measurable biological and quality-of-life parameters over conventional renal replacement therapies in patients with end-stage renal disease. Published small studies evaluating costs have shown savings in terms of ongoing operating costs with this modality. However, all estimates need to include the total costs, including infrastructure, patient training, and maintenance; patient attrition by death, transplantation, technique failure; and the necessity of in-center dialysis. We describe a comprehensive funding model for a large centrally administered but locally delivered home hemodialysis program in British Columbia, Canada that covered 122 patients, of which 113 were still in the program at study end. The majority of patients performed home nocturnal hemodialysis in this 2-year retrospective study. All training periods, both in-center and in-home dialysis, medications, hospitalizations, and deaths were captured using our provincial renal database and vital statistics. Comparative data from the provincial database and pricing models were used for costing purposes. The total comprehensive costs per patient-incorporating startup, home, and in-center dialysis; medications; home remodeling; and consumables-was $59,179 for years 2004-2005 and $48,648 for 2005-2006. The home dialysis patients required multiple in-center dialysis runs, significantly contributing to the overall costs. Our study describes a valid, comprehensive funding model delineating reliable cost estimates of starting and maintaining a large home-based hemodialysis program. Consideration of hidden costs is important for administrators and planners to take into account when designing budgets for home hemodialysis.

Correlates of physical activity level among hemodialysis patients in Selangor, Malaysia.

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Wong, S W; Chan, Y M; Lim, T S

2011-12-01

There is mounting evidence demonstrating the importance of adequate physical activity to promote better well-being among hemodialysis patients. Available data pertaining to the levels of physical activity and its determinants among hemodialysis patients is, however, scarce in Malaysia. The objectives of this study are hence to determine the levels of physical activity and it associated factors among hemodialysis patients. A total of 70 subjects were recruited from three dialysis centres in Selangor. A face-to-face interview was conducted to obtain socio-demographic data and subjects' knowledge on dietary sources. Medical history, biochemical parameters and weight status were obtained from medical records. Physical activity level (PAL) was assessed using the Global Physical Activity Questionnaire (GPAQ). A total of 81.4% and 18.6% of the respondents had low and moderate PALs, respectively. Thus, none of the respondents had high PAL. Serum creatinine, education level, personal income and knowledge score on potassium-related medical complications were factors found to correlate significantly with PAL. Multiple linear regression analysis showed that higher PAL was predicted by a lower knowledge score on dietary sodium source, higher education and higher serum creatinine. Despite consistent documentation of the potential positive impact of physical exercise on hemodialysis outcomes, the level of physical activity remains low among these patients. It is hoped that these findings can add to the existing body of knowledge and serve as a supporting document for the formulation of appropriate interventions to improve the status of physical activity among hemodialysis patients in Malaysia.

Atrial Fibrillation, Atrioventricular Blocks and Bundle Branch Blocks in Hemodialysis Patients

OpenAIRE

Mandic, Ante; Tomic, Monika; Petrov, Bozo; Romic, Zeljko

2012-01-01

Atrial fibrillation is one of the most frequent arrhythmias diagnosed in clinical practice and it is also relatively common in dialysis patients. Atrioventricular and intraventricular conduction disturbances are less investigated in hemodialysis patients and data about their prevalence are insufficient. The objective of this study was to determine the prevalence of atrial fibrillation, atrioventricular blocks and bundle branch blocks in hemodialysis patients and to analyze different clinical ...

Analysis of the levels of endotoxin and β-d-glucan in the synovial fluid of hemodialysis patients.

Science.gov (United States)

Shiota, E; Maekawa, M; Kono, T

2001-12-01

Abstract We analyzed the levels of endotoxin and β-d-glucan, which possibly induce cytokine production, in the synovial fluid of patients on long-term hemodialysis and compared the results to those in patients with osteoarthritis and rheumatoid arthritis. We studied 42 knees in 42 hemodialysis patients, 21 in 21 osteoarthritis patients, and 26 in 26 rheumatoid arthritis patients. The mean ages were 60.7, 63.2, and 59.7 years, respectively. The duration of hemodialysis in the long-term hemodialysis group averaged 14.0 years. The concentrations of endotoxin and β-d-glucan in the synovial fluid of these three groups were measured. The concentration of endotoxin was the same in the three groups. However, the concentration of β-d-glucan was significantly higher in long-term hemodialysis patients. This finding suggests that β-d-glucan may have some relation to the pathogenesis of the synovitis which exists in the hydrarthrosis of long-term hemodialysis patients.

Diagnostic discordance for hepatitis C virus infection in hemodialysis patients.

Science.gov (United States)

Kalantar-Zadeh, Kamyar; Miller, Loren G; Daar, Eric S

2005-08-01

Hepatitis C virus (HCV) infection is associated with an increase in proinflammatory cytokine levels. Similar changes are seen in maintenance hemodialysis patients with malnutrition-inflammation-cachexia syndrome (MICS), which is associated with poor clinical outcomes in this population. We hypothesized that HCV transcription-mediated amplification (TMA), a sensitive qualitative molecular test for HCV RNA, may identify maintenance hemodialysis patients with HCV infection not detected by means of antibody enzyme immunoassay (EIA), particularly in those with MICS. We evaluated HCV status in 314 maintenance hemodialysis patients by using HCV antibody EIA (version 2.0; Abbott Laboratories, Abbott Park, IL) and HCV TMA (Bayer Diagnostics Laboratories, Berkeley, CA). Twenty-five patients (8%) were EIA positive (EIA+)/TMA+; 4 patients (1%), EIA+/TMA negative (TMA-), and 22 patients (7%), EIA-/TMA+. In the 47 TMA+ patients, the sensitivity of EIA for HCV infection was only 53%. TMA+ patients had lower albumin levels and higher tumor necrosis factor alpha and serum glutamic oxaloacetic transaminase levels than TMA- patients. EIA+/TMA+ patients were more likely than EIA-/TMA+ or EIA-/TMA- patients to have hypoalbuminemia and higher iron and transaminase levels. Of all TMA+ patients, EIA- patients were more likely to have diabetes, be on dialysis therapy longer, and have lower liver enzyme levels and higher proinflammatory cytokine levels, including tumor necrosis factor alpha and interleukin 6. Maintenance hemodialysis patients infected with HCV according to TMA have clinical features suggestive of MICS. In this population, HCV EIA appears to have a low sensitivity for the identification of HCV infection, which may be caused by the confounding effect of MICS or other demographic or clinical factors. These apparently false-negative HCV antibody test results are seen in persons with a longer time on hemodialysis therapy, mirroring observations in other populations with serious

Quality of Sleep and its Relationship to Quality of Life in Hemodialysis Patients

Science.gov (United States)

Parvan, Kobra; lakdizaji, Sima; Roshangar, Fariborz; Mostofi, Mahtab

2013-01-01

Introduction: Despite many advances in the treatment of chronic renal failure, the quality of sleep in patients who suffer from this disease is at the risk. The high prevalence of sleep disorders in hemodialysis patients, which is concomitant with physical, behavioral, and psychological problems, has always affected these patients' quality of life (QOL). This study aimed to determine the relationship between quality of sleep and quality of life in hemodialysis patients. Methods: By using a descriptive and correlational design, this study was conducted on 245 hemodialysis patients in 2012. Patients were selected by convenience sampling from the hemodialysis ward of four training hospitals of Tabriz and Maragheh. Quality of sleep was measured by the Pittsburgh Sleep Quality Index (PSQI), and the quality of life for patients was measured by the Kidney Disease Quality Of Life questionnaire (KDQOL-SF). Results: 83.3% of hemodialysis patients had poor quality of sleep. Poor quality of life was significantly associated with poor quality of sleep. There was a significant negative correlation between global PSQI and important aspects of quality of life including physical health, symptoms and problems, the impact of kidney disease on daily life, burden of kidney disease, mental health, social support, and sexual function. Conclusion: The low quality of sleep in hemodialysis patients has an effect on the deterioration of their quality of life. Therefore, training, counseling, and advocacy programs should be developed to improve the patients' quality of sleep and quality of life, especially those with lower education level and income, and older people. PMID:25276738

Effect of using ultrapure dialysate for hemodialysis on the level of circulating bacterial fragment in renal failure patients.

Science.gov (United States)

Kwan, Bonnie Ching-Ha; Chow, Kai-Ming; Ma, Terry King-Wing; Cheng, Phyllis Mei-Shan; Leung, Chi-Bon; Li, Philip Kam-Tao; Szeto, Cheuk-Chun

2013-01-01

Cardiovascular disease is the major cause of mortality and morbidity in dialysis patients. Recently, circulating endotoxin is found to associate with the systemic inflammatory state and cardiovascular disease of dialysis patients. Previous studies showed that the use of ultrapure dialysate for hemodialysis could reduce the exposure to exogenous endotoxin. We studied the effect of using ultrapure dialysate for hemodialysis on circulating endotoxin and bacterial DNA fragment levels and vascular stiffness. This is an open-labeled prospective study of 25 patients (14 male). Circulating endotoxin and bacterial DNA level, vascular stiffness as represented by arterial pulse wave velocity (PWV), nutrition and hydration status were monitored before and repeatedly throughout 12 months after the use of ultrapure dialysate for hemodialysis. The average age was 58.9 ± 10.2 years; 21 patients completed the study. Within 4 weeks of conversion to ultrapure dialysate for hemodialysis, the plasma endotoxin level fell from 0.302 ± 0.083 to 0.209 ± 0.044 EU/ml (p hemodialysis patients, circulating endotoxin level is associated with vascular stiffness and systemic inflammation. Using ultrapure dialysate for hemodialysis effectively reduces circulating endotoxin level in hemodialysis patients. The long-term benefit of using ultrapure dialysate for hemodialysis requires further study. © 2013 S. Karger AG, Basel.

Prognostic Factors Influencing the Patency of Hemodialysis Vascular Access: Literature Review and Novel Therapeutic Modality by Far Infrared Therapy

Directory of Open Access Journals (Sweden)

Chih-Ching Lin

2009-03-01

Full Text Available In Taiwan, more than 85% of patients with end-stage renal disease undergo maintenance hemodialysis (HD. The native arteriovenous fistula (AVF accounts for a prevalence of more than 80% of the vascular access in our patients. Some mechanical factors may affect the patency of hemodialysis vascular access, such as surgical skill, puncture technique and shear stress on the vascular endothelium. Several medical factors have also been identified to be associated with vascular access prognosis in HD patients, including stasis, hypercoagulability, endothelial cell injury, medications, red cell mass and genotype polymorphisms of transforming growth factor-β1 and methylene tetrahydrofolate reductase. According to our previous study, AVF failure was associated with a longer dinucleotide (GTn repeat (n ≥ 30 in the promoter of the heme oxygenase-1 (HO-1 gene. Our recent study also demonstrated that far-infrared therapy, a noninvasive and convenient therapeutic modality, can improve access flow, inflammatory status and survival of the AVF in HD patients through both its thermal and non-thermal (endothelial-improving, anti-inflammatory, antiproliferative, antioxidative effects by upregulating NF-E2-related factor-2-dependent HO-1 expression, leading to the inhibition of expression of E-selectin, vascular cell adhesion molecule-1, and intercellular adhesion molecule-1.

Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results

Energy Technology Data Exchange (ETDEWEB)

Won, Jong Yun; Lee, Kwang Hun; Lee, Do Yun [Dept. of Radiology, Research Institute of Radiological Science, Yensei University College of Medicine, Seoul (Korea, Republic of); Kim, Myoung Soo [Dept. of Radiology, Yensei University College of Medicine, Seoul (Korea, Republic of); Kang, Byung Chul [Dept. of Radiology, Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of); Kim, Seung Jung [Dept. of Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of)

2011-08-15

To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.

Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment.

Science.gov (United States)

Richardson, Ian P; Sturtevant, Rachael; Heung, Michael; Solomon, Michael J; Younger, John G; VanEpps, J Scott

2016-01-01

Central line-associated bloodstream infections (CLABSIs) are not easily treated, and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50°C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter, positioned with tip in the human vena cava as well as computational fluid dynamic simulations, we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature.

[Medication adherence of 65 patients in hemodialysis in Togo].

Science.gov (United States)

Sabi, K A; Noto-Kadou-Kaza, B; Amekoudi, Y E; Tsevi, M C; Sylla, F; Kossidze, K; Gnionsahe, D A

2014-01-01

The aim of this study was to assess adherence in people on hemodialysis and determine the factors of poor adherence. This cross-sectional study took place throughout the month of September, 2012, in the hemodialysis center of the Sylvanus Olympio University Hospital, the only such center in Togo. The study included 65 patients, with a mean age of 49.5 years (range: 22 to 77 years), more often men (sex ratio: 1.82) and married (74 %). More than half (58%) had completed secondary education, while 73% belonged to the least advantaged socioeconomic class; 61 (94%) had health insurance, and 57% had been on dialysis for 1 to 4 years. The compliance rate was 11%. The main factors associated with good adherence were marital status (p = 0.0339) and the patient's general health status (p = 0.001). Treatment fatigue (p = 0.0347), forgetfulness (p = 0.0001), dosage forms and drug characteristics (p = 0.0198) were all factors of noncompliance. Therapeutic non-compliance was proportional to the number of drugs prescribed (p = 0.4263). Adherence in hemodialysis patients in Togo is very poor.

Five months of physical exercise in hemodialysis patients

DEFF Research Database (Denmark)

Molsted, Stig; Eidemak, Inge; Sorensen, Helle Tauby

2004-01-01

BACKGROUND: The number of chronic renal failure patients treated by hemodialysis (HD) is continuously increasing. Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases. The aim of this study was to determine the effects of 5 months physical exercise...... limitations, severe peripheral polyneuropathy, inability to speak Danish or English, dementia or other mental disorders. The patients were randomly assigned to an exercise group (EG, n = 22) or a control group (CG, n = 11). Prior to randomization, baseline testing was performed. The effects were measured...... by aerobic capacity, '2-min stair climbing', 'squat test', self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. RESULTS: 20 patients completed the intervention. Attendance was 74...

Recurrent white thrombi formation in hemodialysis tubing: a case report.

Science.gov (United States)

Sathe, Kiran P; Yeo, Wee-Song; Liu, Isaac Desheng; Ekambaram, Sudha; Azar, Mohammed; Yap, Hui-Kim; Ng, Kar-Hui

2015-01-15

While the appearance of red clots in the dialyzer is a common phenomenon in every hemodialysis unit, the occurrence of white thrombi in the tubing is relatively rare. We describe an adolescent male with recurrent white thrombi formation in the hemodialysis tubing. This patient had chronic renal failure from focal segmental glomerulosclerosis, but was no longer nephrotic at the time of the thrombi formation. He had a history of recurrent thrombosis of his vascular access. However, no pro-thrombotic risk factors could be identified. White particulate matter, measuring 1 to 3mm in size, and adherent to the arterial and venous blood tubing lines was found during the rinse back of a hemodialysis session. This was associated with a 60% decrease in his platelet count. Light microscopic examination of the deposits revealed the presence of platelet aggregates. He subsequently developed thrombosis of his arteriovenous graft six hours later. The white thrombi recurred at the next dialysis session, as well as six months later. These episodes occurred regardless of the type of dialysis machine or tubing, and appeared to resolve with an increase in heparin dose. Recurrent white thrombi formation can occur in the hemodialysis tubing of a patient with no identifiable pro-thrombotic factors. The white thrombi may be a harbinger of arteriovenous graft thrombosis and may be prevented by an increase in heparin dose.

Subjective sleep efficiency of hemodialysis patients

NARCIS (Netherlands)

Koch, B.C.P.; Nagtegaal, J.E.; Hagen, E.C.; van Dorp, W.Th.; Boringa, J.B.S.; Kerkhof, G.A.; ter Wee, P.M.

2008-01-01

Background: Sleep disturbances have a major influence on quality of life. A commonly used measure of sleep disturbances is sleep efficiency. The purpose of this study was to investigate the prevalence of decreased subjective sleep efficiency in hemodialysis patients. An additional goal was to

Depressive Symptomatology in Children and Adolescents with Chronic Renal Insufficiency Undergoing Chronic Dialysis

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Edith G. Hernandez

2011-01-01

Full Text Available This paper presents a descriptive study, using the Birleson Scale to determine the frequency of depressive symptomatology in children and adolescents with chronic renal insufficiency (CRI undergoing hemodialysis (HD and chronic peritoneal dialysis (CPD. There were 67 patients (40 female and 27 male with a mean age of 14.76±2.71 years, duration of illness ≥3 months, 43 (64.18% patients with CPD and 24 (35.82% undergoing HD. The frequency of high occurrence, low occurrence, and absence of depressive symptomatology was 10.45% (=7, 43.28% (=29, and 46.27% (=31, respectively; all of the seven (100% patients with high occurrence of depressive symptomatology were female (=0.04, and none of these (0% had a friend to confide in (=0.03. Depressive symptomatology in patients with CPD was associated with a lower weekly / compared to those without depressive symptomatology (2.15±0.68 versus 2.52±0.65; =0.01. There was no association with patient age, caregiver, time and dialysis type, anemia, bone disease, nutritional or financial status, origin, schooling, or employment.

Quadriplegia after parathyroidectomy in a hemodialysis patient.

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Wang, Yu-Chieh; Huang, Shih-Yu; Lin, Ho-Tien; Hu, Jenkin-S; Chan, Kwok-Hon; Tsou, Mei-Yung

2011-03-01

We present a case of post-operative iatrogenic quadriplegia, which occurred after subtotal parathyroidectomy. This patient was on long-term hemodialysis for 7 years. The need of prolonged neck extension for this procedure was probably the main risk factor for the spinal cord injury. Systemic hypotension which contributed to the injury in this case, should be anticipated and promptly treated to prevent further damage. Spinal deformities associated with end-stage renal disease may make such patients more susceptible. Since appropriate precautions against potential neurologic damage can be undertaken, we suggest that evaluating carefully for the pre-existing spinal stenosis before a procedure requiring prominent and prolonged hyper-extension of the neck, especially in long-term hemodialysis patients is of paramount importance. Copyright © 2011. Published by Elsevier B.V.

Adherence to treatment and hospitalization risk in hemodialysis patients.

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Vaiciuniene, Ruta; Kuzminskis, Vytautas; Ziginskiene, Edita; Skarupskiene, Inga; Bumblyte, Inga A

2012-01-01

The aim of this study was to evaluate whether adherence to treatment is associated with hospitalization risk in hemodialysis patients. We completed a cohort analysis of risk factors during 1 census month (November) and 1 year of follow-up during 5 consecutive years (2002-2006) in all end-stage renal disease patients hemodialyzed in the Kaunas region. During the census month, we collected data on noncompliance defined as (i) skipping of a hemodialysis (HD) session, (ii) shortening of 1 or more HD sessions, (iii) presence of hyperkalemia, (iv) presence of hyperphosphatemia, or (v) interdialytic weight gain (IDWG). In addition, data on age, sex, disability status, comorbidities, anemia control, malnutrition and inflammation, calcium-phosphorus metabolism and hospitalization rate were collected. Relative risk of hospitalization was estimated using Cox regression evaluating time to first hospitalization. We analyzed 559 patients for a total of 1,163 patient-years during the 5 years of the study. On multivariate analysis, adjusting for ischemic heart disease, diabetes mellitus, higher number of comorbid conditions, higher systolic blood pressure before dialysis, worse disability status, lower hemoglobin, albumin and urea before dialysis, the relative risk for hospitalization increased by 1.1 for every additional percentage point of IDWG and by 1.19 with each 1 mmol/L rise of serum phosphorus level. Skipping or shortening of hemodialysis sessions and serum potassium level were not associated with hospitalization. Higher IDWG and higher serum levels of phosphorus independently increased the relative risk of hospitalizations in hemodialysis patients. With skipped and shortened dialysis sessions, higher serum potassium level was not associated with hospitalization risk.

Effects of different blood purification methods on serum inflammatory cytokine in maintenance hemodialysis patients

International Nuclear Information System (INIS)

Zhang Yijing; Tian Jinsheng; Feng Xiaoyan

2012-01-01

Objective: To study the effects of low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD) and hemodiafiltration (HDF) on the serum inflammatory cytokine in maintenance hemodialysis (MHD) patients. Methods: Sixty MHD patients were randomly divided into LFHD group, HFHD group and HDF group. Results: The levels of serum CRP, IL-6, IL-8 and TNF-α were detected in three groups and control group. The results showed that levels of CRP, IL-6, IL-8 and TNF-α in patients with MHD before treatment were much higher than these in control group (P 0.05). The levels of CRP, IL-6, IL-8 and TNF-α did not significantly decrease in patients with HFHD after the first hemodialysis (P>0.05). The levels of CRP, IL-6, IL-8 and TNF-α decreased markedly in patients with HFHD after 6 months hemodialysis (P<0.05). The levels of CRP, IL-6, IL-8 and TNF-α decreased significantly in patients with HDF after the first hemodialysis and after 6 months (P<0.05). The levels of CRP, IL-6, IL-8 and TNF-α in HDF group were significantly lower than those in HFHD group after 6 months (P<0.05). Conclusion: There was microinflammatory state in MHD patients. The lowering of patients' serum CRP, IL-6, IL-8 and TNF-α levels and thus the recovery from microinflammatory state may be achieved by HDF, HFHD, and HFHD preferably by HDF. (authors)

A Peer-to-Peer Mentoring Program for In-Center Hemodialysis: A Patient-Centered Quality Improvement Program.

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St Clair Russell, Jennifer; Southerland, Shiree; Huff, Edwin D; Thomson, Maria; Meyer, Klemens B; Lynch, Janet R

2017-01-01

A patient-centered quality improvement program implemented in one Virginia hemodialysis facility sought to determine if peer-to-peer (P2P) programs can assist patients on in-center hemodialysis with self-management and improve outcomes. Using a single-arm, repeatedmeasurement, quasi-experimental design, 46 patients participated in a four-month P2P intervention. Outcomes include knowledge, self-management behaviors, and psychosocial health indicators: self-efficacy, perceived social support, hemodialysis social support, and healthrelated quality of life (HRQoL). Physiological health indicators included missed and shortened treatments, arteriovenous fistula placement, interdialytic weight gain, serum phosphorus, and hospitalizations. Mentees demonstrated increased knowledge, self-efficacy, perceived social support, hemodialysis social support, and HRQoL. Missed treatments decreased. Mentors experienced increases in knowledge, self-management, and social support. A P2P mentoring program for in-center hemodialysis can benefit both mentees and mentors. Copyright© by the American Nephrology Nurses Association.

Benfotiamine reduces genomic damage in peripheral lymphocytes of hemodialysis patients.

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Schupp, Nicole; Dette, Eva Maria; Schmid, Ursula; Bahner, Udo; Winkler, Michaela; Heidland, August; Stopper, Helga

2008-09-01

Hemodialysis patients have an elevated genomic damage in peripheral blood lymphocytes (PBLs) and an increased cancer incidence, possibly due to accumulation of uremic toxins like advanced glycation end products (AGEs). Because the vitamin B1 prodrug benfotiamine reduces AGE levels in experimental diabetes, and dialysis patients often suffer from vitamin B1 deficiency, we conducted two consecutive studies supplementing hemodialysis patients with benfotiamine. In both studies, genomic damage was measured as micronucleus frequency of PBLs before and at three time-points after initiation of benfotiamine supplementation. AGE-associated fluorescence in plasma, and in the second study additionally, the antioxidative capacity of plasma was analyzed. Benfotiamine significantly lowered the genomic damage of PBLs in hemodialysis patients of both studies independent of changes in plasma AGE levels. The second study gave a hint to the mechanism, as the antioxidative capacity of the plasma of the treated patients clearly increased, which might ameliorate the DNA damage.

Costos directos de la hemodiálisis en unidades públicas y privadas Direct cost analysis of hemodialysis units

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Luis Durán-Arenas

2011-01-01

Full Text Available OBJETIVO. Estimar y comparar el costo por sesión de hemodiálisis dentro del sector público y privado en la Ciudad de México. MATERIAL Y MÉTODOS. Se calcularon los costos de los insumos utilizados en las hemodiálisis de cuatro hospitales públicos y dos privados de la Ciudad de México, mediante la estrategia de micro-costeo denominada PAATI. Para la obtención de los datos se utilizó el método de sombra; además, se empleó Excel para elaborar cédulas en las que se determina el PAATI para cada sesión. RESULTADOS. El costo anual promedio directo en el sector público por el tratamiento de un individuo en hemodiálisis es de $158 964.00 M. N., y el costo de atender a la población que podría demandar terapia de reemplazo renal se estima en $10 921 788 072.00 M. N. CONCLUSIÓN. La disponibilidad de recursos humanos e infraestructura en el país es muy limitada para el campo de la nefrología en general y, en particular, para ofrecer servicios de hemodiálisis, por lo que sería necesario inyectar más recursos para poder responder ante la demanda por insuficiencia renal terminal.OBJECTIVE. To estimate and compare direct costs per hemodialysis session in public and private units in Mexico City. MATERIAL AND METHODS. PAATI, a microcosting strategy, was used to determine total costs of four public and two private health hospitals in Mexico City. A "shadow study" approach was employed to collect the needed data. Charts containing the "PAATI" information for each session were developed in Microsoft Excel. RESULTS. The average annual cost per patient undergoing hemodialysis in public units is $158 964.00 MX. The estimated cost for the care of all population estimated in need of renal replacement therapy (via hemodialysis was estimated to be $10 921 788 072.00 MX. CONCLUSION. Human resources and infrastructure availability in México are very limited for nephrology, and in consequence for offering hemodialysis services.

The NKF-NUS hemodialysis trial protocol - a randomized controlled trial to determine the effectiveness of a self management intervention for hemodialysis patients

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Krishnan Deby

2011-01-01

Full Text Available Abstract Background Poor adherence to treatment is common in patients on hemodialysis which may increase risk for poor clinical outcomes and mortality. Self management interventions have been shown to be effective in improving compliance in other chronic populations. The aim of this trial is to evaluate the effectiveness of a recently developed group based self management intervention for hemodialysis patients compared to standard care. Methods/Design This is a multicentre parallel arm block randomized controlled trial (RCT of a four session group self management intervention for hemodialysis patients delivered by health care professionals compared to standard care. A total of 176 consenting adults maintained on hemodialysis for a minimum of 6 months will be randomized to receive the self management intervention or standard care. Primary outcomes are biochemical markers of clinical status and adherence. Secondary outcomes include general health related quality of life, disease-specific quality of life, mood, self efficacy and self-reported adherence. Outcomes will be measured at baseline, immediately post-intervention and at 3 and 9 months post-intervention by an independent assessor and analysed on intention to treat principles with linear mixed-effects models across all time points. A qualitative component will examine which aspects of program participants found particularly useful and any barriers to change. Discussion The NKF-NUS intervention builds upon previous research emphasizing the importance of empowering patients in taking control of their treatment management. The trial design addresses weaknesses of previous research by use of an adequate sample size to detect clinically significant changes in biochemical markers, recruitment of a sufficiently large representative sample, a theory based intervention and careful assessment of both clinical and psychological endpoints at various follow up points. Inclusion of multiple dependent

Omega-3 intake in people with epilepsy under regular hemodialysis program: here to stay

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Carla Alessandra Scorza

2013-07-01

Full Text Available Among the many risk factors suggested for sudden unexpected death in epilepsy (SUDEP, higher frequency of seizures is a very consistent issue. Furthermore, it has been established that hemodialysis-associated seizure is a complication of the dialysis procedure. Thus, since a possible relation between cardiovascular abnormalities and SUDEP among patients with chronic renal insufficiency in regular hemodialysis program should not be neglected, we propose in this paper that omega-3 fatty acids offer opportunities for prevention of sudden cardiac death or improved treatment in people with epilepsy under the regular hemodialysis program.

Hemodialysis knowledge and medical adherence in African Americans diagnosed with end stage renal disease: results of an educational intervention.

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Wells, Janie R

2011-01-01

The purpose of this three-group quasi-experimental research study was to describe the relationship between hemodialysis knowledge and perceived medical adherence to a prescribed treatment regimen in African Americans diagnosed with end stage renal disease and to determine if an educational intervention improved hemodialysis knowledge and medical adherence. Eighty-five African Americans participated in this study using the Life Options Hemodialysis Knowledge Test and the Medical Outcomes Study Measures of Patient Adherence tools. No significant correlation was found between hemodialysis knowledge and medical adherence. Paired sample t-tests revealed significantly higher hemodialysis knowledge scores in the post-test group compared to the pre-test group, t(26) = -3.79, p adherence. This study suggests that more education is needed to improve the knowledge level of African-American patients on hemodialysis.

Survival predictability of lean and fat mass in men and women undergoing maintenance hemodialysis.

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Noori, Nazanin; Kovesdy, Csaba P; Dukkipati, Ramanath; Kim, Youngmee; Duong, Uyen; Bross, Rachelle; Oreopoulos, Antigone; Luna, Amanda; Benner, Debbie; Kopple, Joel D; Kalantar-Zadeh, Kamyar

2010-11-01

Larger body size is associated with greater survival in maintenance hemodialysis (MHD) patients. It is not clear how lean body mass (LBM) and fat mass (FM) compare in their associations with survival across sex in these patients. We examined the hypothesis that higher FM and LBM are associated with greater survival in MHD patents irrespective of sex. In 742 MHD patients, including 31% African Americans with a mean (± SD) age of 54 ± 15 y, we categorized men (n = 391) and women (n = 351) separately into 4 quartiles of near-infrared interactance-measured LBM and FM. Cox proportional hazards models estimated death hazard ratios (HRs) (and 95% CIs), and cubic spline models were used to examine associations with mortality over 5 y (2001-2006). After adjustment for case-mix and inflammatory markers, the highest quartiles of FM and LBM were associated with greater survival in women: HRs of 0.38 (95% CI: 0.20, 0.71) and 0.34 (95% CI: 0.17, 0.67), respectively (reference: first quartile). In men, the highest quartiles of FM and percentage FM (FM%) but not of LBM were associated with greater survival: HRs of 0.51 (95% CI: 0.27, 0.96), 0.45 (95% CI: 0.23, 0.88), and 1.17 (95% CI: 0.60, 2.27), respectively. Cubic spline analyses showed greater survival with higher FM% and higher "FM minus LBM percentiles" in both sexes, whereas a higher LBM was protective in women. In MHD patients, higher FM in both sexes and higher LBM in women appear to be protective. The survival advantage of FM appears to be superior to that of LBM. Clinical trials to examine the outcomes of interventions that modify body composition in MHD patients are indicated.

The Virtual Anemia Trial: An Assessment of Model‐Based In Silico Clinical Trials of Anemia Treatment Algorithms in Patients With Hemodialysis

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Topping, Alice; Kappel, Franz; Thijssen, Stephan; Kotanko, Peter

2018-01-01

In silico approaches have been proposed as a novel strategy to increase the repertoire of clinical trial designs. Realistic simulations of clinical trials can provide valuable information regarding safety and limitations of treatment protocols and have been shown to assist in the cost‐effective planning of clinical studies. In this report, we present a blueprint for the stepwise integration of internal, external, and ecological validity considerations in virtual clinical trials (VCTs). We exemplify this approach in the context of a model‐based in silico clinical trial aimed at anemia treatment in patients undergoing hemodialysis (HD). Hemoglobin levels and subsequent anemia treatment were simulated on a per patient level over the course of a year and compared to real‐life clinical data of 79,426 patients undergoing HD. The novel strategies presented here, aimed to improve external and ecological validity of a VCT, significantly increased the predictive power of the discussed in silico trial. PMID:29368434

C-reactive protein and other markers of inflammation in hemodialysis patients

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Heidari, Behzad

2013-01-01

Hemodialysis patients are at greater risk of cardiovascular disease. Higher than expected cardiovascular morbidity and mortality in this population has been attributed to dislipidemia as well as inflammation. The causes of inflammation in hemodialysis patients are multifactorial. Several markers were used for the detection of inflammatory reaction in patients with chronic renal disease. These markers can be used for the prediction of future cardiovascular events. Among the several parameters of inflammatory markers, serum, CRP is well known and its advantages for the detection of inflammation and its predictor ability has been evaluated in several studies. This review addressed the associated factors and markers of inflammation in hemodialysis patients. In addition, their ability in predicting future atherosclerosis and effect of treatment has been reviewed. However, this context particularly in using CRP as a prediction marker of inflammation and morbidity requires further studies. PMID:24009946

C-reactive protein and other markers of inflammation in hemodialysis patients.

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Heidari, Behzad

2013-01-01

Hemodialysis patients are at greater risk of cardiovascular disease. Higher than expected cardiovascular morbidity and mortality in this population has been attributed to dislipidemia as well as inflammation. The causes of inflammation in hemodialysis patients are multifactorial. Several markers were used for the detection of inflammatory reaction in patients with chronic renal disease. These markers can be used for the prediction of future cardiovascular events. Among the several parameters of inflammatory markers, serum, CRP is well known and its advantages for the detection of inflammation and its predictor ability has been evaluated in several studies. This review addressed the associated factors and markers of inflammation in hemodialysis patients. In addition, their ability in predicting future atherosclerosis and effect of treatment has been reviewed. However, this context particularly in using CRP as a prediction marker of inflammation and morbidity requires further studies.

The effect of different dialyzer membrane on the clearance of serum β2-MG in maintenance hemodialysis patients

International Nuclear Information System (INIS)

Lu Yun; Xue Jun; Lin Xiangtong; Deng Shouzhen; Li Ding

2001-01-01

Objective: To investigate the effect of different membrane on the clearance of serum β 2 -MG in maintenance hemodialysis patients. Method: 106 maintenance hemodialysis patients randomized divided into group A and group B. Group A used cellulose triacetate membrane (N-130E), Group B used polysulfone membrane (F6). The levels of serum β 2 -MG before and after hemodialysis were compared in Group A and B, respectively. Results: Before hemodialysis, the level of serum β 2 -MG was not significant different between Group A and B (46.74 ± 19.46 mg/L vs 47.49 ± 16.71 mg/L, P>0.05). In Group A, compared with that before hemodialysis, the level of serum β 2 -MG after hemodialysis decreased significantly. (46.74±19.46 mg/L vs 39.76 ±17.66 mg/L, before HD vs after HD, P 2 -MG between before and after hemodialysis (47.49±16.71 mg/L vs 50.19±22.76 mg/L, P>0.05). Conclusion: N-130E dialyzer is better than F6 dialyzer as the effect of clearance serum β 2 -MG is concerned

Citrate Anticoagulation in Tandem Membrane Plasma-Exchange or Immunoadsorption and Hemodialysis in Patients With Immunological Diseases and Dialysis-Dependence.

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Ponikvar, Rafael; Gubenšek, Jakob; Ponikvar, Jadranka Buturović

2016-06-01

In 1996 we performed tandem membrane plasma exchange-hemodialysis in a 3-year-old girl and tandem immunoadsorption-hemodialysis with citrate as the only anticoagulant in a patient with Goodpasture's syndrome. In the present study, we evaluated the feasibility, efficacy and safety of 24 tandem plasma exchange/immunoadsorption hemodialysis procedures in four different circuit setups with citrate as the only anticoagulant. In two setups, the tandem procedures were connected in series (plasma exchange hemodialysis and immunoadsorption hemodialysis), while in the other two setups they were in parallel (plasma exchange hemodialysis with independent blood circuits and plasma exchange hemodialysis with independent arterial blood lines, but with a common return line). All tandem procedures were feasible, efficient and safe. No serious side-effects were recorded. The most elegant setup was the procedure with independent, parallel blood circuits. However, serial tandem procedures provided for the elimination of citrate and normalization of electrolytes before blood was returned to the patient. © 2016 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.

Seroprevalence occurrence of viral hepatitis and HIV among hemodialysis patients

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Inass Mahmood Abid Kamal

2018-05-01

Full Text Available Background: Patients with chronic renal failure (CRF were on maintenance invasive hemodialysis (HD procedure. This procedure by itself affects immunity of the patients and became more susceptible to viral infections. Aim of the study: to investigate the occurrence of HBV, HCV and HIV infections in patients with hemodialysis. Patients and methods: A retrospective study of 430 end-stage renal failure patients, referred to hemodialysis department at XXXX Teaching Hospital, Baghdad-Iraq from January-2015 to January-2017. Patients were investigated for HBs-Ag using enzyme-labeled antigen test (Foresight-EIA-USA, HCV- Abs (IgG specific immunoglobulin using an HCV enzyme-labeled antigen test (Foresight-EIA-USAand anti - HIV Abs (IgG using enzyme-labeled antigen test (Foresight-EIA-USA. Results: The frequency of HBV infection in the first year was not significant between males (1.11% and females (0.00% (P = 0.295. About HCV also there are no significant differences between males (12.63% and females (9.31% (P = 0.347. After one year of follow up the frequencies of HBV and HCV were not significant between two sexes. Additionally, no any one of the patients had HIV infection. Conclusions: This study brings a light on that HBV and HCV were having the same frequencies in both genders and lower occurrence with time. Furthermore, HIV was not detected in those patients. Keywords: Virus, Hemodialysis, Infection

Influence of maintained hemodialysis on viral load in patients with end-stage renal disease with HBV infection

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ZHANG Huifang

2017-07-01

Full Text Available In the patients with end-stage renal disease (ESRD with hepatitis B virus (HBV infection who underwent hemodialysis, the viral load of HBV DNA is relatively low and stable. For this phenomenon, some studies suggest that hemodialysis can reduce the HBV DNA load. The mechanism, which remains unclear, may be as follows: when HBV DNA enters the dialysate through the dialysis membrane, it was adsorbed onto the dialysis membrane; some virus particles were destroyed, and antiviral substances were produced in the course of hemodialysis. At present, there is no consensus on the mechanism responsible for the influence of maintained hemodialysis on the viral load of HBV DNA. This article reviews the factors involved in the influence of maintained hemodialysis on the viral load in ESRD patients with HBV infection and the recent progress.

A Virtual Ward for Home Hemodialysis Patients – A Pilot Trial

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Michael J. Raphael

2015-11-01

Full Text Available Background: Patients with end-stage renal disease (ESRD have a high rate of hospitalization and are prone to care gaps that may occur during the transition from hospital to home. The virtual ward (VW is an innovative model that provides short-term transitional care to patients upon hospital discharge. The VW may be an effective intervention to address care gaps. Objectives: The primary objective of the pilot study was to assess the feasibility and practicality of implementing the Home Dialysis VW (HDVW on a broader scale. Design: The HDVW Pilot Study enrolled home hemodialysis patients following one of four inclusion criteria: 1. Discharge from hospital, 2. Completion of an in-hospital medical procedure, 3. Prescription of an antibiotic, 4. Completion of home hemodialysis training. Patients were followed in the HDVW for 14 days and during this time were assessed serially with a clinician-led telephone interview for one of three transitional care gaps: 1. Requirement for change in hemodialysis prescription, 2. Requirement for coordination of follow-up care, 3. Requirement for medication change. Setting: The study was conducted in Toronto, Ontario, Canada at a quaternary care academic teaching hospital from 2012–2013. Patients: This study included 52 HDVW admissions among 35 patients selected from the existing home hemodialysis program. Measurements: The primary outcome was the identification of the number of care gaps at each HDVW admission. Secondary outcomes included the identification of potential predictors of care gaps and description of clinical adverse events following HDVW admission (readmissions, emergency department visits, unplanned visits to the home hemodialysis in-center. Results: The implementation and execution of the HDVW Pilot Study proved to be technically feasible and practical. A care gap was identified in 35 (67 % of the HDVW admissions. In total, the cohort experienced 85 care gaps. There were no baseline demographic

Reduced deep regional cerebral venous oxygen saturation in hemodialysis patients using quantitative susceptibility mapping.

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Chai, Chao; Liu, Saifeng; Fan, Linlin; Liu, Lei; Li, Jinping; Zuo, Chao; Qian, Tianyi; Haacke, E Mark; Shen, Wen; Xia, Shuang

2018-02-01

Cerebral venous oxygen saturation (SvO 2 ) is an important indicator of brain function. There was debate about lower cerebral oxygen metabolism in hemodialysis patients and there were no reports about the changes of deep regional cerebral SvO 2 in hemodialysis patients. In this study, we aim to explore the deep regional cerebral SvO 2 from straight sinus using quantitative susceptibility mapping (QSM) and the correlation with clinical risk factors and neuropsychiatric testing . 52 hemodialysis patients and 54 age-and gender-matched healthy controls were enrolled. QSM reconstructed from original phase data of 3.0 T susceptibility-weighted imaging was used to measure the susceptibility of straight sinus. The susceptibility was used to calculate the deep regional cerebral SvO 2 and compare with healthy individuals. Correlation analysis was performed to investigate the correlation between deep regional cerebral SvO 2 , clinical risk factors and neuropsychiatric testing. The deep regional cerebral SvO 2 of hemodialysis patients (72.5 ± 3.7%) was significantly lower than healthy controls (76.0 ± 2.1%) (P deep regional cerebral SvO 2 in patients. The Mini-Mental State Examination (MMSE) scores of hemodialysis patients were significantly lower than healthy controls (P deep regional cerebral SvO 2 did not correlate with MMSE scores (P = 0.630). In summary, the decreased deep regional cerebral SvO 2 occurred in hemodialysis patients and dialysis duration, parathyroid hormone, hematocrit, hemoglobin and red blood cell may be clinical risk factors.

alpha-Ketoglutarate application in hemodialysis patients improves amino acid metabolism.

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Riedel, E; Nündel, M; Hampl, H

1996-01-01

In hemodialysis patients, free amino acids and alpha-ketoacids in plasma were determined by fluorescence HPLC to assess the effect of alpha-ketoglutarate administration in combination with the phosphate binder calcium carbonate on the amino acid metabolism. During 1 year of therapy in parallel to inorganic phosphate, urea in plasma decreased significantly, histidine, arginine and proline as well as branched chain alpha-ketoacids, in particular alpha-ketoisocaproate, a regulator of protein metabolism, increased. Thus, administration of alpha-ketoglutarate with calcium carbonate effectively improves amino acid metabolism in hemodialysis patients as it decreases hyperphosphatemia.

Novel equations to estimate lean body mass in maintenance hemodialysis patients.

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Noori, Nazanin; Kovesdy, Csaba P; Bross, Rachelle; Lee, Martin; Oreopoulos, Antigone; Benner, Deborah; Mehrotra, Rajnish; Kopple, Joel D; Kalantar-Zadeh, Kamyar

2011-01-01

Lean body mass (LBM) is an important nutritional measure representing muscle mass and somatic protein in hemodialysis patients, for whom we developed and tested equations to estimate LBM. A study of diagnostic test accuracy. The development cohort included 118 hemodialysis patients with LBM measured using dual-energy x-ray absorptiometry (DEXA) and near-infrared (NIR) interactance. The validation cohort included 612 additional hemodialysis patients with LBM measured using a portable NIR interactance technique during hemodialysis. 3-month averaged serum concentrations of creatinine, albumin, and prealbumin; normalized protein nitrogen appearance; midarm muscle circumference (MAMC); handgrip strength; and subjective global assessment of nutrition. LBM measured using DEXA in the development cohort and NIR interactance in validation cohorts. In the development cohort, DEXA and NIR interactance correlated strongly (r = 0.94, P < 0.001). DEXA-measured LBM correlated with serum creatinine level, MAMC, and handgrip strength, but not with other nutritional markers. Three regression equations to estimate DEXA-measured LBM were developed based on each of these 3 surrogates and sex, height, weight, and age (and urea reduction ratio for the serum creatinine regression). In the validation cohort, the validity of the equations was tested against the NIR interactance-measured LBM. The equation estimates correlated well with NIR interactance-measured LBM (R² ≥ 0.88), although in higher LBM ranges, they tended to underestimate it. Median (95% confidence interval) differences and interquartile range for differences between equation estimates and NIR interactance-measured LBM were 3.4 (-3.2 to 12.0) and 3.0 (1.1-5.1) kg for serum creatinine and 4.0 (-2.6 to 13.6) and 3.7 (1.3-6.0) kg for MAMC, respectively. DEXA measurements were obtained on a nondialysis day, whereas NIR interactance was performed during hemodialysis treatment, with the likelihood of confounding by volume status

Bath salt intoxication causing acute kidney injury requiring hemodialysis.

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Regunath, Hariharan; Ariyamuthu, Venkatesh Kumar; Dalal, Pranavkumar; Misra, Madhukar

2012-10-01

Traditional bath salts contain a combination of inorganic salts like Epsom salts, table salt, baking soda, sodium metaphosphate, and borax that have cleansing properties. Since 2010, there have been rising concerns about a new type of substance abuse in the name of "bath salts." They are beta-ketone amphetamine analogs and are derivates of cathinone, a naturally occurring amphetamine analog found in the "khat" plant (Catha edulis). Effects reported with intake included increased energy, empathy, openness, and increased libido. Serious adverse effects reported with intoxication included cardiac, psychiatric, and neurological signs and symptoms. Not much is known about the toxicology and metabolism of these compounds. They inhibit monoamine reuptake (dopamine, nor epinephrine, etc.) and act as central nervous system stimulants with high additive and abuse potential because of their clinical and biochemical similarities to effects from use of cocaine, amphetamine, and 3,4-methylenedioxy-N-methylamphetamine. Deaths associated with use of these compounds have also been reported. We report a case of acute kidney injury associated with the use of "bath salt" pills that improved with hemodialysis. © 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.

[The history of home hemodialysis and its likely revival].

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Ralli, Chiara; Imperiali, Patrizio; Duranti, Ennio

2016-01-01

The home extracorporeal hemodialysis, which aroused a great interest in the past, has not kept its promises due to the complexity and expectations for family involvement in treatment management. In the United States NxStage One portable system was proposed and designed for home use. In this work we describe, starting from the history of home hemodialysis, the method with NxStage system by comparing it with the conventional HD in 5 patients. The dialysis efficiency was similar between the two treatments, even if home hemodialysis showed a reduction in serum urea, creatinine and phosphorus. At the same time phosphate binders use decreased with an increase in serum calcium while hemoglobin increased reducing doses of erythropoietin. The method was successful in the training of the patients and their partners during hospital training and at home. Patients have shown great enthusiasm at the beginning and during the therapy, which is developed around the users personal needs, being able to decide at its own times during 24 hours according to personal needs, in addition to faster recovery after the dialysis. This method certainly improved the patients' wellness and increased their autonomy.

White Thrombus Formation in Blood Tubing Lines in a Chronic Hemodialysis Unit

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Watnick, Suzanne; Stooksbury, Michael; Winter, Rolf; Riscoe, Michael; Cohen, David M.

2008-01-01

Background and objectives: Previous reports have described white particulate matter in banked blood components, but no prior public reports describe such matter in blood tubing during the course of routine in-center hemodialysis. This report describes the events, investigations, and preliminary conclusions associated with the spontaneous formation of adherent white thrombus in the venous and arterial blood lines during routine in-center hemodialysis treatments.

[Correction of anemia in hemodialysis, effect of intravenous iron without erythropoietin].

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Alvo, Miriam; Elgueta, Leticia; Aragón, Henry; Cotera, Alejandro

2002-08-01

In the last two decades, the use of erythropoietin for the correction of anemia in hemodialysis patients has been recommended. In Chile, only 10% of hemodialysis patients use erythropoietin, therefore, the correction of iron deficiency must be optimized. To report the effects of intravenous iron without erythropoietin in the management of anemia in hemodialysis patients. Retrospective analysis of 42 patients that received intravenous ferrous sacharate in doses of 100 mg/week during 5 weeks and 100 mg bimonthly during six months. These patients did not receive erythropoietin. Thirty six patients had iron deficiency. Basal ferritin was 137 +/- 22 micrograms/l and increased to 321 +/- 28 micrograms/l after treatment. Packed red cell volume increased from 24 +/- 2% to 29 +/- 3%. No adverse effects were reported. Iron deficiency is frequent in hemodialyzed patients. Intraveineous iron is safe and effective in the treatment of iron deficiency in these patients.

Nephrologists’ Perspectives on Defining and Applying Patient-Centered Outcomes in Hemodialysis

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Winkelmayer, Wolfgang C.; Wheeler, David C.; van Biesen, Wim; Tugwell, Peter; Manns, Braden; Hemmelgarn, Brenda; Harris, Tess; Crowe, Sally; Ju, Angela; O’Lone, Emma; Evangelidis, Nicole; Craig, Jonathan C.

2017-01-01

Background and objectives Patient centeredness is widely advocated as a cornerstone of health care, but it is yet to be fully realized, including in nephrology. Our study aims to describe nephrologists’ perspectives on defining and implementing patient-centered outcomes in hemodialysis. Design, setting, participants, & measurements Face-to-face, semistructured interviews were conducted with 58 nephrologists from 27 dialysis units across nine countries, including the United States, the United Kingdom, Australia, Austria, Belgium, Canada, Germany, Singapore, and New Zealand. Transcripts were thematically analyzed. Results We identified five themes on defining and implementing patient-centered outcomes in hemodialysis: explicitly prioritized by patients (articulated preferences and goals, ascertaining treatment burden, defining hemodialysis success, distinguishing a physician-patient dichotomy, and supporting shared decision making), optimizing wellbeing (respecting patient choice, focusing on symptomology, perceptible and tangible, and judging relevance and consequence), comprehending extensive heterogeneity of clinical and quality of life outcomes (distilling diverse priorities, highly individualized, attempting to specify outcomes, and broadening context), clinically hamstrung (professional deficiency, uncertainty and complexity in measurement, beyond medical purview, specificity of care, mechanistic mindset [focused on biochemical targets and comorbidities], avoiding alarm, and paradoxical dilemma), and undermined by system pressures (adhering to overarching policies, misalignment with mandates, and resource constraints). Conclusions Improving patient-centered outcomes is regarded by nephrologists to encompass strategies that address patient goals and improve wellbeing and treatment burden in patients on hemodialysis. However, efforts are hampered by ambiguities about how to prioritize, measure, and manage the plethora of critical comorbidities and broader

Estimation of liver parameters and oxidative stress in chronic renal failure patients on hemodialysis in Erbil governorate

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Kakey, Musher Ismail Salih; Abdoulrahman, Kamaran Kaiani

2017-09-01

The present study aims to evaluate iron related parameters in chronic renal failure (CRF) patients on hemodialysis (HD). The study was carried out in Kidney Dialysis Center of Hawler Teaching Hospital in Erbil governorate. This study comprised (76) patients with chronic renal failure on hemodialysis and 41 healthy subjects as a control group of same ages. All hemodialysis patients were taking erythropoietin. The blood samples were taken from the patients before and after the process of hemodialysis for liver parameters and oxidative stress estimations. The results of this study showed lower levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total bilirubin, total protein and total antioxidant capacity (TAC), while higher levels of alkaline phosphatase (ALP), direct bilirubin and malondialdeyhde (MDA) before analysis was seen. Hemodialysis causes increasing in AST, ALT, albumin, total bilirubin, total protein and decreasing in ALP, direct bilirubin MDA and TAC.

A comparative study of direct hemoperfusion and hemodialysis for the removal of glufosinate ammonium.

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Tanaka, J; Yamashita, M; Yamamoto, T

1995-01-01

BASTA is a herbicide containing glufosinate ammonium 18.5% and a surface-active agent. There were six fatalities in 34 cases of glufosinate ammonium poisoning reported by the Japan Poison Information Center. To evaluate efficacy in the removal of glufosinate ammonium from the blood, two bottles were prepared containing 600 mL of heparinized bovine blood with 1 mL or 3 mL of BASTA. Direct hemoperfusion or hemodialysis was performed for two hours at a flow rate of 50 mL/min. The final glufosinate ammonium concentration of the blood bottle containing 1 mL of BASTA decreased to 96.9% of the initial concentration after direct hemoperfusion and to 0.5% after hemodialysis. The final glufosinate ammonium concentration of the bottle containing 3 mL of BASTA decreased to 62.2% after direct hemoperfusion and to 0.9% after hemodialysis. Hemodialysis is more effective than direct hemoperfusion for removal of glufosinate ammonium from blood.

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

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Nadienka Rodríguez Ramos

2010-12-01

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

Pulse wave velocity is associated with cognitive impairment in hemodialysis patients.

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Angermann, Susanne; Baumann, Marcus; Wassertheurer, Siegfried; Mayer, Christopher Clemens; Steubl, Dominik; Hauser, Christine; Suttmann, Yana; Reichelt, Anna-Lena; Satanovskij, Robin; Lorenz, Georg; Lukas, Moritz; Haller, Bernhard; Heemann, Uwe; Grimmer, Timo; Schmaderer, Christoph

2017-07-01

Cognitive impairment in hemodialysis patients is common and associated with adverse outcomes. So far, the underlying pathogenesis remains unclear. Therefore, we examined the potential relationship between cognitive impairment and three different categories of risk factors with particular focus on arterial stiffness measured by pulse wave velocity (PWV). A total of 201 chronic hemodialysis patients underwent cognitive testing under standardized conditions using the Montreal Cognitive Assessment (MoCA). Demographic data including cardiovascular risk factors, dialysis-associated factors as well as factors related to chronic kidney disease (CKD) were analyzed. To account for arterial stiffness, PWV was measured by ambulatory blood pressure monitoried with an oscillometric device that records brachial blood pressure along with pulse waves. In our cohort, 60.2% of patients showed pathological MoCA test results indicating cognitive impairment. PWV was significantly associated with cognitive impairment apart from age, educational level, diabetes, and hypercholesterolemia. High prevalence of cognitive impairment in hemodialysis patients was confirmed. For the first time, an association between cognitive impairment and arterial stiffness was detected in a larger cohort of hemodialysis patients. Concerning the underlying pathogenesis of cognitive impairment, current results revealed a potential involvement of arterial stiffness, which has to be further evaluated in future studies. © 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

Some Aspects of the Renin-Angiotensin-System in Hemodialysis Patients

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Umar Malik

2015-11-01

Full Text Available Understanding of the renin-angiotensin system (RAS has changed remarkably over the past decade. Renin, angiotensin converting enzyme (ACE, angiotensin II (Ang II, and Ang II receptors are the main components of the RAS. Recent studies identified the ACE2/Ang 1-7/Mas receptor axis, which counter-regulates the classical RAS. Many studies have examined the effects of the RAS on the progression of cardiovascular disease and chronic kidney disease (CKD. In addition, many studies have documented increased levels of ACE in hemodialysis (HD patients, raising concerns about the negative effects of RAS activation on the progression of renal disease. Elevated ACE increases the level of Ang II, leading to vasoconstriction and cell proliferation. Ang II stimulation of the sympathetic system leads to renal and cardiovascular complications that are secondary to uncontrolled hypertension. This review provides an overview of the RAS, evaluates new research on the role of ACE2 in dialysis, and reviews the evidence for potentially better treatments for patients undergoing HD. Further understanding of the role of ACE and ACE2 in HD patients may aid the development of targeted therapies that slow the progression of CKD and cardiovascular disease.

Predictors of renal function recovery among patients undergoing renal replacement therapy following orthotopic liver transplantation.

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Andreoli, Maria Claudia Cruz; Souza, Nádia Karina Guimarães de; Ammirati, Adriano Luiz; Matsui, Thais Nemoto; Carneiro, Fabiana Dias; Ramos, Ana Claudia Mallet de Souza; Iizuca, Ilson Jorge; Coelho, Maria Paula Vilela; Afonso, Rogério Carballo; Ferraz-Neto, Ben-Hur; Almeida, Marcio Dias de; Durão, Marcelino; Batista, Marcelo Costa; Monte, Julio Cesar; Pereira, Virgílio Gonçalves; Santos, Oscar Pavão Dos; Santos, Bento Cardoso Dos

2017-01-01

Renal dysfunction frequently occurs during the periods preceding and following orthotopic liver transplantation (OLT), and in many cases, renal replacement therapy (RRT) is required. Information regarding the duration of RRT and the rate of kidney function recovery after OLT is crucial for transplant program management. We evaluated a sample of 155 stable patients undergoing post-intensive care hemodialysis (HD) from a patient population of 908 adults who underwent OLT. We investigated the average time to renal function recovery (duration of RRT required) and determined the risk factors for remaining on dialysis > 90 days after OLT. Log-rank tests were used for univariate analysis, and Cox proportional hazards models were used to identify factors associated with the risk of remaining on HD. The results of our analysis showed that of the 155 patients, 28% had pre-OLT diabetes mellitus, 21% had pre-OLT hypertension, and 40% had viral hepatitis. Among the patients, the median MELD (Model for End-Stage Liver Disease) score was 27 (interquartile range [IQR] 22-35). When they were listed for liver transplantation, 32% of the patients had serum creatinine (Scr) levels > 1.5 mg/dL or were on HD, and 50% had serum creatinine (Scr) levels > 1.5 mg/dL or were on HD at the time of OLT. Of the transplanted patients, 25% underwent pre-OLT intermittent HD, and 14% and 41% underwent continuous renal replacement therapy (CRRT) pre-OLT and post-OLT, respectively. At 90 days post-OLT, 118 (76%) patients had been taken off dialysis, and 16 (10%) patients had died while undergoing HD. The median recovery time of these post-OLT patients was 33 (IQR 27-39) days. In the multivariate analysis, fulminant hepatic failure as the cause of liver disease (prenal function after OLT, and those who were diagnosed with fulminant hepatic failure, had no pre-OLT hypertension, received a lower transfused volume of intraoperative FFP and did not undergo pre-OLT intermittent HD had a higher probability

Intermittent hemodialysis in dogs with chronic kidney disease stage III

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Alessandra Melchert

2017-08-01

Full Text Available ABSTRACT: Intermittent hemodialysis (IHD is a form of renal replacement that is used in veterinary medicine for cases involving drug removal, electrolyte imbalance, acute kidney injury, and chronic kidney disease (CKD. The aim of the present study was to verify the efficacy of IHD in dogs with CKD staged at grade III and to evaluate the effect of IHD on quality of life. Twelve dogs with CKD at stage III met the inclusion criteria and were divided equally into two groups. The control group (n=6 received only clinical treatment and intravenous fluid therapy, and the hemodialysis group (n=6 received clinical and IHD treatments. Blood samples were collected before and after treatments in both groups. We evaluated complications and clinical parameters of IHD every 30 minutes. Hemodialysis decreased serum urea, creatinine, and phosphorus. Despite the evident removal of nitrogen compounds, dialysis treatment did not increase survival time in these patients. The results of this study do not support the early use of dialysis in dogs with chronic kidney disease stage III.

Determining the Levels of Vitamin D and Parathyroid Hormone in Patients on Hemodialysis

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Mihaylov R.

2016-03-01

Full Text Available Vitamin D deficiency is fequently observed in chronic kidney disease. We conducted this study to determine the concentration of the above-mentioned parameters and the correlation between them in order to optimize therapy with vitamin D in patients with end-stage renal disease (ESRD on hemodialysis. In 53 patients on hemodialysis due to ESRD, vitamin D [Calcidiol (25(OHD], parathyroid hormone (PTH, calcium, phosphorus, albuminuria, albumin:creatinine ratio (ACR and other parameters have been followed up. Analysis of the levels of vitamin D has been carried out by High Performance Liquid Chromatography (HPLC, the PTH is determined by the system Centaur XP, Siemens Diagnostic, Electro-chemiluminescence immunoassay (ECLIA, and for albumin in urine we used immunological method [Miltigent microalbumin assay (Abbott Laboratories Diagnostics. We found out deficiency and insufficiency of vitamin D in 56.6% and 37.7%, as well as average 4.5 times increase in the PTH, hyperphosphatemia, hypocalcemia, albuminuria (A2 or A3, over 10 times increase in the ACR, secondary hyperparathyroidism. We registered a negative correlation between vitamin D and PTH. We confirmed the increase in creatinine and cystatin C in the patients on hemodialysis. There are few literature data for patients on hemodialysis, however, regarding the extent of the vitamin deficiency and its relationship with PTH, albuminuria, calcium, phosphorus, etc. Our data have indicated that patients on hemodialysis due to ESRD are associated with high incidence of vitamin D insufficiency or deficiency.

Extracellular fluid management and hypertension in urban dwelling versus rural dwelling hemodialysis patients.

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Tonelli, Marcello; Lloyd, Anita; Pannu, Neesh; Klarenbach, Scott; Ravani, Pietro; Jindal, Kailash; MacRae, Jennifer; Unsworth, Larry; Manns, Braden; Hemmelgarn, Brenda

2018-02-01

Rural-dwelling hemodialysis patients have less frequent contact with nephrologists than urban-dwelling patients, and are known to have higher mortality. We hypothesized that rural-dwelling hemodialysis patients would have more evidence of poorly controlled extracellular fluid volume (ECVF) than otherwise similar urban-dwellers. We studied prevalent hemodialysis patients within a single renal program in Alberta, Canada and assessed ECFV using bioimpedance spectroscopy (BIS). Our primary outcome was impedance vector length (ohm/m) as assessed by BIS using the Xitron Hydra 4200 device, where shorter vector length indicated poorer ECFV control. Because poor ECFV control can lead to hypertension, we also assessed pre- and post-dialysis blood pressure. We measured outcomes at baseline. We studied 228 hemodialysis patients, of whom 115 (50.4 %) and 113 (49.6 %) were urban- and rural-dwelling, respectively. There were no differences in volume control in urban versus rural participants; odds ratio (OR) for vector length in the lowest sex-specific quartile of vector length was 0.93 (95 % CI 0.54, 1.59) after adjusting for age, sex, diabetic status, years since dialysis initiation and phase angle. The odds of very poor blood pressure control (pre-dialysis blood pressure ≥180/100) did not differ between urban and rural participants [fully adjusted OR 0.96 (0.36, 2.60)]. Differences in ECFV control do not appear to explain higher mortality among remote- and rural- dwelling hemodialysis patients, compared to urban-dwellers.

The role of adequate reference materials in density measurements in hemodialysis

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Furtado, A.; Moutinho, J.; Moura, S.; Oliveira, F.; Filipe, E.

2015-02-01

In hemodialysis, oscillation-type density meters are used to measure the density of the acid component of the dialysate solutions used in the treatment of kidney patients. An incorrect density determination of this solution used in hemodialysis treatments can cause several and adverse events to patients. Therefore, despite the Fresenius Medical Care (FME) tight control of the density meters calibration results, this study shows the benefits of mimic the matrix usually measured to produce suitable reference materials for the density meter calibrations.

The role of adequate reference materials in density measurements in hemodialysis

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Furtado, A; Moura, S; Filipe, E; Moutinho, J; Oliveira, F

2015-01-01

In hemodialysis, oscillation-type density meters are used to measure the density of the acid component of the dialysate solutions used in the treatment of kidney patients. An incorrect density determination of this solution used in hemodialysis treatments can cause several and adverse events to patients. Therefore, despite the Fresenius Medical Care (FME) tight control of the density meters calibration results, this study shows the benefits of mimic the matrix usually measured to produce suitable reference materials for the density meter calibrations

Vascular access choice in incident hemodialysis patients: a decision analysis.

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Drew, David A; Lok, Charmaine E; Cohen, Joshua T; Wagner, Martin; Tangri, Navdeep; Weiner, Daniel E

2015-01-01

Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 70% of United States dialysis patients. A decision tree model was constructed to reflect progression from hemodialysis initiation. Patients were classified into one of three vascular access choices: maintain CVC, attempt fistula, or attempt graft. We explicitly modeled probabilities of primary and secondary patency for each access type, with success modified by age, sex, and diabetes. Access-specific mortality was incorporated using preexisting cohort data, including terms for age, sex, and diabetes. Costs were ascertained from the 2010 USRDS report and Medicare for procedure costs. An AV fistula attempt strategy was found to be superior to AV grafts and CVCs in regard to mortality and cost for the majority of patient characteristic combinations, especially younger men without diabetes. Women with diabetes and elderly men with diabetes had similar outcomes, regardless of access type. Overall, the advantages of an AV fistula attempt strategy lessened considerably among older patients, particularly women with diabetes, reflecting the effect of lower AV fistula success rates and lower life expectancy. These results suggest that vascular access-related outcomes may be optimized by considering individual patient characteristics. Copyright © 2015 by the American Society of Nephrology.

Aldosterone and mortality in hemodialysis patients: role of volume overload.

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Hung, Szu-Chun; Lin, Yao-Ping; Huang, Hsin-Lei; Pu, Hsiao-Fung; Tarng, Der-Cherng

2013-01-01

Elevated aldosterone is associated with increased mortality in the general population. In patients on dialysis, however, the association is reversed. This paradox may be explained by volume overload, which is associated with lower aldosterone and higher mortality. We evaluated the relationship between aldosterone and outcomes in a prospective cohort of 328 hemodialysis patients stratified by the presence or absence of volume overload (defined as extracellular water/total body water >48%, as measured with bioimpedance). Baseline plasma aldosterone was measured before dialysis and categorized as low (280 pg/mL). Overall, 36% (n = 119) of the hemodialysis patients had evidence of volume overload. Baseline aldosterone was significantly lower in the presence of volume overload than in its absence. During a median follow-up of 54 months, 83 deaths and 70 cardiovascular events occurred. Cox multivariate analysis showed that by using the low aldosterone as the reference, high aldosterone was inversely associated with decreased hazard ratios for mortality (0.49; 95% confidence interval, 0.25-0.76) and first cardiovascular event (0.70; 95% confidence interval, 0.33-0.78) in the presence of volume overload. In contrast, high aldosterone was associated with an increased risk for mortality (1.97; 95% confidence interval, 1.69-3.75) and first cardiovascular event (2.01; 95% confidence interval, 1.28-4.15) in the absence of volume overload. The inverse association of aldosterone with adverse outcomes in hemodialysis patients is due to the confounding effect of volume overload. These findings support treatment of hyperaldosteronemia in hemodialysis patients who have achieved strict volume control.

Rapid reversal of neuromuscular blockade by sugammadex after continuous infusion of rocuronium in patients with liver dysfunction undergoing hepatic surgery.

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Fujita, Ai; Ishibe, Natsuki; Yoshihara, Tatsuya; Ohashi, Jun; Makino, Hideichi; Ikeda, Mizuko; Setoguchi, Hidekazu

2014-06-01

Sugammadex rapidly reverses neuromuscular blockade (NMB) induced by rocuronium. NMB induced by rocuronium is prolonged in patients with liver dysfunction, because the drug is mainly excreted into the bile. However, the efficacy and safety of sugammadex in terms of reversing rocuronium-induced NMB in patients with liver dysfunction undergoing hepatic surgery have not been evaluated. This observational study investigated the efficacy and safety of sugammadex after continuous infusion of rocuronium in patients with liver dysfunction undergoing hepatic surgery. Remifentanil/propofol anesthesia was administered to 31 patients: 15 patients in the control group, and 16 patients from a group with liver dysfunction. Rocuronium (0.6 mg/kg) was administered, followed by continuous infusion. The enrolled patients were then subdivided into two groups according to the dose of sugammadex. In the first group a single dose of sugammadex (2.0 mg/kg) was given at the reappearance of the second twitch (T2). In the second group a single dose of sugammadex (4.0 mg/kg) was given at the first twitch response if T2 did not reappear in 15 minutes after stopping rocuronium. The primary outcome was time from administration of sugammadex to recovery of a train-of-four ratio to 0.9. The dose of rocuronium required in the liver dysfunction group was lower than that in the control group (6.2 vs. 8.2 μg/kg/min, p = 0.002). The mean time from the administration of sugammadex to recovery of the train-of-four ratio to 0.9 was not significantly different between the liver dysfunction group and the control group (2.2 minutes vs. 2.0 minutes in the 2 mg/kg administration group, p = 0.44 and 1.9 minutes vs. 1.7 minutes in the 4 mg/kg administration group, p = 0.70, respectively). No evidence of recurarization was observed in any of the patients. Most of the adverse events were found to be mild and such events were not related to the use of sugammadex. None of the patients was eliminated from the study

A comparison of center-based vs. home-based daily hemodialysis for patients with end-stage renal disease.

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Kraus, Michael; Burkart, John; Hegeman, Rebecca; Solomon, Richard; Coplon, Norman; Moran, John

2007-10-01

Home hemodialysis has been a therapeutic option for almost 4 decades. The complexity of dialysis equipment has been a factor-limiting adoption of this modality. We performed a feasibility study to demonstrate the safety of center-based vs. home-based daily hemodialysis with the NxStage System One portable hemodialysis device. We also performed a retrospective analysis to determine if clinical effects previously associated with short-daily dialysis were also seen using this novel device. We conducted a prospective, 2-treatment, 2-period, open-label, crossover study of in-center hemodialysis vs. home hemodialysis in 32 patients treated at 6 U.S. centers. The 8-week In-Center Phase (6 days/week) was followed by a 2-week transition period and then followed by the 8-week Home Phase (6 days/week). We retrospectively collected data on hemodialysis treatment parameters immediately preceding the study in a subset of patients. Twenty-six out of 32 patients (81%) successfully completed the study. Successful delivery of at least 90% of prescribed fluid volume (primary endpoint) was achieved in 98.5% of treatments in-center and 97.3% at home. Total effluent volume as a percentage of prescribed volume was between 94% and 100% for all study weeks. The composite rate of intradialytic and interdialytic adverse events per 100 treatments was significantly higher for the In-Center Phase (5.30) compared with the Home Phase (2.10; p=0.007). Compared with the period immediately preceding the study, there were reductions in blood pressure, antihypertensive medications, and interdialytic weight gain. Daily home hemodialysis with a small, easy-to-use hemodialysis device is a viable dialysis option for end-stage renal disease patients capable of self/partner-administered dialysis.

Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study

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Johnson David W

2011-10-01

Full Text Available Abstract Background Nightly extended hours hemodialysis may improve left ventricular hypertrophy and function and endothelial function but presents problems of sustainability and increased cost. The effect of alternate nightly home hemodialysis (NHD on cardiovascular structure and function is not known. Methods Sixty-three patients on standard hemodialysis (SHD: 3.5-6 hours/session, 3-5 sessions weekly converted to NHD (6-10 hours/session overnight for 3-5 sessions weekly. 2Dimensional transthoracic echocardiography and ultrasound measures of brachial artery reactivity (BAR, carotid intima-media thickness (CIMT, total arterial compliance (TAC and augmentation index (AIX were performed post dialysis at baseline and 18-24 months following conversion to NHD. In 37 patients, indices of oxidative stress: plasma malonyldialdehyde (MDA and anti-oxidant enzymes: catalase (CAT, glutathione peroxidase (GPX and superoxide dismutase (SOD activity and total antioxidant status (TAS were measured at baseline, 3 and 6 months. Results Left ventricular mass index (LVMI remained stable. Despite significant derangement at baseline, there were no changes in diastolic function measures, CIMT, BAR and TAC. AIX increased. Conversion to NHD improved bone mineral metabolism parameters and blood pressure control. Interdialytic weight gains increased. No definite improvements in measures of oxidative stress were demonstrated. Conclusions Despite improvement in uremic toxin levels and some cardiovascular risk factors, conversion to an alternate nightly NHD regimen did not improve cardiovascular structure and function. Continuing suboptimal control of uremic toxins and interdialytic weight gains may be a possible explanation. This study adds to the increasing uncertainty about the nature of improvement in cardiovascular parameters with conversion to intensive hemodialysis regimens. Future randomized controlled trials will be important to determine whether increases in

Intravenous iron supplementation in children on hemodialysis.

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Leijn, E.; Monnens, L.A.H.; Cornelissen, E.A.M.

2004-01-01

BACKGROUND: Children with end-stage renal disease (ESRD) on hemodialysis (HD) are often absolute or functional iron deficient. There is little experience in treating these children with intravenous (i.v.) iron-sucrose. In this prospective study, different i.v. iron-sucrose doses were tested in

Reversed association between aldosterone and mortality in hemodialysis patients: Role of volume overload.

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Hung, Szu-Chun; Tarng, Der-Cherng

2016-07-01

The role of aldosterone has expanded from its genomic effects that involve renal sodium transport to nongenomic effects such as cardiac and renal fibrosis. Elevated aldosterone levels are associated with increased mortality in the general population. However, the association is reversed in patients with end-stage renal disease on maintenance hemodialysis. We have shown that the inverse association between aldosterone and mortality in hemodialysis patients is due to the confounding effect of volume overload. Volume overload, which is prevalent in patients with chronic kidney disease, is associated with both lower aldosterone concentrations and higher mortality. Our findings support salt and water restriction and treatment of hyperaldosteronemia in hemodialysis patients who have achieved strict volume control. Copyright © 2016 Elsevier Inc. All rights reserved.

The Physician-Patient Working Alliance in Hemodialysis Treatment.

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Fuertes, Jairo N; Rubinstein, Sofia; Reyes, Mariela; Iampornpipopchai, Pichet; Mujeeb, Shanza; Smith, Carroll R; Toporovsky, Arielle

2017-01-01

Over the past 20 years, the role of psychological and social factors, including the physician-patient working alliance, have emerged as integral components of medical care for patients with a myriad of health conditions. The current study examines a model comprised of psychological-interpersonal factors and the extent to which it explains patient satisfaction with and adherence to hemodialysis treatment. One hundred and seven adults with end-stage renal disease who were receiving regular outpatient hemodialysis participated in the study. Path analyses show that the physician-patient working alliance indirectly predicts patient adherence through patient satisfaction and patients' outcome expectations. The working alliance directly predicts patients' quality of life. It is concluded that consistent with previous research, the physician-patient working alliance is a significant factor in predicting key patient behaviors in medical care.

Radiologic placement of hemodialysis central venous catheters: a practical guide

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Schemmer, D.; Sadler, D.J.; Gray, R.R.; Saliken, J.C.; So, C.B. [Foothills Hospital, Dept. of Diagnostic Imaging, Calgary, Alberta (Canada)

2001-04-01

Typical indications for central venous catheters (CVCs) are hemodialysis (HD), apheresis, total parenteral nutrition, analgesia, chemotherapy, long-term antibiotic therapy and cases of difficult or absent peripheral venous access. One of the largest medical services requesting CVC insertion is nephrology for HD patients. Demographics dictate that the demand for CVCs will continue to grow over the next few decades, placing striking demands on interventional radiology departments. In our centre, interventional radiologists now place nearly all percutaneously inserted HD CVCs. Radiologists provide rapid access to CVC services with significantly fewer complications than CVCs placed by other clinicians. With the demand for CVC management increasing and available operating room time decreasing, many clinicians now refer CVC insertions to radiologists. As well, clinicians who ordinarily place their own lines often refer high-risk patients, such as those who are obese or uncooperative and those with burns or coagulopathy. Our experience, derived from over 7000 CVC insertions, manipulations and removals, has allowed us to continually progress and improve our techniques, many of which are summarized here. (author)

Hemodialysis and nutritional status in children: malnutrition and cachexia.

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Fischbach, Michel; Dheu, Céline; Seuge, Laure; Orfanos, Nadia

2009-01-01

Malnutrition is a common state in chronic hemodialyzed children. More than malnutrition, which infers that dietary supplementation would be curative, cachexia, which implies loss of protein stores, are combined factors of impaired linear growth and reduced muscle mass in uremic patients. Adequate diet to prevent malnutrition is of major importance. But to avoid cachexia in children on chronic hemodialysis, the management of acidosis, inflammation, abnormal metabolic rate, and endocrine disturbances should not, be forgotten. Daily hemodialysis regimen using convective flow therapy and ultrapure dialysate, i.e., on line hemodiafiltration together with growth hormone therapy, appears as a hopeful strategy for the chronic dialyzed child to achieve catch-up growth, a parameter of optimal nutrition.

Factors associated with personal protection equipment use and hand hygiene among hemodialysis staff.

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Shimokura, Gayle; Weber, David J; Miller, William C; Wurtzel, Heather; Alter, Miriam J

2006-04-01

Because exposure to blood by health care workers is frequent during hemodialysis, gloves are required for all contact with patients and their equipment, followed by hand hygiene. In this study, we investigated factors associated with performing these practices as recommended. Staff members from a sample of 45 US hemodialysis facilities were surveyed using an anonymous self-administered questionnaire. Factors independently associated with reporting increased compliance with recommended hand hygiene and glove use practices during patient care were identified with multivariate modeling. Of 605 eligible staff members, 420 (69%) responded: registered nurses, 41%; dialysis technicians, 51%; and licensed practical nurses, 8%. Only 35% reported that dialysis patients were at risk for bloodborne virus infections, and only 36% reported always following recommended hand hygiene and glove use practices. Independent factors associated with more frequent compliance were being a technician (versus a registered nurse) and reporting always doing what was needed to protect themselves from infection. Compliance with recommended hand hygiene and glove use practices by hemodialysis staff was low. The rationale for infection control practices specific to the hemodialysis setting was poorly understood by all staff. Infection control training should be tailored to this setting and should address misconceptions.

International practice patterns and factors associated with non-conventional hemodialysis utilization

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Allen Nathan

2011-12-01

Full Text Available Abstract Background The purpose of our study was to determine characteristics that influence the utilization of non-conventional hemodialysis (NCHD therapies and its subtypes (nocturnal (NHD, short daily (SDHD, long conventional (LCHD and conventional hemodialysis (CHD as well as provider attitudes regarding the evidence for NCHD use. Methods An international cohort of subscribers of a nephrology education website http://www.nephrologynow.com was invited to participate in an online survey. Non-conventional hemodialysis was defined as any forms of hemodialysis delivered > 3 treatments per week and/or > 4 hours per session. NHD and SDHD included both home and in-centre. Respondents were categorized as CHD if their centre only offered conventional thrice weekly hemodialysis. Variables associated with NCHD and its subtypes were determined using multivariate logistic regression analysis. The survey assessed multiple domains regarding NCHD including reasons for initiating and discontinuing, for not offering and attitudes regarding evidence. Results 544 surveys were completed leading to a 15.6% response rate. The final cohort was limited to 311 physicians. Dialysis modalities utilized among the respondents were as follows: NCHD194 (62.4%, NHD 83 (26.7%, SDHD 107 (34.4%, LCHD 81 (26% and CHD 117 (37.6%. The geographic regions of participants were as follows: 11.9% Canada, 26.7% USA, 21.5% Europe, 6.1% Australia/New Zealand, 10% Africa/Middle East, 10.9% Asia and 12.9% South America. Variables associated with NCHD utilization included NCHD training (OR 2.47 CI 1.25-4.16, government physician reimbursement (OR 2.66, CI 1.11-6.40, practicing at an academic centre (OR 2.28 CI 1.25-4.16, higher national health care expenditure and number of ESRD patients per centre. Hemodialysis providers with patients on NCHD were significantly more likely to agree with the statements that NCHD improves quality of life, improves nutritional status, reduces EPO requirements

Effects of 12 weeks nutrition education on nutritional status in hemodialysis patients

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Harin Rhee

2012-06-01

Full Text Available Protein-energy malnutrition is present in a large proportion of patients with end stage renal disease and, is a strong risk factor for mortality in these patients. This study was aimed to evaluate the effectiveness of 12-weeks nutrition education during the hemodialysis session for the improvement of nutritional status. From the June 2011 to the September 2011, patients who were on regular hemodialysis in Pusan National University Hospital were enrolled in this study. In education group, intensive nutrition education was performed by the hemodialysis nurse, for fifty to sixty minutes during the hemodialysis session, once a week. Curriculum for renal nutrition includes regular taking of their medication, intake of moderate amount of protein and sufficient calories, reduction of water, salt, potassium and phosphate intake. Otherwise, any education program was not performed in patients of control group. Nutrition status was assessed by the subjective global assessment (SGA,body mass index (BMI, triceps skinfold thickness (TSF, arm muscle area(AMC and laboratory markers such as serum albumin, serum blood urea nitrogen(BUN and hemoglobin(Hb level before and after the education. Effect of nutrition education was analyzed using ANCOVA test. A total of 49 patients were enrolled in this study and nutrition education was provided to 25 hemodialysis patients. Their mean age was 57.20±15.49 in education group and 55.13±14.42 in control groupand male was 56.0% in education group and 50.0% in control group and, other baseline characteristics were not significantly different between two groups. After the 12-week education, significant improvement was found in SGA, serum albumin, BUN and Hb level. SGA score was improved from 6.36±0.99 to 6.72±0.61 in education group, compared to control group(6.38±0.88 to 6.42±0.88, p=0.029 . Improvement of serum albumin level, BUN and Hb was as follows: serum albumin(4.23±0.28 to 4.30±0.25 in education group, 4.28±0

Dietary patterns and clinical outcomes in hemodialysis patients in Japan: a cohort study.

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Kazuhiko Tsuruya

Full Text Available Little is known about actual dietary patterns and their associations with clinical outcomes in hemodialysis patients. We identified dietary patterns in hemodialysis patients in Japan and examined associations between dietary patterns and clinical outcomes.We used data from 3,080 general-population participants in the Hisayama study (year 2007, and data from 1,355 hemodialysis patients in the Japan Dialysis Outcomes and Practice Patterns Study (JDOPPS: years 2005-2007. Food intake was measured using a brief self-administered diet-history questionnaire (BDHQ. To identify food groups with the Hisayama population data, we used principal components analysis with Promax rotation. We adjusted the resulting food groups for total daily energy intake, and then we used those adjusted food-group scores to identify dietary patterns in the JDOPPS patients by cluster analysis (Ward's method. We then used Cox regression to examine the association between dietary patterns and a composite of adverse clinical outcomes: hospitalization due to cardiovascular disease or death due to any cause.We identified three food groups: meat, fish, and vegetables. Using those groups we then identified three dietary patterns: well-balanced, unbalanced, and other. After adjusting for potential confounders, we found an association between an unbalanced diet and important clinical events (hazard ratio 1.90, 95% C.I. 1.19-3.04.Hemodialysis patients whose diet was unbalanced were more likely to have adverse clinical outcomes. Thus hemodialysis patients might benefit not only from portion control, but also from a diet that is well-balanced diet with regard to the food groups identified here as meat, fish, and vegetables.

Significant positive relationship between serum magnesium and muscle quality in maintenance hemodialysis patients.

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Okazaki, Hisanori; Ishimura, Eiji; Okuno, Senji; Norimine, Kyoko; Yamakawa, Kenjiro; Yamakawa, Tomoyuki; Shoji, Shigeichi; Nishizawa, Yoshiki; Inaba, Masaaki

2013-01-01

Serum magnesium (Mg) levels have been associated with muscle performance in the general population. We hypothesized that serum Mg would be associated with muscle quality in hemodialysis patients. A total of 310 patients were examined (age: 58 ± 12 years, hemodialysis duration: 6.4 ± 6.0 years, 60.6% men, and 36.1% diabetics). Arm lean mass was measured by dual energy X-ray absorptiometry (DXA) on the dominant side. Arm muscle quality was defined as the ratio of the handgrip strength to the arm lean mass of the same side (kg/kg). Serum Mg was 1.15 ± 0.16 mmol/L (2.8 ± 0.4 mg/dL), being higher than the reference range of normal subjects. There was a significant negative correlation between muscle quality and age (r = -0.326, p<0.0001) and duration of hemodialysis (r = -0.253, p<0.0001). The muscle quality of the diabetics was significantly lower than that of the non-diabetics (p<0.001). There was a significant, positive correlation between muscle quality and serum Mg (r = 0.118, p<0.05), but not serum calcium or phosphate. In multiple regression analysis, age, gender, hemodialysis duration, diabetes, and serum Mg (β = 0.129, p<0.05) were significantly and independently associated with muscle quality (R(2) = 0.298, p<0.0001). These results demonstrated that a lower serum Mg concentration was significantly associated with poor muscle quality in hemodialysis patients. Further studies are needed to explore the mechanism by which lower serum Mg affects muscle quality.

Air contamination during hemodialysis should be minimized.

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Stegmayr, Bernd

2017-04-01

During preparation of the hemodialysis (HD) extracorporeal circuit (ECC) a priming solution is used to remove air from the tubes and dialyzer. Ultra sound techniques have verified micro embolic signals (MES) in the ECC that may derive from clots or gas embolies. In vitro studies could clarify that embolies of air develop within the ECC and also pass the safety systems such as air traps and enter the venous line that goes into the patient. Clinical studies have confirmed the presence of MES within the ECC that pass into the return-venous-line during conventional HD without inducing an alarm. In addition, studies confirmed that such MES were present within the AV fistula and subclavian vein, but also detected within the carotid artery. Autopsy studies revealed the presence of gas embolies surrounded by clots within the lung but also brain and myocardial tissue. This review will focus on how the MES develop and measures of how the exposure can be limited. © 2016 International Society for Hemodialysis.

[Hemodialysis in patients with chronic renal insufficiency].

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Canaud, Bernard; Leray-Moragués, Hélène; Chenine-Koualef, Leila; Patrier, Laure

2012-01-01

Hemodialysis is the most advanced form of artificial renal support. It ensures the survival of almost 2 million patients wordwide. Considerable progress has been made in recent years thanks to a better understanding of uremia, optimization of treatment modalities and more personalized treatment schedules. Increase of uremic toxins removal, improvement of hemodynamic tolerance of the sessions, reduction of proinflammatory reactions due to the bioincompatibility system are major advances that may explain the reduction of morbidity and mortality in dialysis patients. New technologies (nanotechnology, biotechnology, microelectronics) are now expected to introduce further progresses by miniaturizing devices and providing them with an "artificial intelligence" capable of interacting with the patient. The main obstacle remains ageing of uremic patients, increasing prevalence of comorbidities and shortage of social resources that are not conducive to innovation. By promoting a more physiological, longer and more effective hemodialysis performed at home with help of teledialysis monitoring that would probably be an interesting option to evaluate on a medico-economical point of view.

Cognitive Behavioral Treatment to Improve Adherence to Hemodialysis Fluid Restrictions: A Case Report

OpenAIRE

Anson, Heather M.; Byrd, Michelle R.; Koch, Ellen I.

2009-01-01

This case report describes outpatient psychological treatment targeting adherence to fluid restrictions in a hemodialysis patient. The consequences of nonadherence to fluid restrictions in hemodialysis patients range from minor discomfort to increased hospitalizations and mortality rates. In addition, when patients chronically fail to adhere, they may no longer be candidates for kidney transplant. The interventions focused on polydipsia, characterized by excessive fluid intake. The methods in...

Association of Beta-2 Microglobulin with Inflammation and Dislipidemia in High-Flux Membrane Hemodialysis Patients.

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Topçiu-Shufta, Valdete; Miftari, Ramë; Haxhibeqiri, Valdete; Haxhibeqiri, Shpend

2016-10-01

Higher than expected cardiovascular mortality in hemodialysis patients, has been attributed to dyslipidemia as well as inflammation. Beta2-Microglobulin (β2M) is an independent predictor of outcome for hemodialysis patients and a representative substance of middle molecules. In 40 patients in high-flux membrane hemodialysis, we found negative correlation of β2M with high density lipoprotein (r=-0.73, p<0.001) and albumin (r= -0.53, p<0.001) and positive correlation with triglycerides (r=0.69, p<0.001), parathyroid hormone (r=0.58, p < 0.05) and phosphorus (r= 0.53, p<0.001). There was no correlation of β2M with C- reactive protein (CRP) and interleukin-6 (IL-6). During the follow-up period of three years, 6 out of 40 patients have died from cardiovascular events. In high-flux membrane hemodialysis patients, we observed a significant relationship of β2M with dyslipidemia and mineral bone disorders, but there was no correlation with inflammation.

Prevalence of Secondary Hyper Parathyroidism in Hemodialysis Patients

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F Behzad

2007-04-01

Full Text Available Introduction: Osteodystrophy is one of the long term complications of chronic renal failure and is expressed in two forms;low turn over and high turn over. It is an important cause of morbidity in patients with renal failure and if diagnosed and managed properly, many problems of these patients can be resolved. In this study we evaluated the prevalence of hyperparathyroidism in hemodialysis patients and its correlation with different factors. Methods: This study was an analytic, observational study that was done by the cross- sectional method. We formatted a questionnaire for hemodialysis patients who were enrolled in the study over a period of 6 months. Fasting blood samples (5-10c.c were drawn to measure levels of PTH(parathyroid hormone ,calcium, phosphorous and alkaline phosphatase. Skull and wrist X-rays were also taken and the radiologist evaluated them with regards to hyperparathyroidism. Results: In the 80 patients studied, prevalence of hyperparathyroidism was 45% (36 patients. 44 patients were diabetics. Among different factors, hyperparathyroidism did not correlate with frequency and duration of dialysis, age, sex ,familial history, diabetes, hypertension , bone pains, muscle weakness, purities and level of calcium and phosphorous. But there was a significant relationship between hyperparathyroidism and alkaline phosphatase levels and radiological findings. Conclusion: We can use alkaline phosphatase levels and/or radiographic changes for evaluation of renal osteodystrophy in hemodialysis patients and prevent complications by early diagnosis and proper management.

Maintenance hemodialysis patients have high cumulative radiation exposure.

LENUS (Irish Health Repository)

Kinsella, Sinead M

2010-10-01

Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20 mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7 mSv, in which 13 patients had a total cumulative effective radiation dose over 75 mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients.

Comparison of cardiovascular risk factors in maintenance hemodialysis patients based on phase angle of bioimpedance analysis

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Muzasti, R. A.; Lubis, H. R.

2018-03-01

Mortality and morbidity rate, especially from cardiovascular disease in hemodialysis patients in Indonesia is still quite high. One of indicator to assess the predictive value of mortality is the phase angle (PhA) of bioimpedance analysis (BIA) scan examination. Determining the comparison of BMI and laboratory data as cardiovascular risk factors in hemodialysis patients based on PhA.A cross-sectional analytical study was done on 155 outpatientsin RasyidaRenal Hospital, Medan in 2016. Patients were two groups, namely PhAcardiovascular risk factors of hemodialysis patients were determined by age, BMI, and hemoglobin.

Resilience, religiosity and treatment adherence in hemodialysis patients: a prospective study.

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Freire de Medeiros, Camila Maroni Marques; Arantes, Eder Pinheiro; Tajra, Rafael Dib de Paulo; Santiago, Hendrio Reginaldo; Carvalho, André Ferrer; Libório, Alexandre Braga

2017-06-01

Resilience and religiosity have received attention as an important process in the experience and management of chronic comorbidities; however, there is no study evaluating resilience in hemodialysis patients and its association with other psychological dimensions or with treatment adherence. This observational prospective study assessed resilience (25 item Wagnild and Young Resilience Scale), religiosity under three dimensions (organizational, non-organizational and intrinsic) using DUREL scale, depressive symptoms (Patient Health Questionnaire-9) and health-related quality of life (Short Form-36 questionnaire). The main outcomes were medication adherence using the Morisky Medication Adherence Scale-8 (MMAR-8) and the missing/shortened dialysis sessions in the following six months. Of 208 patients approached, 202 (97.1%) agreed to participate. One hundred twenty-three patients (60.9%) were males and mean age was 52.8 ± 14.8 years-old. The median time on hemodialysis was 36 months (IQR, 12, 84). 82 (40.6%) patients obtained a MMAS-8 score adherence'. Overall, the mean score of medication adherence was low (5.7 ± 2.1). About adherence to hemodialysis sessions, patients missed a total of 234 (1.6%) hemodialysis sessions. Forty-eight patients (23.7%) missed an average of at least three sessions in six months. Regarding adherence to medication, there was no association in the uni- or multivariate analysis between religiosity dimensions and MMAS-8 score. After adjustment, resilience was positively associated with MMAS-8 score (standardized β coefficient .239, p = .016). Organized and intrinsic religiosity were associated with adherence to dialysis sessions (standardized β coefficient .258, p = .004 and .231, p = .026, respectively). Interestingly, opposite to medication adherence, more resilient patients were associated with less adherence to hemodialysis sessions (standardized β coefficient -.296, p = .001). Religiosity was associated with dialysis

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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Mitsue FUJIMAKI

1998-04-01

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.

Home hemodialysis: beliefs, attitudes, and practice patterns.

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Jayanti, Anuradha; Morris, Julie; Stenvinkel, Peter; Mitra, Sandip

2014-10-01

There is increasing interest of the worldwide kidney community in home hemodialysis (HHD). This is due to emerging evidence of its superiority over conventional hemodialysis (HD), largely attributed to improved outcomes on intensive schedule HD, best deployed in patient's own homes. Despite published work in this area, universal uptake remains limited and reasons are poorly understood. All those who provide HD care were invited to participate in a survey on HHD, initiated to understand the beliefs, attitudes, and practice patterns of providers offering this therapy. The survey was developed and posted on the Nephrology Dialysis Transplantation-Educational (NDT-E) website. Two hundred and seventy-two responses were deemed suitable for complete analysis. It is apparent from the survey that there is great variability in the prevalence of HHD. Physicians have a great deal of interest in this modality, with majority viewing home as being the ideal location for the offer of intensive HD schedules (55%). A significant number (21%) feel intensive HD may be offered even outside the home setting. Those who offer this therapy do not see a financial disadvantage in it. Many units identify lack of appropriately trained personnel (35%) and funding for home adaptation (50.4%) as key barriers to widespread adoption of this therapy. Despite the interest and belief in this therapy among practitioners, HHD therapy is still not within reach of a majority of patients. Modifiable organizational, physician, and patient factors exist, which could potentially redefine the landscape of HHD provision. Well-designed systematic research of national and local barriers is needed to design interventions to help centers facilitate change. © 2014 International Society for Hemodialysis.

Measurement of endotoxin levels in blood of hemodialysis Patients by 'Lal' test and comparision of its efficacy with blood culture

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Gh Vazirzadeh

2006-01-01

Full Text Available Introduction: Presently, bacteremia is the principal cause of morbidity in patients undergoing hemodialysis. Gram-negative bacteria account for approximately 50 percent of documented infections. Endotoxins released during lysis of gram negative bacteremia result in inflammatory and defense response by the body and if not treated promptly result in septic shock and ultimately death of the patient. This study describes the detection of endotoxins in blood of patients with bacteremia due to gram - negative bacteria by LAL test. Method: Blood samples of 278 hemodialysis patients were analyzed in this study and pathogens were isolated from blood culture samples. Then, their antibiotic sensitivity was determined. In patients with positive blood culture, endotoxin levels were measured by LAL-test. Results: Frequency of bacteremia in patients was 13.6% . The prevalence of gram – negative bacteremia was 44.7%. E coli were the major pathogens, while staphylococcus aureus was the most common gram positive bacterium. Endotoxin was detected in 15 patients (3.8 ± 1.08 EU/ml . The sensitivity and specificity of endotoxins for gram – negative bacteremia were 88% and 95%, respectively. Conclusion: The results indicate that the LAL method is a fast, sensitive and simple method. There was no significant difference between the results of blood culture and LAL – test ( P > 0.05 .

Vascular access complications and risk factors in hemodialysis ...

African Journals Online (AJOL)

Tarek A. Ghonemy

2015-08-18

Aug 18, 2015 ... BMI were significant in patients with central blood infection (p < 0.008, <0.008 and <0.001 ... grafts) for hemodialysis over using the venous catheter as they ... were subjected to the following: thorough full history taking.

Removal of uremic retention products by hemodialysis is coupled with indiscriminate loss of vital metabolites.

Science.gov (United States)

Zhang, Zhi-Hao; Mao, Jia-Rong; Chen, Hua; Su, Wei; Zhang, Yuan; Zhang, Li; Chen, Dan-Qian; Zhao, Ying-Yong; Vaziri, Nosratola D

2017-12-01

Although dialysis ameliorates uremia and fluid and electrolytes disorders, annual mortality rate remains high in dialysis population reflecting its shortcoming in replacing renal function. Unlike the normal kidney, dialysis causes dramatic shifts in volume and composition of body fluids and indiscriminate removal of vital solutes. Present study was undertaken to determine the impact of hemodialysis on plasma metabolites in end-stage renal disease (ESRD) patients. 80 hemodialysis patients and 80 age/gender-matched healthy controls were enrolled in the study. Using ultra performance liquid chromatography-high-definition mass spectrometry, we measured plasma metabolites before, during, and after hemodialysis procedure and in blood entering and leaving the dialysis filter. Principal component analysis revealed significant difference in concentration of 214 metabolites between healthy control and ESRD patients' pre-dialysis plasma (126 increased and 88 reduced in ESRD group). Comparison of post-dialysis with pre-dialysis data revealed significant changes in the 362 metabolites. Among ESI + metabolites 195 decreased and 55 increased and among ESI - metabolites 82 decreased and 30 increased following hemodialysis. Single blood passage through the dialyzer caused significant changes in 323 metabolites. Comparison of ESRD patients' post-hemodialysis with healthy subjects' data revealed marked differences in metabolic profiles. We identified 55 of the 362 differential metabolites including well known uremic toxins, waste products and vital biological compounds. In addition to uremic toxins and waste products hemodialysis removes large number of identified and as-yet un-identified metabolites. Depletion of vital biological compounds by dialysis may contribute to the high morbidity and annual mortality rate in this population. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

The Virtual Anemia Trial: An Assessment of Model-Based In Silico Clinical Trials of Anemia Treatment Algorithms in Patients With Hemodialysis.

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Fuertinger, Doris H; Topping, Alice; Kappel, Franz; Thijssen, Stephan; Kotanko, Peter

2018-04-01

In silico approaches have been proposed as a novel strategy to increase the repertoire of clinical trial designs. Realistic simulations of clinical trials can provide valuable information regarding safety and limitations of treatment protocols and have been shown to assist in the cost-effective planning of clinical studies. In this report, we present a blueprint for the stepwise integration of internal, external, and ecological validity considerations in virtual clinical trials (VCTs). We exemplify this approach in the context of a model-based in silico clinical trial aimed at anemia treatment in patients undergoing hemodialysis (HD). Hemoglobin levels and subsequent anemia treatment were simulated on a per patient level over the course of a year and compared to real-life clinical data of 79,426 patients undergoing HD. The novel strategies presented here, aimed to improve external and ecological validity of a VCT, significantly increased the predictive power of the discussed in silico trial. © 2018 The Authors CPT: Pharmacometrics & Systems Pharmacology published by Wiley Periodicals, Inc. on behalf of American Society for Clinical Pharmacology and Therapeutics.

Pharmacokinetics of Imipenem/Cilastatin Burn Intensive Care Unit Patients Undergoing High-Dose Continuous Venovenous Hemofiltration.

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Boucher, Bradley A; Hudson, Joanna Q; Hill, David M; Swanson, Joseph M; Wood, G Christopher; Laizure, S Casey; Arnold-Ross, Angela; Hu, Zhe-Yi; Hickerson, William L

2016-12-01

High-dose continuous venovenous hemofiltration (CVVH) is a continuous renal replacement therapy (CRRT) used frequently in patients with burns. However, antibiotic dosing is based on inference from studies assessing substantially different methods of CRRT. To address this knowledge gap for imipenem/cilastatin (I/C), we evaluated the systemic and extracorporeal clearances (CLs) of I/C in patients with burns undergoing high-dose CVVH. Prospective clinical pharmacokinetic study. Ten adult patients with burns receiving I/C for a documented infection and requiring high-dose CVVH were studied. Blood and effluent samples for analysis of I/C concentrations were collected for up to 6 hours after the I/C infusion for calculation of I/C total CL (CL T otal ), CL by CVVH (CL HF ), half-life during CVVH, volume of distribution at steady state (Vd ss ), and the percentage of drug eliminated by CVVH. In this patient sample, the mean age was 50 ± 17 years, total body surface area burns was 23 ± 27%, and 80% were male. Nine patients were treated with high-dose CVVH for acute kidney injury and one patient for sepsis. The mean delivered CVVH dose was 52 ± 14 ml/kg/hour (range 32-74 ml/kg/hr). The imipenem CL HF was 3.27 ± 0.48 L/hour, which accounted for 23 ± 4% of the CL T otal (14.74 ± 4.75 L/hr). Cilastatin CL HF was 1.98 ± 0.56 L/hour, which accounted for 45 ± 19% of the CL T otal (5.16 + 2.44 L/hr). The imipenem and cilastatin half-lives were 1.77 ± 0.38 hours and 4.21 ± 2.31 hours, respectively. Imipenem and cilastatin Vd ss were 35.1 ± 10.3 and 32.8 ± 13.8 L, respectively. Efficient removal of I/C by high-dose CVVH, a high overall clearance, and a high volume of distribution in burn intensive care unit patients undergoing this CRRT method warrant aggressive dosing to treat serious infections effectively depending on the infection site and/or pathogen. © 2016 Pharmacotherapy Publications, Inc.

NUTRITIONAL STATUS OF PATIENTS ON MAINTENANCE HEMODIALYSIS WITH BALKAN (ENDEMIC NEPHROPATHY

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Miomir Stojanovic

2003-10-01

Full Text Available The aim of this study was to ascertain the nutritional status of patients with Balkan (Endemic Nephropathy (BEN on maintenance hemodialysis (HD. The specimen of examines included 14 patients with BEN and 178 patients with another diagnosis on hemodialysis in Institute of Nephrology and Hemodialysis, Clinical Center Nis in 2002. Body mass index (BMI of male patients with BEN was 25.7±5.0 kg/m2; normal body weight was present in 66.7% of cases and obese in 33.3% of cases. BMI of female patients with BEN was 24.5±4.3 kg/m2; malnutrition was present in 12.5% of cases, normal body weight in 50.0% and obese in 37.5% of cases. Anthropometric indexes (BMI, lean body mass, body height, relative body weight, biceps, triceps, sub-scapular and iliac skinfold thickness, as well as, percent of body fat, mid-arm circumference and mid-arm muscle circumference of another HD patients was slight lower then HD patients with BEN, but differences was not statistically significant.

Sexual dysfunction in women with ESRD requiring hemodialysis

NARCIS (Netherlands)

Strippoli, G.F.; Vecchio, M.; Palmer, S.; De Berardis, G.; Craig, J.; Lucisano, G.; Johnson, D.; Pellegrini, F.; Nicolucci, A.; Sciancalepore, M.; Saglimbene, V.; Gargano, L.; Bonifati, C.; Ruospo, M.; Navaneethan, S.D.; Montinaro, V.; Stroumza, P.; Zsom, M.; Torok, M.; Celia, E.; Gelfman, R.; Bednarek-Skublewska, A.; Dulawa, J.; Graziano, G.; Gentile, G.; Ferrari, J.N.; Santoro, A.; Zucchelli, A.; Triolo, G.; Maffei, S.; Hegbrant, J.; Wollheim, C.; De Cosmo, S.; Manfreda, V.M.; Steiner, K.; et al.,

2012-01-01

BACKGROUND AND OBJECTIVES: The few existing studies of sexual dysfunction in women on hemodialysis are limited by small sample size. This large, cross-sectional study evaluated the prevalence and correlates of female sexual dysfunction in advanced kidney disease. DESIGN, SETTING, PARTICIPANTS,

Effect of Educational Program on the Burden of Family Caregivers of Hemodialysis Patients

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Mansoureh Ashghali Farahani

2016-04-01

Full Text Available Background: Studies suggest that family caregivers of hemodialysis patients experience a high level of burden, which could lead to numerous physical and psychological problems. Despite the need for adequate training and support, these caregivers are mostly neglected, and few studies have been performed in this regard. Aim: to evaluate the effect of educational programs on the home care of hemodialysis patients and burden of their family caregivers. Method: This randomized controlled clinical trial was conducted on 76 caregivers of hemodialysis patients referred to Shahid Hasheminejad Hemodialysis Center of Tehran, Iran in 2015.­ Subjects were divided into two groups of intervention and control (n=38. The intervention group received four training sessions on the home care of hemodialysis patients for two weeks, and the control group received routine care. Data were collected using the Caregiver Burden Inventory (CBI at the beginning and six weeks after the intervention­. Data analysis was performed in SPSS V.21 using Chi-square, Fisher’s exact test, independent and paired T-test, and Mann-Whitney U test. Results: In this study, no significant difference was observed between the two groups in terms of demographic characteristics. At the baseline, mean score of caregiver burden in the intervention and control groups was 88.5±11.7 and 84.9±15.1, respectively, and no significant difference was observed between the groups in this regard (P=0.30. Six weeks after the intervention, the results of independent T-test revealed a significant difference between the mean scores of caregiver burden in the intervention (58.7±6.6 and control groups (87.8±11.7 ­(P

Inflammation but not dietary macronutrients insufficiency associated with the malnutrition-inflammation score in hemodialysis population.

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Chen, Jie; Peng, Hongquan; Xiao, Long; Zhang, Kun; Yuan, Zhimin; Chen, Jianping; Wang, Zhiyu; Wang, Jingfeng; Huang, Hui

2013-01-01

Malnutrition is associated with increased risk of mortality in hemodialysis patients. And insufficient dietary intake is the common cause for malnutrition. So, in order to survey the dietary intake of hemodialysis patients and study the relationship between the dietary feature and nutritional status, a cross-sectional study was performed. 75 hemodialysis patients from South China participated in the dietary intake survey and nutrition assessment. A three-day diet diary record was used to estimate the major dietary macronutrients. Nutritional status was assessed by malnutrition-inflammation score (MIS) in addition to several related anthropometric measurements. Serum albumin, transferrin, and high-sensitivity C-reactive protein (CRP) were measured. Receiver operating characteristic (ROC) curve analysis was used to quantify the assessing value of independent parameters for nutritional status. The results showed that 48% patients were malnourished according to the MIS. The malnourished patients had a lower body mass index (BMI), fat mass (FM), albumin and a higher level of CRP, compared with normal nourished patients (P macronutrients (calories, protein, fat, carbohydrates, etc) were found between the two nutrition groups (P > 0.05). The multivariate regression analysis showed that the major macronutrients had no significant association with MIS (P > 0.05). In conclusion, malnutrition is very common in South China hemodialysis population and these data indicated that inflammation but not dietary macronutrients insufficiency might be the candidate cause for malnutrition in hemodialysis population.

Low resting energy expenditure in middle-aged and elderly hemodialysis patients with poor nutritional status.

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Kogirima, Miho; Sakaguchi, Katsuhiko; Nishino, Kohsuke; Ichikawa, Yoko; Hiramatsu, Fumie; Yamamoto, Shigeru

2006-02-01

Due to high resting energy expenditure (REE) in maintenance hemodialysis patients, an increase in energy intake is usually recommended to improve their nutritional status. However, some patients appear to have poor appetite and low energy intake. In such patients low energy metabolism is expected. We hypothesized that in maintenance hemodialysis patients there are two types of the energy metabolism, high and low. This study was aimed at finding the energy metabolism in maintenance hemodialysis patients, especially in those with poor nutritional status. Subjects were hemodialysis out-patients (34 males and 20 females, mean age 59.1+/-10.7 y). REE was measured by an indirect calorimeter. Protein intake was obtained from normalized protein catabolic rate (nPCR), and physical activity level (PAL) was obtained by time study. Nutritional status assessed by serum albumin concentration was poor (3.7+/-0.2 g/dL) in spite of the adequate protein intake (1.1+/-0.3 g/kg per day). Only 11% of the subjects had appropriate serum albumin concentration. Mean REE was 24.6 kcal/kg per day which was lower than that of healthy Japanese (26.5 kcal/kg per day). REE and PAL positively correlated with serum albumin concentration (p<0.01). The results suggest that maintenance hemodialysis patients with poor nutritional status may have low REE.

Hemodialysis in a patient with severe hemophilia A and factor VIII inhibitor.

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Gopalakrishnan, Natarajan; Usha, Thiruvengadam; Thopalan, Balasubramaniyan; Dhanapriya, Jeyachandran; Dineshkumar, Thanigachalam; Thirumalvalavan, Kaliaperumal; Sakthirajan, Ramanathan

2016-10-01

Hemophilia A is a hereditary X-linked recessive disease caused by mutations in the gene encoding factor VIII (FVIII), occurring in 1 out of 10,000 persons. Life expectancy and quality of life have dramatically improved recently in patients with hemophilia. Chronic kidney disease and need for renal replacement therapy in these patients are rare. The development of inhibitors to FVIII is the most serious complication of hemophilia and makes treatment of bleeds very challenging. We describe here a 28-year-old male patient with severe hemophilia A with presence of factor VIII inhibitor, who had end stage renal disease. Central venous access device was inserted along with infusion of factor eight inhibitor bypass activity before and after the procedure. He is currently on thrice weekly hemodialysis and doing well for 6 months without bleeding episodes. To our knowledge, hemophilia A with factor VIII inhibitor managed with hemodialysis has not been reported so far. © 2016 International Society for Hemodialysis.

Outcomes of predialysis nephrology care in elderly patients beginning to undergo dialysis.

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Seon Ha Baek

Full Text Available The proportion of elderly patients beginning to undergo dialysis is increasing globally. Whether early referral (ER of elderly patients is associated with favorable outcomes remains under debate. We investigated the influence of referral timing on the mortality of elderly patients.We retrospectively assessed mortality in 820 patients aged ≥70 years with end-stage renal disease (ESRD who initiated hemodialysis at a tertiary university hospital between 2000 and 2010. Mortality data was obtained from the time of dialysis initiation until December 2010. We assigned patients to one of two groups according to the time of their first encounters with nephrologists: ER (≥ 3 months and late referral (LR; < 3 months.During a mean follow-up period of 25.1 months, the ER group showed a 24% reduced risk of long-term mortality relative to the LR group (HR = 0.760, P = 0.009. Rate of reduction in 90-day mortality for ER patients was 58% (HR = 0.422, P=0.012. However, the statistical significance of the difference in mortality rates between ER and LR group was not observed across age groups after 90 days. Old age, LR, central venous catheter, high white blood cell count and corrected Ca level, and lower levels of albumin, creatinine, hemoglobin, and sodium were significantly associated with increased risk of mortality.Timely referral was also associated with reduced mortality in elderly ESRD patients who initiated hemodialysis. In particular, the initial 90-day mortality reduction in ER patients contributed to mortality differences during the follow-up period.

Cognitive Behavioral Treatment to Improve Adherence to Hemodialysis Fluid Restrictions: A Case Report

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Heather M. Anson

2009-01-01

Full Text Available This case report describes outpatient psychological treatment targeting adherence to fluid restrictions in a hemodialysis patient. The consequences of nonadherence to fluid restrictions in hemodialysis patients range from minor discomfort to increased hospitalizations and mortality rates. In addition, when patients chronically fail to adhere, they may no longer be candidates for kidney transplant. The interventions focused on polydipsia, characterized by excessive fluid intake. The methods involved 11-sessions of individual psychotherapy incorporating strategies including increasing awareness, decreasing motivation, increasing effort, engaging in competing events, conducting thought stopping, breaking repetitive routines, eliciting social support, and receiving reinforcement. Results demonstrated that the patient successfully restricted his fluid intake at or below recommended levels 83% of days after fading of treatment began. This case report demonstrates the success of cognitive behavioral treatment strategies with a nonpsychiatric hemodialysis patient.

Bone Marrow Pathology Predicts Mortality in Chronic Hemodialysis Patients

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Cheng-Hao Weng

2015-01-01

Full Text Available Introduction. A bone marrow biopsy is a useful procedure for the diagnosis and staging of various hematologic and systemic diseases. The objective of this study was to investigate whether the findings of bone marrow studies can predict mortality in chronic hemodialysis patients. Methods. Seventy-eight end-stage renal disease patients on maintenance hemodialysis underwent bone marrow biopsies between 2000 and 2011, with the most common indication being unexplained anemia followed by unexplained leukocytosis and leukopenia. Results. The survivors had a higher incidence of abnormal megakaryocyte distribution P=0.001, band and segmented cells P=0.021, and lymphoid cells P=0.029 than the nonsurvivors. The overall mortality rate was 38.5% (30/78, and the most common cause of mortality was sepsis (83.3% followed by respiratory failure (10%. In multivariate Cox regression analysis, both decreased (OR 3.714, 95% CI 1.671–8.253, P=0.001 and absent (OR 9.751, 95% CI 2.030–45.115, P=0.004 megakaryocyte distribution (normal megakaryocyte distribution as the reference group, as well as myeloid/erythroid ratio (OR 1.054, CI 1.012–1.098, P=0.011, were predictive of mortality. Conclusion. The results of a bone marrow biopsy can be used to assess the pathology, and, in addition, myeloid/erythroid ratio and abnormal megakaryocyte distribution can predict mortality in chronic hemodialysis patients.

Rocuronium-sugammadex use for electroconvulsive therapy in a hemodialysis patient: a case report

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Kurita, Shigeaki; Moriwaki, Katsuyuki; Shiroyama, Kazuhisa; Sanuki, Mikako; Toyota, Yukari; Takebayashi, Minoru

2016-01-01

Background Recently, rocuronium with subsequent use of sugammadex was proposed for electroconvulsive therapy (ECT) as an alternative to succinylcholine. Because sugammadex is cleared via the kidney with no metabolism, it is unknown that rocuronium-sugammadex use is safe in hemodialysis patients who received ECT. Case presentation In this case report, we used rocuronium with subsequent administration of sugammadex in a 69-year-old female, hemodialysis patient, scheduled for ten ECT sessions fo...

Clinical and biochemical aspects of hemodialysis and hemodiafiltration

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den Hoedt, C.H.

2012-01-01

In hemodialysis (HD) clearance of uremic toxins occurs as a result of a concentration gradient between the blood and the dialysate, a process called diffusion. During hemodiafiltration (HDF), diffusion is combined with pressure driven fluid transport across the dialysis membrane, a process called

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

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2013-01-01

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 We included 145 ESRD patients undergoing HD. Social adaptability was estimated by the Social Adaptability Index (SAI). Substance abuse was defined according to SAI. We screened for depression by applying the 20-item version of the Center for Epidemiologic Studies Depression Scale. A score ≥ 24 classified the patients as depressed. Comparisons between depressed and non-depressed patients were carried out and logistic regression was performed to test gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable (yes/no) as predictors of depression. Results There were 36 (24.8%) depressed patients. There were no differences regarding demographic and laboratory data between the depressed and non-depressed patients. Mean SAI among depressed and non-depressed patients was, respectively, 6.1 ± 1.6 vs. 6.2 ± 1.9 (p=0.901). The percentage of patients with or without substance abuse among depressed patients was, respectively, 13.8% vs. 13.9% (p=1.000). Gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable did not predict depression. Conclusions Social adaptability and substance abuse did not predict depression in HD patients. We propose that aspects related to socioeconomic status not comprised in SAI items should be ruled out as predictors of depression. PMID:23320829

[Pulmonary hypertension in hemodialysis patients: Prevalence and associated factors].

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Reque, Javier; Quiroga, Borja; Ruiz, Caridad; Villaverde, Maria Teresa; Vega, Almudena; Abad, Soraya; Panizo, Nayara; López-Gómez, J Manuel

2016-02-19

Pulmonary hypertension (PH) is a progressive disorder that can be caused by several underlying conditions or an intrinsic alteration of the pulmonary vasculature. Chronic increased pressure in the pulmonary vasculature leads to changes in the architecture of the vessels that can perpetuate PH and produce right ventricular dysfunction. These structural and functional alterations can decrease survival and quality of life of patients on hemodialysis; however, there is a lack of evidence about this problem in this population. The aim of this study is to establish the prevalence of PH in patients on hemodialysis and its association with specific factors related to this patient population. We included 202 prevalent patients on hemodialysis for at least 6 months and who were clinically stable. We collected demographic data, routine laboratory parameters and data of 2D Doppler-echocardiography. PH was defined as a systolic pulmonary artery pressure (SPAP) estimated by Doppler ultrasound above 35mmHg. Hydration status was assessed by determining the plasma concentration of N-terminal pro brain natriuretic peptide (Nt-proBNP). PH prevalence was 37.1% (75 patients). The average SPAP in the entire study population was 32±12mmHg and in the group with PH it was 45±11mmHg. We found a direct and statistically significant correlation between the presence of PH and age (P=.001), time on renal replacement therapy (P=.04), the presence of systolic dysfunction (P=.007), diastolic dysfunction (P= 01), mitral valve disease (P=.01) and double mitral and aortic disease (P=.007). Volume overload was closely associated with PH, as demonstrated by the correlation between the SPAP and Nt-proBNP levels (P=.001). We conclude that prevalence of PH in hemodialysis patients is high. And one of the most important associated factors is volume overload. More studies are needed to establish the impact of PH on morbidity and mortality of patients and to assess whether a better volume control improves

Association of Beta-2 Microglobulin with Inflammation and Dislipidemia in High-Flux Membrane Hemodialysis Patients

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Topçiu–Shufta, Valdete; Miftari, Ramë; Haxhibeqiri, Valdete; Haxhibeqiri, Shpend

2016-01-01

Background: Higher than expected cardiovascular mortality in hemodialysis patients, has been attributed to dyslipidemia as well as inflammation. Beta2-Microglobulin (β2M) is an independent predictor of outcome for hemodialysis patients and a representative substance of middle molecules. Results: In 40 patients in high-flux membrane hemodialysis, we found negative correlation of β2M with high density lipoprotein (r=-0.73, p<0.001) and albumin (r= -0.53, p<0.001) and positive correlation with triglycerides (r=0.69, p<0.001), parathyroid hormone (r=0.58, p < 0.05) and phosphorus (r= 0.53, p<0.001). There was no correlation of β2M with C- reactive protein (CRP) and interleukin-6 (IL-6). During the follow-up period of three years, 6 out of 40 patients have died from cardiovascular events. Conclusion: In high-flux membrane hemodialysis patients, we observed a significant relationship of β2M with dyslipidemia and mineral bone disorders, but there was no correlation with inflammation. PMID:27994294

Complication of Hemodialysis Access: A Case Report of Venous Hypertension

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Sadegh Asadi

2018-03-01

Full Text Available Vascular access for dialysis is essential for these patients with end-stage renal disease, improvements in hemodialysis managment have lead to extended life expectancy. The creation and maintenance of hemoaccess occupies a significant portion of most vascular and general surgery practices.Venous hypertension due to arteriovenous fistula is usually secondary to venous outlet obstruction. Side to side proximal artery arteriovenous fistula serves as a certain cause of hemodialysis, but it is rarely reported as a peripheral venous hypertension cause. We are reporting a case with developed venous hypertension having dermal injuries in the arm. The patient underwent successful side-to-side radio cephalic fistula creation in the snuffbox a year ago.

Osteoprotegerin and mortality in hemodialysis patients with cardiovascular disease

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Winther, Simon; Christensen, Jeppe Hagstrup; Flyvbjerg, Allan

2013-01-01

Abstract BACKGROUND: Patients treated with hemodialysis (HD) have an increased mortality, mainly caused by cardiovascular disease (CVD). Osteoprotegerin (OPG) is a glycoprotein involved in the regulation of the vascular calcification process. Previous studies have demonstrated that OPG.......08; in the adjusted analyses, the p-value for trend was 0.03. CONCLUSIONS: In a high-risk population of hemodialysis patients with previously documented cardiovascular disease, a high level of OPG was an independent risk marker of all-cause mortality....... is a prognostic marker of mortality. The aim of this study was to investigate if OPG was a prognostic marker of all-cause mortality in high-risk patients with end-stage renal disease and CVD. METHODS: We prospectively followed 206 HD patients with CVD. OPG was measured at baseline and the patients were followed...

Effect of hepatitis C virus infection on erythropoiesis in patients on hemodialysis

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Saifan C

2013-06-01

Full Text Available Chadi Saifan, Elie El-Charabaty, Morton Kleiner, Suzanne El-SayeghDepartment of Medicine, Division of Nephrology, Staten Island University Hospital, Staten Island, NY, USABackground: Erythropoietin is a hormone that regulates erythropoiesis and is mainly produced by the kidneys. Several animal studies as well as a few case reports and case series have demonstrated that regenerating hepatic tissue can produce more erythropoietin than normal hepatic tissue. The purpose of the study was to examine the difference in hemoglobin and hematocrit levels as well as epoetin dosage in patients on hemodialysis with and without hepatitis C (HCV.Methods: A retrospective chart review was performed. Seventy-six patients were included in the study (19 with HCV and 57 without HCV at a ratio of 1:3. Exclusion criteria were a history of gastrointestinal bleeding or blood transfusion over the previous six months, polycystic kidney disease, and pregnancy. Variables examined included gender, age, duration of hemodialysis, hemoglobin, hematocrit, epoetin dose, aspartate transaminase, and ferritin levels over a three-month period.Results: The patients were divided into two groups. The first consisted of patients with HCV on hemodialysis and the second of patients on hemodialysis without HCV. Mean hemoglobin was 12.6 ± 1.2 g/dL for the HCV-positive group and 11.9 ± 1.1 g/dL for the HCV-negative group. The difference was statistically significant (P = 0.03. Mean hematocrit was higher in the HCV-positive group, but was not significantly different at 39.08% ± 4.06% versus 37.43% ± 3.4% in the HCV-negative group (t-test, P = 0.11. Further, the HCV-positive group required less epoetin, but this was not significantly different from that required in the HCV-negative group at 6258 ± 5208 IU versus 7596 ± 7056 IU, respectively (t-test, P = 0.38.Conclusion: In our study, patients with HCV infection were found to have higher hemoglobin and hematocrit levels and lower epoetin

Bioimpedance-Guided Fluid Management in Hemodialysis Patients

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Arias-Guillén, Marta; Wabel, Peter; Fontseré, Néstor; Carrera, Montserrat; Campistol, José Maria; Maduell, Francisco

2013-01-01

Summary Background and objectives Achieving and maintaining optimal fluid status remains a major challenge in hemodialysis therapy. The aim of this interventional study was to assess the feasibility and clinical consequences of active fluid management guided by bioimpedance spectroscopy in chronic hemodialysis patients. Design, setting, participants, & measurements Fluid status was optimized prospectively in 55 chronic hemodialysis patients over 3 months (November 2011 to February 2012). Predialysis fluid overload was measured weekly using the Fresenius Body Composition Monitor. Time-averaged fluid overload was calculated as the average between pre- and postdialysis fluid overload. The study aimed to bring the time-averaged fluid overload of all patients into a target range of 0.5±0.75 L within the first month and maintain optimal fluid status until study end. Postweight was adjusted weekly according to a predefined protocol. Results Time-averaged fluid overload in the complete study cohort was 0.9±1.6 L at baseline and 0.6±1.1 L at study end. Time-averaged fluid overload decreased by −1.20±1.32 L (P<0.01) in the fluid-overloaded group (n=17), remained unchanged in the normovolemic group (n=26, P=0.59), and increased by 0.59±0.76 L (P=0.02) in the dehydrated group (n=12). Every 1 L change in fluid overload was accompanied by a 9.9 mmHg/L change in predialysis systolic BP (r=0.55, P<0.001). At study end, 76% of all patients were either on time-averaged fluid overload target or at least closer to target than at study start. The number of intradialytic symptoms did not change significantly in any of the subgroups. Conclusions Active fluid management guided by bioimpedance spectroscopy was associated with an improvement in overall fluid status and BP. PMID:23949235

Food intake in patients on hemodialysis

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Inaiana Marques Filizola Vaz

2014-12-01

Full Text Available Objective: To evaluate the intake of energy and nutrients by individuals on hemodialysis, following especific recommendations for this population and according to Food Guide for the Brazilian Population. Methods: A cross-sectional study, 118 adult patients, considered stable from, ten dialysis centers in Goiânia, Goiás. Dietary intake was estimated by six 24-hour recalls, and classified as adequate or inadequate, according to specific recommendations for individuals undergoing dialysis and that recommended for a healthy diet. A descriptive analysis was performed. Results: Average dietary intake of 2022.40 ± 283.70 kcal/day; 31.18 kcal/kg/day; 55.03 ± 4.20% carbohydrate; 30.23 ± 3.71% lipid, 1.18 ± 0.23 g protein/kg/day. Important prevalences of inadequacy were observed for the intake of calories (39.0%, protein (39.0% and other nutrients such as retinol (94.9%, saturated fat (87.3%, cholesterol (61,9%, iron (61.0%, potassium (60.2% and zinc (45.0%. Patients had a low intake of fruit food group (1.22 ± 0.89 servings and vegetables (1.76 ± 1.01 servings, dairy products (0.57 ± 0.43 servings and high intake of food group of oils and fats (3.45 ± 0.95 servings, sugars and sweets (1.55 ± 0.77 servings. Conclusion: Observed food consumption imbalance, characterized by excess of oils and fats, especially saturated oils and cholesterol, sugars and sweets, parallel to low intake of fruits and vegetables and dairy products. A considerable percentage of patients did not intake the minimum recommended of calories, protein, retinol, iron, zinc and potassium.

Effects of flaxseed consumption on systemic inflammation and serum lipid profile in hemodialysis patients with lipid abnormalities.

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Khalatbari Soltani, Saman; Jamaluddin, Rosita; Tabibi, Hadi; Mohd Yusof, Barakatun Nisak; Atabak, Shahnaz; Loh, Su-Peng; Rahmani, Leila

2013-04-01

Inflammation and lipid abnormalities are two important risk factors for cardiovascular disease in hemodialysis (HD) patients. The present study was designed to investigate the effects of flaxseed consumption on systemic inflammation and serum lipid profile in HD patients with lipid abnormalities. This was an unblinded, randomized clinical trial. Thirty HD patients with dyslipidemia (triglyceride >200 mg/dL and/or high-density lipoprotein-cholesterol (HDL-C) consumption improves lipid abnormalities and reduces systemic inflammation in HD patients with lipid abnormalities. © 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.

The comparative evaluation of patients′ body dry weight under hemodialysis using two methods: Bioelectrical impedance analysis and conventional method

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Neda Alijanian

2012-01-01

Full Text Available Background: Dry weight (DW is an important concept related to patients undergoing hemodialysis. Conventional method seems to be time consuming and operator dependent. Bio impedance analysis (BIA is a new and simple method reported to be an accurate way for estimating DW. In this study, we aimed to compare the conventional estimation of DW with measuring DW by BIA. Materials and Methods: This study involved 130 uremic patients, performed in Isfahan, Iran. DW was calculated by both conventional (CDW and BIA (BIADW method and results were compared based on different grouping factors including sex, underlying cause of renal failure (RF (diabetic RF and non-diabetic RF, body mass index (BMI status, and sessions of hemodialysis. We also calculated the difference between DWs of 2 methods (DW diff = CDW-BIADW. Results: The mean of BIADW was significantly lower than CDW (57.20 ± 1.82 vs 59.36 ± 1.77, P value < 0.001. After grouping cases according to the underlying cause, BMI, sex, and dialysis sessions BIADW was significantly lower than CDW. Conclusion: Based on the combination of problems with CDW measurement which are corrected by BIA, and more clinical reliability of CDW, we concluded that although conventional method is a time-consuming and operator-dependent way to assess DW, DW could be estimated by combining both of these methods by finding the mathematic correlation between these methods.

Association of Increased Serum Ferritin With Impaired Muscle Strength/Quality in Hemodialysis Patients.

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Nakagawa, Chie; Inaba, Masaaki; Ishimura, Eiji; Yamakawa, Tomoyuki; Shoji, Shigeichi; Okuno, Senji

2016-07-01

We reported previously that muscle quality and muscle strength provide clinically relevant predictors for better survival in hemodialysis patients. Iron overload might impair muscle function by its accumulation in muscle in such patients. Serum ferritin, a marker for body iron store, was examined for its association with handgrip strength (HGS) and muscle quality which was defined as the ratio of HGS to arm lean mass measured with dual-energy X-ray absorptiometry. In 300 Japanese hemodialysis patients, age, hemodialysis duration, body mass index, and serum albumin were 58.0 ±12.0 (mean ± standard deviation) years, 4.2 (1.8-10.4) (median [25th-75th percentile]) years, 20.4 ± 2.8 kg/m(2), 4.0 ± 0.3 g/dL, respectively. Hemoglobin and hematocrit were 8.9 ± 1.2 g/dL, and 28.8 ± 3.9%, respectively, whereas transferrin saturation and serum ferritin were 29.8 ± 11.0% and 100 (54-172) ng/mL, respectively. Serum ferritin significantly correlated in a positive manner with the total dose of iron orally administered during the previous 6 months (r = 0.185, P = .0013). HGS and muscle quality were 23.1 ± 10.4 kg and 11.6 ± 3.8 kg/kg, respectively. In multivariate analysis to elucidate the factors associated with HGS and muscle quality in 300 hemodialysis patients, which included transferrin saturation and log serum ferritin, in addition to age, gender, hemodialysis duration, the presence/absence of diabetes, body mass index as independent variables, log serum ferritin emerged as a significant and independent factor which associated in a negative fashion with HGS (β = -0.091, P = .0395) and tendency toward negative association with muscle quality (β = -0.100, P = .0754). In summary, the present study demonstrated the significant association of serum ferritin with HGS and muscle quality in hemodialysis patients and thus suggested that we should be careful of iron overload to avoid its possible harmful effect on muscle in such patients. Copyright © 2016 National Kidney

Sublethal microcystin exposure and biochemical outcomes among hemodialysis patients

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Cyanobacteria are commonly-occurring contaminants of surface waters worldwide. Microcystins, potent hepatotoxins, are among the best characterized cyanotoxins. During November, 2001, a group of 44 hemodialysis patients were exposed to microcystins via contaminated dialysate. Seru...

Hemodialysis for near-fatal sodium phosphate toxicity in a child receiving sodium phosphate enemas.

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