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  1. Tuberculosis in children undergoing hemodialysis

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    Gargah Tahar

    2010-04-01

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

  2. Prevalence of uremic itching in patients undergoing hemodialysis.

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    Kavurmac?, Mehtap

    2015-10-01

    Uremic itching is a common problem with multifactorial etiology seen in hemodialysis patients. This study was carried out to determine the factors affecting and incidence of itching in patients undergoing hemodialysis treatment. The descriptive study was carried out in 130 patients who underwent hemodialysis treatment because of end-stage renal disease in Eastern Turkey between October 2014 and December 2014. A questionnaire prepared by the researcher based on the literature and the Visual Analog Scale were used for data collection. The data were collected by the researcher through face-to-face interviews in the hemodialysis unit. The evaluation of data obtained in the research has been performed using SPSS 16.0 software using percentages, chi-square analysis, and t-test. As a result of the study, 85.4% of the patients were found to have itching, the severity of itching was 4.86?±?3.01 according to Visual Analog Scale, and itching of the patients was found to be affected by serum phosphorus and parathyroid hormone levels. Uremic itching continues to be seen as a problem in hemodialysis patients. PMID:25855159

  3. Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

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    Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C

    2015-02-01

    Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p sleepwalking, sleep hygiene, depression or anxiety. ESRD patients undergoing any one of the three dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established. PMID:25358390

  4. Periodontal status in patients undergoing hemodialysis

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    Parkar, S. M.; Ajithkrishnan, C. G.

    2012-01-01

    The aim of the study was to assess the periodontal status of patients among group of patients receiving hemodialysis in two super specialty renal institutes in the state of Gujarat. A cross-sectional study of 304 subjects, 152 subjects each in dialysis, and control group was conducted. Oral hygiene status was assessed using a Simplified Oral Hygiene Index, and periodontal status was assessed using the Community Periodontal Index (CPI) and Loss of Attachment (LOA) as per WHO methodology 1997. ...

  5. Salivary function in patients with chronic renal failure undergoing hemodialysis

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

  6. HEARING ASSESSMENT IN CHRONIC RENAL FAILURE PATIENTS UNDERGOING HEMODIALYSIS

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    Arjun Singh

    2014-01-01

    Full Text Available The auditory sensitivity of 63 patient of chronic renal failure on hemodialysis was assessed in order to know the effect of dialysis on hearing threshold. All selected patient were non diabetic with normal tympanic membrane and with no history of ototoxic drug and any hereditary hearing problems. Pure tone audiometry was done before and after dialys is and all cases were followed for 3 month. A high incidence of high frequency sensorineural hearing loss was obtained which could not be attributed to age , noise exposure and ottotoxicity. An association between high frequency sensorineural hearing loss a nd hemodialysis is thus suggested KEYWORDS: Hemodialysis ; Pure tone audiometry ; High frequency sensorineural hearing loss ; Duration of disease ; Chronic renal failure

  7. Restless legs syndrome in end stage renal disease patients undergoing maintenance hemodialysis

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    To study the frequency of restless legs syndrome in patients of end stage renal disease undergoing maintenance hemodialysis. Design: Cross sectional descriptive study. Place and Duration of Study: Department of medicine, CMH Multan from Nov 2010 to April 2011. Patients and Methods: One hundred and ninety four (n=194) patients of End stage renal disease who had been on maintenance hemodialysis for at least 3 months, were included in the study after full informed consent and using consecutive sampling. Patients having dementia, psychiatric illness, pregnancy, hypothyroidism, Parkinson's disease and alcoholics were excluded from the study. Patients who fulfilled all four diagnostic criteria for restless legs syndrome as proposed by International restless legs syndrome study group (IRLSSG), by direct questioning were diagnosed as having restless legs syndrome. Results: The frequency of restless legs syndrome was found to be 12.4% in patients undergoing hemodialysis (10.5% in males versus 16% in females). The mean duration of hemodialysis was higher among RLS positive patients (12.88 +- 5.543 months) as compared to RLS negative patients (6.94 +- 4.610 months). Conclusion: RLS is a frequent, under-diagnosed co-morbidity in patients undergoing maintenance hemodialysis. (author)

  8. Gastrointestinal symptoms after the substitution of sevelamer hydrochloride with lanthanum carbonate in Japanese patients undergoing hemodialysis.

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    Suzuki, D; Ichie, T; Hayashi, H; Sugiura, Y; Sugiyama, T

    2015-08-01

    Lanthanum carbonate has the same phosphorus depressant effect as the other phosphorus adsorbents, and is expected to decrease digestive symptom onset such as constipation in Japanese patients undergoing hemodialysis compared to sevelamar hydrochloride. In this study, we investigated the short- and long-term changes in digestive symptoms in these patients after substituting sevelamar hydrochloride with lanthanum carbonate. We studied 16 patients (4 men, 12 women) and evaluated their gastrointestinal symptoms before administration, at the time of administration, and 2, 4, 8, and 12 weeks after administration, using the Gastrointestinal Symptom Rating Scale. In addition, we conducted repeat evaluations 52 weeks after administration for the patients in whom lanthanum carbonate was administered continuously for 52 weeks. Fourteen (87.5%) out of the 16 patients could tolerate continuous administration for 12 weeks. The constipation score was 3.21 ± 1.74 before administration, 2.07 ± 0.83 2 weeks after administration, 1.76 ± 0.83 4 weeks after administration, 1.57 ± 0.56 8 weeks after administration, and 11.41 ± 0.48 12 weeks after administration. The scores improved significantly 4 weeks after administration (p < 0.05) and even 12 weeks after continuous administration. Among the 16 study patients, 9 patients (1 men, 8 women) were received lanthanum carbonate continuously for 52 weeks. The constipation score was 3.74 ± 1.92 at the start of administration, 1.37 ± 0.56 12 weeks after administration, and 1.85 ± 0.63 52 weeks after administration, with significant improvement even 52 weeks after administration (p < 0.05). This study shows that substituting sevelamar hydrochloride with lanthanum carbonate improves constipation symptoms in hemodialysis patients from an early stage, which indicates its usefulness in improving constipation symptoms caused by sevelamar hydrochloride. PMID:26380521

  9. Effects of pyridoxal phosphate in analysis of aminotransferase activity in patients undergoing hemodialysis

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    Lokesh K Sharma

    2014-05-01

    Full Text Available Background and Aims: Factors like hemodilution, pyridoxine deficiency, hepatocyte growth factor and uremic toxins have been proposed for low aminotransferase activity in chronic kidney disease (CKD patients undergoing haemodialysis. This may be a concerning factor in making diagnosis of liver disorders like hepatitis in patients undergoing haemodialysis. In present study we attempted to find out the cause of hypoaminotransferasemia in chronic kidney diseases and biochemical principle of analysis.Materials and Methods:  Serum levels of various biochemical parameters are measured in CKD patients undergoing haemodialysis. The serum activities of Aspartate Aminotransferase (AST and Alanine Aminotransferase (ALT are determined (with and without the addition of PLP in a group of 176 patients undergoing hemodialysisResults: Serum AST and ALT activities are significantly lower in the CKD patients compared to the control group (P value 0.0003 and 0.001 respectively. Measurement of activity with pyridoxal phosphate containing reagent resulted into a significant increase in values comparison to without pyridoxal phosphate. The percentage activation is higher in patients as compared to controls.Conclusion: The upper limit of reference range for aminotransferases in CKD patients undergoing hemodialysis should be considered lower as compared to healthy subjects. Reagent containing pyridoxal phosphate is considered appropriate for aminotransferase activity measurement.

  10. Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis

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    Sabanis, Nikos; Paschou, Eleni; Gavriilaki, Eleni; Mourounoglou, Maria; Vasileiou, Sotirios

    2015-01-01

    Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused by Enterococcus faecalis in a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location. PMID:26301109

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

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    Rias Pratiwi Safitri; Ria Safaria Sadif

    2013-01-01

    Hemodialysis is the process of separation and retention of excess fluid metabolic waste substances from the blood into the dialysis fluid through a membrane that is semi permiabel the dialysis machine by diffusion, ultrafiltration and convection so that the composition of substances and fluids in the near normal blood. Giving SEFT aims to determine the effectiveness SEFT to lower levels of depression in patients with chronic renal failure undergoing hemodialysis. Participants in the study wer...

  12. Relationship Between the Prognostic Expectations of Seriously Ill Patients Undergoing Hemodialysis and Their Nephrologists

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    Wachterman, Melissa W.; Marcantonio, Edward R.; Davis, Roger B.; Cohen, Robert A.; Waikar, Sushrut S.; Phillips, Russell S.; McCarthy, Ellen P.

    2014-01-01

    IMPORTANCE Patients undergoing hemodialysis have an annual mortality rate exceeding 20%, comparable to many types of cancer. Past research has shown that patients with cancer overestimate their likelihood of survival relative to their physicians, but this relationship has not been examined in patients with noncancer diagnoses. Perceptions of prognosis and transplant candidacy may influence goals of care. OBJECTIVES To compare the perceptions of hemodialysis patients and their nephrologists concerning prognosis and the likelihood of transplant; to follow actual survival; and to explore the relationship between patients’ expectations and their goals of care. DESIGN We completed a medical record abstraction to estimate 1-year mortality risk among patients who underwent dialysis at any time from November 1, 2010, through September 1, 2011. We then conducted in-person interviews with eligible patients whose predicted 1-year mortality, based on validated prognostic tools, was at least 20%. We also interviewed their nephrologists. We compared patients’ and physicians’ expectations about 1- and 5-year survival and transplant candidacy and measured the association between patients’ expectations and goals of care. We then followed actual survival using Kaplan-Meier methods. SETTING AND PARTICIPANTS Two dialysis units in Boston. Two hundred seven patients undergoing hemodialysis included in the medical record review, with 62 eligible patients interviewed. MAIN OUTCOMES AND MEASURES Predicted 1-year mortality risk using validated prognostic tools; actual survival; patients’ and physicians’ expectations about 1-year survival and likelihood of transplant; and patients’ goals of care. RESULTS Of the 207 hemodialysis patients, 72.5% had a predicted 1-year mortality of at least 20%. Of the 80 patients eligible for interview, 62 participated (response rate, 78%). Patients were significantly more optimistic than their nephrologists about 1- and 5-year survival (P < .001 for both) and were more likely to think they were transplant candidates (37 [66%] vs 22 [39%] [P = .008]). Of the 81% of patients reporting a 90% chance or greater of being alive at 1 year, 18 (44%) preferred care focused on extending life, even if it meant more discomfort, compared with 1 (9%) among patients reporting a lower chance of survival (P = .045). Actual survival was 93% at 1 year but decreased to 79% by 17 months and 56% by 23 months. CONCLUSIONS AND RELEVANCE Hemodialysis patients are more optimistic about prognosis and transplant candidacy than their nephrologists. In our sample, patients’ expectations about 1-year survival were more accurate than those of their nephrologists, but their longer-term survival expectations dramatically overestimated even their 2-year survival rates. Patients’ prognostic expectations are associated with their treatment preferences. Our findings suggest the need for interventions to help providers communicate effectively with patients about prognosis. PMID:23712681

  13. A comparative study of phosphate binders in patients with end stage kidney disease undergoing hemodialysis.

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    Prajapati, Viken A; Galani, Varsha J; Shah, Pankaj R

    2014-05-01

    In the present study, a comparative evaluation of the effects of calcium acetate, calcium carbonate, sevelamer hydrochloride and lanthanum carbonate was carried out in 120 patients with end stage kidney disease (ESKD) undergoing hemodialysis. Biochemical parameters, like serum phosphorous, serum calcium and serum alkaline phosphatase level and intact parathyroid hormone level, were measured. A statistically significant reduction in serum phosphorous, serum calcium, calcium × phosphorous and serum alkaline phosphatase level were observed with all phosphate binders during 3 months of treatment. Reduction in serum phosphorous were observed with calcium acetate (1.5 mg/dL), calcium carbonate (1.3 mg/dL), sevelamer hydrochloride (2.1 mg/dL) and lanthanum carbonate (1.79 mg/dL). The reduction of serum alkaline phosphatase was observed more commonly with sevelamer (107.37 IU/L) and lanthanum (104.33 IU/L) treatments than with calcium acetate (93.9 IU/L) and calcium carbonate (86.57 IU/L). There was no statistically significant change in serum calcium observed with sevelamer and lanthanum treatments, while calcium-based phosphate binders caused a significant rise in the serum calcium level. Serum intact parathyroid hormone level was significantly reduced with all phosphate binder treatments. This decline was highest with sevelamer and lowest with calcium carbonate. All treatments were well tolerated and safety profiles were consistent with previous reports in hemodialysis patients. It is concluded that all phosphate binders are safe and effective for the treatment of hyperphosphatemia in patients with ESKD undergoing hemodialysis. However, sevelamer hydrochloride seems to be superior among all with lowering incidence of hypercalcemia. PMID:24821148

  14. Hyperkalemia in hypertensive patients undergoing regular hemodialysis during enalapril and fosinopril therapy

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    Dimkovi? Nada

    2006-01-01

    Full Text Available Introduction. Hypertension is evident in 80%-85% of patients with chronic renal failure and antihypertensive therapy is needed in 25%-30% of patients. Apart from antihypertensive effect, ACEi’s decrease the left ventricular hypertrophy and mortality in dialysis patients. Even so, their use is limited due to hyperkalemia. Objective. The objective of the study was to compare the effect of fosinopril and enalapril on serum potassium level in hypertensive hemodialysis patients. Method. Prospective pilot study included 16 patients undergoing chronic hemodialysis, with mean age of 58.9±9.6 years and mean duration of hypertension 11.3±7.1 years. The effect of antihypertensive drugs of equivalent dose was followed during three periods (three months each: period 1 (therapy with enalapril, period 2 (therapy with fosinopril and period 3 (therapy with enalapril. Dialysis conditions were constant and patients were without signs of catabolic state. Laboratory results were followed on monthly basis and mean values were compared by ANOVA-one way test. Difference between variables between periods was tested using Bonferoni method. Results. There was significant difference between mean serum potassium levels throughout three therapeutic periods (5.88±0.38 vs. 4.99±0.44 vs. 5.46±0.46mmol/l; p<0.001. Difference was evident even in the first month of fosinopril therapy. The effect can not be explained by dialysis adequacy since Kt/ V was similar throughout three treatment periods (1.18±0.24 vs. 1.25±0.21 vs. 1.25±0.14; p=ns. Systolic blood pressure was regulated even better with fosinopril than with enalapril (187.5±21.4 mmHg vs.160.0±20.0 mmHg; p=0.01 and this effect was prolonged during period 3 (160.0±26.1mmHg. Hemoglobin values mainly depended on specific anemia therapy and not on particular ACEi drug. Conclusion. Fosinopril carries less risk of hyperkalemia in hypertensive hemodialysis patients than enalapril. Although definite conclusion may be drawn after well-designed studies, the results presented in this pilot study suggest that fosinopril may be recommended for hypertensive hemodialysis patients who are at risk to develop inter-dialytic hyperkalemia.

  15. 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-? (TNF-?, and asymmetric dimethylarginine (ADMA, as well as routine laboratory follow-up.Results: EPO doses and ERI were significantly decreased in the treatment group, while they did not change in the control group. Hemoglobin, iron store indices, malondialdehyde, oxidized ox-LDL, IL-6, TNF-?, and ADMA were similar in both treatment and control groups at baseline, and did not change by the end of study period. Likewise, routine laboratory measures were not affected by the treatment.Conclusion: ALA could be used in hemodialysis patients to reduce requirements for EPO. However, larger and longer term studies are required to clarify the exact role of ALA in hemodialysis as well as in pre-hemodialysis patients.Keywords: alpha-lipoic acid, anemia, asymmetric dimethylarginine, erythropoietin, hemodialysis, oxidative stress

  16. Correlation between conjunctival and corneal calcification and cardiovascular calcification in patients undergoing maintenance hemodialysis.

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    Sun, Wenxue; Sun, Mei; Zhang, Minghui; Liu, Yi; Lin, Xiaomin; Zhao, Sisi; Ma, Lulu

    2015-04-01

    The purpose of this study was to investigate the correlation of conjunctival and corneal calcification (CCC) with cardiovascular calcification in patients undergoing maintenance hemodialysis (MHD). A total of 122 patients undergoing MHD in our hospital were included in this study. Conjunctival and corneal calcification was examined by slit lamp and graded. Abdominal aortic calcification (AAC), aortic valve calcification (AVC), and mitral valve calcification (MVC) were determined by X-ray or ultrasound. The correlation of CCC with AAC, AVC, and MVC was analyzed. Biochemical, hematological, and cardiovascular data were compared between patients with different severity of CCC or AAC. Mitral valve calcification was significantly associated with AAC in our patients. Conjunctival and corneal calcification positively correlated with AAC. We also found that patients with severe CCC exhibited significantly higher levels of serum calcium, phosphate, product of calcium and phosphate, serum copper, cystatin, intact parathyroid hormone, and vitamin D than patients with mild CCC. In addition to significantly increased levels of serum calcium, product of calcium and phosphate, serum copper, and cystatin, patients with severe AAC also had higher high-sensitivity C-reactive protein level and greater left ventricular posterior wall thickness and left ventricular end-diastolic interventricular septum thickness than patients with mild AAC. Our results suggest that patients undergoing MHD with severe CCC or AAC have high degree of mineral metabolism disorder, inflammation, and cardiovascular function disorder. The strong correlation between CCC and AAC indicates that CCC score might be used as an indirect indicator to predict cardiovascular risks in patients undergoing MHD. PMID:25377787

  17. Evaluation of Knowledge About and Attitudes Towards Kidney Transplantation in Patients Undergoing Hemodialysis Treatment

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    Nurten KALENDER

    2015-09-01

    Full Text Available OBJECTIVE: The aim of the present study was to evaluate hemodialysis (HD patients’ knowledge about and attitudes towards Kidney Transplantation (KT. MATERIAL and METHODS: A total of 104 HD patients from two HD centers in a large city in central Turkey were included in this descriptive study. The questionnaire that was developed by researchers included questions on sociodemographic data and dialysis vintage, level of satisfaction resulting from HD treatment, willingness to undergo KT, knowledge about KT and choice of donor, etc. RESULTS: The mean age of the 104 patients was 60.03±17.01 years and the mean of dialysis vintage was 4.53±3.04 years. Of these patients, 62.5% declared their willingness to undergo KT, and among these, 76.9% declared that they had knowledge about KT. In regard to choice of donor, 79.7% stated that it was not important, while 56.7% were not informed about the existence of a waiting list for cadaveric donors. CONCLUSION: In order to increase in our country the number of cadaveric donors, which represent the most appropriate source of organ donation, several strategies should be considered, such as awareness-raising activities for patients and the community through campaigns by both the public and private sectors, and mass media.

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

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    Rias Pratiwi Safitri

    2013-05-01

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

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

    International Nuclear Information System (INIS)

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

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

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

    2007-08-15

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

  1. Incidence, Clinical, Microbiological Features and Outcome of Bloodstream Infections in Patients Undergoing Hemodialysis

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    Fysaraki, Maria; Samonis, George; Valachis, Antonis; Daphnis, Eugenios; Karageorgopoulos, Drosos E.; Falagas, Matthew E.; Stylianou, Kostas; Diamantis P. Kofteridis

    2013-01-01

    Objectives: Infection is a common cause of death among hemodialysis patients. The study investigated incidence, risk factors, clinical features and outcome of bloodstream infections (BSIs) in haemodialysis patients.

  2. 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.

  3. Serum N-Glycan Profiling Predicts Prognosis in Patients Undergoing Hemodialysis

    OpenAIRE

    Shingo Hatakeyama; Maho Amano; Yuki Tobisawa; Tohru Yoneyama; Megumi Tsushima; Kazuko Hirose; Takahiro Yoneyama; Yasuhiro Hashimoto; Takuya Koie; Hisao Saitoh; Kanemitsu Yamaya; Tomihisa Funyu; Shin-Ichiro Nishimura; Chikara Ohyama

    2013-01-01

    Background. The aim of this study is to evaluate the usefulness of serum N-glycan profiling for prognosis in hemodialysis patients. Methods. Serum N-glycan analysis was performed in 100 hemodialysis patients in June 2008 using the glycoblotting method, which allows high-throughput, comprehensive, and quantitative N-glycan analysis. All patients were longitudinally followed up for 5 years. To evaluate the independent predictors for prognosis, patients' background, blood biochemistry, and N-gly...

  4. Pharmacokinetics of Ertapenem in Critically Ill Patients Receiving Continuous Venovenous Hemodialysis or Hemodiafiltration

    OpenAIRE

    Eyler, Rachel F.; Vilay, A. Mary; Nader, Ahmed M.; Heung, Michael; Pleva, Melissa; Sowinski, Kevin M; DePestel, Daryl D; Sörgel, Fritz; Kinzig, Martina; Mueller, Bruce A

    2014-01-01

    This study characterizes the pharmacokinetics of ertapenem, a carbapenem antibiotic, in critically ill adult subjects receiving continuous renal replacement therapy (CRRT). Eight critically ill patients with suspected/known Gram-negative infections receiving continuous venovenous hemodialysis (CVVHD) or continuous venovenous hemodiafiltration (CVVHDF) and ertapenem were enrolled. One gram of ertapenem was infused over 30 min. Predialyzer blood samples were drawn with the first dose of ertapen...

  5. Stabilizing Effects of Cool Dialysate Temperature on Hemodynamic Parameters in Diabetic Patients Undergoing Hemodialysis

    Directory of Open Access Journals (Sweden)

    Ghasemi Asghar

    2008-01-01

    Full Text Available 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 o C temperature dialysate solution. During the study, all the dialysis conditions were maintained the same except coo-ling the dialysate from 37 o C to 35°C. 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 temperature compared to cool dialysis. Maximum decrease of systolic, diastolic, and mean arterial pressure was observed during the third hour of dia-lysis and the 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 dialy-sis levels decreased significantly with cool and standard temperature dialysate (59 ± 5 vs. 37 ± 4, and 63 ± 7 vs. 41 ± 5, µmol/L respectively, P< 0.01. Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than in-creased serum nitric oxide levels may be involved in hemodialysis hypotension in this group of patients.

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

    Scientific Electronic Library Online (English)

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

    2012-02-01

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

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

    OpenAIRE

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

    2003-01-01

    Since heparin is an anticoagulant commonly used in hemodialysis and the patients on hemodialysis are repeatedly exposed to heparin, heparin may be the cause of the development of heparin-dependent antibodies and thrombotic complications in patients on hemodialysis. The purpose of this study was to determine the prevalence and the clinical significance of the antibodies against heparin-platelet factor 4 complexes as determined by enzyme immunoassay in patients on maintenance hemodialysis. The ...

  8. Hemodialysis-related headache.

    Science.gov (United States)

    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. PMID:24766311

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

    Directory of Open Access Journals (Sweden)

    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-1? (HIF-1?, 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-1? 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-1? and OSI correlated positively with TPX, but, negatively with TAC. In after-dialysis session, HIF-1? 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-1? and TAC at before- compared to after-dialysis levels.

  10. Hypercalcemia associated with eosinophilic myocarditis in a patient undergoing maintenance hemodialysis.

    Science.gov (United States)

    Tanaka, Ken-ichiro; Yano, Shozo; Okuyama, Keisuke; Sato, Masatake; Yamauchi, Mika; Yamaguchi, Toru; Tanabe, Kazuaki; Himeno, Yasutoshi; Sugimoto, Toshitsugu

    2012-01-01

    A 77-year-old man previously treated with maintenance hemodialysis was admitted due to appetite loss, nausea and shortness of breath. He showed progressive heart failure and eosinophilia without any basal disorders and was diagnosed with idiopathic hypereosinophilic syndrome (HES) accompanied by eosinophilic myocarditis. Laboratory data revealed hypercalcemia, a low serum parathyroid hormone level and a high 1,25(OH)(2)D concentration in spite of renal failure and no causal medications. Steroid therapy resulted in the patient's rapid recovery from heart failure, hypereosinophilia and hypercalcemia. Since the serum 1,25(OH)(2)D level promptly and markedly decreased, the hypercalcemia complicated with HES was most likely caused by extrarenal production of 1,25(OH)(2)D. PMID:23064567

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Scientific Electronic Library Online (English)

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

    2013-03-01

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

  13. Prevalence of hepatitis C in patients with renal disease undergoing hemodialysis treatment / Prevalência de hepatite C em pacientes com doença renal submetidos a tratamento hemodialítico

    Scientific Electronic Library Online (English)

    Marcos Frank, Bastiani; Graziella Gasparotto, Baiocco; Sandrine Comparsi, Wagner.

    2014-10-01

    Full Text Available Introdução e objetivo: Este trabalho teve como objetivo determinar a prevalência de hepatite C em 649 pacientes diagnosticados com doença renal aguda ou crônica ? eles se submeteram a tratamento hemodialítico em uma unidade de hemodiálise de um hospital de grande porte de Porto Alegre-RS, de janeir [...] o a dezembro de 2012 ?, bem como relacionar os dados encontrados com os apresentados no censo nacional, relatar casos de coinfecção de hepatite C e vírus da imunodeficiência humana (HIV) e, finalmente, conhecer o perfil demográfico dos pacientes. Método: Realizou-se um estudo observacional do tipo transversal cujos dados foram obtidos por meio de informações dos prontuários eletrônicos dos pacientes. Resultado e Conclusão: A prevalência de hepatite C encontrada no presente estudo foi de 10,17% da população amostrada. Entretanto, seriam necessárias mais análises em outros centros a fim de estimar a real prevalência para infecção pelo vírus da hepatite C em pacientes submetidos a hemodiálise em Porto Alegre. Abstract in english Introduction and Objective: This study aimed at determining the prevalence of hepatitis C among 649 patients diagnosed with chronic or acute kidney disease ? patients were undergoing hemodialysis treatment at a large hemodialysis center in Porto Alegre-RS, from January through December, 2012 –, as [...] well as relating our data to that presented in the national census, reporting cases of coinfection by hepatitis C and human immunodeficiency virus (HIV), and defining the demographic profile of these patients. Method: An observational cross-sectional study was conducted and data was obtained from information in patients’ electronic medical records. Result and conclusion: The prevalence of hepatitis C in this study was 10.17% of the sampled population. However, further analysis of other liver centers would be required to estimate an accurate prevalence rate of infection caused by the hepatitis C virus in patients undergoing hemodialysis in Porto Alegre.

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

    Directory of Open Access Journals (Sweden)

    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

  15. Total peroxyl radical-trapping capacity of plasma in patients undergoing regular hemodialysis treatment and kidney transplantation.

    Czech Academy of Sciences Publication Activity Database

    ?íž, Milan; Kubala, Lukáš; ?ížová, Hana; Soška, V.; ?erný, J.; Lojek, Antonín

    Roma, 2001. s. 87. [Meeting of the Society for Free Radical Research Europe SFRR 2001. 22.06.2001-24.06.2001, Roma] R&D Projects: GA ?R GA524/01/1219 Keywords : peroxyl radical-trapping * plasma * hemodialysis and kidney transplantation Subject RIV: BO - Biophysics

  16. HEMODIALYSIS MEMBRANES: PAST, PRESENT AND FUTURE TRENDS

    OpenAIRE

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

    2013-01-01

    Renal failure is one of the major health problems faced by many people all over the world. These patients choose either transplantation procedure or undergo hemodialysis. Approximately 28% people suffer from renal failures worldwide, among which a quarter are very critical. Patients who opt for hemodialysis have to undergo it regularly. The membranes used in hemodialysis are very vital. The first ever polymer used asan artificial hemodialysis membrane was collodion, which is a derivative of c...

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

    DEFF Research Database (Denmark)

    Henning, Bernhard F; Holzhausen, Helge

    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 measured PON activity in 377 hemodialysis patients photometrically using the substrates 4-nitrophenylacetate and phenylacetate. The PON ratio was calculated from 4-nitrophenylacetate-derived activity divided by phenylacetate-derived activity. Frequency distribution of the PON ratio showed three different PON phenotypes. 74% of hemodialysis patients showed PON phenotype 1, 21% PON phenotype 2, and 5% PON phenotype 3. Compared to hemodialysis patients with PON 1, patients with PON 2 or 3 showed higher conversion rates for 4-nitrophenylacetate. We observed a significant reduction of PON ratio with increasing dialysis vintage (P

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

    DEFF Research Database (Denmark)

    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 measured PON activity in 377 hemodialysis patients photometrically using the substrates 4-nitrophenylacetate and phenylacetate. The PON ratio was calculated from 4-nitrophenylacetate-derived activity divided by...

  19. Estudio descriptivo del uso de dosis única de heparina no fraccionada en pacientes en hemodiálisis. / Descriptive study using single dose of unfractionated heparin in patients undergoing hemodialysis

    Scientific Electronic Library Online (English)

    Gessica, Parvina De la O; César, Loza; Javier, Cieza.

    2011-07-01

    Full Text Available Objetivo: Evaluar la evolución de la anticoagulación con dosis única de heparina no fraccionada (HNF) de pacientes en hemodiálisis. Material y métodos: Evaluamos 31 pacientes en hemodiálisis crónica, quienes recibieron HNF 30 UI/Kg/hora en bolo único, obteniéndose una muestra de sangre al inicio, 5, [...] 60, 120 minutos y al final de la hemodiálisis, midiéndose el tiempo parcial de tromboplastina activada (TTP) en cada punto para determinar el nivel de anticoagulación. Resultados: La relación de TTP al inicio fue de 1,22 ± 0,49, de ellos, trece pacientes (41,94%) ingresaron con relación de TTP anormal. Los valores de relación de TTP en todos los pacientes a los 5’ y a los 60’ fueron mayores a 6,9 (TTP > 300 segundos); a los 120’ once de ellos (35,8%) presentaron valores de relación de TTP mayores a 6,9 y veinte pacientes (64,52%) tuvieron una media de 5,59 ± 1,35; estando todos por encima del rango terapéutico recomendado. Al final del procedimiento la media de la relación TTP fue 2,17 ± 0,75 y sólo 4 pacientes mostraron relación de TTP por debajo del rango terapéutico. Se evidenciaron dos episodios de hemorragia macroscópica sin complicaciones y no hubo variación en la reducción del volumen efectivo de los dializadores. Conclusión: El empleo de heparina no fraccionada en bolo único durante la hemodiálisis presenta una anticoagulación muy por encima de los valores terapéuticos y se prolongan hasta el final de la hemodiálisis; por lo que se recomienda el desuso de esta práctica.(Rev Med Hered 2011;22:103-107). Abstract in english Objective: To assess the evolution of anticoagulation with single dose of unfractionated heparin (UFH) in patients undergoing hemodialysis. Material and methods: We evaluated 31 patients undergoing chronic hemodialysis received one dose of UFH 30UI/Kg/hr, and got blood samples at 0, 5, 60, 120 minut [...] es and at the end of the hemodialysis to measure the activated tromboplastin time (aTPT) to monitor the anticoagulation. Results: The aTPT ratio at time 0 was 1.22 ± 0.49, from these, 13 patients (41.94%) started the hemodialysis with abnormal aTPT ratio. At 5’and 60’, all the patients showed values of aTPT ratio higher than 6.9 (aTPT > 300 seconds); at 120’ eleven of these (35.8%) had aTPT ratio higher than 6.9 and 20 patients (64.52%) showed an aTPT ratio of 5.59 ± 1.35; all of them over the recommended interval. At the end of the procedure, the mean of the aTPT ratio was 2.17 ± 0.75 and only 3 patients showed aTPT ratio under the anticoagulation interval. We observed two cases of macroscopic bleeding without complications, and there were no contraindications for the reuse of the dializers. Conclusion: The use of UFH in one bolus dose during hemodialysis showed anticoagulation levels higher than the upper limit of the therapeutic range, which persist up to the end of the procedure. It is recommended to stop the practice of this method.(Rev Med Hered 2011;22:103-107).

  20. Anticorpo contra o vírus C da hepatite em pacientes sob programa de hemodiálise em Salvador, BA, Brasil / Anti-HCV in patients undergoing hemodialysis in Salvador, BA, Brazil

    Scientific Electronic Library Online (English)

    Genoile Oliveira, SANTANA; Helma P., COTRIM; Eduardo, MOTA; Raymundo, PARANÁ; Nelma Pereira, SANTANA; Luiz, LYRA.

    2001-01-01

    Full Text Available Racional - A prevalência da infecção pelo vírus da hepatite C em pacientes sob programa de hemodiálise tem sido amplamente variável. Objetivos -- Determinar a prevalência do anticorpo contra o vírus C da hepatite (anti-VHC) em pacientes sob hemodiálise em Salvador, BA e sua associação com transfusão [...] de sangue, duração de hemodiálise e elevação de alaninoaminotransferase. Métodos - Durante um período de 17 meses, foram avaliados todos os pacientes em programa de hemodiálise, totalizando 395 indivíduos, que responderam a questionário e forneceram soro para análise laboratorial (alaninoaminotransferase sérica e anti-VCH pelo ELISA II com confirmação pelo Immunoblotting (RIBA III). Resultados - O anti-VHC foi positivo em 23,8% (94/395). A presença de transfusão mostrou associação com o anti-VHC e quanto maior o número de transfusões, mais freqüente o anti-VHC. Dos pacientes que nunca foram transfundidos, 12,5% (6/48) foram anti-VHC positivos. A duração do tratamento dialítico foi de 53,44 ± 36,45 meses no grupo anti-VHC positivo e de 22,10 ± 22,75 meses no grupo negativo. A elevação de alaninoaminotransferase foi mais freqüente no grupo positivo para o anti-VHC. A positividade para as frações do RIBA III foi de 79,8%, 100%, 80,9% e 52,1% para o c100-3, c33, c22 e NS5, respectivamente. O anti-NS5 foi ainda menos freqüente no grupo com alaninoaminotransferase elevada. Conclusões - A prevalência do anti-VHC em pacientes sob hemodiálise crônica de Salvador, BA é elevada e está associada com transfusão de sangue, maior duração de tratamento dialítico e elevação de alaninoaminotransferase. Abstract in english Background -- Hepatitis C infection in hemodialysis units has been evaluated in different grographic regions. Aims - The prevalence of anti-HCV in patients undergoing hemodialysis program in the city of Salvador, State of Bahia, Brazil, was studied and its association with transfusions, duration of [...] hemodialysis and ALT elevation. Method - During a period of 17 months, all patients undergoing dialytic treatment, were evaluated. The total number of patients was 395, all of whom completed a questionnaire and provided serum samples for laboratory analysis. Serological levels were measured for ALT and the samples were tested for anti-HCV using ELISA II with a further confirmation using RIBA III. Results - Anti-HCV was positive in 23,8% (94/395). The presence of transfusions was associated with anti-HCV and as the number of transfusions used increased, so did the frequency of anti-HCV. Of the patients who never received transfusions, 12,5% (6/48) were anti-HCV positive. The duration of dialytic treatment lasted from 53,44 ± 36,45 months in the anti-HCV positive group and 22,10 ± 22,75 months for the group testing negative. ALT elevation was more frequent in the anti-HCV positive group. Positivity for the RIBA III fractions was 79,8%, 100%, 80,9% and 52,1%, for c100-3, c33, c22 and NS5, respectively. The anti-NS5 was even less frequent in the group with elevated ALT. Conclusions - The prevalence of anti-HCV in patients undergoing chronic hemodialysis in Salvador, Bahia, is elevated and it is associated with transfusions, a longer duration of dialytic treatment and ALT elevation.

  1. Sclerosing peritonitis complicating continuous ambulatory peritoneal dialysis managed by hemodialysis and home parenteral nutrition.

    Science.gov (United States)

    Pearson, S; Jackson, M A; Rylance, P B

    2002-09-01

    A 47-year-old dialysis patient developed severe sclerosing peritonitis. The patient has been unable to take any nutrition by mouth for 27 months. She has been maintained daily on home parenteral nutrition and hemodialysis 3 times per week. It has been possible for her to have a good quality of life and to maintain good nutritional status. PMID:12356196

  2. 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; B?lá?ek, J.; Kurcová, I.; Komzák, O.; Šálek, T.; Latta, J.; Turek, R.; Bo?ek, R.; Ku?era, C.; Hubá?ek, J. A.; Fenclová, Z.; Pet?ík, V.; ?ermák, M.; Hovda, K. E.

    2014-01-01

    Ro?. 86, ?. 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

  3. Phosphate binders and metabolic acidosis in patients undergoing maintenance hemodialysis—sevelamer hydrochloride, calcium carbonate, and bixalomer.

    Science.gov (United States)

    Sanai, Toru; Tada, Hideo; Ono, Takashi; Fukumitsu, Toma

    2015-01-01

    The serum bicarbonate (HCO3(-)) levels are decreased in chronic hemodialysis (HD) patients treated with sevelamer hydrochloride (SH). We assessed the effects of bixalomer on the chronic metabolic acidosis in these patients. We examined 12 of the 122 consecutive Japanese patients with end-stage renal disease on HD, who orally ingested a dose of SH (?2250?mg), and an arterial blood gas analysis and biochemical analysis were performed before HD. Patients whose serum HCO3(-) levels were under 18?mmol/L were changed from SH to the same dose of bixalomer. A total of 12 patients were treated with a large amount of SH. Metabolic acidosis (a serum HCO3(-) level under 18?mmol/L) was found in eight patients. These patients were also treated with or without small dose of calcium carbonate (1.2?±?1.1?g). The dose of SH was changed to that of bixalomer. After 1 month, the serum HCO3(-) levels increased from 16.3?±?1.4 to 19.6?±?1.7?mmol/L (P?

  4. Avaliação nutricional de pacientes submetidos à hemodiálise em centros de Belo Horizonte / Nutritional assessment of patients undergoing hemodialysis at dialysis centers in Belo Horizonte, MG, Brazil

    Scientific Electronic Library Online (English)

    Gláucia Thaise Coimbra de, Oliveira; Eli Iola Gurgel, Andrade; Francisco de Assis, Acurcio; Mariângela Leal, Cherchiglia; Maria Isabel Toulson Davisson, Correia.

    2012-04-01

    Full Text Available OBJETIVO: O presente trabalho tem como objetivo caracterizar o estado nutricional de pacientes submetidos à hemodiálise em centros de diálise de Belo Horizonte por meio da Avaliação Global Subjetiva (AGS) e associá-lo a variáveis socioeconômicas, sociodemográficas e clínicas. MÉTODOS: Foram avaliado [...] s 575 pacientes em 12 centros de diálise de Belo Horizonte. As variáveis socioeconômicas, sociodemográficas e clínicas foram coletadas em entrevistas por meio de questionários especificamente desenvolvidos para tal. O modelo de regressão logística foi utilizado para verificar o efeito ou influência de cada variável no estado nutricional. RESULTADOS: A prevalência de desnutrição foi significante (19,5%). A população avaliada apresentou, de modo geral, baixo nível socioeconômico, acesso limitado aos serviços de saúde particulares, alta taxa de comorbidades associadas e recebimento de grande número de recomendações nutricionais, não necessariamente adequadas. A idade > 60 anos, a renda igual ou inferior a um salário mínimo, a presença de depressão e o fato de ser aposentado foram fatores de risco para desnutrição, de acordo com a análise multivariada. CONCLUSÃO: A desnutrição é prevalente entre pacientes submetidos a hemodiálise. As diferenças nas características socioeconômicas, sociodemográficas, gerais e clínicas podem ser utilizadas para identificar pacientes que demandam mais atenção, em termos de risco para desnutrição - nesse caso, os idosos, os aposentados, aqueles com depressão e com baixo nível socioeconômico. Abstract in english OBJECTIVE: This study aims to assess the nutritional status of patients undergoing hemodialysis at dialysis centers in Belo Horizonte, MG, Brazil using the Subjective Global Assessment (SGA), and associate it with socioeconomic, demographic and clinical variables. METHODS: A total of 575 patients we [...] re evaluated at 12 dialysis centers in Belo Horizonte, MG, Brazil. Socioeconomic, demographic, and clinical variables were gathered through interviews using a questionnaire specifically developed for this purpose. The logistic regression model was used to determine the effect or influence of each variable on the nutritional status. RESULTS: Malnutrition was significantly prevalent (19.5%). Generally, the study population had low socioeconomic status, limited access to private health services, high rate of comorbidities, and received a large number of dietary recommendations, which were not necessarily appropriate. According to multivariate analysis, the risk factors for malnutrition were age over 60 years, family income at or below one minimum wage, presence of depression, and retirement. CONCLUSION: Malnutrition is prevalent among patients undergoing hemodialysis. Differences in socioeconomic, demographic, clinical, and general characteristics can be used to identify patients who require more attention due to the risk of malnutrition, particularly in the elderly, retirees, and those with depression and low socioeconomic status.

  5. Avaliação nutricional de pacientes submetidos à hemodiálise em centros de Belo Horizonte Nutritional assessment of patients undergoing hemodialysis at dialysis centers in Belo Horizonte, MG, Brazil

    Directory of Open Access Journals (Sweden)

    Gláucia Thaise Coimbra de Oliveira

    2012-04-01

    Full Text Available OBJETIVO: O presente trabalho tem como objetivo caracterizar o estado nutricional de pacientes submetidos à hemodiálise em centros de diálise de Belo Horizonte por meio da Avaliação Global Subjetiva (AGS e associá-lo a variáveis socioeconômicas, sociodemográficas e clínicas. MÉTODOS: Foram avaliados 575 pacientes em 12 centros de diálise de Belo Horizonte. As variáveis socioeconômicas, sociodemográficas e clínicas foram coletadas em entrevistas por meio de questionários especificamente desenvolvidos para tal. O modelo de regressão logística foi utilizado para verificar o efeito ou influência de cada variável no estado nutricional. RESULTADOS: A prevalência de desnutrição foi significante (19,5%. A população avaliada apresentou, de modo geral, baixo nível socioeconômico, acesso limitado aos serviços de saúde particulares, alta taxa de comorbidades associadas e recebimento de grande número de recomendações nutricionais, não necessariamente adequadas. A idade > 60 anos, a renda igual ou inferior a um salário mínimo, a presença de depressão e o fato de ser aposentado foram fatores de risco para desnutrição, de acordo com a análise multivariada. CONCLUSÃO: A desnutrição é prevalente entre pacientes submetidos a hemodiálise. As diferenças nas características socioeconômicas, sociodemográficas, gerais e clínicas podem ser utilizadas para identificar pacientes que demandam mais atenção, em termos de risco para desnutrição - nesse caso, os idosos, os aposentados, aqueles com depressão e com baixo nível socioeconômico.OBJECTIVE: This study aims to assess the nutritional status of patients undergoing hemodialysis at dialysis centers in Belo Horizonte, MG, Brazil using the Subjective Global Assessment (SGA, and associate it with socioeconomic, demographic and clinical variables. METHODS: A total of 575 patients were evaluated at 12 dialysis centers in Belo Horizonte, MG, Brazil. Socioeconomic, demographic, and clinical variables were gathered through interviews using a questionnaire specifically developed for this purpose. The logistic regression model was used to determine the effect or influence of each variable on the nutritional status. RESULTS: Malnutrition was significantly prevalent (19.5%. Generally, the study population had low socioeconomic status, limited access to private health services, high rate of comorbidities, and received a large number of dietary recommendations, which were not necessarily appropriate. According to multivariate analysis, the risk factors for malnutrition were age over 60 years, family income at or below one minimum wage, presence of depression, and retirement. CONCLUSION: Malnutrition is prevalent among patients undergoing hemodialysis. Differences in socioeconomic, demographic, clinical, and general characteristics can be used to identify patients who require more attention due to the risk of malnutrition, particularly in the elderly, retirees, and those with depression and low socioeconomic status.

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

    Directory of Open Access Journals (Sweden)

    Krotin Mirjana

    2007-01-01

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

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

    DEFF Research Database (Denmark)

    Pakpour, Amir H.; Zedi, Isa mohammadi

    2011-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2011-03-01

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

  9. Methicillin-Resistant Staphylococcus aureus USA300 Latin American Variant in Patients Undergoing Hemodialysis and HIV Infected in a Hospital in Bogotá, Colombia

    Science.gov (United States)

    Hidalgo, Marylin; Carvajal, Lina P.; Rincón, Sandra; Faccini-Martínez, Álvaro A.; Tres Palacios, Alba A.; Mercado, Marcela; Palomá, Sandra L.; Rayo, Leidy X.; Acevedo, Jessica A.; Reyes, Jinnethe; Panesso, Diana; García-Padilla, Paola; Alvarez, Carlos; Arias, Cesar A.

    2015-01-01

    We aimed to determine the prevalence of MRSA colonization and examine the molecular characteristics of colonizing isolates in patients receiving hemodialysis and HIV-infected in a Colombian hospital. Patients on hemodialysis and HIV-infected were prospectively followed between July 2011 and June 2012 in Bogota, Colombia. Nasal and axillary swabs were obtained and cultured. Colonizing S. aureus isolates were identified by standard and molecular techniques. Molecular typing was performed by using pulse-field gel electrophoresis and evaluating the presence of lukF-PV/lukS-PV by PCR. A total of 29% (n = 82) of HIV-infected and 45.5% (n = 15) of patients on hemodialysis exhibited S. aureus colonization. MSSA/MRSA colonization was observed in 28% and 3.6% of the HIV patients, respectively and in 42.4% and 13.3% of the hemodialysis patients, respectively. Staphylococcal cassette chromosome mec typing showed that four MRSA isolates harbored the type IV cassette, and one type I. In the hemodialysis group, two MRSA isolates were classified as belonging to the USA300-LV genetic lineage. Conversely, in the HIV infected group, no colonizing isolates belonging to the USA300-Latin American Variant (UDA300-LV) lineage were identified. Colonizing isolates recovered from the HIV-infected group belonged to the prevalent hospital-associated clones circulating in Latin America (Chilean [n = 1] and Pediatric [n = 2]). The prevalence of MRSA colonization in the study groups was 3.6% (HIV) and 13.3% (hemodialysis). Surveillance programs should be implemented in this group of patients in order to understand the dynamics of colonization and infection in high-risk patients. PMID:26474075

  10. Influence of Continuous Nursing on the Psychological State and Coping Style of Patients Undergoing Pacemaker Implantation

    Directory of Open Access Journals (Sweden)

    Xin LIU

    2015-10-01

    Full Text Available Background: Patients undergoing pacemaker implantation often experience anxiety and fear. As such, studies have focused on the mechanisms that relieve the negative emotions caused by the intervention. Continuous nursing is a safe and effective nursing mode. In this study, continuous nursing intervention was provided for elderly patients undergo-ing pacemaker implantation and an empirical investigation was performed to determine the effects of their negative emotion and disease-coping ability.Methods: Overall, 114 (68 males and 46 females elderly patients who were undergoing pacemaker implantation from Harbin City (China, were enrolled in the study. The patients were divided into two groups, namely, the control group and the intervention group, based on different nursing methods. Routine nursing was applied to the control group; continuous nursing support was provided for the intervention group from January 2014 to January 2015. The nursing results of the two groups were compared. These results were also evaluated using self-rating depression scale, self-rating anxiety scale, and trait coping style questionnaire.Result: The effects of depression and anxiety intervention were significant in the intervention group (P<0.05. Com-pared with the control group, the intervention group did not significantly differ. The coping style of the intervention group elicited significant effects. Compared with the control group, the intervention group was significantly different (P < 0.05.Conclusion: Continuous nursing can relieve the negative emotion and improve the negative coping style of patients undergoing pacemaker implantation.

  11. Clinical study of cerebral infarction in hemodialysis patients

    International Nuclear Information System (INIS)

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

  12. Music for Hemodialysis patients

    DEFF Research Database (Denmark)

    Gross, B; Ketema Wassie, F; Agnholt, Hanne; Bjerre, R; Laursen, Birgitte Schantz

    2010-01-01

    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 d...

  13. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    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.

  14. Dissecting aortic aneurysm in maintenance hemodialysis patients

    OpenAIRE

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

    2009-01-01

    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.

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

    OpenAIRE

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

    2010-01-01

    INTRODUCTION: Vitamin D3 has diverse biological effects extending beyond the maintenance of calcium and phosphorus homeostasis and ensuring the proper functioning of the body. OBJECTIVES: This study evaluated the levels of vitamin D3 and its association with nutritional status, immunological activity, and selected markers of cardiovascular disease in patients on long?term hemodialysis (HD). PATIENTS AND METHODS: We measured 25?hydroxyvitamin D3 (25(OH)D3) levels in a group of 84 patients (mea...

  16. HEMODIALYSIS MEMBRANES: PAST, PRESENT AND FUTURE TRENDS

    Directory of Open Access Journals (Sweden)

    Gautham A

    2013-06-01

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

  17. Pregnancy in women undergoing hemodialysis: case series in a Southeast Brazilian reference center / Gestação em mulheres em tratamento hemodialítico: série de casos em um centro de referência do Sudeste do Brasil

    Scientific Electronic Library Online (English)

    Maria Beatriz Bracco, Suarez; Maria Laura, Costa; Mary Ângela, Parpinelli; Fernanda Garanhani, Surita.

    2015-01-01

    Full Text Available OBJETIVOS: Descrever os resultados maternos e neonatais de mulheres grávidas que estavam em tratamento de hemodiálise em um centro de referência no Sudeste brasileiro. MÉTODOS: Estudo retrospectivo e descritivo, com revisão de prontuários de todas as gestações em hemodiálise, acompanhadas no p [...] ré-natal especializado da região Sudeste do Brasil. RESULTADOS: Entre as 16 mulheres identificadas, 2 foram excluídas devido à perda de seguimento. Das 14 descritas, a hipertensão foi a causa mais frequente de insuficiência renal crônica (50% dos casos). A maioria (71,4%) realizava tratamento de hemodiálise há mais de um ano e todas elas foram submetidas a 5 ou 6 sessões por semana. Onze mulheres tinham hipertensão crônica, 1 das quais também era diabética, e 6 eram fumantes. Em relação às complicações da gravidez, 1 das mulheres hipertensas desenvolveu hipertensão maligna (com restrição de crescimento fetal e parto prematuro com 29 semanas), 2 tiveram edema pulmonar agudo e 2 apresentaram descolamento prematuro de placenta. O tipo de parto foi cesariana em 9 mulheres (64,3%). Todos os recém-nascidos tiveram Apgar aos cinco minutos maior que 7. CONCLUSÕES: Para melhorar os resultados perinatais e maternos de mulheres em hemodiálise, é importante ter uma abordagem multidisciplinar em centro de referência, um controle rigoroso da uremia, hemoglobina e pressão arterial materna, bem como acompanhar de perto o bem-estar fetal e a morbidade materna. Outra estratégia importante é a orientação adequada para contracepção nessas mulheres. Abstract in english PURPOSE: To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side. METHODS: Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clin [...] ic of high- risk prenatal care in Southeast Brazil. RESULTS: Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7. CONCLUSIONS: To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women.

  18. Pets are ‘risky business’ for patients undergoing continuous ambulatory peritoneal dialysis

    OpenAIRE

    Al-Fifi, Yahya Salim Yahya; Sathianathan, Chris; Murray, Brenda-Lee; Alfa, Michelle J

    2013-01-01

    The authors report the first case in Manitoba of a patient undergoing continuous ambulatory peritoneal dialysis who experienced three successive infections with Pasteurella multocida and Capnocytophaga species over an eight-month period. These zoonotic infections were believed to originate from contact with the patient’s household pets. To prevent such infections, the authors recommend the development and implementation of hygiene guidelines outlining the risks associated with owning domestic...

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

    Scientific Electronic Library Online (English)

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

    2010-06-01

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

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

    Scientific Electronic Library Online (English)

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

    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. Abstract in english Background: The cardiovascular diseases constitutes the main one of cause of mortality in patient in hemodialysis and the main one predict is the hypertension still before that the dislipemia and the consumption of tobacco. Objective: Describe the prevalence and risk factors of hypertension among pa [...] tients on chronic hemodialysis. Methods: A transversal descriptive study was carried out in 22 patients with chronic kidney diseases in the nephrological service of Augusto Cesar Sandino Teaching Hospital of Pinar del Rio City, since June to December, 2009. Variables such as: age, etiology of the chronic renal failure, time elapsed in hemodialysis were included in the study. Information was gathered through surveys and from the morbimortality book of the nephrology unit. The statistical analysis of frequency distribution was used for each category of variables. The independence test was also used to test the association of variable null hypothesis. The level of significance was set at á = 0.05. Results: The age average went of 53 years with a half prior time in hemodialysis of 57 months. Among the main causes by which they arrived at the processing purifier the patient were the done not relate to the diabetes mellitus in the 86, 4 %. In 14 patients (63, 6%) history was collected of hypertension prediálisis and in hemodialysis. The analysis multivariado showed that the hypertension was associated with the age advanced, the average time of life in hypertension and the presence of diabetes mellitus. Conclusions: The hypertension is highly prevalence among patient in hypertension chronic and this associate to the hipervolemia, the hypertension and the diabetes mellitus.

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

    Directory of Open Access Journals (Sweden)

    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 hypertension among patients on chronic hemodialysis. Methods: A transversal descriptive study was carried out in 22 patients with chronic kidney diseases in the nephrological service of Augusto Cesar Sandino Teaching Hospital of Pinar del Rio City, since June to December, 2009. Variables such as: age, etiology of the chronic renal failure, time elapsed in hemodialysis were included in the study. Information was gathered through surveys and from the morbimortality book of the nephrology unit. The statistical analysis of frequency distribution was used for each category of variables. The independence test was also used to test the association of variable null hypothesis. The level of significance was set at á = 0.05. Results: The age average went of 53 years with a half prior time in hemodialysis of 57 months. Among the main causes by which they arrived at the processing purifier the patient were the done not relate to the diabetes mellitus in the 86, 4 %. In 14 patients (63, 6% history was collected of hypertension prediálisis and in hemodialysis. The analysis multivariado showed that the hypertension was associated with the age advanced, the average time of life in hypertension and the presence of diabetes mellitus. Conclusions: The hypertension is highly prevalence among patient in hypertension chronic and this associate to the hipervolemia, the hypertension and the diabetes mellitus.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-10-15

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

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

    International Nuclear Information System (INIS)

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

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

    DEFF Research Database (Denmark)

    Crawford, M E; Møiniche, S; Orbæk, Janne; Bjerrum, H; Kehlet, H

    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 measured at supine rest, during orthostatic stress, and after walking prior to and 24, 48, and 72 h and 48 h postoperatively compared to preoperatively (P < or = 0.008); 16 vs 6 patients presented resting...

  5. Home Hemodialysis

    Science.gov (United States)

    ... if the patient can do all the tasks alone. New machines for home hemodialysis are smaller and easier to use. The ... for daily home HD will be covered. Nightly home HD can be done three times per week and can be paid for by Medicare alone. [ Top ] Points to Remember New, smaller dialysis machines ...

  6. Depression in hemodialysis patients

    International Nuclear Information System (INIS)

    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)

  7. Evaluation of Bone Mineral Density in Hemodialysis Patients

    OpenAIRE

    Mukadder Ay?e Bilgiç; Oya Özdemir

    2010-01-01

    Objective: Low bone mass in end-stage renal disease patients, especially those undergoing hemodialysis, can lead to serious health problems such as fragility fractures and may have negative impact on their quality of life. The aim of this study was to determine bone mineral density (BMD) in a group of hemodialysis patients and to evaluate its relationship with several clinical parameters and markers of biochemical bone turnover.Materials and Methods: Thirty hemodialysis patients, with a mean ...

  8. Thrombocytopenia in the Setting of Hemodialysis Using Biocompatible Membranes

    OpenAIRE

    Kathryn B. Muir; Packer, Clifford D

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Azar Baradaran

    2005-11-01

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

  10. Diagnósticos de Enfermería en Pacientes Sometidos a Hemodiálisis / Nursing Diagnoses in Patients Undergoing Hemodialysis / Diagnósticos de enfermagem em pacientes submetidos à hemodiálise

    Scientific Electronic Library Online (English)

    Vanessa de Brito, Poveda; Juliana da Silva, Alves; Elaine de Freitas, Santos; Alessandra, Garcia Emerick Moreira.

    2014-04-01

    Full Text Available Objetivo: determinar os diagnósticos de enfermagem mais frequentes em pacientes submetidos a tratamento hemodialítico, baseados na nomenclatura da North American Nursing Diagnosis Association-Internacional (NANDA-I) 2009-2011. Método: trata-se de estudo quantitativo, do tipo descritivo exploratório, [...] realizado em uma clínica de hemodiálise no interior do estado de São Paulo, com uma amostra de 50 pacientes. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade do Vale do Paraíba sob número H236/CEP/2009. Resultados: foram identificados 24 diagnósticos mais frequentes, sendo seis encontrados em 100% da amostra estudada: eliminação urinária prejudicada, integridade da pele prejudicada, risco de infecção, risco de perfusão renal ineficaz, mobilidade física prejudicada e risco de desequilíbrio eletrolítico. Conclusão: o estabelecimento dos diagnósticos de enfermagem comuns aos sujeitos submetidos a hemodiálise auxiliará o profissional de enfermagem envolvido no atendimento aos pacientes renais crônicos, fornecendo ferramentas para o planejamento da assistência. Abstract in spanish Objetivo: Determinar los más comunes diagnósticos de enfermería en pacientes sometidos a tratamiento de hemodiálisis, basados en la nomenclatura de la North American Nursing Diagnosis Association - International (NANDA-I) 2009-2011. Método: Este es un estudio cuantitativo, de tipo descriptivo explor [...] atorio, realizado en una clínica de hemodiálisis en el estado de São Paulo, Brasil, con una muestra de 50 pacientes. El estudio fue aprobado por el Comité de Ética de la Investigación de la Universidad del Vale do Paraíba, bajo el protocolo Nº H236/CEP/2009. Resultados: Se identificaron 24 diagnósticos más frecuentes, seis de los cuales se encontraron en 100% de la muestra estudiada; estos eran: eliminación urinaria afectada; integridad de la piel afectada; riesgo de infección; riesgo de perfusión renal ineficaz; movilidad física reducida; y riesgo de desequilibrio electrolítico. Conclusión: La determinación de los diagnósticos de enfermería comunes en los sujetos sometidos a hemodiálisis ayudará a los profesionales de enfermería en la atención a los pacientes renales crónicos proporcionando herramientas para la planificación de la asistencia. Abstract in english Objective: To determine the most common nursing diagnoses in patients under hemodialysis treatment, based on the nomenclature of the North American Nursing Diagnosis Association -International (NANDA-I) 2009-2011. Method: This is a quantitative, descriptive and exploratory study, accomplished in a h [...] emodialysis clinic in the State of São Paulo, Brazil, with a sample of 50 patients. The study was approved by the Committee of Ethics in Research of the University of Vale do Paraíba, under protocol No. H236/CEP/2009. Results: We identified 24 most frequent diagnoses, of which six were found in 100% of the sample studied; they were: impaired urinary elimination; impaired skin integrity; risk of infection; risk of ineffective renal perfusion; impaired physical mobility; and risk of electrolyte imbalance. Conclusion: Determining nursing diagnoses common to subjects submitted to hemodialysis will help nursing professionals deal with chronic renal patients care by providing tools for planning assistance.

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

    Directory of Open Access Journals (Sweden)

    Khawaja AR

    2013-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2010-12-01

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

  13. A equipe de saúde, a pessoa com doença renal em hemodiálise e suas relações interpessoais / The professional health team, the renal patient undergoing hemodialysis and interpersonal relationships / El equipo de salud, el enfermo renal en hemodialisis y sus relaciones personales

    Scientific Electronic Library Online (English)

    Claudinei José Gomes, Campos; Egberto Ribeiro, Turato.

    2003-10-01

    Full Text Available Na literatura científica, discussões amplas sobre a relação entre equipe de saúde e doentes renais apresentam singularidades relativas à formação profissional e ao tratamento. Analisamos do ponto de vista do doente em hemodiálise, o atendimento dos profissionais de saúde e suas relações interpessoai [...] s. Utilizando o método clfnico­qualitativo, realizamos entrevistas semi­estruturadas com sete pacientes de uma unidade de hemodiálise, escolhidos numa amostragem intencional. Tratamos os dados coletados através da técnica de análise de conteúdo temática. Concluímos que os pacientes desejam ser mais ouvidos pela equipe em seus anseios, os quais vão além das expectativas de ordem fisica. A assistência clínica mostrou-se mais voltada aos aspectos biológicos do paciente e aos procedimentos mecãnicos, ocorrendo certa indiscriminação entre relacionamento humano e competência técnica. Abstract in spanish En la literatura científica, las amplias díscusíones sobre la relacíón entre equipo de salud y enfermos renales presentan singularidades relativas a la formación profesional y ai tratamiento. Analizamos, pues, bajo el punto de vista dei enfermo en hemodiálisis, la atención de los profesionales ç/e s [...] alud y sus relaciones interpersonales. Hemos utilizado el método clínico-calitativo, con entrevistas semi-estructuradas hechas a siete pacientes de una unidad de hemodiálisis, quienes se escogieron por muestreo intencional. Hemos tratado los datas recogidos, a través dei análisis de contenido temático. La conclusión muestra que los pacientes desean que el equipo dé más atención a sus anhelos, que los escuchen más en sus expectaciones que están más aliá dei aspecto físico. La asistencia clínica se ha volcado más hacia los aspectos biológicos dei paciente y aios procedimientos mecánicos, y ha ocurrido eon el/o, cierta indiscriminación entre el relacionamiento humano y la competeneia técnica. Abstract in english Comprehensive discussions in scientific Iiterature on the relationship between health professionals teams and renal patients present some particularitíes regarding professional background and the health care provided. In this paper we have analyzed the kind of care health professionals provide and t [...] heir interpersonal relationships from the point of view of patients undergoing hemodialysis. Interviews were made using a clínical­qualítative method, consisting of semistructured interviews with seven patients in a hemodialysis unít, who were chosen through an intentional sampling. The data selected were assessed on a thematic content analysis. We have found that patients wish the health care team would listen to their concerns more carefully. which go beyond physical aspects. The clinical care provided has proved to be more focused on biological aspects of patients and on mechanical procedures, showing a considerable degree of carelessness about how human relationships and technical competency differ.

  14. The adaptation problems of patients undergoing hemodialysis: socio-economic and clinical aspects / Problemas adaptativos de pacientes en hemodiálisis: aspectos socioeconómicos y clínicos / Problemas adaptativos de pacientes em hemodiálise: aspectos socioeconômicos e clínicos

    Scientific Electronic Library Online (English)

    Cecília Maria Farias de Queiroz, Frazão; Jéssica Dantas de, Sá; Ana Beatriz de Almeida, Medeiros; Maria Isabel da Conceição Dias, Fernandes; Ana Luisa Brandão de Carvalho, Lira; Marcos Venícios de Oliveira, Lopes.

    2014-12-01

    Full Text Available OBJETIVOS: identificar os problemas adaptativos de Roy em pacientes submetidos a hemodiálise e correlacioná-los aos aspectos socioeconômicos e clínicos. MÉTODO: estudo transversal, realizado através de um formulário. A amostra foi de 178 indivíduos. Efetuaram-se os testes qui-quadrado e U de M [...] ann-Whitney. RESULTADOS: os problemas adaptativos e os aspectos socioeconômicos e clínicos que apresentaram associações estatísticas foram: hipercalemia e idade; edema e renda; deficiência de um sentido primário: tátil e renda; falha no papel e idade; disfunção sexual e estado civil e sexo; deficiência de um sentido primário: visão e anos de estudo; intolerância à atividade e anos de estudo; dor crônica e sexo e anos de estudo; integridade da pele prejudicada e idade; hipocalcemia e acesso; potencial para lesão e idade e anos de estudo; nutrição menor que as necessidades do organismo e idade; deficiência de um sentido primário: audição e sexo e avaliação cinética da ureia; mobilidade andar e/ou coordenação restritas e meses de hemodiálise e perda de habilidade de autocuidado e meses de hemodiálise e meses de doença. CONCLUSÃO: problemas adaptativos da clientela hemodialítica podem sofrer influências de dados socioeconômicos/clínicos. Tais achados contribuem para o desenvolvimento da profissão, proporcionando reflexão por parte do enfermeiro acerca do cuidado. Abstract in spanish OBJETIVOS: identificar los problemas adaptativos de Roy en pacientes sometidos a hemodiálisis y correlacionarlos a los aspectos socioeconómicos y clínicos. MÉTODO: estudio transversal, realizado a través de un formulario. La muestra fue de 178 individuos. Se efectuaron las pruebas Chi-cuadrado [...] y U de Mann-Whitney. RESULTADOS: los problemas adaptativos y los aspectos socioeconómicos y clínicos que presentaron asociaciones estadísticas fueron: Hiperkalemia y edad; Edema y renta; Deficiencia de un sentido primario: táctil y renta; Fracaso en el papel y edad; Disfunción sexual y estado civil y sexo; Deficiencia de un sentido primario: visión y años de estudio; Intolerancia a la actividad y años de estudio; Dolor crónico y sexo y años de estudio; Integridad de la piel perjudicada y edad; Hipocalcemia y acceso; Potencial para lesión y edad y años de estudio; Nutrición menor que las necesidades del organismo y edad; Deficiencia de un sentido primario: audición y sexo y evaluación cinética de la urea; Movilidad andar y/o coordinación restringidas y meses de hemodiálisis; y, Pérdida de habilidad de autocuidado y meses de hemodiálisis y meses de enfermedad. CONCLUSIÓN: los problemas adaptativos de la clientela hemodialítica pueden sufrir influencias de datos socioeconómicos/clínicos. Esos hallazgos contribuyen para el desarrollo de la profesión, permitiendo la reflexión del enfermero acerca del cuidado. Abstract in english OBJECTIVES: to identify adaptation problems under Roy's Model in patients undergoing hemodialysis and to correlate them with the socioeconomic and clinical aspects. METHOD: a transversal study, undertaken using a questionnaire. The sample was made up of 178 individuals. The Chi-squared and Man [...] n-Whitney U tests were undertaken. RESULTS: the adaptation problems and the socioeconomic and clinical aspects which presented statistical associations were: Hyperkalemia and age; Edema and income; Impairment of a primary sense: touch and income; Role failure and age; Sexual dysfunction and marital status and sex; Impairment of a primary sense: vision and years of education; Intolerance to activity and years of education; Chronic pain and sex and years of education; Impaired skin integrity and age: Hypocalcemia and access; Potential for injury and age and years of education; Nutrition below the organism's requirements and age; Impairment of a primary sense: hearing and sex and kinetic evaluation of urea; Mobility in gait and/or coordination restricted, and months of hemodialysis; and, Loss of ability for self-care, and months of hemodialysis and

  15. Life Quality of Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Noorallah Tahery

    2013-05-01

    Full Text Available Introduction: Patients with chronic and advanced kidney failure undergo hemodialysis treatment and because of various drug therapies have basic problems in their life style which affects their psychosocial operation. The purpose of this study was to determine the hemodialysis patients’ quality of life in Abadan and Khorramshahr in 2011. Methods: This is a cross - sectional study in which all patients (80 cases referring to Abadan and Khorramshahr hemodialysis clinics completed a questionnaire which included two sections of demographic data and kidney diseases quality of life (KDQOL. Data analysis was done using SPSS-17 software and statistical tests such as ANOVA, Pearson correlation coefficient, and Independent T test were used. Results: The mean score of life quality of the participants was 47.22 ± 8.82 which indicates their low quality of life. Result showed that between quality of life and age (P = 0.04 & r = 0.5 and ESRD patience period (P=0.03 & r= 0.23, there exists a statistically significant relationship. A positive and significant association was also observed between education and quality of life (p= 0.003 and between income level and quality of life (P<0.0001. Conclusion: Life quality of Hemodialysis patients is low and authorities need to provide these patients with more social support and see into their welfare.

  16. Headache associated with hemodialysis

    Directory of Open Access Journals (Sweden)

    Niki? Petar M.

    2008-01-01

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

  17. [Management of iodine-131 ablation therapy for thyroid carcinoma in a patient on chronic hemodialysis].

    Science.gov (United States)

    Zenasni, Nadia; Elkhayat, Salma; Taleb, Sara; Zamd, Mohammed; Medkouri, Ghizlaine; Benghanem Gharbi, Mohammed; Ramdani, Benyounes; Aschawa, Hind; Guensi, Amal

    2015-04-01

    Iodine-131 ablation therapy for thyroid cancer in the patient on chronic hemodialysis represents a real problem since the main route of elimination of radioiodine is urinary. There is no recommendation on the management of this treatment in the patient on hemodialysis. We report our experience of management of this treatment in a patient aged 38 years, undergoing hemodialysis for chronic renal failure, and who have been indicated the treatment with iodine-131 for papillary thyroid carcinoma high risk. After multidisciplinary discussions (nephrologists and specialists in nuclear medicine and radiation safety), it has been decided to treat the patient with continuous ambulatory peritoneal dialysis therapy (CAPD). Because of the low but continuous elimination of iodine in the case of CAPD, the patient received a reduced ablative (131)I dose of 1850 MBq, which is 30% of the usual dose delivered in subjects with normal renal function. The patient was hospitalized for four days in nuclear medicine unit and the (131)I radioactivity emitted from him was 2.5 ?Sv/h at one meter at his hospital discharge. In conclusion, CAPD in relay of hemodialysis is a technique of renal replacement therapy that can be suggested to minimize exposure to radioactivity to the patient, his family and the medical staff. PMID:25709102

  18. Associação entre qualidade de vida e estado nutricional em pacientes renais crônicos em hemodiálise / Association between the level of quality of life and nutritional status in patients undergoing chronic renal hemodialysis

    Scientific Electronic Library Online (English)

    Ana Carolina Bonelá dos, Santos; Manuela do Carmo, Machado; Luciene Rabelo, Pereira; Juliana Lemos Pratti, Abreu; Marisa Barbosa, Lyra.

    2013-12-01

    Full Text Available INTRODUÇÃO: A Doença Renal Crônica (DRC) e a hemodiálise (HD) provocam limitações na vida dos pacientes, interferindo na qualidade de vida e o cuidado nutricional é fundamental para no tratamento da doença. OBJETIVO: O objetivo da pesquisa é analisar a associação entre qualidade de vida com o uso do [...] instrumento SF-36 com consumo alimentar, estado nutricional em pacientes com DRC em HD por meio de pesquisa quantitativa e transversal. MÉTODOS: Realizou-se avaliação antropométrica, coleta dos resultados de exames bioquímicos, aplicação do questionário SF-36 e anamnese alimentar (recordatório alimentar de 24h). RESULTADOS: A amostra foi composta por 30 pacientes adultos com idade entre 28 a 76 anos. A doença relacionada com DRC mais encontrada foi hipertensão arterial sistêmica (53,3%), a média do Índice de Massa Corporal foi 25,04 ± 4,50 kg/m². Pela dobra cutânea do braço, 73,3% estavam em desnutrição. O diagnóstico nutricional final foi 80% de desnutrição entre os pacientes estudados. O tempo de diagnóstico de doença renal teve média de 4,84 ± 3,51 anos. Pela média dos exames bioquímicos, somente fósforo 5,51 ± 1,61 mg/dl e creatinina 10,84 ± 3,33 mg/dl estavam adequados. Nas médias das pontuações do SF-36, o menor valor encontrado foi para limitação por aspectos físicos (16,67 ± 29,60) e o maior para aspectos sociais (68,17 ± 33,67). CONCLUSÃO: O consumo energético e proteico médio esteve abaixo do recomendado. Obteve-se correlação positiva do consumo calórico, proteico, fibra, cálcio e carboidrato com qualidade de vida. Conclui-se, então, que a alimentação está associada à qualidade de vida do paciente renal hemodialítico. Abstract in english INTRODUCTION: The chronic kidney disease and undergoing hemodialysis (HD) cause limitation in patients' life interfering in their life's quality and the nutritional care is fundamental to the disease treatment. OBJECTIVE: The objective is the goal is to analyze the association between quality of lif [...] e through the instrument (SF-36) with dietary intake, nutritional status in patients with chronic kidney disease in HD through quantitative research and transversal. METHODS: Realized valuation anthropometric, collection of the results of biochemical tests, application of the questionnaire SF-36 and dietary anamnesis (food recall of 24h). RESULTS: The sample consisted of thirty adult patients with age between 28 to 76 years. The disease related with chronic kidney disease was found more hypertension systemic arterial (53.3%) The average body mass index was 25.04 ± 4.50 kg/m². By fold cutaneous arm, 73.3% were in malnutrition. The end nutritional diagnosis of malnutrition was 80% among the patients studied. The time of diagnosis of renal disease had a mean of 4.84 ± 3.51 years. By the middle of biochemical tests only phosphorus creatinine were adequate. In the mean the scores of SF-36 the lowest value found was limited to physical aspects (16.67 ± 29.60) and the largest for the social aspect (68.17 ± 33.67). CONCLUSION: The average energy consumption and protein was below the recommended. Got positive correlation of calories, protein, fiber, calcium and carbohydrate, with quality of life. It was concluded that feeding is associated with quality of life of renal patients undergoing hemodialysis.

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

    Directory of Open Access Journals (Sweden)

    Humberto Kukhyun Choi

    2003-01-01

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

  20. Peritonitis Due to Blastobotrys proliferans in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis?

    OpenAIRE

    Quirin, N.; Desnos-Ollivier, M.; Cantin, J. F.; Valery, J. C.; Doussy, Y.; Goursaud, R.; Dromer, F.; Tivollier, J. M.

    2007-01-01

    Blastobotrys proliferans is an ascomycetous yeast never previously reported as a human pathogen. Here we report a case of peritonitis due to Blastobotrys proliferans in a 46-year-old man undergoing peritoneal dialysis.

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

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    Mohammad Reza Tamadon

    2011-07-01

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

  2. Componentes do modelo teórico de Roy em pacientes submetidos à hemodiálise / Components of a Roy's adaptation model in patients undergoing hemodialysis / Componentes del modelo teórico de Roy en pacientes sometidos a hemodiálisi

    Scientific Electronic Library Online (English)

    Cecília Maria Farias de Queiroz, Frazão; Maria Isabel da Conceição Dias, Fernandes; Maria das Graças Mariano, Nunes; Jéssica Dantas de, Sá; Marcos Venícios de Oliveira, Lopes; Ana Luisa Brandão de Carvalho, Lira.

    2013-12-01

    Full Text Available Estudo transversal, objetivando identificar os componentes do modelo teórico de Roy em pacientes submetidos à hemodiálise em um centro de diálise. Participaram 178 pacientes de um centro dialítico no Nordeste do Brasil. A coleta de dados ocorreu de outubro/2011 a fevereiro/2012, por entrevista e exa [...] me físico. Os componentes identificados foram: problemas adaptativos, comportamentos e estímulos. Os principais problemas adaptativos foram: retenção de líquido intracelular, hipercalemia, hipotermia, edema, intolerância à atividade. Os comportamentos foram: anúria, desequilíbrio hidroeletrolítico, aumento de peso em curto período, aumento do potássio sérico, temperatura corporal abaixo de 36°C, retenção de líquidos, fadiga, dificuldade em realizar atividades de vida diária. Os estímulos foram: lesão renal, circulação extracorpórea, hemodiálise, não seguimento da restrição hídrica, distúrbio eletrolítico, ambiente frio, efeitos adversos relacionados ao tratamento. Conclui-se que a identificação desses componentes, enquadrados no modo fisiológico, contribui para o planejamento de intervenções de enfermagem específicas e voltadas para a adaptação da clientela. Abstract in spanish Estudio transversal, objetivando identificar los componentes del modelo teórico de Roy en pacientes sometidos a hemodiálisis en un centro de diálisis. Participaron 178 pacientes de un centro de diálisis en el Noreste de Brasil. La recogida de datos ocurrió de octubre/2011 a febrero/2012 por entrevis [...] ta y examen físico. Los componentes identificados fueron: problemas de adaptación, comportamientos y estímulos. Los principales problemas adaptativos fueron: retención de líquido intracelular, hiperpotasemia, hipotermia, edema, intolerancia a la actividad. Los comportamientos fueron: anuria, desequilibrio electrolítico, aumento de peso en corto período de tiempo, aumento del potasio sérico, temperatura corporal por debajo de 36 °C, retención de líquidos, fatiga, dificultad para realizar actividades de la vida diaria. Los estímulos fueron: lesión renal, circulación extracorpórea, la hemodiálisis, no sigue restricción hídrica, alteración electrolítica, ambiente frío, efectos adversos relacionados con el tratamiento. Se concluye que la identificación de estos componentes, clasificados en el modo fisiológico, contribuye a la planificación de las intervenciones de enfermería específicas y dirigidas a la adaptación de esta clientela. Abstract in english Cross-sectional study aimed to identify the components of a Roy's adaptation model in patients undergoing hemodialysis at a dialysis center. 178 patients participated in a dialysis center in the Brazil Northeast region. Data collection occurred from October/2011 to February/2012 through the use of i [...] nterviews and physical examinations. The components identified were: adaptive problems, behaviors and stimuli. The main adaptive problems were: intracellular fluid retention, hyperkalemia, hypothermia, edema, intolerance for performing daily activities. The behaviors were: anuria, hydroelectrolyte imbalance, gain of weight in a short period of time, elevated serum potassium concentrations, body temperature below 36 ° C, fluid retention, fatigue, difficulty performing activities of daily living. The stimuli were: renal injury, cardiopulmonary bypass, hemodialysis, failure to observe fluid intake restriction, electrolyte disorder, cold environment, adverse effects related to treatment. We conclude that the identification of these components, classified as physiological mode, contribute to the planning of specific nursing interventions focused on the adaptation of the clientele.

  3. Hope and spirituality among patients with chronic kidney disease undergoing hemodialysis: a correlational study / Esperanza y espiritualidad de pacientes renales crónicos en hemodiálisis: un estudio de correlación / Esperança e espiritualidade de pacientes renais crônicos em hemodiálise: estudo correlacional

    Scientific Electronic Library Online (English)

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

    2014-04-01

    Full Text Available OBJETIVO: analisar a relação entre a esperança e a espiritualidade de pacientes renais crônicos em tratamento hemodialítico. MÉTODO: trata-se de estudo correlacional, de corte transversal. A amostra foi composta por 127 sujeitos em tratamento em uma Unidade de Terapia Renal Substitutiva. Os da [...] dos foram coletados por meio de entrevista individual, utilizando-se os instrumentos: caracterização dos sujeitos, Escala de Esperança de Herth e Escala de Espiritualidade de Pinto Pais-Ribeiro. RESULTADOS: o escore médio da Escala de Esperança de Herth foi de 38,06 (±4,32) e da Escala de Espiritualidade de Pinto Pais-Ribeiro nas dimensões "crenças" foi de 3,67 (±0,62) e "esperança/otimismo", 3,21 (±0,53). O coeficiente de Spearman indicou a existência de correlação positiva, de moderada magnitude entre a Escala de Esperança de Herth e as dimensões da Escala de Espiritualoidade de Pinto Pais-Ribeiro: "crenças" (r=0,430; p Abstract in spanish OBJETIVO: analizar la relación entre la esperanza y la espiritualidad de pacientes renales crónicos en tratamiento de hemodiálisis. MÉTODO: se trata de un estudio de correlación, de corte transversal. La muestra fue compuesta por 127 sujetos en tratamiento en una Unidad de Terapia Renal Substi [...] tutiva. Los datos fueron recolectados, por medio de entrevista individual, utilizando los instrumentos: caracterización de los sujetos, Escala de Esperanza de Herth (EEH) y Escala de Espiritualidad de Pinto Pais-Ribeiro (EEPP-R). RESULTADOS: el puntaje promedio de la EEH fue 38,06 (±4,32) y de la EEPP-R en las dimensiones "creencias" 3,67 (±0,62) y "esperanza/optimismo" 3,21 (±0,53). El coeficiente de Spearman indicó la existencia de correlación positiva, de moderada magnitud entre la EEH y las dimensiones de la EEPP-R: "creencias" (r=0,430; p Abstract in english 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 ind [...] ividual 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

  4. Transcriptome changes in STSV2-infected Sulfolobus islandicus REY15A undergoing continuous CRISPR spacer acquisition

    DEFF Research Database (Denmark)

    León-Sobrino, Carlos; Kot, Witold P; Garrett, Roger A

    2015-01-01

    A transcriptome study was performed on Sulfolobus islandicus REY15A actively undergoing CRISPR spacer acquisition from the crenarchaeal monocaudavirus STSV2 in rich and basal media over a 6 day period. Spacer acquisition preceded strong host growth retardation, altered transcriptional activity of four different CRISPR-Cas modules and changes in viral copy numbers, and with significant differences in the two media. Transcript levels of proteins involved in the cell cycle were reduced, while those...

  5. Epidemiology of hemodialysis patients in Aleppo city

    Directory of Open Access Journals (Sweden)

    Moukeh Ghamez

    2009-01-01

    Full Text Available To determine the characteristics of the hemodialysis (HD patients in Aleppo city, we surveyed the hospitals representing the main dialysis centers in the city including private and community facilities during 2006. Personal patients? interviews and hospitals records were the source of data. The total number of patients in 2006 undergoing HD was 550 patients; 280 (50.9% were males, and the age ranged from 5-82 years with mean and median age 44.7 and 45 years, respectively. The incidence (IR and prevalence rate (PR for hemodialysis were 60 pmp and 226 pmp, respectively. The major primary renal diseases in the end-stage renal disease (ESRD patients included hypertension (HTN, glomerulonephritis (GN, and diabetes mellitus (DM, 21.1%, 20.5 %, and 19.45, respectively. The percent of Anti-HCV, HBV hepatitis and HBV vaccine were 54.4%, 7.8%, and 52.9%, respectively. This study suggests that the IR of hemodialysis was relatively low due to the high cost of treatment, and the PR for hemodialysis was also relatively low may be due to high mortality rate and low kidney transplantation rate in this country. There was an equal percentage of both genders in the hemodialysis population.

  6. Transcriptome changes in STSV2-infected Sulfolobus islandicus REY15A undergoing continuous CRISPR spacer acquisition.

    DEFF Research Database (Denmark)

    León Sobrino, Carlos; Kot, W.P.

    2015-01-01

    A transcriptome study was performed on Sulfolobus islandicus REY15A actively undergoing CRISPR spacer acquisition from the crenarchaeal monocaudavirus STSV2 in rich and basal media over a 6 day period. Spacer acquisition preceded strong host growth retardation, altered transcriptional activity of four different CRISPR-Cas modules and changes in viral copy numbers, and with significant differences in the two media. Transcript levels of proteins involved in the cell cycle were reduced, while those of DNA replication, DNA repair, transcriptional regulation, and some antitoxin-toxin pairs and transposases were unchanged or enhanced. Antisense RNAs were implicated in the transcriptional regulation of adaptation and interference modules of the type I-A CRISPR-Cas system and evidence was found for the occurrence of functional coordination between the single CRISPR-Cas adaptation module and the functionally diverse interference modules.

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

    Scientific Electronic Library Online (English)

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

    2011-12-01

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

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

    Scientific Electronic Library Online (English)

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

    2012-08-01

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

  9. Mortality Associated with Low Serum Sodium Concentration in Maintenance Hemodialysis

    Science.gov (United States)

    Waikar, Sushrut S.; Curhan, Gary C.; Brunelli, Steven M.

    2011-01-01

    BACKGROUND Low serum sodium concentrations are associated with an increased risk of death in the general population, but causality is uncertain due to confounding from clinical conditions such as congestive heart failure and cirrhosis, in which hyponatremia results from elevated levels of arginine vasopressin. METHODS To examine the association between predialysis serum sodium concentration and mortality in patients undergoing hemodialysis for end-stage renal disease, a condition in which arginine vasopressin does not affect water excretion and osmoregulation, we studied 1549 oligoanuric participants in the HEMO study, a randomized controlled trial of hemodialysis patients examining the effect of hemodialysis dose and flux. We used proportional hazards models to compare the risk of death according to predialysis serum sodium concentration. RESULTS Considered as a continuous variable, each 4-mEq/L increment in baseline predialysis serum sodium concentration was associated with a hazard ratio for all-cause mortality of 0.84 (95% confidence interval (CI), 0.78–0.90). Multivariable adjustment for demographic, clinical, laboratory, and dialysis-specific covariates, including ultrafiltration volume, did not appreciably change the results (hazard ratio for all-cause mortality of 0.89; 95% CI, 0.82–0.96). The results also were consistent in time-updated analyses using repeated measures of serum sodium and other relevant covariates. CONCLUSION Lower predialysis serum sodium concentration is associated with an increased risk of death. Considering the unique physiology in the dialysis population, these findings raise the possibility that hyponatremia itself may be a causal determinant of mortality in the broader population. PMID:21187188

  10. Peritonitis associated with Strongyloides stercoralis in a patient undergoing continuous ambulatory peritoneal dialysis

    OpenAIRE

    Sav, Tansu; Yaman, Ozan; Gunal, Ali Ihsan; Oktay OYMAK; Utas, Cengiz

    2009-01-01

    A 67-year-old male continuous ambulatory peritoneal dialysis (CAPD) patient presented with abdominal pain and pruritus. Strongyloides stercoralis larvae were seen on dialysate sediment and stool microscopic examination. Albendazole was given and improved the symptoms in 4 days. There was no episode of relapsing peritonitis after the therapy. This is the first report of S. stercoralis peritonitis in patients on CAPD. Strongyloides should be considered as a probable peritoneal pathogen in CAPD ...

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Proteomic and gene expression analysis of zebrafish brain undergoing continuous light/dark stress.

    Science.gov (United States)

    Purushothaman, Sruthi; Saxena, Sandeep; Meghah, Vupalapathy; Meena Lakshmi, Mula G; Singh, Sachin K; Brahmendra Swamy, Cherukuvada V; Idris, Mohammed M

    2015-08-01

    Several organisms irrespective of their complexity in structure and function have an inbuilt circadian rhythm. Zebrafish could be used as an alternate model animal in sleep research as it exhibits similar sleep-wake dynamics as mammals and Drosophila. In this study, we have analysed the adult zebrafish brain for its differential proteome and gene expression during perturbed light/dark cycle. A total of 53 and 25 proteins including sncb, peroxiredoxins and TCR alpha were identified based on two-dimensional gel electrophoresis Fourier transform mass spectrometer/ion trap tandem mass spectrometer and differential in-gel electrophoresis MALDI TOF MS/MS analysis, respectively, with at least 1.5-fold changes between the control and experimental brains. Real time-polymerase chain reaction revealed that many circadian pathway-associated genes, such as per1b, bmal1b, cry1b, bmal2 and nr1d2, were differentially regulated during continuous light/dark exposures. It is hypothesized that the differential regulation of these genes might lead to the discovery of potential diagnostic markers for gaining insight into the light/dark-associated stress in humans. PMID:25726855

  13. An Evaluation of Ciprofloxacin Pharmacokinetics in Critically Ill Patients undergoing Continuous Veno-venous Haemodiafiltration

    LENUS (Irish Health Repository)

    Spooner, Almath M

    2011-08-04

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

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

    Directory of Open Access Journals (Sweden)

    Yanet Parodis López

    2006-03-01

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

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

    Scientific Electronic Library Online (English)

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

    2006-03-01

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

  16. The dose of dialysis in hemodialysis patients: impact on nutrition.

    Science.gov (United States)

    Schulman, Gerald

    2004-01-01

    Multiple lines of evidence have indicated that the dose of hemodialysis impacts upon patient outcome. Among these outcome measures, nutrition is inextricably linked to the adequacy of the treatment. All of the methods of determining dialysis adequacy are based on assessing the removal of toxic substances retained in renal failure, the majority of which are derivatives of protein metabolism. Urea kinetics, employing urea as a surrogate for quantifying the elimination of small molecular weight nitrogenous substances, is the method that has been most thoroughly validated to date as defining a dose range for thrice-weekly hemodialysis: Both inadequate and optimal levels of hemodialysis dose have been identified by prospective, randomized clinic trials utilizing Kt/V(urea) as the index of adequacy. The impact of urea kinetics on nutritional status during thrice-weekly hemodialysis is discussed. Recently, in an attempt to improve outcome beyond that achievable with thrice-weekly hemodialysis, alternative regimens, consisting of daily treatments, have received increasing interest. In order to compare the dose of hemodialysis associated with these regimens with conventional thrice-weekly regimens in terms of removal of small molecular weight substances, standard Kt/V(urea), a parameter that combines treatment dose with treatment frequency, and thus allows for various intermittent therapies to be compared to continuous therapy, must be used. In addition, membrane flux and middle molecule removal, factors that have not yet been well defined as parameters of adequacy during thrice-weekly regimens, may be shown to be important indices with longer hemodialysis treatments, particularly daily nocturnal hemodialysis. The impact that these alternative regimens have had on nutritional status in hemodialysis patients and how they compare to conventional therapy are important considerations. PMID:15660579

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

    Scientific Electronic Library Online (English)

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

    2012-09-01

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

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

    Scientific Electronic Library Online (English)

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

    2003-01-01

    Full Text Available OBJETIVO: A hiperpigmentação cutânea é comumente encontrada em pacientes portadores de insuficiência renal crônica (IRC), sendo também uma das manifestações mais evidentes da Porfiria Cutânea Tarda (PCT). Essa doença, que tem sido relatada em pacientes em hemodiálise (HD), tem como um dos fatores pr [...] ecipitantes a infecção pelo vírus da hepatite C (HCV). Este estudo tem como objetivo avaliar a prevalência de hiperpigmentação cutânea difusa em pacientes com IRC infectados pelo HCV. MÉTODOS: Foi desenvolvido um estudo transversal com 47 pacientes (idade média de 50,35 ± 15,16 anos, 31 homens e 16 mulheres) que estavam realizando hemodiálise na Unidade de Diálise do Hospital de Clínicas de Porto Alegre. Os pacientes foram divididos em dois grupos: grupo 1, anti-HCV positivos (n=17), e grupo 2, anti-HCV negativos (n=30). RESULTADOS: A prevalência de pacientes com hiperpigmentação cutânea relacionada a HD foi de 36,2% (n=17). Havia 10 pacientes (58,8 %) no grupo 1 e sete pacientes (23,3%) no grupo 2 (Razão de Risco de 2,52 e Intervalo de Confiança de 95% de 1,18 a 5,4; p Abstract in english BACKGROUND: Skin pigmentation is commonly found in patients with chronic renal failure (CRF). This symptom is also one of the most evident features of Porphyria Cutanea Tarda (PCT). Hepatitis C virus (HCV) is an important precipitating agent of this disease, which has been described in patients unde [...] rgoing hemodialysis (HD). In this paper, we intend to evaluate the prevalence of difuse skin hyperpigmentation in patients with CRF infected with the HCV. METHODS: We developed a transversal study with 47 patients (mean age 50,35 + 15,16 years; 31 men and 16 women) who were on hemodialysis in march of 2001 at the Unit of Dialysis of Hospital de Clínicas de Porto Alegre. Patients were divided in two groups: group 1, anti-HCV positives (n=17), and group 2, anti-HCV negatives (n=30). RESULTS: The prevalence of skin hyperpigmentation related to HD was 36,2% (n=17). There were 10 patients (58,8%) in group 1 and 7 (23,3%) in group 2 (Odds Ratio of 2,52 and 95% Confidence Interval of 1,18-5,4; p

  19. The economic burden of hemodialysis in Jordan

    Directory of Open Access Journals (Sweden)

    Emad Adel Al-Shdaifat

    2013-01-01

    Full Text Available Background: Hemodialysis treatment is a costly procedure that requires specific resources. It has a considerable burden on patients, caregivers, and healthcare system. The aim of this study was to estimate the economic burden borne by the Ministry of Health (MOH in Jordan, with a focus on direct medical, direct non-medical, and indirect cost. Materials and Methods:The study was conducted at MOH hospitals in Jordan, from August to November 2010. A total of 138 patients and 49 caregivers were involved in the study. An economic evaluation study was used to analyze the burden of hemodialysis treatment at MOH, Jordan. Direct medical costs were estimated through micro and macro costing from the provider?s perspective. Patients? and caregivers? costs were included to calculate direct non-medical costs. Human capital approach was employed to evaluate the productivity loss for indirect cost and premature death and potential year life loss was used to estimate the premature death cost. Results: The total burden of hemodialysis at MOH, Jordan was USD17.70 million per year. Cost per session was $72 and the annual cost per patient was $9976. Direct medical cost was $7.20 million (41% and direct non-medical cost was $2.02 million (11%. On the other hand, indirect cost (productivity loss was $8.48 million (48%. All 722 patients on hemodialysis at MOH hospitals consumed 2.7% of MOH budget. Conclusions: Costs of treating and managing patients on hemodialysis at MOH hospitals in Jordan are substantial. Therefore, efforts should be taken to slow down the progress of renal failure to save resources and a comparative study with other modalities, such as continuous ambulatory peritoneal dialysis and kidney transplantation, should be considered.

  20. Mortalidade dos pacientes com doença renal crônica em hemodiálise de manutenção em um hospital público do Peru / Mortality in patients with chronic kidney disease undergoing hemodialysis in a public hospital of Peru

    Scientific Electronic Library Online (English)

    Percy, Herrera-Añazco; Vicente, Benites-Zapata; Adrian V., Hernandez; Edward, Mezones-Holguin; Manuela, Silveira-Chau.

    2015-06-01

    Full Text Available Resumo Introdução: O Ministério da Saúde do Peru não tem um programa nacional de hemodiálise e os hospitais que oferecem este tipo de tratamento apresentam problemas de cobertura que podem resultar em aumento da mortalidade. Objetivo: Avaliar a mortalidade da população incidente em hemodiálise em um [...] hospital de Lima. Métodos: Análise da população acima de 18 anos que iniciou o tratamento entre 1 de janeiro de 2012 e 31 de dezembro de 2013, com data de corte final do acompanhamento em 31 de março de 2014. Foi realizada regressão logística bivariada e multivariada dos fatores associados com a mortalidade e usadas as curvas de Kaplan-Meier para determinar a probabilidade de sobrevivência durante o acompanhamento. Resultados: Foram incluídos 235 pacientes para estudo, com idade média de 56,4 ± 15,8 anos. A mediana de acompanhamento foi 0,6 anos (IQR 0,3 a 1,5). A pesquisa mostra que 50% dos pacientes abandonaram o tratamento durante o estudo por falta de vagas ou recursos econômicos. No final do terceiro mês, a mortalidade foi 37,7% (IC 95% 29,3 a 48,5) e 49,5% (IC 95% 38,8 a 61,4) ao sétimo mês. A mortalidade foi menor quando o paciente tinha mais de seis meses com diagnóstico de doença insuficiência renal crônica (OR = 0,39 [IC 95% 0,12-1,27]) e quando o paciente ingressava à diálise programada (OR = 0,28 [IC 95% 0,01 a 2,28]). Conclusão: Metade dos pacientes foi a óbito no sétimo mês de seguimento. Ter ingressado com diálise programada e ter mais tempo de diagnóstico foi associado à menor mortalidade. Abstract in english Abstract Introduction: The Peruvian Ministry of Health does not have a national program of hemodialysis and hospitals that offer it have coverage problems, which may result in increased mortality. Objective: We evaluated mortality of a population with incident hemodialysis in a Peruvian public hospi [...] tal as well as its associated factors. Methods: Retrospective and descriptive study of a population over 18 years-old who started treatment between January 1, 2012 and December 31, 2013 with the final follow-up day on31 March 2014. We used bivariate and multivariate logistic regression models to evaluate factors associated with mortality and Kaplan Meier curves were used to determine the probability of survival. Results: We included 235 patients with a mean age of 56.4 ± 15.8 years. Median follow-up was 0.6 years (IQR 0.3 to 1.5). 50% of years withdrew from therapy during the study for lack of financial resources or space available. The third month mortality was 37.7% (95% CI 4.7 to 48.5) and 49.5% (95% CI 5.8 to 61.4) at 7 months. There was a trend towards lower mortality when patients had more than 6 months with a diagnosis of chronic kidney disease (CKD) (OR = 0.39 [95% CI 0.12 to 1.27]) and when the patient was admitted with scheduled dialysis (OR = 0.28 [95% CI 0.01 to 2.28]). Conclusion: Half of patients died within seven months of follow-up. Scheduled dialysis and having longer time with CKD diagnosis tend to be associated with lower mortality

  1. Temporal Risk Profile for Infectious and Noninfectious Complications of Hemodialysis Access

    OpenAIRE

    Ravani, Pietro; Gillespie, Brenda W.; Quinn, Robert Ross; MacRae, Jennifer; Manns, Braden; Mendelssohn, David; Tonelli, Marcello; Hemmelgarn, Brenda; James, Matthew; Pannu, Neesh; Robinson, Bruce M; Xin ZHANG; Pisoni, Ronald

    2013-01-01

    Vascular access complications are a major cause of morbidity in patients undergoing hemodialysis, and determining how the risks of different complications vary over the life of an access may benefit the design of prevention strategies. We used data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) to assess the temporal profiles of risks for infectious and noninfectious complications of fistulas, grafts, and tunneled catheters in incident hemodialysis patients. We used longitudin...

  2. Prediction of Malnutrition Using Modified Subjective Global Assessment-dialysis Malnutrition Score in Patients on Hemodialysis

    OpenAIRE

    Janardhan, Vasantha; Soundararajan, P.; Rani, N. Vanitha; Kannan, G; Thennarasu, P.; Chacko, Rosney Ann; Reddy, C. Uma Maheswara

    2011-01-01

    Malnutrition is widely prevalent among patients on hemodialysis. Malnutrition can be estimated using a fully quantitative scoring system Subjective Global Assessment-Dialysis Malnutrition Score which is simple, reliable and dynamic. The primary objective of the study was to assess the severity of malnutrition in patients with end stage renal disease and undergoing hemodialysis in a tertiary care teaching hospital in Chennai, using Subjective Global Asses sment-Dialysis Malnutrition Score and ...

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

    OpenAIRE

    Kang Yu-Chuan; Tai Wei-Chen; Yu Chun-Chen; Kang Je-Ho; Huang Yhu-Chering

    2012-01-01

    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 hosp...

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

    Scientific Electronic Library Online (English)

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

    2011-12-01

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

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

    Directory of Open Access Journals (Sweden)

    R. C. Noleto Magalhães

    2011-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Luiz Carlos SEVERO

    1999-07-01

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

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

    Scientific Electronic Library Online (English)

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

    1999-07-01

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

  8. Evaluation of Bone Mineral Density in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Mukadder Ay?e Bilgiç

    2010-06-01

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

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

    Scientific Electronic Library Online (English)

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

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

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

    Scientific Electronic Library Online (English)

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

    2012-08-01

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

  11. Luminescence as a Continuous Real-Time Reporter of Promoter Activity in Yeast Undergoing Respiratory Oscillations or Cell Division Rhythms

    OpenAIRE

    Robertson, J. Brian; Johnson, Carl Hirschie

    2011-01-01

    This chapter describes a method for generating yeast respiratory oscillations in continuous culture and monitoring rhythmic promoter activity of the culture by automated real-time recording of luminescence. These techniques chiefly require the use of a strain of Saccharomyces cerevisiae that has been genetically modified to express firefly luciferase under the control of a promoter of interest and a continuous culture bioreactor that incorporates a photomultiplier apparatus for detecting ligh...

  12. Longitudinal study of leptin levels in chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    Baradaran, Azar; Mohammad-Reza ARDALAN; NASRI, Hamid

    2010-01-01

    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 he...

  14. Cognitive function among hemodialysis patients in Japan

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    Saitoh Hisao

    2011-08-01

    Full Text Available Abstract Background Over 290,000 patients are undergoing hemodialysis (HD in Japan. With old age, the odds of undergoing HD treatment sharply increase, as does the prevalence of cognitive impairment. The aim of the present work was to assess cognitive impairment in HD patients and its relation to clinical characteristics. Methods Using a cross-sectional design, we administered the Mini-Mental State Examination (MMSE to 154 HD outpatients and 852 participants from the Iwaki Health Promotion Project 2010, representing the general population. Results The prevalence of cognitive impairment based on the MMSE was 18.8% in HD patients. HD patients showed a higher prevalence of cognitive impairment in older groups (50 years and older. In a logistic regression model with age, gender and amount of education as covariates, undergoing HD was a significant independent factor (OR = 2.28, 95% CI 1.33 to 3.94 associated with a lower MMSE score. Among HD patients, we found that level of education was associated with MMSE score. Conclusions There is a high prevalence of cognitive impairment among HD patients that has adverse implications for hospitalization and shortens their life expectancy. HD treatment was an independent risk factor for cognitive impairment. Clinicians should carefully monitor and treat cognitive impairment in HD patients. Further studies are required to determine the reasons for cognitive impairment in HD patients.

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

    OpenAIRE

    Santos Paulo Roberto; Arcanjo Francisco Plácido Nogueira

    2013-01-01

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

  16. Variable pulmonary manifestations in hemodialysis patients

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

  18. Technical aspects of home hemodialysis

    Directory of Open Access Journals (Sweden)

    Alhomayeed B

    2009-01-01

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

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

    DEFF Research Database (Denmark)

    Pakpour, Amir H.; Nourozi, Saeedeh; Mølsted, Stig; Harrison, Adrian Paul; Nourozi, Khadije; Fridlund, Bengt

    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. Reliab...

  20. Accidental salicylate intoxication in a hemodialysis patient.

    Science.gov (United States)

    Kleinman, K S; Schweitzer, S; Nissenson, A R

    1988-10-01

    A 61-year-old woman receiving long-term hemodialysis presented with symptoms of tinnitus, insomnia, malaise, and disequilibrium. On close questioning, it was discovered that she had received a prescription for salsalate (Disalcid) from a consulting physician who had evaluated her for joint pain. This tablet was similar in appearance to a dried aluminum hydroxide gel preparation (Alu-tab) that the patient was taking as a phosphate binder. She had mistakenly been taking six Disalcid tablets with each meal. Her salicylate level was 5.86 mmol/L, but she had no change in her serum electrolyte levels or acid-base status. When the salsalate treatment was stopped and regular dialysis treatments were continued, the symptoms of salicylism resolved. This case illustrates one of the potential dangers of polypharmacy in patients with chronic disease. The midl course was probably due to ongoing hemodialysis, which prevented the appearance of the usual acid-base abnormalities of salicylate intoxication. PMID:3178384

  1. Referral pattern of hemodialysis patients to nephrologists

    International Nuclear Information System (INIS)

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

  2. Obesity and hemodialysis vascular access failure.

    Science.gov (United States)

    Plumb, Troy J; Adelson, Anthony B; Groggel, Gerald C; Johanning, Jason M; Lynch, Thomas G; Lund, Bryce

    2007-09-01

    A variety of factors have been proposed to explain arteriovenous fistula primary failures in patients undergoing hemodialysis, including obesity, diabetes mellitus, female sex, and the absence of preoperative vein mapping. In this report, we describe 2 women for whom premature upper-extremity arteriovenous fistula failures occurred in the setting of venographic evidence of soft-tissue compression of the venous outflow with the patient's arm in the adducted position. In each instance, preoperative noninvasive duplex vein mapping showed veins of adequate diameter (0.28 to 0.54 cm), and further evaluation showed no evidence of a hypercoagulable state. Upper-extremity venography was used to assess central venous patency and fully assess the venous vasculature. Unlike the widely patent venous systems seen in the abducted position, venography performed with the upper extremities in adduction showed marked narrowing of the brachial and/or axillary veins. The hemodynamic effects of this narrowing were readily apparent in patient 2 with the appearance of collateral filling of the cephalic vein in the adducted position. Patient 1 had a body mass index of 39 kg/m(2), and patient 2 had a body mass index of 34 kg/m(2). Each patient had excess axillary soft tissue that appeared to compress the venous outflow in adduction. To our knowledge, this is the first report to radiographically document soft-tissue compression of the venous outflow of the upper extremity in the adducted position, suggesting a mechanism whereby obesity, or at least excess axillary fat, can lead to premature hemodialysis vascular access failures. PMID:17720524

  3. The effect of continuous low dose methylprednisolone infusion on inflammatory parameters in patients undergoing coronary artery bypass graft surgery: a randomized-controlled clinical trial.

    Directory of Open Access Journals (Sweden)

    Abbas Ghiasi

    2015-02-01

    Full Text Available This trial was performed to determine if a continuous low-dose infusion of methylprednisolone is as effective as its bolus of high-dose in reducing inflammatory response. The study was single-center, double-blinded randomized clinical trial and performed in a surgical intensive care unit of an academic hospital. In this study, 72 consecutive patients undergoing elective coronary artery bypass grafting (CABG were assigned to receive either a methylprednisolone loading dose (1mg/kg followed by continuous infusion (2mg/Kg/24 hours for 1 day (low-dose regime or a single dose of methylprednisolone (15 mg/kg before cardiopulmonary bypass (high dose regime. Serum concentrations of IL-6 and C- reactive protein (CRP were measured preoperatively and 6, 24 and 48 hours after surgery, and serum creatinine was measured before the operation and 24, 48 and 72 hours postoperatively. The measurements were then compared between the groups to evaluate the efficacy of each regimen. The basic characteristics and measurements were not different between the study groups. There was no significant difference in IL-6 and CRP elevation (P=0.52 and P=0.46, respectively. Early outcomes such as the length of stay in the intensive care unit, intubation time, changes in serum creatinine and blood glucose levels, inotropic support, insulin requirements, and rate of infection were also similar in both groups. A continuous low dose infusion of methylprednisolone was as effective as a single high dose methylprednisolone in reducing the inflammatory response after CABG with extracorporeal circulation with no significant difference in the postoperative measurements and outcomes.

  4. Paricalcitol reduces oxidative stress and inflammation in hemodialysis patients

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    Izquierdo María

    2012-11-01

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

  5. ADIPONECTIN LEVELS AND ATHEROSCLEROTIC RISK FACTORS IN CHILDREN ON HEMODIALYSIS

    International Nuclear Information System (INIS)

    Atherosclerotic cardiovascular disease (ACVD) is the major cause of mortality in patients with end stage renal disease (ESRD) treated with hemodialysis (HD), even in children. Adiponectin (ADPN) is an adipocyte derived plasma protein having anti-atherogenic properties. ADPN levels are elevated in ESRD but it has been reported that ESRD patients with low plasma ADPN levels have a high risk of cardiovascular death. The aim of this study is to evaluate the relation between ADPN and atherosclerotic risk factors in children on hemodialysis.Twenty-eight children (17 boys and 11girls) with a mean age of 10.6 ± 3.34 years undergoing hemodialysis (HD) for a mean period of 11.96 ± 8.32 months (ranged from 6 to 36 months) and 10 healthy age and sex matched control subjects were enrolled in this study. The acute effect of a hemodialysis session on serum ADPN and other atherosclerotic risk factors , including blood pressure, serum lipids, C-reactive protein (CRP) and tumor necrosis factor-? (TNF-?) were assessed by comparison of pre- and post-hemodialysis determinations. Serum levels of ADPN and TNF-? were measured by enzyme linked immunosorbant assay (ELISA) while CRP was measured by the semi-quantitative latex agglutination assay.The data showed that serum ADPN levels were twice higher in the HD group as compared to the control subjects. Concerning the atherosclerotic risk factors, TNF-?, CRP and triglycerides levels showed significant elevation in the HD group. Meanwhile, serum albumin, cholesterol and phosphorus levels showed significant decreases. The linear regression analysis showed that adiponectin was negatively correlated with glomerular filtration rate (GFR) (r = -0.68,P < 0.0001), and body mass index (r = -0.73, P < 0.0007); ADPN levels are directly related to HDL cholesterol levels (r = 0.76, P < 0.0001) and inversely related to triglycerides level (r = -0.63, P < 0.0003). No relationship was found between adiponectin and CRP.It could be concluded that patients on regular hemodialysis were at increased risk for premature atherosclerosis due to high levels of CRP, LDL-cholesterol and triglycerides. The elevated ADPN levels in the hemodialyzed patients may have a protective role against atherosclerosis

  6. Lidocaine versus ropivacaine for postoperative continuous paravertebral nerve blocks in patients undergoing laparoscopic bowel surgery: a randomized, controlled, double- blinded, pilot study

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-09-01

    Full Text Available Daniela Ghisi,1,3 Andrea Fanelli,1,2 Julie Jouguelet-Lacoste,1 Luca La Colla,1,4 Anne-Sophie Auroux,1,5 Jacques E Chelly1 1Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Anesthesia and Intensive Care Unit, Policlinico S.Orsola-Malpighi, Bologna, Italy; 3Department of Anesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy; 4Department of Anesthesia, Intensive Care and Pain Therapy, Università degli Studi di Parma, Parma, Italy 5Institut des Sciences Pharmaceutiques et Biologiques-Faculté de Pharmacie de Lyon Université Claude Bernard Lyon, FranceBackground and objectives: Lidocaine could provide many advantages in continuous regional anesthesia techniques, including faster onset, greater titratability, and lower cost than long-acting local anesthetics. This prospective, randomized, double-blinded, pilot study is therefore intended to compare lidocaine to ropivacaine in bilateral continuous paravertebral blocks using a multimodal approach for postoperative pain management following laparoscopic bowel surgery.Methods: Thirty-five ASA I–III consecutive patients undergoing elective laparoscopic bowel surgery and bilateral thoracic paravertebral continuous blocks were analyzed: bilateral thoracic paravertebral infusions of ropivacaine 0.2% (Group Ropi, n=18 or lidocaine 0.25% (Group Lido, n=17 were started at 7 mL/h in the postanesthesia care unit. For each patient, we collected numerical rating scores (NRS for pain at rest and during movement at baseline, at postanesthesia care unit discharge, at 24 hours and 48 hours after the end of surgery, as well as hydromorphone patient-controlled analgesia requirements, local anesthetic consumption, side effects, postoperative complications, and functional outcomes.Results: No effect of group distribution on NRS scores for pain at rest or at movement (P=0.823 and P=0.146, nor on hydromorphone (P=0.635 or local anesthetic consumption (P=0.063 was demonstrated at any analyzed time point. Hospital length of stay and spontaneous ambulation were comparable between groups (P=0.636 and P=0.148. In the context of a multimodal approach, the two drugs showed comparable safety profiles.Discussion: Lidocaine 0.25% and ropivacaine 0.2% provided similar analgesic profiles after elective abdominal surgeries, without any difference in terms of functional outcomes. The easier titratability of lidocaine together with its lower cost induced our clinical practice to definitely switch from ropivacaine to lidocaine for postoperative bilateral paravertebral continuous infusions.Keywords: laparoscopic bowel surgery, lidocaine, ropivacaine, continuous paravertebral nerve blocks, pilot study

  7. Physical activity level and depressive symptoms in patients undergoing hemodialysis: a cross-sectional study / Nível de atividade física e sintomas depressivos em pacientes submetidos à hemodiálise: um estudo de corte transversal / Nivel de actividad física y síntomas depresivos en pacientes sometidos a hemodiálisis: un estudio de corte transversal

    Scientific Electronic Library Online (English)

    Cléssyo Tavares de Amorim, Cavalcanti; José Cândido de, Araújo Filho; Patrícia Érika de Melo, Marinho.

    2014-04-01

    Full Text Available Este estudo objetivou avaliar a associação entre a presença de sintomas depressivos e o nível de atividade física (NAF) em pacientes renais crônicos submetidos à hemodiálise (HD). Estudo transversal constituído por 101 pacientes sob HD, com idade média de 47,4±12,5 anos. Foram coletados dados sociod [...] emográficos, econômicos, clínicos, avaliação de sintomas depressivos (Escala de Depressão de Beck - BDI), NAF (Questionário Internacional de Atividade Física - IPAQ), orientação para realização da atividade física (AF) e tempo de HD. A prevalência de sedentários e de sintomas depressivos foi 79,2% e 39,6%, respectivamente. Os sintomas depressivos foram observados em 47,5% dos pacientes sedentários (?2=10,029, p=0,002), sendo a razão de prevalência desses sintomas 5 vezes maior nesse grupo. Dos pacientes sob HD, 68,3% não receberam orientação para a prática de AF. Abaixo de 49 meses de tratamento hemodialítico, 63,8% dos sedentários (?2=3,011, p=0,083) e 57,5% dos pacientes com sintomas depressivos (?2=0,100, p=0,752) já apresentavam essas características. Embora pouco se conheça sobre a relação entre depressão e AF entre pacientes sob HD, o presente estudo verificou que os sintomas depressivos foram mais prevalentes entre os inativos. Os resultados deste estudo demonstram também que pacientes submetidos à HD apresentam baixo NAF, relativa presença de sintomas depressivos e elevada ausência de orientação quanto à realização de AF. Abstract in spanish Este estudio tuvo como objetivo evaluar la asociación entre la presencia de síntomas depresivos y el nivel de actividad física (NAF) en pacientes renales crónicos sometidos a hemodiálisis (HD). Estudio transversal constituido por 101 pacientes sob HD, con una edad media de 47,4±12,5 años. Se recogie [...] ron datos sociodemográficos, económicos, clínicos, evaluación de síntomas depresivos (Inventario de Depresión de Beck - BDI), NAF (Cuestionario Internacional de Actividad Física - IPAQ), orientación para la realización de actividad física (AF) y el tiempo de HD. La prevalencia de sedentarios y de síntomas depresivos fue 79,2% y 39,6 % , respectivamente. Se observaron síntomas depresivos en 47,5% de los pacientes sedentarios (?2=10,029, p=0,002), siendo la proporción de prevalencia de estos síntomas 5 veces mayor en este grupo. De los pacientes sob HD, 68,3% no recibieron ninguna orientación para la práctica de AF. Menos de 49 meses de tratamiento com hemodiálisis, 63,8% de los sedentarios (?2=3,011, p=0,083) y 57,5% de los pacientes con síntomas depresivos (?2=0,100, p=0,752) ya presentaban esas características. Aunque se sabe poco acerca de la relación entre la depresión y AF entre pacientes sob HD, el presente estudio verificó que los síntomas depresivos fueron más prevalentes entre los inactivos. Los resultados de este estudio también demuestran que los pacientes sometidos a HD tienen bajo NAF, relativa presencia de síntomas depresivos y alta falta de orientación sobre la realización de AF. Abstract in english This study aimed to evaluate the association between the presence of depressive symptoms and physical activity level (PAL) in patients with chronic kidney disease undergoing hemodialysis (HD). Cross-sectional study comprising 101 patients on HD, mean age 47.4±12.5 years. Sociodemographic data, econo [...] mic, clinical, assessment of depressive symptoms (Beck Depression Scale - BDI), PAL (International Physical Activity Questionnaire - IPAQ), guidance for performing physical activity (PA) and time of HD. The prevalence of sedentary and depressive symptoms was 79.2% and 39.6%, respectively. Depressive symptoms were observed in 47.5% of sedentary patients (?2=10.029, p=0.002), the ratio of prevalence of these symptoms five times higher in this group. 68.3% of patients on HD received no guidance for PA. Under 49 months of hemodialysis treatment, 63.8% of sedentary (?2=3.011, p=0.083) and 57.5% of patients with depressive symptoms (?2=0.100, p=0.752) alrea

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

    Scientific Electronic Library Online (English)

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

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

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

    Scientific Electronic Library Online (English)

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

    2010-06-01

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

  10. HEMODIALYSIS THERAPY SUSTAINED LOW EFFICIENCY DAILY DIALISIS FOR CHRONIC KIDNEY DESEASE PATIENT IN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Gede Andry Nicolas

    2013-04-01

    Full Text Available Kidney failure is a clinical condition characterized by an irreversible decline in kidney function, to a degree that requires the permanent renal replacement therapy, in the form of dialysis or kidney transplantation. Dialysis consists of two major categories such as dialysis / hemodialysis intermittent and continuous dialysis / continuous renal replacement therapy (CRRT. SLEDD is the latest technique of renal replacement therapy that uses conventional hemodialysis equipment, but the therapeutic results like continuous dialysis therapy / CRRT were appropriate used in patien with critical ill.

  11. Increased Cerebral Water Content in Hemodialysis Patients

    OpenAIRE

    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. Neuro...

  12. Urea biosensor for hemodialysis monitoring

    Science.gov (United States)

    Glass, Robert S. (Livermore, CA)

    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.

  13. Optimizing lithium dosing in hemodialysis

    DEFF Research Database (Denmark)

    Bjarnason, N H; Munkner, R; Kampmann, J P; Tornoe, C W; Ladefoged, Susanne; Dalhoff, K

    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 in which we developed an algorithm based on a 2-compartment distribution without elimination. The GFR estimate led to plasma concentrations 3-4 times lower than those anticipated. In contrast, the esti...

  14. Rosuvastatin in diabetic hemodialysis patients

    DEFF Research Database (Denmark)

    Holdaas, Hallvard; Holme, Ingar

    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 to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) trial included patients with and without diabetes, we conducted a post hoc analysis to determine whether rosuvastatin might reduce the risk of cardiac events in diabetic patients receiving hemodialysis. Among the 731 participants with diabetes, traditional risk factors such as LDL-C, smoking, and BP did not associate with cardiac events (cardiac death and nonfatal myocardial infarction). At baseline, only age and high-sensitivity C-reactive protein were independent risk factors for cardiac events. Assignment to rosuvastatin associated with a nonsignificant 16.2% reduction in risk for the AURORA trial's composite primary endpoint of cardiac death, nonfatal MI, or fatal or nonfatal stroke (HR 0.84; 95% CI 0.65 to 1.07). There was no difference in overall stroke, but the rosuvastatin group had more hemorrhagic strokes than the placebo group (12 versus two strokes, respectively; HR, 5.21; 95% CI 1.17 to 23.27). Rosuvastatin treatment significantly reduced the rates of cardiac events by 32% among patients with diabetes (HR 0.68; 95% CI 0.51 to 0.90). In conclusion, among hemodialysis patients with diabetes mellitus, rosuvastatin might reduce the risk of fatal and nonfatal cardiac events.

  15. Pulmonary hypertenstion ad leading factor in patients undergoing dialysis

    International Nuclear Information System (INIS)

    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)

  16. Necrotizing fasciitis and infective endocarditis caused by Escherichia coli in a hemodialysis patient.

    Science.gov (United States)

    Tsai, Ming-Hsien; Leu, Jyh-Gang; Fang, Yu-Wei; Hsieh, Shih-Chung

    2015-10-01

    Patients with uremia are often immunocompromised and uremia patients undergoing maintenance dialysis are often vulnerable to uncommon infections. We report a 40-year-old man who was undergoing maintenance hemodialysis and was initially diagnosed with monomicrobal necrotizing fasciitis of the lower limbs, based on blood and pus cultures that yielded Escherichia coli. His condition improved after surgical debridement and antibiotic therapy. However, he eventually died of intracranial hemorrhage related to septic emboli. Concurrent infective endocarditis was diagnosed based on an echocardiogram that indicated vegetation in the left ventricular region. Escherichia coli-related necrotizing fasciitis and infective endocarditis is rarely seen in clinical practice. There should be a high index of suspicion for multiple infections when a hemodialysis patient presents with an uncommon infection. PMID:25582556

  17. Low Potassium Dialysate as a Protective Factor of Sudden Cardiac Death in Hemodialysis Patients with Hyperkalemia

    Science.gov (United States)

    Huang, Chien-Wei; Lee, Min-Jing; Lee, Po-Tsang; Hsu, Chih-Yang; Huang, Wei-Chieh; Chen, Chien-Liang; Chou, Kang-Ju; Fang, Hua-Chang

    2015-01-01

    Aim Hyperkalemia increases the risk of sudden cardiac death (SCD) in hemodialysis patients. Our objective was to determine the association between administering low potassium dialysate to hyperkalemic hemodialysis patients and SCD. Methods We conducted a retrospective cohort study with patients undergoing maintenance hemodialysis from May 1, 2006, through December 31, 2013. The dialysate composition was adjusted over time according to monthly laboratory results. A 1.0 mEq/L potassium dialysate was applied in patients with predialysis hyperkalemia (>5.5 mEq/L) and was included as a time-dependent confounding factor. The clinical characteristics of enrolled patients, the incidence and timing of SCD and risk factors for all-cause mortality and SCD were analyzed. Results There were 312 patients on maintenance hemodialysis during the study period. One hundred and fifty-seven patients had been dialyzed against a 1.0 mEq/L potassium dialysate at least once. The rates of all-cause mortality and SCD were 48.17 and 20.74 per 1000 patient-years, respectively. A 1.12-fold increase in the risk of SCD in the 24-hour period starting with the hemodialysis procedure and a 1.36-fold increase in the 24 hours preceding a weekly cycle were found (p = 0.017). Multivariate Cox proportional hazards models showed that age, diabetes mellitus and predialysis hyperkalemia (>5.0 mEq/L) were significant predictors of all-cause mortality and SCD. Exposure to 1.0 mEq/L potassium dialysate, Kt/V, and serum albumin were independent protective factors against all-cause mortality. Only exposure to 1.0 mEq/L potassium dialysate significantly prevented SCD (hazard ratio = 0.33, 95% CI = 0.13–0.85). Conclusions Using low potassium dialysate in hyperkalemic hemodialysis patients may prevent SCD. PMID:26440515

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Idiopathic erythrocytosis in a patient on chronic hemodialysis.

    Science.gov (United States)

    Lee, Dong Hyun; Min, Ji Hye; Bae, Sang Byung; Gil, Hyo Wook; Yang, Jong Oh; Lee, Eun Young; Hong, Sae Yong

    2015-03-01

    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. PMID:26484022

  20. Management of Calcium and Phosphorus Metabolism in Hemodialysis Patients in Tehran Province, Iran

    OpenAIRE

    Mitra Mahdavi-Mazdeh; Mahnaz Zamyadi; Shahram Norouzi; Alireza Heidary Rouchi

    2009-01-01

    Introduction. Our aim was to evaluate the degree of achievement of the recommended values in National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) guidelines for the laboratory indicators of bone metabolism in patients undergoing hemodialysis (HD) in Tehran province.Materials and Methods. We evaluated the laboratory information of 2630 HD patients in Tehran province. Demographic data of the patients and the clinical information including the duration of dialysis session, di...

  1. Body composition, fitness score and arterial stiffness assesment in a chronic hemodialysis population

    OpenAIRE

    Adelina Mih?escu; Nicu Olariu; Alexandra Rusu; Claudiu Avram; Dan Gai??; Adalbert Schiller

    2011-01-01

    Patients undergoing long-term hemodialysis have a high risk of cardiovascular disease. Arterial stiffness is highly prevalent in this type of patients. The aim of our study was to analyse the relationship between body composition, blood chemistries and arterial stiffness in a poorly fit population of chronic hemodialysed patients. Patients and methods involved measuring body composition and fitness score by multifrequence bioimpedance with the body composition analyzer InBody720 and arterial ...

  2. Ultrasound Thrombolysis in Hemodialysis Access: In Vitro Investigation

    International Nuclear Information System (INIS)

    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

  3. Ultrasound thrombolysis in hemodialysis access: In vitro investigation

    International Nuclear Information System (INIS)

    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.

  4. Cutaneous manifestations in patients with chronic renal failure on hemodialysis

    Directory of Open Access Journals (Sweden)

    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.

  5. Cost-Effectiveness of Maintenance Hemodialysis in Japan.

    Science.gov (United States)

    Takura, Tomoyuki; Nakanishi, Takeshi; Kawanishi, Hideki; Nitta, Kosaku; Akizawa, Tadao; Hiramatsu, Makoto; Kawasaki, Tadayuki; Kukita, Kazutaka; Soejima, Hidehisa; Hirakata, Hideki; Yoshida, Toyohiko; Miyamoto, Takashi; Takahashi, Susumu

    2015-10-01

    The cost-effectiveness according to primary disease or dialysis duration has never been analyzed with respect to maintenance hemodialysis (MHD). Study candidates were?>?20 years of age and had received hemodialysis for at least 6 months. Hemodialysis patients were prospectively observed for 36 months, and patient utility was assessed based on the Euro-QOL 5-dimensions (EQ-5D), from which the quality adjusted life years (QALYs) were estimated. Medical costs were calculated based on medical service fees. The cost-effectiveness defined as the incremental cost utility ratio (ICUR) was analyzed from a social perspective. A total of 29 patients (mean age; 59.9?±?13.1 years) undergoing 437 dialysis sessions were analyzed. Utility based upon the EQ-5D score was 0.75?±?0.21, and the estimated total medical cost for one year of MHD treatment was 4.52?±?0.88 US$10?000. ICUR was 6.88?±?4.47 US$10?000/QALY on average, and when comparing ICUR based on the causes of kidney failure, the value for diabetic nephropathy was found to be higher than that for glomerulonephritis (8.17?±?6.28 vs. 6.82?±?4.07). ICUR after 36 months observation increased mainly in the patients below 65 years of age (All; P?

  6. Potassium Balances in Maintenance Hemodialysis

    OpenAIRE

    Choi, Hoon Young; Ha, Sung Kyu

    2013-01-01

    Potassium is abundant in the ICF compartment in the body and its excretion primarily depends on renal (about 90%), and to a lesser extent (about 10%) on colonic excretion. Total body potassium approximated to 50mmol/kg body weight and 2% of total body potassium is in the ECF compartment and 98% of it in the intracellular compartment.Dyskalemia is a frequent electrolyte imbalance observed among the maintenance hemodialysis patients. In case of hyperkalemia, it is frequently "a silent and a pot...

  7. Novel Sunitinib Strategy in Metastatic Renal Cell Carcinoma on Hemodialysis: Intermittent Dose of Sunitinib after Hemodialysis

    OpenAIRE

    Yoon, Sang Hyun; Kim, Ki Hyang; Choi, Junjeong; Kim, Gun Min; Kim, Joo Hoon; Kim, Hyo Song; Park, Young Nyun; Rha, Sun Young

    2010-01-01

    The proper dose and schedule of sunitinib have yet to be established for patients with metastatic renal cell carcinoma (RCC) on hemodialysis. We reviewed two patients with metastatic RCC on hemodialysis who had been treated with sunitinib in Yonsei Cancer Center, Yonsei University College of Medicine. Fifty milligrams of sunitinib was administered intermittently after each hemodialysis session (3 or 4 times a week). Overall responses were partial response in both cases. Progression-free survi...

  8. Morbimortality study of infection in patients undergoing different types of dialysis in a renal replacement therapy center

    Scientific Electronic Library Online (English)

    Natália Fabiane Ridão, Curty; Lucilene Fagundes da Silva, Martins; Carmen Antônia Sanches, Ito; Marcelo, Schafranski; Dorelayne Aparecida, Brites; César Roberto, Busato.

    2014-06-01

    Full Text Available INTRODUCTION: Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of [...] infection and increased mortality. OBJECTIVES: To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis. METHODS: This is case-control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients). RESULTS: One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95% = 2.13-5.17; p = 0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24-2.85; p = 0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12-0.31; p = 0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group. CONCLUSIONS: Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group.

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

    International Nuclear Information System (INIS)

    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)

  10. Serum trypsin inhibitory capacity in hemodialysis patients

    International Nuclear Information System (INIS)

    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)

  11. The relevance of dietary sodium in hemodialysis

    Science.gov (United States)

    Mc Causland, Finnian R.; Waikar, Sushrut S.; Brunelli, Steven M.

    2013-01-01

    Since the earliest days of hemodialysis, dietary sodium restriction has been recommended as a therapeutic means to mitigate problems of extracellular volume overload, hypertension and inter-dialytic weight gain. Recently, there has been a proliferation of human subjects' research examining the potential effects of dietary sodium curtailment. Herein we examine the available evidence with respect to the effects of dietary sodium restriction on clinically relevant endpoints among hemodialysis patients. PMID:23129821

  12. The relevance of dietary sodium in hemodialysis

    OpenAIRE

    Mc Causland, Finnian R.; Waikar, Sushrut S.; Brunelli, Steven M.

    2012-01-01

    Since the earliest days of hemodialysis, dietary sodium restriction has been recommended as a therapeutic means to mitigate problems of extracellular volume overload, hypertension and inter-dialytic weight gain. Recently, there has been a proliferation of human subjects' research examining the potential effects of dietary sodium curtailment. Herein we examine the available evidence with respect to the effects of dietary sodium restriction on clinically relevant endpoints among hemodialysis pa...

  13. Long-term home hemodialysis in children

    Science.gov (United States)

    Borra, Sonia; Kaye, Michael

    1971-01-01

    Experience with chronic hemodialysis as a definitive form of therapy is described for six children aged 11 to 15 years at the onset. Duration on dialysis in the home has been between one and 4½ years. All patients are alive and rehabilitated without serious complications. It is concluded that although transplantation is the most desirable form of treatment for children, long-term hemodialysis is an alternative acceptable second choice. ImagesFIG. 2 PMID:5150193

  14. Fiberoptic monitoring of central venous oxygen saturation (PediaSat in small children undergoing cardiac surgery: continuous is not continuous [v3; ref status: indexed, http://f1000r.es/3qt

    Directory of Open Access Journals (Sweden)

    Francesca G. Iodice

    2014-06-01

    Full Text Available Background: Monitoring of superior vena cava saturation (ScvO2 has become routine in the management of pediatric patients undergoing cardiac surgery. The objective of our study was to evaluate the correlation between continuous ScvO2 by the application of a fiber-optic oximetry catheter (PediaSat and intermittent ScvO2 by using standard blood gas measurements. These results were compared to those obtained by cerebral near infrared spectroscopy (cNIRS. Setting: Tertiary pediatric cardiac intensive care unit (PCICU. Methods and main results: A retrospective study was conducted in consecutive patients who were monitored with a 4.5 or 5.5 F PediaSat catheter into the right internal jugular vein. An in vivo calibration was performed once the patient was transferred to the PCICU and re-calibration took place every 24 hours thereafter. Each patient had a NIRS placed on the forehead. Saturations were collected every 4 hours until extubation. Ten patients with a median age of 2.2 (0.13-8.5 years and a weight of 12.4 (3.9-24 kg were enrolled. Median sampling time was 32 (19-44 hours: 64 pairs of PediaSat and ScVO2 saturations showed a poor correlation (r=0.62, 95% CI 44-75; p<0.0001 and Bland Altman analysis for repeated measures showed an average difference of 0.34 with a standard deviation of 7,9 and 95% limits of agreement from -15 to 16. Thirty-six pairs of cNIRS and ScVO2 saturations showed a fair correlation (r=0.79, 95% CI 0.60-0.89; p<0.0001 an average difference of -1.4 with a standard deviation of 6 and 95% limits of agreement from -13 to 10. Analysis of median percentage differences between PediaSat and ScvO2 saturation over time revealed that, although not statistically significant, the change in percentage saturation differences was clinically relevant after the 8th hour from calibration (from -100 to +100%. Conclusion: PediaSat catheters showed unreliable performance in our cohort. It should be further investigated whether repeating calibrations every 8 hours may improve the accuracy of this system. CNIRS may provide similar results with a lower invasiveness.

  15. Bicarbonate versus acetate hemodialysis in ventilated patients.

    Science.gov (United States)

    van Geelen, J A; Woittiez, A J; Schalekamp, M A

    1987-09-01

    Hemodynamic tolerance to bicarbonate versus acetate hemodialysis was studied in seven ventilated, critically ill patients, suffering from acute renal failure. Both kinds of hemodialysis were carried out with a recirculating dialysate delivery system and a relatively low blood flow (180 ml/min). Each patient underwent two hemodialysis procedures, one with bicarbonate and one with acetate, lasting for four hours. Ultrafiltration rates were kept below 250 ml/h and only biocompatible membranes with a relatively small surface area (Biospal 2400, Hospal, France) were used. Despite the mild hemodialysis conditions, hypotensive episodes with a mean blood pressure below 70 mmHg were observed in 3 out of 7 bicarbonate sessions and 4 out of 7 acetate sessions. Thus, we could not demonstrate a hemodynamic advantage of bicarbonate hemodialysis in this group of ventilated patients. This contrasts with other studies conducted in non-ventilated patients. Prevention of hypoxemia by mechanical ventilation and control of vascular tone by the use of vasoactive drugs may be of more clinical relevance than the kind of hemodialysis procedure that is used. PMID:3117466

  16. High fluoride exposure in hemodialysis patients.

    Science.gov (United States)

    Bello, V A; Gitelman, H J

    1990-04-01

    The observation of higher plasma flouride levels in our hemodialysis (HD) patients than our continuous ambulatory peritoneal dialysis (CAPD) patients (4.0 +/- 0.5 mumol/L [n = 17] v 2.5 +/- 0.3 mumol/L [n = 17], P less than 0.005) prompted an evaluation of fluoride metabolism during HD. We found that serum fluoride was completely ultrafiltrable across cuprophane membranes (99% +/- 4%) and that HD produced acute changes in plasma fluoride levels that correlated well with the fluoride gradient between plasma and dialysis fluid at the start of dialysis. Our HD fluids contained significantly higher fluoride concentrations than were present in commercially prepared peritoneal dialysis fluid. Our fluids are prepared from fluoridated tap water that is purified by reverse osmosis (RO). We conclude that the different concentrations of fluoride in our dialysis fluids account for the differences in the plasma flouride concentrations between our dialysis groups. Since many HD units rely on RO systems to purify fluoridated tap water, it is likely that many HD patients are being exposed inadvertently to increased concentrations of fluoride. PMID:2321644

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

    International Nuclear Information System (INIS)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  19. Hepatitis D Is a Forgotten Problem in Hemodialysis Patients in the World

    Directory of Open Access Journals (Sweden)

    Seyed-Moayed Alavian

    2008-02-01

    Full Text Available Hepatitis Delta Virus (HDV is a small defective virus that replicates only in the presence of Hepatitis B surface Antigen (HBsAg (1. The epidemiology of HDV infection is similar to HBV but with notable exceptions. Evidence of HDV infection was found all around the world. It is estimated that approximately 5% of HBsAg carriers are infected with HDV infection all around the world. HDV infection occurs worldwide but incidence and prevalence data are limited due to inaccurate reporting and delayed detection. It is more difficult to determine the number of cases of acute or fulminant hepatitis related to HDV infection, as the incidence varies among continents, countries, and regions. In general, three epidemiological patterns of HDV infection can be identified. They include the endemic pattern (such as what occurs in southern Italy and Greece, the epidemic pattern (epidemics have been reported in the Amazon Basin of Venezuela, and the occurrence of HDV infection among high-risk groups such as intravenous drug users (in developed Western countries. The epidemiology of HDV infection seems to be changing in some regions. Vaccination against HBV, decrease in HBV infection and thus in the pool of HBsAg carriers who may be infected with HDV are responsible for this decrease. Immigration patterns can be expected to have an impact on HDV infection. Nonetheless, it continues to represent a public health problem in some parts of the world yet (2-5. HBV infection in dialysis patients varies among different localities and correlates with the endemicity in the general population of the region. HBV prevalence has decreased in many countries in general population and dialysis patients. Improvement of people's knowledge about risk factors, national vaccination programs for neonates and vaccination of high risk groups are responsible for these decrease in prevalence of HBV infection in general population (6. The overall incidence and prevalence of HBV infection in dialysis patients has decreased over the years as a result of routine screening of blood products for HBsAg, the advent of recombinant human erythropoietin, HBV vaccination and the implementation of infection control measures (7, 8. However, the prevalence and incidence rates of HBsAg positivity are still high among patients undergoing maintenance hemodialysis in the less developed countries (9.Transmission of HDV is similar to HBV, via blood and blood fluids containing the virus, and infection occurs by parenteral routs (10. Dialysis patients may acquire HDV infection as they are at risk of hepatitis B infection. The information on the epidemiology of HDV infection in the dialysis patients is limited. This may be in part related to limited use or availability of delta testing. In European countries, such as France, Sweden, and the USA, HDV infection is restricted to high risk group of drug addicts and has decreased during recent years (11. There are some reports of acute and fulminant hepatitis or symptom-free transmission in dialysis patients with HBV and HDV infections (12-14. The prevalence was different from zero to 44.5% in hemodialysis patients (15, 16. The prevalence of HDV in different groups is related to routs of transmission. In Iran, the main route for HBV transmission was vertical in past (6, 17 and the difference between the prevalence of HDV infection in hemodialysis patients (44.5% and asymptomatic carriers (2.5% is meaningful (15.Delta virus is of particular potential concern in hemodialysis units where segregation of HBsAg positive atients to minimize hepatitis B transmission to susceptible patients may facilitate the transmission of delta agent (18. HDV infection is not important in developed countries, but may be a major risk for fulminant hepatitis in hemodialysis patients with HBV infection in developing countries. The importance of HDV is rising due to immigration phenomenon from area of developing countries. I recommend periodic testing for HDV infection by anti-HDV antibody in HBsAg positive carriers on chronic hemodialysis treatment.

  20. Erythropoiesis activity, iron availability and reticulocyte hemoglobinization during treatment with hemodialysis and in subjects with uremia.

    Science.gov (United States)

    Schoorl, Marianne; Schoorl, Margreet; Nubé, Menso J; Bartels, Piet C M

    2006-01-01

    In hemodialysis subjects correction of anemia is facilitated by combined supplementation of intravenous iron and recombinant human erythropoietin. Reticulocyte hemoglobin content (RET-He) is considered to be an actual indicator reflecting functional iron availability for erythropoiesis. In the present study, interdependence between biochemical analytes reflecting iron status and hemocytometric parameters indicating the degree of hemoglobinization of reticulocytes and red blood cells, respectively, is established. Participants of the study were reference subjects (n=75), subjects with iron deficiency anemia (n=52), subjects with uremia (n=19) and subjects undergoing hemodialysis treatment (n=43). If compared with the reference subjects the results for RBC counts and MCHC are statistically significantly decreased in case of subjects with hemodialysis and uremia, whereas increased results are established with regard to RDW-sd values. Significantly increased results for absolute reticulocyte counts and immature reticulocyte fractions (IRF) are also observed in case of subjects with hemodialysis and uremia. Slightly increased values for the ZPP/heme ratio in combination with elevated reticulocyte count reflect increased activity of erythropoiesis. At a definite MCV value, decreased levels for the hemoglobin content of reticulocytes (RET-He) and hemoglobin content of red blood cells (RBC-He) are observed in case of subjects treated with hemodialysis and in subjects with uremia if compared with identical MCV values of the group of reference subjects. For the ratio of RET-He and RBC-He obviously decreased results are demonstrated in case of subjects with iron deficiency anemia (1.02 +/- 0.08, mean +/- SD), hemodialysis (1.05 +/- 0.05) and uremia (1.02 +/- 0.10) if compared with the group of reference subjects (1.11 +/- 0.02). From the combined interpretation of the MCV values within the reference range and decreased values for RET-He and RET-He/RBC-He ratios, respectively, a decreased degree of hemoglobinization is concluded in the case of subjects with hemodialysis or uremia. The conclusion implicating the presumption of reduced functional availability of iron for hemoglobin synthesis is supported by the detection of increased results for sTfR concentrations and ZPP/heme ratios. PMID:17175894

  1. The experience of person with chronic renal disease in hemodialysis: meanings attributed for the patients

    Directory of Open Access Journals (Sweden)

    Claudinei José CJGC Gomes Campos

    2007-12-01

    Full Text Available Hemodialysis treatment received by chronic renal patients is known to be distressing and to impose a set of biological, psychological and social limitations(1. This work aimed to study how renal patients experience disease and hemodialysis treatment in a specialized service of a State University Hospital. As specific aims they were to analyze and understand the meanings the patient attributes to disease and treatment; to know the bio-psychosocial limitations experienced by the renal patient undergoing hemodialysis and to understand how they cope with them besides to analyze under the patient viewpoint how he realizes the treatment received from health professionals and their interpersonal relationships. The method used was clinical qualitative (2, using semi guided interview as instrument of data collection (3. The sample of 7 patients was obtained by intentional sampling and data saturation and the interviews were audio recorded and fully transcripted. The data were analyzed according the thematic content (4. Four categories were obtained: 1 – the experiences and meanings of hemodialysis for the patient, 2- psychological aspects involved, 3- physical and social limitations caused by the disease and treatment and 4 – the relationship with the hemodialysis team. The conclusions were that chronic renal patient attributes diverse meanings to hemodialysis treatment and that survival appeared as the main meaning for such event. The renal disease and hemodialysis treatment cause individual emotional alterations in different degrees that can interfere in the treatment evolution. Patients have difficulties in social and professional life, relations with friends and family members besides somewhat social discrimination. On the interpersonal relation with the health team, patients indicate the need for more attention and willingness to be listened more (5. Referências Bibliográficas 1 - Matta GC. Hospitais, subjetividade e glomérulos inoperantes: da doença renal ao renal crônico. (Dissertação. Rio de Janeiro (RJ: Instituto de Medicina Social da Universidade do Estado do Rio de Janeiro; 1998. 2 - Turato EG. Introdução à metodologia da pesquisa clínico-qualitativa: definição e principais características. Revista Portuguesa de Psicossomática 2000; 2(1:93-108. 3 - Kvale S. Interviews: an introduction to qualitative research interviewing. Thousand Oaks: SAGE; 1996. 4 - Downe-Wamboldt B. Content analysis: method, applications, and issues. Health Care Women Int, 1992; 13(3:313-21. 5 - Perestrello D. A Medicina da pessoa. 4a ed., São Paulo (SP: Atheneu; 1996.

  2. The experience of person with chronic renal disease in hemodialysis: meanings attributed for the patients

    Directory of Open Access Journals (Sweden)

    Claudinei José CJGC Gomes Campos

    2007-09-01

    Full Text Available Hemodialysis treatment received by chronic renal patients is known to be distressing and to impose a set of biological, psychological and social limitations(1. This work aimed to study how renal patients experience disease and hemodialysis treatment in a specialized service of a State University Hospital. As specific aims they were to analyze and understand the meanings the patient attributes to disease and treatment; to know the bio-psychosocial limitations experienced by the renal patient undergoing hemodialysis and to understand how they cope with them besides to analyze under the patient viewpoint how he realizes the treatment received from health professionals and their interpersonal relationships. The method used was clinical qualitative (2, using semi guided interview as instrument of data collection (3. The sample of 7 patients was obtained by intentional sampling and data saturation and the interviews were audio recorded and fully transcripted. The data were analyzed according the thematic content (4. Four categories were obtained: 1 – the experiences and meanings of hemodialysis for the patient, 2- psychological aspects involved, 3- physical and social limitations caused by the disease and treatment and 4 – the relationship with the hemodialysis team. The conclusions were that chronic renal patient attributes diverse meanings to hemodialysis treatment and that survival appeared as the main meaning for such event. The renal disease and hemodialysis treatment cause individual emotional alterations in different degrees that can interfere in the treatment evolution. Patients have difficulties in social and professional life, relations with friends and family members besides somewhat social discrimination. On the interpersonal relation with the health team, patients indicate the need for more attention and willingness to be listened more (5.Referências Bibliográficas1 - Matta GC. Hospitais, subjetividade e glomérulos inoperantes: da doença renal ao renal crônico. (Dissertação. Rio de Janeiro (RJ: Instituto de Medicina Social da Universidade do Estado do Rio de Janeiro; 1998.2 - Turato EG. Introdução à metodologia da pesquisa clínico-qualitativa: definição e principais características. Revista Portuguesa de Psicossomática 2000; 2(1:93-108.3 - Kvale S. Interviews: an introduction to qualitative research interviewing. Thousand Oaks: SAGE; 1996.4 - Downe-Wamboldt B. Content analysis: method, applications, and issues. Health Care Women Int, 1992; 13(3:313-21.5 - Perestrello D. A Medicina da pessoa. 4a ed., São Paulo (SP: Atheneu; 1996.

  3. Heterochronic spontaneous rupture of bilateral renal cell carcinomas in a hemodialysis patient.

    Science.gov (United States)

    Yamada, Shunsuke; Yotsueda, Hideki; Nagara, Tadashi; Goto, Ken; Nakashima, Yutaka; Hirakata, Hideki; Fujimi, Satoru; Tsuruya, Kazuhiko

    2013-01-01

    A 64-year-old man undergoing chronic hemodialysis was admitted under a shock state with macrohematuria and fatigue lasting for two hours. A blood analysis revealed severe anemia. Computed tomography disclosed a large right-sided perirenal hematoma. The patient was successfully treated with radical nephrectomy, leading to a histological diagnosis of spontaneous rupture of renal cell carcinoma (RCC). One year after rupture of the right RCC, he again developed macrohematuria and computed tomography revealed a left-sided perirenal hematoma. Radical nephrectomy followed by a histological examination revealed spontaneous rupture of the left-sided RCC. This case emphasizes the importance of conducting periodic imaging evaluations of chronic hemodialysis patients with renal cystic masses. PMID:23503408

  4. Hemodialysis

    Science.gov (United States)

    ... Cares Peers Support Ask the Doctor My Food Coach Nutrition Dialysis Patient & Family Resources Emergency Resources Join ... Legal and Copyright Information © 2015 National Kidney Foundation, Inc., 30 East 33rd Street, New York, NY 10016, ...

  5. Non-Invasive, Non-Contact Heart Monitoring of Hemodialysis Patients with a Micropower Impulse Radar Technique

    Energy Technology Data Exchange (ETDEWEB)

    Chang, J; Levin, N; Poland, D; Welsh, P; Paulsen, C; Trebes, J; Rosenbury, R; Killip, T

    2002-02-01

    This report summarizes the LLNL LDRD funded portion of a collaborative project to demonstrate and clinically evaluate the micropower impulse radar technology as a means to non-invasively monitor the heart of chronic care patients undergoing hemodialysis. The development is based upon technologies and expertise unique to LLNL. The LLNL LDRD funded portion of this project was used to assist in the definition, design, construction, and evaluation of the prototype.

  6. Serum IL-6 level and associated factors: hemodialysis patients

    Directory of Open Access Journals (Sweden)

    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

  7. Effect of Auricular Acupressure on Uremic Pruritus in Patients Receiving Hemodialysis Treatment: A Randomized Controlled Trial

    Science.gov (United States)

    Yan, Cui-na; Yao, Wei-guo; Bao, Yi-jie; Shi, Xiao-jing; Yu, Hui; Yin, Pei-hao; Liu, Gui-zhen

    2015-01-01

    Background. Uremic pruritus (UP) is a common symptom in patients undergoing maintenance hemodialysis for end-stage renal disease (ESRD). Objective. To determine the clinical efficacy of auricular acupressure therapy on pruritus in hemodialysis patients and to explore possible underlying mechanisms. Methods. Patients receiving maintenance hemodialysis at a referral medical center were recruited and assigned to intervention (n = 32) and control (n = 30) groups. The intervention group underwent auricular acupressure treatment three times a week for six weeks. Auricular acupressure was not applied to patients in the control group. However, tape without Vaccaria seeds was applied to the same six auricular acupoints as the intervention group. Pruritus scores were assessed using VAS scores, and enzyme-linked immunosorbent assays (ELISA) were used to measure levels of other possible contributory biochemical factors. Results. There was a significant difference in mean VAS scores between the postintervention and control groups during follow-up (3.844 ± 1.687 versus 5.567 ± 2.285, F = 22.32, P < 0.0001). Compared to the control group, serum histamine levels in the postintervention group at the six-week follow-up had decreased significantly (F = 5.01, P = 0.0290). Conclusion. Our findings suggest that auricular acupressure may be a useful treatment in the multidisciplinary management of UP in ESRD patients.

  8. GST M1 Polymorphism Associates with DNA Oxidative Damage and Mortality among Hemodialysis Patients

    OpenAIRE

    Lin, Yi-Sheng; Hung, Szu-Chun; Wei, Yau-Huei; Tarng, Der-Cherng

    2009-01-01

    Leukocyte 8-hydroxy-2?-deoxyguanosine (8-OHdG) is a surrogate marker of oxidant-induced DNA damage in patients undergoing maintenance hemodialysis (MHD). Glutathione S-transferase M1 (GST M1) is a member of the GST family of proteins, which protect cellular DNA against oxidative damage. This study tested the association of a common GST M1 gene polymorphism [GST M1(?)], known to produce a dysfunctional enzyme, with levels of 8-OHdG in peripheral blood leukocytes and all-cause mortality among M...

  9. Prediction of malnutrition using modified subjective global assessment-dialysis malnutrition score in patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Vasantha Janardhan

    2011-01-01

    Full Text Available Malnutrition is widely prevalent among patients on hemodialysis. Malnutrition can be estimated using a fully quantitative scoring system Subjective Global Assessment-Dialysis Malnutrition Score which is simple, reliable and dynamic. The primary objective of the study was to assess the severity of malnutrition in patients with end stage renal disease and undergoing hemodialysis in a tertiary care teaching hospital in Chennai, using Subjective Global Asses sment-Dialysis Malnutrition Score and correlate it with standard indicators of malnutrition like anthropometric and biochemical parameters of the study population by Pearson?s correlation. Anthropometric assessment included height, body weight, triceps skin fold thickness, mid arm circumference, mid arm muscle circumference % and biochemical parameters included serum albumin, transferrin, ferritin, total protein, total cholesterol, blood urea nitrogen and creatinine. Based on the scores, of the 66 patients, 91% were moderately malnourished. There was a significant negative correlation between modified Subjective Global Assessment-Dialysis Malnutrition Score and anthropometric measures such as triceps skin fold thickness, mid arm circumference, mid arm muscle circumference; biochemical markers such as albumin, transferrin and ferritin. The data obtained from this study confirm that a high degree of malnutrition was prevalent in patients on hemodialysis, as shown by anthropometric assessment, biochemical markers of malnutrition and Subjective Global Assessment-Dialysis Malnutrition Score. Nutritional status as determined by Subjective Global Assessment-Dialysis Malnutrition Score is a useful and reliable index for identifying patients at risk for malnutrition and it correlates well with anthropometric and biochemical assessment. may be integrated in regular assessment of malnutrition in patients on maintenance hemodialysis.

  10. Costos directos de la hemodiálisis en unidades públicas y privadas / Direct cost analysis of hemodialysis units

    Scientific Electronic Library Online (English)

    Luis, Durán-Arenas; Paula D, Ávila-Palomares; Rodrigo, Zendejas-Villanueva; María Magaly, Vargas-Ruiz; Laura L, Tirado-Gómez; Malaquías, López-Cervantes.

    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 est [...] rategia 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. Abstract in english 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 e [...] mployed 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.

  11. Postoperative continuous wound infusion of ropivacaine has comparable analgesic effects and fewer complications as compared to traditional patient-controlled analgesia with sufentanil in patients undergoing non-cardiac thoracotomy

    Science.gov (United States)

    Liu, Fang-Fang; Liu, Xiao-Ming; Liu, Xiao-Yu; Tang, Jun; Jin, Li; Li, Wei-Yan; Zhang, Li-Dong

    2015-01-01

    Objective: To compare the postoperative analgesic effects of continuous wound infusion of ropivacaine with traditional patient-controlled analgesia (PCA) with sufentanil after non-cardiac thoracotomy. Methods: One hundred and twenty adult patients undergoing open thoracotomy were recruited into this assessor-blinded, randomized study. Patients were randomly assigned to receive analgesia through a wound catheter placed below the fascia and connected to a 2 ml/h ropivacaine 0.5% (RWI group) or sufentanil PCA (SPCA group). Analgesia continued for 48 h. Visual analogue scores (VAS) at rest and movement, Ramsay scores and adverse effects were recorded at 2, 8, 12, 24, 36 and 48 h after surgery. Three months after discharge, patient’s satisfaction, residual pain and surgical wound complications were assessed. Results: General characteristics of patients were comparable between two groups. There were no statistical differences in the VAS scores and postoperative pethidine consumption between two groups (P > 0.05). However, when compared with SPCA group, the incidences of drowsiness, dizziness and respiratory depression, ICU stay and hospital expenditure reduced significantly in RWI group (P < 0.05). Patients’ satisfaction with pain management was also improved markedly in RWI group (P < 0.05). Conclusion: Continuous wound infusion with ropivacaine is effective for postoperative analgesia and has comparable effects to traditional PCA with sufentanil. Furthermore, this therapy may also reduce the incidences of drowsiness, dizziness, respiratory depression and decrease the ICU stay and hospital expenditure. PMID:26131121

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

    International Nuclear Information System (INIS)

    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)

  13. FGF-23 and cognitive performance in hemodialysis patients

    OpenAIRE

    Drew, David A; TIGHIOUART, Hocine; Scott, Tammy M; Lou, Kristina V.; Fan, Li; SHAFFI, Kamran; WEINER, Daniel E.; Sarnak, Mark J.

    2013-01-01

    Although cognitive impairment is common in hemodialysis patients, the etiology of and risk factors for its development remain unclear. Fibroblast growth factor 23 (FGF-23) levels are elevated in hemodialysis patients and are associated with increased mortality and left ventricular hypertrophy. Despite FGF-23 being found within the brain, there are no prior studies assessing whether FGF-23 levels are associated with cognitive performance. We measured FGF-23 in 263 prevalent hemodialysis patien...

  14. Development of practice guidelines for hemodialysis in Egypt

    OpenAIRE

    Ahmed, A. M. A.; Allam, Mohd. F.; Habil, E. S.; Metwally, A. M.; Ibrahiem, N. A.; Radwan, M.; El-Gaafary, M. M.; Afifi, A.; Gadallah, M. A.

    2010-01-01

    Although hemodialysis is the main modaility of treatment of end-stage renal disease, no practice guidelines are available in Egypt. Applying international guidelines for hemodialysis would not be suitable or feasible, because of different health system and lack of resources. The aim of this project was the development of evidence- and consensus-based clinical practice guidelines for hemodialysis in Egypt. The Egyptian guidelines were adopted from the standards developed by The College of Phys...

  15. Lifestyle of Hemodialysis Patients in Comparison with Outpatients

    OpenAIRE

    Moghadasian, Sima; Sahebi Hagh, Mohammad Hasan; Aghaallah Hokmabadi, Leila

    2012-01-01

    Introduction: Nowadays, the chronic diseases are known to be associated with lifestyle risk factors. Hemodialysis patients encounter considerable amount of physical, mental and social pressure. Lifestyle is important because it affects quality of life and has important role in prevention. This study aimed to compare the lifestyle of hemodialysis patients and outpatients in health clinics of Tabriz. Methods: This was a case-control study on 155 hemodialysis patients and 155 o...

  16. Regression of left ventricular mass following conversion from conventional hemodialysis to thrice weekly in-centre nocturnal hemodialysis

    OpenAIRE

    Wald Ron; Yan Andrew T; Perl Jeffrey; Jiang Depeng; Donnelly M Sandra; Leong-Poi Howard; McFarlane Philip A; Weinstein Jordan J; Goldstein Marc B

    2012-01-01

    Abstract Background Increased left ventricular mass (LVM) is associated with adverse outcomes in patients receiving chronic hemodialysis. Among patients receiving conventional hemodialysis (CHD, 3×/week, 4 hrs/session), we evaluated whether dialysis intensification with in-centre nocturnal hemodialysis (INHD, 3×/week, 7-8 hrs/session in the dialysis unit) was associated with regression of LVM. Methods We conducted a retrospective cohort study of CHD recipients who converted to INHD and receiv...

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

    DEFF Research Database (Denmark)

    Pakpour, Amir H.; Nourozi, Saeedeh

    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 of the questionnaire was extracted by performing a confirmatory factor analysis. RESULTS: Cronbach alpha for physical and mental component summaries were 0.89 and 0.90, respectively. The SF-12 showed a good discriminatory ability between subgroups of patients based on demographic and clinical variables. The confirmatory factor analysis for the original two-factor structure showed a good fit index (chi2 = 23.30, degrees of freedom = 13), goodness-of-fit index = 0.96, and root mean squared error of approximation = 0.079). CONCLUSIONS: In general, the SF-12 has good psychometric properties and can be used as a shorter version of the SF-36 questionnaire in future studies involving Iranian patients undergoing hemodialysis.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. Successful creation of an anemia management algorithm for hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Hara K

    2015-06-01

    Full Text Available Kazuhiro Hara, Yasuhide Mizutani, Hitoshi Kodera, Masato Miyake, Yoshiki Yasuda, Sanae Ohara Department of Nephrology, Yokkaichi Social Insurance Hospital, Yokkaichi, Mie Prefecture, Japan Introduction: Several anemia guidelines for hemodialysis patients have recommended a target hemoglobin (Hb range of 10–12 g/dL. However, maintaining Hb values continuously within a narrow target has been difficult, and there has been no generally accepted anemia management algorithm for hemodialysis patients. Methods: In our study, we created an anemia management algorithm that considers the length of erythrocyte lifetimes, focuses on the combination of erythropoiesis-stimulating agent management and iron administration, and prevents iron deficiency and overload. Our algorithm established a target Hb range of 10–12 g/dL. Results: We evaluated our algorithm in 49 patients for 6 months. The mean Hb values were approximately 11 g/dL during our study period. The percentage of patients in the target Hb range of 10–12 g/dL increased from 77.6% (38 of 49 at baseline to 85.7% (42 of 49 at 4–6 months. Throughout monthly regular blood tests during 1–6 months after we introduced our algorithm, Hb values remained within the target range in 55.1% (27 of 49 of patients. The standard deviation of Hb values significantly decreased at 5 and 6 months (P=0.013 and P=0.047, respectively; 1 g/dL at 0 month, 0.7 g/dL at 5 months, and 0.7 g/dL at 6 months. Our algorithm also succeeded in suppressing cumulative doses of iron (?800 mg and decreasing the ferritin values significantly (P=0.011. There were no significant differences in erythropoiesis-stimulating agent doses between 0 and 6 months (P=0.357. Conclusion: Our anemia management algorithm successfully increased the number of patients in the target Hb range, significantly decreased the Hb standard deviation, suppressed cumulative doses of iron, and decreased ferritin values. These results suggest a better prognosis for hemodialysis patients. Further studies are required to evaluate our algorithm. Keywords: erythropoiesis-stimulating agent, hemoglobin, iron, hemoglobin standard deviation, target hemoglobin range, ferritin

  1. Compromiso ocular en pacientes en hemodialysis / Eye involment in patients undergoin hemodialysis

    Scientific Electronic Library Online (English)

    Percy, Herrera Añazco; Miriam Giovanna, Díaz Sánchez; Melisa, Palacios Guillén; Luisa, Núñez Talavera; Alfonzo, López Herrera; José, Valencia Rodríguez; Manuela, Silveira Chau.

    2013-07-01

    Full Text Available Introducción: Los pacientes en diálisis tienen complicaciones crónicas que alteran su calidad de vida, como las oftalmológicas, producidas por comorbilidades de la ERC, o por efectos propios de la misma. Nuestro estudio pretendió describir los hallazgos oculares en una población en diálisis crónica [...] convencional en los aspectos de fondo de ojo, agudeza visual y presión intraocular. Material y Métodos: Estudio observacional descriptivo de corte transversal entre los pacientes en hemodiálisis crónica en el Servicio de Nefrología del Hospital Nacional 2 de Mayo de Lima - Perú. Resultados: Se estudiaron 31 pacientes cuya edad promedio fue 62.67±12.46 años; el 45.16% fueron varones. El 87.1% tenía HTA y el 45.16% Diabetes Mellitus. Los síntomas oculares más frecuentes fueron: Visión borrosa (67.74%), lagrimeo (38.71%), prurito (25.81%), ardor ocular (16.13%) y astenopia (6.41%). La presión intraocular promedio fue 14.5±5.28 mm Hg en el ojo derecho, y 14.23±4.78 mmHg en el ojo izquierdo. En el examen de agudeza visual se encontró ceguera en el 6.07% de los pacientes y baja visión en 39.39% de pacientes. Los hallazgos externos más frecuentes fueron: Depósitos córneo conjuntivales (41.94%), alteración en la película lagrimal (35.48%) e hiperpigmentación (35.48%).La alteración de refracción más frecuente fue hipermetropía y astigmatismo (80.77%). Las enfermedades oftalmológicas con diagnóstico definido más frecuentes fueron: Retinopatía diabética no proliferativa (37.93%) y degeneración macular relacionada con la edad (24.14%). En el análisis bivariado, entre los síntomas y el diagnóstico oftalmológico final, se encontró que los pacientes con visión borrosa presentaban menos retinopatía hipertensiva (p=0.002); y la ausencia de lagrimeo se asoció con menos retinopatía hipertensiva (p=0.03). Conclusión: Los hallazgos oftalmológicos anormales son frecuentes en nuestra población en diálisis crónica, siendo pocos los pacientes con agudeza visual normal. La evaluación ocular debería ser rutinaria en esta población. Abstract in english Introduction: Dialysis patients have chronic complications that impair their quality of life, such as eye involvement caused by chronic kidney disease (CKD) comorbidities, or because of specific CKD effects. This paper aims to describe funduscopy, visual acuity and intraocular pressure findings in a [...] population undergoing chronic conventional dialysis. Material and Methods: This is a descriptive and observational crosssectional study performed in patients undergoing chronic hemodialysis in the Nephrology Service of 2 de Mayo National Hospital in Lima - Peru. Results: Thirty-one patients were studied, their average age was 62.67 ± 12.46 years, 45.16% were male, 87.1% had hypertension, and 45.16% had diabetes mellitus 45.16%. The most common ocular symptoms were blurred vision (67.74%), tearing (38.71%), pruritus (25.81%), burning sensation in the eyes (16.13%) and asthenopia (6.41%). The average intraocular pressure was 14.5 ± 5.28 mm Hg in the right eye and 14.23 ± 4.78 mm Hg in the left eye. When visual acuity was examined, we found that 6.07% of patients were blind, and poor vision was found in 39.39% of patients. Most frequent external findings were corneal and conjunctival infiltrates (41.94%), tear film alterations (35.48%), and hyperpigmentation (35.48%). Most frequent refraction defects found were hyperopia and astigmatism (80.77%). Most common well-defined ophthalmological conditions were non-proliferative diabetic retinopathy (37.93%) and age-related macular degeneration (24.14%). A bivariate analysis performed relating symptoms and final ophthalmologic diagnoses, we found that patients with blurred vision developed hypertensive retinopathy less frequently (p = 0.002) and the absence of tearing was also associated with fewer cases of hypertensive retinopathy (p = 0.03). Conclusions: Abnormal ophthalmological findings are frequently found in persons undergoing hemodialysis, and only few patients have normal

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

    Directory of Open Access Journals (Sweden)

    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.

  3. Complex central venous catheter insertion for hemodialysis.

    Science.gov (United States)

    Powell, Steven; Belfield, Jane

    2014-01-01

    Despite the introduction of payment by results in the UK, there has been no decrease in central venous catheter (CVC) use. In part, this may relate to a requirement to dialyse through a CVC while autogenous access matures. Mortality data have improved in parallel and patients on hemodialysis live longer, which may lead to an increased exposure to CVCs.Exposure to CVCs carries a significant risk of infection and occlusion requiring their repositioning or exchange. The mid to long-term sequelae of CVC use is central venous occlusion leaving clinical teams with an ever increasing challenge to find adequate venous access.In this article, we will discuss the challenges faced by operators inserting CVCs into the hemodialysis-dependent patient who has exhausted more tradition insertion sites. These include translumbar caval catheters, transocclusion and transcollateral catheters, transjugular Inferior Vena Cava catheter positioning, and transhepatic catheters. We will demonstrate the techniques employed, complications, and anticipated longevity of function. PMID:24817471

  4. Postoperative Complications Following Hemodialysis Access Procedures

    OpenAIRE

    KEÇEL?G?L, H.T.; KOLBAKIR, F.; ARIKAN, A.; S Canbaz

    2010-01-01

    From July 1986 to September 1996, 322 arteriovenous fistulas were constructed in 250 patient for permanent hemodialysis: 315 autogenous and 7 graft fistulas (polytetraflouroethylen (PTFE)-4, dacron-3). 269 snuffbox (84%), 29 radiocephalic (8%), 24 brachiocephalic (7%) and 1 subclavian (0.3%) arteriovenous fistulas were performed. Successfull rate at first operations (255/322) was 79%. In the immediate postoperative period, 54 snuff box fistulas (20%) developed complications (52 early occlusio...

  5. The cost of hemodialysis in Iran

    OpenAIRE

    Arefzadeh Alireza; Lessanpezeshki Mahboub; Seifi Sepideh

    2009-01-01

    The use of dialysis in patients with end-stage renal disease (ESRD) remains one of the most resource-intensive and hence, expensive therapeutic interventions. The purpose of this study was to assess the cost of hemodialysis (HD) in Iran. This study was conducted in the Department of Nephrology at the Imam Khomeini Hospital of Tehran University of Medical Sciences, Iran, between April 2006 and June 2007. Patients with ESRD on chronic HD were involved in the study. Relevant data were collected ...

  6. Ultrasound Evaluation Before and After Hemodialysis Access

    Directory of Open Access Journals (Sweden)

    Daryoush Saedi

    2009-01-01

    Full Text Available   "nThe basic concept of hemodialysis access is to make a route to the central circulation in CRF patients. Vascular access procedures and subsequent complications represent a major cause of morbidity, hospitalization and cost for hemodialysis patients. Native arteriovenous fistulas (AVFs are preferable to synthetic arteriovenous grafts because they are associated with a lower frequency of thrombosis and infection, as well as greater longevity. AVFs that are never usable and early graft failures are associated with the common problem of inadequate vessel (artery or vein selection. The surgeon’s preoperative physical examination is the primary basis for AVF versus graft selection. Only palpable veins are considered for construction of AVFs, and the more proximal draining venous anatomy is not known prior to the operation. Physical examination is the traditional surgical evaluation performed prior to hemodialysis access placement. Palpation and inspection are difficult in obese arms, and few patients have vessels that are visible throughout their entire course. Patients with end-stage renal disease have often had multiple venipunctures and numerous intravenous lines placed and thus have an increased likelihood of venous stenosis or occlusion. Central vein problems are difficult to detect at visual inspection. By colour Doppler analysis vessels can be assessed for size, stenosis, and occlusion. US mapping assists in surgical planning and is especially valuable in patients who are difficult surgical cases (eg, obesity, diabetes, history of prior access, elderly women.  "nThis lecture contains two separate sections: 1-Vascular mapping prior to access placement and 2-Fistula maturity by US evaluation. Ultrasonography (US is an excellent modality for hemodialysis access evaluation because it is  readily available, non-invasive and inexpensive. It avoids the risks associated with iodinated contrast material and ionizing radiation.   

  7. Blood pressure and mortality among hemodialysis patients

    OpenAIRE

    Agarwal, Rajiv

    2010-01-01

    Blood pressure measured before and after dialysis does not agree well with those recorded outside the dialysis unit. Whether recordings obtained outside the dialysis unit are of greater prognostic value than blood pressure obtained just before and after dialysis remains incompletely understood. Among 326 patients on long-term hemodialysis, blood pressure was self-measured at home for one week, over an interdialytic interval by ambulatory recording and before and after dialysis over two weeks....

  8. Evaluation of the oral health status in Chinese hemodialysis patients.

    Science.gov (United States)

    Xie, Tian; Yang, Ziliang; Dai, Guanyu; Yan, Kaixiao; Tian, Yuan; Zhao, Dan; Zou, Huawei; Deng, Fei; Chen, Xiaolei; Yuan, Quan

    2014-07-01

    Chronic kidney disease has become a worldwide public health problem, and it negatively affects oral health. However, the data of the hemodialysis (HD) patients in Chinese population is unknown. This study was aimed to evaluate the dental health status and oral hygiene behavior of the HD patients in China. Patients undergoing HD therapy at two hospitals were asked to finish a questionnaire and receive dental examination (DMF-T). A total of 306 patients, aged 24-88 (58.09?±?14.06), took part in this study. Although majority of the patients (77.78%) brushed their teeth at least twice a day, few (less than 5%) had ever used dental floss or mouthwash. More than half of the patients have not visited a dentist since the commencement of HD therapy. The dental examination showed that DMF-T was 9.63?±?7.54, and the number of filled teeth (F-T) was only 0.70?±?1.48. Moreover, the average caries restoration ratio and replacement index were 17.57% and 32.59%, respectively. HD therapy seems to prevent patients from visiting a dentist, and there is a great need for dental treatment for Chinese HD patients. PMID:24593805

  9. Growing bone cysts in long-term hemodialysis

    International Nuclear Information System (INIS)

    All patients with chronic renal failure undergoing hemodialysis for more than 10 years in the university hospitals of Leuven were selected for this study. The medical records and radiographs of these 21 patients were studied retrospectively. Skeletal surveys were examined for the presence and location of subchondral cysts. The predialysis films and the films taken after 5, 10, 15 and 20 years of dialysis were reviewed. Subchondral cysts that grew in size and number were found in the wrist, humeral head, hip, and patella. Accurate measurements were made of cysts in the wrist and compared with a control group. In the dialysis group, cystic involvement of the wrist was more common and the size and number of the cysts were larger. Soft tissue swelling was seen in the dialysis group but not in controls. Soft tissue swelling was assessed on shoulder radiographs by measuring the acromiohumeral distance (ACD) and in the knees by ultrasonic measurement of synovial thickness. In 11 patients synovial or bone biopsies or aspirated synovial fluid were available. All these patients had swollen joints and multiple subchondral periarticular cysts. Amyloid deposition was found in ten of these patients, and this proved to be composed of B2 microglobulins in seven. (orig.)

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

    Directory of Open Access Journals (Sweden)

    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 describes key features UP in Republic of Srpska (Bosnia and Herzegovina and results that the UP is significantly more common in men. This study demonstrates that the serum level of PTH and phosphate isn’t associated with the incidence of pruritus in HD patients.

  11. Vitamin D deficiency in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Beena Bansal

    2012-01-01

    Full Text Available Background : Vitamin D [(25(OHD] deficiency and insufficiency is common in patients with chronic kidney disease (CKD. 25(OHD has been found to have beneficial effects on bone, cardiovascular and immune functions. There are little data about vitamin D levels in Indian patients on dialysis. This study was undertaken to determine the vitamin D status of Indian CKD patients on hemodialysis. Materials and Methods : We included 45 patients on maintenance hemodialysis coming to Medanta, Medicity, Gurgaon. 25(OHD levels were measured with radioimmunoassay (Diasorin method and parathyroid hormone (PTH was measured using electrochemiluminiscence immunoassay (ECLIA. Results : The mean age of patients was 55 ± 13 years. 32/45 (71% were males. 23/45 (51% were diabetics. The median duration of hemodialysis was 5.5 months (range 1-74 months. 33/45 (74% patients were on thrice weekly hemodialysis. The mean level of vitamin D was 10.14 ± 8.7 ng/ml. Majority of the patients [43/45 (95.5%] were either vitamin D deficient or had insufficient levels. 40/45 (88.9% were vitamin D deficient (levels <20 ng/ml; of these, 29/40 (64.4% had severe vitamin D deficiency (levels <10 ng/ml and 3/45 (6.7% had insufficient levels (20-30 ng/ml of vitamin D. Only 2/45 (4.4% patients had normal levels of vitamin D. 23/45 (51% of patients were receiving calcitriol. The mean levels of serum calcium, phosphorus, alkaline phosphatase, and albumin were 8.8 ± 0.64 mg/dl, 5.0 ± 0.7 mg/dl, 126 ± 10.3 IU/l and 3.6 ± 0.62 g/dl, respectively. PTH levels ranged from 37 to 1066 pg/ml, and the median was 195.8 pg/ml. There was a weak correlation between 25(OHD levels and weight, sex, hemoglobin, albumin, alkaline phosphatase, and presence of diabetes. There was, however, no correlation with duration of dialysis or PTH levels. Conclusion : Vitamin D deficiency and insufficiency are universal in our hemodialysis patients, with severe vitamin D deficiency in two-third of patients.

  12. The prevalance, epidemiology and risk factors for onychomycosis in hemodialysis patients

    OpenAIRE

    Satar Salim; Akcali Cenk; Duru Mehmet; Horoz Mehmet; Genctoy Gultekin; Çetin Meryem; Kuvandik Güven; Kiykim Ahmet A; Kaya Hasan

    2007-01-01

    Abstract Background Onychomycosis has a high prevalance among immunocompromised patients such as diabetics and hemodialysis patients. In the present study, we aimed to investigate the prevalence of onychomycosis among hemodialysis patients with and without diabetes mellitus, and to find out the factors likely to be associated with the development of onychomycosis among hemodialysis patients. Methods One hundred and nine hemodialysis patients were enrolled. Fifty-seven of hemodialysis patients...

  13. Designing a model to minimize inequities in hemodialysis facilities distribution

    Directory of Open Access Journals (Sweden)

    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.

  14. Functional Status of Patients on Maintenance Hemodialysis

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    Akash Nabil

    1999-01-01

    Full Text Available Factors associated with physical well being were examined in adults with end-stage renal disease (ESRD in two large hemodialysis units of the Royal Medical Services in Jordan. Utilizing the Karnofski scale we measured the functional status of 200 Patients who had been on maintenance hemodialysis for at least 12 months. A Marnofski scale of less than 70 incidents frank disability (Inability to perform routine living activities without assistance, in addition current vocational status was assessed as well as any existing comorbid conditions. The mean age of the study group was 45.2 years (range 16 to 70 and included 108 (54% males and 92 (46% females, there were 39 (19.5% diabetic patients and 27 (13.5% patients were receiving erythropoietin (EPO. The mean hematocrit of the entire group was 27.8%. As measured by Karnofski scale, 64 (32% of the patients were unable to perform routine living activity without assistance; dependence on wheelchair was reported by 9 (4.5% patients. The mean comorbidity index of patients who scored less than 70 on the Karnofski scale was 1.5 compared to 0.7 for those who scored at least 70 on the same scale (p< 0.001. Analysis of factors showed that age and diabetes mellitus affected functional status. Of the laboratory variables measured, only serum albumin concentration correlated significant with Karnofski scale. Fourteen (21.8% of the patients who scored below 70, had serum albumin concentration above 40g/L compared to 66 (48.5% of the patients who scored at least 70 on the Karnofski scale (p< 0.001. We conclude that a significant proportion of patients on maintenance hemodialysis is functionally disabled. The elderly, diabetics, patients with high co-morbidity index and those with low serum albumin are most likely to have poor functional status.

  15. Association of Smoking with Cardiovascular and Infection-Related Morbidity and Mortality in Chronic Hemodialysis

    Science.gov (United States)

    Brunelli, Steven M.; Waikar, Sushrut S.

    2012-01-01

    Summary Background and objectives Smoking is common in the hemodialysis population and is associated with increased all-cause mortality and development of cardiovascular disease. Cause-specific outcomes have not yet been examined in detail. This study investigated the association of baseline smoking status with all-cause, cardiovascular, and infection-related morbidity and mortality in patients undergoing long-term hemodialysis. Design, setting, participants, & measurements Post hoc analysis of the HEMO Study in patients with available comorbidity, clinical, and nutritional data. Cox proportional hazards regression models were fit to estimate the association of smoking status with mortality. Poisson and negative binomial regression models were fit to estimate the association of smoking status with hospitalization rate. Results Complete data were available for 1842 individuals (44% male, 63% black, 45% diabetic). Mean age was 58±14 years. At baseline, 17% were current smokers and 32% were former smokers. After case-mix adjustment, compared with never smoking, current smoking was associated with greater infection-related mortality (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.32–3.10) and all-cause mortality (HR, 1.44; 95% CI, 1.16–1.79) and greater cardiovascular (incidence rate ratio [IRR], 1.49; 95% CI, 1.22–1.82), infection-related (IRR, 1.35; 95% CI, 1.11–1.64) and all-cause (IRR, 1.43; 95% CI, 1.24–1.65) hospitalization rates. The population attributable fraction (i.e., fraction of observed deaths that may have been avoided) was 5.3% for current smokers versus never-smokers and 2.1% for current versus former smokers. Conclusions Active smoking is prevalent in the chronic hemodialysis population and is associated with greater all-cause, cardiovascular, and infection-related morbidity and mortality. PMID:22917700

  16. Temporal risk profile for infectious and noninfectious complications of hemodialysis access.

    Science.gov (United States)

    Ravani, Pietro; Gillespie, Brenda W; Quinn, Robert Ross; MacRae, Jennifer; Manns, Braden; Mendelssohn, David; Tonelli, Marcello; Hemmelgarn, Brenda; James, Matthew; Pannu, Neesh; Robinson, Bruce M; Zhang, Xin; Pisoni, Ronald

    2013-10-01

    Vascular access complications are a major cause of morbidity in patients undergoing hemodialysis, and determining how the risks of different complications vary over the life of an access may benefit the design of prevention strategies. We used data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) to assess the temporal profiles of risks for infectious and noninfectious complications of fistulas, grafts, and tunneled catheters in incident hemodialysis patients. We used longitudinal data to model time from access placement or successful treatment of a previous complication to subsequent complication and considered multiple accesses per patient and repeated access complications using baseline and time-varying covariates to obtain adjusted estimates. Of the 7769 incident patients identified, 7140 received at least one permanent access. During a median follow-up of 14 months (interquartile range, 7-22 months), 10,452 noninfectious and 1131 infectious events (including 551 hospitalizations for sepsis) occurred in 112,085 patient-months. The hazards for both complication types declined over time in all access types: They were 5-10 times greater in the first 3-6 months than in later periods after access placement or a remedial access-related procedure. The hazards declined more quickly with fistulas than with grafts and catheters (P<0.001; Weibull regression). These data indicate that risks for noninfectious and infectious complications of the hemodialysis access decline over time with all access types and suggest that prevention strategies should target the first 6 months after access placement or a remedial access-related procedure. PMID:23847278

  17. Processo de cuidar do idoso em Diálise Peritoneal Ambulatorial Contínua no domicílio Proceso de cuidar del anciano, que hace Diálisis Peritoneal Ambulatorial Contínua en el domicilio Home care for the elderly undergoing Continuous Ambulatory Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    Daniele Favaro Ribeiro

    2009-12-01

    Full Text Available Objetivo: Caracterizar os idosos com insuficência renal crônica termina em tratamento de diálise peritoneal ambulatorial contínua e seus cuidadores e descrever o processo de cuidadr desses idosos. Métodos: Estudo de abordagem qualitativa com dados coletados por meio de entrevista com nove cuidadores utilizando a história oral temática e a análise temática dso dados. Resultados: Dentre os nove idosos, cinco eram homens, média de idade 70 anos e todos dependiam do cuidador para troca da bolsa de diálise. Dos cuidadores, oito eram mulheres, média de idade 41,5 anos e despencia oito horas diárias para o cuidado. As falas referentes à categoria processo de cuidar do idoso com IRCT em DPACl contínua no domicílio. Conclusão: O estudo revelou a necessidade de auxiliar o cuidador a desenvolver conhecimentos e habilidades para lidar com a demanda de cuidados que o idoso exige, principalmente, em relação a DPAC.Objetivos: Caracterizar a los ancianos con insuficiencia renal crónica terminal (IRTC en tratamiento de diálisis peritoneal en ambulatorio y la continuación (DPAC del cuidado en el domicilio; caracterizar a sus cuidadores; y, describir el proceso de cuidar de esos ancianos. Métodos: Se trata de un estudio con abordaje cualitativo, utilizando la historia oral temática para la recolección de datos con nueve cuidadores y el análisis temático de los datos. Resultados: Entre los nueve ancianos, cinco eran hombres; promedio de edad 70 años; todos dependían del cuidador para cambiar la bolsa de diálisis. Entre los cuidadores, ocho eran mujeres; promedio de edad 41,5 años y dedicaban ocho horas diarias al cuidado. En el análisis, fue constituida la categoría: el proceso de cuidar del anciano con IRCT en DPAC en el domicilio. Conclusión: El estudio reveló la necesidad de auxiliar al cuidador a desarrollar conocimientos y habilidades para lidiar con la demanda de cuidados que el anciano exige, principalmente, en relación a DPAC.Objectives: To describe the elders with end stage renal disease (ESRD undergoing continuous ambulatory peritoneal dialysis (CAPD, their caregivers, and the care the caregivers provide to the elders. Methods: This was a qualitative study with 9 caregivers. Data were collected through oral history. Data analysis consisted of thematic content analysis. Results: The sample consisted of 5 male and 4 female elders and all them were dependent on caregivers to change the dialysis collection bag. The mean age of the participants was 70 years. Among the caregivers, 8 of them were female with a mean age of 41.5 years and they provided 8 hours of care to the elders daily. The main theme emerging from the content analysis was "home care for the elderly undergoing continuous ambulatory peritoneal dialysis." Conclusion: Caregivers need support for the development of knowledge and skills to deal with the elders' demand of care, particularly in regard to the management of CAPD.

  18. Processo de cuidar do idoso em Diálise Peritoneal Ambulatorial Contínua no domicílio / Home care for the elderly undergoing Continuous Ambulatory Peritoneal Dialysis / Proceso de cuidar del anciano, que hace Diálisis Peritoneal Ambulatorial Contínua en el domicilio

    Scientific Electronic Library Online (English)

    Daniele Favaro, Ribeiro; Sueli, Marques; Luciana, Kusumota; Rita de Cássia Helu Mendonça, Ribeiro.

    2009-12-01

    Full Text Available Objetivo: Caracterizar os idosos com insuficência renal crônica termina em tratamento de diálise peritoneal ambulatorial contínua e seus cuidadores e descrever o processo de cuidadr desses idosos. Métodos: Estudo de abordagem qualitativa com dados coletados por meio de entrevista com nove cuidadores [...] utilizando a história oral temática e a análise temática dso dados. Resultados: Dentre os nove idosos, cinco eram homens, média de idade 70 anos e todos dependiam do cuidador para troca da bolsa de diálise. Dos cuidadores, oito eram mulheres, média de idade 41,5 anos e despencia oito horas diárias para o cuidado. As falas referentes à categoria processo de cuidar do idoso com IRCT em DPACl contínua no domicílio. Conclusão: O estudo revelou a necessidade de auxiliar o cuidador a desenvolver conhecimentos e habilidades para lidar com a demanda de cuidados que o idoso exige, principalmente, em relação a DPAC. Abstract in spanish Objetivos: Caracterizar a los ancianos con insuficiencia renal crónica terminal (IRTC) en tratamiento de diálisis peritoneal en ambulatorio y la continuación (DPAC) del cuidado en el domicilio; caracterizar a sus cuidadores; y, describir el proceso de cuidar de esos ancianos. Métodos: Se trata de un [...] estudio con abordaje cualitativo, utilizando la historia oral temática para la recolección de datos con nueve cuidadores y el análisis temático de los datos. Resultados: Entre los nueve ancianos, cinco eran hombres; promedio de edad 70 años; todos dependían del cuidador para cambiar la bolsa de diálisis. Entre los cuidadores, ocho eran mujeres; promedio de edad 41,5 años y dedicaban ocho horas diarias al cuidado. En el análisis, fue constituida la categoría: el proceso de cuidar del anciano con IRCT en DPAC en el domicilio. Conclusión: El estudio reveló la necesidad de auxiliar al cuidador a desarrollar conocimientos y habilidades para lidiar con la demanda de cuidados que el anciano exige, principalmente, en relación a DPAC. Abstract in english Objectives: To describe the elders with end stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD), their caregivers, and the care the caregivers provide to the elders. Methods: This was a qualitative study with 9 caregivers. Data were collected through oral history. [...] Data analysis consisted of thematic content analysis. Results: The sample consisted of 5 male and 4 female elders and all them were dependent on caregivers to change the dialysis collection bag. The mean age of the participants was 70 years. Among the caregivers, 8 of them were female with a mean age of 41.5 years and they provided 8 hours of care to the elders daily. The main theme emerging from the content analysis was "home care for the elderly undergoing continuous ambulatory peritoneal dialysis." Conclusion: Caregivers need support for the development of knowledge and skills to deal with the elders' demand of care, particularly in regard to the management of CAPD.

  19. SERUM TRACE ELEMENTS IN CHILDREN ON MAINTENANCE HEMODIALYSIS

    Directory of Open Access Journals (Sweden)

    S. T. Esfahani

    2007-08-01

    Full Text Available During dialysis some trace elements can accumulate while others may be removed from blood, leading to deficiency of some trace elements. For evaluating changes of serum trace elements in children on maintenance hemodialysis we measured copper (Cu, zinc (Zn, cobalt (Co, manganese (Mn, chromium (Cr and nickel (Ni in 3 groups of children: Group 1, children with CRF who were on regular hemodialysis; Group 2, children with CRF who were on conservative management, and Group 3, healthy children. For evaluating the impact of duration of dialysis on serum trace elements, group 1 patients were divided into two subgroups: A, patients who were on hemodialysis therapy for shorter than 18 months, and B, patients who were on hemodialysis therapy for longer than 18 months. The technique used for measurement of trace elements was PIXE (Proton Induced X-ray Emission. Mean serum levels of Zn, Mn, and Ni in group 1 were lower than group 2 and group 3. There were not significant differences in serum levels of Zn, Mn and Ni between group 2 and 3. The differences in serum levels of Cr, Co and Cu among 3 groups were not significant. The serum levels of Zn, Mn and Ni were significantly lower in subgroup B compared to subgroup A. Correlation test showed that there were an inverse linear relation between the period of hemodialysis and serum levels of Zn, Mn and Ni. Chronic hemodialysis leads to abnormalities of some trace elements in children, and these derangements increase with duration of hemodialysis.

  20. Restless legs syndrome in patients on hemodialysis

    OpenAIRE

    Salman Saleh Mohammad

    2011-01-01

    Restless legs syndrome (RLS) is common among dialysis patients, with a reported prevalence of 6-60%. The prevalence of RLS in Syrian patients on hemodialysis (HD) is not known. The purpose of this study is to determine the prevalence of RLS in patients on regular HD, and to find the possible correlation between the presence of RLS and demographic, clinical, and biochemical factors. One hundred and twenty-three patients (male/female = 70/53, mean age = 41.95 ± 15.11 years) on HD th...

  1. The Effect of Holy Qur'an Recitation on Anxiety in Hemodialysis Patients: A Randomized Clinical Trial.

    Science.gov (United States)

    Babamohamadi, Hassan; Sotodehasl, Nemat; Koenig, Harold G; Jahani, Changiz; Ghorbani, Raheb

    2015-10-01

    Kidney disease and its related psychological costs have significantly increased in recent years. The aim of this study was to investigate the impact of Qur'an recitation on anxiety in hemodialysis patients. Sixty hemodialysis patients were randomized to either Qur'an recitation or a control group. Spielberger's State-Trait Anxiety Inventory (STAI) was completed by patients at baseline and 1 month afterward. The intervention involved listening to the recitation of the Qur'an in traditional cantillation voice. The control group received no intervention. The data were analyzed using Student's t test and general linear models. Recitation of the Qur'an was effective in reducing anxiety in the intervention group, decreasing STAI score at baseline from 128.5 (SD = 13.0) to 82.1 (SD = 11.3), compared to the control group which experienced no change in anxiety scores from baseline to follow-up (118.3, SD = 14.5, vs. 120.1, SD = 14.4, respectively. Between-subject comparison at follow-up, after adjusting for baseline differences, indicated a significant reduction in anxiety in the intervention versus the control group (F = 15.5, p = 0.0002, Cohen's d = 1.03). Listening to the Holy Qur'an being recited is an effective intervention for anxiety in patients undergoing hemodialysis in Iran. PMID:25559332

  2. The Effects Education Methods on Changes of Body Weight and Some of Serum Indices in Hemodialysis Patients Referred to Qom Kamkar Hospital in 2007

    Directory of Open Access Journals (Sweden)

    M. Abbasi

    2007-09-01

    Full Text Available Background and objectives: The number of hemodialysis patients has been increasing in recent years. Accumulation of metabolic waste products due to nonobservance of the proper diet is one of the mechanisms that threatens the health of these patients. In this study, the effects of lecture and handbook education methods have been evaluated on changes of body weight, serum sodium, potassium, blood urea nitrogen, creatinine and phosphorus in hemodialysis patients.Methods: In this clinical trial study, 113 hemodialysis patients were divided into three groups including control, lecture education, and handbook education groups. The indices were measured monthly, starting 3 months before and continuing for 3 months after the intervention. A comparison was made between the mean of each index measured before and after the intervention, using One-way ANOVA, followed by the Tukey’s post-hoc test. Results: Except sodium concentration, all other indices showed a significant reduction in both lecture and handbook education groups in comparison with controls (P <0.05. Although, in lecture education group the reduction of indices was higher than handbook education group, the reduction was not significant except for the serum blood urea nitrogen. Conclusion: Education can effectively help hemodialysis patients to reduce their weight and serum indices and it seems that education by lecture is more effective than by handbook.Keywords: Education, Handbook, Lecture, Laboratory Manuals, Body Weight Changes, Hemodialysis

  3. Conocimientos sobre la enfermedad renal crónica y el proceder de hemodiálisis / Knowledge about chronic kidney disease and hemodialysis procedure

    Scientific Electronic Library Online (English)

    Manuel Conrado, Domínguez Valdés; Mayra, Pacheco García; Bárbara Regla, Montero Torres; Milena, Rodríguez Carrillo; Jorge Félix, Rodríguez Ramos.

    2014-06-01

    Full Text Available Introducción: el consentimiento informado supone un proceso que va más allá de la firma de un documento de autorización. Objetivo: determinar el nivel de conocimientos sobre la enfermedad renal crónica y el proceder de hemodiálisis de los pacientes del Hospital General Docente Abel Santamaría Cuadra [...] do de Pinar del Río en el período comprendido de marzo a mayo de 2012. Material y método: se realizó un estudio observacional, descriptivo, transversal y aplicado. El universo estuvo constituido por los pacientes que reciben hemodiálisis (N = 102). La muestra estuvo integrada por los pacientes que recibieron hemodiálisis el día escogido para aplicar la encuesta que debió coincidir con la segunda sesión de hemodiálisis de la semana, utilizando un método aleatorio simple (n= 85), a los que se aplicó una encuesta formulario. Para determinar la asociación entre variables se utilizó el estadígrafo ji cuadrado al 95 % de confianza. Resultados: la muestra resultó ser mayoritariamente joven, con bajo nivel educacional, siendo el dominio de la enfermedad bastante bajo, y aún más crítico el conocimiento sobre posibles complicaciones durante la hemodiálisis, cuestiones evitables de existir un documento informador previo a este proceder. Conclusiones: los pacientes con enfermedad renal crónica y con tratamientos depuradores, como la hemodiálisis, necesitan la existencia de un consentimiento informado, que sea adaptable a cada paciente, para prepararlos mejor y así lograr bienestar, confort y su total cooperación. Abstract in english Introduction: informed knowledge involves a process that goes beyond the signing of an authorization document. Objective: to determine the level of knowledge about the chronic kidney disease and the hemodialysis procedure by the patients of Abel Santamaría Cuadrado General Teaching Hospital of Pinar [...] del Río, in the period between March and May 2012. Material and method: an observational, descriptive, cross-sectional and applied study was performed. The universe was made up of the patients undergoing hemodialysis (n=120). The sample was composed by the patients who underwent hemodialysis on the days chosen for applying the survey, which should coincide with the second session of hemodialysis within the week, using the random simple method (n=85), whom were conducted the questionnaire-survey on. To determine association amongst variables, the statistical chi-square test was used at 95% of confidence. Results: the sample came to be mostly young, with low schooling, being also low their knowledge on the disease, and even more critical their knowledge about potential complications in hemodialysis, matters evitable to occur in an authorization document before this procedure. Conclusions: patients with chronic kidney disease and with purifying treatments, as hemodialysis, need to know about a proper informed concernment, applicable to each patient, in order to better prepare them and in doing so to achieve welfare, comfort and their total recovery.

  4. Radiologic placement of hemodialysis central venous catheters: a practical guide

    International Nuclear Information System (INIS)

    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)

  5. Radiologic placement of hemodialysis central venous catheters: a practical guide

    Energy Technology Data Exchange (ETDEWEB)

    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)

  6. Clinical significance of N-Terminal Pro-B-type natriuretic peptide (NT-proBNP) in hemodialysis patients

    OpenAIRE

    Mohseni Amira; Helal Imed; Belhadj Raja; Bazdeh Lilia; Drissa Habiba; ELyounsi Fethi; Abdallah Taieb; Abdelmoula Jaouida; Kheder Adel

    2010-01-01

    Circulating biomarkers play a major role in the early detection of cardiovascular di-sease. The purpose of this study was to determine levels of N-Terminal Pro-B-type Natriuretic Pep-tide (NT-proBNP) in hemodialysis (HD) patients and to examine the relationship of this marker to left ventricular hypertrophy and to cardiac dysfunction. Plasma NT-proBNP concentrations were measured in patients undergoing chronic HD, who did not any clinical evidence of heart failure, (n=32; mean age 43.14 ±...

  7. Dialysate and serum potassium in hemodialysis.

    Science.gov (United States)

    Hung, Adriana M; Hakim, Raymond M

    2015-07-01

    Most patients with end-stage renal disease depend on intermittent hemodialysis to maintain levels of serum potassium and other electrolytes within a normal range. However, one of the challenges has been the safety of using a low-potassium dialysate to achieve that goal, given the concern about the effects that rapid and/or large changes in serum potassium concentrations may have on cardiac electrophysiology and arrhythmia. Additionally, in this patient population, there is a high prevalence of structural cardiac changes and ischemic heart disease, making them even more susceptible to acute arrhythmogenic triggers. This concern is highlighted by the knowledge that about two-thirds of all cardiac deaths in dialysis are due to sudden cardiac death and that sudden cardiac death accounts for 25% of the overall death for end-stage renal disease. Developing new approaches and practice standards for potassium removal during dialysis, as well as understanding other modifiable triggers of sudden cardiac death, such as other electrolyte components of the dialysate (magnesium and calcium), rapid ultrafiltration rates, and safety of a number of medications (ie, drugs that prolong the QT interval or use of digoxin), are critical in order to decrease the unacceptably high cardiac mortality experienced by hemodialysis-dependent patients. PMID:25828570

  8. Serum Protein Profile Alterations in Hemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, G A; Davies, R W; Choi, M W; Perkins, J; Turteltaub, K W; McCutchen-Maloney, S L; Langlois, R G; Curzi, M P; Trebes, J E; Fitch, J P; Dalmasso, E A; Colston, B W; Ying, Y; Chromy, B A

    2003-11-18

    Background: Serum protein profiling patterns can reflect the pathological state of a patient and therefore may be useful for clinical diagnostics. Here, we present results from a pilot study of proteomic expression patterns in hemodialysis patients designed to evaluate the range of serum proteomic alterations in this population. Methods: Surface-Enhanced Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (SELDI-TOFMS) was used to analyze serum obtained from patients on periodic hemodialysis treatment and healthy controls. Serum samples from patients and controls were first fractionated into six eluants on a strong anion exchange column, followed by application to four array chemistries representing cation exchange, anion exchange, metal affinity and hydrophobic surfaces. A total of 144 SELDI-TOF-MS spectra were obtained from each serum sample. Results: The overall profiles of the patient and control samples were consistent and reproducible. However, 30 well-defined protein differences were observed; 15 proteins were elevated and 15 were decreased in patients compared to controls. Serum from one patient exhibited novel protein peaks suggesting possible additional changes due to a secondary disease process. Conclusion: SELDI-TOF-MS demonstrated dramatic serum protein profile differences between patients and controls. Similarity in protein profiles among dialysis patients suggests that patient physiological responses to end-stage renal disease and/or dialysis therapy have a major effect on serum protein profiles.

  9. Hirudin as anticoagulant in experimental hemodialysis.

    Science.gov (United States)

    Markwardt, F; Nowak, G; Bucha, E

    1991-01-01

    After genetically engineered recombinant DNA desulfatohirudin (r-hirudin) had been investigated as to its pharmacokinetic behavior and blood level course in nephrectomized dogs, the compound was studied for its capability to prevent thrombus formation in the extracorporeal circulation. Beagle dogs underwent bilateral functional nephrectomy followed by experimental hemodialysis. r-Hirudin content in blood, fibrinogen level as well as platelet count were determined before and during the dialysis. Furthermore, the blood loss during the experiment was measured as well as the mean arterial pressure and the pressure in the blood line system. Intravenous administration of the thrombin inhibitor resulted in initial distribution in the extracellular space (distribution phase 90 min) followed by retarded decrease of the r-hirudin blood level (t1/2 beta approximately 6-8 h) which is due to the missing renal excretion of the inhibitor. This caused a long-lasting, dose-dependent anticoagulant effect, which is not only characterized by the prevention of increasing pressure before the capillary dialyzer but also by the reduced drop in fibrinogen and platelets during hemodialysis. The required dose of r-hirudin (0.5 mg/kg) is within a range where bleeding complications will not occur yet. PMID:1894190

  10. Hemodialysis vascular access stenosis detection using auditory spectro-temporal features of phonoangiography.

    Science.gov (United States)

    Sung, Po-Hsun; Kan, Chung-Dann; Chen, Wei-Ling; Jang, Ling-Sheng; Wang, Jhing-Fa

    2015-05-01

    For end-stage renal disease patients undergoing hemodialysis, thrombosis caused by stenosis hinders the long-term use of vascular access. However, traditional spectral bruit analysis techniques for detecting the severity of vascular access stenosis are not robust. Accordingly, the present study proposes an automated method for mimicking a trained practitioner in performing the auscultation process. In the proposed approach, the bruit obtained using a standard phonoangiographic method is transformed into the time-frequency domain, and two spectro-temporal features, namely the auditory spectrum flux and the auditory spectral centroid, are then extracted. The distributions of the two features are analyzed using a multivariate Gaussian distribution (MGD) model. Finally, the distribution parameters of the MGD model are used to detect the presence (or otherwise) of vascular access stenosis. The validity of the proposed approach is investigated using the phonoangiography signals obtained from 16 hemodialysis patients with straight arteriovenous grafts over the upper arm region. The results show that the MGD covariance matrix coefficient of the auditory spectral centroid feature yields an accuracy of 83.87 % in detecting significant vascular access stenosis. Thus, the proposed method has significant potential for the applications of vascular access stenosis detection. PMID:25681949

  11. Bone cyst of atlantoaxial joint in long-term hemodialysis patients

    International Nuclear Information System (INIS)

    A systematic study of the upper cervical spine was performed using computed tomography in 32 patients (17 men and 15 women) who had been undergoing hemodialysis for more then 20 years. Twenty-one patients had bone cysts in the lateral mass of the atlas. Nine patients had bone cysts in the screw insertion path of the axis during the Magerl technique. Eight patients had bone cysts in the dens of the axis. In patient with destructive Spondyloarthropathy (DSA) of the atlantoaxial joint, this condition tended to progress quickly, resulting in atlantoaxial subluxation and severe myelopathy requiring surgery at this site. Surgical methods for atlantoaxial subluxation include C1/2 transarticular screw fixation (Magerl screw) and wedge compression arthrodesis of the atlantoaxial joint (Brooks method) and atlantoaxial posterior fixation (Goel method or Tan method). But, most patients on long-term hemodialysis over 20 years were found with bone cysts in the lateral mass of the atlas, making atlantoaxial screw fixation difficult. We consider evaluation of bone cysts in the atlantoaxial joint before operation to be important. (author)

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

    International Nuclear Information System (INIS)

    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 cm2, 2.31 and 0.74, which were significantly higher than those in the control group (37.4 cm2, 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)

  13. Hemochromatosis (HFE gene mutations in Brazilian chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    F.V. Perícole

    2005-09-01

    Full Text Available Patients with chronic renal insufficiency (CRI have reduced hemoglobin levels, mostly as a result of decreased kidney production of erythropoietin, but the relation between renal insufficiency and the magnitude of hemoglobin reduction has not been well defined. Hereditary hemochromatosis is an inherited disorder of iron metabolism. The importance of the association of hemochromatosis with treatment for anemia among patients with CRI has not been well described. We analyzed the frequency of the C282Y and H63D mutations in the HFE gene in 201 Brazilian individuals with CRI undergoing hemodialysis. The analysis of the effects of HFE mutations on iron metabolism and anemia with biochemical parameters was possible in 118 patients of this study (hemoglobin, hematocrit, ferritin levels, transferrin saturation, and serum iron. A C282Y heterozygous mutation was found in 7/201 (3.4% and H63D homozygous and heterozygous mutation were found in 2/201 (1.0% and 46/201 (22.9%, respectively. The allelic frequencies of the HFE mutations (0.017 for C282Y mutation and 0.124 for H63D mutation did not differ between patients with CRI and healthy controls. Regarding the biochemical parameters, no differences were observed between HFE heterozygous and mutation-negative patients, although ferritin levels were not higher among patients with the H63D mutation (P = 0.08. From what we observed in our study, C282Y/H63D HFE gene mutations are not related to degrees of anemia or iron stores in CRI patients receiving intravenous iron supplementation (P > 0.10. Nevertheless, the present data suggest that the H63D mutation may have an important function as a modulating factor of iron overload in these patients.

  14. Nadir Hemoglobin Levels after Discontinuation of Epoetin in Hemodialysis Patients

    OpenAIRE

    Calvo, Jose A.; Miskulin, Dana C.; Meyer, Klemens B.; WEINER, Daniel E.

    2010-01-01

    Background and objectives: In hemodialysis patients, both hemoglobin variability and targeting normalization of hemoglobin may have adverse consequences. There are few data on epoetin management in patients achieving high hemoglobin levels.

  15. Kidney Failure: Eat Right to Feel Right on Hemodialysis

    Science.gov (United States)

    ... potassium in the blood to keep the heart beating at a steady pace. Potassium levels can rise ... and Hemodialysis National Kidney Foundation 30 East 33rd Street New York, NY 10016 Phone: 1–800–622– ...

  16. 21 CFR 876.5820 - Hemodialysis system and accessories.

    Science.gov (United States)

    2010-04-01

    21 Food and Drugs 8 2010-04-01 2010-04-01...5820 Section 876.5820 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH...the dialyzer holder set, dialysis tie gun and ties, and hemodialysis...

  17. Current practice of conventional intermittent hemodialysis for acute kidney injury

    OpenAIRE

    Schiffl, H.; Lang, S. M.

    2013-01-01

    The use of conventional intermittent hemodialysis (IHD) represents a mainstay of supportive care of patients with acute kidney injury (AKI). However, a number of fundamental questions regarding the optimal management of IHD remain unanswered after more than six decades of renal replacement therapy (RRT). This review summarizes current evidence regarding the timing of initiation of intermittent hemodialysis, the comparative outcomes (mortality and recovery of renal function), the prescription ...

  18. Study of Elements, Antioxidants and Lipid Peroxidation in Hemodialysis Patients

    OpenAIRE

    MENEV?E, Esma

    2006-01-01

    Background: During hemodialysis, most of the elements must be kept in a rather narrow physiological range, otherwise life-threatening events may occur. Furthermore, lipid peroxidation in patients may be partly due to the trace element disturbances. It has been mentioned that there are relations between deficiency in trace elements and antioxidant levels. The present study aimed to determine whether there were differences between hemodialysis patients and a healthy group according to selenium,...

  19. Disappearance of diabetic macular hard exudates after hemodialysis introduction.

    OpenAIRE

    Matsuo, Toshihiko

    2006-01-01

    We report herein the disappearance of macular hard exudates after the introduction of hemodialysis in diabetic patients. A 62-year-old woman and a 52-year-old man with diabetes mellitus showed hard exudates in the macula of the left eyes. Both patients had previously undergone panretinal photocoagulation in both eyes. During the follow-up, hemodialysis was introduced for deteriorating chronic renal failure caused by diabetic nephropathy. Half a year later, macular hard exudates in th...

  20. Montelukast for Treatment of Refractory Pruritus in Patients on Hemodialysis

    OpenAIRE

    Ali Reza Nasrollahi; Amirhosein Miladipour; Esmat Ghanei; Parvin Yavari; Farshid Haghverdi

    2009-01-01

    Introduction. One of the most common complaints in patients with end-stage renal disease (ESRD) is uremic pruritus. In the recent years, many drugs have been proposed for its treatment which have had paradoxical outcomes. We studied the antipruritus effect of montelukast sodium, a leukotriene receptor antagonist, in patients on hemodialysis.Materials and Methods. The study was conducted as randomized, single-blind, placebo-controlled crossover study in 5 hemodialysis centers. Sixteen patients...

  1. Comparison of microbiologic assay methods for hemodialysis fluids.

    OpenAIRE

    Arduino, M. J.; Bland, L A; Aguero, S M; Carson, L.; Ridgeway, M; Favero, M. S.

    1991-01-01

    To help prevent pyrogenic reactions and bacteremia in hemodialysis patients, the Association for the Advancement of Medical Instrumentation and the Centers for Disease Control recommend microbiologic assay of hemodialysis fluids at least monthly. Five commercially available assay systems were evaluated by using the membrane filtration technique with standard methods agar and trypticase soy agar as the standards for comparison. Each assay system was challenged with dialysate and reverse-osmosi...

  2. Hemodialysis-associated pseudoporphyria resistant to N-acetylcysteine

    Directory of Open Access Journals (Sweden)

    Bahadi Abdellali

    2011-01-01

    Full Text Available We report a 33-year-old female patient who had hemodialysis-associated pseudo-porphyria which did not respond to treatment with oral N-acetylcysteine. She responded favorably to treatment with the anti-malarial drug, chloroquine. The case is being reported to highlight the difficulty in interpreting the urinary porphyrin assays in patients on hemodialysis. Additionally, the current literature on pseudoporphyria disorders in patients with end-stage renal disease is briefly discussed.

  3. Improving the efficiency of short-term single-needle hemodialysis.

    Science.gov (United States)

    Rostoker, Guy; Griuncelli, Mireille; Loridon, Christelle; Bourlet, Thomas; Welsch, Karen; Benmaadi, Abbes

    2009-01-01

    It is widely believed that single-needle (SN) hemodialysis is inferior to conventional double-needle (DN) hemodialysis. The purpose of this study was to compare two SN dialysis regimens using different blood flow rates with conventional DN hemodialysis. The primary outcome measure was ionic dialysance. We studied eight patients (two women, six men) undergoing chronic intermittent DN bicarbonate hemodialysis three times per week on a Cimino-Brescia fistula for at least three months. The study had a prospective four-period design and lasted four weeks. During weeks 1 and 3, the participants had standard DN hemodialysis sessions, with Wallace needles at a blood flow rate of 250-300 mL/min. During week 2, they had single-needle dialysis sessions with a short 15-gauge stainless-steel needle, an effective blood flow rate of 180 mL/min (360 mL/min for each of the two pumps), and venous pressure below 200 mmHg. During week 4, they had SN dialysis sessions with a short 15-gauge stainless-steel needle, an effective blood flow rate of 250 mL/min (500 mL/min for each of the two pumps), and a venous pressure below 200 mmHg. Ionic dialysance recorded 45 minutes after the beginning of the dialysis session and 30 minutes before the end of the session were used for statistical analysis. The effective blood flow target of 250 mL/min was achieved in six of the eight patients. Ionic dialysance 45 minutes after the beginning of the session differed among the four periods (p < 0.001, Friedman test). Ionic dialysance was better during each DN dialysis period than during the 180 mL/min SN period (p < 0.01, Dunn's multiple comparison tests), but there was no difference with the 250 mL/min SN period. Ionic dialysance 30 minutes before the end of the dialysis session differed among the four periods (p < 0.001, Friedman test). Ionic dialysance was far better during each DN period than during the 180 mL/min SN period (p < 0.001, Dunn's multiple comparison test) and slightly better than during the 250 mL/min SN period (p < 0.05, Dunn's multiple comparison test). The single-pool Kt/V ratio differed among the four periods (p < 0.0001, Friedman test). The Kt/V ratios were far better during each DN period than during the 180 mL/min SN period (p < 0.001, Dunn's multiple comparison test) and slightly better than during the 250 mL/min SN period (p < 0.01, Dunn's multiple comparison test). The Kt/v provided by the dialysis monitor gave identical results to single pool Kt/v. We conclude that single-needle dialysis with an effective blood flow rate of 180 mL/min delivers an inadequate dialysis dose, which may be harmful. In contrast, an effective blood flow rate of 250 mL/min appears acceptable for brief periods of single-needle dialysis lasting one or two weeks. Otherwise, an increase in the length of the dialysis session and/or the use of a larger membrane surface area and even higher blood flow is required to obtain the same quality of dialysis as with conventional double-needle hemodialysis. Careful monitoring of the dialysis dose delivered is mandatory during single-needle dialysis. PMID:19462273

  4. Radiological diagnosis of renal osteodystrophy with reference to clinical features in patients undergoing maintenance hemodialysis

    International Nuclear Information System (INIS)

    Pathophysiological, histological and radiological findings in renal osteodystrophy are described. Special emphasis is laid on secondary hyperparathyroidism. Preliminary results of the authors' investigations show a good correlation between radiological findings in the phalanges of the hand and the concentration of parathyroid hormone (PTH) in 14 patients. The concentration of the hormone in the blood was measured by a new 'two-site' immunoradiometric assay, which is specific for the intact, biologically active hormone. Patients with high concentrations of PTH in the blood tended to have more severe radiological changes. In 4 patients for whom radiographs of the hands revealed no pathologic findings, normal PTH concentrations in the blood were measured by this method, whereas the conventional assay gave elevated hormone concentrations for the same patients. This is due to the lack of specificity of the conventional method for the intact, biologically active hormone. Nevertheless, further investigations are needed to confirm these findings. (orig.)

  5. Study of factors related to hypotension in hemodialysis patients.

    Science.gov (United States)

    Furukawa, A; Miyamoto, T; Tamura, M; Kawanishi, Y; Numata, A; Yuasa, M; Imagawa, A; Kagawa, S

    1992-04-01

    The factors related to hypotension in hemodialysis patients were evaluated. The subjects consisted of 120 hemodialysis patients (61 males and 59 females), whose ages ranged between 28 and 82 years, and who had undergone hemodialysis treatment for a period ranging between 3 and 201 months. They were divided into three groups: Group A, 53 normotensive patients; Group B, 52 patients with hypotension during hemodialysis; and Group C, 15 patients with constant hypotension. The evaluated factors were age, sex, etiology of renal failure, hemodialysis term, ultrafiltered volume, responsiveness to vasopressor drugs, Cr, Na, Ht, TP, cardiothoracic ratio, presence or absence of heart disease, and microvibration pattern. Statistical analysis was performed using multivariate analysis (Quantification II and IV methods). The results of the Quantification IV method indicated that Groups A and B were similar but Group C was quite different from the other two groups. The results of the Quantification II method indicated that the most important factor which characterized the difference between Group A and Group C was the responsiveness to vasopressor drugs, and the most important factor in the difference between Group B and Group C was the microvibration pattern. Group B was characterized by abnormal microvibration patterns and Group C was characterized by a low responsiveness of the peripheral vessels to vasopressor drugs. We conclude that the hypotension during hemodialysis was caused predominantly by dysfunction of the autonomic nervous system, while the constant hypotension was caused predominantly by a deterioration of constriction of the peripheral vessels. PMID:1635287

  6. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt

    OpenAIRE

    Mourad B; Hegab D; Okasha K; Rizk S

    2014-01-01

    Basma Mourad,1 Doaa Hegab,1 Kamal Okasha,2 Sarah Rizk3 1Dermatology and Venereology Department, 2Internal Medicine Department, Faculty of Medicine, Tanta University, 3Ministry of Health, Tanta, EgyptIntroduction: Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodia...

  7. Avaliação nutricional de pacientes em hemodiálise / Nutritional evaluation of patients on hemodialysis

    Scientific Electronic Library Online (English)

    Poliana Coelho, Cabral; Alcides da Silva, Diniz; Ilma Kruze Grande de, Arruda.

    2005-02-01

    Full Text Available OBJETIVO: O objetivo deste estudo foi o de avaliar o estado nutricional e a ingestão de energia e de nutrientes de uma população em hemodiálise no Hospital das Clínicas, Universidade Federal de Pernambuco. MÉTODOS: De um total de 47 pacientes em hemodiálise de manutenção, 37 indivíduos (18 homens e [...] 19 mulheres, idade 50,4 ± 16,3 anos) foram selecionados. O índice de massa corporal foi utilizado para a classificação do estado nutricional e a dieta foi investigada por meio do método do diário alimentar de 4 dias. RESULTADOS: Os resultados evidenciaram um predomínio de indivíduos eutróficos (62,2%) e igual prevalência de baixo peso e excesso de peso (18,9% de pacientes em cada caso). Com relação à dieta, os achados desta pesquisa revelaram um adequado consumo energético-protéico. De uma forma geral, a ingestão média diária de nutrientes foi considerada adequada, exceto pelo cálcio e pela vitamina A, que apresentaram Abstract in english OBJECTIVE: To evaluate the nutritional status, and the energy and nutrient intakes of a population undergoing hemodialysis at the Hospital das Clínicas, Universidade Federal de Pernambuco, Brazil. METHODS: From a pool of 47 outpatients undergoing maintenance hemodialysis, 37 individuals (18 males an [...] d 19 females, aged 50.4 ± 16.3 years) were selected. The body-mass index was used to determine the nutritional status, and the diet was investigated through the 4-day food diary method. RESULTS: The results revealed a predominance of normal, eutrophic patients (62.2%), while presenting equal prevalence of underweight and overweight patients (18.9% of them in each case). Regarding the diet, the findings of this survey showed there was adequate protein-energy consumption. In general, the average daily intake of nutrients was adequate, except for calcium and vitamin A, which presented only

  8. [A case of tuberculous peritonitis in a hemodialysis patient revealed by severe diarrhea and stomachache].

    Science.gov (United States)

    Hara, Masayuki; Hatta, Tsuguru; Ohtani, Mai; Segawa, Hiroyoshi; Ueno, Risa; Sawada, Katsunori

    2013-01-01

    A 53-year-old woman was admitted to our hospital due to abdominal pain, diarrhea, and shunt occlusion caused by dehydration. She had undergone hemodialysis due to diabetic nephropathy over a ten-year period. She was hospitalized again with fever and a persistent high serum CRP level. We started antibiotic administration using cefotiam hexetil hydrochloride because of ascites and peritoneum thickening observed by abdominal computed tomography. Although her symptoms, such as abdominal pain and diarrhea, improved after the administration of antibiotics, the ascites and the peritoneum thickening did not improve. On the fourth hospital day, we attempted ascites aspiration to investigate the etiology of the peritonitis. Cytological examination suggested tuberculous peritonitis because of predominant macrophage cell proliferation, a high level of ADA concentration, and a high level of CA125 of ascites. Although QuantiFERON-tuberculosis (QFT) and the Gaffky scale were negative, we started multidrug therapy (isoniazid + rifampicin + pyrazinamide + ethambutol) on the 20th hospital day. She was finally diagnosed as mycobacterium tuberculous peritonitis based on biopsy of the tissue of the ileum and the results of colonoscopy. Administration of antituberculosis chemotherapy improved abdominal fullness and ascites and the patient was discharged on the 97th hospital day. Moreover Kuno et al. reported that serum soluble interleukin-2 receptor(sIL-2R) and CA-125 levels can be used to monitor the response to anti-tuberculosis treatment. In this case, we use these markers to monitor the response to treatment. We experienced a case of tuberculous peritonitis undergoing hemodialysis. Tuberculosis should be suspected when patients undergoing dialysis have long-term fever of unknown etiology. There are many reports stating that the sensitivity and specificity of QuantiFERON-tuberculosis (QFT) and sputum culture are low in latent tuberculosis infection of dialysis patients. Accordingly it is necessary to diagnose mycobacterium tuberculous peritonitis comprehensively by the clinical symptoms and image analysis. PMID:23461214

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

    DEFF Research Database (Denmark)

    Plesner, Louis Lind; Warming, Peder Emil; Nielsen, Ture; Dalsgaard, Morten; Schou, Morten; Høst, Ulla; Rydahl, Casper; Brandi, Lisbet; Køber, Lars; Vestbo, Jørgen; Iversen, Kasper

    2015-01-01

    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...

  10. Effectiveness of Disinfectants Used in Hemodialysis against both Candida orthopsilosis and C. parapsilosis Sensu Stricto Biofilms

    OpenAIRE

    Pires, Regina Helena; da Silva, Julhiany de Fátima; Gomes Martins, Carlos Henrique; Fusco Almeida, Ana Marisa; Pienna Soares, Christiane; Soares Mendes-Giannini, Maria José

    2013-01-01

    Biofilms have been observed in the fluid pathways of hemodialysis machines. The impacts of four biocides used for the disinfection of hemodialysis systems were tested against Candida parapsilosis sensu stricto and Candida orthopsilosis biofilms generated by isolates obtained from a hydraulic circuit that were collected in a hemodialysis unit. Acetic acid was shown to be the most effective agent against Candida biofilms. Strategies for effective disinfection procedures used for hemodialysis sy...

  11. Development of practice guidelines for hemodialysis in Egypt.

    Science.gov (United States)

    Ahmed, A M A; Allam, Mohd F; Habil, E S; Metwally, A M; Ibrahiem, N A; Radwan, M; El-Gaafary, M M; Afifi, A; Gadallah, M A

    2010-10-01

    Although hemodialysis is the main modaility of treatment of end-stage renal disease, no practice guidelines are available in Egypt. Applying international guidelines for hemodialysis would not be suitable or feasible, because of different health system and lack of resources. The aim of this project was the development of evidence- and consensus-based clinical practice guidelines for hemodialysis in Egypt. The Egyptian guidelines were adopted from the standards developed by The College of Physicians and Surgeons of Alberta (Canada), The National Kidney Foundation (USA), The Clinical Standards Board for Scotland (Scotland), and The College of Physicians and Surgeons of Ontario (Canada). In addition, the guidelines published in Oxford Handbook of Dialysis were reviewed. Thereafter, a panel of Egyptian experts in the field of nephrology and hemodialysis was selected and invited to participate in this project. The Delphi technique was applied to build up the consensus among the experts on the formulated guidelines. The final version of the Egyptian Hemodialysis Practice Guidelines included five main sections; personnel, patient care practices, infection prevention and control, facility, and documentation/records. A consensus on practice guidelines for hemodialysis has been successfully produced and is supported by levels of evidence. The 12 Egyptian experts who participated in the Delphi technique and the reviewers assured the completeness and acceptability of the developed practice guidelines. Also, including experts from the university hospitals together with the Directorates of Cairo and Giza Health Affairs of the Egyptian Ministry of Health (MOH) avoided conflicts between clinical recommendations and feasible application in the MOH hemodialysis facilities. PMID:21206681

  12. Macrocytosis may be associated with mortality in chronic hemodialysis patients: a prospective study

    Directory of Open Access Journals (Sweden)

    West Kenneth A

    2011-05-01

    Full Text Available Abstract Background Macrocytosis occurs in chronic hemodialysis (CHD patients; however, its significance is unknown. The purpose of this study was to establish the prevalence and distribution of macrocytosis, to identify its clinical associations and to determine if macrocytosis is associated with mortality in stable, chronic hemodialysis patients. Methods We conducted a single-centre prospective cohort study of 150 stable, adult CHD patients followed for nine months. Macrocytosis was defined as a mean corpuscular volume (MCV > 97 fl. We analyzed MCV as a continuous variable, in tertiles and using a cutoff point of 102 fl. Results The mean MCV was 99.1 ± 6.4 fl, (range 66-120 fl. MCV was normally distributed. 92 (61% of patients had an MCV > 97 fl and 45 (30% > 102 fl. Patients were not B12 or folate deficient in those with available data and three patients with an MCV > 102 fl had hypothyroidism. In a logistic regression analysis, an MCV > 102 fl was associated with a higher Charlson-Age Comorbidity Index (CACI and higher ratios of darbepoetin alfa to hemoglobin (Hb, [(weekly darbepoetin alfa dose in micrograms per kg body weight / Hb in g/L*1000]. There were 23 deaths at nine months in this study. Unadjusted MCV > 102 fl was associated with mortality (HR 3.24, 95% CI 1.42-7.39, P = 0.005. Adjusting for the CACI, an MCV > 102 fl was still associated with mortality (HR 2.47, 95% CI 1.07-5.71, P = 0.035. Conclusions Macrocytosis may be associated with mortality in stable, chronic hemodialysis patients. Future studies will need to be conducted to confirm this finding.

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Results of cataract surgery in renal transplantation and hemodialysis patients

    Science.gov (United States)

    Luo, Li-Hua; Xiong, Shi-Hong; Wang, Yan-Ling

    2015-01-01

    AIM To compare the effect of cataract surgery in renal transplantation and hemodialysis patients. METHODS We evaluated 51 eyes of 31 renal transplantation patients, 41 eyes of 29 hemodialysis patients and 45 eyes of 32 normal control patients who received phacoemulsification and intraocular lens (IOL) implantation from January, 2000 to August, 2014 in the Beijing Friendship Hospital. Each individual underwent a blood routine and a kidney function examination. Routine ophthalmologic examination included best-corrected visual acuity (BCVA), a slit-lamp examination to detect cataract type, determination of intraocular pressure, a corneal endothelial count, and fundus examination. All patients received phacoemulsification and an IOL implantation. RESULTS For the types of cataract in the three groups, transplantation group was significantly different from normal control group (P=0.04), the most kind is posterior subcapsular cataract (PSC) in transplantation group 33 (64.7%), hemodialysis group had no significantly difference from normal control group (P=0.43), and the difference between transplantation group and hemodialysis group also had significantly difference (P=0.02). For postoperative BCVA in the three groups, transplantation group had significantly difference from normal control group (P=0.03), hemodialysis group was significantly different from normal control group (P=0.00), and the difference between transplantation group and hemodialysis group also had significantly difference (P=0.00). The multiple linear regression equation is Y=0.007 hemoglobin (Hb)-0.000233 serum creatinine (Cr), R2=0.898. Postoperative fundus examination showed that hemorrhage, exudation, and macular degeneration were greater in the hemodialysis group. CONCLUSION This study showed that the PSC was more in the renal transplantation patients. BCVA was better and fundus lesions were less frequent in the renal transplantation group than in the hemodialysis group after cataract surgery. The multiple linear regression was showed that the Hb was positively correlated with postoperative BCVA, while Cr was negatively correlated with postoperative BCVA. These results may act as indicators in predicting visual acuity for the renal transplantation and hemodialysis patients. PMID:26558211

  15. Nurse Manager Safety Practices in Outpatient Hemodialysis Units.

    Science.gov (United States)

    Thomas-Hawkins, Charlotte; Flynn, Linda; Lindgren, Teri G; Weaver, Susan

    2015-01-01

    Little is known regarding the specific managerial activities or best practices that nurse managers in outpatient hemodialysis settings use to achieve positive safety outcomes. The purpose of this study was to identify and describe specific managerial practices used by nurse managers in outpatient hemodialysis units to enhance patient safety and quality of care. A descriptive qualitative design was used. Seventeen nurse managers in outpatient hemodialysis units comprised the study sample. Telephone interviews were conducted, and qualitative content analysis was used to encode the data. Nurse managers identified patients, staff, the dialysis unit environment, and the dialysis organization as sources of safety risks. Nurse manager safety practices illuminated from the data were complex and multifaceted, and were aimed at reducing patient, staff environmental, and organization risks. The findings from this study offer a description and a better understanding of the practices in which nurse managers in outpatient hemodialysis units engage to keep patients safe in their units, and they underscore the critical role of nurse managers in creating and maintaining patient safety within outpatient hemodialysis settings. PMID:26207274

  16. Cloxacillin-induced seizure in a hemodialysis patient.

    Science.gov (United States)

    El Nekidy, Wasim; Dziamarski, Nicole; Soong, Derrick; Donaldson, Christine; Ibrahim, Muhieldean; Kadri, Albert

    2015-10-01

    We are reporting a cloxacillin-induced seizure in a patient with stage 5 chronic kidney disease requiring hemodialysis. To our knowledge, there are no published case reports of seizures induced by parenteral cloxacillin in hemodialysis patients. A young hemodialysis female was admitted to the hospital with decreased level of consciousness. Blood cultures revealed methicillin-sensitive Staphylococcus aureus where cloxacillin 2?g intravenously every 4 hours was initiated. Head computed tomography (CT) was not significant. After 14 hours of cloxacillin therapy (4 doses), the patient demonstrated tonic/clonic seizure activity, where phenytoin and lorazepam were initiated. The anti-seizure medications partially reduced seizure activity. Once the cloxacillin was discontinued, the seizures stopped. Two weeks later, all anti-seizure medications were stopped with no further seizure activity. Cloxacillin elimination in hemodialysis patients is similar to patients with normal kidney function. Although cloxacillin does not significantly cross the blood-brain barrier, the correlation between the start of seizures and cloxacillin initiation was confirmed by the negative CT and blood chemistry laboratory results. Moreover, seizure activity was terminated upon discontinuation of cloxacillin. Although further investigation for the cause of such seizures is warranted, clinicians should use caution when giving high doses of cloxacillin in hemodialysis patients. PMID:25582344

  17. Efeitos do treinamento muscular inspiratório nos pacientes em hemodiálise / Effects of inspiratory muscle training in hemodialysis patients

    Scientific Electronic Library Online (English)

    Vanessa Giendruczak da, Silva; Carolina, Amaral; Mariane Borba, Monteiro; Daniela Meirelles do, Nascimento; Jaqueline Regina, Boschetti.

    2011-03-01

    Full Text Available INTRODUÇÃO: A doença renal crônica associada ao tratamento hemodialítico pode apresentar uma diversidade de complicações músculo-esqueléticas, além de trazer repercussões à função pulmonar. OBJETIVO: Avaliar os efeitos do treinamento muscular inspiratório na força muscular inspiratória, função pulmo [...] nar e capacidade funcional em pacientes com insuficiência renal crônica submetidos à hemodiálise. MÉTODO: Ensaio clínico não controlado, composto por 15 indivíduos com diagnóstico médico de insuficiência renal crônica, submetidos à hemodiálise. Foram avaliados pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) através da manovacuometria; função pulmonar pela espirometria e a capacidade funcional através da distância percorrida e consumo de oxigênio obtido no teste da caminhada dos seis minutos (TC6M). No período de oito semanas, foi aplicado o protocolo de treinamento muscular respiratório (TMI) durante a sessão de hemodiálise, com carga estabelecida de 40% da PImáx e uma frequência semanal de três dias alternados. RESULTADOS: Houve um aumento significativo na variável distância percorrida após o treinamento (455 ± 98 versus 558 ± 121; p = 0,003). Não foram encontradas diferenças estatísticas na comparação antes e após treinamento nas demais variáveis do estudo. CONCLUSÃO: O estudo não apresentou diferença estatística na força muscular respiratória, na função pulmonar e no consumo de oxigênio. Observou-se apenas um aumento na distância do TC6M. Abstract in english INTRODUCTION: Chronic kidney disease associated with hemodialysis can have a variety of musculoskeletal complications, in addition to repercussions in pulmonary function. OBJECTIVE: To evaluate the effects of inspiratory muscle training on inspiratory muscle strength, pulmonary function, and functio [...] nal capacity in patients with chronic kidney failure undergoing hemodialysis. METHOD: Non-controlled clinical trial, comprising 15 individuals diagnosed with chronic kidney failure and undergoing hemodialysis. Maximum inspiratory (PImax) and expiratory (PEmax) pressures were assessed by use of pressure vacuum meter reading. Pulmonary function was assessed by use of spirometry. Functional capacity was assessed by use of walked distance and oxygen consumption obtained in the six-minute walk test (6MWT). For eight weeks, the inspiratory muscle training (IMT) protocol was applied during hemodialysis sessions, with load set to 40% of PImax and weekly frequency of three alternate days. RESULTS: A significant increase in the walked distance was observed after training (455.5 ± 98 versus 557.8 ± 121.0; p = 0.003). No statistically significant difference was observed in the other variables when comparing their pre- and posttraining values. CONCLUSION: The study showed no statistically significant difference in respiratory muscle strength, pulmonary function, and oxygen consumption. An increase in the walked distance was observed in the 6MWT.

  18. Accelerated hemodialysis: a new safe and simple method of a high filter-low patient blood flow rate hemodialysis.

    Science.gov (United States)

    Mohamad, E H

    1999-09-01

    Accelerated hemodialysis (AHD) is a new safe method of hemodialysis that is done using accelerated hemodialysis blood lines (registered). These lines allow partial controlled recirculation of blood through a recirculation segment. AHD allows increase in the filter blood flow without increasing the patient blood flow and thus allows the use of larger filters of higher efficiency, and provides a high blood flow in most parts of the dialysis circuit to permit heparin free dialysis. On the other hand, the patient blood flow can be decreased without increasing the filter blood flow and allows safe sessions for low body weight patients and those with hemodynamic instability or inefficient vascular assess. Twenty-five hemodialysis sessions were conducted with an adolescent girl, 13 years old, 30 kg body weight, on a chronic hemodialysis program. The sessions included: five double-needle hemodialysis sessions (DNHD) with a pediatric filter at a rate of 130 mL/min; five accelerated hemodialysis sessions (AHD) using the same filter at a rate of (65 + 65) mL/min and another five sessions at rate of (130 + 130) mL/min; five (DNHD) were done using an adult hemodialysis filter rate of 130 mL/min; and five (AHD) using the same filter at a rate of (130 + 130) mL/min. In all sessions pre- and post-dialysis levels of BUN and creatinine were measured and post/predialysis ratios were calculated. In AHD the BUN and creatinine level in the patient, and filter segments of the arterial line and in the recirculation segment were measured and the actual patient blood flow was calculated. The efficiency of AHD was decreased by decreasing the actual patient blood flow (p filter blood flow in both pediatric and adult filters (p > 0.05). There were no significant changes between the intended patient blood flow rate and the actual patient blood flow as calculated from BUN and creatinine levels. The AHD is a simple safe and applicable mode of hemodialysis that needs further studies to verify factors affecting its efficiency and to approve its clinical applications. PMID:10516996

  19. Preparation of Polyvinylidene Fluoride (PVDF Hollow Fiber Hemodialysis Membranes

    Directory of Open Access Journals (Sweden)

    Qinglei Zhang

    2014-02-01

    Full Text Available In this study, the polyvinylidene fluoride (PVDF hollow fiber hemodialysis membranes were prepared by non-solvent induced phase separation (NIPS. The influences of PVDF membrane thickness and polyethylene glycol (PEG content on membrane morphologies, pore size, mechanical and permeable performance were investigated. It was found that membrane thickness and PEG content affected both the structure and performance of hollow fiber membranes. The tensile strength and rejection of bovine serum albumin (BSA increased with increasing membrane thickness, while the Ultrafiltration flux (UF flux of pure water was the opposite. The tensile strength, porosity and rejection of BSA increased with increasing PEG content within a certain range. Compared with commercial F60S membrane, the PVDF hollow fiber membrane showed higher mechanical and permeable performance. It was proven that PVDF material had better hydrophilicity and lower BSA adsorption, which was more suitable for hemodialysis. All the results indicate that PVDF hollow fiber membrane is promising as a hemodialysis membrane.

  20. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update.

    Science.gov (United States)

    2015-11-01

    The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for all stages of chronic kidney disease (CKD) and related complications since 1997. The 2015 update of the KDOQI Clinical Practice Guideline for Hemodialysis Adequacy is intended to assist practitioners caring for patients in preparation for and during hemodialysis. The literature reviewed for this update includes clinical trials and observational studies published between 2000 and March 2014. New topics include high-frequency hemodialysis and risks; prescription flexibility in initiation timing, frequency, duration, and ultrafiltration rate; and more emphasis on volume and blood pressure control. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Limitations of the evidence are discussed and specific suggestions are provided for future research. PMID:26498416

  1. Disappearance of diabetic macular hard exudates after hemodialysis introduction.

    Directory of Open Access Journals (Sweden)

    Matsuo,Toshihiko

    2006-06-01

    Full Text Available

    We report herein the disappearance of macular hard exudates after the introduction of hemodialysis in diabetic patients. A 62-year-old woman and a 52-year-old man with diabetes mellitus showed hard exudates in the macula of the left eyes. Both patients had previously undergone panretinal photocoagulation in both eyes. During the follow-up, hemodialysis was introduced for deteriorating chronic renal failure caused by diabetic nephropathy. Half a year later, macular hard exudates in the left eyes disappeared dramatically in both patients, but the visual acuity remained the same. No additional laser treatment was done during the observation period. Hemodialysis is considered to have accelerated the resolution of macular hard exudates in both patients. The deposition of macular hard exudates in diabetic patients is due in part to concurrent poor renal function.

  2. Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study

    Directory of Open Access Journals (Sweden)

    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 dialysis session duration, frequency or both are most beneficial for improving cardiovascular disease whilst minimizing costs and the impact of dialysis on quality of life.

  3. Electrocardiographic manifestations of hyperkalemia in hemodialysis patients

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    Nemati Eghlim

    2010-01-01

    Full Text Available This study was performed to evaluate whether any electrocardiogram (ECG para-meter can predict the presence of hyperkalemia in patients on maintenance hemodialysis (HD. In January 2006, we conducted a cross-sectional study of 80 stable patients with end-stage renal disease from four university-based HD units of Tehran, Iran, receiving conventional thrice-weekly HD. Pre-HD serum electrolyte values and conventional 12-lead ECG were obtained from each pa-tient. Bivariate linear regression was used for assessing relationship of the study variables with hyperkalemia (K + > 5.2 mg/dL. Multivariable logistic regression was used for evaluating inde-pendent relationship between decreased T wave duration (? 170 ms and other variables. Bivariate correlation analysis showed a significant inverse correlation between serum potassium concentration and T wave duration (P < 0.05. None of the patients with serum potassium of ? 5.6 mg/dL had T wave duration > 200 ms. Multivariate logistic analysis, after adjustment for other factors, also showed a significant relationship between decreased T wave duration (? 170 ms and hyper-kalemia. We conclude that although hyperkalemia does not induce the usual ECG changes in HD patients, decreased T wave duration was found to be a good indicator of this lethal condition.

  4. The cost of hemodialysis in Iran.

    Science.gov (United States)

    Arefzadeh, Alireza; Lessanpezeshki, Mahboub; Seifi, Sepideh

    2009-03-01

    The use of dialysis in patients with end-stage renal disease (ESRD) remains one of the most resource-intensive and hence, expensive therapeutic interventions. The purpose of this study was to assess the cost of hemodialysis (HD) in Iran. This study was conducted in the Department of Nephrology at the Imam Khomeini Hospital of Tehran University of Medical Sciences, Iran, between April 2006 and June 2007. Patients with ESRD on chronic HD were involved in the study. Relevant data were collected using interview and questionnaire. Analyzed costs included: transportation plus absence from work, treatment instruments, drugs and other medical procedures, diet, staff salary, equipment and building support services, non-medical supplies, depreciation of installations and equipments, depreciation of reverse osmosis (RO) and building rent. Sixty-three patients of whom 47.7% were males and 52.3% were females, with mean age of 47 +/- 12 years were studied. The estimated cost of each HD session was about 74 US dollars by which an annual cost of $11549 could be estimated for each patient. Transportation and work leaves (28.9%), staff costs and salaries (21.5%), and treatment instruments (21.1%) were among the greatest expenses. We conclude that the annual cost of dialysis in Iran is similar to other developing countries, but significantly less than the cost in developed countries. PMID:19237828

  5. The cost of hemodialysis in Iran

    Directory of Open Access Journals (Sweden)

    Arefzadeh Alireza

    2009-01-01

    Full Text Available The use of dialysis in patients with end-stage renal disease (ESRD remains one of the most resource-intensive and hence, expensive therapeutic interventions. The purpose of this study was to assess the cost of hemodialysis (HD in Iran. This study was conducted in the Department of Nephrology at the Imam Khomeini Hospital of Tehran University of Medical Sciences, Iran, between April 2006 and June 2007. Patients with ESRD on chronic HD were involved in the study. Relevant data were collected using interview and questionnaire. Analyzed costs included: transportation plus absence from work, treatment instruments, drugs and other medical procedures, diet, staff salary, equipment and building support services, non-medical supplies, depreciation of installations and equipments, depreciation of reverse osmosis (RO and building rent. Sixty-three patients of whom 47.7% were males and 52.3% were females, with mean age of 47 ± 12 years were studied. The estimated cost of each HD session was about 74 US dollars by which an annual cost of $11549 could be estimated for each patient. Transportation and work leaves (28.9%, staff costs and salaries (21.5%, and treatment instruments (21.1% were among the greatest expenses. We conclude that the annual cost of dialysis in Iran is similar to other developing countries, but significantly less than the cost in developed countries.

  6. Trace elements in renal disease and hemodialysis

    International Nuclear Information System (INIS)

    A number of considerations suggest that trace element disturbances might occur in patients with renal disease and in hemodialysis (HD) patients. Using particle induced X-ray emission, we demonstrated the relations between serum concentration, urinary excretion of the trace elements and creatinine clearance (Ccr) in randomized 50 patients. To estimate the effects of HD, we also observed the changes of these elements in serum and dialysis fluids during HD. Urinary silicon excretion decreased, and serum silicon concentration increased as Ccr decreased, with significant correlation (r=0.702, p<0.001 and r=0.676, p<0.0001, respectively). We also observed the increase of serum silicon, and the decrease of silicon in dialysis fluids during HD. These results suggested that reduced renal function and also dialysis contributed to silicon accumulation. Although serum selenium decreased significantly according to Ccr decrease (r=0.452, p<0.01), we could detect no change in urinary selenium excretion and no transfer during HD. Serum bromine and urinary excretion of bromine did not correlate to Ccr. However we observed a bromine transfer from the serum to the dialysis fluid that contributed to the serum bromine decrease in HD patients

  7. Exploring the reasons for the tiny percentage of patients on home hemodialysis.

    Science.gov (United States)

    Koester, Lisa

    2013-01-01

    The number of patients requiring renal replacement therapy continues to grow. When patients are told they need a life-sustaining treatment, it is a profound experience that impacts all aspects of their lives and the lives of their families. In the United States, the stark reality is the majority of patients are treated with in-center hemodialysis, and only a very small percentage with a home dialysis therapy, such as peritoneal dialysis or home hemodialysis. Why is this? Do patients not factor in preference, independence, or quality and maintenance of a normal life? Or is it that as a renal community, nephrology nurses do not expose patients to the knowledge they need and promote involvement in this decision-making? Is patient autonomy being fostered? This article explores the reasons for the tiny percentage of patients on home dialysis and suggests strategies to address the education needed, the dynamics of why patients decide on a therapy, patient selection characteristics, and myths of who is and is not a candidate. PMID:23539804

  8. Pulsatility Produced by the Hemodialysis Roller Pump as Measured by Doppler Ultrasound.

    Science.gov (United States)

    Fulker, David; Keshavarzi, Gholamreza; Simmons, Anne; Pugh, Debbie; Barber, Tracie

    2015-11-01

    Microbubbles have previously been detected in the hemodialysis extracorporeal circuit and can enter the blood vessel leading to potential complications. A potential source of these microbubbles is highly pulsatile flow resulting in cavitation. This study quantified the pulsatility produced by the roller pump throughout the extracorporeal circuit. A Sonosite S-series ultrasound probe (FUJIFILM Sonosite Inc., Tokyo, Japan) was used on a single patient during normal hemodialysis treatment. The Doppler waveform showed highly pulsatile flow throughout the circuit with the greatest pulse occurring after the pump itself. The velocity pulse after the pump ranged from 57.6?±?1.74?cm/s to -72?±?4.13?cm/s. Flow reversal occurred when contact between the forward roller and tubing ended. The amplitude of the pulse was reduced from 129.6?cm/s to 16.25?cm/s and 6.87?cm/s following the dialyzer and venous air trap. This resulted in almost nonpulsatile, continuous flow returning to the patient through the venous needle. These results indicate that the roller pump may be a source of microbubble formation from cavitation due to the highly pulsatile blood flow. The venous air trap was identified as the most effective mechanism in reducing the pulsatility. The inclusion of multiple rollers is also recommended to offer an effective solution in dampening the pulse produced by the pump. PMID:25921287

  9. Effect of flow adjustment dialysate (Qd hemodialysis on effectiveness of underweight patients

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    Daniel Ducuara

    2013-05-01

    Full Text Available KDOQI guidelines in 2006 using standard dialysis adequacy Kt/V, where V is volume of distributionof urea, underweight patients have lower total body water, lower V, which couldreduce the requirement without affecting Qd the efficiency of dialysis. Objective: to evaluatethe effect on the adequacy of dialysis Qd reduction occurs in patients weighing less than orequal to 60 kg who are on hemodialysis. Methodology: patients with chronic kidney diseaseon hemodialysis regularly with weight less than or equal to 60 kg of a renal clinic to evaluatetwo periods I and II, were continued therapy parameters with decrease of Qd for the secondperiod. The variables were collected directly by the researchers of the history. The values thusobtained would be compared using t test or paired variables, and statistical significance of thetest below 0,05. Results: we included 61 patients, 60.7% female, mean age 57,3 years (SD 14,8.Average age of men 60.1 (SD 13,9 and women was 55,9 (SD 15,4. There were no statisticallysignificant differences for the variables Kt/V, Hemoglobin and there was a significant reductionin the phosphorus levels. Conclusions: this study demonstrates that adequate therapy is achievedwith less than Qd traditional standards, with 400 ml/min in patients with low weight as long asyou keep the other parameters of renal substitution.

  10. The effect of hemodialysis on right ventricular functions in patients with end-stage renal failure

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    Mehmet Akkaya

    2012-02-01

    Full Text Available Objective: The aim of this study was to evaluate the effects of hemodialysis (HD on right ventricular echocardiographic parameters in patients with end-stage renal failure (ESRF. Methods: Forty-three uremic patients who underwent echocardiography before and 30 minutes after dialysis included in this prospective observational study. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE by M-mode echocardiography and tricuspid lateral annular systolic velocity (Sa by tissue Doppler echocardiography whereas diastolic function was evaluated using tricuspid early (E and late (A diastolic flow velocities by conventional and tricuspid lateral annular early (Ea and late (Aa diastolic velocities by tissue Doppler echocardiography. Myocardial performance index was taken as an indicator of global functions. Paired t test or Wilcoxon test were used for statistical analysis where appropriate.Results: E decreased significantly (68±13 cm/s and 56±12 cm/s before and after HD, respectively; p<0.0001 but A did not (p=0.797.TAPSE was 1.84±0.34 cm before HD and showed a significant increase to 2.03±0.20 cm after HD (p=0.006. Right ventricular MPI, Sa and Aa did not change significantly by dialysis (p=0.504; p=0.118 and p=0.150 respectively whereas Ea decreased to 8.8±2.5 cm/s from 11.3±3.4 cm/s (p<0.001. Ea/Aa ratio also decreased significantly to 0.69±0.35 from 0.84±0.44 with HD (p=0.007.Conclusion: The results of this study indicates that parameters of right ventricular systolic function such as Sa and MPI are independent of preload whereas the conventional and tissue Doppler parameters of right ventricular diastolic function are preload dependent in patients with end-stage renal failure who undergo regular hemodialysis.

  11. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt

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    Mourad B

    2014-11-01

    Full Text Available Basma Mourad,1 Doaa Hegab,1 Kamal Okasha,2 Sarah Rizk3 1Dermatology and Venereology Department, 2Internal Medicine Department, Faculty of Medicine, Tanta University, 3Ministry of Health, Tanta, EgyptIntroduction: Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients.Patients and methods: Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18–80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV antibodies were evaluated.Results: This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level.Conclusion: Nonspecific mucocutaneous manifestations are common in patients on hemodialysis, particularly xerosis, dyspigmentation, and pruritus. Early and prompt recognition and treatment of dermatological conditions in patients on dialysis may improve their quality of life.Keywords: End-stage renal disease, skin changes, hair disorders, nail disorders

  12. Perceived illness intrusion among patients on hemodialysis

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    Bapat Usha

    2009-01-01

    Full Text Available Dialysis therapy is extremely stressful as it interferes with all spheres of daily acti-vities of the patients. This study is aimed at understanding the perceived illness intrusion among pa-tients on hemodialysis (HD and to find the association between illness intrusion and patient demo-graphics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering socio-demographics and a 13 item illness intrusion checklist covering the various aspects of life was ca-rried out. The study patients were asked to rate the illness intrusion and the extent. The data were ana-lyzed statistically. The mean age of the subjects was 50.28 ± 13.69 years, males were predominant (85%, 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear fami-lies. The mean duration on dialysis was 24 ± 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%, work (70% finance (55%, diet (50% sexual life (38% and psychological status (25%. Illness had not intruded in areas of rela-tionship with spouse (67%, friends (76%, family (79%, social (40% and religious functions (72%. Statistically significant association was noted between illness intrusion and occupation (P= 0.02.

  13. Telemedicine technology and applications for home hemodialysis.

    Science.gov (United States)

    Agroyannis, B; Fourtounas, C; Romagnoli, G; Skiadas, M; Tsavdaris, C; Chassomeris, C; Tzanatos, H; Kopelias, I; Lymberopoulos, D; Psarras, J

    1999-10-01

    Home hemodialysis (HD) for the treatment of patients with end-stage renal disease (ESRD) was first put into practice about 30 years ago. In this paper we describe the application of telematics monitoring services (TMS) for supporting patients who need home or satellite HD (SHD). For the clinical trials two modified HD machines were located in the renal unit and a central control station (UNIX workstation with multimedia PC-terminal) was located in another room of the hospital. Bi-directional communication between modified HD machines and central control station was managed via ISDN (Integrated Services Digital Network) links. Using these HD-machines 150 HD sessions were performed in nine patients over a period of five months. This system enabled on-line remote supervision of the HD machine-related functions (air in the blood, leak of blood, low conductivity etc.) and the clinical condition of patients through measurement of blood pressure (BP), pulse rate, PO2 (pulse oxymetry) and electrocardiogram (ECG) from the central control station (CCS). The user checked the type of alarm/warning, its appearance on HD machines and multimedia terminal units (MTU), the action of the protective system and the appearance of consultative messages from CCS on the remote terminal unit RTU. According to the data collected, the disturbances of HD machine function were visible and audible in the CCS and the user messages were always observed on the RTU. No unusual dialysis-associated complications were observed, all data and alarms/warnings were transmitted correctly and patients had adequate HD treatment. PMID:10585132

  14. Restless legs syndrome in patients on hemodialysis

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    Salman Saleh Mohammad

    2011-01-01

    Full Text Available Restless legs syndrome (RLS is common among dialysis patients, with a reported prevalence of 6-60%. The prevalence of RLS in Syrian patients on hemodialysis (HD is not known. The purpose of this study is to determine the prevalence of RLS in patients on regular HD, and to find the possible correlation between the presence of RLS and demographic, clinical, and biochemical factors. One hundred and twenty-three patients (male/female = 70/53, mean age = 41.95 ± 15.11 years on HD therapy at the Aleppo University Hospital were enrolled into the study. RLS was diagnosed based on criteria established by the International Restless Legs Syn-drome Study Group (IRLSSG. Data procured were compared between patients with and without RLS. Applying the IRLSSG criteria for the diagnosis, RLS was seen in 20.3% of the study pa-tients. No significant difference in age, gender, and intake of nicotine and caffeine was found between patients with and without the RLS. Similarly, there was no difference between the two groups in the duration of end-stage renal disease (ESRD, the period of dialysis dependence, dialysis adequacy, urea and creatinine levels, and the presence of anemia. The co-morbidities and the use of drugs also did not differ in the two groups. Our study suggests that the high prevalence of RLS among patients on HD requires careful attention and correct diagnosis can lead to better therapy and better quality of life. The pathogenesis of RLS is not clear and further studies are required to identify any possible cause as well as to discover the impact of this syndrome on sleep, quality of life, and possibly other complications such as cardiovasculare disease.

  15. Perceived illness intrusion among patients on hemodialysis

    International Nuclear Information System (INIS)

    Dialysis therapy is extremely stressful as it interferes with all spheres of daily activities of the patients. This study is aimed at understanding the perceived illness intrusion among patients on hemodialysis (HD) and to find the association between illness intrusion and patient demo-graphics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD) stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering sociodemographics and a 13 item illness intrusion checklist covering the various aspects of life was carried out. The study patients were asked to rate the illness intrusion and the extent. The data were analyzed statistically. The mean age of the subjects was 50.28 + - 13.69 years, males were predominant (85%), 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear families. The mean duration on dialysis was 24 + - 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%), work (70%) finance (55%), diet (50%) sexual life (38%) and psychological status (25%). Illness had not intruded in areas of relationship with spouse (67%), friends (76%), family (79%), social (40%) and religious functions (72%). Statistically significant association was noted between illness intrusion and occupation (P= 0.02). (author)

  16. RECONSTRUCTIVE OPERATIONS ON THE PERMANENT VASCULAR ACCESS FOR HEMODIALYSIS

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    V. I. Lotts

    2010-06-01

    Full Text Available In patients with end stage renal failure it is vitally necessary to have permanent long functioning vascular access, providing all requirements of modern hemodialysis. Authors have evaluated the terms of functioning of arterio- venous fistulas after operations at 56 patients. Undertaking reconstructive operation on arteriovenous fistula allows to enlarge duration of the permanent vascular access function for two years in average. 

  17. Dynamic hemodialysis: a potential solution for middle molecule removal.

    Science.gov (United States)

    Kim, Jeong Chul; Garzotto, Francesco; Ronco, Claudio

    2011-01-01

    Better clearance of middle molecular weight solutes has been associated with improved patient outcomes. However, blood-membrane interaction during dialysis results in the development of secondary protein layers on the dialysis membrane surface, leading to impairments in middle molecular weight solute removal. The shear rate at the surface of the dialysis membrane is one of the important factors that influence blood-membrane surface interaction. In this paper, we discuss the concept of 'dynamic hemodialysis', i.e. using mechanical vibration to increase shear rate at the surface of dialysis membrane. For longitudinal and transverse vibratory motions, hemodynamic changes inside the membrane and their consequent effects on membrane morphology and dialysis efficiency are discussed. Longitudinal vibration generates a reverse flow by relative membrane motion, and transverse vibration generates a symmetric swirling flow inside the hollow fiber, which increases shear rate and enhances flow mixing. Additionally, the impulse induced by the vibration could sustain the absorption capacity of the membrane to specific uremic toxins. In conclusion, dynamic hemodialysis could enhance solute removal by minimizing the morphological changes in the dialysis membrane during hemodialysis. However, the operating conditions of dynamic hemodialysis (i.e. the amplitude and frequency of mechanical vibration) need to be optimized in terms of hemolysis and noise from the mechanical vibration. PMID:21625098

  18. Dialysate sodium, serum sodium and mortality in maintenance hemodialysis

    OpenAIRE

    Mc Causland, Finnian R.; Brunelli, Steven M.; Waikar, Sushrut S.

    2011-01-01

    Background. Individuals with end-stage kidney disease appear to have stable pre-dialysis serum sodium concentrations over time, with lower values associating with increased mortality. Dialysate sodium concentrations have increased over many years in response to shorter treatments, but the relationship between serum sodium, dialysate sodium and outcomes in chronic hemodialysis patients has not yet been systematically examined.

  19. Chronic hemodialysis in children weighing less than 10 kg.

    LENUS (Irish Health Repository)

    Quinlan, Catherine

    2013-05-01

    Hemodialysis (HD) in infants is usually used when peritoneal dialysis (PD) has failed. We describe our experience with HD, outlining the morbidity, complications, and outcomes for infants weighing less than 10 kg managed with HD for more than 6 months over a 10-year period.

  20. Metabolic syndrome in hemodialysis patients as a risk factor for new-onset diabetes mellitus after renal transplant: a prospective observational study

    Directory of Open Access Journals (Sweden)

    Bonet J

    2013-09-01

    Full Text Available Josep Bonet1, Albert Martinez-Castelao2, Beatriz Bayés11Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 2Department of Nephrology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, SpainPurpose: Metabolic syndrome is a cluster of biochemical abnormalities including cardiovascular and diabetes risk factors. The development of diabetes mellitus after renal transplant represents a major posttransplant complication that may adversely affect graft/patient survival. The aim of this study was to assess the role of metabolic syndrome in patients on hemodialysis as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant.Patients and methods: This was a prospective observational epidemiologic study carried out in adult nondiabetic patients undergoing chronic hemodialysis and on the renal transplant waiting list between November 2008 and April 2009. Patients were followed up from Visit 1 (baseline to 6 months after the renal transplant. The analysis of the role of metabolic syndrome in hemodialysis patients as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant included the estimation of relative risk and its 95% confidence interval (CI.Results: A total of 383 evaluable patients were entered into the study (mean age, 52.7 years; male, 57.7%; Caucasian, 90.1%. The prevalence of metabolic syndrome on hemodialysis was 30.4% (95% CI, 25.8%–35.4%. Hypertension was the most prevalent criterion for metabolic syndrome (65.0%, followed by low levels of high-density lipoprotein cholesterol (52.7%, abdominal obesity (36.2%, hypertriglyceridemia (32.4%, and impaired glucose (8.9%. After the renal transplant, the prevalence of metabolic syndrome was still 25.8%. During the posttransplant period, the incidence of new-onset diabetes mellitus reached 13.0% (95% CI, 7.8%–20.6% and patients with pretransplant metabolic syndrome were 2.6 times (95% CI, 1.043–6.608 more likely to develop new-onset diabetes mellitus after the renal transplant than those without metabolic syndrome.Conclusion: The presence of metabolic syndrome in patients undergoing hemodialysis represents an independent risk factor for the incidence of new-onset diabetes mellitus after renal transplant.Keywords: dialysis, kidney transplantation, metabolic syndrome X, posttransplant diabetes

  1. Metabolic syndrome in hemodialysis patients as a risk factor for new-onset diabetes mellitus after renal transplant: a prospective observational study

    Science.gov (United States)

    Bonet, Josep; Martinez-Castelao, Albert; Bayés, Beatriz

    2013-01-01

    Purpose Metabolic syndrome is a cluster of biochemical abnormalities including cardiovascular and diabetes risk factors. The development of diabetes mellitus after renal transplant represents a major posttransplant complication that may adversely affect graft/patient survival. The aim of this study was to assess the role of metabolic syndrome in patients on hemodialysis as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant. Patients and methods This was a prospective observational epidemiologic study carried out in adult nondiabetic patients undergoing chronic hemodialysis and on the renal transplant waiting list between November 2008 and April 2009. Patients were followed up from Visit 1 (baseline) to 6 months after the renal transplant. The analysis of the role of metabolic syndrome in hemodialysis patients as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant included the estimation of relative risk and its 95% confidence interval (CI). Results A total of 383 evaluable patients were entered into the study (mean age, 52.7 years; male, 57.7%; Caucasian, 90.1%). The prevalence of metabolic syndrome on hemodialysis was 30.4% (95% CI, 25.8%–35.4%). Hypertension was the most prevalent criterion for metabolic syndrome (65.0%), followed by low levels of high-density lipoprotein cholesterol (52.7%), abdominal obesity (36.2%), hypertriglyceridemia (32.4%), and impaired glucose (8.9%). After the renal transplant, the prevalence of metabolic syndrome was still 25.8%. During the posttransplant period, the incidence of new-onset diabetes mellitus reached 13.0% (95% CI, 7.8%–20.6%) and patients with pretransplant metabolic syndrome were 2.6 times (95% CI, 1.043–6.608) more likely to develop new-onset diabetes mellitus after the renal transplant than those without metabolic syndrome. Conclusion The presence of metabolic syndrome in patients undergoing hemodialysis represents an independent risk factor for the incidence of new-onset diabetes mellitus after renal transplant. PMID:24082792

  2. 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 .

  3. 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.

  4. Hepatitis C virus infection in hemodialysis patients in Maracaibo, Venezuela / Infecção pelo vírus da Hepatite C em pacientes em hemodiálise em Maracaibo, Venezuela

    Scientific Electronic Library Online (English)

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

    2012-02-01

    Full Text Available Durante período de 2 anos, estudamos a incidência da infecção pelo vírus da hepatite C (VHC) em 29 pacientes em tratamento de diálise, com idades entre 15 e 75 anos (c ± DS; 45 ± 39,5 anos), procedentes da unidade de hemodiálise do Hospital Universitário de Maracaibo, Estado Zulia, Venezuela. Para a [...] detecção dos anticorpos contra o VHC (anti-VHC) utilizamos a técnica de imunoensaio enzimático (ELISA, Innotest HCV Ab IV) e em amostras reativas por ELISA, utilizamos o método de immunoblot recombinante de terceira geração (Inno-LIA HCV Ab III), ambos da casa comercial Innogenetics N.V., Bélgica. Os resultados demonstram ausência de soroconversão ao VHC nos pacientes hemodializados durante o período estudado, o que foi confirmado pelo método de imunoblot recombinante. Os fatores de risco ao VHC foram 0,327 (95% CI: 0,01323 - 8,080) nos pacientes submetidos ao tratamento de diálise. Nossos resultados sugerem ausência de fontes de infecção neste centro de hemodiálise e que as medidas universais de controle de infecção são cumpridas. Abstract in english 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 usin [...] g 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.

  5. 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.

  6. TTV as A Risk Factor in Hemodialysis Process

    International Nuclear Information System (INIS)

    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 ?GT. 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.

  7. The perception of the Illness with Subsequent Outcome Measure in More Favorable in Continuos Peritoneal Dialysis vs Hemodialysis in the Framework of Appraisal Model of Stress

    OpenAIRE

    Nowak, Zbigniew; Lauda?ski, Krzysztof

    2014-01-01

    The aim of the study was to use the appraisal model of stress to compare hemodialysis (HD) and continuous peritoneal dialysis (CAPD) patients with special focus on the perception of end-stage renal disease and subsequent emotional profile and health related quality of life (HQoL) in. We hypothesize that different circumstances related to both modes of therapies will result in dissimilar perception of chronic illness with subsequent changes in emotional profile and heath related quality of lif...

  8. Clinical Performance of a Salivary Amylase Activity Monitor During Hemodialysis Treatment

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    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.

  9. A Better Diet Quality is Attributable to Adequate Energy Intake in Hemodialysis Patients

    OpenAIRE

    Kim, Hyerang; LIM, Hyunjung; Choue, Ryowon

    2015-01-01

    Poor diet quality is one of strong predictors of subsequent increased mortality in hemodialysis patients. To determine diet quality and to define major problems contributing to poor diet quality in hemodialysis patients, a cross-sectional study was conducted between June 2009 and October 2010. Sixty-three hemodialysis patients (31 men, 32 women; aged 55.3 ± 11.9 years) in stable condition were recruited from the Artificial Kidney Center in Kyung Hee University, Seoul, Korea. Three-day diet re...

  10. Pharmacokinetics of cefaclor in renal failure: effects of multiple doses and hemodialysis.

    OpenAIRE

    Spyker, D A; Gober, L. L.; Scheld, W. M.; Sande, M A; Bolton, W K

    1982-01-01

    The pharmacokinetics of cefaclor were characterized in 15 functionally anephric patients on hemodialysis. Each patient received a 500-mg oral dose of cefaclor every 8 h for 10 days. Multiple serum drug levels were measured by bioassay on day 0 (no hemodialysis), day 10 during hemodialysis, and as single determinations 1 h after administration on days 1, 3, and 5. Analysis of cefaclor kinetics in these 15 patients along with kinetics from 24 previously studied patients showed that weight was t...

  11. Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients

    OpenAIRE

    Pupim, Lara B.; Flakoll, Paul J.; Brouillette, John R.; Levenhagen, Deanna K.; Hakim, Raymond M.; Ikizler, T Alp

    2002-01-01

    Decreased dietary protein intake and hemodialysis-associated protein catabolism are among several factors that predispose chronic hemodialysis (CHD) patients to protein calorie malnutrition. Since attempts to increase protein intake by dietary counseling are usually ineffective, intradialytic parenteral nutrition (IDPN) has been proposed as a potential therapeutic approach in malnourished CHD patients. In this study, we examined protein and energy homeostasis during hemodialysis in seven CHD ...

  12. Plasma Serotonin and Markers of Bone Formation and Bone Resorption in Hemodialysis Patients

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    Theodoros Eleftheriadis

    2013-01-01

    Full Text Available Introduction. Serotonin receptors are present in osteoblasts and osteoclasts, and serotonin affects bone metabolism. The association of plasma serotonin with markers of bone formation and bone resorption in hemodialysis patients was evaluated. Materials and Methods. Twenty-four hemodialysis patients (11 diabetics and 22 healthy volunteers were enrolled into the study. Serotonin was assessed in platelet-free plasma, whereas the markers of osteoblastic activity N-terminal midfragment osteocalcin and total procollagen type-1 aminoterminal propeptide as well as the marker of osteoclastic activity ?-isomerized C-terminal cross-linked peptide of collagen type I were measured in serum. Serum intact parathyroid hormone was also assessed. Results. Serotonin did not significantly differ between hemodialysis patients and healthy volunteers. All evaluated markers of bone metabolism and intact parathyroid hormone were much higher in hemodialysis patients. Serotonin was significantly correlated with all evaluated markers of bone metabolism in hemodialysis patients. Serotonin was reversely related to the patients' age. Serotonin, osteocalcin, procollagen type-1 aminoterminal propeptide, and ?-isomerized C-terminal cross-linked peptide of collagen type I were much lower in diabetic hemodialysis patients. Conclusions. Serotonin may increase both bone formation and bone resorption in hemodialysis patients. The reverse relation of serotonin to patients' age as well as its lower levels in diabetic hemodialysis patients indicate that low plasma serotonin may contribute to the higher incidence of low-turnover bone disease that characterizes old and diabetic hemodialysis patients.

  13. Surgical site infection rates in dialysis patients undergoing endovascular procedures.

    Science.gov (United States)

    Urbanes, Aris Q; Litchfield, Terry; Graham, Kevin; Hutyra, Carolyn A

    2015-10-01

    A surgical site infection (SSI) is an infection related to surgery that develops within 30 days after an operation or within 1 year of implant placement. Postoperative SSIs are the most common health-care-associated infections, occurring in up to 5% of surgical patients. Endovascular surgical procedures related to vascular access are common in the dialysis population and may cause SSIs. A large outpatient vascular access system developed and implemented a surveillance program to measure and monitor SSIs in their population. The health-care surveillance system extended to 76 ambulatory care centers across the United States and Puerto Rico. Based on a recorded 92,880 patient encounters, the surveillance system tabulated 12,541 valid patient survey responses documenting self-reported symptoms of infection within a 30-day postoperative period. The SSI rate was tabulated based on the presence of two or more specified indicators of infection: antibiotics, pus, dehiscence, pain, warmth, and swelling. Patients undergoing interventional procedures received surveys at discharge. Data were collected and analyzed using SPSS software. Survey analysis indicated a less than 3% superficial incisional SSI rate in hemodialysis patients undergoing endovascular procedures. The SSI rate for clean wound procedures is generally 2% or less. These data indicate that dialysis patients undergoing interventional procedures in vascular access centers may have a slightly greater risk of developing SSIs due to the presence of additional risk factors including obesity, diabetes, and age. This study was limited by a set of loose diagnostic criteria self-reported by patients, which may have overestimated the prevalence of infection. SSIs are a serious medical problem associated with increased morbidity and mortality and increased medical care costs. All providers should consider an active surveillance program following endovascular procedures given the comorbidities associated with the dialysis population. PMID:26448384

  14. Avaliação da condição periodontal de pacientes renais em hemodiálise Assessment of periodontal condition of kidney patients in hemodialysis

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    Cláudia Régia Dias de Souza

    2005-10-01

    Full Text Available OBJETIVOS/MÉTODOS: Avaliou-se a condição periodontal de 30 pacientes, em hemodiálise, através do índice de placa, índice gengival, índice de cálculo, PSR e quantidade de IgA na saliva, visando determinar a condição periodontal de doentes renais crônicos. RESULTADOS: Os resultados demonstraram que os índices de placa, índice gengival e índice de calculo foram considerados altos nestes pacientes. Com relação à necessidade de tratamento periodontal, observou-se que a maior parte dos pacientes em hemodiálise precisava de medidas de higiene bucal, raspagem supra e subgengival e fluoretação tópica (código 2. Em relação aos valores de IgA na saliva, somente três pacientes apresentaram densidade baixa. CONCLUSÃO: Concluiu-se que pacientes renais crônicos em hemodiálise apresentam maior acúmulo de placa bacteriana e elevada formação de cálculo dentário, necessitando de tratamento periodontal como raspagem supra e subgengival.OBJECTIVES AND METHODS: 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: 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. CONCLUSIONS: 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.

  15. The relationship between Personality Traits, Anxiety and Depression, in Life Quality of patients under treatment by Hemodialysis [HD

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    Maryam Bakhtiari

    2013-05-01

    Full Text Available Please cite this article as: Bakhtiari M, Falaknazi K, Lotfi M, Noori M, Naseri Saleh Abad A. The relationship between Personality Traits, Anxiety and Depression, in Life Quality of patients under treatment by Hemodialysis [HD]. Novel Biomed 2013;1:1-7.Background: The purpose of this study is to examine personality traits in renal patients undergoing haemodialysis (HD and its connection to depression, anxiety, and life quality. In this study we also aim to propose an intervention for treatment and prevention of these personality traits.Methods: This cross-sectional study was performed on 70 patients affected by chronic renal failure undergoing haemodialysis treatment. Patients were selected based on an accessible sample. Required data were gathered through questioners: Hospital Anxiety and Depression, NEO-FFL, and SF-36 Health Survey.Results: Based on the results obtained from this study 47.1% of patients undergoing HD treatment fall into the abnormal category according to the rate of depression. There is a positive meaningful correlation between conscientiousness and agreeableness and a negative correlation between extroversion, anxiety, and depression in life quality of renal patients.Conclusion: With respect to the correlation existing between the quality of life and the personality traits, anxiety and depression, in patients under HD treatment, life quality and treatment outcome can be improved if psychological problems are diagnosed early and psycho education and social interventions are presented.

  16. Homocysteine, folic acid and vitamin B12 serum levels in hemodialysis patients referring to hemodialysis unit of Jahrom hospital

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    abdoreza Sotoodeh Jahromi

    2011-05-01

    Full Text Available Homocysteine, folic acid and vitamin B12 serum levels in hemodialysis patients referring to hemodialysis unit of Jahrom hospitalSotoodeh Jahromi A1,2, Farjam MR*3, Shojaei M4Received: 09/25/2010Revised: 01/27/2011Accepted: 01/29/20111. Dept. of Immunology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran2. Research Center for Zoonotic Diseases, Jahrom University of Medical Sciences, Jahrom, Iran 3. Dept. of Biochemistry, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran4. Dept. of Internal Medicine, School of Medicine, Jahrom University of Medical Sciences, Jahrom, IranJournal of Jahrom University of Medical Sciences, Vol. 9, No. 1, Spring 2011 AbstractIntroduction:Homocysteine is an amino acid yielded from methionin to cysteine metabolism. Increased level of homocysteine can increase the risk of cardiovascular diseases. Several factors such as uremia, genetic factors, dialysis related factors and vitamin B group deficiency lead to increased plasma level of homocysteine in dialysis patients. This study aimed to evaluate plasma levels of homocysteine, vitamin B12 and folic acid in Jahrom hemodialysis patients.Materials and Methods:This cross-sectional study was carried out on a total of 43 hemodialysis patients and 43 age and sex matched healthy individuals without any underlying renal disease as control group during December 2008 and September 2009. The serum level of homocysteine was measured using ELISA method and the serum levels of vitamin B12 and folic acid were measured by radioimmunoassay method.Results:Comparing the patients with the control group, there were significant differences between the two groups in mean serum levels of homocysteine (22.709±5.765 µmol/L vs. 16.518±5.425 µmol/L, folic acid (513.814±15.378 ng/ml vs. 22.976±7.462 ng/ml and vitamin B12 (5366.814±1734.752 pg/ml vs. 868.907±251.484 pg/ml (P<0.001. A significant positive correlation was found between mean serum level of homocysteine and duration of hemodialysis therapy (r=0.893, P<0.001.Conclusion:Although in the present study the homocysteine level in the patients was more than that of the healthy subjects, it was lower than that of hemodialysis patients in other countries.

  17. Current practice of conventional intermittent hemodialysis for acute kidney injury.

    Science.gov (United States)

    Schiffl, H; Lang, S M

    2013-11-01

    The use of conventional intermittent hemodialysis (IHD) represents a mainstay of supportive care of patients with acute kidney injury (AKI). However, a number of fundamental questions regarding the optimal management of IHD remain unanswered after more than six decades of renal replacement therapy (RRT). This review summarizes current evidence regarding the timing of initiation of intermittent hemodialysis, the comparative outcomes (mortality and recovery of renal function), the prescription of the intensity of this therapy and discontinuation of dialysis. The way conventional IHD is performed has an impact on the outcome of sick patients with AKI. The value of regular education and training of those who provide IHD cannot be emphasized enough. However, we must be realistic in our expectations that no mode of RRT per se will substantially alter the excessive mortality of critically ill-patients with AKI. PMID:24339514

  18. Prognostic factors in hemodialysis patients: experience of a Havana Hospital

    Scientific Electronic Library Online (English)

    Julio, Valdivia; Carlos, Gutiérrez; Janete, Treto; Ernesto, Delgado; Daymiris, Méndez; Irma, Fernández; Anselmo, Abdo; Lourdes, Pérez; Mabel, Forte; Yanisbell, Rodríguez.

    2013-07-01

    Full Text Available INTRODUCTION: Knowledge of prognostic factors in end-stage renal disease patients has improved dialysis management and methods for reducing morbidity and mortality, underlining the importance of identification, prevention and control of these factors. OBJECTIVE: Identify factors affecting prognosis [...] (survival or death) in hemodialysis patients at the Medical-Surgical Research Center in Havana over a ten-year period. METHODS: Descriptive, prospective study of 81 end-stage renal disease patients who received hemodialysis at the Medical-Surgical Research Center from 1995 to 2004. Prognostic factors were identified at initiation of and during dialysis treatment, using chi square, t test, McNemar test, Kaplan Meier analysis, log-rank test and Cox regression model, with significance threshold set at p

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Rosiglitazone Is Associated with Mortality in Chronic Hemodialysis Patients

    OpenAIRE

    Ramirez, Sylvia P. B.; Albert, Justin M.; Blayney, Margaret J.; Tentori, Francesca; Goodkin, David A.; Wolfe, Robert A.; Young, Eric W.; Bailie, George R; Pisoni, Ronald L.; Port, Friedrich K.

    2009-01-01

    Recent studies have associated rosiglitazone, a thiazolidinedione drug, with adverse cardiovascular outcomes in the general population with diabetes. Using data from the Dialysis Outcomes and Practice Patterns Study in the United States, we examined cardiovascular hospitalization and mortality associated with prescription of rosiglitazone, compared with other oral hypoglycemic agents, among 2393 long-term hemodialysis patients who were followed for a median of 1.1 yr. We assessed mortality ri...

  1. Preparation of Polyvinylidene Fluoride (PVDF) Hollow Fiber Hemodialysis Membranes

    OpenAIRE

    Qinglei Zhang; Xiaolong Lu; Lihua Zhao

    2014-01-01

    In this study, the polyvinylidene fluoride (PVDF) hollow fiber hemodialysis membranes were prepared by non-solvent induced phase separation (NIPS). The influences of PVDF membrane thickness and polyethylene glycol (PEG) content on membrane morphologies, pore size, mechanical and permeable performance were investigated. It was found that membrane thickness and PEG content affected both the structure and performance of hollow fiber membranes. The tensile strength and rejection of bovine serum a...

  2. Effect of Insulin Infusion on Liver Protein Synthesis during Hemodialysis

    DEFF Research Database (Denmark)

    Reinhard, Mark; Frystyk, Jan; Jespersen, Bente; Ivarsen, Per

    2011-01-01

    Background Hemodialysis (HD) is a catabolic procedure that may contribute to the high frequency of protein-energy wasting among patients receiving maintenance HD. The present study investigated the additional effect of glucose and glucose-insulin infusion on liver protein synthesis during HD compared with a meal alone. Methods In a randomized cross-over study with three arms, 11 non-diabetic HD patients were assigned to receive a conventional HD session with either: • no treatment (NT) • IV infu...

  3. Elizabethkingia meningoseptica: Emerging nosocomial pathogen in bedside hemodialysis patients

    OpenAIRE

    Ratnamani, M. S.; Rao, Ratna

    2013-01-01

    Elizabethkingia meningoseptica, a ubiquitous gram-negative aerobic bacillus, is an emerging hospital acquired pathogen in patients on dialysis. It has been isolated in the hospital environment in water supplies, disinfectants, and medical devices. We present here an analysis of eight healthcare-acquired infections with this organism in adults. To the best of our our knowledge, this is the first report of infections with this organism in patients on hemodialysis.

  4. The Adequacy of Phosphorus Binder Prescriptions Among American Hemodialysis Patients

    OpenAIRE

    Huml, Anne M.; Sullivan, Catherine M.; Leon, Janeen B.; Sehgal, Ashwini R.

    2012-01-01

    Because hemodialysis treatment has a limited ability to remove phosphorus, dialysis patients must restrict dietary phosphorus intake and use phosphorus binding medication. Among patients with restricted dietary phosphorus intake (1000 mg/d), phosphorus binders must bind about 250 mg of excess phosphorus per day and among patients with more typical phosphorus intake (1500 mg/d), binders must bind about 750 mg per day. To determine the phosphorus binding capacity of binder prescriptions among A...

  5. Virological features of hepatitis C virus infection in hemodialysis patients.

    OpenAIRE

    Silini, E; Bono, F.; Cerino, A; V Piazza; Solcia, E; Mondelli, M U

    1993-01-01

    The clinical and epidemiological relevance of circulating antibodies to hepatitis C virus (HCV) in hemodialysis patients is uncertain, since clinical signs of infection are often mild or absent, with alanine aminotransferase (ALT) values that are virtually always normal, and liver biopsies are only rarely performed. Determination of HCV RNA in serum is therefore critical for distinguishing chronic HCV infection from previous exposure to the virus. We studied HCV viremia by reverse transcripti...

  6. Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients

    OpenAIRE

    Helal Imed; Smaoui Wided; Hamida Fethi; Ouniss Monder; Aderrahim Ezzeddine; Hedri Hafedh; ELyounsi Fethi; Maiz Hedi; abdallah Taieb; Kheder Adel

    2010-01-01

    Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD). The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD) and peritoneal dialysis (PD) patients. We studied 74 patients with ESRD (38 males, 36 females), maintained either on chronic HD (n= 50) or chronic PD (n= 24) and age and sex matched 20 healthy subjects as controls. The lipid profile, homo-cysteine (Hcy) and C reactive pr...

  7. Medical Complications in Hemodialysis Patients Requiring Vascular Access Radiology Procedures

    OpenAIRE

    Hammes, Mary S.

    2004-01-01

    Vascular access maintenance is crucial to providing adequate hemodialysis (HD) and hence preventing signs and symptoms of uremia. The best vascular assess is a permanent arteriovenous fistula (AVF) because it has the longest survival with the least number of complications. However, because of problems with AVF maturation, the majority of HD in the United States is provided via an arteriovenous graft (AVG) or tunneled cuffed central venous catheter. The most common access complications include...

  8. Differences in Coagulation Between Hemodialysis and Peritoneal Dialysis

    OpenAIRE

    Donald F. Brophy; Carl, Daniel E.; Mohammed, Bassem M.; Song, Jingmei; Martin, Erika J; Bostic, Jessica L.; Gehr, Todd W. B.

    2014-01-01

    ? Background: End-stage renal disease patients have significant cardiovascular morbidity and mortality, but little is known about differences in coagulation profiles between patients on hemodialysis (HD) and on peritoneal dialysis (PD). Given their long-term exposure to glucose-based dialysate, patients on PD can experience metabolic derangements. Theoretically, that exposure should create a more prothrombotic environment than occurs in HD patients. The objective of the present study was to q...

  9. Predictors of quality of life of hemodialysis patients in India

    OpenAIRE

    Veerappan, I.; Arvind, R. M.; Ilayabharthi, V.

    2012-01-01

    Little is known about the quality of life and survival in the patients on maintenance hemodialysis (HD) in India. Poor nutrition and dialysis noncompliance is common. This study investigates the factors that affect the quality of life (QoL) in HD patients in India. This cross-sectional study included 78 patients on HD for ? two months. Demographic, nutritional, functional subjective global assessment and Kidney Disease Quality of Life (KDQOL-36) assessments were done. Predictors of QoL were a...

  10. Habitual Coffee Consumption Enhances Attention and Vigilance in Hemodialysis Patients

    OpenAIRE

    Petar M. Niki?; Branislav R. Andri?; Biljana B. Stojimirovi?; Jasna Trbojevic-Stankovi?; Zoran Bukumiri?

    2014-01-01

    Objective. Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. Methods. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognit...

  11. Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors

    OpenAIRE

    Nakamura, Yuya; Hasegawa, Hitomi; Tsuji, Mayumi; Udaka, Yuko; Mihara, Masatomo; Shimizu, Tatsuo; Inoue, Michiyasu; Goto, Yoshikazu; Gotoh, Hiromichi; Inagaki, Masahiro; Oguchi, Katsuji

    2015-01-01

    Although several previous studies have been published on the effects of dipeptidase-4 (DPP-4) inhibitors in diabetic hemodialysis (HD) patients, the findings have yet to be reviewed comprehensively. Eyesight failure caused by diabetic retinopathy and aging-related dementia make multiple daily insulin injections difficult for HD patients. Therefore, we reviewed the effects of DPP-4 inhibitors with a focus on oral antidiabetic drugs as a new treatment strategy in HD patients with diabetes. The ...

  12. Prevalence of Parasitic Infections in Iranian Stable Hemodialysis Patients

    OpenAIRE

    Shiva SEYRAFIAN; Nader PESTECHIAN; Nasrin NAMDARI; Mahshid AVIANI; Kerdegari, Maryam; Farzad PARVIZIAN; Leila KASSAII; Afrouz ESHAGHIAN; NASRI, Hamid

    2011-01-01

    Background: Hemodialysis (HD) patients are prone to infections as a result of impaired immune system. Early detection of disease helps to prevent complications. The aim of this study was to evaluate the prevalence of intestinal parasite infections in HD patients and compare it with control groups. Methods: In a cross sectional study, the stool sample of 155 HD patients, and 294 controls were examined for parasitic contaminations. Control groups included: 130 patients’ family, 16 staffs of thr...

  13. Predialysis Systolic BP Variability and Outcomes in Hemodialysis Patients

    OpenAIRE

    Shafi, Tariq; Sozio, Stephen M.; Bandeen-Roche, Karen J.; Ephraim, Patti L; Luly, Jason R.; St. Peter, Wendy L; McDermott, Aidan; Scialla, Julia J; Crews, Deidra C; Tangri, Navdeep; Miskulin, Dana C.; Michels, Wieneke M.; Jaar, Bernard G.; Herzog, Charles A; Zager, Philip G.

    2014-01-01

    BP variability (BPV) is an important predictor of outcomes in the general population, but its association with clinical outcomes in hemodialysis patients is not clear. We identified 11,291 patients starting dialysis in 2003–2008 and followed them through December 31, 2008 (median=22 months). Predialysis systolic BPV was assessed over monthly intervals. Outcomes included factors associated with BPV, mortality (all-cause and cardiovascular), and first cardiovascular event (cardiovascular death ...

  14. Morphological Characterization of the Polyflux 210H Hemodialysis Filter Pores

    OpenAIRE

    Hedayat, A.; Szpunar, J.; N. A. P. Kiran Kumar; Peace, R.; Elmoselhi, H.; Shoker, A.

    2012-01-01

    Background. Morphological characterization of hemodialysis membranes is necessary to improve pore design. Aim. To delineate membrane pore structure of a high flux filter, Polyflux 210H. Methods. We used a Joel JSM-6010LV scanning electron microscope (SEM) and a SU6600 Hitachi field emission scanning electron microscope (FESEM) to characterize the pore and fiber morphology. The maximal diameters of selected uremic toxins were calculated using the macromolecular modeling Crystallographic Object...

  15. Organizational Traits, Care Processes, and Burnout Among Chronic Hemodialysis Nurses

    OpenAIRE

    Flynn, Linda; Thomas-Hawkins, Charlotte; Clarke, Sean P.

    2009-01-01

    In light of evidence linking registered nurse (RN) staffing levels to patient outcomes in chronic hemodialysis facilities, U.S. government regulations have set minimum RN staffing requirements during dialysis. Consequently, facility administrators are focused on decreasing nurse attrition in this crucial practice setting. This study used a cross-sectional, correlational design to investigate the effects of workload, practice environment, and care processes on burnout among nurses in U.S. chro...

  16. Serum lipoprotein (a and atherosclerotic changes in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Nasri Hamid

    2013-06-01

    Full Text Available Introduction: Lipoprotein (a [Lp(a] is considered as a risk factor for coronary atherosclerotic disorder and an increase in plasma Lp(a concentration is usually seen in patients with kidney failure.Objectives: We aimed in this study to evaluate the impact of plasma Lp(a level on early changes of atherosclerotic vessels in stable hemodialysis (HD patients.Patients and Methods: In this clinical study 61 patients (50 non-diabetic (F=20 M=30 and 11 diabetic HD patients, receiving maintenance hemodialysis were included and serum Lp(a was measured. B-mode ultrasonography of carotid intima-media thickness (cIMT was also determined.Results: The mean ±SD of patients Lp(a was 58.5±19 mg/dL. The mean ±SD of diabetic patients’ Lp(a was 62±12mg/dL and for nondiabetic ones was 57.7± 20mg/dL. In this study the thickening of Intima-media complex in diabetic group was more than non-diabetics, and no significant difference was found of Lp(a between diabetic and non diabetic HD patients. There was a significant positive association between serum Lp(a and cIMT.Conclusion: Accelerated atherosclerosis seen in diabetic hemodialysis patients. Lp(a might have an important role in progression of atherosclerosis to accelerate progressive atherosclerosis in these patients.

  17. 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.

  18. Prevalence of Secondary Hyper Parathyroidism in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    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.

  19. Coronary events in obese hemodialysis patients before and after renal transplantation.

    Science.gov (United States)

    De Lima, Jose Jayme G; Gowdak, Luis Henrique W; de Paula, Flavio J; Muela, Henrique Cotchi S; David-Neto, Elias; Bortolotto, Luiz A

    2015-11-01

    We examined the impact of obesity (BMI ?30 kg/m(2) , n = 357) on prognosis in 1696 hemodialysis (HD) patients before and after renal transplantation (TX). End-points were coronary events, composite cardiovascular (CV) events, and death. Obese HD patients were older (55.9 ± 9.2 vs. 54.2 ± 11), had more diabetes (54% vs. 40%), dyslipidemia (49% vs. 30%), altered myocardial scan (38% vs. 31%), myocardial infarction (MI) (16% vs. 10%), coronary intervention (11% vs. 7%), higher total cholesterol (186 ± 52 vs. 169 ± 47), and triglycerides (219 ± 167 vs. 144 ± 91). Obese undergoing TX had more dyslipidemia (46% vs. 31%), angina (23% vs. 14%), MI (18% vs. 5%), increased total cholesterol (185 ± 56 vs. 172 ± 48), and triglycerides (237 ± 190 vs. 149 ± 100). Obesity was independently associated with coronary events (log-rank = 0.008, HR 2.55% CI 1.27-5.11) and death (log-rank 0.046, HR 1.52, % CI 1.007-2.30) in TX but not in HD. Obese HD patients had more risk factors and ischemic heart disease, but these characteristics did not interfere with prognosis. In TX patients, obesity predicts coronary events and death. PMID:26277344

  20. Manifestações musculoesqueléticas em pacientes submetidos à hemodiálise Musculoskeletal manifestations in patients under hemodialysis

    Directory of Open Access Journals (Sweden)

    Walber Pinto Vieira

    2005-12-01

    Full Text Available As anormalidades musculoesqueléticas em pacientes submetidos à hemodiálise são numerosas e freqüentes, sendo mais prevalentes naqueles em tratamento dialítico de longa duração. A artralgia é o sintoma mais comum, ocorrendo em mais de 70% dos pacientes. O hiperparatireoidismo secundário é a principal causa da doença renal óssea, e as manifestações clínicas são: dor óssea, artralgia e prurido. A amiloidose, decorrente da deposição de proteína beta2-microglobulina nos tecidos, manifesta-se pela presença de ombro doloroso, síndrome do túnel do carpo, dedo em gatilho, ruptura espontânea de tendão e fratura patológica. Outras manifestações musculoesqueléticas observadas são a artrite induzida por cristais, necrose avascular, artrite séptica, fraqueza muscular e cãibras musculares.Musculoskeletal manifestations in hemodialysis patients are numerous and frequent, being more prevalent in those undergoing long duration dialytic treatment. Arthralgia is the most commom symptom, occurring in more than 70% of patients. Secondary hyperparathyroidism is the main cause of bone renal disease, and clinical manifestations are bone pain, arthralgia and pruritus. Amyloidosis, due to beta2-microglobulin deposition in tissues, manifests as shoulder pain, carpal tunnel syndrome, trigger finger, spontaneous tendon rupture and pathological fractures. Other musculoskeletal manifestations observed are crystal-induced arthritis, avascular necrosis, septic arthritis, muscle weakness and muscle cramps.

  1. Manifestações musculoesqueléticas em pacientes submetidos à hemodiálise / Musculoskeletal manifestations in patients under hemodialysis

    Scientific Electronic Library Online (English)

    Walber Pinto, Vieira; Kirla Wagner Poti, Gomes; Niedja Bezerra, Frota; José Eyorand Castelo Branco, Andrade; Rejane Maria Rodrigues de Abreu, Vieira; Francisca Edwiges Araújo, Moura; Francisco José Fernandes, Vieira.

    2005-12-01

    Full Text Available As anormalidades musculoesqueléticas em pacientes submetidos à hemodiálise são numerosas e freqüentes, sendo mais prevalentes naqueles em tratamento dialítico de longa duração. A artralgia é o sintoma mais comum, ocorrendo em mais de 70% dos pacientes. O hiperparatireoidismo secundário é a principal [...] causa da doença renal óssea, e as manifestações clínicas são: dor óssea, artralgia e prurido. A amiloidose, decorrente da deposição de proteína beta2-microglobulina nos tecidos, manifesta-se pela presença de ombro doloroso, síndrome do túnel do carpo, dedo em gatilho, ruptura espontânea de tendão e fratura patológica. Outras manifestações musculoesqueléticas observadas são a artrite induzida por cristais, necrose avascular, artrite séptica, fraqueza muscular e cãibras musculares. Abstract in english Musculoskeletal manifestations in hemodialysis patients are numerous and frequent, being more prevalent in those undergoing long duration dialytic treatment. Arthralgia is the most commom symptom, occurring in more than 70% of patients. Secondary hyperparathyroidism is the main cause of bone renal d [...] isease, and clinical manifestations are bone pain, arthralgia and pruritus. Amyloidosis, due to beta2-microglobulin deposition in tissues, manifests as shoulder pain, carpal tunnel syndrome, trigger finger, spontaneous tendon rupture and pathological fractures. Other musculoskeletal manifestations observed are crystal-induced arthritis, avascular necrosis, septic arthritis, muscle weakness and muscle cramps.

  2. Body composition, fitness score and arterial stiffness assesment in a chronic hemodialysis population

    Directory of Open Access Journals (Sweden)

    Adelina Mih?escu

    2011-12-01

    Full Text Available Patients undergoing long-term hemodialysis have a high risk of cardiovascular disease. Arterial stiffness is highly prevalent in this type of patients. The aim of our study was to analyse the relationship between body composition, blood chemistries and arterial stiffness in a poorly fit population of chronic hemodialysed patients. Patients and methods involved measuring body composition and fitness score by multifrequence bioimpedance with the body composition analyzer InBody720 and arterial stiffness by the measurement of aortic Pulse Wave Velocity (PWVao and Aortic Augmentation Index (Aix using an oscillometric method on 65 HD patients; measurements were made before a midweek dialysis session. Results: PWVao correlated significantly with weight (p=0.01, r2=1.14, body fat mass (p=0.007, r2=0.14, abdominal circumference (p=0.01, r2=0.12 and with fitness score (p=0.01, r2=0.11. Aix correlated with weight (p<0.05, r2=0.25, intracellular, extracellular- and total body water (p<0.05, r2=0.24 with body protein, soft lean mass, minerals, fat free mass and skeletal muscle mass (p<0.05, r2= 0.3 and with serum calcium (p=0.005, r2=0.2. Conclusions: Arterial stiffness is a common feature of the hemodialysed patients, significantly related to the blood calcium, fitness score and the body composition, especially fat body mass.

  3. Endoscopic Findings and Helicobacter pylori in Children on Long-Term Hemodialysis

    Directory of Open Access Journals (Sweden)

    Fakhrossadat Mortazavi

    2008-01-01

    Full Text Available The aim of this study is to evaluate the prevalence of GI symptoms, endoscopic abnormalities, histologic gastritis and Helicobacter pylori infection in children with End Stage Renal Disease (ESRD undergoing maintenance hemodialysis. Upper endoscopy and gastric biopsy were performed in 31 consecutive ESRD children from 2002-2007, before renal transplantation. H. pylori status was determined by urease test and histology. The mean age of patients was 11 ±3.3 years (4-16 year. The mean duration of dialysis was 12.4 ±11 months (1.5-54 months. Seventeen patients (54.8% were symptomatic. Twenty patients (64.5% had endoscopic abnormalities. Antral erythema, esophagitis, antral nodularity and diffuse gastritis were common endoscopic findings. Endoscopic abnormalities were more common in symptomatic patients than asymptomatic patients (p<0.05. Twenty patients (64.5% were H. pylori positive. There was no statistical correlation between age, sex, serum creatinine level, presence of any symptoms and endoscopic abnormalities with H. pylori positivity. The mean duration of dialysis in H. pylori negative patients was significantly longer in comparison with H. pylori positive patients. High prevalence of eodoscopic abnormalities and H. pylori infection in both symptomatic and asymptomatic patients emphasize the necessity of upper GI evaluation in ESRD children before renal transplantation.

  4. Epidemiology of end-stage renal disease and hemodialysis treatment in Serbia at the turn of the millennium.

    Science.gov (United States)

    Djukanovi?, Ljubica; Aksi?-Mili?evi?, Biserka; Anti?, Miodrag; Bakovi?, Jovan; Varga, Željko; Gojakovi?, Biljana; Dimkovi?, Nada; ?or?evi?, Verica; ?or?evi?, Vidojko; ?uri?, Stevan; ?uri?, Sun?ica; Zec, Nenad; Jela?i?, Rosa; Kova?evi?, Zoran; Lazarevi?, Tatjana; Ležai?, Višnja; Mandi?, Milan; Mari?, Ivko; Milenkovi?, Srboljub; Mili?evi?, Olivera; Miškovi?, Milena; Miti?, Igor; Nikoli?, Zora; Pilipovi?, Draga; Plješa, Stevo; Radakovi?, Miroslava; Raki?, Nenad; Rangelov, Vanja; Stojanovi?, Radivoje; Stojanovi?-Stanojevi?, Marina; Tirmenštajn-Jankovi?, Biserka; Haviža-Lili?, Branimir; Hadžibuli?, Edvin; Hrva?evi?, Rajko; Cveti?anin, Anica

    2012-10-01

    The study presents the epidemiological features of patients treated with renal replacement therapy (RRT) in Serbia from 1997 to 2009 and compares the results of hemodialysis treatment in 1999 and 2009. Epidemiological data were obtained from the National Registry of RRT patients and data on hemodialysis treatment from special surveys conducted in 1999 and 2009. Within the period 1997-2009 the incidence of patients on RRT increased from 108 to 179 per million population (pmp), prevalence rose from 435 to 699 pmp, while mortality rate fell from 20.7% to 16.7%. The frequency of patients with glomerulonephritis decreased, while that of patients with diabetes and hypertensive nephropathy increased. In late 2009 there were 5208 patients receiving RRT in Serbia. Within the examined period new hemodialysis and reverse osmosis equipment were purchased, high-flux dialyzers with synthetic membranes were increasingly used and the number of patients receiving hemodiafiltration increased to 17.6%. Kt/V greater than 1.2 was recorded in 16% of the patients in 1999 but 52% in 2009. Options for correction of anemia and mineral disorders have also improved. The percentage of patients with HbsAg (13.8% vs. 4.8%) as well as anti-hepatitis C virus antibodies positive patients (23.2% vs. 12.7%) was significantly lower in 2009 than in 1999. Both the incidence and prevalence of RRT patients in Serbia are rising continuously, while the mortality rate is falling. More favorable conditions for dialysis treatment have brought about significant improvement in the results over the last 10 years. PMID:22515550

  5. Hemodialysis patients have plasmatic hypercoagulability and decreased fibrinolytic vulnerability: role of carbon monoxide.

    Science.gov (United States)

    Matika, Ryan W; Nielsen, Vance G; Steinbrenner, Evangelina B; Sussman, Amy N; Madhrira, Machaiah

    2014-01-01

    Chronic hemodialysis is associated with significant thrombophilia. Of interest, hemodialysis patients have increased carboxyhemoglobin (COHb) and exhaled carbon monoxide (CO), signs of upregulated heme oxygenase (Hmox) activity. Given that CO enhances plasmatic coagulation, we determined whether patients requiring chronic hemodialysis had an increase in endogenous CO, plasmatic hypercoagulability and decreased fibrinolytic vulnerability. Carbon monoxide was determined by noninvasive pulse oximetry measurement of COHb. Blood samples were obtained just before hemodialysis. Thrombelastographic methods to assess plasma coagulation kinetics, fibrinolytic kinetics, and formation of carboxyhemefibrinogen (COHF) were used. Hemodialysis patients (n = 45) had abnormally increased COHb concentrations of 2.2 ± 1.9%, indicative of Hmox upregulation. Coagulation and fibrinolytic parameter normal values were determined with normal individual (n = 30) plasma. Thirty-seven patients of the hemodialysis cohort had COHF formation (82.2%, [67.9%-92.0%]; mean, [95% confidence interval]), and many of this group of patients had abnormally great velocity of clot growth (73.3%, [58.1%-85.4%]) and strength (75.6%, [60.5%-87.1%]). Furthermore, over half of COHF positive patients had a hypofibrinolytic state, evidenced by an abnormally prolonged time to maximum rate of lysis (53.3%, [37.9%-68.6%]) and clot lysis time (64.4%, [48.8%-78.1%]). Carbon monoxide enhanced coagulation and diminished fibrinolytic vulnerability in hemodialysis patients. Future investigation of hemodialysis, CO-related thrombophilia is warranted. PMID:25232771

  6. The prevalance, epidemiology and risk factors for onychomycosis in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Satar Salim

    2007-08-01

    Full Text Available Abstract Background Onychomycosis has a high prevalance among immunocompromised patients such as diabetics and hemodialysis patients. In the present study, we aimed to investigate the prevalence of onychomycosis among hemodialysis patients with and without diabetes mellitus, and to find out the factors likely to be associated with the development of onychomycosis among hemodialysis patients. Methods One hundred and nine hemodialysis patients were enrolled. Fifty-seven of hemodialysis patients had the diagnosis of diabetes mellitus. Nail scrapings were obtained from 76 patients who had dystrophic nail changes. Samples were examined with 20% potassium hydroxide solution and all of the samples were inoculated on Saboraud's dextrose agar, potateus dextrose agar and mycobiotic agar. Diagnosis of onychomycosis was based on the presence of both positive clinical signs and positive potassium hydroxide test. Results Onychomycosis was diagnosed in 26.6% of hemodialysis patients. Diabetes mellitus was present in 68.9% of patients with onychomycosis. Toenail scraping cultures were reported to be positive in 19.7% of patients with dystrophic nail changes. Logistic regression analysis revealed that the presence of diabetes mellitus and the mean duration of hemodialysis were the significant predictors associated with the development of onychomycosis. Conclusion The prevalence of dystrophic nail changes and onychomycosis is increased among hemodialysis patients. The dialysis duration and the presence of diabetes mellitus are the independent risk factors associated with the development of onychomycosis in uraemic patients.

  7. The Relationship between Iron Deficiency and Restless Legs Syndrome in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    R Ghanei Gheshlagh

    2012-10-01

    Full Text Available Introduction: Restless legs syndrome is a neurological disorder; hemodialysis patients seem to suffer more from this syndrome. Although the pathophysiology of restless legs syndrome is still unknown, assessment of factors associated with this syndrome can help to develop medical knowledge in this field. The present study assessed the relationship between restless legs syndrome, serum iron, and serum ferritin levels in patients on hemodialysis. Methods: This descriptive study was carried out with purposive sampling method on 168 hemodialysis patients who referred to the Urmia Taleghani Hospital Hemodialysis Unit. Data were gathered using restless legs syndrome questionnaire and laboratory Index of serum iron and ferritin. Data were analyzed using descriptive and inferential statistical tests. Results: The study results revealed that 38.7 percent of samples complained from restless legs syndrome whose average score serum iron was 78±29.3 ?g. Results showed in hemodialysis patients with restless legs syndrome, serum iron and serum ferritin levels were significantly lower than hemodialysis patients without restless legs syndrome (p=0. 02, p=0.005. Conclusion: Considering the high prevalence of restless legs syndrome in patients with hemodialysis, identification of factors associated with this syndrome and providing the necessary solutions for modifying or eliminating the factors, seem to be necessary. Since the relationship between indicators of iron and ferritin and restless legs syndrome in hemodialysis patients is confirmed, the results can be helpful in the treatment and management of these patients.

  8. Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

    OpenAIRE

    Goodkin, David A.; Fuller, Douglas S.; Robinson, Bruce M; Combe, Christian; Fluck, Richard; Mendelssohn, David; Akizawa, Tadao; Pisoni, Ronald L.; Port, Friedrich K.

    2011-01-01

    A small percentage of hemodialysis patients maintain higher hemoglobin concentrations without transfusion or erythropoietic therapy. Because uncertainty exists regarding the effects of higher hemoglobin concentration on mortality and quality of life among hemodialysis patients, studying this group of patients with sufficient endogenous erythropoietin may provide additional insights. The prospective, observational Dialysis Outcomes and Practice Patterns Study provides an opportunity to investi...

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

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    Santos Paulo Roberto

    2013-01-01

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

  10. Renal transplantation vs hemodialysis: Cost-effectiveness analysis

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    Perovi? Saša

    2009-01-01

    Full Text Available Background/Aim. Chronic renal insufficiency (CRI, diabetes, hypertension, autosomal dominant polycystic kidney disease (ADPKD are the main reasons for starting dialysis treatment in patients having kidney function failure. At present, dialysis treatments are performed in about 4,100 patients at 46 institutions in Serbia, out of which 90% are hemodialyses. At end-stage renal disease (ESRD the only correct selection is kidney transplatation. The basic aim of the planned research was to compare ratio of costs and effects (Cost Effectiveness Analysis - CEA of hemodialysis and kidney transplantation in patients at ESRD. Methods. As the main issue of treatment in patients from both groups the life quality measured by the validated McGill Questionary, was used. The study included 150 patients totally, divided into two groups. The study group consisted of 50 patients with kidney transplantation performed at the Clinical Center of Serbia and the control group consisted of 100 patients on hemodialysis at Clinical Center of Serbia, Clinical Hospital Center Zemun, Clinical Hospital Center 'Zvezdara', Clinical Center Kragujevac and Health Center 'Studenica', Kraljevo, comparable with respect to sex, age and length of treatment with the study group. Results. Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in the form of incremental ratio of costs and effects (Incremental Cost-Effectiveness Ratio - ICER. It is clear from the enclosed tables that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of EUR 132,256.25 per one year of contribution Quality Adjusted Life Years (QALY within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, psychological symptoms, existential well-being and support, difference is statistically important in favor of transplant patents. Conclusion. The costs of patient therapy by hemodialysis at end-stage renal disease is far greater than by performing therapy of transplantation and maintenance, by almost three and a half times. Difference in total quality aspects of human life (physical, emotional, social, spiritual and financial between dialyzed and transplant patients is statistically significant and by 18.12% greater in transplant patients than in patients on hemodialysis.

  11. Home hemodialysis and conventional in-center hemodialysis in Japan: a comparison of health-related quality of life.

    Science.gov (United States)

    Watanabe, Yusuke; Ohno, Yoichi; Inoue, Tsutomu; Takane, Hiroshi; Okada, Hirokazu; Suzuki, Hiromichi

    2014-10-01

    Health-related quality of life (HRQOL) is an important measure of how disease affects patients' daily life. Conventional in-center hemodialysis (CHD) patients have been found to have decreased HRQOL. Recent study reported that at-home hemodialysis (HHD) improved the long-term HRQOL compared with CHD; however, there have been no data from Japanese HHD patients. A sample of 80 Japanese hemodialysis patients (46 HHD and 34 CHD) was matched for age, sex, and cause of end-stage renal disease. Patient HRQOL was measured using two health surveys: Medical Outcomes Study 36 Item Short Form Health Survey-Version 2 and Kidney Disease Quality of Life-Short Form. HHD patients reported better scores on seven out of eight domains (all domains except general heath) of the Medical Outcomes Study 36 Item Short Form Health Survey-Version 2, as well as better Kidney Disease Quality of Life-Short Form scores with respect to symptoms and problems, effect of kidney disease, and work status. No significant differences were observed for burden of kidney disease, cognitive function, quality of social interaction, sexual function, or sleep. More than 65% of HHD patients stated that they were not bothered at all by limitations on food and water intake. Japanese HHD patients demonstrate significantly higher HRQOL scores. However, while their HRQOL and employment rate were high and they were able to enjoy fewer dietary restrictions, kidney disease remained a great burden. PMID:25330829

  12. Occult hepatitis B virus infection in Egyptian hemodialysis patients with or without hepatitis C virus infection

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    Hisham Ismail

    2010-08-01

    Full Text Available Hisham Ismail1*, Mohamed Soliman2, Nahed Ismail31Department of Molecular Diagnosis, GEBR Institute, 2Department of Clinical Pathology, College of Medicine, Menoufia University, Menoufia, Egypt; 3Department of Pathology and Department of Microbiology and Immunology, Meharry Medical College, Nashville, Tennessee, USA *Current affiliation: College of Medicine, Qassim University, Saudi ArabiaAbstract: Hepatitis B virus (HBV and hepatitis C virus (HCV infections are frequent in patients with end-stage renal disease who are on maintenance hemodialysis. There are limited data about the prevalence of occult HBV infection in patients on long-term hemodialysis. Occult HBV is defined as positive HBV DNA in the blood in the absence of hepatitis B surface ­antigen in the serum. In this study, we determined the prevalence of occult HBV in hemodialysis patients with or without HCV infection. The study included 116 patients with end-stage renal disease on chronic hemodialysis, of whom 64 patients were HCV RNA positive (Group 1, and 52 were HCV RNA negative (Group 2. We found that four of 64 (6.3% hemodialysis patients with HCV infection (Group 1 had occult HBV, while only two of 52 (3.8% hemodialysis patients without HCV (Group 2 had occult HBV. We then examined whether gender-matched ­hemodialysis patients with positive HBV DNA in the two hemodialysis groups differed in specific parameters, ie, age, degree of liver dysfunction, and presence of ­coinfection with schistosomiasis, a common parasitic infection of the liver. We found no significant difference between the groups having positive HBV DNA with regard to serum levels of liver enzymes, aspartate transaminase, albumin, and hepatitis B core antigen (P > 0.05. However, we detected significantly higher levels of alanine transaminase, a prolonged duration of hemodialysis, and higher levels of schistosomal antibodies in Group 1 than in Group 2. Interestingly, we found that the presence of schistosomal antibodies, history of past blood transfusion, and longer hemodialysis ­duration could distinguish patients with occult HBV infection from those with HBV DNA negative infection in hemodialysis patients. In conclusion, the prevalence of occult HBV in chronic hemodialysis patients is low, and does not significantly differ between hemodialysis patients with or without HCV coinfection.Keywords: occult hepatitis B virus, hepatitis C virus, schistosomiasis, hemodialysis

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

    International Nuclear Information System (INIS)

    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 (P0.05). 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

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

    International Nuclear Information System (INIS)

    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.

  15. Raquianestesia contínua em paciente submetido à gastrectomia parcial: relato de caso Raquianestesia continua en paciente sometido a la gastrectomía parcial: relato de caso Continuous spinal block in a patient undergoing partial gastrectomy: case report

    Directory of Open Access Journals (Sweden)

    Patrícia Falcão Pitombo

    2009-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Devido à alta incidência de complicações técnicas e neurológicas, a raquianestesia contínua foi abandonada por muitos anos. Com o surgimento dos cateteres intermediários, a técnica vem ressurgindo e ganhando simpatia no arsenal anestesiológico. O objetivo deste relato foi resgatar a utilidade da técnica como alternativa viável para procedimento de médio a grande porte. RELATO DO CASO: Paciente feminina, 58 anos, 62 kg, estado físico ASA I, com relato de enxaqueca, lombalgia e procedimentos cirúrgicos prévios sob raquianestesia sem intercorrências. Candidata à laparotomia exploradora por provável tumor pélvico. Após venóclise com cateter 18G, monitorização com cardioscópio, pressão arterial-não invasiva e oximetria de pulso, foi sedada com midazolam 2 mg e fentanil 100 ¼g e colocada em decúbito lateral esquerdo. Foi submetida à raquianestesia contínua por via mediana em L3-L4. Foram injetados 9 mg de bupivacaína hiperbárica a 0,5% e 120 ¼g de sulfato de morfina. Após inspeção da cavidade, verificou-se que o tumor era proveniente do estroma gástrico, sendo necessária ampliação da incisão e realização de gastrectomia parcial. Todo o procedimento foi realizado com pequena dose de solução hiperbárica e completa estabilidade hemodinâmica. Não houve necessidade de UTI no pós-operatório e a paciente evoluiu sem queixas e com alto grau de satisfação. Recebeu alta hospitalar após 72 horas sem nenhuma intercorrência. CONCLUSÕES: Os cateteres intermediários utilizados em raquianestesia contínua mostram-se promissores em tornar a técnica bastante atraente e de grande utilidade em operações de médio a grande porte, podendo inclusive ser alternativa eficaz no manuseio de pacientes em estado crítico, em que grandes repercussões hemodinâmicas podem ser deletérias.JUSTIFICATIVA Y OBJETIVOS: A causa de la elevada incidencia de las complicaciones técnicas y neurológicas, la raquianestesia continua fue abandonada durante muchos años. Con el surgimiento de los catéteres intermediarios, la técnica ha venido evolucionando nuevamente y obteniendo la simpatía en el arsenal anestesiológico. El objetivo de este relato, fue rescatar la utilidad de la técnica como una alternativa viable para el procedimiento de medio y gran porte. RELATO DEL CASO: Paciente femenina, 58 años, 62 kg, estado físico ASA I, con relato de jaqueca, lumbago y procedimientos quirúrgicos previos, bajo raquianestesia sin intercurrencias. Candidata a laparotomía exploradora por un probable tumor pélvico. Después de efectuada la venoclisis con catéter 18G, monitorización con cardioscopio, presión arterial no invasiva, y la oximetría de pulso, se le sedó con midazolam 2 mg y fentanil 100 ¼g y se le puso en decúbito lateral izquierdo. Se le sometió a la raquianestesia continua por vía mediana en L3-L4. Se le inyectaron 9 mg bupivacaína hiperbárica a 0,5% y 120 ¼g de sulfato de morfina. Después de la inspección de la cavidad, se verificó que el tumor era proveniente del estroma gástrico, siendo necesaria la ampliación de la incisión y la realización de gastrectomía parcial. Todo el procedimiento fue realizado con una pequeña dosis de solución hiperbárica y una completa estabilidad hemodinámica. No hubo necesidad de UCI en el postoperatorio y la paciente evolucionó sin quejarse y con un alto grado de satisfacción. Recibió el alta después de 72 horas sin ningún problema. CONCLUSIONES: Los catéteres intermediarios utilizados en la raquianestesia continua parecen ser promisorios en hacer con que la técnica sea bastante atractiva y de gran utilidad en operaciones de medio y gran porte, y puede incluso ser una alternativa eficaz en el manejo de pacientes en estado crítico, donde las grandes repercusiones hemodinámicas pueden ser perjudiciales.BACKGROUND AND OBJECTIVES: Due to the high incidence of technical and neurological complications, continuous spinal blocks were not performed for several years. With the advent of intermediate

  16. Radiology of the kidneys in patients under maintenance hemodialysis; Radiologische Diagnostik der Nieren bei Dialysepatienten

    Energy Technology Data Exchange (ETDEWEB)

    Bahner, M.L.; Kaick, G. van [Deutsches Krebsforschungszentrum Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie; Bommer, J.; Sommerer, C. [Heidelberg Univ. (Germany). Sektion Nephrologie

    1999-05-01

    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.) [Deutsch] An den Nieren von Patienten mit terminaler Niereninsuffizienz unter chronischer Haemodialyse koennen unterschiedliche Veraenderungen oder Komplikationen auftreten. Am haeufigsten sind sekundaere, erworbene Nierenzysten, die nach achtjaehriger Dialysedauer bei 92% der Patienten gefunden werden. Solitaere (bei 12,5% der Patienten) sowie multipel (8,3%) eingeblutete Nierenzysten sind haeufige Befunde, darueber hinaus kann es zu einer Haematurie oder zur Zystenruptur kommen. Hierbei sind Einblutungen bei Patienten mit familiaeren Zystennieren haeufiger und koennen dann auch multilokulaer auftreten. Konkremente der Nieren sind aufgrund der zunehmenden Oligurie selten, Verkalkungen im Bereich der Nierenzysten und Matrixsteine finden sich allerdings bei ca. 71% der Patienten. Tumoren sind 41fach haeufiger als bei Nierengesunden, im eigenen Kollektiv fanden sie sich bei 4,2% der Langzeitdialysepatienten. Differentialdiagnostisch koennen die relativ langsam wachsenden und spaet metastasierenden malignen Tumoren von den haeufiger auftretenden Adenomen nicht unterschieden werden. Dennoch fuehren wir ein regelmaessiges Screening im Abstand von drei bis vier Jahren mittels Computertomographie durch, da die Sonographie bei diesen Patienten nicht ausreichend sensitiv ist. (orig.)

  17. Oncocitosis renal de paciente en hemodialisis / Renal oncocytomatosis in a patient receiving hemodialysis

    Scientific Electronic Library Online (English)

    Raquel, González Resina; Enrique, Argüelles Salido; David, Marcilla Plaza; Pedro, Campoy Martínez; Belén, Congregado Ruiz; Rafael, Medina López.

    2007-09-01

    Full Text Available Objetivo: La oncocitosis renal es una patología infrecuente. Presentamos el primer caso publicado de paciente diagnosticado de esta patología y sometido posteriormente a trasplante combinado riñón-páncreas. Métodos: Presentamos el caso de un paciente en el que, en una revisión rutinaria por Insufici [...] encia Renal Crónica Terminal (IRCT) y tratamiento con hemodiálisis, en espera de trasplante renal, se diagnostican de forma incidental dos oncocitomas renales y focos de oncocitomatosis microscópica. Se realiza nefrectomía radical derecha y tras el estudio anatomo-patológico, con masas dominantes caracterizadas como oncocitomas renales (OR), se sometió a trasplante combinado reno-pancreático nueve meses después. Resultados: El postoperatorio cursa sin incidencias. Tras un seguimiento de tres años el paciente no ha mostrado recidiva de su patología oncocítica, y el injerto es normofuncionante. Conclusiones: La presencia del antecedente de IRCT en tratamiento con hemodiálisis en los pacientes con oncocitomatosis renal es llamativa, no quedando establecida la causa de esta relación. El tratamiento al que se someta el paciente para la oncocitosis renal y las características anatomopatológicas presentes en el espectro de esta patología condicionarán cuando es posible la realización de un trasplante renal en este tipo de enfermos, y condicionará el pronóstico. Es aconsejable el seguimiento de los pacientes a largo plazo, dada la posibilidad de afectación metacrónica o bilateral, y la asociación entre oncocitomatosis renal (OCR) y carcinoma de células renales (CCR) hasta en un 32%. Abstract in english Objective: Renal oncocytosis is a rare pathology. We report the first case published of a patient with this disease undergoing combined pancreas-kidney transplantation. Methods: We report the case of one patient with end stage chronic renal failure receiving hemodialysis with the incidental diagnosi [...] s of two renal oncocytomas and microscopic oncocytomatosis in a routine revision while awaiting for renal transplantation. Right radical nephrectomy was performed with the pathologic diagnosis of renal oncocytomas. The patient underwent combined kidney-pancreas transplantation nine months later. Results: The postoperative course was uneventful. After three years of follow-up the patient has not shown recurrence and the graft has normal function. Conclusions: The presence of the antecedent of end stage renal disease under treatment with hemodialysis in patients with renal oncocytomatosis is striking, but the causative relationship is not established. The treatment for renal oncocytosis and pathologic characteristics present will condition when will be possible the performance of a kidney transplant in these patients, and will also condition prognosis. Longterm follow-up is recommendable due to the possibility of metachronic or bilateral involvement, and the association between renal oncocytomatosis and renal cell carcinoma in up to 32% of the cases.

  18. Parâmetros ecocardiográficos como preditores de eventos cardiovasculares em pacientes em hemodiálise Echocardiographic parameters as cardiovascular event predictors in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Thayse Mayara Aragão Siqueira

    2012-08-01

    Full Text Available FUNDAMENTO: Pacientes com doença renal crônica (DRC em hemodiálise possuem altas taxas de morbidade e mortalidade cardiovascular. Apesar de alterações ecocardiográficas estruturais e funcionais em pacientes submetidos à hemodiálise terem sido objeto de diversos estudos de análise de sobrevida, o valor prognóstico destas alterações ainda não está bem estabelecido na literatura. OBJETIVO: Determinar o valor prognóstico de parâmetros ecocardiográficos em pacientes com DRC em hemodiálise. MÉTODOS: Sessenta pacientes consecutivos com DRC em tratamento hemodialítico foram avaliados clinicamente e submetidos ao ecodopplercardiograma, sendo acompanhados durante 19 ± 6 meses. Os desfechos avaliados foram eventos cardiovasculares fatais e não fatais e mortalidade geral. O valor preditivo das variáveis ecocardiográficas foi avaliado pelo modelo de regressão de Cox, as curvas de sobrevida foram construídas pelo método de Kaplan-Meier e o teste log rank foi utilizado para compará-las. RESULTADOS: As taxas de sobrevida livre de eventos cardiovasculares, de mortalidade cardiovascular e de mortalidade global em dois anos foram de 79,4%, 88,5% e 83%, respectivamente. Diabetes, diagnóstico prévio de doença cardiovascular (DCV, fração de ejeção, fração de encurtamento, diâmetro sistólico do ventrículo esquerdo e relação E/e' foram preditores de desfecho cardiovascular na análise univariada. Na análise multivariada, história prévia de DCV (HR = 6,17; IC 95% 1,7 - 22,2; p = 0,005 e disfunção diastólica moderada a grave (HR = 3,76; IC 95% 1,05 - 13,4; p = 0,042 foram fatores de risco independentes para eventos cardiovasculares. CONCLUSÃO: Disfunção diastólica de moderada a grave é um preditor independente de eventos cardiovasculares em pacientes em hemodiálise.BACKGROUND: Patients with chronic kidney disease (CKD on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established in literature. OBJECTIVE: To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis. METHODS: Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them. RESULTS: Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD, ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005 and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042 were independent risk factors for cardiovascular events. CONCLUSION: Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.

  19. Parâmetros ecocardiográficos como preditores de eventos cardiovasculares em pacientes em hemodiálise / Echocardiographic parameters as cardiovascular event predictors in hemodialysis patients

    Scientific Electronic Library Online (English)

    Thayse Mayara Aragão, Siqueira; Pedro Antônio Muniz, Ferreira; Francisco das Chagas, Monteiro Júnior; Natalino, Salgado Filho; Adalgisa de Souza Paiva, Ferreira; Eugênio dos, Santos Neto; Francival Leite de, Souza; Paulo de Tarso, Cardoso.

    2012-08-01

    Full Text Available FUNDAMENTO: Pacientes com doença renal crônica (DRC) em hemodiálise possuem altas taxas de morbidade e mortalidade cardiovascular. Apesar de alterações ecocardiográficas estruturais e funcionais em pacientes submetidos à hemodiálise terem sido objeto de diversos estudos de análise de sobrevida, o va [...] lor prognóstico destas alterações ainda não está bem estabelecido na literatura. OBJETIVO: Determinar o valor prognóstico de parâmetros ecocardiográficos em pacientes com DRC em hemodiálise. MÉTODOS: Sessenta pacientes consecutivos com DRC em tratamento hemodialítico foram avaliados clinicamente e submetidos ao ecodopplercardiograma, sendo acompanhados durante 19 ± 6 meses. Os desfechos avaliados foram eventos cardiovasculares fatais e não fatais e mortalidade geral. O valor preditivo das variáveis ecocardiográficas foi avaliado pelo modelo de regressão de Cox, as curvas de sobrevida foram construídas pelo método de Kaplan-Meier e o teste log rank foi utilizado para compará-las. RESULTADOS: As taxas de sobrevida livre de eventos cardiovasculares, de mortalidade cardiovascular e de mortalidade global em dois anos foram de 79,4%, 88,5% e 83%, respectivamente. Diabetes, diagnóstico prévio de doença cardiovascular (DCV), fração de ejeção, fração de encurtamento, diâmetro sistólico do ventrículo esquerdo e relação E/e' foram preditores de desfecho cardiovascular na análise univariada. Na análise multivariada, história prévia de DCV (HR = 6,17; IC 95% 1,7 - 22,2; p = 0,005) e disfunção diastólica moderada a grave (HR = 3,76; IC 95% 1,05 - 13,4; p = 0,042) foram fatores de risco independentes para eventos cardiovasculares. CONCLUSÃO: Disfunção diastólica de moderada a grave é um preditor independente de eventos cardiovasculares em pacientes em hemodiálise. Abstract in english BACKGROUND: Patients with chronic kidney disease (CKD) on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the progn [...] ostic value of these alterations is not well established in literature. OBJECTIVE: To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis. METHODS: Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them. RESULTS: Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD), ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005) and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042) were independent risk factors for cardiovascular events. CONCLUSION: Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.

  20. Bone mineral density and markers of bone turnover in patients with renal transplantation and regular hemodialysis

    Directory of Open Access Journals (Sweden)

    Samir M. Ibrahim,. Khalid H Abdel-Mageed, Magdi M El-Sharkawy

    2002-09-01

    Full Text Available Background: Decreased bone mineral density (BMD is a known complication for the uremic state antedating dialysis / renal transplantation (RTx. The issue of stabilized versus continued decrease of BMD especially on long-term basis, continues to be unresolved. Patients and Methods: !"#"hemodialysis (HD-#" $% " &'( &'(-group had been evaluated for metabolic bone changes by calcium homeostasis parameters (serum calcium, phosphorus, alkaline phosphatase "ALP" and vitamin D "calcitriol", markers of bone formation (bone alkaline phosphatase "BAP", osteocalcin "OC", N-terminal propeptide of collagen type I "PINP", bone resorption markers (pyridoline "PYL" and deoxypyridoline "DPYL", and intact parathyroid hormone (iPTH. Also, BMD had been assessed by dual energy x-ray absorptiometry (DEXA twice, at inclusion time and * ! "" Results: comparing both groups regarding calcium homeostasis, markers of bone turnover and iPTH showed non significant difference. However, there was a significant drop of BMD (as evidenced by T-score at follow up in the HD group, compared to stabilization of T-score for the RTx-group. Furthermore, annual T-score change was significantly more in HD-group, compared to RTx-group. Results also showed that, the best marker correlating with T-score annual changes and iPTH to be PINP. Irrespective of normal calcium homeostasis parameters, low BMD is a prevalent disorder among patients on regular HD and renal transplants.Conclusion: Follow up for * ! " %+ ,- ." % """"!to continued bone loss in patients on regular HD. This could raise recommendation for calcium and calcitriol supplementation, especially in the predialysis period, early post transplantation period, and continued guided replacement for those on maintenance HD. Serum PINP showed best correlations with BMD changes and iPTH and could be considered a reliable marker reflecting bone formation in those patients. Keywords: hemodialysis, renal transplantation, markers of bone formation; bone alkaline phosphatase (BAP, osteocalcin (OC, N-terminal propeptide of collagen type I (PINP, markers of bone resorption; pyridoline (PYL, deoxypyridoline (DPYL, intact parathyroid hormone (iPTH, dual energy x-ray absorptiometry (DEXA, bone mineral density (BMD. Introduction and aim af aork: hyperparathyroidism, parathormone Chronic renal failure (CRF is a resistance of bone cells, vitamin D known cause of reduction of bone metabolic disorders, immobility of mineral density (BMD with subsequent patients, hypogonadism, amyloidosis enhanced bone fragility. The and toxic osteodystrophy by aluminum pathophysiological causes include or poor dialysis quality . In addition,

  1. The Effects Education Methods on Changes of Body Weight and Some of Serum Indices in Hemodialysis Patients Referred to Qom Kamkar Hospital in 2007

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    M Abbasi

    2012-05-01

    Full Text Available  

    Background and objectives: The number of hemodialysis patients has been increasing in recent years. Accumulation of metabolic waste products due to nonobservance of the proper diet is one of the mechanisms that threatens the health of these patients. In this study, the effects of lecture and handbook education methods have been evaluated on changes of body weight, serum sodium, potassium, blood urea nitrogen, creatinine and phosphorus in hemodialysis patients.

    Methods: In this clinical trial study, 113 hemodialysis patients were divided into three groups including control, lecture education, and handbook education groups. The indices were measured monthly, starting 3 months before and continuing for 3 months after the intervention. A comparison was made between the mean of each index measured before and after the intervention, using One-way ANOVA, followed by the Tukey’s post-hoc test.

    Results: Except sodium concentration, all other indices showed a significant reduction in both lecture and handbook education groups in comparison with controls (P <0.05. Although, in lecture education group the reduction of indices was higher than handbook education group, the reduction was not significant except for the serum blood urea nitrogen.

     

    Conclusion: Education can effectively help hemodialysis patients to reduce their weight and serum indices and it seems that education by lecture is more effective than by handbook.

  2. Prevalence and Impact on Stroke in Patients Receiving Maintenance Hemodialysis versus Peritoneal Dialysis: A Prospective Observational Study

    Science.gov (United States)

    Lei, Ming; Luo, Zhengmao; Zhong, Xianyang; Huang, Yuanhang; Zhang, Hong; Liu, Riguang; Tong, Junrong; He, Feng

    2015-01-01

    Background Patients undergoing maintenance dialysis are at increased risk of stroke, however, less is known about the prevalence and impact on stroke in the patients. Methods In this prospective cohort study, 590 patients undergoing hemodialysis (HD; n = 285) or peritoneal dialysis (PD; n = 305) from January 1, 2008 to December 31, 2012 were recruited. Baseline demographic, clinical, and laboratory data were collected. Timeline incidence data were analyzed using a Poisson model. The Cox proportional hazards regression assessed adjusted differences in stroke risk, a multivariate analysis was also performed. Results 62 strokes occurred during 1258 total patient-years of follow-up. Stroke occurred at a rate of 49.2/1,000 patient-years with a predominance in HD patients compared with PD patients (74.0 vs. 31.8/1,000 patient-years). The cumulative hazard of developing stroke was significantly higher in HD patients (hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.15–3.62; p = 0.046) after adjusting for potential confounders. HD patients had an increased risk of ischemic stroke (HR, 2.62; 95% CI, 1.56–4.58; p = 0.002). The risk of hemorrhagic stroke was not significantly different between PD and HD patients. On multivariate Cox analysis, risk factors of stroke in both HD and PD patients were older age, diabetes, and cardiovascular disease. Other independent risk factors of stroke were lower albumin-corrected calcium in HD patients and higher triglycerides in PD patients. Conclusions Patients undergoing PD were less likely to develop ischemic stroke than those undergoing HD. Comprehensive control of diabetes, cardiovascular disease, calcium-phosphorus metabolism, and triglyceride levels may be useful preventive strategies for stroke in dialysis patients. PMID:26485155

  3. Epidemiological study of orthopedic injuries in hemodialysis patients in Taiwan: a fixed cohort survey, 2004–2008

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    Chang NT

    2013-03-01

    Full Text Available Nien-Tzu Chang,1,2,* Yi-Hui Lee,2,3 Jiin-Chyr Hsu,4 Chien-Lung Chan,5 Guey-Shiun Huang,2 Jenn-Huei Renn,1,6,* Nan-Ping Yang1,4,* 1Community Health Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; 2Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; 3Department of Nursing, School of Nursing, Chang-Gang University, Taoyuan, Taiwan; 4Department of Medical Research and Biostatistics Office, Tao-Yuan General Hospital, Department of Health, Taoyuan, Taiwan; 5Department of Information Management, Yuan-Ze University, Taoyuan, Taiwan; 6Department of Orthopedics, Kaohsiung Veterans General Hospital, Executive Yuan, Kaohsiung, Taiwan*These authors contributed equally to this workBackground: The burden of chronic kidney disease (CKD is a growing concern worldwide. The prevalence of hemodialysis in Taiwan is the highest in the world, and this may increase the prevalence of orthopedic fractures. The aim of this study was to explore the incidences of various orthopedic injuries and the related risk factors.Methods: A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2004–2008. A total of 82,491 CKD patients were selected as the fixed cohort population. The International Classification of Diseases 9-CM diagnosis codes and treatment codes were identified as the inclusion criteria for orthopedic injury.Results: A total of 82,491 Taiwanese people with CKD were identified in 2004, and 4915 orthopedic injuries occurred during the 5-year follow-up period. The cumulative incidences of orthopedic injuries were 42.56‰ for lower limb fractures, and 12.93‰, 3.27‰, and 1.64‰ for upper limb fractures, vertebrae fractures, and joint dislocations, respectively. All three types of orthopedic fractures were more common in the oldest age stratum (?65 years old. In the CKD patients, the risk ratio of osteoporosis was 3.47 (95% confidence interval, 3.10–3.89 for all orthopedic injuries. Patients of advanced age, the female gender, and those with high comorbidity were also at significant risk of sustaining orthopedic fractures.Conclusion: The results from this Taiwanese CKD cohort support the strong influence of aging and osteoporosis on all kinds of orthopedic injuries. The postponing of osteoporosis may need to be taken into consideration for the prevention of orthopedic injury among CKD patients undergoing hemodialysis.Keywords: chronic kidney disease, renal osteodystrophy, hemodialysis, orthopedic injuries

  4. Blood color is influenced by inflammation and independently predicts survival in hemodialysis patients: quantitative evaluation of blood color.

    Science.gov (United States)

    Shibata, Masanori; Nagai, Kojiro; Doi, Toshio; Tawada, Hideo; Taniguchi, Shinkichi

    2012-11-01

    Blood color of dialysis patients can be seen routinely. Darkened blood color is often observed in critically ill patients generally because of decreased oxygen saturation, but little is known about the other factors responsible for the color intensity. In addition, quantitative blood color examination has not been performed yet. Therefore, no one has evaluated the predictive power of blood color. The aim of this study was to evaluate if blood color darkness reflects some medical problems and is associated with survival disadvantage. Study design is a prospective cohort study. One hundred sixty-seven patients were enrolled in this study. Quantification of blood color was done using a reflected light colorimeter. Demographic and clinical data were collected to find out the factors that can be related to blood color. Follow-ups were performed for 2 years to analyze the risk factors for their survival. Regression analysis showed that C-reactive protein and white blood cell count were negatively correlated with blood color. In addition, blood color was positively correlated with mean corpuscular hemoglobin concentration and serum sodium concentration as well as blood oxygen saturation. During a follow-up, 34 (20.4%) patients died. Cox regression analysis revealed that darkened blood color was an independent significant risk factor of mortality in hemodialysis patients as well as low albumin and low Kt/V. These results suggest that inflammation independently affects blood color and quantification of blood color is useful to estimate prognosis in patients undergoing hemodialysis. It is possible that early detection of blood color worsening can improve patients' survival. PMID:22845854

  5. Absence of peripheral blood mononuclear cells priming in hemodialysis patients

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    Santos B.C.

    2003-01-01

    Full Text Available As a consequence of the proinflammatory environment occurring in dialytic patients, cytokine overproduction has been implicated in hemodialysis co-morbidity. However, there are discrepancies among the various studies that have analyzed TNF-alpha synthesis and the presence of peripheral blood mononuclear cell (PBMC priming in this clinical setting. We measured bioactive cytokine by the L929 cell bioassay, and evaluated PBMC TNF-alpha production by 32 hemodialysis patients (HP and 51 controls. No difference in TNF-alpha secretion was observed between controls and HP (859 ± 141 vs 697 ± 130 U/10(6 cells. Lipopolysaccharide (5 µg/ml did not induce any further TNF-alpha release, showing no PBMC priming. Paraformaldehyde-fixed HP PBMC were not cytotoxic to L929 cells, suggesting the absence of membrane-anchored TNF-alpha. Cycloheximide inhibited PBMC cytotoxicity in HP and controls, indicating lack of a PBMC TNF-alpha pool, and dependence on de novo cytokine synthesis. Actinomycin D reduced TNF-alpha production in HP, but had no effect on controls. Therefore, our data imply that TNF-alpha production is an intrinsic activity of normal PBMC and is not altered in HP. Moreover, TNF-alpha is a product of de novo synthesis by PBMC and is not constitutively expressed on HP cell membranes. The effect of actinomycin D suggests a putative tighter control of TNF-alpha mRNA turnover in HP. This increased dependence on TNF-alpha RNA transcription in HP may reflect an adaptive response to hemodialysis stimuli.

  6. Nonoxidized, biologically active parathyroid hormone determines mortality in hemodialysis patients

    DEFF Research Database (Denmark)

    Tepel, Martin; Armbruster, Franz Paul

    2013-01-01

    Background: It was shown that nonoxidized PTH (n-oxPTH) is bioactive, whereas the oxidation of PTH results in a loss of biological activity. Methods: In this study we analyzed the association of n-oxPTH on mortality in hemodialysis patients using a recently developed assay system. Results: Hemodialysis patients (224 men, 116 women) had a median age of 66 years. One hundred seventy patients (50%) died during the follow-up period of 5 years. Median n-oxPTH levels were higher in survivors (7.2 ng/L) compared with deceased patients (5.0 ng/L; P = .002). Survival analysis showed an increased survival in the highest n-oxPTH tertile compared with the lowest n-oxPTH tertile (?(2), 14.3; P = .0008). Median survival was 1702 days in the highest n-oxPTH tertile, whereas it was only 453 days in the lowest n-oxPTH tertile. Multivariable-adjusted Cox regression showed that higher age increased odds for death, whereas higher n-oxPTH reduced the odds for death. Another model analyzing a subgroup of patients with intact PTH (iPTH) concentrations at baseline above the upper normal range of the iPTH assay (70 ng/L) revealed that mortality in this subgroup was associated with oxidized PTH but not with n-oxPTH levels. Conclusions: The predictive power of n-oxPTH and iPTH on the mortality of hemodialysis patients differs substantially. Measurements of n-oxPTH may reflect the hormone status more precisely. The iPTH-associated mortality is most likely describing oxidative stress-related mortality.

  7. Surto de reações hemolíticas associado a residuais de cloro e cloraminas na água de hemodiálise Outbreak of hemolytic reactions associated with chlorine and chloramine residuals in hemodialysis water

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    Rachel VV Calderaro

    2001-10-01

    Full Text Available OBJETIVO: Relatar o processo de investigação da contaminação da água e a conseqüente avaliação do surto ocorrido no serviço de hemodiálise. MÉTODOS: Em setembro de 2000, 16 pacientes sob terapia de hemodiálise de um hospital em Minas Gerais apresentaram reações hemolíticas compatíveis a sintomas de intoxicação por cloro e cloramina em água. Foi feita a medição das concentrações de cloro e cloramina em amostras coletadas em diversos pontos do sistema de tratamento e distribuição de água do serviço inspecionado. A identificação dos casos ocorridos durante o período de estudo foi feita pela revisão das anotações de prontuários dos pacientes. Foi feita a revisão dos procedimentos da equipe técnica, médica e de enfermagem por meio de entrevistas. RESULTADOS: A taxa de sintomas foi significativamente alta (pOBJECTIVE: To investigate the process of water contamination and to assess the subsequent outbreak in the hemodialysis center. METHODS: In September 2000, sixteen patients undergoing chronic hemodialysis at a dialysis center in Minas Gerais, Brazil, experienced hemolytic reactions compatible with toxic symptoms due to chlorine and chloramine water contamination. Chlorine and chloramine concentrations in samples obtained from various sites of the dialysis center's water treatment and distribution system were measured. Case-patients were identified by reviewing medical records and nursing notes for all dialysis sessions carried out during the study period. Interviews with technicians, nursing and medical staff members were conducted. RESULTS: Reaction rate was significantly higher (p£0.5 mg/L for chlorine and £ 0.1 mg/L for chloramine. Individuals exposed to high chlorine and chloramine concentrations presented a relative risk of 2.58 (1.0-6.28 of having hemolytic reactions. CONCLUSION: There is a need to observe surveillance procedures to secure that the maximum allowable concentrations of regulated substances in the water used in the hemodialysis process are not exceeded.

  8. Surto de reações hemolíticas associado a residuais de cloro e cloraminas na água de hemodiálise / Outbreak of hemolytic reactions associated with chlorine and chloramine residuals in hemodialysis water

    Scientific Electronic Library Online (English)

    Rachel VV, Calderaro; Léo, Heller.

    2001-10-01

    Full Text Available OBJETIVO: Relatar o processo de investigação da contaminação da água e a conseqüente avaliação do surto ocorrido no serviço de hemodiálise. MÉTODOS: Em setembro de 2000, 16 pacientes sob terapia de hemodiálise de um hospital em Minas Gerais apresentaram reações hemolíticas compatíveis a sintomas de [...] intoxicação por cloro e cloramina em água. Foi feita a medição das concentrações de cloro e cloramina em amostras coletadas em diversos pontos do sistema de tratamento e distribuição de água do serviço inspecionado. A identificação dos casos ocorridos durante o período de estudo foi feita pela revisão das anotações de prontuários dos pacientes. Foi feita a revisão dos procedimentos da equipe técnica, médica e de enfermagem por meio de entrevistas. RESULTADOS: A taxa de sintomas foi significativamente alta (p Abstract in english OBJECTIVE: To investigate the process of water contamination and to assess the subsequent outbreak in the hemodialysis center. METHODS: In September 2000, sixteen patients undergoing chronic hemodialysis at a dialysis center in Minas Gerais, Brazil, experienced hemolytic reactions compatible with to [...] xic symptoms due to chlorine and chloramine water contamination. Chlorine and chloramine concentrations in samples obtained from various sites of the dialysis center's water treatment and distribution system were measured. Case-patients were identified by reviewing medical records and nursing notes for all dialysis sessions carried out during the study period. Interviews with technicians, nursing and medical staff members were conducted. RESULTS: Reaction rate was significantly higher (p£0.5 mg/L for chlorine and £ 0.1 mg/L for chloramine. Individuals exposed to high chlorine and chloramine concentrations presented a relative risk of 2.58 (1.0-6.28) of having hemolytic reactions. CONCLUSION: There is a need to observe surveillance procedures to secure that the maximum allowable concentrations of regulated substances in the water used in the hemodialysis process are not exceeded.

  9. Phylogenetic Analysis of Isolated HCV Strains from Tunisian Hemodialysis Patients

    OpenAIRE

    Kchouk, Fatma Houissa; Gorgi, Yousr; Bouslama, Lamjed; Sfar, Imen; Ayari, Rym; Khiri, Hacene; Halfon, Phillipe; Aouadi, Houda; Jendoubi Ayed, Saloua; Ayed, Khaled; Ben Abdallah, Taieb

    2013-01-01

    The present study describes the strains of hepatitis C virus (HCV) isolated from Tunisian hemodialysis patients. Thirty-three HCV strains isolated from different dialysis centers in Tunis City were amplified by RT-PCR in a region of the NS5b gene, genotyped by sequencing, and compared to international sequences by phylogenetic analysis. The phylogenetic tree showed that 16 HCV isolates have been identified as subtype 4k (48.5%), 7 as unspecified HCV-4 subtype (21.2%), 5 as subtype 4a et 1b (e...

  10. Clinical Characteristics of Patients on Hemodialysis With Peripheral Arterial Disease.

    Science.gov (United States)

    Matsuzawa, Ryota; Aoyama, Naoyoshi; Yoshida, Atsushi

    2015-11-01

    Patients on hemodialysis (HD; n = 210) were examined for peripheral arterial disease (PAD) using ankle-brachial index (ABI) and toe-brachial index (TBI). The prevalence of PAD was 38.1%. Among patients with PAD, 87.5% were newly diagnosed with PAD, 42.5% were diagnosed with TBI insufficient daily activity to experience exertional leg symptoms. Screening for PAD using the ABI and TBI increased diagnostic efficiency in patients on HD and may lead to effective early treatments, including pharmacotherapy, revascularization therapy, and exercise rehabilitation to avoid the worst possible scenario such as lower limb amputation, cardiovascular event, and death. PMID:25694516

  11. Therapeutic Drug Monitoring in Neonatal HSV Infection on Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Funaki, Takanori; Miyata, Ippei; Shoji, Kensuke; Enomoto, Yuki; Sakamoto, Seisuke; Kasahara, Mureo; Miyairi, Isao

    2015-07-01

    Optimal acyclovir dosing under continuous renal replacement therapy (CRRT) in neonates is unknown. We monitored serum acyclovir levels and herpes simplex virus 1 (HSV-1) DNA levels in a neonate with disseminated HSV-1 infection and renal failure undergoing CRRT. A full-term, 5-day-old female presented with a 2-day history of lethargy and fever. She developed fulminant hepatitis and was diagnosed with HSV-1 infection by real-time polymerase chain reaction. Acyclovir was initiated at 60 mg/kg/day, which was lowered to 20 mg/kg/day because of development of renal failure. She was placed on continuous hemodialysis. Acyclovir dosing was adjusted according to serum acyclovir levels, and HSV-1 viral load was sequentially monitored. Semiquantification of serum HSV-1 levels was performed by real-time polymerase chain reaction. Acyclovir levels were measured by using liquid chromatography-tandem mass spectrometry. Acyclovir was administered at 20 mg/kg intravenously over 1 hour; peak concentration was 18.9 ?g/mL. The half-life of acyclovir was estimated to be 2 to 3 h. Viral load remained high during dosing every 24 hours, with a decline of 0.17 log copies/24 hours. Acyclovir dosing was changed to 20 mg/kg/dose every 8 hours, with an average viral load decline of 0.44 log copies/24 hours. Despite the guideline recommendation of 24-hour redosing, acyclovir was dialyzed at a rate that resulted in suboptimal treatment. Individual therapeutic drug monitoring for acyclovir and dosing adjustment may be required to optimize therapy for patients undergoing CRRT. PMID:26101355

  12. Short daily and nocturnal hemodialysis: New therapies for a new century?

    Directory of Open Access Journals (Sweden)

    Rocco Micheal

    2009-01-01

    Full Text Available The National Institutes of Health (NIH sponsored HEMO Study did not demonstrate that an increase in dialysis dose was associated with an improvement in patient mortality rates. Despite this negative result, there is ongoing interest in determining if still higher doses of dialysis may be of benefit to patients receiving chronic hemodialysis therapy. Testing this hypothesis requires the use of more fre-quent hemodialysis and/or a much longer duration for each dialysis session. "Short daily hemodialysis", actually six times per week hemodialysis for 1.5 to 3 hours per session, provides a significant increase in small molecule clearance as measured by urea kinetics. "Long nocturnal daily hemodialysis", actually six times per week hemodialysis for 6-8 hours per session, provides a significant increase in both small and large molecular weight clearance and often alleviates the need to take phosphate binders. Both forms of more frequent dialysis have been shown to improve control of blood pressure. One small randomized trial of nocturnal versus conventional home dialysis showed a decrease in left ventricular (LV mass at 6 months in the nocturnal arm only. Most clinical trials conducted in these dialysis modalities have been observational trials and have enrolled small numbers of patients. The National Institutes of Health is sponsoring two clinical trials via the Frequent Hemodialysis Network to determine the effect of these two more frequent dialysis modalities on intermediate outcomes. In the short daily study, 250 patients will be randomized to receive either six times per week HD, with a session length of 1.5 to 2.75 hours, or conventional in-center hemodialysis. In the nocturnal study, 150 patients will be randomized to receive either six times per week overnight dialysis, with a session length of at least 6 hours, or conventional home hemodialysis.

  13. Omega-3 intake in people with epilepsy under regular hemodialysis program: here to stay

    Directory of Open Access Journals (Sweden)

    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.

  14. Does antibiotic lock therapy prevent catheter-associated bacteremia in hemodialysis?

    Directory of Open Access Journals (Sweden)

    Macarena Jiménez

    2015-01-01

    Full Text Available Central venous catheter-related blood stream infection is a major cause of morbidity and mortality in patients with renal disease treated with hemodialysis. Antibiotic lock solutions can be effective in preventing this complication in patients with hemodialysis. Searching in Epistemonikos database, which is maintained by screening more than twenty databases, we identified eight systematic reviews including seventeen randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded that antibiotic lock solutions probably decrease catheter-related blood stream infection in hemodialysis patients.

  15. Needle Migration to the Heart: An Unusual Association of Hemodialysis and Cardiovascular Morbidity.

    Science.gov (United States)

    Honikman, Rafael; Chikwe, Joanna; Tokita, Joji Erik; Mittnacht, Alexander J C

    2015-10-15

    In this report, we present a unique complication of hemodialysis: the hemodialysis access needle was lost into an arteriovenous fistula. The event went unnoticed for several months. The needle eventually migrated into the right ventricle, requiring an operative retrieval. Loss of the needle was likely unrecognized because of the use of a retracting safety cannula that conceals the needle within a sheath after removal. This case highlights a rare and potentially serious complication of hemodialysis access, demonstrates a possible hazard of retracting safety needles, and reviews the management of foreign bodies that have migrated into the heart. PMID:26466304

  16. Hemodiálise estendida em lesão renal aguda / Extended hemodialysis in acute kidney injury

    Scientific Electronic Library Online (English)

    Fabiano Bichuette, Custodio; Emerson Quintino de, Lima.

    2013-06-01

    Full Text Available Cerca de 10% dos pacientes em unidade de terapia intensiva que desenvolvem injúria renal aguda irão depender de terapia renal substitutiva. Embora não existam dados que comprovem redução da mortalidade, quando comparadas às terapias intermitentes, as terapias contínuas fornecem maiores doses de diál [...] ise cumulativa e maior estabilidade hemodinâmica. Contudo, apresentam custos elevados e não estão disponíveis em vários centros. Nesse contexto, a Hemodiálise Estendida ganha espaço na prática clínica, pois combina a tolerabilidade hemodinâmica, o controle de soluto lento e sustentado e as doses efetivas de diálise das terapias contínuas associadas aos custos reduzidos e facilidades logísticas das terapias intermitentes. Abstract in english About 10% of patients in the intensive care unit which develop acute renal failure will depend on renal replacement therapy. Although there are no data showing reduction in mortality when compared with intermittent therapy, continuous therapies provide higher cumulative doses of dialysis and greater [...] hemodynamic stability. However, have high costs and are not available in many centers. In this context the Extended Hemodialysis gaining ground in clinical practice because it combines the hemodynamic tolerability, slow and sustained solute control and effective doses of continuous dialysis therapies associated with reduced costs and logistics facilities of intermittent therapy.

  17. Angina mesentérica: causa infrecuente de dolor crónico en paciente en hemodiálisis / Mesenteric angina as a cause of abdominal pain in a patient in chronic hemodialysis: Report of one case

    Scientific Electronic Library Online (English)

    Jaime, Duclos H; María Soledad, Urquieta A; Marcos, Opazo L.

    2002-10-01

    Full Text Available [...] Abstract in english We report a 73 years old male undergoing chronic hemodialysis with a history of seven years of abdominal pain and weight loss. A mesenteric angiography disclosed a critical stenosis of the celiac artery and a partial stenosis of the superior mesenteric artery. Other causes of abdominal pain were exc [...] luded. The patient was subjected to a successful angioplasty with stent placement that resulted in a complete relief of the pain (Rev Méd Chile 2002; 130: 1155-8)

  18. Uterus neuroendocrine tumor - a severe prognostic factor in a female patient with alcoholic cirrhosis undergoing chronic hemodialysis.

    Science.gov (United States)

    Sinescu, Ruxandra Diana; Niculae, Andrei; Peride, Ileana; Vasilescu, Florina; Bratu, Ovidiu Gabriel; Mischianu, Dan Liviu Dorel; Jinga, Mariana; Checheri??, Ionel Alexandru

    2015-01-01

    There is increased evidence that end-stage renal disease patients, especially the hemodialyzed population, may present various unexpected forms of complications, contributing to a poor prognosis. Furthermore, neuroendocrine tumors, rarely encountered in daily practice, present in dialyzed individuals can significantly exacerbate the inflammatory condition with negative impact on patients' quality of life. We present an unusual case of uterus neuroendocrine tumor with multiple metastases in a 49-year-old female hemodialyzed patient with a history of alcoholic liver cirrhosis and uterus fibromatous. Multiple endoscopic techniques (e.g., upper endoscopy, colonoscopy, upper and lower echoendoscopy), histological evaluation of biopsy samples from involved areas (the operatory piece) were performed in order to complete and refine the diagnosis. PMID:26193237

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

    OpenAIRE

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

    2013-01-01

    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 eff...

  20. Survival Benefit of Statins in Hemodialysis Patients Awaiting Renal Transplantation.

    Science.gov (United States)

    Aftab, Waqas; Gazallo, Juliana; Motabar, Ali; Varadrajan, Padmini; Deedwania, Prakash C; Pai, Ramdas G

    2015-06-01

    End-stage renal disease (ESRD) patients have extraordinarily high cardiovascular risk and mortality, yet the benefit of statins in this population remains unclear based on the randomized trials. We investigated the prognostic value of statins in a large, pure cohort of prospectively recruited patients with ESRD awaiting renal transplantation, and being followed up in a dedicated cardiac clinic. We prospectively collected demographic, clinical, laboratory, and pharmacological data on 423 consecutive ESRD patients on hemodialysis awaiting renal transplantation. Survival analysis was performed as a function of statin therapy. The baseline characteristics were as follows: age 57?±?11 years, males 64%, diabetes mellitus in 68%, known coronary artery disease in 30%, left ventricular (LV) ejection fraction 61?±?11%. Over a mean follow-up of 2 years, there were 43 deaths. Adjusted for age, gender, hypertension, body mass index, diabetes mellitus, coronary artery disease, smoking, and treatment with angiotensin converting enzyme inhibitor, ? blocker, and antiplatelet medications, statin use was a predictor of lower mortality (hazard ratio 0.30, 95% confidence interval 0.11-0.79, p?=?0.01). This beneficial effect of statin was supported by propensity score analysis (p?=?0.02) and was consistent across all clinical subgroups. The benefit of statins seemed to be greater in those with LV hypertrophy and smoking. Statin therapy in hemodialysis patients awaiting renal transplant is independently associated with better survival supporting its use in this high-risk population. PMID:26060381

  1. Psychological and physiological factors predicting the outcome on home hemodialysis.

    Science.gov (United States)

    Richmond, J M; Lindsay, R M; Burton, H J; Conley, J; Wai, L

    1982-03-01

    As part of a study of "Adaptation to home dialysis" we have examined psychological, physiological, and social factors influencing the success of 136 patients on home hemodialysis, followed for greater than 18 months. The study has demonstrated specific physical, psychological, and stress factors associated with increased probability of failure on home hemodialysis. In those under 45 years of age, the profile of failure is of higher diastolic blood pressure in training, more frequent episodes of congestive heart failure, higher levels of stress associated with varying health and loss of sleep and greater anxiety and depression. In the older age group failure was associated with higher levels of depression and self depreciation, and higher levels of stress associated with fear of death, pain during dialysis and blood clotting. On the other hand, higher denial levels were positively correlated with success. There were no significant differences between profiles of those patients who succeeded and those who died. Although analysis is based on a retrospective study, the time sequence between data collection and end points suggests that patient profiling can be used in a predictive manner. The study emphasizes the importance of psychological and social factor analysis in the overall management of the patient with renal failure. PMID:7067172

  2. Amiloidosis asociada a la hemodiálisis / Hemodialysis-Associated Amyloidosis

    Scientific Electronic Library Online (English)

    Harold, Joseph Planas; Lázaro Leopoldo, Capote Pereira; Mara, Herrera Almirola; Mariela, González Ramos; Eloísa, del Cueto de Inastría.

    2014-12-01

    Full Text Available La amiloidosis asociada a la diálisis es una complicación frecuente en los pacientes con insuficiencia renal crónica terminal en hemodiálisis con más de 10 años de tratamiento. Se presentó un paciente que con tan solo 4 años en hemodiálisis tuvo un cuadro clínico de dolores articulares crónicos, en [...] las articulaciones de hombros, codos y rodillas, acompañados de aumento de volumen e impotencia funcional. Se le realizó punción y aspiración del contenido articular donde se halló un contenido proteináseo con características amiloides, Rojo Congo positivo. Este caso constituye el primero de amiloidosis por B2 microglubulina que se publica en una revista científico técnica de Cuba. Pone de manifiesto la posibilidad de que la susceptibilidad del paciente desempeña un importante papel en la patogenia de esta entidad. Abstract in english The dialysis-associated amyloidosis is a frequent complication in patients with end stage renal disease (ESRD) on hemodialysis with over 10 years of treatment. A patient was presented with only four years on hemodialysis had a clinical condition of chronic joint pain, at shoulder, elbow, and knees j [...] oints, accompanied by increased volume and loss of function. This patient underwent joint puncture and aspiration of content. Proteinase content with amyloid characteristics, positive Congo red was found. This case is the first of amyloidosis B2 macroglobulin published in a biomedical journal of Cuba. It highlights the possibility that the patient's susceptibility plays an important role in the pathogenesis of this entity.

  3. Montelukast for Treatment of Refractory Pruritus in Patients on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Ali Reza Nasrollahi

    2009-04-01

    Full Text Available Introduction. One of the most common complaints in patients with end-stage renal disease (ESRD is uremic pruritus. In the recent years, many drugs have been proposed for its treatment which have had paradoxical outcomes. We studied the antipruritus effect of montelukast sodium, a leukotriene receptor antagonist, in patients on hemodialysis.Materials and Methods. The study was conducted as randomized, single-blind, placebo-controlled crossover study in 5 hemodialysis centers. Sixteen patients with refractory pruritus were selected and were divided into 2 groups to receive firstly montelukast and then placebo, or vice versa. Patients were treated by montelukast tablets, 10 mg daily, for 20 days and the washout period was 14 days.Results. Of 16 patients whom were included in the study, 1 died during the placebo period of myocardial infarction and another patient who received montelukast for 20 days faced hemoglobin decrease during the placebo period diagnosed as myelodysplastic syndrome. At the end of the treatment with montelukast, pruritus was reduced by 35% (95% CI, 9.5% to 62.5%, while it was reduced 7% (95% CI, 0.5% to 15.9% with placebo (P = .002. The patients’ compliance was assessed satisfactory, except for 1 patient who exited the study due to anemia.Conclusions. Montelukast is more effective than placebo in the treatment of uremic pruritus not responding to the currently available antipruritus drugs, and it can be considered as a new and rather safe and effective treatment option in uremic patients.

  4. Prevalência de Fatores de Risco Cardiovascular em Pacientes em Hemodiálise - O Estudo CORDIAL / Prevalence of Cardiovascular Risk Factors in Hemodialysis Patients - The CORDIAL Study

    Scientific Electronic Library Online (English)

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

    2014-06-10

    Full Text Available Fundamentos: Há uma carência de dados epidemiológicos sobre o perfil de risco cardiovascular nos pacientes renais crônicos em hemodiálise no Brasil. Objetivo: O estudo CORDIAL foi planejado para avaliar fatores de risco cardiovascular e acompanhar a evolução de uma população em programa de hemodi [...] álise numa cidade metropolitana do Brasil. Métodos: Todos os pacientes em hemodiálise por doença renal crônica nos quinze centros de nefrologia de Porto Alegre foram considerados para inclusão na fase inicial do estudo CORDIAL. Dados clínicos, laboratoriais e demográficos foram obtidos nos registros médicos, e em entrevistas individuais estruturadas realizadas com todos os pacientes por pesquisadores treinados. Resultados: Foram incluídos 1215 pacientes (97,3% de todos os que estavam em hemodiálise na cidade de Porto Alegre). A média de idade era 58,3 anos, 59,5% eram homens e 62,8% eram brancos. A prevalência de fatores de risco cardiovascular encontrada foi 87,5% para hipertensão, 84,7% para dislipidemia, 73,1% para sedentarismo, 53,7% para tabagismo e 35,8% para diabetes. Em uma análise multivariada ajustada, sedentarismo (p = 0,032; RP 1,08 - IC95%: 1,01-1,15), dislipidemia (p = 0,019; RP 1,08 - IC95%: 1,01-1,14), e obesidade (p Abstract in english Background: There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. Objective: The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. Methods: All p [...] atients 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. Results: 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

  5. Pathophysiological, cardiovascular and neuroendocrine changes in hypertensive patients during the hemodialysis session.

    Science.gov (United States)

    Gutiérrez-Adrianzén, O A; Moraes, M E A; Almeida, A P; Lima, J W O; Marinho, M F; Marques, A L; Madeiro, J P V; Nepomuceno, L; da Silva, J M S; Silva, G B; Daher, E F; Rodrigues Sobrinho, C R M

    2015-06-01

    The pathophysiological mechanisms of arterial hypertension during hemodialysis (HD) in patients with end-stage renal disease (ESRD) are still poorly understood. The aim of this study is to investigate physiological, cardiovascular and neuroendocrine changes in patients with ESRD and its correlation with changes in blood pressure (BP) during the HD session. The present study included 21 patients with ESRD undergoing chronic HD treatment. Group A (study) consisted of patients who had BP increase and group B (control) consisted of those who had BP reduction during HD session. Echocardiograms were performed during the HD session to evaluate cardiac output (CO) and systemic vascular resistance (SVR). Before and after the HD session, blood samples were collected to measure brain natriuretic peptide (BNP), catecholamines, endothelin-1 (ET-1), nitric oxide (NO), electrolytes, hematocrit, albumin and nitrogen substances. The mean age of the studied patients was 43 ± 4.9 years, and 54.6% were males. SVR significantly increased in group A (P<0.001). There were no differences in the values of BNP, NO, adrenalin, dopamin and noradrenalin, before and after dialysis, between the two groups. The mean value of ET-1, post HD, was 25.9 pg ml(-1) in group A and 13.3 pg ml(-1) in group B (P = < 0.001). Patients with ESRD showed different hemodynamic patterns during the HD session, with significant BP increase in group A, caused by an increase in SVR possibly due to endothelial dysfunction, evidenced by an increase in serum ET-1 levels. PMID:25339292

  6. Management of Calcium and Phosphorus Metabolism in Hemodialysis Patients in Tehran Province, Iran

    Directory of Open Access Journals (Sweden)

    Mitra Mahdavi-Mazdeh

    2009-04-01

    Full Text Available Introduction. Our aim was to evaluate the degree of achievement of the recommended values in National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI guidelines for the laboratory indicators of bone metabolism in patients undergoing hemodialysis (HD in Tehran province.Materials and Methods. We evaluated the laboratory information of 2630 HD patients in Tehran province. Demographic data of the patients and the clinical information including the duration of dialysis session, dialysate calcium concentration, Kt/V, and serum values of calcium, phosphorus, and intact parathyroid hormone (PTH were recorded. The laboratory values were compared to the recommended ranges by the K/DOQI work group in patients with end-stage renal disease.Results. Only 1.8% of the patients could enjoy a successful management according to the K/DOQI recommendations for the 4 target laboratory tests of serum calcium, phosphorus, intact parathyroid hormone, and calcium-phosphorus product. Hypocalcemia was diagnosed in 33.2% of the patients, whereas 13.6% were diagnosed with hypercalcemia. Hypophosphatemia and secondary hyperparathyroidism were diagnosed in 6.8% and 24.2% of the patients, respectively.Conclusions. Our findings proved that complying with the recommendations established by the K/DOQI work group in the clinical management of mineral metabolism is very demanding. Phosphate binders frequently lead to untoward toxicities and imbalance in bone metabolism of patients on HD, warranting new cost-effective therapies with fewer side effects. It would be of great interest to analyze, in the future, the benefits derived from the effect of new therapies such as calcimimetics or new phosphate binders regarding the achievement of the K/DOQI guidelines.

  7. Clinical effects of the new phosphorus binder, bixalomer in hemodialysis patients switched from sevelamer hydrochloride.

    Science.gov (United States)

    Gen, Shikou; Sasaki, Takaya; Saito, Kanako; Nobe, Kanako; Nodaira, Yuka; Ikeda, Naofumi

    2014-06-01

    It has been reported that sevelamer hydrochloride, which is often used as a polymer phosphorus (P) binder for managing serum P concentration in dialysis patients, causes gastrointestinal adverse effects such as constipation, etc. The reason for this is thought to be that sevelamer hydrochloride has high water absorption, causing it to absorb water and swell in the gastrointestinal tract. In June 2012, the new polymer P binder bixalomer was launched in Japan. Since bixalomer has low swelling due to water absorption, it can be expected to alleviate adverse effects in the gastrointestinal system. In our study, for 21 cases of maintenance hemodialysis patients undergoing treatment with sevelamer hydrochloride at our hospital, the P binder was switched from sevelamer hydrochloride to the same dosage of bixalomer, and the concentrations of serum P, corrected calcium (Ca) and whole parathyroid hormone (PTH) before and one month after the switch were compared. In addition, gastrointestinal symptoms (acid reflux, abdominal pain, indigestion, diarrhea and constipation) were evaluated before and after the switch using a questionnaire based on the Japanese version of the Gastrointestinal Symptom Rating Scale (GSRS). By switching to bixalomer, serum P concentration was significantly reduced (P=0.024), but there were no significant changes observed for serum corrected Ca and whole PTH. Furthermore, there were no significant changes observed for all five of the evaluation items of the GSRS, before and after the switch. These results suggest that although bixalomer can more potently reduce the serum P concentration than sevelamer hydrochloride, there were no significant differences in the effects of both P binders on the gastrointestinal symptoms. PMID:24975889

  8. Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients

    OpenAIRE

    Mc Causland, Finnian R.; Waikar, Sushrut S.; Brunelli, Steven M.

    2012-01-01

    Dietary sodium is thought to play a major role in the pathogenesis of hypertension, hypervolemia and mortality in hemodialysis patients. Thus, restriction is almost universally recommended. However, the evidence on which these assumptions are based is limited.

  9. 21 CFR 876.5600 - Sorbent regenerated dialysate delivery system for hemodialysis.

    Science.gov (United States)

    2010-04-01

    ...dialyzer. The device is used with the extracorporeal blood system and the dialyzer of the hemodialysis system...means to maintain the temperature, conductivity, electrolyte balance, flow rate and pressure of the dialysate, and...

  10. You cannot choose your family: sociological ambivalence in the hemodialysis unit.

    Science.gov (United States)

    Wilson, Patricia M; Reston, Jonathan D; Bieraugel, Rebecca; Da Silva Gane, Maria; Wellsted, David; Offredy, Maxine; Farrington, Ken

    2015-01-01

    Living with end-stage renal disease is challenging and requires a great deal of self-management, but little is known about the experiences of patients and staff around the subject. We held six focus groups in three hemodialysis units, each unit hosting 1 staff and 1 patient focus group. A total of 15 staff members and 15 patients participated. We employed thematic analysis using a priori and emerging codes. Five key themes emerged: challenges, enablers, complex balancing acts, good patient/bad patient, and the hemodialysis unit as a family. We explored the family metaphor further through the work of Bourdieu, but concluded that relationships in the hemodialysis unit most closely fit the concept of sociological ambivalence. We present an explanatory framework around inherent tensions characterizing relationships within the hemodialysis unit and highlight implications for facilitating self-management and developing collaborative approaches to care. PMID:25205792

  11. The quest to standardize hemodialysis care.

    Science.gov (United States)

    Hegbrant, Jörgen; Gentile, Giorgio; Strippoli, Giovanni F M

    2011-01-01

    A large global dialysis provider's core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence-based guidelines and clinical protocols; consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner, incorporating information on interclinic and intercountry variations; and revising targets, guidelines and clinical protocols based on sound scientific data. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice; and auditing of clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety. PMID:21625088

  12. Citalopram Versus Psychological Training for Depression and Anxiety Symptoms in Hemodialysis Patients

    OpenAIRE

    Seyed Hamzeh Hosseini; Fatemeh Espahbodi; Seyyed Mohammad Mehdi Mirzadeh Goudarzi

    2012-01-01

    Introduction. This study was designed to compare an antidepressant medication, citalopram, with psychological training in hemodialysis patients with symptoms of anxiety and depression. Materials and Methods. A total number of 44 hemodialysis patients scored 8 and more on the Hospital Anxiety and Depression Scale (HADS) were randomly allocated to two groups to receive citalopram, 20 mg/d, for 3 months or to attend 6 sessions of 1-hour psychological training. A nephrologist and a senior psychi...

  13. An economic assessment model for in-center, conventional home, and more frequent home hemodialysis

    OpenAIRE

    Komenda, Paul; Gavaghan, Meghan B; Garfield, Susan S; Poret, Amy W; Sood, Manish M

    2011-01-01

    More intensive and/or frequent hemodialysis may provide clinical benefits to patients with end-stage renal disease; however, these dialysis treatments are more convenient to the patients if provided in their homes. Here we created a standardized model, based on a systematic review of available costing literature, to determine the economic viability of providing hemodialysis in the home that arrays costs and common approaches for assessing direct medical and nonmedical costs. Our model was bas...

  14. The effect of hemodialysis on protein metabolism. A leucine kinetic study.

    OpenAIRE

    Lim, V S; Bier, D M; Flanigan, M J; Sum-Ping, S T

    1993-01-01

    To assess the effect of hemodialysis on protein metabolism, leucine flux was measured in seven patients before, during, and after high efficiency hemodialysis using cuprophane dialyzers and bicarbonate dialysate during a primed-constant infusion of L-[1-13C]leucine. The kinetics [mumol/kg per h, mean +/- SD] are as follows: leucine appearance into the plasma leucine pool was 86 +/- 28, 80 +/- 28, and 85 +/- 25, respectively, before, during, and after dialysis. Leucine appearance into the whol...

  15. Acute Hepatitis C Infection without Anti-HCV Antibody in a Chronic Hemodialysis Patient

    OpenAIRE

    Yi-Jung Lee; Chiz-Tzung Chang; Mai-Szu Wu

    2006-01-01

    Liver disease caused by hepatitis C virus (HCV) may cause significant morbidity andmortality among patients with end stage renal disease under maintenance hemodialysis(HD). The anti-HCV antibody detection is the current method used to detect HCV infection.However, there are many seronegative HCV infections. Reverse transcriptase polymerasechain reaction for HCV RNA provides a better diagnostic tool to detect the infection. Wepresent a chronic hemodialysis patient with HCV infection. HCV RNA w...

  16. International practice patterns and factors associated with non-conventional hemodialysis utilization

    OpenAIRE

    Allen Nathan; Schwartz Daniel; Komenda Paul; Pauly Robert P; Zimmerman Deborah; Tanna Gemini; Schiff Jeffery; Rigatto Claudio; Sood Manish M

    2011-01-01

    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 surve...

  17. Intolerance to Sunitinib Treatment in Hemodialysis Patients With Metastatic Renal Cell Carcinoma

    OpenAIRE

    YILDIZ, IBRAHIM; Sen, Fatma; Kilic, Leyla; Ciftci, Rumeysa; BASARAN, MERT

    2014-01-01

    Sunitinib is a multiple tyrosine kinase receptor inhibitor that is approved for the treatment of metastatic renal cell carcinoma (RCC). However, neither an appropriate dose nor dosing schedule of sunitinib has yet been established for patients with metastatic RCC who are on hemodialysis. Here, we report on two hemodialysis patients who received sunitinib to treat metastatic RCC. Sunitinib was planned to be administered at a dosage of 25 mg/d for 4 of every 6 weeks. Although sunitinib toxicity...

  18. Association of Serum C-Reactive Protein (CRP) with Some Nutritional Parameters of Maintenance Hemodialysis Patients

    OpenAIRE

    Azar Baradaran; Hamid Nasri

    2005-01-01

    Malnutrition and inflammation are common in hemodialysis patients, and are usually closely associated. Serum C-reactive protein (CRP) concentrations have been found to be significantly elevated in hemodialysis patients and reflects chronic inflammation, and as an acute-phase reactant, is a sensitive and independent marker of malnutrition. To investigate the association of serum CRP level with some nutritional variables in diabetic and non diabetic end-stage renal failure patients under...

  19. Association Between Serum Magnesium and Risk Factors of Cardiovascular Disease in Hemodialysis Patients

    OpenAIRE

    Mohammad Reza Khatami; Elham Mirchi; Zahra Khazaeipour; Alireza Abdollahi; Afsaneh Jahanmardi

    2013-01-01

    Introduction. There are associations between serum magnesium level and some risk factors of cardiovascular disease and atherosclerosis, such as lipid profile, serum albumin, C-reactive protein, serum phosphorus, parathyroid hormone, and diabetes mellitus in hemodialysis patients. The aim of this study was to examine these associations. Materials and Methods. This study was conducted on 103 patients with end-stage renal disease on maintenance hemodialysis. Laboratory assessment was performed b...

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

    OpenAIRE

    Kobra Parvan; Sima lakdizaji; Fariborz Roshangar; Mahtab Mostofi

    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 de...

  1. Clinical Performance of a Salivary Amylase Activity Monitor During Hemodialysis Treatment

    OpenAIRE

    Masaru Shimazaki; Takayuki Matsuki; Kazuaki Yamauchi; Michihiro Iwata; Hiroshi Takahashi; Kenichi Sakamoto; Junichi Ohata; Yuichi Nakamura; Yusuke Okazaki

    2008-01-01

    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...

  2. The experience of person with chronic renal disease in hemodialysis: meanings attributed for the patients

    OpenAIRE

    Claudinei José CJGC Gomes Campos; Egberto Ribeiro Turato

    2007-01-01

    Hemodialysis treatment received by chronic renal patients is known to be distressing and to impose a set of biological, psychological and social limitations(1). This work aimed to study how renal patients experience disease and hemodialysis treatment in a specialized service of a State University Hospital. As specific aims they were to analyze and understand the meanings the patient attributes to disease and treatment; to know the bio-psychosocial limitations experienced by the renal patient ...

  3. Successful endovascular treatment of a hemodialysis graft pseudoaneurysm by covered stent and direct percutaneous thrombin injection.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-07-25

    Vascular access for hemodialysis remains a challenge for nephrologists, vascular surgeons, and interventional radiologists alike. Arteriovenous fistula and synthetic grafts remain the access of choice for long-term hemodialysis; however, they are subject to complications from infection and repeated needle cannulation. Pseudoaneurysms are an increasingly recognized adverse event. At present, there are many minimally invasive methods to repair these wall defects. We present a graft pseudoaneurysm, which required a combination of endovascular stent graft placement and percutaneous thrombin injection for successful occlusion.

  4. The effects of cholecalciferol treatment on mineral metabolism and inflammation markers in Turkish hemodialysis patients

    OpenAIRE

    Sultan Ozkurt; Ahmet Musmul

    2013-01-01

    Objectives: To evaluate the effects of 25-hydroxycholecalciferol (25-[OH] D) on bone mineral metabolism and inflammation parameters in hemodialysis patients. Methods: The study was carried out at Hitit University Corum Education and Research Hospital, Corum, Turkey between July and September 2012. All of the 36 patients that underwent treatment in our hemodialysis unit were included in this study. Four patients were excluded from the study due to other complications. Of the remaining 32 pat...

  5. Volume Control by Using the Body Composition Monitor in a Puerperal Patient on Hemodialysis

    OpenAIRE

    Chung, Wookyung; Choi, Shung Han; Sung, Jiyoon; Jung, Eul Sik; Shin, Dong Su; Jung, Ji Yong; Chang, Jae Hyun; Lee, Hyun Hee; Lee, Seung-Ho; Kim, Sejoong

    2011-01-01

    Accurate measurement of the volume status in hemodialysis patients is important as it can affect mortality. However, no studies have been conducted regarding volume management in cases where a sudden change of body fluid occurs, such as during puerperium in hemodialysis patients. This report presents a case in which the patient was monitored for her body composition and her volume status was controlled using a body composition monitor (BCM) during the puerperal period. This case suggests that...

  6. Cardiac and vascular structure and function parameters do not improve with alternate nightly home hemodialysis: An interventional cohort study

    OpenAIRE

    Johnson David W; Jeffries Janine K; Matsumoto Aya; Coombes Jeffrey; Hawley Carmel M; Haluska Brian; Jeffriess Leanne; Van Eps Carolyn L; Campbell Scott B; Isbel Nicole M; Mudge David W; Marwick Thomas

    2011-01-01

    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 tra...

  7. Demographic data and hemodialysis population dynamics in Qatar: A five year survey

    Directory of Open Access Journals (Sweden)

    Fituri Omar

    2009-01-01

    Full Text Available Hemodialysis was initiated in Qatar in 1981, since then the hemodialysis population has been expanding rapidly. This report describes the demographics and outcome of our hemo-dialysis patients during a five years study period. Data of all the patients on regular hemodialysis from January 1 st , 2002 to December 31 st , 2006 were included in this study was collected from the medical records and entered into an especially designed questionnaire. The prevalence of end stage kidney disease in Qatar is 624 patients per million populations with an incidence of 202 patients per million populations per year. Currently, 278 patients are on hemodialysis, 65% of them are Qatari, males represent 51%, whereas 44.6% are between 65-74 years of age. Diabetic nephropathy is the commonest cause of end stage kidney disease (48%, followed by primary glomerulonephritis and hypertensive glomerulopathy. Arteriovenous fistula was the vascular access in 57% of patients. The incidence of Hepatitis B, C and Human immunodeficiency virus had been stable throughhout the study period though our hemodialysis population had increased by 1.5 fold. The first and five years survival rates of our patients were 84 and 53% respectively. Qatar has one of the highest rates of dialysis patients with a good long-term survival report. Peritoneal dialysis remained to be the key solution for the rapidly expanding patients? pool. Maintenance of national registry of dialysis patients and improving our organ transplant program is an essential goal.

  8. The effects of free radicals on antioxidant defence systems and organism in hemodialysis patients

    International Nuclear Information System (INIS)

    Chronic Renal Failure (CRF) is accompanied by a variety of complications which may develop due to an increase in oxidant stress and/or a decrease in antioxidant activities. Hemodialysis (HD) is still the most prevalent method used for the end stage renal failure throughout the world. In this study, it was aimed to research thoroughly whether an increase in lipid peroxidation occurs in hemodialysis patients with advanced CRF and to evaluate antioxidant enzyme activities. Plasma MDA which is the indicator of lipid peroxidation and plasma SOD, CAT, GSH-Px levels as well as total antioxidant status (TAS) values which are the indicators of antioxidant defense systems have been determined in CRF patients who have undergone hemodialysis treatment and in the control group. Compared to those found in the control group, MDA and SOD levels in CRF patient group have statistically increased (p<0,001), while GSH-Px and CAT values have been found to decrease (p<0,001). TAS values have been determined to increase in the control group before the hemodialysis and to decrease after the hemodialysis, which is statistically insignificant. With regard to the correlation calculation we've made, a statistically positive correlation have been found between urea and creatinine both pre- and after hemodialysis, while no statistically significance have been recorded among other parameters. (author)

  9. Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review

    Scientific Electronic Library Online (English)

    Luís Henrique Bezerra Cavalcanti, Sette; Edmundo Pessoa, de Almeida Lopes.

    2014-04-01

    Full Text Available We reviewed the literature regarding the serum levels of the enzymes aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase in patients with chronic kidney disease on hemodialysis with and without viral hepatitis. Original articles published up to January 2013 on adult [...] patients with chronic kidney disease on hemodialysis were selected. These articles contained the words “transaminases” “aspartate aminotransferase” “alanine aminotransferase” “gamma glutamyl transferase,” “liver enzymes”, AND “dialysis” OR “hemodialysis”. A total of 823 articles were retrieved. After applying the inclusion and exclusion criteria, 49 articles were selected. The patients with chronic kidney disease on hemodialysis had reduced serum levels of aminotransferases due to hemodilution, lower pyridoxine levels, or elevated homocysteine levels. The chronic kidney disease patients on hemodialysis infected with the hepatitis C virus also had lower aminotransferase levels compared with the infected patients without chronic kidney disease. This reduction is in part due to decreased viremia caused by the dialysis method, the production of a hepatocyte growth factor and endogenous interferon-?, and lymphocyte activation, which decreases viral action on hepatocytes. Few studies were retrieved on gamma-glutamyl transferase serum levels; those found reported that there were no differences between the patients with or without chronic kidney disease. The serum aminotransferase levels were lower in the patients with chronic kidney disease on hemodialysis (with or without viral hepatitis) than in the patients with normal renal function; this reduction has a multifactorial origin.

  10. Modeling of change in blood volume and extracellular fluid volume during hemodialysis.

    Science.gov (United States)

    Zhu, Fansan; Kappel, Franz; Leonard, Edward F; Kotanko, Peter; Levin, Nathan W

    2013-01-01

    Knowledge of dynamics of shift of fluid volume between intra- and extravascular compartments during hemodialysis (HD) is important for managing HD treatment to help patients approach dry weight without hypotension. The Relative blood volume (RBV) monitor indicates change in plasma volume based on the difference between ultrafiltration rate (UFR) and plasma refilling rate (PRR) during HD. However, the absolute value of PRR cannot be obtained from RBV. The aim of this study was to investigate whether fluid transport from the interstitial to blood spaces can be quantitatively analyzed with a two compartments model. 14 patients (30 measurements) were studied. RBV using a blood volume monitor (BVM, Fresenius) and calf extracellular volumes (ECV) by calf bioimpedance device (Hydra 4200, Xitron) were continuously measured during HD. A mathematic model was established with unknown transport coefficients (k1, k2, ?, ?, ?, ?) and these coefficients were estimated using a Least Squares Optimization algorithm by fitting from experimental data. A high correlation (R(2)>0.8) between experimental data and calculation by the model were observed in both RBV and ECV measurements. Coefficients k1 and ? significantly differed with different degree of hydration. This model provides parameters which can used to understand relationships between degree of hydration and refilling rate. PMID:24109985

  11. Right Brachial to Atrial Xenograft Conduit for Hemodialysis Access: A Case Report.

    Science.gov (United States)

    Lu, Tony; Anaya-Ayala, Javier E; Reardon, Michael J; Peden, Eric K; Davies, Mark G

    2015-11-01

    Biologic grafts may be a viable alternative to their prosthetic counterparts in the patients who have exhausted conventional access alternatives given their superior patency rates and possible resilience to infection. This is a case report of a 66-year-old woman with end-stage renal disease and human immunodeficiency virus who has had multiple failed peripheral arteriovenous (AV) fistulas and grafts as well as inferior vena caval obstruction necessitating a transhepatic catheter for hemodialysis (HD). Given the patient's comorbidities and history, a right brachial artery-to-atrial conduit was created for long-term access. Biologic bovine carotid artery was used given its decreased susceptibility to infection and favorable patency rates. The AV access continues to function at 3.5-year follow-up and remains her primary means of HD. We present this novel use of a biologic graft as an option in patients with central venous obstruction and high risk of infection requiring exotic dialysis access. PMID:26315798

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

    Directory of Open Access Journals (Sweden)

    Wafae Fadili

    2007-04-01

    Full Text Available Atrial fibrillation (AF is a frequent arrhythmia in patients undergoing hemodialysis (HD. P wave duration (PWdu and P wave dispersion (PWdi have been shown to be predictors of emerging AF in different clinical conditions. We sought to study the impact of HD on PWdu, PWdi, and P wave amplitude in a cohort of patients undergoing HD. Seventeen patients (8 men, 31±10 years were studied. Echocardiography parameters, the sum of the amplitude of P waves in all 12 ECG leads (SP, mean PWdu, and PWdi, along with a host of other parameters (body weight, heart rate, electrolytes and hemoglobin/hematochrit were measured 1/2h, before and after, HD. SP increased (11.8±3.9 vs 15.3±4.0 mm, p = 0.004, mean PWdu remained stable (82.7±11.1 vs 81.6±10.5 ms, p = 0.606, PWdi decreased (51.7±19.1 vs 41.7±19.1 ms, p = 0.03, and left atrial dimension decreased (37.96±3.90 vs 30.62±3.38 mm, p = 0.0001, after HD. The change in PWdi correlated with fluid removed by HD (r = -0.55, p = 0.022. Re-measurements of P-wave parameters in a random group of 11 of the 17 patients revealed augmented SP (p = 0.01, and stable mean PWdu (p = 0.36, and PWdi (p = 0.31, after HD. Fluid removed by HD leads to an increase in SP, a stable mean PWdu, and decrease (or stability on re-measurement in a subgroup of patients in PWdi. Stability of PWdu may be due to the effects of augmentation of the P-wave amplitude and the reduction of the left atrial volume, cancelling each other. Variability of PWdi may stem from the occasional impossibility to measure PWdu (or measure it correctly in minute P-waves in certain ECG leads, which in turn profoundly affects the PWdi.

  13. The futility of hemoperfusion and hemodialysis in Amanita phalloides poisoning.

    Science.gov (United States)

    Mullins, M E; Horowitz, B Z

    2000-04-01

    Amanita phalloides mushrooms are extremely toxic. A variety of treatments have been proposed based as often on anecdotal experience as on firm evidence. General consensus exists regarding some treatments, such as the use of silibinin, penicillin, and activated charcoal. The most polarized debate concerns the value of extracorporeal elimination. We describe a case of 2 adults with confirmed Amanita phalloides poisoning treated with hemodialysis (HD) immediately after arrival at our tertiary care hospital (23 h after ingestion) and later with hemoperfusion (HP); a series blood samples were taken to determine the clearance of the toxin by each method. No amatoxin was detected before treatment, after treatment, or in the HD/HP circuits. Neither HD nor HP contributed to the clearance of amatoxin. PMID:10750173

  14. Pregnancy in End Stage Renal Disease Patients on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Rohina Swaroop

    2009-07-01

    Full Text Available Pregnancy in patients suffering from chronic renal failure is still rare due to numerous factors that impairfertility. Even if pregnancy does occur pregnancy outcome with a live birth has a low success rate.Moreover there is a significant risk of worsening of renal disease in the mother.The purpose of hemodialysisis not only to maintain life but also to make the quality of life as normal as possible for the patient.Propogation of life is basic to all life forms and the ability to do so can be considered as a success in apatient of chronic renal failure. As patients of End stage renal disease rarely complain about sexual orgynecological problems ,considering them trivial as compared to their more life threatening renal condition,it is the physicians role to be attentive to these aspects of the disease.We hereby report 2 cases ofsuccessful pregnancy managed on hemodialysis by Northwest Louisiana Nephrology

  15. Depression in hemodialysis patients: the role of dialysis shift

    Scientific Electronic Library Online (English)

    Flavio, Teles; Vega Figueiredo Dourado de, Azevedo; Claudio Torres de, Miranda; Milma Pires de Melo, Miranda; Maria do Carmo, Teixeira; Rosilene M., Elias.

    2014-03-01

    Full Text Available OBJECTIVE: Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objecti [...] ve of this study. METHOD: This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS: A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p

  16. Vancomycin: the need to suit serum concentrations in hemodialysis patients

    Scientific Electronic Library Online (English)

    Lívia Luize, Marengo; Fernando de Sá, Del Fiol; Sara de Jesus, Oliveira; Celso, Nakagawa; Eduardo Leite, Croco; Silvio, Barberato-Filho; Marcela Pellegrini, Peçanha; Douglas Felix da, Silva; Maria Inês de, Toledo.

    2010-04-01

    Full Text Available The vancomycin dose for hemodialysis (HD) patients should be adjusted by monitoring drug serum concentrations. However, this procedure is not available in most health services in Brazil, which usually adopts protocols based on published studies. The trials available are controversial, and several ha [...] ve not been conducted with current dialyzers. This study aimed at assessing the suitability of vancomycin serum concentrations in HD patients at a public hospital. Blood samples of HD patients were collected from November 2006 to May 2007, at time intervals of 48, 96, 120, or 168 hours after vancomycin administration. Drug measurement was performed with polarized light immunofluorescence. Approximately 86% of trough vancomycin serum concentrations were below the recommended value, indicating exposure to subtherapeutic doses and a higher risk for selecting resistant microorganisms.

  17. Surveillance of Hemodialysis Vascular Access with Ultrasound Vector Flow Imaging

    DEFF Research Database (Denmark)

    Brandt, Andreas Hjelm; Olesen, Jacob Bjerring

    2015-01-01

    The aim of this study was prospectively to monitor the volume flow in patients with arteriovenous fistula (AVF) with the angle independent ultrasound technique Vector Flow Imaging (VFI). Volume flow values were compared with Ultrasound dilution technique (UDT). Hemodialysis patients need a well-functioning vascular access with as few complications as possible and preferred vascular access is an AVF. Dysfunction due to stenosis is a common complication, and regular monitoring of volume flow is recommended to preserve AVF patency. UDT is considered the gold standard for volume flow surveillance, but VFI has proven to be more precise, when performing single repeated instantaneous measurements. Three patients with AVF were monitored with UDT and VFI monthly for five months. A commercial ultrasound scanner with a 9 MHz linear array transducer with integrated VFI was used to obtain data. UDT values were obtained with Transonic HD03 Flow-QC Hemodialysis Monitor. Three independent measurements at each scan session were obtained with UDT and VFI each month. Average deviation of volume flow between UDT and VFI was 25.7 % (Cl: 16.7% to 34.7%) (p= 0.73). The standard deviation for all patients, calculated from the mean variance of each individual scan sessions, was 199.8 ml/min for UDT and 47.6 ml/min for VFI (p = 0.002). VFI volume flow values were not significantly different from the corresponding estimates obtained using UDT, and VFI measurements were more precise than UDT. The study indicates that VFI can be used for surveillance of volume flow.

  18. Osteoprotegerin and mortality in hemodialysis patients with cardiovascular disease

    DEFF Research Database (Denmark)

    Winther, Simon; Christensen, Jeppe Hagstrup

    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 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 for 2 years or until reaching the primary endpoint, i.e., all-cause mortality. RESULTS: All-cause mortality during follow-up was 44% (90/206). High OPG was associated with increased mortality, using the first tertile as reference, with an unadjusted HR of 1.70 (CI 1.00 - 2.88) for the second tertile and HR of 1.63 (CI 0.96 - 2.78) for the third tertile. In a multivariate Cox-regression analysis age, CRP and OPG in both the second and third tertile were significantly associated with increased mortality In the unadjusted survival analysis, a test for trend of OPG yielded a p-value of 0.08; 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.

  19. Excessive daytime sleepiness in patients with chronic kidney disease undergone hemodialysis / Sonolência excessiva diurna em pacientes com doença renal crônica submetidos a hemodiálise

    Scientific Electronic Library Online (English)

    Nina Teixeira, Fonsêca; Israel R., Santos; Virgilio, Fernandes; Vinicius Alves Thomaz, Fernandes; Viviane Cristina Delgado, Lopes; Vicente F. Oliveira, Luis.

    2014-12-01

    Full Text Available Introdução Aproximadamente 80% dos pacientes com doença renal crônica (DRC) referem alguma queixa sobre distúrbios do sono, sendo muito maior do que na população em geral. A sonolência excessiva diurna é a terceira queixa mais frequente e está significativamente associada com um maior rico de apneia [...] do sono. O objetivo deste estudo foi avaliar a presença de sonolência excessiva diurna em pacientes com doença renal em estágio final (DREF) submetidos a hemodiálise diurna. Materiais e métodos A escala de sonolência de Epworth (ESE) foi aplicada em pacientes em DREF, que realizam hemodiálise diurna no Centro de Nefrologia da Zona Norte, na cidade de São Paulo. Resultados Cento e sessenta e oito pacientes foram incluídos no estudo. Trinta e um por cento da amostra apresentou uma leve propensão a dormir, de acordo com ESE, enquanto que vinte e dois por cento apresentaram uma moderada propensão e dezessete por cento apresentaram uma grave propensão. Conclusão Nosso estudo concluiu que 70% da amostra em DREF submetidos a hemodiálise apresentaram uma propensão de dormir em circunstâncias inapropriadas, de acordo com a escala de sonolência de Epworth. Uma vez que a sonolência excessiva diurna está associada com a apneia do sono e outras comorbidades é essencial estar atento às queixas desses pacientes. Abstract in english Introduction Approximately 80% of patients with chronic kidney disease complain about sleep disorders, which is a much higher percentage than in the general population. Excessive daytime sleepiness is the third most frequent complaint in these patients, and it is significantly associated with a high [...] er risk of sleep apnea. The aim of this study was to assess the presence of daytime sleepiness in patients with end stage renal disease (ESRD) who were undergoing diurnal hemodialysis. Materials and methods The Epworth Sleepiness Scale (ESS) was applied to patients with ESRD who underwent diurnal hemodialysis in the Centro de Nefrologia da Zona Norte in Sao Paulo, Brazil. Results A total of 168 patients were included in the study. According to the ESS, 31% presented with a mild propensity to sleep, 22% with a moderate propensity, and 17% with a severe propensity. Conclusion Our study concluded that 70% of the sample of patients with ESRD who were undergoing hemodialysis presented with a propensity to sleep in inappropriate circumstances on the ESS. When excessive daytime sleepiness is associated with sleep apnea and other comorbidities, it is essential to carefully assess patients’ complaints.

  20. Risk and Prognosis of Bloodstream Infections among Patients on Chronic Hemodialysis : A Population-Based Cohort Study

    DEFF Research Database (Denmark)

    Skov Dalgaard, Lars; NØrgaard, Mette

    2015-01-01

    BACKGROUND AND OBJECTIVES: Infections are common complications among patients on chronic hemodialysis. This population-based cohort study aims to estimate risk and case fatality of bloodstream infection among chronic hemodialysis patients. METHODS: In this population-based cohort study we identified residents with end-stage renal disease in Central and North Jutland, Denmark who had hemodialysis as first renal replacement therapy (hemodialysis patients) during 1995-2010. For each hemodialysis patient, we sampled 19 persons from the general population matched on age, gender, and municipality. Information on positive blood cultures was obtained from regional microbiology databases. All persons were observed from cohort entry until first episode of bloodstream infection, emigration, death, or end of hemodialysis treatment, whichever came first. Incidence-rates and incidence-rate ratios were computed and risk factors for bloodstream infection assessed by Poisson regression. Case fatality was compared by Cox regression. RESULTS: Among 1792 hemodialysis patients and 33 618 matched population controls, we identified 461 and 1126 first episodes of bloodstream infection, respectively. Incidence rates of first episode of bloodstream infection were 13.7 (95% confidence interval (CI), 12.5-15.0) per 100 person-years among hemodialysis patients and 0.53 (95% CI, 0.50-0.56) per 100 person-years among population controls. In hemodialysis patients, the most common causative microorganisms were Staphylococcus aureus (43.8%) and Escherichia coli (12.6%). The 30-day case fatality was similar among hemodialysis patients and population controls 16% (95% CI, 13%-20%) vs. 18% (95% CI, 15%-20%). CONCLUSIONS: Hemodialysis patients have extraordinary high risk of bloodstream infection while short-term case fatality following is similar to that of population controls.

  1. Hemodialysis improves endothelial venous function in end-stage renal disease

    Scientific Electronic Library Online (English)

    A.M.V., Silva; L.U., Signori; R.D.M., Plentz; H., Moreno Jr.; E., Barros; A., Belló-Klein; B.D., Schaan; M.C., Irigoyen.

    2008-06-01

    Full Text Available The objective of the present study was to determine the acute effect of hemodialysis on endothelial venous function and oxidative stress. We studied 9 patients with end-stage renal disease (ESRD), 36.8 ± 3.0 years old, arterial pressure 133.8 ± 6.8/80.0 ± 5.0 mmHg, time on dialysis 55.0 ± 16.6 month [...] s, immediately before and after a hemodialysis session, and 10 healthy controls matched for age and gender. Endothelial function was assessed by the dorsal hand vein technique using graded local infusion of acetylcholine (endothelium-dependent venodilation, EDV) and sodium nitroprusside (endothelium-independent venodilation). Oxidative stress was evaluated by measuring protein oxidative damage (carbonyls) and antioxidant defense (total radical trapping antioxidant potential - TRAP) in blood samples. All patients were receiving recombinant human erythropoietin for at least 3 months and were not taking nitrates or a-receptor antagonists. EDV was significantly lower in ESRD patients before hemodialysis (65.6 ± 10.5) vs controls (109.6 ± 10.8; P = 0.010) and after hemodialysis (106.6 ± 15.7; P = 0.045). Endothelium-independent venodilation was similar in all comparisons performed. The hemodialysis session significantly decreased TRAP (402.0 ± 53.5 vs 157.1 ± 28.3 U Trolox/µL plasma; P = 0.001). There was no difference in protein damage comparing ESRD patients before and after hemodialysis. The magnitude of change in the EDV was correlated negatively with the magnitude of change in TRAP (r = -0.70; P = 0.037). These results suggest that a hemodialysis session improves endothelial venous function, in association with an antioxidant effect.

  2. Doses intermitentes de estatina em pacientes em hemodiálise com LDL-colesterol espontaneamente baixo / Intermittent doses of statin in hemodialysis patients with spontaneous low LDL cholesterol levels

    Scientific Electronic Library Online (English)

    Paulo Giovanni de Albuquerque, Suassuna; Marcus Gomes, Bastos.

    2008-02-01

    Full Text Available FUNDAMENTO: A mortalidade na diálise continua elevada e ocorre principalmente por causas cardiovasculares. A inflamação participa da gênese da aterosclerose acelerada, calcificação vascular, desnutrição e anemia, e tem enorme impacto na sobrevida destes pacientes. As estatinas, através dos seus efei [...] tos pleiotrópicos, podem representar uma opção terapêutica para atenuação do processo inflamatório crônico dos pacientes em hemodiálise. OBJETIVO: Avaliar os efeitos de uma baixa dose de sinvastatina sobre marcadores inflamatórios, parâmetros hematimétricos e nutricionais de pacientes em hemodiálise. MÉTODOS: Pacientes em hemodiálise clinicamente estáveis foram divididos, segundo os níveis basais de LDL-colesterol, em um grupo com níveis abaixo (Grupo 1) e outro com níveis iguais ou superiores a 100 mg/dl (Grupo 2) e tratados com sinvastatina por oito semanas. O Grupo 1 recebeu apenas 20 mg após cada sessão de diálise (dose intermitente), enquanto o Grupo 2 recebeu 20 mg/dia. Dados laboratoriais, índice de resistência a eritropoetina e parâmetros nutricionais foram obtidos antes e após o tratamento. RESULTADOS: Houve redução significativa e equivalente dos níveis de proteína C-reativa em ambos os grupos (35,97±49,23% vs 38,32±32,69%, p=0,86). No Grupo 1 também houve tendência a queda da resistência a eritropoetina (228,6±16,2 vs 208,9±16,2, p=0,058) e melhora dos parâmetros hematimétricos (hematócrito: 33,1±5,9% vs 36,1±4,5%, p=0,021). CONCLUSÃO: A dose intermitente mostrou-se tão eficaz quanto a dose usual em reduzir os níveis de proteína C-reativa e resistência a eritropoetina, além de melhorar os parâmetros hematimétricos, apontando para uma importante redução do risco cardiovascular avaliado por esses parâmetros. Abstract in english BACKGROUND: Mortality in dialysis patients remains high and is due mainly to cardiovascular causes. Inflammation has a role in the genesis of accelerated atherosclerosis, vascular calcification, malnutrition and anemia, and a huge impact on the survival of these patients. The pleiotropic effects of [...] statins can be a therapeutic option for reducing chronic inflammatory processes of patients undergoing hemodialysis. OBJECTIVE: To evaluate the effects of low doses of simvastatin on inflammatory markers, hematimetric and nutritional parameters of patients undergoing hemodialysis. METHODS: Clinically-stable patients undergoing hemodialysis were classified according to their baseline LDL-cholesterol levels in two groups: those with levels below 100mg/dl (Group 1) and those with levels equal to or greater than 100mg/dl (Group-2), and were treated with simvastatin during eight weeks. Group 1 received 20mg only after each session of hemodialysis (intermittent dose), whereas Group 2 received 20mg/daily. Laboratory data, erythropoietin resistance index and nutritional parameters were obtained before and after treatment. RESULTS: A significant and equivalent reduction in C-reactive protein levels in both groups was observed (35.97±49.23% vs 38.32±32.69%, p=0.86). In group 1, there was also a tendency towards reduced resistance to erythropoietin (228.6±16.2 vs 208.9±16.2, p=0.058) and improvement of hematimetric parameters (hematocrit: 33.1±5.9% vs 36.1±4.5%, p=0.021). CONCLUSION: Intermittent doses proved to be as effective as the usual dose in reducing C-reactive protein levels and resistance to erythropoietin, besides improving the hematimetric parameters, indicating an important reduction of the cardiovascular risk evaluated by these parameters.

  3. Brazil nut (Bertholletia excelsa, H.B.K.) improves oxidative stress and inflammation biomarkers in hemodialysis patients.

    Science.gov (United States)

    Stockler-Pinto, Milena Barcza; Mafra, Denise; Moraes, Cristiane; Lobo, Julie; Boaventura, Gilson Teles; Farage, Najla Elias; Silva, Wellington Seguins; Cozzolino, Silvia Franciscato; Malm, Olaf

    2014-04-01

    Cumulative evidence indicates that oxidative stress and inflammation frequently occurs in patients undergoing maintenance hemodialysis (HD) and as a result of overproduction of reactive oxygen species (ROS) and a decrease of antioxidant defenses such as selenium (Se). Previous studies in our laboratory showed that the supplementation of 1 unit of Brazil nut (the richest known food source of Se) a day during 3 months is effective to improve Se status and increase glutathione peroxidase (GPx) levels in HD patients. The aim of this study was to evaluate the effect of Brazil nut supplementation on oxidative stress and inflammation markers in HD patients. Forty HD patients from Rio de Janeiro, Brazil were studied. All patients received one nut per day for 3 months. The Se plasma levels and GPx, 8-isoprostane, 8-hydroxy-2-deoxyguanosine (8-OHdG), and cytokine (TNF-? and IL-6) levels and lipid profile were determined before and after 3 months of supplementation. The plasma Se and GPx activity increased, while cytokines, 8-OHdG, and 8-isoprostane plasma levels decreased significantly after 3 months supplementation. HDL-c levels increased and LDL-c levels decreased significantly. These data suggest that the consumption of only one Brazil nut per day during 3 months was effective to reduce the inflammation, oxidative stress markers, and the atherogenic risk, thereby increasing the antioxidant defenses in HD patients. Our results indicate that Brazil nut as Se source plays an important role as an anti-inflammatory and antioxidant agent in HD patients. PMID:24504745

  4. Aspirin in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

    Devereaux, P J; Mrkobrada, Marko

    2014-01-01

    BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and for 7 days in the continuation stratum, after which patients resumed their regular aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: The primary outcome occurred in 351 of 4998 patients (7.0%) in the aspirin group and in 355 of 5012 patients (7.1%) in the placebo group (hazard ratio in the aspirin group, 0.99; 95% confidence interval [CI], 0.86 to 1.15; P=0.92). Major bleeding was more common in the aspirin group than in the placebo group (230 patients [4.6%] vs. 188 patients [3.8%]; hazard ratio, 1.23; 95% CI, 1.01, to 1.49; P=0.04). The primary and secondary outcome results were similar in the two aspirin strata. CONCLUSIONS: Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.).

  5. A method for the estimation of hydration state during hemodialysis using a calf bioimpedance technique

    International Nuclear Information System (INIS)

    Although many methods have been utilized to measure degrees of body hydration, and in particular to estimate normal hydration states (dry weight, DW) in hemodialysis (HD) patients, no accurate methods are currently available for clinical use. Biochemcial measurements are not sufficiently precise and vena cava diameter estimation is impractical. Several bioimpedance methods have been suggested to provide information to estimate clinical hydration and nutritional status, such as phase angle measurement and ratio of body fluid compartment volumes to body weight. In this study, we present a calf bioimpedance spectroscopy (cBIS) technique to monitor calf resistance and resistivity continuously during HD. Attainment of DW is defined by two criteria: (1) the primary criterion is flattening of the change in the resistance curve during dialysis so that at DW little further change is observed and (2) normalized resistivity is in the range of observation of healthy subjects. Twenty maintenance HD patients (12 M/8 F) were studied on 220 occasions. After three baseline (BL) measurements, with patients at their DW prescribed on clinical grounds (DWClin), the target post-dialysis weight was gradually decreased in the course of several treatments until the two dry weight criteria outlined above were met (DWcBIS). Post-dialysis weight was reduced from 78.3 ± 28 to 77.1 ± 27 kg (p ?2 ? m3 kg?1 (p cBIS was 0.3 ± 0.2%. The results indicate that cBIS utilizing a dynamic technique continuously during dialysis is an accurate and precise approach to specific end points for the estimation of body hydration status. Since no current techniques have been developed to detect DW as precisely, it is suggested as a standard to be evaluated clinically

  6. [Distribution and features of infection with hepatitis viruses B and C during hemodialysis treatment].

    Science.gov (United States)

    Zubkin, M L; Selivanov, N A; Stakhanova, V M; Novozhenov, V G; Sel'kova, E P; Kucherova, T E; Baranova, F S; Kozhokar', Iu V; Kirkhman, V V; Kasapova, E N; Stenina, I I; L'vov, D K

    2000-01-01

    The prevalence of hepatitides B and C was evaluated in 140 patients treated by hemodialysis. Almost half of patients (48%) had acute hepatitis B which completely resolved. Acute hepatitis B was detected in 6% in the course of observation. In 6% chronic hepatitis B was diagnosed, and in 24% chronic hepatitis C. A combination of hepatitides B and C was diagnosed in 2% patients. Only 12% patients were not infected with hepatitis. Genotype 1b predominated in patients with HCV infection (73%); genotypes 1a, 21, and 3a were equally incident (9%). Replication of HBV and HCV in patients with uremia under conditions of hemodialysis was detected in 83 and 86% patients, respectively. Relationship between HBV and HCV infection and the duration of hemodialysis treatment was analyzed. The percentage of non-infected patients persistently decreased, and the time course of HBV and HCV infection was different. Infection with HBV after the beginning of hemodialysis occurred sooner (16.0 +/- 4.0 months) than with HCV (30.2 +/- 4.6 months, p < 0.04). The levels of SGPT and SGOT in patients with various manifestations of HBV and HCV infection treated by hemodialysis were followed up. PMID:10695036

  7. Alternate hemodialysis access in patients with occluded peripheral venous access sites

    International Nuclear Information System (INIS)

    Purpose: the goal of this study was to evaluate translumbar and transhepatic placement of hemodialysis (HD) catheters for patients with occlusion of the veins that are commonly used for hemodialysis access. Method: over a 12-month period three translumbar and one transhepatic hemodialysis catheters were placed in 4 patients suffering from end-stage renal disease, who had thrombosis of the upper and lower extremity veins as well as the jugular veins. The percutaneous access was performed under fluoroscopic guidance. After successful passage of a guidewire into the right atrium and creation of a subcutaneous tunnel at the skin entry site, all patients received a 14 F double-lumen catheter that was placed with its tip in the right atrium. Results: percutaneous translumbar and transhepatic placement of the HD catheters was successful in all patients. No intervention-associated complications were observed. Hemodialysis could be started 1 to 20 hours after initial catheter placement in all patients. During an observation period of 3 to 7 months, 3 patients underwent hemodialysis without any complications. In one patient, an occlusion of an translumbar HD catheter was observed after 5 months. This catheter could be temporarily recanalized using rTPA injection and was then exchanged after 6 months. Conclusion: transhepatic and translumbar placement of HD catheters is a safe and viable alternative for patients who have exhausted conventional venous access sites. (orig.)

  8. Risk Factors of Vascular Access Failure in Patients on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Osama Ashry Gheith

    2009-03-01

    Full Text Available Normal 0 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Introduction. The aim of this study was primarily to determine if there was any relationship between hemoglobin levels and vascular access (VA survival. In addition, other risk factors were evaluated with special stress on sex, age, diabetes mellitus, smoking, and medications. Materials and Methods. This study comprised 200 patients who had been on renal replacement therapy for more than 1 month through a permanent VA. The patients were categorized based on their mean blood hemoglobin levels. The possible risk factors for VA failure were also evaluated which included age at the beginning of hemodialysis, sex, diabetes mellitus, baseline levels of intact parathyroid hormone, and antihypertensive therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Results. The younger the age the longer the duration of survival of left radial, left brachial, and right radial fistulas; however, sex had no significant impact on the duration of fistulas. Diabetic patients were more likely to have failed VA compared to nondiabetics. In addition, optimization of hemoglobin levels between 10 g/dL and 12 g/dL was associated with longer fistula survival. A higher risk of right radial arteriovenous fistula failure among hypertensive patients who received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers compared to those without these drugs. Conclusions. Severe anemia, age, diabetes mellitus, and smoking are the main risk factors of VA failure. Our study showed that patients on hemodialysis should benefit from anemia correction, with a target hemoglobin level between 10 g/dL and 12 g/dL, without incurring any increased risk of VA failure.

  9. Sex hormones and erectile dysfunction in hemodialysis patients

    International Nuclear Information System (INIS)

    Objective: To determine the prevalence of Erectile Dysfunction (ED) in hemodialysis patients (HD) and to study the associated changes in sex hormones in these patients. Methodology: This is a hospital based cross sectional study conducted at hemodialysis units of Shalamar and Mayo Hospitals, Lahore from January to March 2008. All male patients with ESRD on maintenance (HD), whose spouses were alive and able to perform intercourse, were included in the study. Patients with cognitive and communication deficits were excluded from study. International index of erectile function-5(IIEF-5), adopted in Urdu was used for determination of prevalence of ED. Demographic data was collected and sex hormones (total testosterone, Dihydroepiandrosteronediones (DHEA), Follicle Stimulating Hormone (FSH), Leutinizing Hormone (LH) and serum Prolactin) were measured. Results: A total number of fifty patients were included in the study. The major cause of ESRD was diabetes mellitus 28 (56%). The prevalence of ED was 86% with a mean IIEF-5 score 10.36 + 7.13. The majority of patients, 33 (66%), were suffering from a severe degree of ED. The total testosterone level was low in 30 (60%) patients and DHEA were low normal in most of patients, 46 (92%). Compared to patients with non-ED, those with ED had a significantly lower DHEA (1.93 +- 0.73 vs 0.81 +- 0.11, p value = 0.007). Total testosterone and DHEA had a negative correlation with age and diabetes mellitus. FSH showed a variable response in these patients, it was low ( 9.74 mIU/ ml) in eight patients. LH was low ( 7.8 mIU/ml) in fifteen patients. FSH and LH showed a positive correlation with duration of dialysis. Prolactin level was low in 21(42%) patients. Total testosterone, FSH, LH and Prolactin had no association with ED. Conclusion: The majority of the patients suffering from ESRD, on maintenance HD had ED. DHEA was significantly lower in patients with ED, compared to those with no-ED. Total testosterone and DHEA had an inverse relationship with diabetes and age of the patients. Total testosterone, FSH, LH and prolactin did not affect erectile function. (author)

  10. Effects of Unsaturated Fat Dietary Supplements on Blood Lipids, and on Markers of Malnutrition and Inflammation in Hemodialysis Patients

    DEFF Research Database (Denmark)

    Ewers, Bettina; Riserus, Ulf

    2009-01-01

    OBJECTIVE: We examined the effects of commercially available unsaturated fat dietary supplements on blood lipids, and on markers of malnutrition and inflammation, in an adult population of hemodialysis (HD) patients. DESIGN: This was a restricted, randomized (equal blocks), investigator-blinded 2x6 week crossover trial, without a washout interval. SETTING: This study was conducted at the Department of Nephrology, Copenhagen University Hospital Herlev, Herlev, Denmark, in spring 2007. PATIENTS: Participants included 40 (30 males and 10 females) stable, adult patients undergoing regular HD, with a mean age of 64.6 years and a mean body mass index of 23.3kg/m(2). INTERVENTION: In addition to patients' habitual diets, oral unsaturated fat supplements (90mL of Calogen [SHS International, Ltd., Liverpool, UK] and 4 capsules of Pikasol [Dansk Droge, Ishoej, Denmark]) were given in one period, whereas no supplements were given in the other. Dietary supplements contributed 1.8 MJ (430kcal), 47g fat, 26.5g monounsaturated fatty acids, and 3g marine n-3 polyunsaturated fatty acids per day. Blood sampling and nutritional assessments were performed at baseline, after 6 weeks, and after 12 weeks. MAIN OUTCOME MEASURES: Dietary intakes, blood lipids, dry body weight, serum albumin, and serum C-reactive protein comprised our main outcome measures. RESULTS: According to a per-protocol analysis of 14 study completers, fat supplementation resulted in significantly increased total energy intake (+1.6 MJ/day, or 380kcal/day) and an increased dietary fat energy percentage (+9%). We observed no significant changes in blood lipids. Dry body weight (+0.49kg, P=.04) increased, and serum C-reactive protein concentration fell (-1.69mg/L, P=.01), with fat supplementation. Intention-to-treat analysis of 39 participants confirmed the absence of adverse blood-lipid changes. CONCLUSIONS: Unsaturated fat supplementation increased total dietary energy intake to recommended levels, had no adverse impact on blood lipids, improved nutritional status as assessed according to dry body weight, and reduced systemic inflammation as assessed according to C-reactive protein serum concentrations. Adding unsaturated fat to the diet seems to be a safe and effective way to prevent and treat malnutrition in hemodialysis patients.

  11. Microbiological contamination of a hemodialysis center water distribution system Contaminação microbiológica no sistema de distribuição de água de um centro de hemodiálise

    Directory of Open Access Journals (Sweden)

    Lilian Bueno Montanari

    2009-02-01

    Full Text Available The microbiological monitoring of the water used for hemodialysis is extremely important, especially because of the debilitated immune system of patients suffering from chronic renal insufficiency. To investigate the occurrence and species diversity of bacteria in waters, water samples were collected monthly from a hemodialysis center in upstate São Paulo and tap water samples at the terminal sites of the distribution system was sampled repeatedly (22 times at each of five points in the distribution system; a further 36 samples were taken from cannulae in 19 hemodialysis machines that were ready for the next patient, four samples from the reuse system and 13 from the water storage system. To identify bacteria, samples were filtered through 0.22 µm-pore membranes; for mycobacteria, 0.45 µm pores were used. Conventional microbiological and molecular methods were used in the analysis. Bacteria were isolated from the distribution system (128 isolates, kidney machine water (43 and reuse system (3. Among these isolates, 32 were Gram-positive rods, 120 Gram-negative rods, 20 Gram-positive cocci and 11 mycobacteria. We propose the continual monitoring of the water supplies in hemodialysis centers and the adoption of effective prophylactic measures that minimize the exposure of these immunodeficient patients to contaminated sources of water.O monitoramento microbiológico da água utilizada no procedimento de hemodiálise é de extrema importância, principalmente devido à imunodebilidade dos pacientes com insuficiência renal crônica. Nosso objetivo foi verificar qualitativa e quantitativamente a presença de bactérias na água de um centro de hemodiálise do interior do Estado de São Paulo. Foram realizadas 22 coletas de cada um dos cinco pontos do sistema de distribuição; 36 amostras de 19 máquinas de hemodiálise, prontas para utilização; quatro amostras do sistema de reuso e 13 amostras do sistema de armazenamento de água, empregando-se a técnica da membrana filtrante com poros de 0,22 µm para bactérias e de 0,45 µm para micobactérias. A identificação foi realizada através de métodos microbiológicos convencionais e de biologia molecular. Isolados bacterianos foram obtidos de sistema de distribuição (128, águas das máquinas (43 e sistema de reuso (3. Entre os isolados 32 foram de bacilos Gram-positivos, 120 bacilos Gram-negativos, 20 Cocos Gram-positivos e 11 micobactérias. Neste estudo, sugerimos que suprimentos de água para o Centro de Hemodiálise devam ser monitorados, adotando-se medidas profiláticas eficazes que minimizem a exposição destes pacientes imunodeficientes a fontes aquáticas ambientais contaminadas.

  12. The impact of short daily hemodialysis on anemia and the quality of life in Chinese patients

    Scientific Electronic Library Online (English)

    J.L., Jiang; W., Ren; J., Song; Q.L., Sun; X.Y., Xiao; X.Z., Diao; Y.H., Huang; L., Lan; P., Wang; Z., Hu.

    2013-08-01

    Full Text Available Anemia is a frequent complication in hemodialysis patients. Compared to conventional hemodialysis (CHD), short daily hemodialysis (sDHD) has been reported to be effective in many countries except China. The aim of the present study was to determine whether sDHD could improve anemia and quality of li [...] fe (QOL) for Chinese outpatients with end-stage renal disease. Twenty-seven patients (16 males/11 females) were converted from CHD to sDHD. All laboratory values were measured before conversion (baseline), at 3 months after conversion (sDHD1), and at 6 months after conversion (sDHD2). The patient's QOL was evaluated at baseline and 6 months after conversion using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Hemoglobin concentration increased significantly from 107.4±7.9 g/L at baseline to 114.4±6.8 g/L (P

  13. [Interferon system status in hemodialysis patients infected with hepatitis B and C viruses].

    Science.gov (United States)

    Pri?miagi, L S; Kremerman, I B; Tallo, T G; Tefanova, V T; Luman, M G; Osadchaia, G S

    1999-01-01

    The production of alpha- and gamma-interferon (IFN) by peripheral blood cells in vitro and the concentration of serum IFN were studied in patients treated by hemodialysis at the Pelgulinna Tallinn Hospital and compared to controls. Out of 108 patients on hemodialysis, 19.4% were infected with hepatitis B (HBV), and antibodies to hepatitis C virus (HCV) were detected in 7.4%. During 3.5 years of observation, cases of hepatitis B and C infection among patients and medical staff were rare. The production of alpha- and gamma-IFN in 23 patients with HBV and/or HCV markers on hemodialysis and in 38 patients without markers was similarly decreased in comparison with the controls and the titers of serum IFN were similarly increased. Lack of reliable difference between IFN status of two groups of patients may be explained by the absence of clinical symptoms of hepatitis, confirmed by laboratory findings. PMID:10500984

  14. Genomic instability in patients with type 2 diabetes mellitus on hemodialysis

    Scientific Electronic Library Online (English)

    Roberta Passos, Palazzo; Pamela Brambilla, Bagatini; Patrícia Brandt, Schefer; Fabiana Michelsen de, Andrade; Sharbel Weidner, Maluf.

    Full Text Available OBJECTIVE: A previous study by our research group evaluated the levels of DNA damage using the comet assay in hemodialysis patients with type 2 diabetes mellitus. The same blood samples were also evaluated using the cytochalasin B micronucleus assay. A comparison of the results of the two assays is [...] presented here. METHODS: Whole blood samples were collected from 22 type 2 diabetes mellitus patients on hemodialysis and from 22 control subjects. Samples were collected from patients early in the morning on Mondays, before the first weekly hemodialysis session. The cytokinesis-block micronucleus assay (CBMN) was used to evaluate genomic instability. RESULTS: The frequencies of micronuclei and nuclear buds were higher in patients than in controls (p-value = 0.001 and p-value

  15. Effect of acute intradialytic strength physical exercise on oxidative stress and inflammatory responses in hemodialysis patients

    Science.gov (United States)

    Esgalhado, Marta; Stockler-Pinto, Milena Barcza; de França Cardozo, Ludmila Ferreira Medeiros; Costa, Cinthia; Barboza, Jorge Eduardo; Mafra, Denise

    2015-01-01

    Background Oxidative stress and inflammation are common findings in chronic kidney disease (CKD) patients, and they are directly related to the increased risk of developing cardiovascular disease, which is the major cause of death in these patients, particularly for those undergoing hemodialysis (HD). Strength physical exercise is a new therapeutic approach to reduce these complications in CKD patients. Following this, the purpose of this study was to assess the effect of acute intradialytic strength physical exercise on oxidative stress and inflammatory responses in HD patients. Methods Sixteen HD patients were studied (11 women; 44.4±14.6 years; body mass index 23.3±4.9 kg/m2; 61.6±43.1 months of dialysis) and served as their own controls. Acute (single session) intradialytic physical exercise were performed at 60% of the one-repetition maximum test for three sets of 10 repetitions for four exercise categories in both lower limbs during 30 minutes. Blood samples were collected on two different days at exactly the same time (30 minutes and 60 minutes after initiating the dialysis—with and without exercise). Antioxidant enzymes activity [superoxide dismutase (SOD), catalase, and glutathione peroxidase], lipid peroxidation marker levels (malondialdehyde), and inflammatory marker levels (high-sensitivity C-reactive protein) were determined. Results SOD plasma levels were significantly reduced after acute physical exercise from 244.8±40.7 U/mL to 222.4±28.9 U/mL (P=0.03) and, by contrast, increased on the day without exercise (218.2±26.5 U/mL to 239.4±38.6 U/mL, P=0.02). There was no alteration in plasma catalase, glutathione peroxidase, malondialdehyde, or high-sensitivity C-reactive protein levels in on either day (with or without exercise). Additionally, there was no association between these markers and clinical, anthropometric, or biochemical parameters. Conclusion These data suggest that acute intradialytic strength physical exercise was unable to reduce oxidative stress and inflammation, and in addition, it seems to reduce plasma SOD levels, which could exacerbate the oxidative stress in HD patients.

  16. Examination of survival after transfer from peritoneal dialysis to hemodialysis.

    Science.gov (United States)

    Piraino, Beth; Wyman, A Elizabeth; Sheth, Heena

    2012-01-01

    Data on survival after transfer from peritoneal dialysis (PD) to hemodialysis (HD) is conflicting. We reviewed two decades of outcomes in a PD program to examine short-term survival after transfer from PD to HD. Of 379 patients on PD, 33% transferred to HD. The reasons for transfer were PD-related infections (340%), uremia or failure to thrive (26%), PD catheter problems or loss of mechanical skills (15%), dementia or unable to train (7%), noncompliant with PD (7%), other (10%, including gastrointestinal complications, hernia, encapsulating peritoneal sclerosis, preference, loss of ultrafiltration), and cardiac (2%). All of those transferring for "other" reasons survived 6 months, and as did all except 1 who transferred for uremia (p = 0.035). Overall survival was 92% at 3 months and 85% at 6 months. Using multivariate logistic regression analysis, only score on the Charlson comorbidity index at PD start was a risk factor for dying in the first 6 months on HD: for each 1 point increase in CCI score, the hazard ratio for death was 1.4 (95% confidence interval: 1.16 to 1.74; p = 0.005). To summarize, starting a patient on PD and waiting until uremia to transfer to HD does not have a negative impact on survival. In a program with relatively low PD-related infectious complications, such complications accounted for only one third of transfers to HD. PMID:23311216

  17. Applications and complications of subclavian vein catheterization for hemodialysis

    International Nuclear Information System (INIS)

    Objective: To study the indications, complications and duration of 605 subclavian catheters inserted over a period of 4 years as venous access for the management of renal failure in local setup. Results: Among the patients who underwent subclavian vien catheterization, 75.2% patients were suffering from chronic renal failure and 24.7% patients were admitted for acute renal failure. Among chronic renal failure patients, 21.9% catheters had to be replaced due to various complications e.g. thrombosis, infection or kinking of the catheter. The subclavian catheters remained in place for a mean duration of 4 weeks. Early complications encountered were arterial puncture, inability to cannulate the innominate vein, hemo thorax, punctures of thoracic duct, hemo mediastinum, arrhythmias and pulmonary hematoma in 10.7%, 16.5%, 0.5%, 0.2%, 0.6% and 0.2% of patients respectively. Mortality attributed to the procedure occurred in 0.1 % cases. Delayed complications included early infection in 15% catheterizations while delayed infection occurred in 39 % cases. Conclusion: Percutaneous subclavian catheterization is valuable, relatively easy to learn and safe method with acceptable rate of complications for patients necessitating hemodialysis and no established permanent vascular access. (author)

  18. Psychological characteristics of patients treated by chronic maintenance hemodialysis.

    Science.gov (United States)

    Pop-Jordanova, Nada D; Polenakovic, Momir H

    2013-02-01

    Studies related to psychological aspects of dialysis patients show that depression and anxiety are the most common characteristics. The aim of our study was to analyze the personality profile in patients on chronic maintenance dialysis and to evaluate more specifically the level of depression. The total number of patients was 68 (30 females and 38 males), with mean age 62.3 and 56.5 for females and males respectively. Mean duration of dialysis was 6.73 years for females and 6.68 years for men (the period varied from 0.5 to 18 years). For the evaluation of psychological characteristics, we used two psychometric instruments: Minnesota Multiphase Personality Inventory (MMPI- 201) and Beck Depression Inventory. The obtained results confirmed the presence of depression in patients treated with hemodialysis. The level of depression is variable (minimal is present in 21.43%; mild in 35.71%; moderate in 17.85% and severe in 14.28% of patients). The depression is significantly positively correlated with age (paggression which destroys their social communications. Some response measures for depression such as relaxation training, psychological support, music therapy, or peripheral biofeedback are recommended. PMID:23335381

  19. Intensive hemodialysis and hemoperfusion treatment of Amanita mushroom poisoning.

    Science.gov (United States)

    Sabeel, A I; Kurkus, J; Lindholm, T

    1995-08-01

    Over a period of fifteen years, 41 patients including 23 males and 18 females with Amanita mushroom poisoning were treated at the University Hospital of Lund, Sweden. The intensity of poisoning was graded according to serum transaminase elevations and prothrombin time reductions. Severity was mild in 16 patients (Group A), moderate in 14 (Group B) and severe in 11 (Group C). Members of Group C reported shorter latency periods before the onset of symptoms, (10 +/- 1 hours, P amatoxin assay were reported. Treatment consisted of: fluid and electrolyte replacement, oral activated charcoal and lactulose, i.v. penicillin, combined hemodialysis and hemoperfusion in two 8 hour sessions, some received i.v. thioctic acid, other i.v. silibinin, all received a special diet. This combination of treatment modalities was used to accelerate the elimination of amatoxin from the patients' bodies. The longest period of hospitalization, 13 +/- 2 days, was required by the patients of Group C (p < 0.01). All patients improved and were discharged from the hospital asymptomatic. No sequelae were later reported for the majority of those moderately and severely poisoned. We have concluded that intensive combined treatment applied in these cases is effective in relieving patients with both moderate and severe amanitin poisoning. PMID:8532053

  20. [Postprandial blood pressure drop in hemodialysis: myth or reality?].

    Science.gov (United States)

    Barrau, Dominique; Contreras, Arlette; Felten, Thérèse; Glath, Anita; Lengenfelder, Nathalie; Klicki, Sonia Nergen; Rosenblatt, Isabelle; Ruhlmann, Armand; Westermann, Marie-France; Zint, Peggy; Borzer, Nicole; Geldreich, Marie-Anne; Dimitrov, Yves

    2012-03-01

    The meal is a friendly moment of the sessions of dialysis, appreciated by most of the dialysed persons. However the empirical observation allows to notice that certain dialysed persons, present drops of arterial pressure after taking the meal. Where from the questioning: except factors inherent to the dialysis, has the meal a particular incidence on the blood pressure in the course of session? Numerous studies were realized since 1983 on the low blood pressure comment prandiale at the old person, very few studies are available on the low blood pressure comment prandiale in the course of session of hemodialysis, and sometimes little convincing. A comparative method on 2 sessions, one with meal and one without meal, every patient being its own witness, was used. The tool of evaluation consists of a railing resuming variables retained for the study. In view of the study carried out further to this questioning, the hypothesis of departure does not come true: we cannot demonstrate of significant link between meal and arterial pressure drop. However the number restricted by patients (fifty) include in the study, does not allow us to end in favour of the myth, it is necessary for it to pursue the study to obtain the same data with a much more important population. PMID:22616367

  1. HBV-DNA in hemodialysis patients infected by HCV

    International Nuclear Information System (INIS)

    End-stage renal disease patients on chronic hemodialysis (HD) patients are at risk for both hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and they may coexist. To determine the prevalence and clinical impact of HBV and HCV infection, we studied poly chain reaction (PCR) and reverse transcription (RT)-PCR on the blood samples of 90 HD patients in Kerman, Iran. ELISA test was used to detect anti-HBc, anti-HBs and HBs Ag. We found that 30 out of 90 (33.3%) patients were PCR-RT-PCR positive for HCV-RNA. No HBV-DNA (0%) was detected through the PCR study in both positive and negative HCV-RNA patient groups. Though none of the samples was HBsAg positive, 10 (33.3%) HCV-RNA positive patients were anti-HBc positive, and 12 (40.7%) were anti-HBs positive. We conclude that prevalence of hepatitis C infection is high in HD patients in our region, but not associated with active HBV infection. (author)

  2. Surface characterization of hemodialysis membranes based on streaming potential measurements.

    Science.gov (United States)

    Werner, C; Jacobasch, H J; Reichelt, G

    1995-01-01

    Hemodialysis membranes made from cellulose (CUPROPHAN, HEMOPHAN) and sulfonated polyethersulfone (SPES) were characterized using the streaming potential technique to determine the zeta potential at their interfaces against well-defined aqueous solutions of varied pH and potassium chloride concentrations. Streaming potential measurements enable distinction between different membrane materials. In addition to parameters of the electrochemical double layer at membrane interfaces, thermodynamic characteristics of adsorption of different solved species were evaluated. For that aim a description of double layer formation as suggested by Börner and Jacobasch (in: Electrokinetic Phenomena, p. 231. Institut für Technologie der Polymere, Dresden (1989)) was applied which is based on the generally accepted model of the electrochemical double layer according to Stern (Z. Elektrochemie 30, 508 (1924)) and Grahame (Chem. Rev. 41, 441 (1947)). The membranes investigated show different surface acidic/basic and polar/nonpolar behavior. Furthermore, alterations of membrane interfaces through adsorption processes of components of biologically relevant solutions were shown to be detectable by streaming potential measurements. PMID:7662618

  3. Therapeutic efficacy of a biosimilar epoetin alfa in hemodialysis patients.

    Science.gov (United States)

    Harzallah, Amel; Zouaghi, Karim; Dridi, Afef; Boubaker, Karima; Beji, Soumaya; Ayari, Mohamed; El Younsi, Fethi; Moussa, Fatma Ben; Kheder, Adel

    2015-01-01

    Anemia is a frequent complication in patients with chronic kidney disease. However, human recombinant erythropoietin (rHu-EPO) has revolutionized the management of anemia in chronically dialyzed patients. Epomax ® is a new rHu-EPO alfa manufactured in Tunisia (Medis Laboratories). The aim of this study was to evaluate the efficacy and tolerance of Epomax ® in chronic hemodialysis (HD) patients in a phase-III, multicenter, clinical trial. Fiftythree HD patients (mean age 47.7 ± 13 years) who received a stable dose of rHu-EPO (Hemax ® , a rHu-EPO alfa manufactured by Biosidus Laboratories) subcutaneously were switched to Epomax ® via the same route of administration. At baseline, the mean systolic pressure was 132 ± 18 mm Hg and the mean diastolic pressure was 79 ± 8 mm Hg. The mean blood hemoglobin was 10.2 g/dL and the median ferritin level was 667 ng/mL. After a follow-up of 43 days, the mean blood hemoglobin was 10.5 g/dL under the effect of Epomax ® . There was no significant difference in the mean hemoglobin levels between the treatments with both drugs. Few adverse events were reported during the study. We conclude that Epomax ® was effective at maintaining the hemoglobin levels at target concentrations and was well tolerated in HD patients. PMID:25579720

  4. Long term follow up in hemodialysis patients with parathyroidectomy

    International Nuclear Information System (INIS)

    A retrospective study was performed in 41 patients, in chronic hemodialysis with severe hyperparathyroidism (HPT), who underwent surgery during time period from 1985 to 1997. 22 females, 19 males, aged 50 and 14 years, with PTHI 1345 and 604 pg/ml were followed up 32 and 22 months. Three surgical methods we evaluated: group I) total para thyroidectomy(PTX) with Implants(n=24); group II) subtotal PTX(n=14) and group III) total PTX(n=3). It considered recurrence of HPT when PTH levels were higher than upper range of normal, after 6 months post surgery. persistence was defined when there was no standardization of PTH levels. In group I, 9 patients had normal parathyroid function, 7 had persistent hypoparathyroidism and had hyperparathyroidism (7 recurrences). Group II patients had parathyroid over function in 5 cases (4 persistence s), 5 were normal and 4 hypoparathyroidism. All patients of the third group had hypoparathyroidism. Long term normalization of parathyroid gland activity was achieved in one third of troduccion patients (34,1%) whereas 34,1% permanent hypoparathyroidism and 31,8% hyperparathyroidism. It found no differences in recurrence and histological subtype of parathyroid gland in the different groups. In conclusion, similar long term clinical results were obtained with the different groups. The surgical ideal treatment is controversial. We think that in the long run, the evolution of parathyroid status is mostly influenced by the persistence of uremic state rather than the type of surgery performed

  5. Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin

    Directory of Open Access Journals (Sweden)

    Diego Marquez

    2012-06-01

    Full Text Available INTRODUCTION: Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. OBJECTIVE: To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. METHODS: Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS. RESULTS: Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004, but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16 Excessive sedation was common with gabapentin. Desloratadine was well tolerated. CONCLUSION: Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.

  6. Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors.

    Science.gov (United States)

    Nakamura, Yuya; Hasegawa, Hitomi; Tsuji, Mayumi; Udaka, Yuko; Mihara, Masatomo; Shimizu, Tatsuo; Inoue, Michiyasu; Goto, Yoshikazu; Gotoh, Hiromichi; Inagaki, Masahiro; Oguchi, Katsuji

    2015-06-25

    Although several previous studies have been published on the effects of dipeptidase-4 (DPP-4) inhibitors in diabetic hemodialysis (HD) patients, the findings have yet to be reviewed comprehensively. Eyesight failure caused by diabetic retinopathy and aging-related dementia make multiple daily insulin injections difficult for HD patients. Therefore, we reviewed the effects of DPP-4 inhibitors with a focus on oral antidiabetic drugs as a new treatment strategy in HD patients with diabetes. The following 7 DPP-4 inhibitors are available worldwide: sitagliptin, vildagliptin, alogliptin, linagliptin, teneligliptin, anagliptin, and saxagliptin. All of these are administered once daily with dose adjustments in HD patients. Four types of oral antidiabetic drugs can be administered for combination oral therapy with DPP-4 inhibitors, including sulfonylureas, meglitinide, thiazolidinediones, and alpha-glucosidase inhibitor. Nine studies examined the antidiabetic effects in HD patients. Treatments decreased hemoglobin A1c and glycated albumin levels by 0.3% to 1.3% and 1.7% to 4.9%, respectively. The efficacy of DPP-4 inhibitor treatment is high among HD patients, and no patients exhibited significant severe adverse effects such as hypoglycemia and liver dysfunction. DPP-4 inhibitors are key drugs in new treatment strategies for HD patients with diabetes and with limited choices for diabetes treatment. PMID:26131325

  7. Optimizing hemodialysis practices in Canada could improve patient survival.

    Science.gov (United States)

    Yeates, Karen E; Mendelssohn, David C; Ethier, Jean; Trpeski, Lilyanna; Na, Jingbo; Bragg-Gresham, Jennifer L; Eichleay, Margaret A; Pisoni, Ronald L; Port, Fritz K

    2007-01-01

    Data from the Canadian Organ Replacement Registry (CORR) and the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to determine whether practice patterns have changed in Canada since the introduction of the Canadian Society of Nephrology (CSN) Guidelines in 1999. DOPPS data were then used to calculate the impact of not meeting the proposed guideline targets and to estimate the potential life years gained if all Canadian hemodialysis patients achieved guideline targets. For dialysis dose and hemoglobin targets, Canadian facility performance has significantly improved over time. The vascular access use patterns show trends toward a worse pattern with increased catheter use. A calculation of the percentage of attributable risk suggests that 49% of deaths could possibly be averted if all patients currently outside the guidelines achieved them over the next five years. This corresponds to a decrease in the annual death rate from 18 to 10.1 per hundred patient years. These data support the need for improved adherence to guidelines. If Canadian caregivers were to optimize practice patterns, patient outcomes could be improved. PMID:17691708

  8. Associated factors and prevalence of erectile dysfunction in hemodialysis patients

    Scientific Electronic Library Online (English)

    Marcio Rodrigues, Costa; Alexandre Magno Bahia, Reis; Bruno Paiva, Pereira; Viviane Campos, Ponciano; Enio Chaves de, Oliveira.

    2014-01-01

    Full Text Available Purpose: The proposal of this study was to determine the prevalence and the associated factors of erectile dysfunction (ED) among hemodialysis (HD) patients. Materials and Methods: This was a cross-sectional study based on data collected from HD male patients. Clinical, demographic and laboratory [...] data of all patients were collected in three HD clinics from December 2010 to June 2011. Patients answered questions of erectile function domain from International Index of Erectile Function. Data were evaluated by descriptive analysis and by univariate (ULRA) and multivariate logistic regression analysis (MLRA). Results: Three hundred and five patients participated of the study. The prevalence of ED was 68.19%. ED was associated with diabetes (DM), benign prostatic hyperplasia, glomerulonephritis as cause of chronic renal failure (CRF), smoking habits, lower creatinine levels (ULRA), use of calcium channel blocker (MLRA), aging, lower education level, alcohol consumption, DM (as cause of CRF) and coronary insufficiency (ULRA and MLRA). Conclusions: ED was highly prevalent in the HD men. It was independently associated with aging, current use of alcohol, long alcohol use (even for those who do not drink more), lower education level, diabetes as cause of CRF, coronary insufficiency and use of channel blockers calcium.

  9. Retinol and Alpha-Tocopherol Levels Among Hemodialysis Patients.

    Directory of Open Access Journals (Sweden)

    Awatif M. Abd El Maksoud*, Asmaa M. Abd Allah*, Waleed Massoud

    2004-06-01

    Full Text Available Plasma retinol, alpha tocopherol, total cholesterol and triglycerides were measured in 40 patients aged 27-65 years, under regular hemodialysis (HD for 1.8-13 years at Ahmed Maher teaching Hospital and in 28 healthy age and sex matched control. Predialysis and postdialysis measurements were also, done for a subset of 13 hemodialytic patients. Among hemodialytic patients ,all values ( Plasma retinol ,alpha- tocopherol, total cholesterol and triglycerides were significantly higher ( p 100 ug /dl except for one patient . On the other hand ,alpha-tocopherol level in hemodialytic patients was ranged between deficiency ( 1080 ug/dl. Comparing predialysis and postdialysis measurements , the hemodialytic patients showed non significant difference concerning retinol level , while alpha tocopherol was significantly decreased in postdialytic state .In conclusion ; further studies are needed to answer, if hemodialytic patients are at risk for symptomatic vitamin A toxicity?. Even with normal or low plasma vitamin E, it is needed as an antioxidant accessory therapy in hemodialytic patients.

  10. Morphological Characterization of the Polyflux 210H Hemodialysis Filter Pores.

    Science.gov (United States)

    Hedayat, A; Szpunar, J; Kumar, N A P Kiran; Peace, R; Elmoselhi, H; Shoker, A

    2012-01-01

    Background. Morphological characterization of hemodialysis membranes is necessary to improve pore design. Aim. To delineate membrane pore structure of a high flux filter, Polyflux 210H. Methods. We used a Joel JSM-6010LV scanning electron microscope (SEM) and a SU6600 Hitachi field emission scanning electron microscope (FESEM) to characterize the pore and fiber morphology. The maximal diameters of selected uremic toxins were calculated using the macromolecular modeling Crystallographic Object-Oriented Toolkit (COOT) software. Results. The mean pore densities on the outermost and innermost surfaces of the membrane were 36.81% and 5.45%, respectively. The membrane exhibited a tortuous structure with poor connection between the inner and outer pores. The aperture's width in the inner surface ranged between 34 and 45?nm, which is 8.76-11.60 times larger than the estimated maximum diameter of ?2-microglobulin (3.88?nm). Conclusion. The results suggest that the diameter size of inner pore apertures is not a limiting factor to middle molecules clearance, the extremely diminished density is. Increasing inner pore density and improving channel structure are strategies to improve clearance of middle molecules. PMID:23209902

  11. Sternal instability in a hemodialysis patient with secondary hyperparathyroidism.

    Science.gov (United States)

    Eleftheriadis, Theodoros; Antoniadi, Georgia; Leivaditis, Konstantinos; Pissas, Georgios; Liakopoulos, Vassilios; Stefanidis, Ioannis

    2014-07-01

    A 77-year-old man, 11 years under chronic hemodialysis treatment for chronic renal failure of unknown origin, presented with anterior chest pain, dyspnea with paradoxical breathing, and sternal instability after a simple fall from a standing height. Patient underwent three-vessel coronary artery bypass grafting 31 months ago. Computed tomography with three-dimensional volume rendering showed sternal nonunion with a great gap between the two halves of the sternum and at least one fracture in the left half of the sternum. A successful surgical repair followed. Patient suffered from severe secondary hyperparathyroidism for many years. Despite treatment with sevelamer, paricalcitol and cinacalcet, intact parathyroid hormone was 1682?pg/mL. During the last 5 years, serum intact parathyroid hormone remained steadily above 1000?pg/mL. Patient refused parathyroidectomy in the past. We assume that long-lasting severe hyperparathyroidism contributed to this rare and life-threatening complication of median sternotomy in our patient, due to the detrimental effect of hyperparathyroidism on bone metabolism and its association with increased incidence of bone fractures and defect in bone fracture healing. PMID:24698121

  12. Porphyria cutanea tarda in a chronic hemodialysis patient

    Directory of Open Access Journals (Sweden)

    Labidi Jannet

    2010-01-01

    Full Text Available End-stage renal failure and long-term hemodialysis (HD treatment promote the development of genetically conditioned porphyria cutanea tarda (PCT. Iron overload is often asso-ciated with this disease and is thought to play a role in its pathogenesis. We report a case of HD-related PCT, which improved with deferoxamine treatment. A 33-year-old woman, with end-stage renal failure on HD since 1998, presented with a history of blisters on the face and dorsum of the hands, of several months duration. Laboratory analysis showed: hemoglobin 10.4 g/dL; a moderate hepatic cytolysis; ferritin 1300 ?g/L (Nl: 8-120 ?g/L and negative serology for HIV, HBV and HCV. Porphyrin analyses showed a PCT pattern. Skin biopsy findings and direct immunofluo-rescence were consistent with PCT. The patient received deferoxamine (40 mg/kg intravenously every week for 6 weeks which led to dramatic improvement of the symptoms. Several treatments are proposed in the management of dialysis-related PCT. This case confirms that deferoxamine can induce rapid and prolonged remission.

  13. Successful medical treatment of emphysematous pyelonephritis in chronic hemodialysis.

    Science.gov (United States)

    Vlachopanos, Georgios; Kassimatis, Theodoros; Zerva, Adamantia; Kokkona, Anastasia; Stavroulaki, Eirini; Zacharogiannis, Charilaos; Agrafiotis, Athanasios

    2015-10-01

    Emphysematous pyelonephritis (EPN) is a life-threatening renal infection caused by gas-producing bacteria and fungi. It usually occurs in patients with diabetes and patients with urinary tract obstruction. A combination of systemic antibiotics, percutaneous catheter drainage, or open nephrectomy is typically required to achieve cure. Because of grim prognosis, resorting to interventional methods is frequently inevitable. We report the case of a 77-year-old woman with diabetes and end-stage renal disease on chronic hemodialysis that presented with fever and left flank pain. A bubbly gas pattern inside the left kidney was demonstrated on abdominal computed tomography scan and blood cultures grew Escherichia coli. She was successfully treated solely with systemic antibiotics. This highlights the fact that prompt recognition of imaging findings associated with benign prognosis is essential for a favorable outcome. It allows for an effective management avoiding high-risk interventions, especially in frail patients with multiple comorbidities. Finally, we review all published cases of EPN in chronic dialysis patients. PMID:25643771

  14. Quinine--a tonic too bitter for hemodialysis-associated muscle cramps?

    Science.gov (United States)

    Kobrin, Sidney M; Berns, Jeffrey S

    2007-01-01

    Hemodialysis patients are susceptible to muscle cramps, both during dialysis sessions as well as in the interdialytic interval. These cramps are often very painful, disruptive to the dialysis treatment, and adversely affect quality of life. There is no well-defined means of preventing or treating these cramps. Quinine sulfate has been used with apparent success in some patients, but the Food and Drug Administration recently ordered the cessation of marketing of unapproved quinine formulations and advised consumers to avoid "off-label" use of quinine for cramps. We review the causes and consequences of hemodialysis-associated cramps, and discuss possible preventive measures and treatments. PMID:17897243

  15. Complications of hemodialysis treatments due to dialysate contamination and composition errors.

    Science.gov (United States)

    Davenport, Andrew

    2015-10-01

    Although hemodialysis is a routine outpatient treatment for millions of patients with a proven safety record, accidents and errors do occur from time to time. Many nephrologists are unaware of the technical aspects of providing a safe and reliable dialysate and rely on the support and advice of renal technologists. Complications may arise due to bacterial and chemical contamination of potable water, errors in dialysate acid or bicarbonate solution composition and proportioning, and resetting machine conductivity and temperature controls. As such, clinicians need to be aware of the possible complications of hemodialysis so that these are recognized promptly to provide appropriate management and minimize patient harm. PMID:26448385

  16. Effects of switching from sevelamer hydrochloride to bixalomer on laboratory parameters in hemodialysis patients.

    Science.gov (United States)

    Furukawa, Kazunori; Ikawa, Tomoyoshi; Yokoi, Sayuri; Yokouchi, Shuhei; Kato, Kieko; Ueno, Miki; Takahashi, Junichiro

    2014-06-01

    In Japan, the clinical use of bixalomer, a new polymer preparation like sevelamer hydrochloride, became possible from 2012. In our study, in order to investigate the clinical characteristics of this new phosphorus (P) binder, bixalomer in a clinical practice, for 18 cases of hemodialysis patients at our hospital being treated with sevelamer hydrochloride, we switched the P binder to bixalomer, and compared the laboratory parameters before and after switching. Subjects used for analysis were nine cases in which it was possible to use bixalomer continuously for 10 months. The laboratory parameters measured were the concentrations of serum P, corrected calcium (Ca), whole parathyroid hormone (PTH), albumin and alkaline phosphatase (ALP) as indicators of mineral and bone disorder, and serum high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) as indicators of lipid metabolism. Regarding the results after switching to bixalomer and starting treatment using the same dosage as the dosage previously used for sevelamer hydrochloride, there were many cases that showed increasing P concentrations that required increasing the dosage of bixalomer, the dosage after switching was increased significantly (P=0.002). In the comparison of laboratory parameters before and after switching, the concentrations of serum P and albumin decreased significantly (P=0.035 and 0.033). From these results, it was considered that the decreases in serum P concentrations were due not only to the effects of bixalomer, but that suppression of food intake by patients was another reason. There were no significant changes in corrected Ca, whole PTH or ALP. In addition, after changing the P binder, serum HDL-C concentration decreased significantly (P=0.015) and LDL-C increased significantly (Psevelamer hydrochloride. PMID:24975888

  17. Randomized controlled trial of bixalomer versus sevelamer hydrochloride in hemodialysis patients with hyperphosphatemia.

    Science.gov (United States)

    Akizawa, Tadao; Origasa, Hideki; Kameoka, Chisato; Kaneko, Yuichiro; Kawasaki, Shigenori

    2014-04-01

    Hyperphosphatemia is a prognostic factor for morbidity and mortality in chronic kidney disease. Bixalomer is a nonabsorbable polymer that decreases serum phosphate levels by binding phosphate in the gastrointestinal tract. This study compared the efficacy and safety of bixalomer versus sevelamer hydrochloride for controlling hyperphosphatemia in hemodialysis patients. This was a multicenter, randomized open-label, non-inferiority study. The primary endpoint was serum phosphate on completion of treatment. Administration of bixalomer was started at 1.5?g/day and adjusted to a maximum of 7.5?g/day depending on the serum phosphate level. Sevelamer hydrochloride was started at 3.0 or 6.0?g/day and adjusted to a maximum of 9.0?g/day. Treatment was continued for 12 weeks. Fifty-five patients were randomized to each treatment group. After 12 weeks, the baseline adjusted mean serum phosphate level was 5.87?mg/dL in the bixalomer group and 5.55?mg/dL in the sevelamer group, with a difference of 0.31?mg/dL and 95% confidence interval (CI) of [-0.13 to 0.76]. The upper limit of the 95%CI for the difference of the mean serum phosphate level between the two groups was sevelamer was confirmed. The incidence of adverse events was lower in the bixalomer group, and bixalomer did not promote acidosis. Bixalomer achieved a similar reduction of serum phosphate to sevelamer, while causing fewer adverse reactions. Consequently, the usefulness of bixalomer for treating hyperphosphatemia was confirmed. PMID:24720402

  18. Analyses of viscoelastic solid polymers undergoing degradation

    Science.gov (United States)

    Davoodi, Bentolhoda; Muliana, Anastasia; Tscharnuter, Daniel; Pinter, Gerald

    2015-08-01

    In this paper we study the three-dimensional response of isotropic viscoelastic solid-like polymers undergoing degradation due to mechanical stimuli. A single integral model is used to describe the time-dependent behaviors of polymers under general loading histories. The degradation is associated to excessive deformations in the polymers as strains continuously increase when the mechanical stimuli are prescribed, and therefore we consider a degradation threshold in terms of strains. The degradation part of the deformations is unrecoverable, and upon removal of the prescribed external stimuli, the accumulation of the degradation strains lead to residual strains. We also systematically present material parameter characterization from available experimental data under various loading histories, i.e., ramp loading with different constant rates, creep-recovery under different stresses, and relaxation under several strains. We analyze viscoelastic-degradation response of two polymers, namely polyethylene and polyoxymethylene under uniaxial tensile tests. Longer duration of loading can lead to increase in the degradation of materials due to the substantial increase in the deformations. The single integral model is capable in predicting the time-dependent responses of the polymers under various loading histories and capturing the recovery and residual strains at different stages of degradations.

  19. The influence of serum 25-hydroxy vitamin D levels on Helicobacter Pylori infections in patients with end-stage renal failure on regular hemodialysis

    International Nuclear Information System (INIS)

    This study was designed to determine whether the serum levels of 25-OH vitamin D influence the occurrence of infection with Helicobacter Pylori (H.Pylori) in patients on maintenance hemodialysis (HD). The study subjects were patients with end-stage renal disease who were undergoing maintenance dialysis at the hemodialysis section, Hajar Medical, Educational and Therapeutic Center, Shahrekord, Iran. The serum 25-OH vitamin D level and serum H. Pylori specific antibody titers were measured using an enzyme linked immunosorbent assay (ELISA) method. A total of 36 patients were studied including 21 males and 15 females. The mean age of study group was 47(+17) years. The mean level of serum 25-OH vitamin D was 0.5+-18.7 nmol/L (median: 3.5) while the mean value of serum H.Pylori specific IgG antibody titer was 7.7 (+-9.9) u/ml (median: 2 u/ml). Thus, a significant positive correlation was found between the levels of serum 25-OH vitamin D and serum H.Pylori specific IgG antibody titers (data adjusted for age, urea reduction rate, duration and dose of dialysis) (r=0.36, p=0.043). Our study suggests that vitamin D may positively affect the chronic inflammatory status of dialysis patients and may potentiate the immune response in such patients. Because of this immuno-modulatory effect, vitamin D analogs may offer new means to control the inflammatory status in patients on maintenance dialysis. (author)

  20. Efeito do exercício resistido intradialítico em pacientes renais crônicos em hemodiálise / Effect of resistance exercise intradialytic in renal patients chronic in hemodialysis

    Scientific Electronic Library Online (English)

    Ronaldo, Ribeiro; Gustavo L., Coutinho; Anderson, Iuras; Ana Maria, Barbosa; José Adilson Camargo de, Souza; Denise Pará, Diniz; Nestor, Schor.

    2013-03-01

    Full Text Available INTRODUÇÃO: Pacientes com doença renal crônica (DRC) quando submetidos ao exercício resistido (ER) apresentam substancial melhorias de muitas funções, em especial os relacionados ao sistema cardiovascular, respiratório, muscular e na qualidade de vida (QV). Não existem avaliações do impacto de exerc [...] ício simples e factíveis em pacientes com DRC associada ao Diabetes Mellitus (DM) durante o período intradialítico. OBJETIVO: Estudar o papel do exercício resistido no tratamento e na qualidade de vida em pacientes submetidos à hemodiálise crônica (HD). Assim, submetemos pacientes com DRC e DM ao ER durante a hemodiálise. MÉTODOS: Quinze pacientes em cada grupo: 1: DM com DRC submetidos ao ER; 2: DM com DRC sedentários; 3: DRC e ER e, 4: DRC sedentários. Avaliações durante oito semanas, com ER três vezes na semana. Avaliação laboratorial, teste de força muscular (FM) e QV (SF-36). RESULTADOS: O ER induziu melhoria na glicemia e na FM com discretas, mas significantes alterações na uréia e, K (p Abstract in english INTRODUCTION: Patients with chronic kidney disease (CKD) when subjected to resistance exercise (RE) show substantial improvements in many functions, especially those related to the cardiovascular system, respiratory, muscular and quality of life (QOL). There are no evaluations of the impact of exerc [...] ise simple and feasible in patients with CKD associated with Diabetes Mellitus (DM) during the intradialytic period. Thus, patients with CKD and submit to the DM + RE during hemodialysis. OBJECTIVE: To study the role of resistance exercise in the treatment and quality of life in patients undergoing chronic hemodialysis (HD). METHODS: 15 patients in each group: 1: DM with CKD and RE; 2: DM + CKD sedentary; 3: CKD + RE and 4: DRC sedentary. They were evaluated during eight weeks, with RE three times a week. Parameters: Laboratory assessments, muscle strength testing (FM) and QV (SF-36). RESULTS: RE induced improvement in glucose and FM with subtle but significant changes in urea, or even in the K (p

  1. Evaluation of objective and subjective indicators of death in a period of one year in a sample of prevalent patients under regular hemodialysis

    Directory of Open Access Journals (Sweden)

    Santos Paulo R

    2012-01-01

    Full Text Available Abstract Background To identify objective and subjective indicators of death in prevalent hemodialysis (HD patients in a follow-up study of 12 months. Methods The study included end-stage renal disease patients undergoing HD and analyzed demographic and laboratory data from the dialysis unit's records. Baseline data concerning socioeconomic status, comorbidity, quality of life level, coping style and depression were also assessed. For variables that differed in the comparison between survivors and non-survivors, Cox proportional hazards for death were calculated. Results The mortality rate was 13.0%. Non-survivors differed in age, comorbidity, inclusion on the transplant waiting list and physical functioning score. The hazard ratios of death were 8.958 (2.843-28.223; p p = 0.007 for not being on the transplant waiting list, 1.038 (1.012-1.066; p = 0.005 for age, and 0.980 (0.964-0.996; p = 0.014 for physical functioning. Conclusions Comorbidity, not being on the transplant waiting list, age and physical functioning, which reflects physical status, must be seen as risk indicators of death among patients undergoing HD.

  2. Clonidine in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

    Devereaux, P J; Sessler, Daniel I

    2014-01-01

    BACKGROUND: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. METHODS: We performed a blinded, randomized trial with a 2-by-2 factorial design to allow separate evaluation of low-dose clonidine versus placebo and low-dose aspirin versus placebo in patients with, or at risk for, atherosclerotic disease who were undergoing noncardiac surgery. A total of 10,010 patients at 135 centers in 23 countries were enrolled. For the comparison of clonidine with placebo, patients were randomly assigned to receive clonidine (0.2 mg per day) or placebo just before surgery, with the study drug continued until 72 hours after surgery. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: Clonidine, as compared with placebo, did not reduce the number of primary-outcome events (367 and 339, respectively; hazard ratio with clonidine, 1.08; 95% confidence interval [CI], 0.93 to 1.26; P=0.29). Myocardial infarction occurred in 329 patients (6.6%) assigned to clonidine and in 295 patients (5.9%) assigned to placebo (hazard ratio, 1.11; 95% CI, 0.95 to 1.30; P=0.18). Significantly more patients in the clonidine group than in the placebo group had clinically important hypotension (2385 patients [47.6%] vs. 1854 patients [37.1%]; hazard ratio 1.32; 95% CI, 1.24 to 1.40; P<0.001). Clonidine, as compared with placebo, was associated with an increased rate of nonfatal cardiac arrest (0.3% [16 patients] vs. 0.1% [5 patients]; hazard ratio, 3.20; 95% CI, 1.17 to 8.73; P=0.02). CONCLUSIONS: Administration of low-dose clonidine in patients undergoing noncardiac surgery did not reduce the rate of the composite outcome of death or nonfatal myocardial infarction; it did, however, increase the risk of clinically important hypotension and nonfatal cardiac arrest. (Funded by the Canadian Institutes ofHealth Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.).

  3. Apelin: a peptide involved in cardiovascular risk in hemodialysis patients?

    Science.gov (United States)

    Leal, Viviane O; Lobo, Julie C; Stockler-Pinto, Milena B; Farage, Najla E; Calixto, Antonio; Geloneze, Bruno; Mafra, Denise

    2012-01-01

    Inflammation, oxidative stress, and obesity are important features associated with pathogenesis of cardiovascular disease, a major contributor to the mortality of hemodialysis (HD) patients. Apelin is an adipokine involved in a variety of physiological functions; however, little is known about apelin in chronic kidney disease (CKD). Thus, the purpose of this study was to analyze apelin plasma levels in HD patients and verify whether there is any relationship with inflammation, oxidative markers, and obesity. Twenty-four HD patients [53.6 ± 14.4 years, 14 men, and body mass index (BMI) of 25.0 ± 4.2 kg/m(2)] were studied and compared with 15 healthy subjects (51.3 ± 13.5 years, 7 men, and BMI of 26.3 ± 3.7 kg/m(2)). Plasma apelin-12 and -36 were measured using the enzyme immunometric assay method. Plasma electronegative low-density lipoprotein [LDL(-)] levels were measured using ELISA method, and tumor necrosis factor-?, interleukin-6, leptin, and plasminogen activator inhibitor-1 levels were measured by a multiplex assay kit. C-Reactive protein (CRP) was determined by immunoturbidimetry. Anthropometric data were also evaluated. There was no difference between apelin-36 levels in HD patients (0.82 ± 0.60 ng/mL) and healthy subjects (0.83 ± 0.23 ng/mL). In contrast, apelin-12 levels were significantly higher in patients (0.34 ± 0.15 ng/mL vs. 0.24 ± 0.13 ng/mL in healthy subjects). TNF-?, CRP, and LDL(-) levels were higher in patients; however, there was no correlation among apelin-12 or -36 and inflammatory or oxidative markers. The adiposity parameters were also not associated with apelin-12 or -36. In conclusion, plasma apelin seems to be not associated with cardiovascular risk in HD patients. PMID:22417287

  4. Infective endocarditis in chronic hemodialysis patients: Experience from Morocco

    Directory of Open Access Journals (Sweden)

    Montasser Dina

    2011-01-01

    Full Text Available Since the 1960s, regular hemodialysis (HD was recognized as a risk factor for the development of infective endocarditis (IE, particularly at vascular access sites. The present report describes our experience at the Etat Major General Agadir, Morocco, of taking care of IE in patients on regular dialysis. A retrospective analysis was made of five cases of IE in patients receiving re-gular HD having arteriovenous fistula as vascular access. They were sent from four private centers and admitted in our formation between January 2004 and March 2009. Infective endocarditis was detected after 34.5 months following initiation of dialysis. The causative organisms included Sta-phylococcus and Enterococcus in two cases each and negative blood culture in one case. A recent history of infection (<3 months of the vascular access was found in three cases. Peripheric embolic phenomena were noted in two cases. A pre-existing heart disease was common and contributed to heart failure. Mortality was frequent due to valvular perforations and congestive heart failure, making the medical treatment alone unsatisfactory. Two patients survived and three of our patients received a prosthetic valve replacement, with a median survival after surgery of 10.3 months/person. The clinical diagnosis of infective endocarditis in regularly dialyzed patients remains difficult, with the presence of vascular calcification as a common risk factor. The vascular catheter infections are the cardinal gateway of pathogenic organisms, which are mainly Staphlococcus. The prognosis is bad and the mortality is significant, whereas medical and surgical treatments are often established in these patients who have many factors of comorbidity.

  5. Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Helal Imed

    2010-01-01

    Full Text Available Cardiovascular diseases are a major cause of morbidity and mortality in patients with end-stage renal disease (ESRD. The aim of our investigation was the evaluation of an extensive cardiovascular profile in hemodialysis (HD and peritoneal dialysis (PD patients. We studied 74 patients with ESRD (38 males, 36 females, maintained either on chronic HD (n= 50 or chronic PD (n= 24 and age and sex matched 20 healthy subjects as controls. The lipid profile, homo-cysteine (Hcy and C reactive protein (CRP were measured. When compared to a healthy popu-lation, HD patients displayed a marked atherogenic profile, as attested by increased levels of total cholesterol (TC, triglycerides (TG, low-density lipoprotein-cholesterol (LDL-C, apolipoprotein A (Apo A, CRP, Hcy and lower concentrations of high-density lipoprotein-cholesterol (HDL-C, Apo B, albumin (ALB. A significant difference was noted concerning the rates of Apo B, HDL-C, TC, ALB and Hcy. Same biological disorders that those found at HD patients were noted in these PD patients. One also noted lower concentration in Apo A. there were a significant diffe-rence with the reference group concerning the rates of albumin, Apo A, HDL-Cl and Hcy. When compared to PD patients, HD patients had significantly decreased concentration of LDL-C. The peculiar metabolic changes observed in the present study confirm the marked tendency of patients with impaired renal function for developing cardiovascular diseases, irrespectively of the type of dialysis. We suggest including uremia-related risk factors in the panel for evaluation of cardio-vascular risk in dialysis patients.

  6. Predictors of quality of life of hemodialysis patients in India.

    Science.gov (United States)

    Veerappan, I; Arvind, R M; Ilayabharthi, V

    2012-01-01

    Little is known about the quality of life and survival in the patients on maintenance hemodialysis (HD) in India. Poor nutrition and dialysis noncompliance is common. This study investigates the factors that affect the quality of life (QoL) in HD patients in India. This cross-sectional study included 78 patients on HD for ? two months. Demographic, nutritional, functional subjective global assessment and Kidney Disease Quality of Life (KDQOL-36) assessments were done. Predictors of QoL were assessed by regression analysis. The mean calorie and protein intake were 1245 ± 116.9 kcal and 0.86 ± 0.19 g/kg/day respectively. Male gender (OR = 9.68), serum parathyroid hormone PTH 25 were male gender (OR = 5.06) and urine output at start of dialysis (OR = 1.05). Independent predictors of mental component summary (MCS) ?25 were male gender (OR = 11.02), serum PTH > 150 pg/ml (OR = 0.15), daily protein intake of >0.8 g/kg and caloric intake >20 K.cal/kg (OR = 10.8). Patients with urine output >1 liter per day had more hypotensive episodes during dialysis (r = 0.56, P = 0.045), more headaches (r = 0.63, P = 0.006) but that did not affect the PCS significantly. Low PTH (150 pg/ml and those not on catheter had better total score. Though patients with higher urine output had better PCS, those with output >1 liter had higher incidence of hypotension and dialysis-related headache. Protein-energy malnutrition affected the MCS significantly. Dialysis noncompliance seen in one-fourth of the population did not affect the scores significantly. PMID:22279338

  7. Serum Magnesium and Sudden Death in European Hemodialysis Patients

    Science.gov (United States)

    de Roij van Zuijdewijn, Camiel L. M.; Grooteman, Muriel P. C.; Bots, Michiel L.; Blankestijn, Peter J.; Steppan, Sonja; Büchel, Janine; Groenwold, Rolf H. H.; Brandenburg, Vincent; van den Dorpel, Marinus A.; ter Wee, Piet M.; Nubé, Menso J.; Vervloet, Marc G.

    2015-01-01

    Despite suggestions that higher serum magnesium (Mg) levels are associated with improved outcome, the association with mortality in European hemodialysis (HD) patients has only scarcely been investigated. Furthermore, data on the association between serum Mg and sudden death in this patient group is limited. Therefore, we evaluated Mg in a post-hoc analysis using pooled data from the CONvective TRAnsport STudy (CONTRAST, NCT00205556), a randomized controlled trial (RCT) evaluating the survival risk in dialysis patients on hemodiafiltration (HDF) compared to HD with a mean follow-up of 3.1 years. Serum Mg was measured at baseline and 6, 12, 24 and 36 months thereafter. Cox proportional hazards models, adjusted for confounders using inverse probability weighting, were used to estimate hazard ratios (HRs) of baseline serum Mg on all-cause mortality, cardiovascular mortality, non-cardiovascular mortality and sudden death. A generalized linear mixed model was used to investigate Mg levels over time. Out of 714 randomized patients, a representative subset of 365 (51%) were analyzed in the present study. For every increase in baseline serum Mg of 0.1 mmol/L, the HR for all-cause mortality was 0.85 (95% CI 0.77–94), the HR for cardiovascular mortality 0.73 (95% CI 0.62–0.85) and for sudden death 0.76 (95% CI 0.62–0.93). These findings did not alter after extensive correction for potential confounders, including treatment modality. Importantly, no interaction was found between serum phosphate and serum Mg. Baseline serum Mg was not related to non-cardiovascular mortality. Mg decreased slightly but statistically significant over time (? -0.011 mmol/L/year, 95% CI -0.017 to -0.009, p = 0.03). In short, serum Mg has a strong, independent association with all-cause mortality, cardiovascular mortality and sudden death in European HD patients. Serum Mg levels decrease slightly over time. PMID:26600017

  8. Factors associated with irritable bowel syndrome symptoms in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Bartosz Fiderkiewicz

    2011-01-01

    Full Text Available AIM: To investigate clinical characteristics associated with the presence of irritable bowel syndrome (IBS symptoms in hemodialysis (HD patients. METHODS: This was a cross-sectional study. A questionnaire based on the Bowel Disease Questionnaire that records gastrointestinal symptoms was given to 294 patients in 4 dialysis centers. A total of 196 (67% subjects returned the survey. A multivariable logistic regression model was used to identify factors significantly associated with IBS symptoms. RESULTS: Symptoms compatible with IBS were present in 27 (13.8% subjects and independently associated with low post-dialysis serum potassium [OR = 0.258, 95% CI (0.075-0.891, P = 0.032], paracetamol use [OR = 3.159, 95% CI (1.214-8.220, P = 0.018], and Kidney Disease Quality of Life (KDQOL cognitive function score [OR = 0.977, 95% CI (0.956-0.999, P = 0.042]. Univariate regressions were also performed and the reported significance is for multivariate analysis. No association was detected for age, gender, depressed mood, smoking (present or past, body mass index, albumin level, Kt/V, sodium pre- or post-dialysis level, change in potassium level during HD, proton pump inhibitor or H2 blocker use, aspirin use, residual diuresis, hepatitis B or C infection, diabetes mellitus, marital status and education level. CONCLUSION: This study examined potential risk factors for symptoms compatible with IBS in HD patients and identified an association with paracetamol use, post-dialysis potassium level and KDQOL-cognitive function score.

  9. Depression and quality of sleep in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Trbojevi?-Stankovi? Jasna

    2014-01-01

    Full Text Available Introduction. Sleep disorders and psychological disturbances are common in end-stage renal disease (ESRD patients. However, despite their frequency and importance, such conditions often go unnoticed, since all patients do not clearly manifest fully expressed symptoms. Objective. This study aimed to determine the prevalence of depression and poor sleep quality and to examine the association between these disorders and demographic, clinical and treatment-related characteristics of ESRD patients on hemodialysis (HD. Methods. The study included 222 patients (132 men and 90 women, mean age 57.3±11.9 years, from 3 HD centers in Central Serbia, which provided us with biochemical parameters and demographic data. Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI and Beck Depression Inventory (BDI, respectively. Results. The average BDI was 16.1±11.3. Depressed patients were significantly older (p=0.041, had a significantly lower dialysis adequacy (p=0.027 and a significantly worse quality of sleep (p<0.001, while they did not show significant difference as regarding sex, employment, marital status, comorbidities, dialysis type, dialysis vintage, shift and laboratory parameters. The average PSQI was 7.8±4.5 and 64.2% of patients were poor sleepers. Poor sleepers were significantly older (p=0.002, they were more often females (p=0.027 and had a significantly higher BDI (p<0.001, while other investigated variables were not correlated with sleep quality. A statistically significant positive correlation was found between BDI and PSQI (r=0.604; p<0.001. Conclusion. Depression and poor sleep quality are frequent and interrelated among HD patients.

  10. Hemodialysis-specific factors associated with salivary flow rates.

    Science.gov (United States)

    Marques, Paulo Leonardo Ponte; Libório, Alexandre Braga; Saintrain, Maria Vieira de Lima

    2015-02-01

    The saliva is important to maintain the integrity of tissues and teeth, besides having microbial activity. Hemodialysis (HD) patients usually have reduced salivary flow rate (SFR) and are exposed to all its associated complications. The aim of the present study was to identify HD-related factors associated with reduced SFR. A cross-sectional study was performed with maintenance HD patients. Stimulated whole saliva was collected before and after HD. Xerostomia was assessed through the validated xerostomia inventory and thirst through the dialysis thirst inventory. Parameters of dental health status were obtained by the decayed, missed, and filled teeth index and community periodontal index. One hundred twenty-eight patients (66 males) participated in this study. Stimulated SFR before HD was 0.38?±?0.28?mL/min. In univariate analysis and after adjusting for several factors, serum urea before HD session, serum intact parathormone (iPTH), calcium-phosphorus product (Ca×Pi), serum ferritin, and number of medications were negatively correlated with SFR in univariate analysis. Moreover, patients taking sevelamer had reduced SFR in comparison with those not receiving it (SFR 0.32?±?0.19 vs. 0.44?±?0.23?mL/min, P?=?0.003). At multivariate analysis, including dialysis and nondialysis-related factors, age, elevated pre-HD serum urea, higher Ca×Pi product, higher iPTH, and sevelamer use remained as factors that were independently associated with a reduced SFR. After dialysis, there was a significant increment in SFR (0.39?±?0.28 vs. 0.60?±?0.34?mL/min, P?sevelamer use, and bone and mineral disorders markers. PMID:25041518

  11. Discrepancy between Serological and Virological Analysis of Viral Hepatitis in Hemodialysis Patients

    OpenAIRE

    Chang, Jer-Ming; Huang, Chung-Feng; Chen, Szu-Chia; Dai, Chia-Yen; Yeh, Ming-Lun; Huang, Jee-Fu; Kuo, Hsing-Tao; Chuang, Wan-Long; Yu, Ming-Lung; Hwang, Shang-Jyh; Chen, Hung-Chun

    2014-01-01

    Background and Aim: Viral hepatitis is a health threat for hemodialysis (HD) patients and it may be transmitted during treatment. Some patients categorized to have viral hepatitis were found to be non-viremic. To clarify the discrepancy between the serological tests in HD patients, we conducted the study.

  12. Association of Dietary Phosphorus Intake and Phosphorus to Protein Ratio with Mortality in Hemodialysis Patients

    OpenAIRE

    Noori, Nazanin; Kalantar-zadeh, Kamyar; KOVESDY, Csaba P.; BROSS, RACHELLE; Benner, Debbie; Kopple, Joel D.

    2010-01-01

    Background and objectives: Epidemiologic studies show an association between higher predialysis serum phosphorus and increased death risk in maintenance hemodialysis (MHD) patients. The hypothesis that higher dietary phosphorus intake and higher phosphorus content per gram of dietary protein intake are each associated with increased mortality in MHD patients was examined.

  13. Cine-MRI tagging for assessment of ventricular wall motion in patients under maintenance hemodialysis

    International Nuclear Information System (INIS)

    We evaluated the ventricular wall shortening velocity of patients with volume overload using cine-MRI tagging. The subjects were 12 healthy volunteers and 10 patients under maintenance hemodialysis. Three linear tags (basal, mid-ventricular, and apical) were set up in the 4-chamber view and ? distance/Ejection time (?d/ET) was calculated before and after hemodialysis. Before hemodialysis, ?d/ET was significantly greater at the basal level than after hemodialysis (right ventricular wall : 64.7±14.3 vs 59.1±15.4 mm/s, P<0.05, interventricular septum : 36.3±6.9 vs 32.4±7.6 mm/s, P<0.05, left ventricular free wall : 40.5±6.8 vs 36.1±8.2 mm/s, P<0.05). Thus, volume overload increased ?d/ET of the normal heart. We concluded that cine-MRI tagging could quantitatively evaluate right and left ventricular wall motion. (author)

  14. L-FOLINIC ACID VERSUS FOLIC ACID FOR THE TREATMENT OF HYPERHOMOCYSTEINEMIA IN HEMODIALYSIS PATIENTS

    Science.gov (United States)

    The hyperhomocysteinemia found in most hemodialysis patients is refractory to combined oral B-vitamin supplementation featuring supraphysiological doses of folic acid (FA). We evaluated whether a high-dose L-folinic acid- based regimen provided improved total homocysteine (tHcy)-lowering efficacy in...

  15. Clinical Outcomes of Dialysis Catheter–Related Candidemia in Hemodialysis Patients

    OpenAIRE

    Sychev, Dmitri; Maya, Ivan D.; Allon, Michael

    2009-01-01

    Background and objectives: Candidemia is a rare complication in catheter-dependent hemodialysis patients. As a result, there is uncertainty about its optimal medical management. The goal of this retrospective study was to compare the clinical outcomes of catheter-related candidemia managed with two different strategies: Guidewire exchange of the infected catheter versus removal with delayed replacement.

  16. What Can We Change in the Life of Hemodialysis Patients? The Results of a Project

    Directory of Open Access Journals (Sweden)

    Zehra EREN

    2012-09-01

    Full Text Available OBJECTIVE: To share the results of the project funded by the European Union, entitled “providing poor hemodialysis patients with transportation, food service and subsistence” within the scope of the Eastern Anatolia Development Project conducted at the Hemodialysis Unit of Van Highly Specialized Training and Research Hospital. MATERIAL and METHODS: For eleven months, 66 patients were regularly transported to the hemodialysis unit and were given a meal. The anthropometric measurements, quality of life, anxiety, depression and hopelessness scales of patients were evaluated RESULTS: The evaluation included 66 patients (26 women, 40 men. A signifi cant increase was found in BMI (p = 0.01 and waist circumference (p = 0.00 together with elevated values of albumin (p = 0.02 and ferritin at the end of the project (p = 0.01. In women, there was a signifi cant increase in waist circumference (p = 0.00 and upper arm circumference (p = 0.03. From subscales of the SF-36 test, an increase in (p = 0.00 general health perception (p = 0.01 and the social function scores (p = 0.03 was observed in men. Beck Depression, Beck Hopelessness and Beck Anxiety Scale results showed that the anxiety and depression scores of the male patients had decreased signifi cantly. CONCLUSION: It was observed that regular transportation, adequate and conscious nutrition had positive effects on the treatment. We believe that social programs may have a benefi cial effect on the quality of life of hemodialysis patients in this region.

  17. Effects of Intradialytic Aerobic Training on Sleep Quality in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Reza Afshar

    2011-03-01

    Full Text Available Introduction. Sleep disorders are common in hemodialysis patients. They can affect their quality of life. The purpose of this study was to evaluate the effects of aerobic training on sleep quality, inflammatory status, and serum leptin levels in hemodialysis patients.Materials and Methods. Twenty-eight men in the age range of 28 to 74 years who were on maintenance hemodialysis and had sleep problems were enrolled in this study. They were randomly assigned into control and training groups (14 patients in each group. Patients in the training group performed a 10- to 30-minute stationary cycling, 3 times a week, during the 1st two hours of every dialysis session, for 8 weeks. The Pittsburgh Sleep Quality Index and the Baecke questionnaire on physical activity were filled out for all participants. To assess serum leptin and C-reactive protein levels, blood samples were drawn before the beginning and at the end of the eighth week.Results. At the end of the study, serum leptin and C-reactive protein levels were significantly reduced (P Conclusions. Aerobic exercise with moderate intensity during the first two hours of a dialysis session could improve sleep quality and inflammatory status of hemodialysis patients, which predicts morbidity, mortality, and quality of life. However, additional research is needed to confirm these effects.

  18. Percutaneous Transhepatic Venous Access for Permanent Hemodialysis Catheter Placement; Procedure and Complications

    Directory of Open Access Journals (Sweden)

    A.R Ghasemi Esfe

    2010-10-01

    Full Text Available Maintenance of the patient's hemodialysis access is a major issue in chronic dialysis."nWe report a patient with end stage renal disease who had no alternative for vascular access and failed peritoneal dialysis. A successful vascular access device was inserted using a transhepatic approach.    

  19. Percutaneous Transhepatic Venous Access for Permanent Hemodialysis Catheter Placement; Procedure and Complications

    OpenAIRE

    A.R Ghasemi Esfe; S. M. Vaziri Bozorg; F. Ahmadi; Kh Eslami; M Ghasemi Esfe; H Rokni Yazdi

    2010-01-01

    Maintenance of the patient's hemodialysis access is a major issue in chronic dialysis."nWe report a patient with end stage renal disease who had no alternative for vascular access and failed peritoneal dialysis. A successful vascular access device was inserted using a transhepatic approach.    

  20. Endovascular salvage of a right brachial artery-right atrium hemodialysis graft using a covered endoprosthesis.

    Science.gov (United States)

    Anaya-Ayala, Javier E; Ismail, Nyla; Reardon, Michael J; Peden, Eric K

    2012-01-01

    Creation of a functional hemodialysis access in patients with exhausted peripheral access sites and concomitant central venous occlusive disease (CVOD) is a multifaceted challenge; often requiring complex, innovative solutions, not without their own complications. We present a 57-year-old hemodialysis patient with a history of hypercoagulable disorder and multiple failed arteriovenous accesses. Because of inadequate peripheral access sites and chronic occlusions in superior vena cava, brachiocephalic veins and inferior vena cava, in addition to multiple transhepatic catheter related issues; we decided to perform a right brachial artery to right atrium (RA) hemodialysis graft. The access was used without complications for 18 months at which point he had his first episode of thrombosis; open thrombectomy and percutaneous balloon angioplasty (PTA) at the atrial anastomosis were done with success. The following three months, he endured two more thrombectomies and PTAs. During the last intervention we performed an intravascular Ultrasound (IVUS) through the atrial anastomosis, which demonstrated stenosis; and the decision was made to extend the outflow anastomosis with a covered stent into the atrium. Therefore a 10 cm x 10 mm Viabahn stent-graft (W. L. Gore and Associates, Flagstaff, Ariz.) was deployed and post dilated with 8 mm balloon within the graft component. Repeat injection and Intravascular Ultrasound (IVUS) demonstrated significant improvement and free outflow. The brachial-RA hemodialysis graft could be use immediately and at 5 months has remained fully functional and no reinterventions have been necessary. PMID:22522413

  1. Major bleeding events and risk stratification of antithrombotic agents in hemodialysis: Results from the DOPPS

    OpenAIRE

    Sood, Manish M.; Larkina, Maria; Thumma, Jyothi R.; Tentori, Francesca; Gillespie, Brenda W.; Fukuhara, Shunichi; Mendelssohn, David C.; Chan, Kevin; de Sequera, Patricia; Komenda, Paul; Rigatto, Claudio; Robinson, Bruce M

    2013-01-01

    Benefits and risks of antithrombotic agents remain unclear in the hemodialysis population. We aimed to determine variation in antithrombotic agent use, rates of major bleeding events, and to determine factors predictive of stroke and bleeding to allow for risk stratification, enabling more rational decisions about using antithrombotic agents.

  2. International trends in erythropoietin use and hemoglobin levels in hemodialysis patients.

    Science.gov (United States)

    McFarlane, Philip A; Pisoni, Ronald L; Eichleay, Margaret A; Wald, Ron; Port, Friedrich K; Mendelssohn, David

    2010-07-01

    Hemoglobin levels and the dose of erythropoiesis-stimulating agents (ESAs) have risen over time in hemodialysis patients within the United States. There are concerns that these trends may be driven by reimbursement policies that provide potential incentives to increase this use. To determine this we studied trends in the use of ESA and hemoglobin levels in hemodialysis patients and the relationship of these trends to the mode of reimbursement. Using the Dialysis Outcomes and Practice Patterns Study (DOPPS) database of hemodialysis we analyzed facility practices in over 300 randomly selected dialysis units in 12 countries. At each of three phases (years 1996-2001, 2002-2004, and 2005-present), we randomly selected over 7500 prevalent hemodialysis, hemofiltration, or hemodiafiltration patients. ESA usage rose significantly in every country studied except Belgium. All but Sweden demonstrated a substantial increase in hemoglobin levels. In 2005 more than 40% of patients had hemoglobin levels above the KDOQI upper target limit of 120 g/l in all but Japan. These trends appeared to be independent of the manner of reimbursement even though the United States is the only country with significant financial incentives promoting increased use of these agents. Thus, our study found that prescribing higher doses of ESAs and achieving higher hemoglobin levels by physicians reflects a broad trend across DOPPS countries regardless of the reimbursement policies. PMID:20428102

  3. Cholecalciferol Supplementation in Hemodialysis Patients: Effects on Mineral Metabolism, Inflammation, and Cardiac Dimension Parameters

    OpenAIRE

    Matias, Patrícia João; Jorge, Cristina; Ferreira, Carina; Borges, Marília; Aires, Inês; Amaral, Tiago; Gil, Célia; Cortez, José; Ferreira, Aníbal

    2010-01-01

    Background and objectives: Vitamin D deficiency is highly prevalent in chronic kidney disease. The aim of this study was to evaluate the effects of oral cholecalciferol supplementation on mineral metabolism, inflammation, and cardiac dimension parameters in long-term hemodialysis (HD) patients.

  4. Dialysate sodium and sodium gradient in maintenance hemodialysis: a neglected sodium restriction approach?

    OpenAIRE

    Munoz Mendoza, Jair; Sun, Sumi; CHERTOW, Glenn M.; Moran, John; Doss, Sheila; Schiller, Brigitte

    2011-01-01

    Background. A higher sodium gradient (dialysate sodium minus pre-dialysis plasma sodium) during hemodialysis (HD) has been associated with sodium loading; however, its role is not well studied. We hypothesized that a sodium dialysate prescription resulting in a higher sodium gradient is associated with increases in interdialytic weight gain (IDWG), blood pressure (BP) and thirst.

  5. Impact of Hemodialysis on Visual Parameters in Patients With End-stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Hassan Ghasemi

    2012-11-01

    Full Text Available Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; text-align:justify; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Introduction. Patients with end-stage renal disease who receive hemodialysis are prone to visual disturbances. The aim of this study was to evaluate the effects of metabolic changes on visual parameters during hemodialysis sessions.  Materials and Methods. Demographic information including history of underlying diseases, wearing eyeglasses, any ocular diseases or surgeries, and hemodialysis duration and frequency were recorded in 65 hemodialysis patients. The best corrected visual acuity (BCVA in logarithm of the minimum angle of resolution and spherical equivalent (SE per diopter were measured before and after hemodialysis. Other systemic and metabolic parameters including systolic blood pressure, body weight, KT/V, and blood levels of glucose, urea, and sodium were recorded. Results. A total of 130 eyes of 38 men and 27 women with ages ranged from 24 to 90 years (mean, 60.3 ± 16.7 years were enrolled. The mean BCVA changed significantly after hemodialysis (0.29 ± 0.48 increased to 0.31 ± 0.49; P P P = .05, r = 0.166. There were significant associations between diabetic retinopathy and wearing of eyeglasses with BCVA and SE (P Conclusions. Hemodialysis could influence on visual parameters such as BCVA and refractive status by means of changes in blood glucose or possibly other systemic parameters. 

  6. Sobrevida de pacientes em hemodiálise em um hospital universitário / Survival of hemodialysis patients at a university hospital

    Scientific Electronic Library Online (English)

    Fernanda Ismaela Rolim, Teixeira; Maria Lúcia Holanda, Lopes; Giselle Andrade dos Santos, Silva; Ricardo Ferreira, Santos.

    2015-03-01

    Full Text Available Introdução: A doença renal crônica (DRC) apresenta altas taxas de morbidade e mortalidade, especialmente na população em diálise. Objetivo: Determinar a taxa de sobrevida; caracterizar o perfil epidemiológico e clínico; identificar as comorbidades e as variáveis associadas à sobrevida dos pacientes [...] submetidos à hemodiálise. Métodos: Trata-se de um estudo de natureza descritiva e longitudinal constituído por 162 pacientes submetidos à hemodiálise, em um hospital universitário. As variáveis categóricas foram descritas por meio de frequências e porcentagem e as numéricas por meio de média ± desvio padrão. A análise por meio da regressão de Cox foi utilizada para estudar a influência de diversas variáveis clínicas e demográficas. Foram construídas as curvas de sobrevida das variáveis significantes com o método de Kaplan Meyer. Resultados: A idade média foi de 48,09 anos, a renda familiar mensal e o nível de instrução mostraram-se reduzidos na maior parte dos estudados. A hipertensão arterial mostrou-se a principal comorbidade associada à insuficiência renal crônica terminal, seguida pelo diabetes mellitus. Os fatores que comprometeram significativamente a sobrevida dos pacientes foram a idade avançada no início da terapia, a hemoglobina e a albumina. A taxa de sobrevida global foi de 84,71% e 63,32% em um e cinco anos, respectivamente. Conclusão: A taxa de sobrevida foi considerada baixa e mostrou-se decrescente ao longo dos anos, não representando melhorias apesar dos avanços tecnológicos, diagnósticos e terapêuticos. A idade avançada, a hipoalbuminemia e a anemia são fortes preditores de mortalidade. Abstract in english Introduction: Chronic Kidney Disease (CKD) is associated with high rates of morbidity and mortality, especially in dialyses population. Objective: To determine the overall survival rate; the epidemiological and clinical profiles; the comorbidities and the variables associated with survival of the p [...] atients undergoing hemodialysis. Methods: This is a longitudinal and descriptive study with 162 patients undergoing hemodialysis, at the University Hospital. The categorical variables were described by frequency and percentage; numerical variables by mean and standard-deviation. The analysis by Cox Regression model was used to study the influence of several clinical and demographic variables in survival rates. Kaplan Meyer model was used to construct the survival curves of the significant variables. Results: The mean age was 48.09 years, and the monthly family income and level of education were reduced in most of the patients studied. Hypertension was the main comorbidity associated with CKD in this population, followed by Diabetes Mellitus. The variables that negatively influenced the survival rates were advanced age at the beginning of therapy and low hemoglobin and albumin levels. The overall survival was 84.41% and 63.32% in one and five years, respectively. Conclusion: The rate of survival was considered low compared others studies and was decreasing over the years, not representing improvements despite technological advances in diagnostic and therapeutic approachs. Advanced age, hypoalbuminemia and anemia are strong predictors of mortality.

  7. A Better Diet Quality is Attributable to Adequate Energy Intake in Hemodialysis Patients.

    Science.gov (United States)

    Kim, Hyerang; Lim, Hyunjung; Choue, Ryowon

    2015-01-01

    Poor diet quality is one of strong predictors of subsequent increased mortality in hemodialysis patients. To determine diet quality and to define major problems contributing to poor diet quality in hemodialysis patients, a cross-sectional study was conducted between June 2009 and October 2010. Sixty-three hemodialysis patients (31 men, 32 women; aged 55.3 ± 11.9 years) in stable condition were recruited from the Artificial Kidney Center in Kyung Hee University, Seoul, Korea. Three-day diet records were obtained for dietary assessment. Mean adequacy ratio (MAR) is the average of the ratio of intakes to Dietary Reference Intakes (DRI) for 12 nutrients. Index of nutritional quality (INQ) was determined as the nutritional density per 1,000 kcal of calories. Overall diet quality was evaluated using the Diet Quality Index-International (DQI-I). Statistics were used to determine diet quality, comparing dietary intake to DRI. Dietary calories (21.9 ± 6.7 kcal/kg/day) and protein (0.9 ± 0.3 g/kg/day) were found insufficient in the participants. The overall intake of 12 nutrients appeared to be also inadequate (0.66 ± 0.15), but INQs of overall nutrients, except for folate (0.6) and calcium (0.8), were found relatively adequate (INQ ? 1). As a result of diet quality assessment using DQI-I, dietary imbalance and inadequacy were found to be the most problematic in hemodialysis patients. This study suggests that the main reason for insufficient intake of essential nutrients is insufficient calorie intake. Hemodialysis patients should be encouraged to use various food sources to meet their energy requirements as well as satisfy overall balance and nutrient adequacy. PMID:25713792

  8. Brain Hemodynamics in Patients With End-stage Renal Disease Between Hemodialysis Sessions

    Directory of Open Access Journals (Sweden)

    Mehdi Farhoudi

    2012-03-01

    Full Text Available Normal 0 false false false EN-US X-NONE AR-SA /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif"; mso-fareast-font-family:Calibri; mso-fareast-theme-font:minor-latin;} Introduction. End-stage renal disease has been associated with premature atherosclerosis of the cerebral circulation. The risk of stroke, a frequent complication of uremia as a result of cerebral blood flow reduction, is high in dialysis patients. This study aimed to assess brain hemodynamics between hemodialysis interval periods by transcranial Doppler ultrasonography. Materials and Methods. In a case-control study, to evaluate cerebral circulation homodynamics, 20 hemodialysis patients and 20 age- gender-matched healthy control subjects underwent transcranial Doppler ultrasonography. Blood parameters were also measured simultaneously. Among hemodialysis patients, these studies were performed 48 hours after a dialysis session. Results. The mean blood flow velocity (MV values were significantly higher in the middle cerebral artery (P = .007, anterior cerebral artery (P = .003, posterior cerebral artery-segment 2 (P = .03, basilar artery (P = .05 in hemodialysis patients compared to the controls. The MV had a negative meaningful correlation with hemoglobin and hematocrit in most intracranial arteries of the patients, but no significant correlation was observed between these variables and MV of the arteries in the control group. Conclusions. The MV of the cerebral arteries significantly increases in hemodialysis patients, which could be due to the decrease in hemoglobin levels in these patients.

  9. Determination of the delivered hemodialysis dose using standard methods and on-line clearance monitoring

    Directory of Open Access Journals (Sweden)

    Vlatkovi? Vlastimir

    2006-01-01

    Full Text Available Background/aim: Delivered dialysis dose has a cumulative effect and significant influence upon the adequacy of dialysis, quality of life and development of co-morbidity at patients on dialysis. Thus, a great attention is given to the optimization of dialysis treatment. On-line Clearance Monitoring (OCM allows a precise and continuous measurement of the delivered dialysis dose. Kt/V index (K = dialyzer clearance of urea; t = dialysis time; V = patient's total body water, measured in real time is used as a unit for expressing the dialysis dose. The aim of this research was to perform a comparative assessment of the delivered dialysis dose by the application of the standard measurement methods and a module for continuous clearance monitoring. Methods. The study encompassed 105 patients who had been on the chronic hemodialysis program for more than three months, three times a week. By random choice, one treatment per each controlled patient was taken. All the treatments understood bicarbonate dialysis. The delivered dialysis dose was determined by the calculation of mathematical models: Urea Reduction Ratio (URR singlepool index Kt/V (spKt/V and by the application of OCM. Results. Urea Reduction Ratio was the most sensitive parameter for the assessment and, at the same time, it was in the strongest correlation with the other two, spKt/V indexes and OCM. The values pointed out an adequate dialysis dose. The URR values were significantly higher in women than in men, p < 0.05. The other applied model for the delivered dialysis dose measurement was Kt/V index. The obtained values showed that the dialysis dose was adequate, and that, according to this parameter, the women had significantly better dialysis, then the men p < 0.05. According to the OCM, the average value was slightly lower than the adequate one. The women had a satisfactory dialysis according to this index as well, while the delivered dialysis dose was insufficient in men. The difference between the women and the men was significant. Conclusion. The application of OCM has shown that it is the most rigorous parameter for the assessment of adequacy and that its regular use would contribute to increasing of the delivered dialysis dose and improvement of the treatment quality.

  10. Qualidade de Vida: comparação entre diálise peritoneal automatizada e hemodiálise Calidad de vida: comparación entre diálisis peritoneal automatizada y hemodiálisis Quality of Life: comparison between patients on automated peritoneal dialysis and patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Valquiria Greco Arenas

    2009-01-01

    Full Text Available OBJETIVO: Avaliar a Qualidade de Vida relacionada à saúde em pacientes submetidos à Diálise Peritoneal Automatizada (DPA e Hemodiálise em um centro de diálise satélite no Município de São Paulo. MÉTODOS: Este estudo observacional transversal, incluiu 101 pacientes com idade entre 18-75 anos, em terapia há mais de 90 dias e que compreenderam o questionário. RESULTADOS: O grupo em Hemodiálise (n=79 estava em terapia há mais tempo (p=0.001 e tinha albumina sérica maior (pOBJETIVO: Evaluar la Calidad de Vida relacionada a la salud de pacientes sometidos a Diálisis Peritoneal Automatizada (DPA y Hemodiálisis en un centro de diálisis del Municipio de Sao Paulo. MÉTODOS: Este estudio observacional transversal, incluyó a 101 pacientes con edades comprendidas entre los 18 y 75 años, que se encontraban en terapia hace más de 90 días y que comprendieran el cuestionario. RESULTADOS: El grupo en Hemodiálisis (n=79 estaba en terapia hace más de un tiempo (p=0.001 y tenía albúmina sérica mayor (pOBJECTIVE: To evaluate the health-related quality of life in patients from a satellite dialysis center in São Paulo city undergoing Automated Peritoneal Dialysis (APD or Hemodialysis. METHODS: This cross-sectional descriptive study included 101 patients with ages ranging from 18 to 75 years-old, who were in dialysis treatment over 90 days and able to understand the items of the SF-36 questionnaire in Portuguese. RESULTS: The Hemodialysis group (n=79 had been in dialysis treatment longer (p=0.001 and had higher serum albumin level (p<0.001 than the APD group (n=22. The SF-36 scores of the two groups were similar in all dimensions, except for the physical functioning dimension, on which the hemodialysis group had higher scores than the APD group (p=0.03. There were no statistically significant interactions between the SF-36 score and the other variables of the study. CONCLUSION: There were no differences in quality of life between patients on APD and patients on hemodialysis, except for the physical functioning dimension.

  11. Adesão de portadores de insuficiência renal crônica ao tratamento de hemodiálise Adhesi?n de portadores de insuficiencia renal crónica al tratamiento de hemodiálisis Adherence of chronic renal insufficiency patients to hemodialysis

    Directory of Open Access Journals (Sweden)

    Antônio Cláudio Madeiro

    2010-01-01

    Full Text Available OBJETIVO: Avaliar a adesão do cliente com insuficiência renal crônica (IRC ao tratamento de hemodiálise. MÉTODO: Estudo descritivo, quantitativo, realizado em uma unidade de hemodiálise, Fortaleza-CE, alvo foi composta de 45 clientes em hemodiálise, que participaram de uma entrevista. RESULTADOS: Constatou-se como reações dos clientes diante do diagnóstico de IRC: 58% negativas, 33% indiferentes e 9% positivas. Rea??es diante da hemodiálise: 73,4% negativas, 13,3% indiferentes e 13,3% positivas. Principais dificuldades de adesão: transporte; tempo das sessões; dor da punção da fístula; fatores financeiros; dependência de acompanhantes e déficit de conhecimento. Estratégias de adesão: medo da morte; fé em Deus; esperança de transplante e suporte familiar. CONCLUSÃO: Constatou-se que o cliente portador de IRC adere ao tratamento para sobreviver, mas muitos não se adaptam.OBJETIVO: Evaluar la adhesión del cliente, con insuficiencia renal crónica (IRC, al tratamiento de hemodiálisis. MÉTODO: Se trata de un estudio descriptivo cuantitativo, realizado en una unidad de hemodiálisis, en Fortaleza-CE; la población objeto fue compuesta de 45 clientes que realizaban hemodiálisis, los que fueron entrevistados. RESULTADOS: Delante del diagnóstico se constató como reacciones de los clientes de IRC: 58% negativas, 33% indiferentes y 9% positivas. Las reacciones delante de la hemodiálisis fueron: 73,4% negativas, 13,3% indiferentes y 13,3% positivas. Las principales dificultades en la adhesión fueron: transporte; tiempo de las sesiones; dolor de la punción de la fístula; factores financieros; dependencia de acompañantes; y, déficit de conocimiento. Las estrategias de adhesión fueron: miedo a la muerte; fe en Dios; esperanza de trasplante; y, soporte familiar. CONCLUSIÓN: Se constató que el cliente portador de IRC adhiere al tratamiento para sobrevivir, sin embargo muchos no se adaptan.OBJECTIVE: To evaluate the adherence of patients, with chronic renal failure (CRF, to hemodialysis treatment. METHOD: This is a descriptive-quantitative study, conducted in a hemodialysis unit in Fortaleza-CE, the sample population was composed of 45 clients undergoing hemodialysis, who were interviewed. RESULTS: The reactions of CRF patients confronted with the diagnosis were: 58% negative, 33% indifferent and 9% positive. The reactions related to hemodialysis were: 73.4% negative, 13.3% indifferent and 13.3% positive. The main difficulties in adhering were: transportation, length of the session, pain caused by the puncture made with the fistula, financial factors, dependence of companions, and knowledge deficit. The strategies to adhering were: fear of death, faith in God, hope for transplant, and family support. CONCLUSION: It was found that the CRF patients adhere to treatment to survive, but many do not complied.

  12. Adesão de portadores de insuficiência renal crônica ao tratamento de hemodiálise / Adherence of chronic renal insufficiency patients to hemodialysis / Adhesión de portadores de insuficiencia renal crónica al tratamiento de hemodiálisis

    Scientific Electronic Library Online (English)

    Antônio Cláudio, Madeiro; Pâmmela Dayana Lopes Carrilho, Machado; Isabela Melo, Bonfim; Adna Ribeiro, Braqueais; Francisca Elisângela Teixeira, Lima.

    Full Text Available OBJETIVO: Avaliar a adesão do cliente com insuficiência renal crônica (IRC) ao tratamento de hemodiálise. MÉTODO: Estudo descritivo, quantitativo, realizado em uma unidade de hemodiálise, Fortaleza-CE, alvo foi composta de 45 clientes em hemodiálise, que participaram de uma entrevista. RESULTADOS: C [...] onstatou-se como reações dos clientes diante do diagnóstico de IRC: 58% negativas, 33% indiferentes e 9% positivas. Reações diante da hemodiálise: 73,4% negativas, 13,3% indiferentes e 13,3% positivas. Principais dificuldades de adesão: transporte; tempo das sessões; dor da punção da fístula; fatores financeiros; dependência de acompanhantes e déficit de conhecimento. Estratégias de adesão: medo da morte; fé em Deus; esperança de transplante e suporte familiar. CONCLUSÃO: Constatou-se que o cliente portador de IRC adere ao tratamento para sobreviver, mas muitos não se adaptam. Abstract in spanish OBJETIVO: Evaluar la adhesión del cliente, con insuficiencia renal crónica (IRC), al tratamiento de hemodiálisis. MÉTODO: Se trata de un estudio descriptivo cuantitativo, realizado en una unidad de hemodiálisis, en Fortaleza-CE; la población objeto fue compuesta de 45 clientes que realizaban hemodiá [...] lisis, los que fueron entrevistados. RESULTADOS: Delante del diagnóstico se constató como reacciones de los clientes de IRC: 58% negativas, 33% indiferentes y 9% positivas. Las reacciones delante de la hemodiálisis fueron: 73,4% negativas, 13,3% indiferentes y 13,3% positivas. Las principales dificultades en la adhesión fueron: transporte; tiempo de las sesiones; dolor de la punción de la fístula; factores financieros; dependencia de acompañantes; y, déficit de conocimiento. Las estrategias de adhesión fueron: miedo a la muerte; fe en Dios; esperanza de trasplante; y, soporte familiar. CONCLUSIÓN: Se constató que el cliente portador de IRC adhiere al tratamiento para sobrevivir, sin embargo muchos no se adaptan. Abstract in english OBJECTIVE: To evaluate the adherence of patients, with chronic renal failure (CRF), to hemodialysis treatment. METHOD: This is a descriptive-quantitative study, conducted in a hemodialysis unit in Fortaleza-CE, the sample population was composed of 45 clients undergoing hemodialysis, who were interv [...] iewed. RESULTS: The reactions of CRF patients confronted with the diagnosis were: 58% negative, 33% indifferent and 9% positive. The reactions related to hemodialysis were: 73.4% negative, 13.3% indifferent and 13.3% positive. The main difficulties in adhering were: transportation, length of the session, pain caused by the puncture made with the fistula, financial factors, dependence of companions, and knowledge deficit. The strategies to adhering were: fear of death, faith in God, hope for transplant, and family support. CONCLUSION: It was found that the CRF patients adhere to treatment to survive, but many do not complied.

  13. Functional Polymorphisms in Matrix Metalloproteinases-1, -3, -9 are Associated with Arteriovenous Fistula Patency in Hemodialysis Patients

    OpenAIRE

    Lin, Chih-Ching; Yang, Wu-Chang; Chung, Ming-yi; Lee, Pui-Ching

    2010-01-01

    Background and objectives: Matrix metalloproteinases (MMPs) are risk factors for cardiovascular diseases. This study evaluated the association of genotype polymorphisms of MMPs and tissue inhibitors of metalloproteinases (TIMPs) in hemodialysis (HD) patients with arteriovenous fistula (AVF) failure.

  14. Relationships Between Registered Nurse Staffing, Processes of Nursing Care, and Nurse-Reported Patient Outcomes in Chronic Hemodialysis Units

    OpenAIRE

    Thomas-Hawkins, Charlotte; Flynn, Linda; Clarke, Sean P.

    2008-01-01

    Little attention has been given to the effects of registered nurse (RN) staffing and processes of nursing care on patient outcomes in hemodialysis units. This research examined the effects of patient-to-RN ratios and necessary tasks left undone by RNs on the likelihood of nurse-reported frequent occurrences of adverse patient events in chronic hemodialysis units. Study findings revealed that high patient-to-RN ratios and increased numbers of tasks left undone by RNs were associated with an in...

  15. Blood volume-monitored regulation of ultrafiltration in fluid-overloaded hemodialysis patients: study protocol for a randomized controlled trial

    OpenAIRE

    Hecking Manfred; Antlanger Marlies; Winnicki Wolfgang; Reiter Thomas; Werzowa Johannes; Haidinger Michael; Weichhart Thomas; Polaschegg Hans-Dietrich; Josten Peter; Exner Isabella; Lorenz-Turnheim Katharina; Eigner Manfred; Paul Gernot; Klauser-Braun Renate; Hörl Walter H

    2012-01-01

    Abstract Background Data generated with the body composition monitor (BCM, Fresenius) show, based on bioimpedance technology, that chronic fluid overload in hemodialysis patients is associated with poor survival. However, removing excess fluid by lowering dry weight can be accompanied by intradialytic and postdialytic complications. Here, we aim at testing the hypothesis that, in comparison to conventional hemodialysis, blood volume-monitored regulation of ultrafiltration and dialysate conduc...

  16. Determination of DMFT Index in Patients with End Stage Renal Disease Being Treated by Hemodialysis in Ali Asghar Medical Center

    Directory of Open Access Journals (Sweden)

    H - Khademi

    2005-01-01

    Full Text Available Introduction. End stage renal disease (ESRD is the last stage of the decending process of structural and functional distruction of kidneys. This process is often combined with acute diseases like glumerulonephritis and pyelonephritis. Uremic smell of mouth, enamel hypoplasia and defects, increase in dental debries, periodontal diseases, considerable delay in bone and dental age and fair decrease in oral hygiene are of this general oral symptoms. Despite these unfavorable factors, the recent researches indicated relatively lower DMFT index in these patients. Regarding these results, this study is trying to identify the DMFT index in the above mentioned patients.Methods. In this descriptive- analytic research, 22 patients with end-stage renal disease being treated with hemodialysis were examined. This was the total number of the patients ranging from 17 to 33 years old who were referred to Ali Asghar Medical center in Isfahan. After examining and indicating the DMFT index in these patients, they were compared with a healthy control group which were identical to the study group regarding their sex, age.Results. Comparison between the patients with ESRD being treated by