Full Text Available Background: Chronic microinflammatory state is common in the patients undergoing maintenance hemodialysis (MHD, which seriously affects the long-term survival rate of MHD patients. It is important to improve the microinflammatory state in MHD patients.Objective: To investigate the effects of oxymatrine on microinflammatory state in patients undergoing continuous hemodialysis.Design, setting, participants and interventions: Sixty MHD patients in Blood Purification Center, Wuhan No.1 Hospital, from June to September 2008, were randomized into treatment group (30 cases and control group (30 cases. Oxymatrine Capsule was orally administered to the patients in the treatment group 0.4 g once a day for 3 months, while the patients in the control group were not given oxymatrine. Main outcome measures: The serum concentrations of high-sensitivity C-reactive protein (hs-CRP, interleukin-1?(IL-1?, tumor necrosis factor-? (TNF-?, albumin (Alb, pre-albumin (PAB, total cholesterol (TC and triglyceride (TG were detected before and after 3-month treatment.Results: Three patients in the treatment group had a stomachache on the first day of treatment, and two out of the three quitted the trial. The stomachache disappeared in one patient after stopping taking the drug, and did not recur after continuing to receive the intervention. Two patients in the treatment group had skin rash with pruritus on the second day of treatment. The rash disappeared after the patients stopped taking the drug, and did not recur after continuing to receive the intervention. A total of 58 cases accessed to the statistical analysis, while 2 cases were excluded. In the treatment group, the concentrations of hs-CRP, IL-1? and TNF-? significantly decreased (P<0.01 and the mean values of Alb, PAB, TC and TG significantly increased after the treatment as compared with those before the treatment (P<0.01, but there were no significant differences in all parameters between before and after treatment in the control group. There were significant differences in all parameters between the treatment group and the control group after treatment (P<0.01, P<0.05.Conclusion: Oxymatrine can improve the microinflammatory state in the patients undergoing continuous hemodialysis.
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 RLS compared to those on HD or CAPD (p RLS rates in APD patients have not been established. PMID:25358390
Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C
Patients with end-stage renal failure (ESRF) have a high incidence of tuberculosis. Antituberculosis drug-induced ototoxicity may sometimes be a problem in these group of patients. Streptomycin is an antituberculosis drug with well-known ototoxic side effects. However, ototoxicity with combinations not including streptomycin has been reported only in a report in 7 of 42 ESRF patients undergoing hemodialysis and isoniazid has been suggested as a probable responsible drug which has well-known n...
Yerdelen, Deniz; Tan, Meliha
Full Text Available Patients with end-stage renal failure (ESRF have a high incidence of tuberculosis. Antituberculosis drug-induced ototoxicity may sometimes be a problem in these group of patients. Streptomycin is an antituberculosis drug with well-known ototoxic side effects. However, ototoxicity with combinations not including streptomycin has been reported only in a report in 7 of 42 ESRF patients undergoing hemodialysis and isoniazid has been suggested as a probable responsible drug which has well-known neurotoxic side effects. Here, we presented a 78- year-old man developed hearing loss who was on hemodialysis program and taking antituberculosis drug combination therapy including not streptomycin, but isoniazid, and the probable role of isoniazid in ototoxicity was discussed.
In a prospective observational study was compared a regional citrate anticoagulation protocol versus a standard heparin anticoagulation protocol in critically ill patients on continuous venovenous hemodialysis. We mainly focused on acid-base and electrolyte derangements as well as on filter life. 209 patients were included in study. In 33 patients citrate was used as the only anticoagalant, in 84 patients citrate was used in combination with low-dose heparin, and in 184 patiens only heparin w...
Full Text Available OBJECTIVE: The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis. PATIENTS AND METHODS: Twenty patients on peritoneal dialysis and 40 on hemodialysis were assessed, and the patients were matched according to the length of time that they had been on dialysis. Blood samples were collected (both before and after the session for those on hemodialysis to measure the enzymes and the hematocrit. RESULTS: In the samples from the patients who were undergoing peritoneal dialysis, the aspartate and alanine aminotransferase levels were slightly higher compared with the samples collected from the patients before the hemodialysis session and slightly lower compared with the samples collected after the hemodialysis session. The levels of gamma-glutamyl transferase in the hemodialysis patients were slightly higher than the levels in the patients who were undergoing peritoneal dialysis. In addition, the levels of aminotransferases and gamma-glutamyl transferase that were collected before the hemodialysis session were significantly lower than the values collected after the session. The hematocrit levels were significantly lower in the patients who were on peritoneal dialysis compared with the patients on hemodialysis (both before and after the hemodialysis session, and the levels were also significantly lower before hemodialysis compared with after hemodialysis. CONCLUSION: The aminotransferase levels in the patients who were undergoing peritoneal dialysis were slightly higher compared with the samples collected before the hemodialysis session, whereas the aminotransferase levels were slightly lower compared with the samples collected after the session. The hematocrits and the aminotransferase and gamma-glutamyl transferase levels of the samples collected after the hemodialysis session were significantly higher than the samples collected before the session. Taken together, the present data suggest that hemodilution could alter the serum levels of liver enzymes.
Isabella Ramos de Oliveira Liberato
The aim of this study was to evaluate the prevalence of aspirin resistance (AR) in patients undergoing hemodialysis (HD) and to assess the effect of HD on the results of the Multiplate test. A total of 54 patients undergoing HD were included in this study. Blood samples were taken just before and after the HD session. To determine AR, we used Multiplate test. Platelet aggregation values of the study population were 363.01 ± 225.69 aggregation unit (AU) × minutes before and 375.33 ± 254.05 AU × minutes after the HD (P = .597). There was strong correlation between the values before and after HD (R = .755, P < .0001). The AR status was changed in 9 (16.6%) patients after HD. Agreement of AR status before and after HD was substantial (? coefficient = .667, P < .0001). The prevalence of AR in patients undergoing HD seems higher than in most of the studied populations, and this study has shown that the AR statuses of a significant number of patients undergoing HD change after an HD session. PMID:23698727
Aksu, Hale Unal; Oner, Ender; Celik, Omer; Isiksacan, Nilgun; Aksu, Huseyin; Uzun, Sami; Yavuz, Derya; Ozturk, Savas; Gul, Mehmet; Uslu, Nevzat
Serum undercarboxylated osteocalcin (ucOC)/intact osteocalcin (iOC) ratio increased >1.0 in the patients undergoing hemodialysis, particularly in those with high bone turnover state. Consequently, serum ucOC/iOC ratio might lose its significance as a bone metabolic marker to indicate vitamin K deficiency in hemodialysis patients. PMID:25403902
Nagata, Y; Inaba, M; Imanishi, Y; Okazaki, H; Yamada, S; Mori, K; Shoji, S; Koyama, H; Okuno, S
This study aims to determine the prevalence, types, and associated factors for the use of herbal remedies in hemodialysis patients. Two hundred participants were selected by stratified sampling and were systematically interviewed. One hundred and twenty-six patients (63%) had used herbal remedies some time since their initiation of dialysis treatment. The users of herbal remedies had a significantly older age than nonusers, but no other significant differences were observed. The most prevalent complaints that led to herbal remedies use were gastroenterological complaints, flushing, and excessive thirst. Cichorium intybus, Borage officinalis, Mentha longifolia, and Matricaria recutita were the most prevalently used herbs in our patients. More study should be done on safety and efficacy of these herbs for hemodialysis patients. PMID:24241097
Roozbeh, Jamshid; Hashempur, Mohammad Hashem; Heydari, Mojtaba
Abstract Introduction In the treatment of secondary hyperparathyroidism of chronic kidney disease, calcimimetics - allosteric modulators of the calcium-sensing receptor - inhibit glandular hyperplasia and significantly reduce circulating parathyroid hormone levels. They have a major impact on the management of secondary hyperparathyroidism. Case presentation We present the clinical case of a 41-year-old Caucasian man undergoing chronic hemodialysis, who had a pa...
Conzo Giovanni; Perna Alessandra F; Napolitano Salvatore; Mauriello Claudio; Gambardella Claudio; Satta Ersilia; Ciancia Giuseppe; Capasso Giovanbattista; Santini Luigi
Full Text Available Purpose: To consider the effect of serum parathormone on severity of hypertension in end-stage renal failure patients undergoing hemodialysis treatment. Patients and Methods: A cross-sectional study was performed on patients with end-stage renal disease undergoing maintenance hemodialysis treatment. Serum calcium, phosphorus, alkalene phosphatase, serum albumin and intact PTH levels were measured. Stratification of hypertensive patients was performed from stage one to three. A stage of zero means the absence of hypertension. Stages of hypertension were measured before treatment and at the beginning of the first hemodialysis treatment. Results: The total number of patients was 73 (F=28 M=45, including 58 non-diabetic (F=22 M=36 and 15 diabetic hemodialysis patients (F=6 M=9. The mean age of patients was 46.5±16 years. The mean period of time that patients had spent on hemodialysis was 21.5±23.5 months. Serum iPTH of total patients was 309±349 pg/ml and serum alkaline phosphatase of total patients was 413±348 IU/L. There was a significant positive correlation between the stages of hypertension and serum iPTH levels (r=0.200; p=0.045. There was no significant correlation between the stages of hypertension and serum alkalene phosphatase levels (r=0.135; p=0.128. A significant positive correlation between stages of hypertension with Ca x P products of patients (r = 0.231; p=0.027 was also seen. Conclusion: The relationship between serum iPTH and severity of hypertension in this group requires further research on nontraditional causes of hypertension in hemodialysis patients. Hypertension and secondary hyperparathyroidism both interact in the process of accelerated atherosclerosis in hemodialysis patients. This combination may aggravate the rapid progressive athrosclerosis process
Intermittent hemodynamic instability during hemodialysis treatment is a frequent complication in patients with end-stage renal failure. A noninvasive method for continuous hemodynamic monitoring is needed. We used noninvasive digital photoplethysmography and an algorithm for continuous, investigator-independent, automatic analysis of digital volume pulse in 10 healthy subjects and in 20 patients with end-stage renal failure during the hemodialysis session. The reflective index was defined representing the diastolic component of the digital pulse wave. The properties of the reflective index were studied in healthy control subjects (n=10). An increased reflective index was due to increased peripheral pulse wave reflection (e.g., vasoconstriction). During a hemodialysis session, the reflective index increased significantly from 36+/-3 arbitrary units to 41+/-3 arbitrary units (n=20; p
Burkert, Antje; Scholze, Alexandra
Porphyria cutanea tarda (PCT) is a vesiculobullous skin disorder characterized by a defect in heme biosynthesis. Reduced activity of the hepatic enzyme uroporphyrinogen decarboxylase (URO-D) results in accumulation of photosensitive porphyrins; this ultimately leads to the skin fragility and blistering that is characteristic of this disease. The majority of cases of PCT are associated with acquired deficiencies of the enzyme URO-D, secondary to hepatic injury precipitated by medications or infections. Less commonly, PCT has been documented in patients with end-stage renal disease. The pathogenesis of PCT in long-term hemodialysis (HD) has been attributed to many factors, but the following mechanisms have been implicated: (i) decreased hepatic URO-D activity due to suppressive effects of iron and other hepatotoxins and (ii) poor porphyrin clearance by renal replacement therapies. We report a case of PCT that developed in a patient on maintenance HD for 4 years. He had a history of hepatitis C and evidence of iron overload. However, as the patient was anemic, therapeutic phlebotomy was problematic and therefore erythrocyte-stimulating agents were maximized to mobilize iron stores and allow phlebotomy. With this treatment, the patient's skin lesions improved in conjunction with decreasing ferritin levels. PMID:20331820
Ryali, Madhavi E; Whittier, William L
Severe systemic infections are one of the leading causes of death in patients with end-stage renal disease and are often associated with hospitalization. Since bacteria can be identified in used hemofilters in an ICU setting, it was investigated whether this method might be useful in patients undergoing regular intermittent hemodialysis. By analyzing used hemodialyzers in (n = 13) patients, we identified systemic bacteremia in two patients (15.4%) while corresponding blood cultures were negative. In two further patients, positive microbiological findings from hemodialyzers appeared to be of unclear clinical relevance. Cultures from hemodialyzers might be an add-on approach for the identification of bacteria in the blood stream of patients undergoing regular intermittent hemodialysis. PMID:23918272
Otto, Gordon P; Kropf, Madlen; Rödel, Jürgen; Lösche, Wolfgang; Rüster, Christiane; Claus, Ralf A; Sossdorf, Maik; Busch, Martin
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. PMID:23018400
Orlandi, Fabiana de Souza; Pepino, Barbara Garbelotti; Pavarini, Sofia Cristina Iost; Dos Santos, Damiana Aparecida; de Mendiondo, Marisa Silvana Zazzetta
Infections are frequent complications in end-stage renal failure patients undergoing hemodialysis (HD), and peripheral blood monocytes are important cells in host defense against infections. The majority of circulating monocytes express high levels of lipopolysaccharide receptor antigen CD14 and are negative for the immunoglobulin Fc? receptor type III (CD16). We studied the occurrence of a minor subpopulation coexpressing low levels of CD14 together with CD16 in HD patients. In healthy cont...
Nockher, Wolfgang Andreas; Scherberich, Ju?rgen E.
Full Text Available Background & Aim: Medication usage is the bases of disease management in patients who undergo hemodialysis. Non-adherence to medication regimen increases the incidence of complications among the patients . The aim of this study was to investigate the effect of a cognitive-behavioral intervention on medication adherence in patients undergoing hemodialysis . Methods & Materials: In this clinical trial, 70 patients were selected from Imam Reza and Valiasr hospitals. Patients were assigned into two intervention (n=35 and control (n=35 groups. The intervention group received a cognitive-behavioral intervention including six steps: 1 Identifying the problem; 2 Creating confidence and commitment; 3 Increasing awareness of behavior; 4 Developing and implementing the action plan; 5 Evaluating the plan; and 6 Maintaining the desired behavior. Adherence to medication regimen was assessed using a self-report questionnaire before and immediately after the intervention. Data were analyzed using the independent t-test . Results: At baseline, there was no significant difference in adherence to medicine regimen between the intervention (20.77 ± 4.56 and control (22.34 ± 3.65 groups (P=0.1. After the intervention, significant difference was observed between the two groups in adherence to medication regimen (P<0.001 . Conclusion: Cognitive–behavioral intervention could improve medication adherence in patients undergoing hemodialysis. It is recommended for nurses to use this approach to improve medical care among the patients .
The pharmacokinetics of piperacillin administered intravenously were studied in five patients with stable mild to moderate renal impairment and in five patients undergoing hemodialysis. Patients with stable renal failure given 1 g of piperacillin intravenously had peak serum concentrations within 30 min ranging from 78 to 280 micrograms/ml. The mean serum half-life was 3.57 +/- 1.36 h; the mean apparent volume of distribution was 28.6 +/- 13.5 liters/100 kg; and the plasma clearance was 4.10 ...
Giron, J. A.; Meyers, B. R.; Hirschman, S. Z.; Srulevitch, E.
The aim of the present study was to investigate the effects of three blood purification methods on fibroblast growth factor-23 (FGF-23) clearance in patients with hyperphosphatemia undergoing maintenance hemodialysis (MHD). In addition, the correlation between serum FGF-23 and phosphorus (Pi) levels and the clinical implications were identified. Sixty-five MHD patients with hyperphosphatemia were randomly divided into three groups: Hemodialysis, HD (n=23); hemodiafiltration, HDF (n=21); and hemodialysis+hemoperfusion, HD+HP (n=21) groups. Serum Pi, FGF-23, blood urea nitrogen, serum creatinine and associated bio-marker levels were measured prior to and following treatment. The expression level of serum FGF-23 was observed to be positively correlated with Pi (r=0.45, PHDF and HD+HP groups (PHDF may be an effective method for clearing serum FGF-23 in MHD patients exhibiting hyperphosphatemia. PMID:24669256
Miao, Li-Ying; Zhu, Bin; He, Xiao-Zhou; Liu, Jin-Feng; Jin, Li-Na; Li, Xiu-Rong; Xue, Li-Na; Huang, Tian; Shen, Jian-Qin; Xing, Chang-Ying
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
Metabolic syndrome confers an increased risk of cardiovascular disease (CVD) in the general population. The relationship between adiponectins, and clinical outcomes in patients undergoing hemodialysis remains controversial. We investigated whether adiponectins, biomarkers of inflammation, nutrition status and clinical features predict the mortality of patients undergoing hemodialysis for 6 years. We measured baseline plasma total and high-molecular-weight (HMW) adiponectins, tumor necrosis factor (TNF)-?, serum high sensitivity C-reactive protein (hsCRP), and clinical characteristics including visceral fat area (VFA) and the Geriatric Nutritional Risk Index (GNRI) in 133 patients undergoing chronic hemodialysis. Forty-one of the 133 patients died during follow-up. The deceased patients were significantly older, had more prior CVD and diabetes, higher TNF-? and hsCRP levels but lower GNRI. VFA, and total and HMW adiponectin did not significantly differ between the two groups. TNF-? and hsCRP levels and GNRI score were significant for predicting all-cause and cardiovascular mortality in receiver operating curve analyses. When stratified by a GNRI score of 96, Cox proportional hazards analyses identified TNF-? as a significant predictor of all-cause mortality (hazard ratio [HR] 1.23; P?=?0.038) and hsCRP as a significant predictor of all-cause and cardiovascular mortality (HR, 2.32, P?=?0.003; HR 2.30, P?=?0.012, respectively) after adjusting for age, sex, diabetes mellitus, and prior CVD, only in malnourished patients. These results demonstrate that malnutrition and the inflammatory markers TNF-? and hsCRP, but not metabolic markers, including VFA and adiponectins have a significant impact on 6-year all-cause and cardiovascular mortality in Japanese patients undergoing hemodialysis. PMID:25196142
Nakagawa, Naoki; Matsuki, Motoki; Yao, Naoyuki; Hirayama, Tomoya; Ishida, Hironori; Kikuchi, Kenjiro; Hasebe, Naoyuki
Full Text Available Abstract Introduction In the treatment of secondary hyperparathyroidism of chronic kidney disease, calcimimetics - allosteric modulators of the calcium-sensing receptor - inhibit glandular hyperplasia and significantly reduce circulating parathyroid hormone levels. They have a major impact on the management of secondary hyperparathyroidism. Case presentation We present the clinical case of a 41-year-old Caucasian man undergoing chronic hemodialysis, who had a parathyroidectomy to treat severe secondary hyperparathyroidism resistant to cinacalcet treatment. Preoperatively, 24 months after high-dose cinacalcet hydrochloride, we observed a persistently elevated intact parathyroid hormone serum level, and detected clear parathyroid gland hyperplasia regression on ultrasound. We performed a three-gland parathyroidectomy, which was assumed to be total, associated with a hemithyroidectomy. Our patient then entered a hypoparathyroid state. A histopathological examination showed that the removed parathyroid glands were of small size, with a total weight of 1g, associated with a multifocal small papillary thyroid cancer. Conclusion In the management of secondary hyperparathyroidism, cinacalcet hydrochloride effectively reduces total parathyroid gland hyperplasia. However, a persisting elevated intact parathyroid hormone serum level may be observed, demonstrating that reduced parathyroid hyperplastic tissue may still be associated with severe secondary hyperparathyroidism. Even if calcimimetics are very effective in secondary hyperparathyroidism treatment, further studies are necessary for a better understanding of their actions.
We aimed to study the vascular outcomes in hemodialysis (HD) patients based on their diabetic status. A cohort observational study was conducted among patients undergoing regular HD with a 5-year follow-up. Of the 252 consecutive HD patients, 60% were diabetic. Compared with nondiabetics, diabetics were 11 years older, 4 years lesser on HD, and more likely to have prior cerebrovascular and coronary artery disease (CAD). Overall 5-year follow-up showed that diabetic patients had higher rates of HD vascular accesses (57% vs 41%, P = .01), CAD (64% vs 33%, P = .001), major amputations (8.6% vs 0%, P = .003), and mortality (66% vs 23%, P = .001). On multivariate analysis, independent predictors of mortality included number of vascular accesses in nondiabetics and HD duration, CAD, and peripheral artery disease in diabetic patients. Diabetes mellitus is associated with a significant vascular burden and mortality among HD patients. Moreover, our finding highlights the vascular impact of renal failure and HD. PMID:24576984
Al-Thani, Hassan; Shabana, Adel; Hussein, Ahmed; Sadek, Ahmed; Sharaf, Ahmed; Koshy, Valsa; El-Menyar, Ayman
Full Text Available Aim Today health services aim to provide a higher level of life quality to individuals as much as possible and not being limited only to providing a good treatment. In this context it was aimed to evaluate the life quality and the factors affecting this in chronic renal failure (CRF patients undergoing hemodialysis. Materials and method A total of 144 adult patients with CRF from two dialysis centers in Adana, one private and one in a University, were included in the study. A questionnaire investigating demographic characteristics and short form health survey “SF-36” were filled by face-to-face interview technique. Findings Male to female ratio of the participants was 91(63.2% to 53(36.8%. The mean dialysis history was calculated as 44.4±34.3 months. One to six other diseases were recorded with a mean number of 2.9±1.1 to be concurrent to CRF. SF-36 revealed a health status score mean (TS=total score of 48.1±21.8, with physical status scale (PSS score mean of 46.0±21.1 and mental status scale (MSS score mean of 50.3±22.0. The same scores were calculated to be significantly lower in females (with 40.4, 39.8 and 38.0, respectively in comparison to males (with 52.5, 50.3 and 50.6, respectively (p<0.05. As SF-36 scores lower than 51 were reported to be “low”, and even to be predictive of risky situations, when the risk effects of factors like age, gender, marital status, educational status, length of dialysis history and presence of concurrent diseases were investigated, only lower educational status and the number of concurrent diseases were found to be significant for the risk increase. Conclusion In the context of preventive medicine, optimum functionality is a secondary prevention in chronic diseases. Life quality indexes are not only important evaluators of the functionality, but they play a major role in the prevention of mortality, too. Hence health surveys like SF-36, based on patient’s reporting, are suggested to be introduced in evaluations, not being limited to the evaluations based on performance scoring only. Key words: Hemodialysis, Chronic renal failure, Life quality [TAF Prev Med Bull 2012; 11(4.000: 383-388
OBJECTIVE: Acute kidney injury (AKI) is a frequent complication of hospitalized patients that is associated with high mortality rate despite all developments. Continuous and intermittent hemodialysis are renal replacement treatment modalities for AKI. In our study we aimed to compare the mortality rates of continuous hemodialysis (CHD) and intermittent hemodialysis (IHD) in hospitalized patients.MATERIAL and METHODS: Seventy-two patients in Uludag University Hospital diagnosed with AKI in 200...
Oruc?, Ays?egu?l; Ersoy, Alparslan; Hoyrazli, Ays?e; Altinay, Tu?may; Aktas?, Nimet; Yildiz, Abdu?lmecit; Gu?l, Cuma Bu?lent; Gu?llu?lu?, Mustafa
The clinical course and aluminum status of 38 patients who had been receiving dialysis for at least eight years and were still undergoing dialysis in 1985 were evaluated. Twenty-nine had evidence of increased aluminum burden, although only three had evidence of overt aluminum toxicity, and nine did not have evidence of increased aluminum burden. The patients in both the high- and low-aluminum group were similar with regard to age, the cause of their renal failure, presence of hypertension or coronary artery disease, previous parathyroidectomy, and a number of biochemical parameters, along with the amount of prescribed aluminum. All patients were followed up for the next two years or until they died. The amount of ingested aluminum was reduced, and in selected patients, treatment with intermittent infusions of deferoxamine mesylate was instituted. There were no deaths in the low-aluminum group, but ten of 29 died in the high-aluminum group: seven of vascular disease and three of infection. In addition, morbidity as defined by hospitalization for coronary or cerebral vascular disease or infection occurred in only two of the nine patients in the low-aluminum group and in 19 of the 29 patients in the high-aluminum group. These observations imply that the occurrence of increased body aluminum, as suggested by aluminum blood levels or by results of bone biopsies in some patients, has an adverse effect on morbidity and mortality and should be considered as a possible independent risk factor in patients who are receiving long-term hemodialysis.
Chazan, J.A.; Blonsky, S.L.; Abuelo, J.G.; Pezzullo, J.C.
Pseudomonas oryzihabitans (P.?orizyhabitans) has already been reported both as a human and a zoonotic pathogen. A few cases of?P.?orizyhabitans bacteremia have been reported among patients who underwent peritoneal dialysis. P.?orizyhabitans bacteremia has never been reported among patients on hemodialysis. We report the first case of P.?orizyhabitans bacteremia in a chronic hemodialysis patient; this patient did not have a central venous catheter angioaccess as a potential portal of entry. PMID:24612459
Hellou, Elias; Artul, Suheil; Omari, Sohaib; Taha, Mohamad; Armaly, Zaher; Nseir, William
To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3+-7.5) chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 C) temperature dialysis solution. During the study, all the dialysis conditions were maintained the same except cooling the dailysate from 37C to 35C. Hemodynamic parameters including SBP, DBP and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic and mean arterial pressure decreased significantly during standard compared to cool dialysis. Maximum decrease of systolic, diastolic and mean arterial pressure was observed during the third hour of dialysis and magnitude of decrease was 18, 17 and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialysis levels decreased significantly with cool and standard temperature dialysate (59+-5 vs. 37+-4, and 63+-7 vs. 41+-5, umol/L respectively, P<0.01). Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than increased serum nitric oxide levels may be involved in hm nitric oxide levels may be involved in hemodialysis hypotension in this group of patients. (author)
By using ELISA and assay of MTT participating in IL-6 dependent cell clone. The authors measured the circulating levels of soluble IL-2 receptor (sIL-2R) and IL-6 in patients undergoing hemodialysis (HD). Alterations of the above-mentioned parameters before and after a three-month course of treatment with Chinese drug Epimedium sagittatum on the same HD patients. It is confirmed that in patients with end-stage renal failure (ESRF), sIL-2R level elevated significantly, while IL-6 level decreased apparently (P Epimedium sagittatum. These findings indicated not only the presence of immunodeficiency in ESRF, but also the effectiveness of regulation with Chinese drug Epimedium sagittatum. PMID:7796653
Chen, X; Zhou, M; Wang, J
Full Text Available Introduction: To describe the outcome of the sapheno-femoral fistula as an alternative blood access site for maintenance hemodialysis in a prospective cohort of patients with end - stage renal failure. Methods: Twenty-two patients with vascular access failure in the arms were admitted for establishing sapheno-femoral fistula as a puncture site for hemodialysis. The major saphenous vein was exposed at the junction site with femoral vein and its tributary veins were ligated . The saphenous vein was isolated and mobilized throughout the thigh and end to side anastomosis accomplished with the superficial femoral artery by a running 6-0 prolene suture after conducting the vein through a subcutaneous tunnel. Results: Failure rate of saphenofemoral fistula was 22. 7% at two years follow up. Mean ± SE survival of fistula was 16.4+/- 2.75 months. Significant survival difference wasn’t seen between two sexes. Rate of wound infection and chronic pain of surgery site was similar( 9.1%. Conclusions: Two-year survival rate of 77% and morbidity less than 10% leads to suggestion of saphenofemoral fistula as an alternative for upper extremity fistulas in end- stage renal failure patients
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.
Hamed Enas A
Pyogenic liver abscess (PLA) is a process with significant morbidity and mortality and is a rare complication in an aisled way in patients with autosomal dominant polycystic kidney disease (ADPKD). In addition to hepatic cyst infection, intracystic hemorrhage is another complication seen in ADPKD patients; however, the liver parenchyma itself remains normal. A PLA located in normal liver tissue in these kinds of patients has not been previously reported. Fusobacterium nucleatum is an anaerobic bacterium with rare involvement other than in periodontal infections. A 58-year-old Caucasian male, who was on hemodialysis treatment from July 2004 due to end-stage renal disease secondary to ADPKD, was admitted with fever, rigor, chills, weakness, and abdominal pain of 10 days duration. During that time, ciprofloxacin 500 mg, twice daily, gentamycin 80 mg/48 h, and vancomycin 1 g/week, were prescribed, but treatment was interrupted by hospitalization. Physical examination on admission revealed that the patient had a fever of 39.8 degrees C, pallor, chills, right upper quadrant abdominal pain, and hepatosplenomegaly. Abdominal ultrasound revealed a 5.3 cm diameter collection with irregular configuration located in the caudate lobe. Abdominal computed tomography (CT) showed a large multiloculated hepatic collection. The PLA was managed with antibiotics (metronidazole) and continuous catheter drainage (8Fr drainage catheters [Abocath-T, Abbott, Sligo, Ireland]) into the abscess. Fluid culture was positive for F. nucleatum. Complete remission was obtained after 12 days without complications. We describe a PLA by F. nucleatum, in a very rare location in an ADPKD patient undergoing hemodialysis without complicated cysts, managed with antibiotics and percutaneous drainage with satisfactory resolution. PMID:18257820
Cigarrán, Secundino; Neches, Carmen; Lamas, José María; García-Trio, Gerardo; Alonso, Mario; Saavedra, Jesus
Teh pharmacokinetics of gentamicin were studied in seven chronic renal failure patients undergoing continuous ambulatory peritoneal dialysis. Patients received 100 mg of gentamicin in 2 liters of dialysate during an initial pass, and serum and dialysate samples were collected for gentamicin determination. Approximately 49% of the amount introduced into the peritoneal cavity was absorbed systemically during a 6-h cycle. Subsequent clearance of gentamicin from the serum occurred slowly with an ...
Pancorbo, S.; Comty, C.
Dosing of cefepime during high blood flow (Qb; 300 ml/min), high dialysate flow (Qd; 3 liter/h) continuous venovenous hemodialysis (CVVHD) is undefined. Six patients on CVVHD had serum and effluent cefepime concentrations measured at 0.5, 1, 2, 6, and 12 h after dosing. Three patients had cefepime concentrations less than the MIC for Pseudomonas aeruginosa. A dose of 2,000 mg every 12 h or 1,000 mg every 8 h may increase time at a therapeutic concentration.
Wilson, F. Perry; Bachhuber, Marcus A.; Caroff, Daniel; Adler, Rebecca; Fish, Douglas; Berns, Jeffrey
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A deficiência renal crônica é uma doença sistêmica que provoca a perda da autonomia do paciente, levando-o a limitações físicas, restrições laborais e também a perdas sociais. Pacientes com esse tipo de patologia geralmente são submetidos a sessões regulares de hemodiálise, um tratamento rigoroso e [...] debilitante. O objetivo deste estudo foi investigar o nível de estresse e a ansiedade de pacientes submetidos à hemodiálise no Instituto do Rim de Natal, no 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.
Lionezia dos Santos, Valle; Valéria Fernandes de, Souza; Alessandra Mussi, Ribeiro.
Aim: To investigate the prognosis and to clarify the predictors of both patient and limb survival among hemodialysis (HD) patients with critical limb ischemia (CLI) due to isolated below-the-knee (BK) disease.Methods: An observational cohort study, analyzing a total of 546 HD patients with 681 limbs who underwent endovascular treatment (EVT) for CLI with isolated BK disease at 11 hospitals in Japan between March 2004 and June 2011, was performed.Results: The mean patient age was 69.0±9.5 years, and 420 (76.9%) of the subjects were men. The number of patients classified with Rutherford stage 4, 5 and 6 disease was 103 (18.9%), 332 (60.8%) and 111 (20.3%), respectively. The mean HbA1c level was 6.48±1.20%, and 195 (35.7%) of the subjects were active smokers. During the follow-up period (mean: 557.5 days), 191 (35.0%) patients died and 82 (12.0%) limbs underwent major amputation. The freedom from all-cause death was 75.5%, 53.4% and 36.9% and freedom from major amputation was 86.7%, 83.9% and 83.9% at one, three and five years after EVT, respectively. Cox proportional hazard regression analyses revealed that a non-ambulatory status, low serum albumin level and ?2 runoff vessels after EVT were significant predictors for both all-cause death and major amputation.Conclusions: Although patient survival remains poor, the limb salvage rate after EVT is favorable among those on HD with CLI due to isolated BK disease. The present results allow for the risk stratification of HD patients with CLI undergoing EVT for isolated BK disease. PMID:25346201
Suematsu, Nobuhiro; Iida, Osamu; Takahara, Mitsuyoshi; Yamauchi, Yasutaka; Soga, Yoshimitsu; Nakano, Masatsugu; Hirano, Keisuke; Kawasaki, Daizo; Yamaoka, Terutoshi; Suzuki, Kenji; Shintani, Yoshiaki; Miyashita, Yusuke; Tazaki, Junichi; Meno, Hiroshi; Inou, Tetsuji
Full Text Available OBJECTIVE: Acute kidney injury (AKI is a frequent complication of hospitalized patients that is associated with high mortality rate despite all developments. Continuous and intermittent hemodialysis are renal replacement treatment modalities for AKI. In our study we aimed to compare the mortality rates of continuous hemodialysis (CHD and intermittent hemodialysis (IHD in hospitalized patients.MATERIAL and METHODS: Seventy-two patients in Uludag University Hospital diagnosed with AKI in 2008 were enrolled our study. Intermittent or continuous hemodialysis was prescribed by the nephrology counsultant. Data were recorded from patients files retrospectively.RESULTS: Patients were divided into two groups (38 IHD, 34 CHD. Mortality rate (52,6%, 88,2%, oligoanuria (63.2%, 94.1%, positive inotrope therapy (28.9%, 85.3%, sepsis (15.8%, 55.9%, mechanical ventilation (15.8%, 76.5%, rate of surgery (2.6%, 32.4% and the SOFA score (7.1, 9.5 were significantly higher in CHD group.CONCLUSION: The mortality rate was higher in CHD group, and this might be associated with the greater severity of problems such as hemodynamic instability, multi-organ dysfunction and co-morbid diseases in this group.
Full Text Available Malnutrition is a main problem in undergone hemodialysis patients. Early diagnosis is important and life saving. Using anthropometric indices can help for rapid diagnoses. This study was done to compare anthropometric indices with biochemical parameters. We monitored 60 patients that underwent hemodialysis in Shaheed Rahnemoon hospital. Biochemical parameters and anthropometric indices were measured and compared. On the basis of anthropometric indices, BMI, TSF, MAC; malnutrition prevalence was 18.3%, 21.7%, 28% respectively. By using biochemical parameters include albumin, transferrin, cholesterol, Creatinine and white blood cell Count malnutrition prevalence was 8.3%, 15%, 13%, 10%, 8.3% respectively. Only MAC index has a positive correlation with serum transferrin (r=0.169, p=0.002. Sensitivity and specificity of this test is 40% and 53.33% respectively. Its Negative predictive value is 84.21%. MAC index can be used as a reliable test for rule outing malnutrition in chronic undergone hemodialysis Patients.
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
Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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.
Marcos Frank, Bastiani; Graziella Gasparotto, Baiocco; Sandrine Comparsi, Wagner.
During an outbreak of methanol poisonings in the Czech Republic in 2012, we were able to study methanol and formate elimination half-lives during intermittent hemodialysis (IHD) and continuous veno-venous hemodialysis/hemodiafiltration (CVVHD/HDF) and the relative impact of dialysate and blood flow rates on elimination. Data were obtained from 11 IHD and 13 CVVHD/HDF patients. Serum methanol and formate concentrations were measured by gas chromatography and an enzymatic method. The groups were relatively comparable, but the CVVHD/HDF group was significantly more acidotic (mean pH 6.9 vs. 7.1 IHD). The mean elimination half-life of methanol was 3.7 and formate 1.6?h with IHD, versus 8.1 and 3.6?h, respectively, with CVVHD/HDF (both significant). The 54% greater reduction in methanol and 56% reduction in formate elimination half-life during IHD resulted from the higher blood and dialysate flow rates. Increased blood and dialysate flow on the CVVHD/HDF also increased elimination significantly. Thus, IHD is superior to CVVHD/HDF for more rapid methanol and formate elimination, and if CVVHD/HDF is the only treatment available then elimination is greater with greater blood and dialysate flow rates. PMID:24621917
Zakharov, Sergey; Pelclova, Daniela; Navratil, Tomas; Belacek, Jaromir; Kurcova, Ivana; Komzak, Ondrej; Salek, Tomas; Latta, Jiri; Turek, Radovan; Bocek, Robert; Kucera, Cyril; Hubacek, Jaroslav A; Fenclova, Zdenka; Petrik, Vit; Cermak, Martin; Hovda, Knut Erik
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese INTRODUÇÃO: Pacientes com doença renal crônica (DRC) em diálise têm como principal causa de morte doença cardiovascular (DCV) aterosclerótica, tendo a inflamação e a disfunção endotelial relação direta com a aterosclerose. Além disso, a infecção pelo vírus da hepatite C (HCV), comum nestes pacientes [...] , seria outro fator de piora do estado inflamatório. Níveis aumentados de marcadores de disfunção endotelial são encontrados em pacientes com DRC e hepatite C, e poderiam ser importantes marcadores de aterosclerose nestes indivíduos. OBJETIVO: Comparar atividade endotelial de pacientes em hemodiálise com e sem hepatite C. METODOLOGIA: Selecionamos 28 pacientes em hemodiálise que foram divididos em dois grupos: 1-HCV(+): 18 pacientes (anti-HCV[+] e PCR[+]) e 2-HCV(-): 10 pacientes (anti-HCV[-]). Antes da primeira diálise da semana foi coletada amostra de sangue para dosagem sérica de molécula de adesão intercelular-1 (ICAM-1), fator de crescimento vascular endotelial (VEGF), aspartato alanina aminotransferase (ALT) e tempo de atividade da protrombina (TAP) dos grupos. RESULTADOS: Os níveis de ICAM-1 foram elevados em 60,71%, sendo maiores no grupo HCV(+), porém não estatisticamente significativos (p = 0,2024). Não houve correlação entre os níveis de ICAM-1 e tempo de diálise ou níveis de ALT em nenhum dos grupos. Já os níveis de VEGF foram normais em 92,85%; apenas dois pacientes HCV(+) tinham níveis elevados. Também não houve correlação com tempo de diálise ou níveis de ALT em nenhum grupo. CONCLUSÃO: Pacientes em hemodiálise possuem elevada lesão endotelial, porém a presença de infecção crônica pelo HCV não se mostrou um fator agravante deste quadro. Este resultado pode ter ocorrido por conta do pequeno número de pacientes, sendo necessárias análises com maior número de indivíduos para conclusões mais definitivas. Abstract in english INTRODUCTION: Chronic renal patients undergoing hemodialysis treatment have cardiovascular atherosclerotic disease as the main cause of death. Inflammation and endothelial dysfunction are directly associated with atherosclerosis. Furthermore, the infection resulting from hepatitis C virus, common am [...] ong such patients, would be another worsening factor of the inflammatory state. Increased levels of endothelial dysfunction markers are found in chronic renal disease and hepatitis C, which could be important markers of atherosclerosis among these subjects. OBJECTIVE: To compare endothelial activity in patients undergoing hemodialysis with and without hepatitis C. METHODOLOGY: We selected 28 patients undergoing hemodialysis and classified them into two groups: 1-HCV(+): 18 patients (anti-HCV[+] and PCR[+]) and 2-HCV(-): 10 patients (anti-HCV[-]). Before the first weekly dialysis, blood samples from both groups were collected for ICAM-1, VEGF, ALT and TAP serum dosage. RESULTS: ICAM-1 levels were high in 60.71%. The highest levels were found in HCV(+) group, though not statistically significant (p = 0.2024). There was no correlation between ICAM-1 levels and the hemodialysis time or ALT levels in any group. On the other hand, VEGF levels were normal in 92.85%. Only two patients HCV(+) had high levels. There was also no correlation between VEGF levels and the dialysis time or ALT levels. CONCLUSION: Patients undergoing hemodialysis have high endothelial lesion, nevertheless, the presence of HCV chronic infection did not prove to be an aggravating factor. This result may be due to the small number of patients, hence further analyses with a larger sample are required for definitive conclusions.
Cláudia Maria Pereira, Alves; Maria do Carmo Borges, Teixeira; Maria Cristina De, Martino.
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 ech...
Krotin Mirjana; Vukovi? Dejana; Stojanovi? Olivera; Milovanovi? Branislav; ?eleketi? Dušica; Blagojevi? Radmila
Full Text Available Introduction: To investigate the role of 25-OHD as a marker of nutrition and its association with mineral metabolism and serum parathormone secretion in end-stage renal failure patients undergoing regular hemodialysis (HD, a cross sectional study was carried out on a group of maintenance hemodialysis patients. Material and methods: Serum 25-hydroxy (25-OH vitamin D levels, Intact serum PTH (iPTH and also serum C-reactive protein(CRP, calcium, phosphorus and alkaline phosphatase (ALP were measured. Results: In the study, significant differences of serum 25-OH vitamin D between diabetic and non-diabetics of male dialysis patients with more values in nondiabetic HD patients and a significant positive correlation of serum 25-OH vitamin D with BMI and also a near significant inverse correlation of serum 25-OH vitamin D with serum phosphorus were found, also a significant inverse correlation of serum 25-OH VitD with serum calcium was seen, too. Moreover, a weakly significant inverse correlation of serum 25-OH vitamin D with serum iPTH was seen, too. In this study no significant association between serum 25-OH vitamin D with serum albumin, CRP, ALP, dialysis adequacy and ages of the patients, duration and sessions of dialysis were found. Conclusions: In hemodialysis patients, low serum 25-OHD levels could be a risk factor for secondary hyperparathyroidism. Serum 25-OHD could show the nutritional status of HD patients. In dialysis patients, we suggest that the plasma levels of 25-OHD are maintained around the upper limit of the reference range of sunny countries.
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A avaliação da composição corporal de pacientes com insuficiência renal crônica em hemodiálise é de suma importância para propiciar uma conduta clínica e nutricional adequada, de forma a contribuir para a redução da elevada taxa de morbidade e mortalidade observada nesta população. No entanto, fator [...] es relacionados à doença tais como anormalidades no estado de hidratação e presença de osteodistrofia renal, podem afetar a validade das técnicas de avaliação da composição corporal de pacientes com insuficiência renal crônica. Apesar dos inúmeros métodos de análise de composição corporal existentes, a maioria apresenta limitações para utilização na prática clínica da população em hemodiálise. Este artigo tem como objetivo revisar os métodos de composição corporal de fácil aplicabilidade na rotina clínica dos pacientes em hemodiálise tais como a somatória de pregas cutâneas, a bioimpedância elétrica e a interactância do infravermelho próximo. Abstract in english The evaluation of body composition in chronic renal failure patients on hemodialysis is of paramount importance for an adequate clinical and nutritional intervention, so that it can contribute to reduce the high morbidity and mortality observed in this population. However, factors related to the dis [...] ease process, such as abnormalities in the hydration status and presence of renal osteodystrophy, may affect the validity of body composition evaluation techniques in patients with chronic renal failure. Although there are a number of studies concerning body composition analysis methods, the majority presents limitations for utilization in clinical practice of the hemodialysis population. This paper aims to review the methods of body composition analysis that are easily applicable in the clinical routine of hemodialysis patients, such as the sum of skinfold thicknesses, bioelectrical impedance analysis and near-infrared interactance.
Maria Ayako, Kamimura; Sérgio Antônio, Draibe; Dirce Maria, Sigulem; Lílian, Cuppari.
Background and objectives
Hemodialysis is one of the therapeutic modalities of the end stage renal disease (ESRD). As inadequate dialysis is considered a risk factor leading to higher morbidity and mortality, determination of adequacy of dialysis is necessary. This study was conducted to determine adequacy of dialysis in continuous hemodialysis patients in Kamkar and Hazrat Vali Asr Hospitals in the state of Qom, Iran.
Mousavi Movahed, S. M.
Objectives Health Avatar Beans was for the management of chronic kidney disease and end-stage renal disease (ESRD). This article is about the DialysisNet system in Health Avatar Beans for the seamless management of ESRD based on the personal health record. Methods For hemodialysis data modeling, we identified common data elements for hemodialysis information (CDEHI). We used ASTM continuity of care record (CCR) and ISO/IEC 11179 for the compliance method with a standard model for the CDEHI. According to the contents of the ASTM CCR, we mapped the CDHEI to the contents and created the metadata from that. It was transformed and parsed into the database and verified according to the ASTM CCR/XML schema definition (XSD). DialysisNet was created as an iPad application. The contents of the CDEHI were categorized for effective management. For the evaluation of information transfer, we used CarePlatform, which was developed for data access. The metadata of CDEHI in DialysisNet was exchanged by the CarePlatform with semantic interoperability. Results The CDEHI was separated into a content list for individual patient data, a contents list for hemodialysis center data, consultation and transfer form, and clinical decision support data. After matching to the CCR, the CDEHI was transformed to metadata, and it was transformed to XML and proven according to the ASTM CCR/XSD. DialysisNet has specific consideration of visualization, graphics, images, statistics, and database. Conclusions We created the DialysisNet application, which can integrate and manage data sources for hemodialysis information based on CCR standards. PMID:24872913
Ku, Ho Suk; Kim, Sungho; Kim, HyeHyeon; Chung, Hee-Joon; Park, Yu Rang
Ifosfamide is an alkylating agent used to treat different types of malignancies including lymphomas, sarcomas and germinal cell tumors. Symptoms of ifosfamide neurotoxicity can range from mild confusion, dizziness and hallucination to overt encephalopathy. Various treatment options like methylene blue, albumin infusion and rarely hemodialysis have been used to treat ifosfamide neurotoxicity. We hereby report a case of a patient with relapsed diffuse large B cell lymphoma who received methylene blue after experiencing acute renal failure and encephalopathy due to ifosfamide with no improvement. The prompt use of hemodialysis in this case has led to reversal of both renal failure and neurotoxicity. PMID:23135805
Cherry, Mohamad A; Bhardwaj, Himanshu; Hopps, Sarah; Srour, Samer; Pant, Shubham
Full Text Available OBJETIVO: Analisar os efeitos do comportamento alimentar, entre o hábito de jantar ou não jantar, no perfil de ingestão de macronutrientes e micronutrientes de pacientes com insuficiência renal crônica em hemodiálise. MÉTODO: Estudo transversal em uma clínica de diálise de Belo Horizonte, em Minas Gerais. Participaram do estudo 90 pacientes em tratamento hemodialítico. Foram coletados dados pessoais, clínicos e dietéticos (registro alimentar de três dias. Foi considerado jantar uma refeição completa e não jantar a sua ausência ou substituição por lanches. As estimativas das quantidades de nutrientes ingeridos foram feitas em software específico Dietwin®. RESULTADOS: Os valores de carboidrato, tiamina, riboflavina, ácido ascórbico, cálcio e selênio ingeridos não apresentaram diferença entre os grupos de pacientes que jantavam e não jantavam (p > 0,05. Os valores de Índice de Massa Corporal (IMC, energia, proteína, lipídeos, niacina, ácido pantotênico, piridoxina, ácido fólico, cobalamina, potássio, fósforo, zinco e magnésio ingeridos apresentaram diferença entre estes mesmos grupos (p INTRODUCTION: To assess the effects of the habit of having evening dinner on the dietary macro- and micronutrient profile of chronic kidney failure patients on hemodialysis. METHODS: Cross-sectional study carried out at a dialysis clinic at the city of Belo Horizonte, state of Minas Gerais. The study comprised 90 patients undergoing hemodialysis. Personal, clinical, and dietary (three-day food record data were collected. The habit of having dinner was considered as having a complete evening meal, and the lack of that habit was considered as not having it or replacing it by a fast meal. The amounts of nutrient intake were estimated in the specific software Dietwin®. RESULTS: The carbohydrate, thiamine, riboflavin, ascorbic acid, calcium, and selenium intake values showed no difference between the group having a complete evening meal and that not having it (p > 0.05. Both groups did not differ in the following: body mass index, and energy, protein, lipid, niacin, pantothenic acid, pyridoxine, folic acid, cobalamin, potassium, phosphorus, zinc, and magnesium intake values (p < 0.05. Regarding nutrient adequacy, the complete evening meal group performed better than the other group, except for carbohydrates, lipids, pantothenic acid, ascorbic acid, potassium, calcium, and zinc (p < 0.05. None of the patients showed the adequate pyridoxine, folic acid, and selenium intake values. Few patients in both groups showed adequate energy, pantothenic acid, and zinc intake values. CONCLUSION: The habit of having a complete evening meal influenced positively the micro and macronutrient intakes in chronic kidney failure patients on hemodialysis.
Marcia Machado Cunha Ribeiro
The pharmacokinetics of cefepime were studied in 10 male patients receiving continuous ambulatory peritoneal dialysis therapy. Five patients received a single 1,000-mg dose and the other five received a single 2,000-mg dose; all doses were given as 30-min intravenous infusions. Serial plasma, urine, and peritoneal dialysate samples were collected; and the concentrations of cefepime in these fluids were measured over 72 h by using a high-performance liquid chromatographic assay with UV detecti...
Full Text Available Introduction: Hemodialysis patients often develop resistance to recombinant human erythropoietin due to functional Iron Deficiency. In these patients iron therapy can be hazardous leading to hemosiderosis. Recent studies have suggested that intravenous ascorbic acid may be able to improve this hyporeponsiveness. The aim of this study was to evaluate the effect of intravenous ascorbic acid on functional iron deficiency and whether it results in better correction of anemia or not. Methods: Forty hemodialysis patients with serum ferritin >300ug/l, hemoglobin less than 10 gm/dl, and transferrin saturation less than 20% were selected. The reticulocyte index and KT/V was also calculated. Patients were later administered 500 mg intravenous ascorbic acid three times a week for three months. At the end of study, serum ferritin, transferrin saturation, hemoglobin, reticulocyte index and KT/V were rechecked and compared with the base line values by before and after method. Results: Serum ferritin decreased significantly (median base line ferritin 480.45 ug/dl as compared to final ferritin level of 363.78 (P=0.0001, whereas there was a significant rise in hemoglobin concentration (median baseline hemoglobin 8.92 gm/dl compared to 9.88gm/dl (P=0.0001. Transferrin saturation was also significantly raised (median baseline transferrin saturation 17.35% as compared to final level of 25.12% (P= 0.0001. KT/V before and after treatment with ascorbic acid had no significant change (P =0.396. Finally, the rate of decrease in serum ferritin and increase in hemoglobin according to age and duration of dialysis was studied. The effect of ascorbic acid was found to be significantly greater in older patients and those with longer duration of dialysis (P <0.05; but there was no significant relationship between transferrin saturation increase and age or duration of dialysis. Conclusion: Intravenous ascorbic acid may partially correct functional iron deficiency, although anemia is not totally corrected.
The pharmacokinetics of cefepime were studied in 10 male patients receiving continuous ambulatory peritoneal dialysis therapy. Five patients received a single 1,000-mg dose and the other five received a single 2,000-mg dose; all doses were given as 30-min intravenous infusions. Serial plasma, urine, and peritoneal dialysate samples were collected; and the concentrations of cefepime in these fluids were measured over 72 h by using a high-performance liquid chromatographic assay with UV detection. Pharmacokinetic parameters were calculated by noncompartmental methods. The peak concentrations in plasma and the areas under the plasma concentration-versus-time curve for the 2,000-mg dose group were twice as high as those observed for the 1,000-mg dose group. The elimination half-life of cefepime was about 18 h and was independent of the dose. The steady-state volume of distribution was about 22 liters, and values for the 1,000- and 2,000-mg doses were not significantly different. The values for total body clearance and peritoneal dialysis clearance were about 15 and 4 ml/min, respectively. No dose dependency was observed for the clearance estimates. Over the 72-h sampling period, about 26% of the dose was excreted intact into the peritoneal dialysis fluid. For 48 h postdose, mean concentrations of cefepime in dialysate at the end of each dialysis interval exceeded the reported MICs for 90% of the isolates (MIC90s) for bacteria which commonly cause peritonitis resulting from continuous peritoneal dialysis. A parenteral dose of 1,000 or 2,000 mg of cefepime every 48 h would maintain the antibiotic levels in plasma and peritoneal fluid above the MIC90s for the most susceptible bacteria for the treatment of systemic and intraperitoneal infections [corrected]. PMID:1510432
Barbhaiya, R H; Knupp, C A; Pfeffer, M; Zaccardelli, D; Dukes, G M; Mattern, W; Pittman, K A; Hak, L J
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.
Gláucia Thaise Coimbra de, Oliveira; Eli Iola Gurgel, Andrade; Francisco de Assis, Acurcio; Mariângela Leal, Cherchiglia; Maria Isabel Toulson Davisson, Correia.
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. .
Objective: Patients on dialysis have low physical activity levels. The aim of the study was to examine the validity of action planning and coping planning within the theory of planned behaviour framework, for predicting physical activity behaviour of patients on hemodialysis. Methods: One hundred and forty four patients who were undergoing emodialysis were selected from dialysis centers. The mean age of the patients was 56.61 (SD= 11.38) years. The patients completed a questionnaire including variables from the theory of planned behaviour, action planning and coping planning. Physical activity was prospectively assessed at 4-weeks with the validated International Physical Activity Questionnaire self-report measure. A hierarchical regression analysis was performed to examine the effects of action planning and coping planning on physical activity behaviour. Results: There was a main effect for coping planning but not for action planning. Moreover, the analyses resulted in a significant amount of incremental variance accounted for by the interaction of coping planning and intention. Conclusion: Results suggest the combination of high levels of coping planning and intention is associated with increases in physical activity.
Pakpour, Amir H.; Zedi, Isa mohammadi
To investigate white matter (WM) alterations and their correlation with cognition function in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) using diffusion tensor imaging (DTI) with tract-based spatial statistics (TBSS) approach.This prospective HIPAA-complaint study was approved by our institutional review board. Eighty HD ESRD patients and 80 sex- and age-matched healthy controls were included. Neuropsychological (NP) tests and laboratory tests, including serum creatinine and urea, were performed. DTI data were processed to obtain fractional anisotropy (FA) and mean diffusivity (MD) maps with TBSS. FA and MD difference between the 2 groups were compared. We also explored the associations of FA values in WM regions of lower FA with ages, NP tests, disease, and dialysis durations, serum creatinine and urea levels of ESRD patients.Compared with controls, HD ESRD patients had lower FA value in the corpus callosum, bilateral corona radiate, posterior thalamic radiation, left superior longitudinal fasciculus, and right cingulum (P??0.05).Diffuse interstitial brain edema and moderate WM integrity disruption occurring in HD ESRD patients, which correlated with cognitive dysfunction, and serum urea levels might be a risk factor for these WM changes. PMID:25526483
Kong, Xiang; Wen, Ji-Qiu; Qi, Rong-Feng; Luo, Song; Zhong, Jian-Hui; Chen, Hui-Juan; Ji, Gong-Jun; Lu, Guang Ming; Zhang, Long Jiang
Toxoplasma gondii infection may cause a variety of symptoms involving virtually all organs. Little is known of the epidemiology of T. gondii infection in different patient groups in Mexico. We sought to determine the prevalence of T. gondii infection and associated epidemiological characteristics in 472 patients in Durango, Mexico. Participants were tested for T. gondii IgG and IgM antibodies. In addition, sociodemographic, clinical, and behavioral characteristics from each participant were obtained. Seroprevalences of T. gondii IgG antibodies were found in 7 (8.2%) of 85 patients with hearing impairment, 5 (10.0%) of 50 patients with hemodialysis, 28 (12.0%) of 234 patients with visual impairment, and 7 (6.8%) of 103 at risk of immunosuppression. In total, 47 (10%) of 472 subjects had IgG T. gondii antibodies; 6 (1.3%) of them also had IgM anti- T. gondii antibodies. Patients born in Durango State had a significantly lower prevalence of T. gondii infection than patients born in other Mexican states (9.0% vs. 21.4%, respectively; P < 0.05). Multivariate analysis showed that T. gondii infection was significantly associated with consumption of undercooked meat (adjusted odds ratio [OR] = 2.95; 95% confidence interval [CI]: 1.18-7.35) or raw cow's milk (adjusted OR = 2.52; 95% CI: 1.28-4.96), presence of cats at home (adjusted OR = 2.01; 95% CI: 1.06-3.78), raising animals (adjusted OR = 2.44; 95% CI: 1.06-5.63), or eating away from home (adjusted OR = 2.70; 95% CI: 1.03-7.11). In the group of patients with visual impairment, those with reflex impairment had a significantly higher frequency of T. gondii infection than those with normal reflexes (19% vs. 9.4%, respectively: P = 0.04). Results of the present study are the first step in the design of prevention programs to avoid the sequelae of toxoplasmosis. PMID:20557194
Alvarado-Esquivel, C; Liesenfeld, O; Torres-Castorena, A; Estrada-Martínez, S; Urbina-Alvarez, J D; Ramos-de la Rocha, M; Márquez-Conde, J A; Dubey, J P
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Analisar os efeitos do comportamento alimentar, entre o hábito de jantar ou não jantar, no perfil de ingestão de macronutrientes e micronutrientes de pacientes com insuficiência renal crônica em hemodiálise. MÉTODO: Estudo transversal em uma clínica de diálise de Belo Horizonte, em Minas 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
Marcia Machado Cunha, Ribeiro; Melissa Luciana de, Araújo; Michele Pereira, Netto; Lucas Maciel, Cunha.
Recurrent Pseudomonas luteola (CDC group Ve-1) peritonitis occurred in a patient undergoing continuous ambulatory peritoneal dialysis. Catheter removal was required for cure despite therapy based on antibiotic susceptibilities. This is the third report in the English literature of severe P. luteola infection and the first report of peritonitis caused by this organism.
Connor, B. J.; Kopecky, R. T.; Frymoyer, P. A.; Forbes, B. A.
Tranexamic acid is given continuously or discontinuously as an anti-fibrinolytic therapy during cardiac surgery, but the effects on fibrinolysis parameters remain poorly investigated. We sought to assess the effects of continuous and discontinuous tranexamic acid on fibrinolysis parameters in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Children requiring cardiac surgery or repeat surgery by sternotomy with CPB for congenital heart disease were randomized to receive either continuous or discontinuous tranexamic acid. Blood tranexamic acid, D-dimers, tissue plasminogen activator (tPA), tPA-plasminogen activator inhibitor 1 (tPA-PAI1) complexes, fibrinogen and fibrin monomers were measured and compared to values obtained from children who did not receive tranexamic acid. Tranexamic acid inhibited the CPB-induced increase in D-dimers, with a similar potency between continuous and discontinuous regimens. Time courses for tPA, fibrin monomers, and fibrinogen were also similar for both regimen, and there was a significant difference in tPA-PAI1 complex concentrations at the end of surgery, which may be related to a significantly higher tranexamic acid concentration. Continuous and discontinuous regimen are suitable for an effective inhibition of fibrinolysis in children undergoing cardiac surgery with CPB, but the continuous regimen was previously shown to be more effective to maintain stable tranexamic acid concentrations. PMID:24418941
Couturier, Roland; Rubatti, Marina; Credico, Carmen; Louvain-Quintard, Virginie; Anerkian, Vregina; Doubine, Sylvie; Vasse, Marc; Grassin-Delyle, Stanislas
The pharmacokinetics of teicoplanin after single 6-mg/kg intravenous and intraperitoneal doses were studied in five noninfected patients undergoing continuous ambulatory peritoneal dialysis. Biological samples were assayed for teicoplanin content by a microbiological assay technique. Terminal disposition half-life (266.4 +/- 51.9 h [mean +/- standard error of the mean]) was prolonged and total body clearance (0.040 +/- 0.004 ml/min per kg) was reduced compared with values previously reported ...
Guay, D. R.; Awni, W. M.; Halstenson, C. E.; Kenny, M. T.; Keane, W. F.; Matzke, G. R.
Continuous ambulatory peritoneal dialysis (CAPD) is a well established method of treating end stage renal failure, and is commonly used as an alternative to hemodialysis. Several complications have been observed. These include catheter malfunction, abdominal and inguinal hernia, and peritonitis. A relatively frequent complication is swelling of external genitalia, due to bowel fluid passing through a patent processus vaginalis. Special diagnostic procedures are necessary to determine the nature of the abnormality and to guide the surgical correction. We reported two cases of patent processus vaginalis in patient on CAPD proved by radionuclide peritonea scintiscan using 99mTc-tin colloid.
Chronic inflammation is the cause of malnutrition and cardiovascular disease in hemodialysis patients. The purpose of this study was to assess C Reactive Protein (CRP) as an inflammatory marker and to define the relationship between CRP and other inflammatory and nutritional factors in this group of patients. One hundred and fourteen hemodialysis patients undergoing chronic dialysis (3 times a week for at least 4 hours) in two hemodialysis centers were enrolled in this cross-sectional study. ...
Razeghi Effat; Omati Homeira; Maziar Sima; Khashayar Patricia; Mahdavi-Mazdeh Mitra
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 patient...
Ar, Khawaja; Anees M; Iqbal S; Snb, Rizvi
Full Text Available The aim of present study was the assessment of relationships between PTH abnormalities and the parameter of Helicobacter pylori (H. pylori infection as expressed by concentration of IgG antibodies against H. pylori. The study was carried out on 44 (F = 17, M = 27 stable hemodialysis (HD patients with upper gastrointestinal symptoms. A significant positive correlations of H. pylori IgG antibody titers with serum iPTH and phosphorus also a significant inverse correlation of H. pylori IgG antibody titers with serum alkalin phosphatase was found. It is known that hyperparathyroidism is connected with stimulation of gastrin synthesis as well with increased acidity of gastric juice. Hypergastrinaemia induced stimulation of gastrin synthesis and resultant increased acidity of gastric juice could intensify the H. pylori infection in hemodialysis patients. We strongly propose to more study on the association of secondary hyperparathyroidism with H. pylori infection, because both dyspeptic symptoms and secondary hyperparathyroidism are quite common in chronic hemodialysis patients and in the meantime needs more attention toward control of high levels of parathormone in HD patients.
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
Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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.
Maria Beatriz Bracco, Suarez; Maria Laura, Costa; Mary Ângela, Parpinelli; Fernanda Garanhani, Surita.
Over 383,900 individuals in the U.S. undergo maintenance hemodialysis that exposes them to water, primarily in the form of dialysate. The quality of water and associated dialysis solutions have been implicated in adverse patient outcomes and is therefore critical. The Association for the Advancement of Medical Instrumentation has published both standards and recommended practices that address both water and the dialyzing solutions. Some of these recommendations have been adopted into Federal Regulations by the Centers for Medicare and Medicaid Services as part of the Conditions for Coverage, which includes limits on specific contaminants within water used for dialysis, dialysate, and substitution fluids. Chemical, bacterial, and endotoxin contaminants are health threats to dialysis patients, as shown by the continued episodic nature of outbreaks since the 1960s causing at least 592 cases and 16 deaths in the U.S. The importance of the dialysis water distribution system, current standards and recommendations, acceptable monitoring methods, a review of chemical, bacterial, and endotoxin outbreaks, and infection control programs are discussed. PMID:23859187
Coulliette, Angela D; Arduino, Matthew J
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese FUNDAMENTOS: A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a [...] frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD), e compará-los com uma amostra pareada da população geral. MÉTODOS: 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
Marcos Antonio Rodrigues, Martinez; Carla Lobato, Gregório; Vanessa Pedrassi dos, Santos; Ronaldo Roberto, Bérgamo; Carlos D' Apparecida Santos, Machado Filho.
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)
Patients with end-stage renal disease have two therapeutic options, dialysis and renal transplantation. Infectious complications occurring in such patients will not only condition the effectiveness of such treatments, but are among the main causes of morbidity and mortality in such cases. Knowledge of the advantages and limitations of nuclear techniques is essential for management of these conditions. (author)
Garcia Vicente, Ana Maria; Ruiz Solis, Sebastian; Soriano Castrejon, Angel; Poblete Garcia, Victor Manuel; Talavera Rubio, Maria del Prado; Rodado Marina, Sonia; Cortes Romera, Montserrat [Ciudad Real General Hospital (Spain). Dept. of Nuclear Medicine
Full Text Available Fundamentación: La enfermedad cardiovascular constituye la principal causa de mortalidad en los pacientes en hemodiálisis y el principal predictor es la hipertensión arterial antes que la dislipemia y el consumo de tabaco. Objetivo: describir la prevalencia de hipertensión arterial y sus factores de riesgos en pacientes hemodializados. Método: se realizó un estudio descriptivo, transversal en 22 pacientes con insuficiencia renal crónica, terminal en hemodiálisis del Hospital General Augusto César Sandino de junio a diciembre de 2009. Se estudiaron las variables sociodemográficas, clínicas y del estilo de vida y su relación con la presencia de hipertensión arterial. Se utilizó la técnica estadística de análisis de distribución de frecuencias para categoría de variables, además, se empleó el test de independencia para probar la hipótesis nula de asociación entre las variables; precisándose un nivel de significación á = 0.05. Resultados: la edad promedio fue de 53 años con un tiempo medio previo en hemodiálisis de 57 meses. Entre las principales causas por las cuales llegaron al tratamiento depurador los pacientes estuvieron las no relacionadas a la diabetes mellitus en el 86,4 %. En 14 pacientes, que representa el (63,6 %, se recogía la historia de hipertensión arterial prediálisis y en hemodiálisis. El análisis multivariado mostró que la hipertensión estaba asociada con la edad avanzada, el tiempo de vida media en hemodiálisis y la presencia de diabetes mellitus. Conclusiones: la hipertensión es altamente prevalente entre los pacientes en hemodiálisis crónica y está asociada a la hipervolemia, el envejecimiento y la diabetes mellitus.Background: The cardiovascular diseases constitutes the main one of cause of mortality in patient in hemodialysis and the main one predict is the hypertension still before that the dislipemia and the consumption of tobacco. Objective: Describe the prevalence and risk factors of hypertension among patients on chronic hemodialysis. Methods: A transversal descriptive study was carried out in 22 patients with chronic kidney diseases in the nephrological service of Augusto Cesar Sandino Teaching Hospital of Pinar del Rio City, since June to December, 2009. Variables such as: age, etiology of the chronic renal failure, time elapsed in hemodialysis were included in the study. Information was gathered through surveys and from the morbimortality book of the nephrology unit. The statistical analysis of frequency distribution was used for each category of variables. The independence test was also used to test the association of variable null hypothesis. The level of significance was set at á = 0.05. Results: The age average went of 53 years with a half prior time in hemodialysis of 57 months. Among the main causes by which they arrived at the processing purifier the patient were the done not relate to the diabetes mellitus in the 86, 4 %. In 14 patients (63, 6% history was collected of hypertension prediálisis and in hemodialysis. The analysis multivariado showed that the hypertension was associated with the age advanced, the average time of life in hypertension and the presence of diabetes mellitus. Conclusions: The hypertension is highly prevalence among patient in hypertension chronic and this associate to the hipervolemia, the hypertension and the diabetes mellitus.
Nadienka Rodríguez Ramos
Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations in the dialysate and urine were 9.1 +/- 4.1 micrograms/l and 52.5 +/- 47.3 micrograms/l, respectively. Bone Al concentration was 21.0 +/- 14.9 ppm and correlated significantly with concentrations of Al in serum (p less than 0.01) and dialysate (p less than 0.01). A mass transfer (MT) from the patients to the dialysate was observed in all patients (-44.0 +/- 28.8 micrograms/24 h). There was a highly significant correlation between peritoneal Al MT and serum Al (p less than 0.001), actual Al consumption (p less than 0.05) and bone Al concentration (p less than 0.005) supporting the existence of an overflow phenomenon. Despite very low Al levels in the dialysate, patients are at risk of elevated Al levels in the serum, dialysate, urine and bone because of consumption of Al-containing phosphate binders.
Joffe, P; Olsen, F
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.
The effect of hemodialysis on the plasma glucose profile and liraglutide level after liraglutide injection was investigated in patients with diabetes and end-stage renal disease (ESRD). Either 0.6 mg or 0.9 mg liraglutide was subcutaneously administered daily to 10 Japanese type 2 diabetic patients with ESRD. Hemodialysis was conducted on days 1 and 3. Plasma liraglutide and glucose concentrations were measured by enzyme-linked immunosorbent assay and a continuous glucose monitoring system, respectively. The safety profile of liraglutide was also assessed. Hemodialysis had no effect on the pharmacokinetic parameters of liraglutide in patients with diabetes and ESRD; the maximum plasma concentration (Cmax), tmax, area under the concentration-time curve (AUC), and CL/f were unaltered. Similarly, hemodialysis did not affect the mean or minimum glucose levels, AUC, or duration of hyperglycemia (>180 mg/dL) and hypoglycemia (MAGE) and standard deviation (SD) as markers of glucose fluctuation, and the maximum glucose level were observed during hemodialysis. No adverse events, including hypoglycemia, were observed after liraglutide injection, either off-hemodialysis (day 2) or on-hemodialysis (day 3). Liraglutide was well tolerated in patients with type 2 diabetes and ESRD undergoing hemodialysis. The present results suggested that hemodialysis did not affect the pharmacokinetic profile of liraglutide or most glycemic indices, with the exception of MAGE, SD, and the maximum glucose level. These results suggested that it may be possible to use liraglutide during hemodialysis for diabetes with ESRD, without dose adjustment. Trial Registration UMIN Clinical Trials Registry (UMIN-CTR) UMIN000010159 PMID:25526642
Osonoi, Takeshi; Saito, Miyoko; Tamasawa, Atsuko; Ishida, Hidenori; Tsujino, Daisuke; Nishimura, Rimei; Utsunomiya, Kazunori
Full Text Available SciELO Spain | Language: Spanish Abstract in portuguese 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.
Vanessa de Brito, Poveda; Juliana da Silva, Alves; Elaine de Freitas, Santos; Alessandra, Garcia Emerick Moreira.
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, illiterac 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)
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
Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Avaliar o estado de humor e a qualidade de vida de homens em tratamento hemodialítico, correlacionar as alterações observadas no humor com os diferentes domínios do questionário de qualidade de vida. MÉTODO: Foram incluídos 47 homens em tratamento hemodialítico estável há mais de seis 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
Thales Weber, Garcia; Joel Paulo Russomano, Veiga; Lucilia Domingues Casulari da, Motta; Flávio José Dutra de, Moura; Luiz Augusto, Casulari.
A systematic review of the literature was performed to assess the necessity of a pyloric drainage procedure during an esophagectomy with gastric conduit reconstruction. Earlier data recommend performing a pyloric drainage procedure for all esophagectomies; however, recent studies have questioned this. A thorough literature search (January 2001-November 2011) was performed using the terms esophagectomy, pyloroplasty, pyloromyotomy, botulinum toxin, and pyloric drainage. Only studies that compared patient outcome after undergoing an esophagectomy with a pyloric drainage procedure with those undergoing an esophagectomy without a pyloric drainage procedure were selected. Only four studies, comprising 668 patients in total, were identified that compared patient outcome after undergoing an esophagectomy with or without a pyloric drainage procedure, and two additional meta-analyses were identified and selected for discussion. All studies were retrospective, and because of the heterogeneity of studies, patient demographics, reporting, and statistical analysis of patient outcome, pooling of data and meta-analysis could not be performed. Careful analysis demonstrated that pyloric drainage procedure was associated with a non-significant trend for delayed gastric emptying and biliary reflux, while not affecting the incidence of dumping. No correlation was determined between a pyloric drainage procedure and anastomotic leaks, postoperative pulmonary complications, length of hospital stay, and overall perioperative morbidity. While there are risks associated with a pyloric drainage procedure and data exist supporting its omission during an esophagectomy, no good conclusion can be drawn from the current literature. Larger multi-institutional, prospective studies are required to definitively answer this question. PMID:23442059
Gaur, P; Swanson, S J
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
Full Text Available OBJETIVO: A hiperpigmentação cutânea é comumente encontrada em pacientes portadores de insuficiência renal crônica (IRC, sendo também uma das manifestações mais evidentes da Porfiria Cutânea Tarda (PCT. Essa doença, que tem sido relatada em pacientes em hemodiálise (HD, tem como um dos fatores precipitantes a infecção pelo vírus da hepatite C (HCV. Este estudo tem como objetivo avaliar a prevalência de hiperpigmentação cutânea difusa em pacientes com IRC infectados pelo HCV. MÉTODOS: Foi desenvolvido um estudo transversal com 47 pacientes (idade média de 50,35 ± 15,16 anos, 31 homens e 16 mulheres que estavam realizando hemodiálise na Unidade de Diálise do Hospital de Clínicas de Porto Alegre. Os pacientes foram divididos em dois grupos: grupo 1, anti-HCV positivos (n=17, e grupo 2, anti-HCV negativos (n=30. RESULTADOS: A prevalência de pacientes com hiperpigmentação cutânea relacionada a HD foi de 36,2% (n=17. Havia 10 pacientes (58,8 % no grupo 1 e sete pacientes (23,3% no grupo 2 (Razão de Risco de 2,52 e Intervalo de Confiança de 95% de 1,18 a 5,4; pBACKGROUND: Skin pigmentation is commonly found in patients with chronic renal failure (CRF. This symptom is also one of the most evident features of Porphyria Cutanea Tarda (PCT. Hepatitis C virus (HCV is an important precipitating agent of this disease, which has been described in patients undergoing hemodialysis (HD. In this paper, we intend to evaluate the prevalence of difuse skin hyperpigmentation in patients with CRF infected with the HCV. METHODS: We developed a transversal study with 47 patients (mean age 50,35 + 15,16 years; 31 men and 16 women who were on hemodialysis in march of 2001 at the Unit of Dialysis of Hospital de Clínicas de Porto Alegre. Patients were divided in two groups: group 1, anti-HCV positives (n=17, and group 2, anti-HCV negatives (n=30. RESULTS: The prevalence of skin hyperpigmentation related to HD was 36,2% (n=17. There were 10 patients (58,8% in group 1 and 7 (23,3% in group 2 (Odds Ratio of 2,52 and 95% Confidence Interval of 1,18-5,4; p<0,05. Among patients who have undergone HD for until 36 months (n=24, 6 were anti-HCV positive and 3 of tham (50% mentioned skin pigmentation (OR of 9,0 and 95%CI of 1,1-71,0; p<0,05. Patients from group 2 who referenced the symptom have been on HD for a longer period than those who did not (63,85 + 11,9 vs. 29,3 + 4,71 months; p<0,05. CONCLUSIONS: HCV infection was associated with increased skin hyperpigmentation in patients with CRF undergoing HD. Time on treatment was also associated with this signal.
Humberto Kukhyun Choi
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
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.
Ana Carolina Bonelá dos, Santos; Manuela do Carmo, Machado; Luciene Rabelo, Pereira; Juliana Lemos Pratti, Abreu; Marisa Barbosa, Lyra.
We report a female with amyloid arthropathy of the hip joints. She was a 67-year-old woman who had been treated by hemodialysis for 22 years. She had demonstrated a 5-month history of continuous low-grade fever and pain in her left hip and she was finally unable to walk by herself. Findings on X-ray films and MRI of the hip joints suggested avascular necrosis in both femur heads. To palliate symptoms, bipolar surgery on the left hip joint was performed. Pathological examination of bone tissue specimen demonstrated that there was some , ?2-microglobulin (?2-MG)-related amyloid accumulation in the femur head. Based on this clinical experience, we performed MRI screening for amyloid lesions of the hip joints in another 11 asymptomatic female patients undergoing hemodialysis for 20 years or more. Cystic lesions of the hip joints were observed in 8 patients, amyloid arthropathy in 2 patients, and fluid trapped in the joint in 1 patient. Patients with amyloidosis had significantly lower serum ?2-MG levels than patients without amyloidosis (28.6 mg/L versus 41.4 mg/L; p=0.0339). Our findings show that dialysis-related amyloidosis of the hip joints is one of the potential and significant problems in female patients on long-term hemodialysis therapy. It may be important to screen for this pathological condition in long-term hemodialysis patients. (author)
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
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.
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.
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
Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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
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.
Full Text Available INTRODUCTION Hemodialysis (HD is one of the most accessible methods for the treatment of the growing number of patients suffering from terminal-stage renal insufficiency. Although headache is the most frequently encountered neurological symptom during HD, there are few studies reporting its prevalence and clinical features. OBJECTIVE The objective of this study was to examine the frequency, demographic and clinical features of headache during HD, and to compare these parameters among patients with and without headache. METHOD The study involved 126 patients (48 female and 78 male with chronic renal failure on regular HD for at least six months, at the Dialysis Unit of Nephrology Department, Kruševac. All patients were inquired about their possible problems with headache using the standardized questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders, second edition, published in 2004 (ICHD-II. Subsequently, the patients were clinically evaluated and patients with headaches were further sub classified by a neurologist with special interest in headache disorders. Patients with headache were compared to the patients without headache regarding age, sex, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure, and serum values of the most important blood parameters such as sodium, potassium, urea and creatinine. In the group of patients with headache we analyzed the characteristics of specific headache type according to ICHD-II classification. We also analyzed the most important clinical features of hemodialysis headache (HDH. RESULTS In the group of 126 evaluated patients, 41 (32.5% patients had headaches. There were no statistically significant differences between the patients with headaches and those without headaches regarding sex, age, BMI, duration of HD, causes of end-stage renal disease, arterial blood pressure, red blood cell count, serum concentration of hemoglobin, blood urea nitrogen, creatinine, glucose, MCHC, total protein, sodium and potassium. Fourteen patients (34% of those with headaches experienced headache during the HD session and were sub classified as HDH using diagnostic criteria of the International Headache Society. Tension type headache (41% of those with headaches and migraine without aura (10% were most common in the primary headache group and headache due to arterial hypertension (7% was the most prevalent among the secondary headaches. Although there were some common clinical characteristics, we could not find a unifying clinical pattern in the patients with HDH. CONCLUSION Hemodialysis headache is the most common headache in patients undergoing hemodialysis, and despite some common symptoms, it does not appear to be uniform in its clinical characteristics.
Niki? Petar M.
OBJECTIVE: Continuous assessment of central venous oxygen saturation (S(cevox)O(2)) with the CeVOX device (Pulsion Medical Systems, Munich, Germany) was evaluated against central venous oxygen saturation (S(cv)O(2)) determined by co-oximetry. METHODS: In 20 cardiac surgical patients, a CeVOX fiberoptic probe was introduced into a standard central venous catheter placed in the right internal jugular vein and advanced 2-3 cm beyond the catheter tip. After in vivo calibration of the probe, S(cev...
Baulig, W.; Dullenkopf, A.; Kobler, A.; Baulig, B.; Roth, H. R.; Schmid, E. R.
Coping religioso/espiritual em pessoas com doença renal crônica em tratamento hemodialítico Coping religioso/espiritual en personas con enfermedad renal crónica en tratamiento por hemodiálisis Religious/spiritual coping in people with chronic kidney disease undergoing hemodialysis
Full Text Available O estudo tem como objetivo investigar o uso do coping religioso/espiritual em pacientes com doença renal crônica em hemodiálise. A investigação ocorreu em uma clínica de hemodiálise, por meio de entrevista utilizando um questionário sociodemográfico e a escala de coping religioso/espiritual. Para análise dos dados, foram empregados a estatística descritiva e o teste coeficiente de correlação de Sperman, a análise de variância e o modelo de regressão linear múltipla. Foram entrevistados 123 indivíduos, dos quais 79,6% apresentaram escore alto para o coping religioso/espiritual e nenhum deles apresentou os escores baixos e irrisórios. As variáveis que influenciaram no comportamento do coping religioso/espiritual foram: sexo, faixa etária, tempo de tratamento, renda familiar e prática religiosa. Conclui-se que os pacientes em estudo utilizam de modo positivo o coping religioso/espiritual como estratégia de enfrentamento da doença, destacando-se as mulheres, com renda familiar maior e que frequentam semanalmente a igreja.El estudio objetiva investigar el uso del coping religioso/espiritual en pacientes con enfermedad renal crónica en hemodiálisis. Investigación realizada en clínica de hemodiálisis, mediante entrevista, utilizándose cuestionario sociodemográfico y la escala de coping religioso/espiritual. Se utilizó estadística descriptiva, pruebas de coeficiente de correlación de Spearman, el análisis de varianza y el modelo de regresión lineal múltiple para el análisis de los datos. Fueron entrevistados 123 individuos, de los cuales 76,9% presentaban puntaje alto para coping religioso/espiritual, ninguno de ellos expresando puntajes bajos o irrisorios. Las variables que influyeron en el comportamiento del coping religioso/espiritual fueron: sexo, faja etaria, tiempo de tratamiento, renta familiar y práctica religiosa. Se concluye en que los pacientes estudiados utilizan de modo positivo el coping religioso/espiritual como estrategia de enfrentamiento a la enfermedad, destacándose las mujeres con renta familiar mayor y que frecuentan semanalmente la iglesia.The objective of the present study is to investigate the use of religious/spiritual coping mechanisms in patients with chronic kidney disease undergoing hemodialysis, by means of interviews using a sociodemographic questionnaire and the religious/spiritual coping scale. Data analysis was performed using descriptive statistics and multiple linear regression. A total of 123 individuals were interviewed, 79.6% of whom presented a high score for religious/spiritual coping and none of whom presented low or irrelevant scores. The variables that affected the religious/spiritual coping behavior were: gender, age group, treatment time, family income, and religious practice. In conclusion, the participants used religious/spiritual coping mechanisms as a strategy to cope with the disease, particularly women with a higher family income who attend church every week.
Carolina Costa Valcanti
Forty-nine haemodialyzed patients have been submitted consecutively, under informed consent, to endoscopy with multiple antral gastric mucosa biopsies for Helicobacter pylori (HP) identification, performed by urease, microscopic and cultural tests, as well as histologic examination. Patients have been considered HP negative when negative for all tests; positivity for HP has been correlated with gastritis histologically evaluated according to Whitehead; at endoscopy, blood samples for HP specific IgG, IgA, IgM have been collected; patient's life style concerning smoke, alcohol and drugs as FANS has been investigated as well. HP prevalence in our haemodialyzed patients is 38.8 per cent, similar to general population submitted to endoscopy; a statistically significant correlation between HP and gastritis and specific IgG, but no correlation between HP and age, dialysis duration, IgA, IgM, smoking, alcohol or drugs consumption has been found. PMID:7701407
Giachino, G; Sallio-Bruno, F; Chiappero, F; Saltarelli, M; Rosati, C; Mazzucco, D; Pallante, C; Forneris, G; Suriani, R
The objective of this study was to examine the effect of continuous venovenous haemodiafiltration (CVVHDF) on the pharmacokinetics of amphotericin B (AmB) in critically ill patients following administration of amphotericin B lipid complex (ABLC). Plasma and ultrafiltrate (UF) samples were collected from patients administered ABLC and either receiving or not receiving CVVHDF. Pharmacokinetic (PK) analysis was performed on eight profiles from patients receiving CVVHDF and six profiles from patients not receiving CVVHDF. For patients receiving CVVHDF, the following median PK data were calculated: area under the concentration-time curve (AUC) = 13.9 h·?g/mL, volume of distribution at steady state (V(ss)) = 1476L and drug clearance (CL) = 27.4 L/h; for patients not receiving CVVHDF, the corresponding median PK data were 11.5 h ?g/mL, 2048 L and 43.7 L/h, respectively. The median half-lives calculated during the dosage interval (t(1/2int)) were 30.9 h and 32.5 h on and off CVVHDF, respectively, and the total range of t(1/2int) values was 15.6-180.4 h. Observed median peak concentrations on Day 1 were 0.563 ?g/mL and 0.468 ?g/mL in patients on and off CVVHDF, respectively. From AmB present in the UF, clearance via CVVHDF contributed<1% of total plasma clearance. The AmB concentration-time profiles for patients administered ABLC on and off CVVHDF were compared and no statistically significant differences in AUC, CL, t(1/2int) and V(ss) were observed. In conclusion, CVVHDF had no clinically significant effect on the pharmacokinetics of AmB following administration of ABLC. PMID:23920093
Malone, Maeve E; Corrigan, Owen I; Kavanagh, Pierce V; Gowing, Caitriona; Donnelly, Maria; D'Arcy, Deirdre M
Full Text Available Abstract Background The study aimed to investigate the pharmacokinetics of intravenous ciprofloxacin and the adequacy of 400 mg every 12 hours in critically ill Intensive Care Unit (ICU patients on continuous veno-venous haemodiafiltration (CVVHDF with particular reference to the effect of achieved flow rates on drug clearance. Methods This was an open prospective study conducted in the intensive care unit and research unit of a university teaching hospital. The study population was seven critically ill patients with sepsis requiring CVVHDF. Blood and ultrafiltrate samples were collected and assayed for ciprofloxacin by High Performance Liquid Chromatography (HPLC to calculate the model independent pharmacokinetic parameters; total body clearance (TBC, half-life (t1/2 and volume of distribution (Vd. CVVHDF was performed at prescribed dialysate rates of 1 or 2 L/hr and ultrafiltration rate of 2 L/hr. The blood flow rate was 200 ml/min, achieved using a Gambro blood pump and Hospal AN69HF haemofilter. Results Seventeen profiles were obtained. CVVHDF resulted in a median ciprofloxacin t1/2 of 13.8 (range 5.15-39.4 hr, median TBC of 9.90 (range 3.10-13.2 L/hr, a median Vdss of 125 (range 79.5-554 L, a CVVHDF clearance of 2.47+/-0.29 L/hr and a clearance of creatinine (Clcr of 2.66+/-0.25 L/hr. Thus CVVHDF, at an average flow rate of ~3.5 L/hr, was responsible for removing 26% of ciprofloxacin cleared. At the dose rate of 400 mg every 12 hr, the median estimated Cpmax/MIC and AUC0-24/MIC ratios were 10.3 and 161 respectively (for a MIC of 0.5 mg/L and exceed the proposed criteria of >10 for Cpmax/MIC and > 100 for AUC0-24/MIC. There was a suggestion towards increased ciprofloxacin clearance by CVVHDF with increasing effluent flow rate. Conclusions Given the growing microbial resistance to ciprofloxacin our results suggest that a dose rate of 400 mg every 12 hr, may be necessary to achieve the desired pharmacokinetic - pharmacodynamic (PK-PD goals in patients on CVVHDF, however an extended interval may be required if there is concomitant hepatic impairment. A correlation between ciprofloxacin clearance due to CVVHDF and creatinine clearance by the filter was observed (r2 = 0.76, providing a useful clinical surrogate marker for ciprofloxacin clearance within the range studied. Trial Registration Current Controlled Trials ISRCTN52722850
Donnelly Maria B
Isolated bone marrow infection by nontuberculous mycobacteria (NTM) is extremely rare. Recently, we encountered a case of bone marrow Mycobacterium avium complex (MAC) infection, which presented as a fever of unknown origin shortly after starting continuous ambulatory peritoneal dialysis (CAPD). The patient was diagnosed with MAC infection on the basis of PCR-restriction fragment length polymorphism analysis and sequencing of DNA obtained from bone marrow specimens. Although this was a case of severe MAC infection, there was no evidence of infection of other organs. End-stage renal disease (ESRD) patients undergoing dialysis can be considered immunodeficient; therefore, when these patients present with fever of unknown origin, opportunistic infections such as NTM infection should be considered in the differential diagnosis. PMID:20445335
Chung, Jin Won; Cha, Young Ju; Oh, Dong Jin; Nam, Woo Jin; Kim, Su Hyun; Lee, Mi Kyung; Kim, Hye Ryoun
In patients with chronic renal failure undergoing hemodialysis were recorded and studied by various authors multiple eye damage with time. Studying the literature we conducted a study to assess the impact of intradialitic-interdialitic and postdialitic volemic game above the retinal circulation. By measuring diameters of retinal circulation after processing the digital fundus, we found that, 30 minutes after hemodialysis session takes a degree of dilatation of retinal vessels, permanent vascular insult that can be responsible for stroke and ischamic eye and coronary diseases of these patients. PMID:21774395
Ciocalteu, Alina Mihaela; Dumitrache, Marieta
In patients with chronic renal failure undergoing hemodialysis were recorded and studied by various authors multiple eye damage with time. Studying the literature we conducted a study to assess the impact of intradialitic-interdialitic and postdialitic volemic game above the retinal circulation. By measuring diameters of retinal circulation after processing the digital fundus, we found that, 30 minutes after hemodialysis session takes a degree of dilatation of retinal vessels, permanent vascular insult that can be responsible for stroke and ischamic eye and coronary diseases of these patients. PMID:21888079
Ciocalteu, Alina Mihaela; Dumitrache, Marieta
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
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.
Carolina Costa, Valcanti; Érika de Cássia Lopes, Chaves; Ana Cláudia, Mesquita; Denismar Alves, Nogueira; Emília Campos de, Carvalho.
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
Full Text Available SciELO Colombia | Language: Portuguese Abstract in portuguese Objetivo: Conhecer as vivências dos pacientes masculinos submetidos à hemodiálise acerca de sua sexualidade. Metodologia: Trata-se de uma investigação exploratória, descritiva, com abordagem qualitativa. Os sujeitos da pesquisa, realizada no primeiro semestre de 2004, foram oito pacientes masculinos [...] que estavam em tratamento hemodialítico. O instrumento de coleta foi a entrevista semiestruturada, utilizando a análise categórica. Como cenário da pesquisa, um 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 resea
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.
Vivências dos homens submetidos à hemodiálise acerca de sua sexualidade Experiencias de los hombres sometidos a hemodiálisis acerca de su sexualidad Experience of men undergoing hemodialysis about their sexuality
Full Text Available Objetivo: Conhecer as vivências dos pacientes masculinos submetidos à hemodiálise acerca de sua sexualidade. Metodologia: Trata-se de uma investigação exploratória, descritiva, com abordagem qualitativa. Os sujeitos da pesquisa, realizada no primeiro semestre de 2004, foram oito pacientes masculinos que estavam em tratamento hemodialítico. O instrumento de coleta foi a entrevista semiestruturada, utilizando a análise categórica. Como cenário da pesquisa, um serviço de nefrologia, de um município da Região Sul do Brasil. Resultados: A partir da análise emergiram as seguintes categorias: Aspectos físicos e emocionais acerca do tratamento; As vivências dos pacientes renais crônicos acerca de sua sexualidade; As estratégias para lidar com as limitações relacionadas à sexualidade e A sexualidade dos pacientes renais crônicos após a hemodiálise. Discussão: O desgaste e o cansaço físico foram atribuídos ao tratamento hemodialítico. A vivência dos pacientes renais crônicos acerca de sua sexualidade está intimamente ligada à relação sexual saudável, tanto no biológico quanto no emocional. Os pacientes que buscam estratégias a fim de minimizar ou até mesmo resolver problemas relativos com sua sexualidade, em decorrência da condição crônica, enfrentam com maior facilidade os obstáculos vivenciados. Os sujeitos apresentaram modificações a respeito da sexualidade, no entanto, percebe-se a busca dos pacientes por estratégias que amenizem e até mesmo restabeleçam suas necessidades sexuais, dentro da dimensão biopsicológica. Considerações finais: Este estudo é relevante, pois existe necessidade de capacitar profissionais para trabalharem com a sexualidade humana, percebendo o paciente renal crônico sob uma visão holística.Palavras-chave: insuficiência renal crônica; diálise renal; enfermagem; sexualidade.Objetivo: Conocer las experiencias de los pacientes masculinos sometidos a hemodiálisis acerca de su sexualidad. Metodología: Se trata de una investigación exploratoria, descriptiva, con enfoque cualitativo. Los sujetos de la investigación, realizada en el primer semestre de 2004, fueron ocho pacientes masculinos que se encontraban en tratamiento de hemodiálisis. El instrumento de compilación de datos fue una entrevista semiestructurada, utilizando el análisis categórico. El escenario de investigación fue un servicio de nefrología ubicado en un municipio de la Región Sur de Brasil. Resultados: A partir del análisis surgieron las siguientes categorías: Aspectos físicos y emocionales acerca del tratamiento; las vivencias de los pacientes renales crónicos acerca de su sexualidad; Las estrategias para lidiar con las limitaciones relacionadas con la sexualidad y la sexualidad de los pacientes renales crónicos después de la hemodiálisis. Discusión: El desgaste y el cansancio físico se atribuyeron al tratamiento de hemodiálisis. La experiencia de los pacientes renales crónicos acerca de su sexualidad está íntimamente vinculado con la relación sexual saludables tanto a nivel biológico como emocional. Los pacientes que buscan estrategias dirigidas a minimizar o incluso resolver problemas relativos a su sexualidad, como resultado de la condición crónica, enfrentan con mayor facilidad los obstáculos a los que hacen frente. Los sujetos presentaron modificaciones con respecto a la sexualidad, sin embargo, se percibe la búsqueda de los pacientes por estrategias que amenicen e incluso restablezcan sus necesidades sexuales, dentro de la dimensión bio-sicológica. Consideraciones finales: Este estudio es pertinente, ya que existe la necesidad de capacitar profesionales para que trabajen con la sexualidad humana, percibiendo al paciente renal crónico bajo una visión holística.Objective: To study the experiences of male patients undergoing hemodialysis about their sexuality. Methodology: This is an exploratory, descriptive research with a qualitative approach. The research was conducted in the first half of 2004, and the subjects were eight ma
Denilson Fonseca Rodrigues
Levels of vancomycin in serum are traditionally believed to be unaffected by hemodialysis. By both in vivo and in vitro techniques, the effects of a newer, more permeable dialyzer membrane on vancomycin concentrations were investigated. Six patients who were receiving vancomycin and undergoing maintenance hemodialysis with polyacrylonitrile dialyzer membranes had postdialysis levels in serum that were 63% of predialysis levels; the intradialytic half-life was 5.7 h. Vancomycin concentrations ...
Quale, J. M.; O Halloran, J. J.; Devincenzo, N.; Barth, R. H.
Introduction: Patients undergoing chronic hemodialysis and kidney transplant patients will be afflicted with various mental and physical problems, which may affect their general health. Previous studies have shown that, general health level in these patients is lower than general population. However, definitive studies comparing the general health between the two groups of patients undergoing hemodialysis and kidney transplant recipients have not been done, yet.
Boostani, Hatam; Ghorbani, Ali; Heydarazadzadeh, Maryam
I summarise observations within a continuous-discontinuous shear zone to discuss the local stress and strain conditions experienced within a mixed rheology shear zone undergoing volume loss and deformation approximating simple shear. The Chrystalls Beach Complex, New Zealand, comprises phacoids formed from dismembered beds by layer-parallel extension, enclosed within a relatively incompetent matrix. Local extension is generally subparallel to the regional direction of shortening, and overall it appears that layer-parallel extension is a geometrical necessity in low angle shear zones where significant flattening occurs in response to simple shear accompanied by volume loss. Preferential stress loading of phacoids is predicted by fibre-loading theory, and the failure of phacoids by brittle fracture is thereby governed by fibre stresses transferred from the matrix. The principal stress orientations in a phacoid are likely rotated relative to the matrix, and either parallel or perpendicular to the phacoid-matrix interface. As preferential loading of phacoids decreases the stress level in the matrix, an increased volume fraction of phacoids increases the strength of the shear zone as a whole. However, only small matrix volume fractions are required for the composite to act nearly as weak as the matrix.
Background: Vascular access complications are a major cause of excessive morbidity and mortality in the dialysis population. Moreover, there is not sufficient research regarding the factors correlated with vascular access complications among hemodialysis patients. This study aimed to evaluate the vascular access complications and their related factors such as nursing techniques and self-care in hemodialysis patients. Materials and Methods: A cross-sectional study was performed on 110 patients undergoing hemodialysis in Isfahan Aliasghar hospital during 9 months from July 2010 to March 2011. The data collection tools were a demographic questionnaire and three checklists designed to assess the complications of vascular access and care techniques. Data were collected by observations and interviews with the patients. Fisher's exact test, chi-square test, Pearson correlation coefficient, and descriptive statistics were used to analyze the data through SPSS 16. Results: Among 110 subjects, there were 63 male and 47 female subjects. Subjects’ mean age was 55.88 (15.51) years. There were 72 patients undergoing hemodialysis through arteriovenous fistula and 38 through permanent intra-jugular catheters. Insufficient blood flow in the catheter was the most common complication in patients with jugular catheters. Also, aneurysm was the most prevalent complication in patients with arteriovenous fistula. Low self-care of patients and needling into the aneurysm were correlated with aneurysm size. Presence of underlying diseases was related to ischemia. Conclusions: Nursing techniques and self-care of patients were correlated with the occurrence of complications. Therefore, it draws the attention of the nurses toward continuing professional education and patients’ education, which can increase the longevity of vascular access. PMID:24834093
Adib-hajbagheri, Mohsen; Molavizadeh, Narjes; Alavi, Negin Masoodi; Abadi, Mahmood Hosseiny Mosa
Disturbed sleep is common in end-stage renal disease (ESRD). Exogenous melatonin has somniferous properties in normal subjects and can improve sleep quality (SQ) in several clinical conditions. Recent studies have shown that melatonin may play a role in improving sleep in patients undergoing dialysis. The goal of the present study was to assess the effect of exogenous melatonin administration on SQ improvement in daytime hemodialysis patients. Lipid profile and the required dose of erythropoi...
Edalat-nejad, M.; Haqhverdi, F.; Hossein-tabar, T.; Ahmadian, M.
Introduction. This study evaluated the health-related quality of life (HRQOL) in a sample of Iranian patients undergoing maintenance hemodialysis. The data were compared with the HRQOL for the Iranian general population. Materials and Methods. Two-hundred and fifty patients undergoing hemodialysis were included using a convenience sampling approach in a cross-sectional study. Data collection was performed using a Persian translation of the Short Form-36 questionnaire in combination with ...
Pakpour, Amir H.; Mohsen Saffari; Mir Saeed Yekaninejad; Davood Panahi; Harrison, Adrian P.; Stig Molsted
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
Full Text Available Se presentó la evolución clínica de un paciente de 59 años de edad en hemodiálisis desde el año 1994, que llega a la insuficiencia renal crónica (IRC terminal por la vía aparente de la hipertensión arterial, que luego de 11 años en el proceder dialítico desarrolla un aumento de tamaño de los riñones con grandes quistes, cuyo aspecto en la ecografía y en la tomografía es indistinguible de una poliquistosis renal dominante del adulto.The clinical evolution of a 59-year-old patient on hemodialysis since 1994 that apparently reaches the end-stage chronic kidney failure (CKF by arterial hypertension is presented. After 11 years under the dialytic procedure, it is observed an increase of the size of the kidneys with large cysts, whose aspect in the echography and in the tomography is undistinguishable from an adult dominant polycystic kidney disease.
Yanet Parodis López
Destructive spondyloarthropathy (DSA) has been observed in patients undergoing long-term hemodialysis. The pathophysiology of this condition is still unknown, but there is evidence that amyloid depositions play an important role in its development. Despite several reports, the radiological evolution of these lesions is poorly known. The authors report the results of the radiographic follow-up (12-18 months) of 9 cases (7 female and 2 male patients; age 63±6 years) hemodilized for over 60 months (mean: 126±33). In 7 cases. radiographic patterns of destructive arthropathy were seen in peripheral joints as well. X-ray pictures demonstrated: 1) increased erosion of vertebral end plates (in all cases); 2) increased narrowing of invertebral spaces (in 5 cases); 3) increased collapse of vertebral bodies (in 5 cases); 4) increased malalignment of the involved segments (in 4 cases). In 3 autopsied cases ?2-microglobulin amyloid depositions were found in disc and ligamentous paravertebral tissue. These results confirm that: 1) DSA is progressive in longterm hemodialysis patients; 2) radiographic evolution is often very quick; 3) the cervical spine is the most frequently involved location and the one where lesions are quickest to develop; 4) severe malalignament of the involved spine may be present, with subsequent neurological complications
Full Text Available Abstract This the case of a 63 year-old man with end-stage renal disease (on chronic hemodialysis, unstable angina and significantly impaired myocardial contractility with low left ventricular ejection fraction, who underwent off-pump one vessel coronary bypass surgery. Combined continuous levosimendan and norepinephrine infusion (at 0.07 ?g/kg/min and 0.05 ?g/kg/min respectively started immediately after anesthesia induction and continued for 24 hours. The levosimendan/norepinephrine combination helped maintain an appropriate hemodynamic profile, thereby contributing to uneventful completion of surgery and postoperative hemodynamic stability. Although levosimendan is considered contraindicated in ESRD patients, this case report suggests that combined perioperative levosimendan/norepinephrine administration can be useful in carefully selected hemodialysis patients with impaired myocardial contractility and ongoing myocardial ischemia, who undergo off-pump myocardial revascularization surgery.
Siminelakis Stavros N
Full Text Available Sleep disorders are the most prevalent complaints in hemodialysis patients. Treatments such as Air Way Positive Pressure and medicines frequently are not available or may have side effects. Acupressure is a non-invasive method from traditional Chinese medicine. The effectiveness of this method in treatment of sleep disorders has been proved in some studies. The aim of this study is to research the effect of Acupressure on quality of sleep in hemodialysis patients. This study was a randomized clinical trial; conducted at Razi hospital on a sample of 62 hemodialysis patients who had complains from sleep disorders. The sample were randomized into experimental and control groups. The experimental group received acupressure 3 times per week while undergoing dialysis for 4 weeks. The control group only received unit routine care. Quality of life was measured using Pittsburgh Sleep Quality Index (PSQI before and after intervention. In order to record the pattern of quality of sleep the sleep log were used. Statistical analysis was done by Chi-square, T-test, Mann-Withney and Wilcoxone test. Findings on quality of life showed statistically significant differences between experimental and control groups based on PSQI. Domain of subjective quality of life (p = 0.042, time needed to falling sleep (p = 0.007, sleep duration (p = 0.017, habitual sleep efficiency (p = 0.001, sleep disorders (p = 0.024, daily performance disorders (p = 0.002 and overall score (p = 0.001 were improved in experimental group compared to control group. Moreover, sleep log demonstrated the decrease in nighttime waking and increase in quality of sleep that started from the first week of intervention and continued up to one week after intervention. This study confirmed the previously published studies which showed the effect of acupressure on improving the quality of sleep in hemodialysis patients. This treatment could be used as a non-invasive method for treatment of sleep disorders in these patients.
Razieh Khajeh- Kazemi
Full Text Available Abstract Background Low bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis. It can lead to serious bone health problems such as fragility fractures. The purpose of this study is to investigate the risk factors of low bone mass in the hemodialysis patients. Methods Sixty-three subjects on hemodialysis for at least 6 months were recruited from a single center for this cross-sectional study. We collected data by questionnaire survey and medical records review. All subjects underwent a bone mineral density (BMD assay with dual-energy x-ray absorptiometry at the lumbar spine and right hip. Data were statistically analyzed by means of descriptive analysis, independent t test and one way analysis of variance for continuous variables, Pearson product-moment correlation to explore the correlated factors of BMD, and stepwise multiple linear regression to identify the predictors of low bone mass. Results Using WHO criteria as a cutoff point, fifty-one subjects (81% had a T-score lower than -1, of them 8 subjects (13% had osteoporosis with the femoral neck most commonly affected. Regarding risk factors, age, serum alkaline phosphatase (ALP level, and intact parathyroid hormone (iPTH level had significant negative correlations with the femoral neck and lumbar spine BMD. On the other hand, serum albumin level, effective exercise time, and body weight (BW had significant positive correlations with the femoral neck and lumbar spine BMD. Age, effective exercise time, and serum albumin level significantly predicted the femoral neck BMD (R2 × 0.25, whereas BW and the ALP level significantly predicted the lumbar spine BMD (R2 × 0.20. Conclusion This study showed that advanced age, low BW, low serum albumin level, and high ALP and iPTH levels were associated with a low bone mass in the hemodialysis patients. We suggest that regular monitoring of the femoral neck BMD, maintaining an adequate serum albumin level and BW, and undertaking an exercise program are important to improve bone health in the patients undergoing hemodialysis.
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
Full Text Available INTRODUÇÃO: O Comitê de Nutrição da Sociedade Brasileira de Nefrologia (SBN realizou, em 2010, o primeiro Censo Brasileiro de Nutrição em pacientes em Hemodiálise. Dados multicêntricos contribuem para o desenvolvimento de condutas clínicas e intervenção nutricional. OBJETIVO: Descrever aspectos nutricionais e epidemiológicos de pacientes em hemodiálise. MÉTODO: Estudo transversal em 36 clínicas de diálise, 2.622 participantes selecionados aleatoriamente. Foram coletados: registros sociodemográficos, clínicos, bioquímicos e antropométricos. RESULTADOS: Dos pacientes, 60,45% era da região Sudeste, 13,53% Nordeste, 12,81% Sul, 10,33% Centro-Oeste e 2,86% Norte. Cerca de 58% eram homens e 63,1% tinham menos de 60 anos. Casados ou em união est??vel, 58,5% deles. Aproximadamente 80% dependia do Sistema Único de Saúde. O tabagismo apresentou diferença entre sexo e idade. As etiologias presuntivas foram nefroesclerose hipertensiva 26,4%, nefropatia diabética 24,6%, causas desconhecidas/não diagnosticadas 19,9%, glomerulopatias 13,6% e outros 11,2%. A hipertensão arterial e o Diabetes Mellitus acometiam aproximadamente 30% dos pacientes, principalmente aqueles acima de 60 anos. O Índice de Massa Corporal não diferiu entre sexos, embora tenha diferido entre grupos etários e quando utilizados critérios de avaliação distintos. A média de circunferência da cintura de homens e mulheres foi, respectivamente, 90,5 cm e 88,0 cm. O perfil lipídico não diferiu entre às faixas etárias, porém, houve diferenças entre sexos. Os valores de albumina estiveram menores nas mulheres e em pacientes com idade superior a 60 anos. CONCLUSÃO: O estudo caracterizou os pacientes em hemodiálise no Brasil em 2010, podendo subsidiar novos estudos para acompanhamento de transições nutricionais e epidemiológicas da população.INTRODUCTION: The Nutrition Committee of the Brazilian Society of Nephrology (SBN held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention. OBJECTIVE: To describe epidemiological and nutritional aspects of hemodialysis patients. METHOD: Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected. RESULTS: 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%, Diabetic Nephropathy (24.6%, unknown/undiagnosed causes (19.9%, Glomerulopathies (13.6% and others (11.2%. Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years. CONCLUSION: This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.
Bárbara Margareth Menardi Biavo
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
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.
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.
Continuous renal replacement therapy (CRRT) is a therapeutic technique used to support critically ill patients with acute renal failure in intensive care units. CRRT is preferred over hemodialysis for patients who cannot tolerate the rapid fluid and electrolyte shifts associated with hemodialysis because of their tenuous hemodynamic state. Traditionally, such patients have not been candidates for mobilization and have remained on strict bed rest. Mobilization is now being initiated on patients undergoing CRRT in intensive care units. This case study chronicles the successful mobilization of a patient undergoing CRRT. This experience suggests that CRRT patients who are appropriate candidates may be mobilized safely and therefore should not automatically be excluded from mobilization therapies. PMID:24986178
Brownback, Cherylynn A; Fletcher, Patricia; Pierce, Lynelle N B; Klaus, Susan
Full Text Available Aim: The issue of optimal dialysis dose and frequency has been a central topic in the delivery of dialysis treatment. We aimed to consider the effects of age on some hemodialysis parameters specially dialysis adequacy by urea reduction rate (URR and to compare these parameters between diabetics and non diabetic HD(hemodialysis patients. Material and Method: Patients with end-stage renal disease (ESRD, undergoing maintenance hemodialysis treatment were considered. The urea reduction rate and body mass index were calculated. Results: The total patients were 60 (F=21 M=39, consisting of 44 non diabetic hemodialysis patients (F=15 M=29, and 16 diabetic hemodialysis patients (F=6 M=10. A significant difference of dialysis adequacy between non-diabetics and diabetics was observed with lower values in diabetic group and a significant difference of dialysis adequacy and creatinine was observed in patients, with ages below and more than 50 years old with lower values in older patients. A significant negative correlation of age with dialysis adequacy in total hemodialysis patients and a significant negative correlation of age with serum creatinine were observed. Discussion: The negative effect of age on dialysis adequacy needs more attention to this aspect to reduce the dialysis complications which is frequently observed in older patients.
Background & Aim: Hemodialysis is a common replacement therapy for patients with ESRD, worldwide. Effective and adequate hemodialysis can improve quality of life and reduce complications of renal failure. Enhancing quality of dialysis results in reducing the complications and mortality rate in patients with chronic renal failure. The aim of this study was to assess the adequacy of dialysis in patients undergoing dialysis with Bicarbonate solution in hemodialysis ward of a hospital in Sary.Met...
Ehteram Sadat Ilali; Raheleh Mohseni
Postoperative glucose control directly affects the incidence of deep sternal wound infection and death after patients with diabetes have undergone coronary artery bypass grafting. We compared the effect upon glucose control of continuous insulin infusion with that of glucometer-guided insulin injection after coronary artery bypass.
Li, Jiun-yi; Sun, Shen; Wu, Shye-jao
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
Full Text Available Introduction: Chronic kidney disease promotes changes in the zinc nutritional status and in the antioxidant defense system. This study assessed the relationship between the parameters of the zinc nutritional status and the activity of superoxide dismutase in patients with chronic renal failure who are receiving hemodialysis. Methods: 134 individuals, aged between 18 and 85 years, were divided into two groups: case group (hemodialyzed patients, n = 63 and control group (n = 71. Zinc concentrations in plasma and erythrocytes were determined using the flame atomic absorption spectrophotometry technique. The activity of superoxide dismutase enzyme was determined according to Ransod kit. Results: The mean values of plasma zinc were 62.02 ± 13.59 ?g/dL and 65.58 ± 8.88 ?g/dL, and for erythrocytary zinc the values were 54.52 ± 22.82 ?gZn/gHb and 48.01 ± 15.08 ?gZn/gHb for the chronic renal patients and the control group, respectively. The activity of superoxide dismutase was significantly lower in patients when compared with the control group (p Introducción: La enfermedad renal crónica produce cambios en el estado nutricional del zinc y en el sistema de defensa antioxidante. Por lo tanto, este estudio investigó la relación entre parámetros del estado nutricional del zinc y la actividad de la enzima superóxido dismutase en pacientes con enfermedad renal crónica en hemodiálisis. Métodos: Se incluyeron 134 personas, de 20 a 59 años de edad que fueron divididos en dos grupos: grupo caso (pacientes en hemodiálisis, n = 63 y grupo control (n = 71. El zinc plasmático y eritrocitario fueron analizados según el método de espectrofotometría de absorción atómica. La actividad de la enzima superóxido dismutasa fue analizada de acuerdo con Kit Ransod. Resultados: Los valores medios de zinc plasmatico fueron 62,02 ± 13,59 ?g/dL y 65,58 ± 8,88 ?g/dL y los valores de zinc eritrocitario fueron 54,52 ± 22,82 ?gZn/gHb y 48,01 ± 15,08 ?gZn/gHb, en los pacientes en hemodialisis y en el grupo control, respectivamente. La actividad de la superoxido dismutasa fue significantemente inferior en los pacientes que en controles (p < 0,05. Conclusiones: La actividad de la superóxido dismutasa en pacientes con enfermedad renal crónica en hemodiálisis, que es influenciada por la concentración del zinc, fue significantemente inferior. Hubo una respuesta inadecuada por la enzima al estrés oxidativo en pacientes en hemodiálisis.
R. C. Noleto Magalhães
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
Full Text Available SciELO Spain | Language: English Abstract in spanish Introducción: La enfermedad renal crónica produce cambios en el estado nutricional del zinc y en el sistema de defensa antioxidante. Por lo tanto, este estudio investigó la relación entre parámetros del estado nutricional del zinc y la actividad de la enzima superóxido dismutase en pacientes con 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
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.
Full Text Available Chronic inflammation is the cause of malnutrition and cardiovascular disease in hemodialysis patients. The purpose of this study was to assess C Reactive Protein (CRP as an inflammatory marker and to define the relationship between CRP and other inflammatory and nutritional factors in this group of patients. One hundred and fourteen hemodialysis patients undergoing chronic dialysis (3 times a week for at least 4 hours in two hemodialysis centers were enrolled in this cross-sectional study. Anthropometric and laboratory data including CRP, Il-6, hemoglobin, serum ferritin, triglyceride, cholesterol, albumin, total protein and transferrin were measured. The Kt/V for adequacy of dialysis was also calculated. There was a statistically signi-ficant correlation between the mean CRP and albumin, hemoglobin, and transferrin; while such relation was not found with BMI, ferritin, the length of dialysis, triceps skin fold thickness, mid arm circumference, mid arm muscle circumference, and Kt/V. We conclude that the negative relationship between CRP and albumin, transferrin, and hemoglobin suggests a correlation bet-ween inflammatory and nutritional factors.
The study was planned as a case-control study to examine the effects of music on some of the complications experienced by chronic renal failure (CRF) patients during hemodialysis. A total of 60 patients (30 intervention and 30 control) diagnosed with end-stage renal failure undergoing hemodialysis treatment participated in this study. The study was conducted in Manisa Merkez Efendi State Hospital Hemodialysis Unit and Manisa Özel Anemon Hemodialysis between April 2012 and July 2012. The intervention group listened 30 minutes in each session (12 total sessions) Turkish art music at the beginning of the third hour of their hemodialysis sessions. Patient Information Form and visual analog scale to assess pain, nausea, vomiting, and cramps during hemodialysis session were used. For the analysis of data, the number, percentage, chi-square test, and significance test of independent group differences between two averages were conducted. According to the findings of the study, the average of the intervention and control group ages, respectively, was 50.86?±?11.3 and 55.13?±?9.68. The primary duration of hemodialysis treatment for both intervention and control groups was "1 year and above" (70.0%). The intervention group's pain and nausea scores were lower than the control group for all 12 sessions. The difference between the intervention and the control group's pain scores was significant (P?music can be used as an independent nursing practice for reduction of complications for CRF patients receiving hemodialysis treatment. PMID:24666929
Koca Kutlu, Adalet; Eren, Ay?e Gül
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 ...
Janardhan, Vasantha; Soundararajan, P.; Rani, N. Vanitha; Kannan, G.; Thennarasu, P.; Chacko, Rosney Ann; Reddy, C. Uma Maheswara
It is unknown whether regular patient-doctor contact (PDC) contributes to better outcomes for patients undergoing hemodialysis. Here, we analyzed the associations between frequency and duration of PDC during hemodialysis treatments with clinical outcomes among 24,498 patients from 778 facilities in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). The typical facility PDC frequency, estimated by facility personnel, was high (more than once per week) for 55% of facilitie...
Kawaguchi, Takehiko; Karaboyas, Angelo; Robinson, Bruce M.; Li, Yun; Fukuhara, Shunichi; Bieber, Brian A.; Rayner, Hugh C.; Andreucci, Vittorio E.; Pisoni, Ronald L.; Port, Friedrich K.; Morgenstern, Hal; Akizawa, Tadao; Saran, Rajiv
To elucidate whether and how in patients on maintenance hemodialysis (HD), infection of H. pylori intensifies the anemia, a cross-sectional study that was conducted on 39 patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis treatment who had various upper gastrointestinal complaints consisting of epigastric pain, epigastric burning, postprandial fullness, early satiety, bloating and belching. Mean ages of patients were 46(?18) years. The dialysis du...
Evidence to support improved outcomes with early ambulation is strong in medical literature. Yet, critically ill continuous renal replacement therapy (CRRT) patients remain tethered to their beds by devices delivering supportive therapy. The University of Michigan Adult CRRT Committee identified this deficiency and sought to change it. There was no guidance in the literature to support mobilizing this population; therefore, we reviewed literature from devices with similar technological profiles. Revision of our institutional mobility protocol for the CRRT population included a simple safety acronym, ASK. The acronym addresses appropriate candidacy; secured, appropriate access; and potential device and patient complications as a memorable aid to help nursing staff determine whether their CRRT patients are candidates for early mobility. After implementing our CRRT mobility standard, a preliminary study of 109 CRRT patients and a review of incident reports related to CRRT demonstrated no significant adverse patient events or falls and no access complications related to mobility. This deliberate intervention allows CRRT patients to safely engage in mobility activities to improve this population's outcomes. A simple mobility protocol and safety acronym partnered with strong clinical leadership has permitted the University of Michigan to add CRRT patients to the body of early mobility literature. PMID:23221445
Talley, Cheryl L; Wonnacott, Robert O; Schuette, Janice K; Jamieson, Jill; Heung, Michael
Objective: Catheter colonization is a necessary step in catheter related bacteremia but pathogenesis hasn’t been clarified recently. In our study, we aimed to detect the incidence of catheter colonization and related parameters in patients with indwelling hemodialysis catheters. Material and Method: The data of 43 hemodialysis patients using temporary hemodialysis catheters were evaluated retrospectively. The relation between colonization and factors that affect catheter colonization such a...
?eref Yüksel; Gürsel Acartürk; ?hsan Uslan; Mehmet Çölbay; Özcan Karaman; Zeki Arslan; Zafer Çetinkaya; Serap Demir
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 cardia...
Iodice, Francesca G.; Zaccaria Ricci; Roberta Haiberger; Isabella Favia; Paola Cogo
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 in...
Iodice, Francesca G.; Zaccaria Ricci; Roberta Haiberger; Isabella Favia; Paola Cogo
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 cardia...
Iodice, Francesca G.; Zaccaria Ricci; Roberta Haiberger; Isabella Favia; Paola Cogo
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
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese O presente estudo teve por objetivo avaliar o nível de esperança dos idosos renais crônicos em hemodiálise, por meio da Escala de Esperança de Herth (EEH). Trata-se de um estudo descritivo transversal, realizado em uma Unidade de Terapia Renal Substitutiva do interior do estado de São Paulo. A 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.
Fabiana de Souza, Orlandi; Barbara Garbelotti, Pepino; Sofia Cristina Iost, Pavarini; Damiana Aparecida dos, Santos; Marisa Silvana Zazzetta de, Mendiondo.
Avaliação do nível de esperança de vida de idosos renais crônicos em hemodiálise Evaluación del nivel de esperanza de vida de ancianos con enfermedad renal crónica en hemodiálisis The evaluation of the level of hope of elderly chronic kidney disease patients undergoing hemodialysis
Full Text Available O presente estudo teve por objetivo avaliar o nível de esperança dos idosos renais crônicos em hemodiálise, por meio da Escala de Esperança de Herth (EEH. Trata-se de um estudo descritivo transversal, realizado em uma Unidade de Terapia Renal Substitutiva do interior do estado de São Paulo. A amostra foi composta por 50 idosos em tratamento hemodialítico. Após o consentimento em participar da pesquisa, realizou-se entrevistas individuais com os referidos idosos aplicando-se um instrumento de caracterização e a Escala de Esperança de Herth. Todos os preceitos éticos foram respeitados (protocolo 512/2009. Quanto aos resultados, houve predomínio do sexo masculino (60% e idade média de 70,20 (±6,1 anos. O escore médio obtido com a aplicação da Escala de Esperança de Herth foi de 36,20 (±2,90. Conclui-se que em comparação com o estudo brasileiro de validação da Escala de Esperança de Herth, o nível de esperança dos sujeitos do presente estudo foi mais baixo, indicando a necessidade de intervenção sobre esse sentimento.Se objetivó evaluar el nivel de esperanza de vida de ancianos con enfermedad renal crónica en hemodiálisis, mediante Escala de Esperanza de Herth (EEH. Estudio descriptivo, transversal, realizado en Unidad de Terapia Renal Sustitutiva del interior del estado de São Paulo. Muestra compuesta por 50 ancianos en tratamiento de hemodiálisis. Con consentimiento para participar en la investigación, se realizaron entrevistas individuales con los sujetos, aplicándose un instrumento de caracterización y la Escala de Esperanza de Herth. Fueron respetados todos los preceptos éticos (protocolo 512/2009. Los resultados mostraron predominio del sexo masculino (60%, edad promedio de 70,20 años (±6,1. El puntaje promedio obtenido con EEH fue 36,20 (±2,90. En comparación con el estudio brasileño de validación de la EEH, el nivel de esperanza de vida de los sujetos de este estudio fue más bajo, indicando la necesidad de intervención sobre tal sentimiento.The objective of the present study was to evaluate the level of hope of elderly chronic kidney disease patients undergoing hemodialysis, using the Herth Hope Scale (HHS. This cross-sectional descriptive study was performed at a Renal Replacement Therapy Unit located in upstate São Paulo. The sample consisted of 50 elderly patients currently undergoing hemodialysis treatment. After obtaining the participants' consent to participate, individual interviews were performed with the elderly individuals, utilizing a characterization instrument and the Herth Hope Scale. All of the ethical premises were complied with (protocol 512/2009. Regarding the results, most participants were male (60% and their mean age was 70.20 (±6.1 years. The mean score on the Herth Hope Scale was 36.20 (±2.90. In conclusion, compared with the Brazilian study regarding the validation of the Herth Hope Scale, the subjects' level of hope was lower, thus indicating a need to intervene regarding this feeling.
Fabiana de Souza Orlandi
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.
Mukadder Ay?e Bilgiç
Full Text Available Introduction: There are several potential explanations for the development of PH in patients with stable hemodialysis patients. Hormonal and metabolic derangement associated with end-stage renal failure might lead to pulmonary arterial vasoconstriction and an increase of the pulmonary vascular resistance. The aim of this study was to consider the association of pulmonary artery pressure (PAP with serum parathormone in end-stage renal disease (ESRD patients under regular hemodialysis treatment. Material and methods: This cross-sectional study was conducted on patients with end-stage renal disease undergoing maintenance hemodialysis treatment through an arteriovenous fistula which was created on the hand, and with acetate basis dialysate and polysulfone membranes. For all patients serum intact parathormone (iPTH was measured. For assessment of pulmonary artery pressure, all patients were subjected to two-dimensional and doppler echocardiographic studies that were done for the patients after their hemodialysis sessions. Results: The study comprised 102 patients (F=46, M=56 consisting of 73 non diabetic hemodialysis patients (F=33, M=40, and 29 diabetic hemodialysis patients (F=13, M=16. The duration of hemodialysis was 17.8±29 months. The mean ±SD of serum iPTH of total patients was 338±306 pg/ml. The mean ±SD of pulmonary artery systolic pressure (PAP was 41.5±12.6 mmHg. A significant positive correlation of PAP with the dosage (r=0.36, p=0.001 and duration of hemodialysis (r=0.35, p<0.001 was seen, also a significant positive correlation of pulmonary artery systolic pressure with serum intact parathormone (iPTH in hemodialysis patients was found. Conclusions: A significant positive correlation of serum intact parathormone with pulmonary artery pressure, which is a new aspect of uncontrolled secondary hyperparathyroidism implies the need for a better control of poorly controlled hyperparathyroidism disease in hemodialysis patients.
There is an increased risk of infective endocarditis catheterization usedfor Hemodialysis. We report a case of a young man who had endocarditissecondary to the use of a permanent jugular catheter for hemodialysis. Bloodcultures were repeatedly negative, but vegetations were seen on the tricuspidvalve on echocardiography. A high index of suspicion is recommended for thisserious complication. (author)
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 excluded. The patient was subjected to a successful angioplasty with stent placement that resulted in a complete relief of the pain. PMID:12491833
Duclos, Jaime; Urquieta, María Soledad; Opazo, Marcos
Full Text Available BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo™ system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo™ system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A prospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements, after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia, at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis. RESULTS: There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P < 0.01. Importantly, stroke volume variation increased immediately after newborn delivery (P < 0.001 and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time. DISCUSSION AND CONCLUSIONS: No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia.
José Otavio Costa Auler Junior
Full Text Available OBJECTIVES: In this study, we aimed to investigate plasma homocysteine (Hcy and serum C-reactive protein (CRP levels in hemodialysis (HD and continuous ambulatory peritoneal dialysis (CAPD patients, and the relation among them.
Our previous study had demonstrated that Chinese medicine Epimedium Sagittatum (ES) exerted immuno-enhancing effect on the animal model of chronic renal insufficiency. In present study, we investigated the therapeutic effect of ES on patients of hemodialysis maintenance. 22 cases of regular hemodialytic patients were treated with ES in the form of decoction. 12 patients with hemodialysis were served as controls. It was found that ES had sexual potentiation effect and improved the quality of life in the patients of chronic renal failure with regular hemodialysis. Interleukin 2 (IL-2) activity of peripheral blood monocytes (PBMC) stimulated by PHA was increased significantly in the patients treated with ES. It was suggested that Chinese medicine ES had therapeutic effect on sexual disorder and immunologic inadequacy in the patients of chronic renal failure undergoing hemodialysis. PMID:7647539
Liao, H J; Chen, X M; Li, W G
Full Text Available Introduction. Pruritus is one of the common problems in patients on hemodialysis. There are several causes for pruritus, and different treatment modalities are applied to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in patients on hemodialysis.Materials and Methods. This randomized double-blinded cross-over clinical trial was performed on 34 patients on hemodialysis with uremic pruritus. The patients were divided into 2 groups, one group received capsaicin 0.03% and the other, placebo, for 4 weeks. Treatment was stopped for 2 weeks as washout period and continued as a cross-over technique. Pruritus scores were analyzed and compared.Results. Thirty-four patients on long-term hemodialysis, 14 men and 20 women with a mean age of 57.0 ± 18.6 years were studied. The mean of pruritus score before capsaicin treatment was 15.9 ± 6.3, which was reduced to 6.4 ± 3.9, 4.7 ± 3.1, 3.2 ± 2.9, and 2.5 ± 2.5 on weeks 1 to 4, respectively (P Conclusions. Capsaicin is a new safe and effective topical treatment for hemodialysis-induced pruritus in patients with end-stage renal disease.
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.
In patients with end-stage renal failure physical exercise has beneficial effects on functional capacity, anemia, cardiovascular risks factors and on psychosocial problems. However, only few patients are able or willing to participate in an exercise training which is organised on an outpatient basis. As a consequence, an exercise program was developed which can be performed during hemodialysis. This program consists of a low intensity endurance training with a bed bicycle ergometer, gymnastics to increase muscular strength, flexibility and co-ordination and of relaxation techniques. An increasing number of studies show that this type of exercise training has comparable beneficial effects as an outpatient exercise rehabilitation program. In addition, exercise during hemodialysis increases the solute removal and thereby the efficiency of dialysis probably by an increased perfusion of skeletal muscles. Since 1995 this type of exercise training was implemented in about 200 German dialysis centers. The participation rate is much higher than in supervised outpatient rehabilitation programs as also elderly patients and patients with severe additional medical problems participate. Even in very old patients functional capacity is improved by exercise during dialysis. As a consequence, some patients do not need any longer professional help for the activity of daily living. Up to now no serious adverse effects or complications were induced by exercise during dialysis. This could be achieved as the patients are instructed and supervised by physiotherapists who have special knowledge and skills in renal exercise rehabilitation. Almost all patients can do some exercise during dialysis and therefore this is the most favourable type of exercise training for hemodialysis patients today. PMID:15233244
Daul, A E; Schäfers, R F; Daul, K; Philipp, T
Specific problems during fabrication of concentrated hemodialysis solutions containing bicarbonate arise because of the low solubility of sodium bicarbonate in water and the risk or precipitation of calcium, magnesium carbonates. These problems have been solved by the Pharmacie centrale by making 2 different concentrated solutions, the first one brinding the major essential elements, at the exclusion of bicarbonate, the second less concentrated, with bicarbonate and potassium gluconate, the latter complexing iron and so preventing precipitates of ferric carbonate. The various pharmaceutical steps are described in this paper: formulation, choice of raw materials and manufacturing processes, quality control. PMID:6664421
Hamon, M; Renaux, C; Pradeau, D
Full Text Available SciELO Brazil | Language: English Abstract in english BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo™ system may offer a less invasive technique. The aim of this study was to evaluate [...] cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo™ system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A 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
José Otavio Costa, Auler Junior; Marcelo L.A., Torres; Mônica M., Cardoso; Thais C, Tebaldi; André P., Schmidt; Mario M., Kondo; Marcelo, Zugaib.
The accumulation of amyloid in the bone and joint system has recently been recognized as a peculiar disease in patients undergoing long-term hemodialysis (5 years at least), especially in those who use cuprophan membranes. The pathology of amyloidosis is characterized by deposits of amyloid (? microglobulin mainly) in the bone, in the synovia, and in pericapsular soft tissues. The skeleton of 46 long-term hemodialysis patients (19 males and 27 females) was studied by X-ray; bone and joint abnormalities due to amyloid deposition were observed in 45% of cases. The shoulder, hip, and wrist were the most frequently involved joints. Destructive spondyloarthorapathy was present in 15% of cases. The radiographic patterns of AOD are generally divided into axial and peripheral lesions. In the appendicular skeleton abnormalities include: well-defined lytic areas (geodes), pathologic fractures, marginal erosions, and particular soft tissue swelling. Destructive spondyloarthropathy is frequently present in the cervical spine (85% of our cases) and is characterized by narrowing of the invertebral space, marginal erosion, and subchondral bone sclerosis of the vertebral body
Introduction: Two principal findings of cardiovascular disease in end-stage renal disease patients undergoing regular hemodialysis are left ventricular hypertrophy (LVH) and arterial disease due to rapidly progressive atherosclerotic vascular disease that can be characterized by an enlargement and hypertrophy of arteries (intima-media complex thickening; IMT).Objectives: In this study, we sought to evaluate the relationship between left ventricular hypertrophy with intima-media complex thickening in end-stage renal disease patients undergoing regular hemodialysis. Patients and Methods: Sixty-one patients with end-stage renal disease (ESRD) who were undergoing regular and maintenance hemodialysis treatment (F=23, M=38) were studied. The subjects consisted of 50 non-diabetic hemodialysis patients (F=20, M=30) and 11 diabetic hemodialysis patients (F=3, M=8). For all the subjects, echocardiography and carotid intima-media thickness measuring by B-mode ultrasonography were performed. Results: In this study, there was a positive correlation between stages of LVH with duration of hemodialysis treatment, stages of hypertension (HTN), and with carotid-IMT. A positive correlation was also seen between stages of LVH and presence of chest pain, and more thickening of the intima-media complex was seen in the diabetic group. Diabetes mellitus was associated with the presence of chest pain, as was positive correlation between stages of HTN with IMT, and a reverse correlation was observed between IMT with the percent of cardiac ejection fraction. Conclusion: Prevalence of thickening in intima-media complex is more evident in hemodialysis subjects with LVH. When there is LVH, IMT is similar in severity to the LVH. PMID:25340151
Rafieian-Kopaei, Mahmoud; Nasri, Hamid
Full Text Available Introduction: Two principal findings of cardiovascular disease in end-stage renal disease patients undergoing regular hemodialysis are left ventricular hypertrophy (LVH and arterial disease due to rapidly progressive atherosclerotic vascular disease that can be characterized by an enlargement and hypertrophy of arteries (intima-media complex thickening; IMT.Objectives: In this study, we sought to evaluate the relationship between left ventricular hypertrophy with intima-media complex thickening in end-stage renal disease patients undergoing regular hemodialysis.Patients and Methods: Sixty-one patients with end-stage renal disease (ESRD who were undergoing regular and maintenance hemodialysis treatment (F=23, M=38 were studied. The subjects consisted of 50 non-diabetic hemodialysis patients (F=20, M=30 and 11 diabetic hemodialysis patients (F=3, M=8. For all the subjects, echocardiography and carotid intima-media thickness measuring by B-mode ultrasonography were performed.Results: In this study, there was a positive correlation between stages of LVH with duration of hemodialysis treatment, stages of hypertension (HTN, and with carotid-IMT. A positive correlation was also seen between stages of LVH and presence of chest pain, and more thickening of the intima-media complex was seen in the diabetic group. Diabetes mellitus was associated with the presence of chest pain, as was positive correlation between stages of HTN with IMT, and a reverse correlation was observed between IMT with the percent of cardiac ejection fraction.Conclusion: Prevalence of thickening in intima-media complex is more evident in hemodialysis subjects with LVH. When there is LVH, IMT is similar in severity to the LVH.
The aim of our study was to evaluate the changes in hemodialysis service, main demographic characteristics of hemodialysis patients in Lithuania during 1996-2005, and their correlation with the number of recipients on the kidney waiting list. During the study period, we annually visited all hemodialysis centers in Lithuania and collected data about all hemodialysis patients. There was a sharp increase in the number of hemodialysis centers (from 17 to 43), hemodialysis stations (from 25 to 100 per million population, P<0.001), hemodialysis patients (from 60 to 312 per million population, P<0.001), and new hemodialysis patients (from 54.3 to 95 per million population, P<0.01). The mean age of hemodialysis patients increased from 47.2+/-16.1 years in 1996 to 58.8+/-15.6 years in 2005 (P<0.001). Hemodialysis population became older. The percentage of patients aged more than 60 years increased from 22.8% to 53.2% (P<0.001) and aged more than 70 years from 5.4% to 24.4% (P<0.001). The frequency of chronic glomerulonephritis as underlying disease of end-stage renal disease decreased from 54.5% in 1996 to 21.1% in 2005 (P<0.001). There was an increase in the percentage of patients in whom end-stage renal disease was caused by diabetic (from 7.1% to 19.2%, P<0.01) and hypertensive nephropathies (from 3.1% to 13.9%, P<0.05) and chronic pyelonephritis (from 11.2% to 17.9%, P<0.01). The percentage of recipients on the kidney waiting list decreased from 71.4% in 1996 to 21.1% in 2005. In summary, during the last 9 years, hemodialysis service in Lithuania significantly expanded. The number of hemodialysis patients was continuously rising with predominance of diabetic, hypertensive, and elderly patients. Diabetic nephropathy, chronic glomerulonephritis, and pyelonephritis were the main underlying diseases of end-stage renal disease in hemodialysis patients in 2005. The percentage of recipients on the kidney waiting list decreased probably because of the rise in the number of elderly patients and patients with diabetes mellitus in Lithuanian hemodialysis population. PMID:17551288
Ziginskiene, Edita; Kuzminskis, Vytautas; Bumblyte, Inga Ar?ne; Santockiene, Lina; Dalinkeviciene, Egle; Kardauskaite, Zydr?ne; Uogintaite, Jurgita; Motiej?naite, Agne; Butautas, Ernestas; Vainauskas, Vaclovas; Macius, Kazimieras; Sakalauskiene, Marija; Steckis, Ricardas; Gaupsiene, Egle; Urbanaviciene, J?rate; Labutiene, Vilma
Preemptive renal transplantation is the method of choice for end stage renal disease in childhood and adolescence. However, without preemptive transplantation, waiting time for kidney transplantation might exceed several years. The poor quality of life and the extremely high morbidity and mortality rates of dialysis patients have led to the development of intensified hemodialysis programs in which the modes of dialysis (short daily, nocturnal intermittent or daily nocturnal) are different. Such programs have been shown to significantly improve several uremia-associated parameters, such as blood pressure, phosphate control, anemia and growth retardation, in both adult and pediatric (children and adolescents) patients and lead to a reduction in medications, including phosphate binders, erythropoietin and antihypertensive agents. Fluid limitations and dietary restrictions can also be lifted. With respect to psychosocial rehabilitation and quality of life, nocturnal intermittent dialysis programs provide a reasonable compromise of all forms of intensified programs. Experiences and practical approaches of our own in-center nocturnal intermittent hemodialysis program in the light of the recent publications are described in this review. PMID:25103600
Thumfart, Julia; Müller, Dominik
Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing hemodialysis. Interleukin-10 (IL-10) and tumour necrosis factor-? (TNF-? ) are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular accessm failure and various inflammatory markers including the genetic polymorphisms of IL-10 and TNF-? . Seventy-five patients on hemodialysis with an arterioveno...
Sung, Su Ah; Ko, Gang Jee; Jo, Sang Kyung; Cho, Won Yong; Kim, Hyoung Kyu; Lee, So Young
The doripenem serum concentrations in intensive care patients suffering from acute kidney injury, sepsis, and multi organ dysfunction syndrome undergoing continuous renal replacement therapy slow low-efficiency dialysis
Full Text Available Andrzej Wieczorek, Andrzej Tokarz, Wojciech Gaszynski, Tomasz Gaszynski Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland Abstract: Doripenem is a novel wide-spectrum antibiotic, and a derivate of carbapenems. It is an ideal antibiotic for treatment of serious nosocomial infections and severe sepsis for its exceptionally high efficiency and broad antibacterial spectrum of action. Doripenem is eliminated mainly by the kidneys. In cases of acute kidney injury, dosing of doripenem depends on creatinine clearance and requires adjustments. Doripenem is eliminated during hemodialysis because its molecular weight is 300–400 Da. The aim of this study was to establish the impact of continuous renal replacement therapy (CRRT slow low-efficiency dialysis (SLED on doripenem serum concentrations in a population of intensive-therapy patients with life-threatening infections and severe sepsis. Ten patients were enrolled in this observational study. Twelve blood samples were collected during the first administration of doripenem in a 1-hour continuous infusion while CRRT SLED was provided. Fluid chromatography was used for measurement of the concentration of doripenem in serum. In all collected samples, concentration of doripenem was above the minimum inhibition concentration of this antibiotic. Based on these results, we can draw the conclusion that doripenem concentration is above the minimum inhibition concentration throughout all of CRRT. The dosing pattern proposed by the manufacturer can be used in patients receiving CRRT SLED without necessary modifications. Keywords: AKI, antibiotic, antimicrobial therapy, carbapenem, CRRT, infection, MODS, SLED
Sleep disturbances manifesting as insomnia, daytime sleepiness, fatigue, and other symptoms are frequently found in patients with end-stage renal disease that is being treated with dialysis. Many factors, including neurosis, uremic symptoms, dialysis drugs, and sleep-wake rhythms have been suggested as potential causes for these sleep disturbances. We examined sleep apnea/hypopnea and heart rate variability (HRV) reflecting autonomic activity in hemodialysis patients on their hemodialysis and non-hemodialysis days using a home medical care device (Morpheus C, TEIJIN). Eleven hemodialysis patients and 14 healthy adults were enrolled in this study. We calculated the number of apnea/hypopnea episodes per hour (apnea/hypopnea index: AHI) and HRV (percentage of R-R intervals that differ by at least 50 ms from the previous interval: pNN50, very low frequency: VLF, low frequency: LF, high frequency: HF and LF/ HF). There was no significant difference in the AHI between hemodialysis and non-hemodialysis days. The heart rate in hemodialysis patients on non-hemodialysis days was significantly higher than in the controls, whereas the pNN50 was significantly lower in hemodialysis patients on non-hemodialysis days than in the controls. Although VLF was significantly lower in hemodialysis patients on non-hemodialysis days compared to the controls, there were no significant differences in LF, HF or LF/HF between the two groups. Hemodialysis itself might not be an important contributing factor in sleep-related breathing disturbances. The simultaneous analysis of HRV reflecting autonomic activity and sleep-disordered breathing on both hemodialysis and non-hemodialysis days provides important information. PMID:18954026
Sukegawa, Mayo; Noda, Akiko; Soga, Taro; Adachi, Yuki; Tsuruta, Yoshinari; Ozaki, Norio; Koike, Yasuo
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
Full Text Available SciELO Brazil | Language: English Abstract in portuguese 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 pat
Cléssyo Tavares de Amorim, Cavalcanti; José Cândido de, Araújo Filho; Patrícia Érika de Melo, Marinho.
We report a 68-year-old Japanese man with end-stage renal failure requiring hemodialysis and chronic disseminated intravascular coagulation (DIC) related to thrombosis in an aortic aneurysm. He had undergone graft replacement for the dissection of the ascending and descending thoracic aorta in 1990 and 2002, respectively. Computed tomography disclosed an aneurysm with thrombosis in the residual aorta adjacent to the graft anastomosis. DIC was diagnosed based on elevation of serum fibrinogen degradation products while his activated partial thromboplastin time, prothrombin time and fibrinogen level were normal. In 2008, hemodialysis was initiated for end-stage renal failure. Dialysis was performed without administration of an anticoagulant because his activated clotting time (ACT) was prolonged to 150–180 s. Thereafter, stable hemodialysis continued without clotting in the dialysis circuit until 2013. If monitoring of ACT can be done, hemodialysis without anticoagulation may be a therapeutic option in such patients. PMID:24707280
Yamanouchi, Masayuki; Ubara, Yoshifumi; Mise, Koki; Hayami, Noriko; Hiramatsu, Rikako; Sumida, Keiichi; Suwabe, Tatsuya; Hasegawa, Eiko; Hoshino, Junichi; Sawa, Naoki; Takemoto, Fumi; Takaichi, Kenmei
The aim ofthis study was to examine the impact of introducing the Registered Nurses' Association of Ontario Best Practice Guideline (BPG), Assessment and management of foot ulcers for people with diabetes (2005), on foot ulcer incidence, recurrence, and amputation rate in adult diabetic clients who are undergoing chronic hemodialysis treatments. Fifty-seven individuals from three hemodialysis units participated in the study. Data were collected at three points in time over a 15-month period. A significant reduction in the number of wounds was noted (p BPG showed a positive patient outcome, further research needs to be conducted with a larger sample size. PMID:20136031
Prentice, Dawn; Ritchie, Linda; Crandall, Jackie; Harwood, Lori; McAuslan, Debra; Lawrence-Murphy, Julie Ann; Ridley, Jane; Tigert, Judy; Wilson, Barbara
Aberrant DNA methylation is an emerging characteristic of chronic kidney disease including dialysis patients. It appears to be associated to inflammation. We compared the global DNA methylation status in 10 control subjects compared to 80 dialysis patients (N?=?40 on-line hemodiafiltration, N?=?40 high-flux hemodialysis) in relation to the dialysis technique and inflammation. Whole blood DNA methylation was assessed with a 5-mc DNA enzyme linked immunosorbent assay Kit. Global DNA methylation was higher in hemodialysis (HD) compared to on-line hemodiafiltration (HDF) patients (0.045 vs. 0.039; P?HDF). To study the influence of the dialysis technique on DNA methylation we divided dialysis patients according to the median value of 5-mC. DNA methylation was highest in inflamed patients on hemodialysis. The dialysis technique was the only independent predictor of global DNA methylation in dialysis patients. On-line HDF could be associated with a favorable DNA methylation profile. PMID:25404498
Ghigolea, Adrian-Bogdan; Moldovan, Raluca Argentina; Gherman-Caprioara, Mirela
End-stage liver and kidney disease (ELKD) is an indication for deceased donor simultaneous liver-kidney transplantation. Although a few cases of living donor liver-kidney transplantation have been reported, the invasiveness remains to be discussed. Living donor liver transplantation (LDLT) is an alternative choice for ELKD, but has never been reported. Here, we report a case of successful LDLT for a patient with ELKD on hemodialysis. The patient was a 63-year-old male and had decompensated hepatitis C cirrhosis with seronegativity for hepatitis C virus. He had non-diabetic end-stage renal failure and had been on hemodialysis for 3 years. He was in good general condition except for hepatic and renal failure. The living donor was his 58-year-old healthy wife. A right lobe graft was transplanted to the recipient under continuous hemodiafiltration (CHDF) and extracorporeal veno-venous bypass. CHDF was continued until postoperative day 4, at which point CHDF was converted to hemodialysis. His posttransplant course was good and he was discharged on postoperative day 36. To the best of our knowledge, this is the first report of LDLT for a patient on chronic hemodialysis. Therefore, being on hemodialysis is not a contraindication for LDLT. LDLT is feasible for a patient with ELKD on hemodialysis. PMID:23904841
Morita, Kazutoyo; Shirabe, Ken; Yoshizumi, Tomoharu; Ikegami, Toru; Masuda, Toshiro; Hashimoto, Naotaka; Mano, Yohei; Miyata, Tatsunori; Soejima, Yuji; Maehara, Yoshihiko
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 patien 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)
A 70-year-old woman was admitted to our hospital for repair of vascular access for maintenance hemodialysis. She had been undergoing the maintenance hemodialysis for 20 years, however, her underlying renal disease had not been identified. The laboratory data on admission revealed marked thrombocytopenia with giant platelets and a Dohle body-like cytoplasmic inclusion body in granulocytes. The same hematological abnormalities were also detected in the peripheral blood smear of her daughter. We suspected hereditary macrothrombocytopenia and performed gene analysis of the MYH9 gene that encodes the nonmuscle myosin heavy chain-II A (NMMHC- II A). Mutational analysis showed the heterozygous mutation, c. 1841 G>A, in exon 38 of the MYH9 gene (E1841 K). We further examined intracellular NMMHC- II A localization in granulocytes by immunofluorescent analysis. The results revealed that one or two NMMHC- II A-positive granules were observed in neutrophils, whereas these granules were not detected in the granulocytes of normal healthy volunteers. From these analyses, we diagnosed her disease as MYH9 disorder, especially as a May-Hegglin abnormality. Thrombocytopenia is sometimes observed in maintenance hemodialysis patients. To avoid inappropriate medical intervention for the thrombocytopenia, MYH9 disorders should be differentiated. PMID:21516706
Ishida, Ryo; Kusaba, Tetsuro; Kirita, Yuhei; Matsuoka, Eiko; Nakayama, Mayuka; Uchiyama, Hitoji; Kajita, Yoshihiro
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,levation 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
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)
...and hemodialysis start/stop tray. (b) Classification...for hemodialysis systems and all accessories...extracorporeal blood system and the dialysate delivery system, such as the unpowered...chair, hemodialysis start/stop tray, dialyzer...
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 en...
José Otavio Costa Auler Junior; Torres, Marcelo L. A.; Cardoso, Mo?nica M.; Tebaldi, Thais C.; Schmidt, Andre? P.; Kondo, Mario M.; Marcelo Zugaib
Full Text Available SciELO Brazil | Language: English Abstract in english PURPOSE: To analyze the effect of maintenance hemodialysis on left ventricular diastolic function in patients with end-stage renal disease. METHODS: Study population consisted of 42 patients with end-stage renal disease. Before an arteriovenous fistula was surgically created, the patients were 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.
Mustafa, Duran; Aydin, Unal; Mehmet Tugrul, Inanc; Fatma, Esin; Yucel, Yilmaz; Ender, Ornek.
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 an average difference of -0.38 with a standard deviation of 13 and 95% limits of agreement from -26 to 25. 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 -1.3 with a standard deviation of 7 and 95% limits of agreement from -15 to 12. 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.
Francesca G. Iodice
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.
Francesca G. Iodice
Uremic pruritus in hemodialysis patients is intractable and no effective treatments have been established yet. Although the precise mechanism of the pruritus is still unclear, accumulating evidence suggests that activation of the micro-opioid receptors may induce pruritus in hemodialysis patients. On the other hand, activation of kappa-opioid receptors is known to control or inhibit the signals activated through micro-opioid receptors; therefore, it was expected that kappa-opioid receptor agonists would be able to reduce pruritus in patients undergoing hemodialysis. Nalfurafine hydrochloride is a novel derivative of the opioid receptor antagonist naltrexone. Nalfurafine hydrochloride is a selective kappa-opioid receptor agonist and has a potent antipruritic effect on various types of pruritus through central kappa-opioid receptor activation in non-clinical pharmacological studies. Moreover, clinical studies have demonstrated that nalfurafine hydrochloride possesses efficacy and safety in hemodialysis patients with uremic pruritus. In this review, we provide a detailed description of the activity of nalfurafine hydrochloride using published data of in vitro, in vivo nonclinical pharmacological and clinical studies in hemodialysis patients with uremic pruritus. PMID:19584962
Nakao, Kaoru; Mochizuki, Hidenori
Full Text Available Leptin is a small peptide hormone that is mainly but not exclusively, produced in adipose tissue. leptin is cleared principally by the kidney. Serum leptin concentrations and bone mass are directly related. This cross-sectional study was conducted on patients with end-stage renal disease (ESRD, who were undergoing maintenance hemodialysis. Serum calcium, phosphorus, predialysis serum creatinine, blood urea nitrogen and also alkaline phosphatase (ALP and also intact serum PTH (iPTH and serum Leptin were measured too. In this study a significant difference of serum leptin between males and females of diabetic patients with more values in females was seen. In all patients a significant positive correlation of logarithm of serum leptin with logarithm of serum iPTH and a significant positive correlation of serum leptin and BMI in were found. In male hemodialysis patients a near significant and inverse correlation of serum ALP with serum leptin was seen, moreover in female hemodialysis patients a near significant inverse correlation of serum leptin with serum phosphorus and also a significant inverse correlation of serum leptin with CaXP products were found too. In hemodialysis patients serum leptin affects bone activity and need further investigation this aspect of hemodialysis patients.
Hamid Nasri M.D.
Full Text Available Objective: Catheter colonization is a necessary step in catheter related bacteremia but pathogenesis hasn’t been clarified recently. In our study, we aimed to detect the incidence of catheter colonization and related parameters in patients with indwelling hemodialysis catheters. Material and Method: The data of 43 hemodialysis patients using temporary hemodialysis catheters were evaluated retrospectively. The relation between colonization and factors that affect catheter colonization such as catheter localization, life span of the catheter, accompanied disorders, antibiotic or intravenous iron use, presence of fever or leucocytosis and albumin concentration was investigated. Results: The life span of femoral (21, subclavian (14, and jugular (8 catheters were 17.9±9.9 days and bacterial growth was detected in 15 (34.9% of the catheters. The most common determined pathogen was staphylococci (60%. Catheter withdrawal reasons were as follows: the most common reason was suspicion of catheter infection in culture positive group (40% and recovery from acute renal failure (42.9% in culture negative group. Catheter life span, parenteral iron use and diabetes prevalence were significantly high and albumin concentration was significantly low in culture positive group. Results: In our study it was shown that, diabetes, hypoalbuminemia, parenteral iron treatment and prolonged catheter life span facilitated the catheter colonization. As well as standard therapy additional precaution may be taken to decrease prevalence of catheter colonization and infection in such conditions that facilitate catheter colonization.
Full Text Available SciELO Brazil | Language: English Abstract in english 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.
Natália Fabiane Ridão, Curty; Lucilene Fagundes da Silva, Martins; Carmen Antônia Sanches, Ito; Marcelo, Schafranski; Dorelayne Aparecida, Brites; César Roberto, Busato.
Full Text Available This study aimed to evaluate the effects of maintenance IV iron sucrose vs oral iron gluconate on iron indices and hematological profile in pediatric hemodialysis patients. Twenty four children under regular hemodialysis (13 males and 11 females with median age 11 years were enrolled in this study and had initial adequate iron stores and were maintained on oral iron gluconate daily and erythropoietin alpha (EPO weekly for 3 months prior to study. They were randomly subdivided into two groups. Group A included 12 patients (8 males and 4 females with median age 10 years and they continued to receive oral iron gluconate daily and EPO alpha and group B included 12 patients (5 males and 7 females with median age 12 years who received intravenous iron sucrose every 2 weeks and EPO alpha on same dose of group A for a study period of 3 months. There were significant increase in serum iron (p = 0.002, serum ferritin (p = 0.026 and transferrin saturation (p = 0.001 in (IV iron sucrose group than with oral iron gluconate group. In addition, hemoglobin and hematocrite were increased by 8 and 11.2%, respectively on group B. Iron overload was reported in two patients only of group B (16.7%. We concluded that IV iron sucrose is effective and safe preparation to be used in iron replete children under regular hemodialysis to maintain adequate iron stores and to ensure optimum response to EPO therapy.
Dabigatran is an oral direct thrombin inhibitor indicated for thromboembolism prophylaxis in patients with nonvalvular atrial fibrillation. Since its approval in the United States in 2010, dabigatran-associated hemorrhages have garnered much attention because bleeding rates were higher than initially expected. Additionally, reversing anticoagulation remains challenging. Traditional modes of reversing warfarin-associated coagulopathies are ineffective in reversing anticoagulation from dabigatran. Although hemodialysis is proposed as a method to accelerate dabigatran elimination, evidence supporting its clinical utility remains unproved. We report the case of an 80-year-old man who presented with worsening hemoptysis in the setting of unintentional ingestion of excess dabigatran. Despite transfusion of 2 units of fresh frozen plasma, he continued to bleed, although his international normalized ratio improved from 8.8 to 7.2. He underwent hemodialysis, and serum dabigatran concentration decreased from 1,100 to 18 ng/mL over 4 hours, with an initial extraction ratio of 0.97 and blood clearance of 291 mL/min. Although his serum dabigatran concentration rebounded to 100 ng/mL 20 minutes after the cessation of dialysis, his bleeding stopped and he improved clinically. Hemorrhage in the setting of dabigatran anticoagulation remains a therapeutic predicament. Hemodialysis may play an adjunct role in accelerating the elimination of dabigatran in bleeding patients. PMID:23597859
Chen, Betty C; Sheth, Nijal R; Dadzie, Kobena A; Smith, Silas W; Nelson, Lewis S; Hoffman, Robert S; Winchester, James F
Children with chronic kidney disease stage 5 requiring dialysis can be treated by peritoneal or hemodialysis. In the United Kingdom nearly twice as many children receive peritoneal dialysis compared with hemodialysis. Technical aspects of pediatric hemodialysis are challenging and include the relative size of extracorporeal circuit and child's blood volume, assessment of adequacy,technical and complications of vascular access. Alternatives to standard hospital-based hemodialysis are also increasingly available. Optimizing nutritional status with the support of specialist pediatric dietitians is key to the management of children receiving hemodialysis. The effects of chronic illness on growth and school achievement, as well as the psychological, emotional, and social development of the child should not be underestimated. This review focuses on the above elements and highlights common pediatric practice in the United Kingdom. PMID:24725354
Kaur, Amrit; Davenport, Andrew
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.
Introduction: Two principal findings of cardiovascular disease in end-stage renal disease patients undergoing regular hemodialysis are left ventricular hypertrophy (LVH) and arterial disease due to rapidly progressive atherosclerotic vascular disease that can be characterized by an enlargement and hypertrophy of arteries (intima-media complex thickening; IMT).Objectives: In this study, we sought to evaluate the relationship between left ventricular hypertrophy with intima-media complex thicke...
Rafieian-Kopaei Mahmoud; Nasri Hamid
Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this p...
Soangra, Rahul; Lockhart, Thurmon E.; Lach, John; Abdel-rahman, Emaad M.
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 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.
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.Conclulied 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
We studied plasma, dialysate, and muscle carnitine levels in patients with stable chronic renal failure on hemodialysis, and intermittent peritoneal, or continuous ambulatory peritoneal dialysis (CAPD). In patients on hemodialysis, plasma carnitine levels fell from 46.2 +/- 4.5 mumol/l (mean +/- SEM) to 18.8 +/- 2.7 mumol/l immediately after the procedure (p less than 0.001). Depletion of muscle carnitine was found after hemodialysis (1,518 +/- 273 nmol/g wet weight of tissue) compared to normal levels of 5,230.5 +/- 142.7 nmol/g tissue (p less than 0.01). However, the plasma and muscle carnitine levels remained in the normal range in patients on intermittent peritoneal dialysis and CAPD. We postulate that the rapid decline in plasma levels of carnitine caused by hemodialysis initiates unilateral transport of the compound from muscle to the plasma, thus depleting the skeletal muscle stores of carnitine. PMID:6614070
Moorthy, A V; Rosenblum, M; Rajaram, R; Shug, A L
Background Few studies have examined if infectious arteriovenous access complications vary with the cannulation technique and whether this is modified by dialysis frequency. We compared the infection rate between fistulas cannulated using buttonhole versus stepladder techniques for patients treated with short daily (SDH) or nocturnal hemodialysis at home (NHD). We also compared patients receiving conventional intermittent hemodialysis (CIHD) using stepladder cannulation. Methods Data were prospectively collected from 631 patients dialyzed with a fistula from 2001 to 2010 (Toronto and Ottawa, Canada). We compared the person-time incidence rate of bacteremia and local fistula infections using the exact binomial test. Results Forty-six (7.3%) patients received SDH (?5 sessions/week, 2-4 h/session), 128 (20.3%) NHD (?4 sessions/week, ?5 h/session) and 457 (72%) CIHD (3 sessions/week, ?4 h/session). Fifty percent of SDH and 72% of NHD patients used the buttonhole technique. There were 39 buttonhole-related bacteremias (rate: 0.196/1,000 fistula days) and at least 2 local buttonhole site infections. Staphylococcus aureus accounted for 85% of the bacteremias. There were 5 (13%) infection-related hospitalizations and 3 (10%) serious metastatic infections, including fistula loss. In comparison, there was 1 possible fistula-related infection in CIHD during follow-up (rate: 0.002/1,000 fistula days). Conclusions The rate of buttonhole-related infections was high among patients on frequent hemodialysis and more than 50 times greater than that among patients on CIHD with the stepladder technique. Most bacteremias were due to S. aureus – with serious consequences. The risks and benefits of buttonhole cannulation require individual consideration with careful monitoring, prophylaxis and management. PMID:25473405
Lok, Charmaine E.; Sontrop, Jessica M.; Faratro, Rose; Chan, Christopher T.; Zimmerman, Deborah Lynn
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)
Full Text Available Yoshio Shimizu, Ayano Sonoda, Chieko Nogi, Yoko Ogushi, Reo Kanda, Saori Yamaguchi, Nao Nohara, Tatsuya Aoki, Kaori Yamada, Junichiro Nakata, Hiroaki Io, Atsushi Kurusu, Chieko Hamada, Satoshi Horikoshi, Yasuhiko Tomino Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan Introduction and objective: While pruritus is a common complication in hemodialysis patients, the pathophysiological mechanisms remain obscure. Recently, B-type (brain natriuretic peptide (BNP has been defined as an itch-selective neuropeptide in pruriceptive neurons in mice, and higher serum levels of BNP are frequently observed in hemodialysis patients. The objective of the present study was to evaluate the role of serum BNP in pruritus in patients undergoing hemodialysis. Patients and methods: The current cross-sectional study was performed on 43 patients undergoing maintenance hemodialysis. A visual analog scale (VAS measuring the general severity of pruritus (values from 0 to 10, with higher values indicating more severe pruritus in daytime and at night was self-reported by patients. Each patient's background and laboratory tests, including serum BNP in the post-hemodialysis period, were collected. The correlation between VAS and clinical parameters was evaluated. Results: Both daytime and nighttime VAS scores in diabetic patients were significantly less than those in nondiabetic patients. Multiple regression analysis revealed that pruritus in daytime was worsened by serum BNP (?=2.0, t=2.4, P=0.03, calcium (?=4.4, t=5.2, P<0.0001, and ?2-microglobulin (?=2.0, t=3.0, P=0.007, while it was eased by age (?=–2.2, t=-3.2, P=0.0004. Nocturnal pruritus was severe in nondiabetic patients (?=1.7, t=3.8, P=0.0005 and weakened by the total iron binding capacity (?=–2.9, t=–3.1, P=0.004. Conclusion: It is suggested that a higher level of serum BNP increases the pruritus of hemodialysis patients in daytime and that diabetic patients are less sensitive to itch, especially at nighttime. Keywords: B-type brain natriuretic peptide, pruritus, hemodialysis, visual analog scale, itch-selective neuropeptide, pruriceptive neurons, cerebrospinal fluid
Comparison of intra operative muscle relaxation and neuro muscular recovery from continuous infusion of vecuronium and atracurium in ASA grade I @ II patients undergoing midline and paramedian laparotomies
Full Text Available Background: Vecuronium and Atracurium are two muscle relaxants that come close to fulfill most of the criteria for using them as continuous infusion. In this study in sixty adult patients of either sex, 25-45 years of age, belonging to ASA physical status I&II, were chosen, who were scheduled for midline and paramedian laparotomies under GA. Objective: (1 To assess the recovery time from neuromuscular blockade on stopping the infusion of vecuronium and atracurium. (2 To assess the haemodynamic performance in peri operative period. Materials & Methods: Patients were randomly allocated into two equal groups and received either vecuronium 0.8-1 ?g/kg/min following a bolus dose of 0.1mg/kg or Atracurium 4-12 ?g/kg/min following a bolus dose of 0.5 mg/kg. Intravenous infusion of muscle relaxants were adjusted to maintain 90% of neuromuscular blockade monitored by stimulating ulnar nerve at the wrist by a peripheral nerve stimulator throughout surgery. Results: The median time & interquartile range which were taken from intravenous bolus dose to 10% recovery was less in Vecuronium group (23±2 min than atracurium group (25.± 2 min. Vecuronium (median 15.5 ± 3 min took less time to achieve steady state of block after starting infusion than atracurium (median 18 ± 3 min. Conclusions: Patients who received vecuronium recovered early from relaxant effect with more stable hemodynamics.
The aim of this study was to evaluate the contrast enhancement, pharmacokinetics, dialyzability, and safety of gadodiamide in patients on hemodialysis. Thirteen hemodialysis patients with abdominal disease were examined after receiving intravenous gadodiamide (0.1 mmol/kg body weight) by magnetic resonance imaging (MRI) and were dialyzed at 1, 3, 5, and 8 days. Blood samples were obtained immediately before, during, and at the end of the first hemodialysis session and immediately before and at the end of the next three sessions. The complete blood count, blood biochemistry, ?2-microglobulin, and gadolinium were measured. Dialysis of urea, creatinine, and gadolinium during the first hemodialysis session was assessed. Precontrast and postcontrast MRI and Gd-enhanced MR angiography (MRA) images were reviewed and visually evaluated by two radiologists; their evaluation was based on consensus. Gadodiamide did not cause any changes in renal function. An average of 73.8%, 92.4%, and 98.9% of the gadodiamide dose was eliminated by the end of the first, second, and third hemodialysis sessions, respectively. The average half-time of gadodiamide was 1.93 h (SD 0.55). The mean clearance of gadodiamide during hemodialysis was 63.5 ml/min (SD 21.9). There were no side effects related to the injection of gadodiamide. In all cases, diagnosable MRI and MRA images were obtained after gadodiamide injection in the hemodialysis patients. In hemodialysis patients, gadodiamide a. In hemodialysis patients, gadodiamide achieves diagnosable images. It is dialyzable and can be used safely without measures to increase excretion. (author)
Full Text Available Secondary hyperparathyroidism(SHPTH is a common complication of chronic kidney disease and is characterized by elevated levels of serum parathyroid hormone (PTH and abnormalities in bone and mineral metabolism. This serious disorder could be aggravated by metabolic acidosis which is a common consequence of advanced chronic renal failure and in maintenance dialysis patients. To investigate factors influencing the intensity of secondary hyperparathyroidism (SHPTH in patients on chronic maintenance haemodialysis we tested the association of relative acidosis of hemodialysis patients with parathyroid gland activity. This is a cross-sectional study that was conducted on patients undergoing maintenance hemodialysis treatment with acetate basis dialysate and polysulfone membrane. Serum calcium (Ca, phosphorus (P, magnesium (Mg, alkaline phosphatase (ALP and intact serum PTH (iPTH and plasma HCO3 were measured. A significant positive correlation of plasma HCO3 with duration and dosage of hemodialysis were found. In all patients a significant inverse correlation of logarithm of serum iPTH with plasma HCO3 was seen while this association was very significant in female hemodialysis patients. A strong inverse association between plasma HCO3 and serum PTH in female gender may show the more aggressive form of SHPTH in this group.
M.D. Hamid Nasri
Renal anemia, uremic myopathy, and malnutrition are some of the factors that affect the results of the 6-minute walk test (6MWT) in hemodialysis patients. We hypothesized that skeletal muscle dysfunction caused by skeletal myolysis, protein hypercatabolism, and mitochondrial deficiency are strongly related factors. The purpose of this study was to clarify the factors that affect the 6MWT results in hemodialysis patients to assess their exercise tolerance. The study included 43 outpatients from the hemodialysis unit. The 6MWT was performed, and knee extension strength, 1-leg standing time, and grip were measured. In addition, the subjects' characteristics such as age, preexisting coronary artery disease, hemoglobin level, total iron binding capacity, serum albumin level, creatinine generation rate, and normalized protein catabolic rate were investigated. A stepwise multiple regression model was used to examine the factors affecting the 6MWT results. Multiple regression analysis revealed that knee extension strength (?=0.446, P=0.001), total iron binding capacity (?=-0.299, P=0.021), and preexisting coronary artery disease (?=-0.272, P=0.035) significantly affected the 6MWT results (R=0.66, R(2)=0.44). The 6MWT in hemodialysis patients was strongly affected by muscle strength, iron deficiency anemia, and preexisting coronary artery disease, suggesting that resistance training is important for improving 6MWT results. Our findings indicate that iron deficiency and cardiac function should be assessed before exercising or undergoing an exercise tolerance test. PMID:24674327
Kono, Kenichi; Nishida, Yusuke; Moriyama, Yoshihumi; Yabe, Hiroki; Taoka, Masahiro; Sato, Takashi
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.)
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 estimates based on V(d) and the algorithm derived from pharmacokinetic modeling led to comparable loading dose estimates. Furthermore, the maintenance dose estimated from the central compartment (V1) led to plasma concentrations within the therapeutic range. Thus, a regimen where 12.2 mmol lithium was given after each hemodialysis session resulted in stable between-dialysis plasma lithium concentrations in this patient with no residual kidney function. We did not observe adverse effects related to this regimen, which was monitored from 18 days to 8 months of therapy, and the patient experienced relief from her severe depressive disorder. In conclusion, dialysis patients may be treated with lithium administrated immediately postdialysis. Further observations are necessary to obtain robust long-term safety data and to optimize the monitoring schedule.
Bjarnason, N H; Munkner, R
Background: The effect of kind of dialysis solution on the control of blood pressure and adequacy and efficacy of hemodialysis is a most debated and controversial issue.Methods: Twenty six chronic hemodialized patients in Ghaem hemodialysis center, Mashhad, Iran, in winter of the year 2004, enrolled this study for one month. The patients were dialyzed with bicarbonate buffer and were dialyzed in the next month with acetate. The kind of membranes and the dialysis machines were the same in both...
Garevani H; Mojahedi M J; Hekmat R
Full Text Available Background: The effect of kind of dialysis solution on the control of blood pressure and adequacy and efficacy of hemodialysis is a most debated and controversial issue.Methods: Twenty six chronic hemodialized patients in Ghaem hemodialysis center, Mashhad, Iran, in winter of the year 2004, enrolled this study for one month. The patients were dialyzed with bicarbonate buffer and were dialyzed in the next month with acetate. The kind of membranes and the dialysis machines were the same in both months. Systolic and diastolic pressures were measured before and after hemodialysis in at least three hemodialysis sessions, and he means recorded. The mean of the body weight were also recorded. In the same sessions of hemodialysis by measuring the urea, before and after hemodialysis, urea reduction ratio (URR, was also calculated. Statistical analysis was done with paired student t test for paired measurement, and independent t test for evaluating the effect of the kind of dialysate buffer on the measured parameters.Results: There were no significant statistical differences between acetate and bicarbonate dialysis solution buffers in the control of diastolic blood pressure. But use of acetate buffer resulted in more significant systolic blood pressure reduction compared with bicarbonate buffer (p=0.045. When adequacy of hemodialysis were compared between two kinds of buffers there were no significant statistical differences between them. When the effect of dialysate sodium concentration in the range utilized in two buffers, was evaluated on the systolic and diastolic pressure reduction, no significant differences, between two types of buffers attributable to the difference between dialysates sodium concentrations were found.Conclusion: Hemodialysis with both, acetate and bicarbonate buffers results in significant reductions in systolic and diastolic blood pressure, weight and urea ratio. Use of acetate buffer is more significantly associated with systolic blood pressure reduction compared to bicarbonate buffer (p=0.045, this effect is independent of the dialysate buffer sodium concentration.
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.
Full Text Available Chadi Saifan, Elie El-Charabaty, Suzanne El-SayeghStaten Island University Hospital, Staten Island, NY, USABackground: Elevated total plasma homocysteine is an independent risk factor for arterial and venous thrombosis in patients with normal renal function. Patients on hemodialysis have a high prevalence of mild to moderate hyperhomocysteinemia. Conflicting retrospective analyses and prospective studies have been reported regarding the association between total homocysteine levels and hemodialysis vascular thrombosis. The purpose of this retrospective study was to investigate the relationship between hyperhomocysteinemia and vascular access thrombosis (VAT in patients on hemodialysis.Methods: One hundred and twenty-five patients undergoing dialysis were selected as subjects. The experimental group participants were identified as those having one or more VAT during the previous 13 months and the control group participants had no access thrombosis during the same period. Additional subgroup analysis included the presence of hypertension, diabetes, low-density lipoprotein levels, sex, and use of aspirin.Results: No statistically significant difference was found in total homocysteine levels between the two groups (P = 0.27. No association was found between VAT and sex (P = 0.09, VAT and hypertension (P = 0.96, VAT and diabetes (P = 0.49, nor VAT and low-density lipoprotein level (P = 0.04. A lower rate of VAT was associated with aspirin intake (P = 0.04.Conclusion: This study did not demonstrate a relationship between total homocysteine concentrations and risk of VAT in patients with end-stage renal disease on hemodialysis. There were no significant differences in the number of VAT across additional variables of sex and previous morbidity. Aspirin intake was associated with a lower incidence of VAT.Keywords: hyperhomocysteinemia, vascular access thrombosis, hemodialysis
Full Text Available To elucidate whether and how in patients on maintenance hemodialysis (HD, infection of H. pylori intensifies the anemia, a cross-sectional study that was conducted on 39 patients with end-stage renal disease (ESRD undergoing maintenance hemodialysis treatment who had various upper gastrointestinal complaints consisting of epigastric pain, epigastric burning, postprandial fullness, early satiety, bloating and belching. Mean ages of patients were 46(?18 years. The dialysis duration was 30?(35 months (median: 18 months. Mean?SD of hemoglobin and hematocrit level of all patients were 9?2 g/dl and 28?6%. The value of serum helicobacter pylori (H. Pylori specific IgG antibody titers of all patients was 7.6 (?9.9u/ml (median:2 u/ml. In this study non significant difference of H. Pylori-IgG antibody level between males and females or diabetic and non-diabetic hemodialysis patients were seen, and a significant inverse correlation of H. Pylori-IgG antibody level with serum hemoglobin and hematocrit in male hemodialysis patients and a significant inverse correlation of H. Pylori-IgG antibody level with serum iron were found. Also non significant correlation of serum H. Pylori-IgG antibody level with Hgb, Hct and serum iron in all patients, female, non diabetics and diabetic HD groups were found. In hemodialysis patients an inverse correlation between H. pylori infection with hemoglobin and hematocrit level as well as with serum iron, implies more attention to H. pylori infection in these patients and aggravation of anemia with H. pylori infection needs aggressive treatment of H. pylori infection in these patients.
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"), marke...
Samir M Ibrahim, Khalid H. Abdel-mageed
The effect of hemodialysis on the plasma glucose profile and liraglutide level after liraglutide injection was investigated in patients with diabetes and end-stage renal disease (ESRD). Either 0.6 mg or 0.9 mg liraglutide was subcutaneously administered daily to 10 Japanese type 2 diabetic patients with ESRD. Hemodialysis was conducted on days 1 and 3. Plasma liraglutide and glucose concentrations were measured by enzyme-linked immunosorbent assay and a continuous glucose monitoring system, r...
Osonoi, Takeshi; Saito, Miyoko; Tamasawa, Atsuko; Ishida, Hidenori; Tsujino, Daisuke; Nishimura, Rimei; Utsunomiya, Kazunori
An enzyme immuno assay for hepatitis C core antigen was recently developed and its performance was compared with that of the hepatitis C virus (HCV) RNA in the screening of HCV infection in patients on hemodialysis. One hundred and eleven chronic renal failure patients undergoing haemodialysis between May 2003 and October 2004 were included in the study. All the patients were tested for anti HCV antibody, core antigen and RNA. Fifteen patients were anti HCV antibody positive, three patients w...
Reddy A; Dakshinamurty K; Lakshmi V
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.
Chang, J; Levin, N; Poland, D; Welsh, P; Paulsen, C; Trebes, J; Rosenbury, R; Killip, T
A 76-year-old woman undergoing hemodialysis and having a permanent pacemaker during care elsewhere developed a shunt infection with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Vancomycin (VCM) and other antimicrobial agents were not effective even after her artificial shunt vessel was removed. Linezolid (LZD) was administered for 56 days to resolve fever. MRSA was detected repeatedly in blood culture for 7 months except while LZD was being administered, so she was referred to our hospital for further investigation and treatment. Blood culture isolated 3 MRSA strains, all having a minimum inhibitory concentration (MIC) of LZD above 16 microg/mL while that of VCM varied at 24 microg/mL. Based on these findings, combined VCM, rifampicin, and arbekacin therapy was started but did not resolve the MRSA bacteremia problem. Transesophageal echocardiography showed flat vegetation around the pacemaker lead passing through the tricuspid valve. Based on strongly suspected pacemaker-lead infection, the pacemaker system was removed by heart surgeons using radiographic imaging on day 16 after admission. Her blood culture then became negative. She was returned to the previous hospital on day 66 after admission, where combination antibiotic therapy was continued for about one month. MRSA was not detected again after pacemaker system removal. PMID:23367855
Kojiro, Maiko; Tsuchihashi, Yoshiko; Ishida, Masayuki; Furumoto, Akitsugu; Matsuda, Junichi; Yanagihara, Katsunori; Morimoto, Konosuke; Ariyoshi, Koya
The effect of hemodialysis on the plasma glucose profile and liraglutide level after liraglutide injection was investigated in patients with diabetes and end-stage renal disease (ESRD). Either 0.6 mg or 0.9 mg liraglutide was subcutaneously administered daily to 10 Japanese type 2 diabetic patients with ESRD. Hemodialysis was conducted on days 1 and 3. Plasma liraglutide and glucose concentrations were measured by enzyme-linked immunosorbent assay and a continuous glucose monitoring system, respectively. The safety profile of liraglutide was also assessed. Hemodialysis had no effect on the pharmacokinetic parameters of liraglutide in patients with diabetes and ESRD; the maximum plasma concentration (Cmax), tmax, area under the concentration-time curve (AUC), and CL/f were unaltered. Similarly, hemodialysis did not affect the mean or minimum glucose levels, AUC, or duration of hyperglycemia (>180 mg/dL) and hypoglycemia (UMIN Clinical Trials Registry (UMIN-CTR) UMIN000010159 PMID:25526642
Osonoi, Takeshi; Saito, Miyoko; Tamasawa, Atsuko; Ishida, Hidenori; Tsujino, Daisuke; Nishimura, Rimei; Utsunomiya, Kazunori
Chronic hemodialysis (HD) patients are predisposed to several complications associated with pleural effusion. In addition, uremia can directly cause pleuritis. However, there are inadequate data about pathogenesis and natural course of uremic pleuritis. In this study, 76 chronic HD patients with pleural effusion admitted to the Respiratory Center of Masih Daneshvari Hospital, in Tehran, Iran between June 2005 and May 2011 were evaluated to figure out the etiology of their pleural disease. Among these patients, patients with uremic pleuritis were identified and studied. The rate of uremic pleuritis was 23.7%. Other frequent etiologies of pleural effusion were parapneumonic effusion (23.7%), cardiac failure (19.7%), tuberculosis (6.6%), volume overload, malignancy, and unknown. In patients with uremic pleuritis, dyspnea was the most common symptom, followed by cough, weight loss, anorexia, chest pain, and fever. Compared to patients with parapneumonic effusion, patients with uremic effusion had a significantly higher rate of dyspnea and lower rate of cough and fever. Pleural fluid analysis showed that these patients had a significantly lower pleural to serum lactic dehydrogenase ratio, total pleural leukocytes, and polymorphonuclear count compared to patients with parapneumonic effusion. Improvement was achieved in 94.1% of patients with uremic pleuritis by continuation of HD, chest tube insertion or pleural decortication; an outcome better than the previous reports. Despite the association with an exudative effusion, inflammatory pleural reactions in patients with uremic pleuritis may not be as severe as infection-induced effusions. Owing to the advancement in HD technology and other interventions, outcome of uremic pleuritis may be improved. PMID:22716271
Rashid-Farokhi, Farin; Pourdowlat, Guitti; Nikoonia, Mohammad-Reza; Behzadnia, Neda; Kahkouee, Shahram; Nassiri, Amir-Ahmad; Masjedi, Mohammad-Reza
Conclusion: The probability of clot formation in the second method of heparinization is less than the other methods. Dialysis efficacy in this method is also higher than the other methods. Thus, the second method is recommended.
Full Text Available Anemia is a well-recognized feature in patients with chronic kidney disease (CKD. Recently, two large-scale trials, CREATE and CHOIR, pointed to the complexity of maintaining stable hemoglobin (Hb levels over time. According to these data, patients failing to achieve the target range of Hb levels between 11-12 g/dL may be at increased risk of dying. Both low and high Hb levels are associated with increased cardiovascular events and death. One reason for failure to achieve stable Hb levels within the target range is Hb cycling. Several causes may be responsible for a cyclic pattern of Hb levels: drug-related factors such as differences in pharmacokinetics and bioavailability in eryth-ropoiesis-stimulating agents (ESAs as well as difficulties in iron supplementation may induce Hb instability in patients with CKD. Similarly, patient-related factors such as an inflammatory status or protein energy wasting are associated with this phenomenon. Further, variations in fluid balance and biocompatibility of dialyzer membranes, by differentially affecting inflammation, render the hemodialysis treatment itself a risk factor for Hb cycling. Strategies to reduce Hb cycling are necessary to obtain improved clinical outcomes. This review will describe the phenomenon of Hb cycling, highlighting potential contributing factors and discussing the pos-sible clinical conditions.
Erectile dysfunction (ED) is common among patients with end-stage renal disease (ESRD), who undergo hemodialysis (HD). The aim of this study was to evaluate the safety and effectiveness of sildenafil in male HD patients with ED. Twenty-seven HD patients were recruited for this prospective, randomized, double-blind, placebo-controlled, clinical trial study of sildenafil during a period of 1 week. Efficacy was assessed by using the International Index of Erectile Function (IIEF) before and 1 week after treatment. Baseline demographic and clinical features were similar in both the groups. There was a weak correlation between ED and duration of undergoing dialysis (P = 0.073). There was significant relationship between sildenafil usage and improvement in erectile function (P < 0.0001). Placebo improved significantly the erectile function (P = 0.016), perhaps by psychological way. However, sildenafil had a more significant effect than placebo in increasing IIEF score among HD patients (P = 0.00 compared to 0.016). Sildenafil is effective and safe for treating ED among HD patients. PMID:21072154
Ghafari, A.; Farshid, B.; Afshari, A. T.; Sepehrvand, N.; Rikhtegar, E.; Ghasemi, K.; Hatami, S.
The pituitary-ovarian axis was studied in 12 women with a creatinine clearance of less than 5 ml/min per 17 m2, established on regular hemodialysis for at least 12 months. Follicle stimulating hormone (FSH) serum levels were found to be slightly lower than normal, luteinizing hormone (LH) plasma concentration generally elevated, while progesterone and estradiol values were extremely low. The major reproductive consequence of chronic renal failure in women on hemodialysis is a severe impairment in ovulatory function. PMID:6151921
Mantouvalos, H; Metallinos, C; Makrygiannakis, A; Gouskos, A
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
Seifi S, Mokhtari A
Full Text Available Abstract Background Exercise training in hemodialysis patients improves fitness, physical function, quality of life and markers of cardiovascular disease such as arterial stiffness. The majority of trials investigating this area have used supervised exercise training during dialysis (intradialytic, which may not be feasible for some renal units. The aim of this trial is to compare the effects of supervised intradialytic with unsupervised home-based exercise training on physical function and arterial stiffness. Methods and design This is a randomised, controlled clinical trial. A total of 72 hemodialysis patients will be randomised to receive either six months of intradialytic exercise training, home-based exercise training or usual care. Intradialytic patients will undergo three training sessions per week on a cycle ergometer and home-based patients will be provided with a walking program to achieve the same weekly physical activity. Primary outcome measures are six-minute walk distance (6 MWD and aortic pulse wave velocity (PWV. Secondary outcome measures include augmentation index, peripheral and central blood pressures, physical activity and self-reported health. Measures will be made at baseline, three and six months. Discussion The results of this study will help determine the efficacy of home-based exercise training in hemodialysis patients. This may assist in developing exercise guidelines specific for these patients. Trial Registration ACTRN12608000247370
Fassett Robert G
Full Text Available End-stage renal disease (ESRD patients frequently develop structural cardiac abnormalities, particularly left ventricular hypertrophy (LVH. The mechanisms involved in these processes are not completely understood. In the present study, we evaluated a possible association between parathyroid hormone (PTH levels and left ventricular mass (LVM in patients with ESRD. Stable uremic patients on intermittent hemodialysis treatment were evaluated by standard two-dimensional echocardiography and their sera were analyzed for intact PTH. Forty-one patients (mean age 45 years, range 18 to 61 years, 61% males, who had been on hemodialysis for 3 to 186 months, were evaluated. Patients were stratified into 3 groups according to serum PTH: low levels (280 pg/ml; group III = 21 patients. A positive statistically significant association between LVM index and PTH was identified (r = 0.34; P = 0.03, Pearson's correlation coefficient in the sample as a whole. In subgroup analyses, we did not observe significant associations in the low and intermediate PTH groups; nevertheless, PTH and LVM index were correlated in patients with high PTH levels (r = 0.62; P = 0.003. LVM index was also inversely associated with hemoglobin (r = -0.34; P = 0.03. In multivariate analysis, after adjustment for age, hemoglobin, body mass index, and blood pressure, the only independent predictor of LVM index was PTH level. Therefore, PTH is an independent predictor of LVH in patients undergoing chronic hemodialysis. Secondary hyperparathyroidism may contribute to the elevated cardiovascular morbidity associated with LVH in ESRD.
Encapsulating peritoneal sclerosis is a rare condition of a poorly understood pathogenesis with recognized risk factors, such as medications, surgical interventions, systemic diseases, and malignancies. In endstage renal disease it has been associated with chronic peritoneal dialysis. We hereby report the case of a 59-year-old male hemodialysis patient, who was never treated with peritoneal dialysis and developed an unexplained massive ascites 4 months post laparoscopic cholecystectomy for gallstones. A second laparoscopy and histological evaluation revealed encapsulating peritoneal sclerosis-like findings with parietal peritoneum and spleen involvement. The patient was successfully treated for 12 months with prednisone and tamoxifen. Possible pathogenetic mechanisms of the disease in this case are discussed including peritoneal irritation by chronic cholecystitis, low-grade inflammation of hemodialysis, intraoperative complications and the hypothetical role of oxidized regenerated cellulose used for hemostasis. In conclusion, the suspicion of peritoneal sclerosis should be encountered in cases of unexplained ascites in patients undergoing hemodialysis. The early diagnosis includes laparoscopy and histological evaluation and can result in a good outcome under medical treatment; otherwise, there is a high possibility of bowel obstruction with fatal outcome. PMID:23073060
Sonikian, Makrouhi; Pani, Ioanna; Lazarou, Dimitrios; Khaldi, Lubna; Dounavis, Alexandros; Lafoyanni, Sophia; Vlassopoulos, Dimosthenis
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
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.
Daniele Favaro Ribeiro
Full Text Available Objective: Patients undergoing hemodialysis are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula. This study was designed to measure pain associated with venepuncture during AVF cannulation and to compare the effectiveness of ethyl chloride vapocoolant spray, topical eutectic mixture of local anesthetics (EMLA cream and placebo in controlling pain caused by venepuncture of arteriovenous fistula patients undergoing chronic hemodialysis.Methods: This randomized, placebo-controlled, crossover study, included 41 patients undergoing conventional hemodialysis three times a week. First intervention was conducted as baseline pain assessment (control. In the three consecutive dialysis sessions, every patient randomly received 1 ethyl chloride vapocoolant spray, 2 EMLA, or 3 placebo cream before venepuncture. Pain perception was recorded by patients immediately after cannulation on a 0-100 mm visual analogue scale (VAS. p<0.05 was considered as significant.Results: VAS scores presented a marked inter-individual variation during venepuncture. EMLA application resulted in significantly lower total pain scores compared to control and all other interventions (p<0.05. No patient experienced severe pain with EMLA or vapocoolant. The patients reported less moderate and severe pain with EMLA, and vapocoolant spray compared to control and placebo interventions. Moderate and severe pain scores were similar between EMLA and vapocoolant spray (p>0.05.Conclusion: Venipuncture for AVF cannulation causes mild to moderate pain in hemodialysis patients. Although local application of EMLA is more effective than in preventing venepuncture pain, ethyl chloride vapocoolant is as effective as EMLA for preventing mild to moderate puncture pain in patients undergoing hemodialysis.
Gülperi Çelik, Orhan Özbek, Mümtaz Y?lmaz, Ipek Duman, Seda Özbek, Seza Apiliogullari
Full Text Available The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years chronic hemodialysis (HD patients at the Urology and Nephrology Center, Mansoura Uni-versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS, obstructive sleep apnea syndrome (OSAS, excessive daytime sleepiness (EDS, narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques-tions of Hatoum?s sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa-tients, and the most common sleep abnormality was insomnia (65.9%, followed by RLS (42%, OSAS (31.8%, snoring (27.3%, EDS (27.3%, narcolepsy (15.9%, and sleep walking (3.4%. Insomnia correlated with anemia (r=0.31, P= 0.003, anxiety (r=0.279, P= 0.042, depression (r=0.298, P= 0.24 and RLS (r=0.327, P= 0.002. Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001, anemia (r=0.301 and P= 0.046, hyperphosphatemia (r=0.343 and P= 0.001. EDS correlated with OSAS (r=0.5, P= < 0.0001, snoring (r=0.341, P= 0.001, and social worry (r=0.27, P= 0.011. Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno-graphy, is necessary to confirm our results. Interventional studies for management of sleep disor-ders in HD patients are warranted.
Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Background: Exercise training during the dialytical procedure may have positive cardiovascular effects and prevent or revert muscle wasting in patients undergoing chronic hemodialysis. Aim: To evaluate the effects of an exercise training program in patients undergoing chronic hemodialysis. Material [...] and Methods: Fifteen patients on chronic hemodialysis aged 21 to 69 years (three females) were included in the study. Nine of these were included in an exercise training program. During 16 weeks, exercise sessions were carried out during each dialytical procedure that included a warm-up period, aerobic exercises done using standing cycles, and resistance exercises, performed using Thera-Band® elastic bands and loops. Borg scale was used to control the intensity of training. At baseline and at the end of the study, a blood sample prior and after the dialytical procedure was obtained to measure C reactive protein, tumor necrosis factor ? and interleukin 6. Quadriceps muscle strength, six minutes´ walk and quality of life using the SF-36 questionnaire, were also measured. Results: Four experimental subjects did not complete the study period, two that withdrew before starting, one due to problems with the venous access and one that decided to withdraw after 1 month of training. Among the five patients that finished the training period, significant improvements in the six minutes´ walk and quadriceps strength were observed in the experimental group. No significant changes were observed among controls. No changes were observed in either group in C reactive protein, tumor necrosis factor and interleukin 6 levels or quality of life. Conclusions: Among patients undergoing chronic hemodialysis exercise training improves endurance and muscle strength.
María Soledad, Oliveros R; Marcelo, Avendaño; Daniel, Bunout; Sandra, Hirsch; María Pía, De La Maza; Cristian, Pedreros; Hans, Müller.
Full Text Available Background: Exercise training during the dialytical procedure may have positive cardiovascular effects and prevent or revert muscle wasting in patients undergoing chronic hemodialysis. Aim: To evaluate the effects of an exercise training program in patients undergoing chronic hemodialysis. Material and Methods: Fifteen patients on chronic hemodialysis aged 21 to 69 years (three females were included in the study. Nine of these were included in an exercise training program. During 16 weeks, exercise sessions were carried out during each dialytical procedure that included a warm-up period, aerobic exercises done using standing cycles, and resistance exercises, performed using Thera-Band® elastic bands and loops. Borg scale was used to control the intensity of training. At baseline and at the end of the study, a blood sample prior and after the dialytical procedure was obtained to measure C reactive protein, tumor necrosis factor ? and interleukin 6. Quadriceps muscle strength, six minutes´ walk and quality of life using the SF-36 questionnaire, were also measured. Results: Four experimental subjects did not complete the study period, two that withdrew before starting, one due to problems with the venous access and one that decided to withdraw after 1 month of training. Among the five patients that finished the training period, significant improvements in the six minutes´ walk and quadriceps strength were observed in the experimental group. No significant changes were observed among controls. No changes were observed in either group in C reactive protein, tumor necrosis factor and interleukin 6 levels or quality of life. Conclusions: Among patients undergoing chronic hemodialysis exercise training improves endurance and muscle strength.
María Soledad Oliveros R
Full Text Available 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 undergoing regular hemodialysis, we designed a study of 36 maintenance hemodialysis patients (f = 15 m = 21, consisting of 25 non-diabetic HD patients and 11 diabetic HD patients. In this study we found a near significant difference of CRP between diabetic and non-diabetics of total patients with more values of CRP in diabetics, a significant difference of CRP between diabetic and non-diabetic of female HD patients with more values in diabetics and a significant difference of CRP between males and female of non-diabetic population with more values of CRP in males. An inverse correlation of serum CRP with serum cholesterol and triglyceride levels and a near significant positive correlations of CRP with serum ALP and with serum iPTH were found. An inverse correlation of serum CRP with dialysis efficacy was seen too. No significant association between serum CRP and serum albumin was seen. Compatible with some studies and in contrast to some other studies, the association of serum albumin with serum CRP levels in this study was insignificant. The positive correlation of high serum PTH with inflammation implies further need to control of hyperphosphatemia and secondary hyperparathyroidism in HD patients, also inverse correlation of serum CRP with cholesterol and triglyceride further support the malnutrition-inflammation complex syndrome (MICS which frequently seen in HD patients.
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 unnel 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)
With the ever-increasing number of persons requiring treatment for kidney disease, the need for competent hemodialysis (HD) nurses continues. Professional organizations support the use of nursing orientation programs, which have been shown to decrease staff turnover. An instructor's manual, student's handbook and learner's manual for HD orientation were developed in response to this need. Morrison, Ross & Kemp's (2004) instructional design model guided the creation of this material, while Bandura's concept of self-efficacy (1997) and Knowles' Adult Learning Theory (1984) gave direction for implementing this program. The focus of this paper is to outline how the instructional development model, self-efficacy concept and adult learning theory supported the development of this HD orientation. The materials developed for the orientation program should enable new HD nurses to provide improved holistic care to their patients and families. PMID:17691710
Ludlow, Valerie; Gaudine, Alice; Jacobs, Marilyn
Objective: The determine the frequency of erectile dysfunction in males on hemodialysis. Study Design: Descriptive study. Place and duration: Hemodialysis unit, Combined Military Hospital Kharian from October 2011 to April 2012. Patients and Methods: A total of 150 married male patients of end stage renal disease (ESRD) on hemodialysis were included in the study. Patients with cognitive and/or communication deficits and on hemodialysis for less than 06 months were excluded from the study. Erectile dysfunction (ED) was assessed using International Index of Erectile Function-5 (IIEF-5). Frequency of erectile dysfunction (ED) was analyzed using Statistical Package for Social Sciences (SPSS) version 17. Results: Mean age of the patients were 52.89 = 8.25 years. Mean duration of hemodialysis was 34 +- 9.62 months. The underlying etiology of end stage renal disease were diabetic nephropathy 69(46%), hypertensive nephropathy 51(34%), obstructive nephropathy 18(12%), glomerulonephritis 9(6%), autosomal polycystic kidney disease 3(2%). Mean IIEF-5 score was 13.29 +- 6.38. The frequency of erectile dysfunction was 74%. The majority of the patients, 73(48.7%) had moderate erectile dysfunction, while 24 (16%) had severe and 14 (9.3%) had mild erectile dysfunction. Out of total 150 patients enrolled, 39 (26%) patients had no erectile dysfunction. Conclusion: ED is a highly prevalent problem in men with ESRD. Physicians are urged to recognize the high prevalence of erection problems in men with ESRD and proactively question all patients regarding their sexual function. This will not only improve the recognition of this condition among these patients but also improve the quality of life after adequate treatment. (author)
Full Text Available 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.
Amir H Pakpour
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 physicaland 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.
Pakpour, Amir H.; Nourozi, Saeedeh
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.
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.
Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/V(urea), a 1.74-fold higher average number of treatments per week, and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm. We did not find a significant effect of nocturnal hemodialysis for either of the two coprimary outcomes (death or left ventricular mass (measured by MRI) with a hazard ratio of 0.68, or of death or RAND Physical Health Composite with a hazard ratio of 0.91). Possible explanations for the left ventricular mass result include limited sample size and patient characteristics. Secondary outcomes included cognitive performance, self-reported depression, laboratory markers of nutrition, mineral metabolism and anemia, blood pressure and rates of hospitalization, and vascular access interventions. Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension, but no significant benefit among the other main secondary outcomes. There was a trend for increased vascular access events in the nocturnal arm. Thus, we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either coprimary outcome. PMID:21775973
Rocco, Michael V; Lockridge, Robert S; Beck, Gerald J; Eggers, Paul W; Gassman, Jennifer J; Greene, Tom; Larive, Brett; Chan, Christopher T; Chertow, Glenn M; Copland, Michael; Hoy, Christopher D; Lindsay, Robert M; Levin, Nathan W; Ornt, Daniel B; Pierratos, Andreas; Pipkin, Mary F; Rajagopalan, Sanjay; Stokes, John B; Unruh, Mark L; Star, Robert A; Kliger, Alan S; Kliger, A; Eggers, P; Briggs, J; Hostetter, T; Narva, A; Star, R; Augustine, B; Mohr, P; Beck, G; Fu, Z; Gassman, J; Greene, T; Daugirdas, J; Hunsicker, L; Larive, B; Li, M; Mackrell, J; Wiggins, K; Sherer, S; Weiss, B; Rajagopalan, S; Sanz, J; Dellagrottaglie, S; Kariisa, M; Tran, T; West, J; Unruh, M; Keene, R; Schlarb, J; Chan, C; McGrath-Chong, M; Frome, R; Higgins, H; Ke, S; Mandaci, O; Owens, C; Snell, C; Eknoyan, G; Appel, L; Cheung, A; Derse, A; Kramer, C; Geller, N; Grimm, R; Henderson, L; Prichard, S; Roecker, E; Rocco, M; Miller, B; Riley, J; Schuessler, R; Lockridge, R; Pipkin, M; Peterson, C; Hoy, C; Fensterer, A; Steigerwald, D; Stokes, J; Somers, D; Hilkin, A; Lilli, K; Wallace, W; Franzwa, B; Waterman, E; Chan, C; McGrath-Chong, M; Copland, M; Levin, A; Sioson, L; Cabezon, E; Kwan, S; Roger, D; Lindsay, R; Suri, R; Champagne, J; Bullas, R; Garg, A; Mazzorato, A; Spanner, E; Rocco, M; Burkart, J; Moossavi, S; Mauck, V; Kaufman, T; Pierratos, A; Chan, W; Regozo, K; Kwok, S
In a patient undergoing regular hemodialysis through an arteriovenous fistula access, pleural effusion is a known long term complication. However, a unilateral hemothorax is relatively uncommon. Here we report a 46 year old male, end-stage renal disease patient, on maintenance hemodialysis, who presented with a giant brachiocephalic AV fistula in his left arm and progressive breathlessness. Radiological imaging revealed a left sided pleural effusion. Ultrasound guided aspiration revealed a hemorrhagic pleural fluid. A Doppler study of the fistula revealed a high velocity blood flow through the fistula, thereby establishing the cause of the unilateral hemothorax. Ligation of the fistula resulted in complete resolution of the hemothorax. The other possible causes for hemothorax in a dialysis patient are also discussed in this case report. PMID:18840271
Salim, Shihas; Ganeshram, Prasanthi; Patel, Amish Dilip; Kumar, Anita A; Vemuri, Divya; Jeyachandran, Vijay; Rajamanickam, Deepan; Shantha, Ghanshyam Palamaner Subash
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.)
Uremic toxins are mainly represented by blood urine nitrogen (BUN) and creatinine (Crea) whose removal is critically important in hemodialysis (HD) for kidney disease. Patients undergoing HD have a complex illness, resulting from: inadequate removal of organic waste, dialysis-induced oxidative stress and membrane-induced inflammation. Here we report innovative breakthroughs for efficient and safe HD by using a plasmon-induced dialysate comprising Au nanoparticles (NPs)-treated (AuNT) water that is distinguishable from conventional deionized (DI) water. The diffusion coefficient of K3Fe(CN)6 in saline solution can be significantly increased from 2.76, to 4.62 × 10-6 cm s-1, by using AuNT water prepared under illumination by green light-emitting diodes (LED). In vitro HD experiments suggest that the treatment times for the removals of 70% BUN and Crea are reduced by 47 and 59%, respectively, using AuNT water instead of DI water in dialysate, while additionally suppressing NO release from lipopolysaccharide (LPS)-induced inflammatory cells.
Chen, Hsiao-Chien; Lin, Hsiu-Chen; Chen, Hsi-Hsien; Mai, Fu-Der; Liu, Yu-Chuan; Lin, Chun-Mao; Chang, Chun-Chao; Tsai, Hui-Yen; Yang, Chih-Ping
Myeloperoxidase (MPO) is a proteolytic and prooxidant enzyme largely assembled with the vascular wall, and a heparin-binding protein. We studied if low-molecular-weight heparin enoxaparin administered for hemodialysis (HD) anticoagulation causes systemic MPO activation. Plasma MPO levels were measured in patients undergoing maintenance HD with an intravenous bolus of enoxaparin. Patients were retested during HD employing dialyzers with heparin-grafted polyacrylonitrile membrane and no systemic enoxaparin administration. During enoxaparin-anticoagulated HD plasma MPO levels strikingly increased in all patients (8.6-fold at 10 minutes and 3.3-fold at 120 minutes, both P?0.0001). The increments were directly associated with the enoxaparin dosage and strongly inversely with the predialysis levels of the enzyme. The increase in plasma MPO during systemic heparin-free HD was significantly less pronounced. Enoxaparin administered for HD anticoagulation induces a marked and dose-dependent increase in plasma MPO as a plausibly favorable result of the liberation of the enzyme from the vascular wall. PMID:24837008
Gozdzikiewicz, Joanna; Borawski, Jacek; Koc-Zorawska, Ewa; Mysliwiec, Michal
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.
Objective: The restless legs syndrome (RLS) is characterized by unpleasant sensations and pain in the legs, irresistible urge to move the legs, especially when resting and often accompanied by sleep disorders. RLS prevalence is up to 80% in hemodialysis patients. It is such an important clinical condition that is associated with increased mortality. Moreover etiopathogenesis is not clear. We aimed to evaluate vascular disorders, heart rate variability, oxidative stress parameter in hemodialys...
Hüseyin Atl?; Mehmet Çölbay; Serap Demir; ?eref Yüksel; ?hsan Uslan; Gürcel Acartürk; Özcan Karaman; Tülay Köken; Mehmet Melek
Malnutrition is a predictor of increased mortality in chronic hemodialysis (HD) patients. Various factors may contribute to malnutrition in these patients including energy and protein intake, inflammation, and comorbidity. To determine the importance of these factors in malnutrition of chronic HD patients, we studied 112 chronic HD patients in two centers was evaluated with the Dialysis Malnutrition Score (DMS) and anthropometric and biochemical indices. Seventy six (67.8%) patients we...
Jahromi Soodeh; Hosseini Saeed; Razeghi Effat; Meysamie Ali; Sadrzadeh Haleh
Domenico Santoro,1 Filippo Benedetto,2 Placido Mondello,3 Narayana Pipitò,2 David Barillà,2 Francesco Spinelli,2 Carlo Alberto Ricciardi,1 Valeria Cernaro,1 Michele Buemi11Department of Clinical and Experimental Medicine, Unit of Nephrology, 2Unit of Vascular Surgery, 3Unit of Infectious Disease, University of Messina, ItalyAbstract: A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure. There are three main types of access: na...
Santoro D; Benedetto F; Mondello P; Pipitò N; Barillà D; Spinelli F; Ca, Ricciardi; Cernaro V; Buemi M
Understanding the toxicity of certain potentially toxic compounds on various aquatic organisms allows to assess the impact that these pollutants on the aquatic biota. One source of pollution is the wastewater from hemodialysis. The process of sewage treatment is inefficient in inhibition and removal of pathogenic bacteria resistant to antibiotics in this wastewater. In many countries, such as Brazil, during emergencies, sewage and effluents from hospitals are often dumped directly into waterways without any previous treatment. The objective of this study was to characterize the effluents generated by hemodialysis and to assess the degree of acute and chronic environmental toxicity. The effluents of hemodialysis showed high concentrations of nitrites, phosphates, sulfates, ammonia, and total nitrogen, as well as elevated conductivity, turbidity, salinity, biochemical and chemical oxygen demand, exceeding the thresholds defined in the CONAMA Resolution 430. The samples showed acute toxicity to the green flagellate Euglena gracilis affecting different physiological parameters used as endpoints in an automatic bioassay such as motility, precision of gravitational orientation (r-value), compactness, upward movement, and alignment, with mean EC50 values of recalculate as 76.90 percent (±4.68 percent) of the undiluted effluents. In tests with Daphnia magna, the acute toxicity EC50 was 86.91 percent (±0.39 percent) and a NOEC value of 72.97 percent and a LEOC value 94.66 percent. PMID:24580820
Machado, Carla Keite; Pinto, Luciano Henrique; Del Ciampo, Lineu Fernando; Lorenzi, Luciano; Correia, Cláudia Hack Gumz; Häder, Donat Peter; Erzinger, Gilmar Sidnei
A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management. PMID:21814378
Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh
A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management.
Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh
Hypertension is highly prevalent in hemodialysis patients but its management remains a matter of debate. In this review, we discuss the observational studies on the association of blood pressure with outcomes, measurement of blood pressure in hemodialysis patients and present an opinion-based approach to treating hypertension. PMID:24494716
Shafi, Tariq; Waheed, Sana; Zager, Philip G
Trace element disturbance is often observed in hemodialysis patients. While trace element concentrations have been reported in blood samples from hemodialysis patients, they have not been well investigated in scalp hair. In the present study, 22 trace elemental concentrations were measured by inductively coupled plasma-atomic emission spectrometry in the scalp hair of 80 male hemodialysis patients and compared with those of 100 healthy male subjects. In hemodialysis patients, the concentrations of beryllium, arsenic, magnesium, chromium, manganese, iron, selenium, molybdenum, iodine, vanadium, and cobalt were significantly higher than those in healthy subjects, while lead, mercury, copper, germanium, and bromine were significantly lower than those in the former group. No significant differences were observed for lithium, aluminum, cadmium, zinc, boron, or nickel. There were significant positive correlations between the duration of hemodialysis and the magnesium and manganese concentrations. There was a significant negative correlation between cadmium concentration and the duration of hemodialysis. There were significant positive correlations between dialysis efficacy (Kt/V) and magnesium, manganese, zinc, and selenium concentrations. In conclusion, trace element concentrations of the scalp hair are different between hemodialysis patients and healthy subjects. Essential trace elements, such as magnesium, manganese, zinc, and selenium, may be affected by the duration of hemodialysis and Kt/V. PMID:21234813
Ochi, Akinobu; Ishimura, Eiji; Tsujimoto, Yoshihiro; Kakiya, Ryusuke; Tabata, Tsutomu; Mori, Katsuhito; Shoji, Tetsuo; Yasuda, Hiroshi; Nishizawa, Yoshiki; Inaba, Masaaki
Background and objectives: Fluid overload in hemodialysis patients sometimes requires emergent dialysis, but the magnitude of this care has not been characterized. This study aimed to estimate the magnitude of fluid overload treatment episodes for the Medicare hemodialysis population in hospital settings, including emergency departments.
Arneson, Thomas J.; Liu, Jiannong; Qiu, Yang; Gilbertson, David T.; Foley, Robert N.; Collins, Allan J.
Objective: To assess the clinical value of transcatheter thrombolysis in treating acute arteriovenous fistula thrombosis in hemodialysis patients and to discuss its technical points. Methods: During the period from Jan. 2008 to Jan. 2011, 67 times of acute arteriovenous fistula thrombosis occurred in 50 hemodialysis patients. The diagnosis was confirmed by angiographic findings. First the guide-wire was inserted and pushed forward to pass through the thrombus, then bolus injection (pulse spray) of urokinase (250000 units) through catheter was performed. If the thrombus could not be cleared away, transcatheter micro-pump continuous infusion of urokinase was employed for 1-3 days until the thrombosis was completely dissolved, which was confirmed by angiographic re-examination at 24, 48 and 72 hours after the start of thrombolysis. Results: Of the total 67 times of acute arteriovenous fistula thrombosis, the arteriovenous fistula reopened in 8 cases after transcatheter thrombolysis with pulse spray of urokinase. At 24, 48 and 72 hours after the initiation of thrombolysis treatment, the thrombus was completely dissolved in 34, 18 and 5 cases, respectively. The thrombolysis treatment failed in two cases. No serious complications such as pulmonary embolization, hemorrhage, etc. occurred during the therapeutic course. Conclusion: For the treatment of acute arteriovenous fistula thrombosis in hemodialysis patients, transcatheter thrombolysis is an easily-manipulated, effective, minimally-invasive and safe technique. Therefore, it is of great clinical value. (authors)
Sulfobutylether-beta-cyclodextrin (SBECD), a large cyclic oligosaccharide that is used to solubilize voriconazole (VRC) for intravenous administration, is eliminated mainly by renal excretion. The pharmacokinetics of SBECD and voriconazole in patients undergoing extracorporeal renal replacement therapies are not well defined. We performed a three-period randomized crossover study of 15 patients with end-stage renal failure during 6-hour treatment with Genius dialysis, standard hemodialysis, o...
Hafner, Verena; Czock, David; Burhenne, Ju?rgen; Riedel, Klaus-dieter; Bommer, Ju?rgen; Mikus, Gerd; Machleidt, Christoph; Weinreich, Thomas; Haefeli, Walter E.
Full Text Available SciELO Brazil | Language: English Abstract in english End-stage renal disease (ESRD) patients frequently develop structural cardiac abnormalities, particularly left ventricular hypertrophy (LVH). The mechanisms involved in these processes are not completely understood. In the present study, we evaluated a possible association between parathyroid hormon [...] e (PTH) levels and left ventricular mass (LVM) in patients with ESRD. Stable uremic patients on intermittent hemodialysis treatment were evaluated by standard two-dimensional echocardiography and their sera were analyzed for intact PTH. Forty-one patients (mean age 45 years, range 18 to 61 years), 61% males, who had been on hemodialysis for 3 to 186 months, were evaluated. Patients were stratified into 3 groups according to serum PTH: low levels (280 pg/ml; group III = 21 patients). A positive statistically significant association between LVM index and PTH was identified (r = 0.34; P = 0.03, Pearson's correlation coefficient) in the sample as a whole. In subgroup analyses, we did not observe significant associations in the low and intermediate PTH groups; nevertheless, PTH and LVM index were correlated in patients with high PTH levels (r = 0.62; P = 0.003). LVM index was also inversely associated with hemoglobin (r = -0.34; P = 0.03). In multivariate analysis, after adjustment for age, hemoglobin, body mass index, and blood pressure, the only independent predictor of LVM index was PTH level. Therefore, PTH is an independent predictor of LVH in patients undergoing chronic hemodialysis. Secondary hyperparathyroidism may contribute to the elevated cardiovascular morbidity associated with LVH in ESRD.
R.B., Randon; L.E., Rohde; L., Comerlato; J.P., Ribeiro; R.C., Manfro.
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.
Huebsch, P.; Trattnig, S.; Barton, P.; Seidl, G.; Traindl, O.; Kovarik, J.; Wolszczuk, W.
OBJECTIVES: The aim of this study was to analyze the periodontal parameters of patients with chronic renal failure. MATERIAL AND METHODS: The periodontal status of 16 Brazilian patients aged 29 to 53 (41.7±7.2) years with chronic renal failure (CRF) and another matched group of 14 healthy controls with periodontitis was assessed clinically and microbiologically. Probing pocket depth (PPD), gingival recession (GR), dental plaque index (PLI), gingival index (GI), and dental calculus index (CI)...
Sérgio Aparecido Torres; Odila Pereira da Silva Rosa; Mitsue Fujimaki Hayacibara; Maria do Carmo Machado Guimarães; Hayacibara, Roberto M.; Walter Antônio Bretz
The pharmacokinetic parameters of ceftriaxone in eight patients with end-stage renal disease were determined during dialysis and during the interdialysis period. The mean half-life, clearance, and apparent volume of distribution during dialysis were 16 h, 722 ml/h, and 16.7 liters, respectively. During the interdialysis period, the half-life was 14 h, clearance was 739 ml/h, and volume of distributions was 14 liters. Individual variability in plasma concentrations occurred even in patients wi...
Cohen, D.; Appel, G. B.; Scully, B.; Neu, H. C.
Full Text Available SciELO Brazil | Language: English Abstract in english OBJECTIVES: The aim of this study was to analyze the periodontal parameters of patients with chronic renal failure. MATERIAL AND METHODS: The periodontal status of 16 Brazilian patients aged 29 to 53 (41.7±7.2) years with chronic renal failure (CRF) and another matched group of 14 healthy controls w [...] ith periodontitis was assessed clinically and microbiologically. Probing pocket depth (PPD), gingival recession (GR), dental plaque index (PLI), gingival index (GI), and dental calculus index (CI) were the clinical parameters recorded for the entire dentition (at least 19 teeth), while the anaerobic periodontopathogen colonization in four sites with the highest PPD was evaluated using the BANA test ("PerioScan"; Oral B). RESULTS: The results for the CRF group and control group, respectively were: PPD: 1.77±0.32 and 2.65±0.53; GR: 0.58±0.56 and 0.51±0.36; PLI: 1.64±0.56 and 1.24±0.67; GI: 0.64±0.42 and 0.93±0.50; CI: 1.17±0.54 and 0.87±0.52. Comparison between groups using the "t" test revealed a significantly increased PPD (p
Sérgio Aparecido, Torres; Odila Pereira da Silva, Rosa; Mitsue Fujimaki, Hayacibara; Maria do Carmo Machado, Guimarães; Roberto M, Hayacibara; Walter Antônio, Bretz.
Serum free and esterified carnitine levels as well as lipids were investigated in patients undergoing regular hemodialysis (HD) treatment before and during 12 weeks of treatment with L-carnitine (1 g i.v.) at the end of each HD. The results were compared with those obtained in patients on continuous ambulatory peritoneal dialysis (CAPD; n = 15) or intermittent peritoneal dialysis (IPD; n = 3) and healthy controls (CO; n = 20). In HD patients (n = 23) total carnitine (TC) was 49.9 +/- 3.9 (CO: 46.0 +/- 2.5; NS), free carnitine (FC) was 31.6 +/- 2.8 (CO: 37.4 +/- 1.3; p less than 0.05), short-chain acylcarnitine (SCC) was 17.0 +/- 1.8 (CO: 7.2 +/- 0.9; p less than 0.0001) and long-chain acylcarnitine (LCC) was 1.2 +/- 0.2 mumol/l (CO: 0.6 +/- 0.1; p less than 0.05). FC was in the normal range in CAPD (35.6 +/- 3.2) and IPD (44.5 +/- 8.0 mumol/l) patients, whereas SCC (30.1 +/- 3.5) and LCC (2.9 +/- 0.2) levels were maximal elevated in IPD patients (11.8 +/- 0.8 and 1.5 +/- 0.2 on CAPD). Therefore, TC was higher in IPD than in CAPD patients (77.5 +/- 5.0 vs. 49.0 +/- 3.5 mumol/l). 12 weeks after L-carnitine supplementation in HD patients, TC was 313.9 +/- 22.6, FC was 207.7 +/- 12.4, SCC was 99.6 +/- 12.1 and LCC was 7.1 +/- 0.6 mumol/l. TC and FC were significantly lower in females compared with males. Total cholesterol and ketone bodies were normal, HDL cholesterol was significantly decreased before and after L-carnitine supplementation.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3740128
Wanner, C; Förstner-Wanner, S; Schaeffer, G; Schollmeyer, P; Hörl, W H
Full Text Available Objective: The restless legs syndrome (RLS is characterized by unpleasant sensations and pain in the legs, irresistible urge to move the legs, especially when resting and often accompanied by sleep disorders. RLS prevalence is up to 80% in hemodialysis patients. It is such an important clinical condition that is associated with increased mortality. Moreover etiopathogenesis is not clear. We aimed to evaluate vascular disorders, heart rate variability, oxidative stress parameter in hemodialysis patients with RLS. Material and Methods: Study was conducted with hemodialysis patients. Twenty five patients diagnosed as RLS with International Restless Legs Study Group criteria, and twenty five patients without RLS (control group were included to the study. Patients were examined with complete blood count and biochemical assays, Kt/V, oxidative stress parameter such as malon dialdehyde and sulphydryl, lower extremity Doppler ultrasonography and 24 hour holter heart rate variability. Results: Patients with RLS had significantly lower hemoglobin and sodium levels (p:0.025 ve p:0.038. Tibialis posterior and anterior artery ?ow was significantly reduced in patients with RLS (p:0.011 ve p:0.010. There was significant correlation about low hemoglobin and sodium level and reduced tibialis posterior and anterior artery ?ow. With logistic regression analysis, only hemoglobin was determined as independent factor on RLS (OR 6.211 [%95 CI 1.368-26.176] p=0.018. Conclusion: It is concluded that hemoglobin is an important independent factor for progression to RLS. Therefore hemoglobin level must be maintained in normal range especially in patients with RLS.
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.
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...
Salman Saleh Mohammad
Full Text Available Staphylococcus lugdunensis can cause virulent infections in immunosuppressed individuals. Here we describe a retrospective analysis of hemodialysis patients with Staphylococcus lugdunensis bacteremia admitted to a New York City hospital from January 2005 to December 2010. Six cases of S. lugdunensis bacteremia were identified. The majority had received antibiotic therapy for at least several weeks. None of them developed endocarditis or other serious complications. Four had their tunneled permanent dialysis catheters changed or removed. This pathogen is rare, but could often fail medical therapy alone and may require surgical intervention. This can be avoided with surveillance and early intervention in patients with high risk for infection.
Mallappallil M.C., Moro Salifu, Yalemzewd Woredekal, Martin Kramer, Phillips A.R., Saurabh Malhorta, Khaled Abu-Lawi and Bluth M.H.
Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialysis treatment. We reviewed the course and outcome of 9 pregnancies occurred in women on chronic hemodialysis in our center from 1999-2007; 5 of them ended with delivery of alive newborns, 2 with fetal deaths in-utero, and 2 with abortions. The average age of patients was 34 years. The etiology of the original kidney disease was unknown in 44.4% of the cases, and only 22.2% of the patients main...
Bahadi Abdelali; El Kabbaj Driss; Guelzim Khalid; Kouach Jaouad; Hassani Mohammed; Maoujoud Omar; Aattif Mohammed; Kadiri Mouncif; Montassir Dina; Zajjari Yassir; Alayoud Ahmed; Benyahia Mohammed; Elallam Mostapha; Oualim Zouhir
During the four month period, from December 1988 to March 1989, there was an outbreak of Heinz body positive hemolytic anemia in 34 patients undergoing hemodialysis in a 500-bed hospital, Seoul, Korea. The episodes of hemolysis were not reduced by changing the charcoal column and reverse osmosis system, or by adding ascorbic acid to the dialysate. The concentrations of nitrate, copper, aluminum and zinc in the treated water were all within the standards for hemodialysis. The chloramine concentration of the treated water was over 0.6 mg/L, markedly exceeding the allowable level of 0.1 mg/L. This high level of chloramine was proved to be due to the contamination of the water source by raw sewage. After we changed the source of water supply to another, no more episodes of hemolytic anemia occurred. It is concluded that chloramine is one of the major contaminants causing dialysis-induced hemolytic anemia and regular determinations are necessary, especially during winter and dry seasons. PMID:8031729
Pyo, H J; Kwon, Y J; Wee, K S; Kwon, S Y; Lee, C H; Kim, S; Lee, J S; Cho, S H; Cha, C W
Accelerated atherosclerosis is a major risk for uremic patients undergoing long-term hemodialysis. Because hyperhomocysteinemia may influence this condition, 168 such patients were examined for a possible association between plasma total homocysteine concentration (tHcy) and conventional cardiovascular risk factors. Generalized atherosclerosis was indicated by excessive intimal-medial wall thickness (IMT) of the extracranial carotid artery as measured by B-mode ultrasonography. The results documented tHcy in these patients of 33.0+/-16.9 micromol/L, a significantly higher amount than that of healthy subjects (11.0+/-3.1 micromol/L, p<0.0001). The patients' carotid maximum IMT was 1.79+/-1.16 mm. In multiple regression analyses with forward elimination procedure, carotid maximum IMT was clearly related to age (r = 0.417, p<0.0001), systolic blood pressure (r = 0.262, p = 0.0043), smoking (r = 0.177, p = 0.0076), duration of hemodialysis (r = 0.083, p = 0.0045), and tHcy (r = 0.195, p = 0.0021). These 5 factors accounted for 36.0% of the variation in carotid maximum IMT. Factors determined as unrelated were male gender, diastolic blood pressure, body mass index, total and HDL cholesterol, triglyceride, lipoprotein(a), uric acid, calcium, inorganic phosphate, and parathyroid hormone. Therefore hyperhomocysteinemia, along with advanced age, systolic hypertension and smoking aggravates atherosclerosis in chronic uremic patients. PMID:10496484
Sakurabayashi, T; Fujimoto, M; Takaesu, Y; Haginoshita, S; Goto, S; Aoike, I; Miyazaki, S; Koda, Y; Yuasa, Y; Sakai, S; Suzuki, M; Hirasawa, Y
Access stenosis is a major problem for hemodialysis patients. The access is a vessel, a vein or a graft where blood comes in and out of the patient for cleaning. Stenosis is a narrowing of the access caused by the build-up of a deposit. Stenosis causes thrombosis, the loss of a site (only a few sites are possible), expensive hospital procedures, and death. ^ Two measurement methods for access surveillance are (VascAlert, VA)—electronically monitored, continually trended, venous access pre...
The aim of this study was to determine the spectrum of MR findings of presumed amyloid arthropathy of the hip joints in patients on long-term hemodialysis. We prospectively performed T1- and T2-weighted spin-echo imaging on 152 consecutive patients on hemodialysis. The duration of hemodialysis ranged from 5 months to 24 years, 2 months (mean: 8 years, 8 months). The frequency, location, and signal intensity of bone lesions were assessed. In 12 cases with contrast-enhanced MR examination, enhancement pattern of bone lesions, synovial lesions, and intra-articular lesions were characterized. Bone lesions presumed to be amyloid deposits were identified in 60 patients (39 %). Magnetic resonance imaging revealed that amyloid lesions were more extensive than anticipated by plain radiographs. All bone lesions showed decreased signal intensity on T1-weighted images. On T2-weighted images, bone lesions showed increased signal intensity in 32 patients (54 %), decreased signal intensity in 11 patients (18 %), and both increased and decreased signal intensity in 17 patients (28 %). Following intravenous injection of gadolinium-based contrast, all bone lesions showed moderate enhancement. Synovial thickening could not be identified on T1- and T2-weighted images. However, contrast-enhanced images showed thickened synovial membrane, which could be differentiated from joint fluid. Intra-articular nodules showed decreased or intermediate signal intensity on T1-weighted images and decre intensity on T1-weighted images and decreased signal intensity on T2-weighted images; the intra-articular nodules were contiguous with subchondral bone lesions. Magnetic resonance imaging is useful for evaluating the distribution and extent of amyloidosis of the hip joints in patients undergoing long-term hemodialysis. (orig.) (orig.)
The aim of this study was to determine the spectrum of MR findings of presumed amyloid arthropathy of the hip joints in patients on long-term hemodialysis. We prospectively performed T1- and T2-weighted spin-echo imaging on 152 consecutive patients on hemodialysis. The duration of hemodialysis ranged from 5 months to 24 years, 2 months (mean: 8 years, 8 months). The frequency, location, and signal intensity of bone lesions were assessed. In 12 cases with contrast-enhanced MR examination, enhancement pattern of bone lesions, synovial lesions, and intra-articular lesions were characterized. Bone lesions presumed to be amyloid deposits were identified in 60 patients (39 %). Magnetic resonance imaging revealed that amyloid lesions were more extensive than anticipated by plain radiographs. All bone lesions showed decreased signal intensity on T1-weighted images. On T2-weighted images, bone lesions showed increased signal intensity in 32 patients (54 %), decreased signal intensity in 11 patients (18 %), and both increased and decreased signal intensity in 17 patients (28 %). Following intravenous injection of gadolinium-based contrast, all bone lesions showed moderate enhancement. Synovial thickening could not be identified on T1- and T2-weighted images. However, contrast-enhanced images showed thickened synovial membrane, which could be differentiated from joint fluid. Intra-articular nodules showed decreased or intermediate signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images; the intra-articular nodules were contiguous with subchondral bone lesions. Magnetic resonance imaging is useful for evaluating the distribution and extent of amyloidosis of the hip joints in patients undergoing long-term hemodialysis. (orig.) (orig.) With 4 figs., 1 tab., 17 refs.
Otake, S.; Yamana, D. [Department of Radiology, Narita Memorial Hospital, Aichi (Japan); Tsuruta, Y. [Department of Nephrology, Narita Memorial Hospital, Aichi (Japan); Mizutani, H.; Ohba, S. [Department of Radiology, Nagoya City University Medical School, Aichi (Japan)
Full Text Available The primary aim of the study was to assess the medication knowledge of hemodialysis patients and to evaluate the impact of education on their medication knowledge. This was a prospective randomised study, conducted in two phases. Study population consisted of 90 hemodialysis patients, randomised into two groups. Baseline medication knowledge of these patients was assessed using medication knowledge assessment questionnaire developed for the study. During the first phase of the study, group I patients received the education provided by a trained clinical pharmacist regarding their medications for eight-weeks and group II patients were deprived of clinical pharmacist provided education but received services only by usual healthcare group. At the end of week eight, medication knowledge assessment questionnaire was applied to both the groups of patients. In the second phase, group I patients were deprived of clinical pharmacist education and group II patients were rendered with clinical pharmacist provided education for eight-weeks and medication knowledge assessment questionnaire was once again administered to both the groups at the end of week 16. At the end of week eight, there was a statistically significant ( P 0.05 improvement in the medication knowledge assessment questionnaire scores observed in group I, compared to baseline medication knowledge assessment questionnaire scores and week eight scores of group II patients. There was no significant ( P >0.05 improvement observed in scores of group II compared to baseline. At the end of week 16 of the study period, there was a statistically significant ( P 0.05 improvement in the medication knowledge assessment questionnaire scores of the group II patients compared to their baseline and week eight scores. At the end of week 16 there was a significant ( P 0.05 drop in the medication knowledge assessment questionnaire scores of group I patients compared to their week nine scores. The study confirms that medication knowledge of the hemodialysis patients was extremely poor regarding the name, indication and dosage regimen of their medications. Study emphasizes the need for the continued education to the hemodialysis patients for better understanding of the medications they use. A trained clinical pharmacist could play a vital role in educating hemodialysis patients, which has obvious benefits on therapeutic outcome.
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.
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
Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialysis treatment. We reviewed the course and outcome of 9 pregnancies occurred in women on chronic hemodialysis in our center from 1999-2007; 5 of them ended with delivery of alive newborns, 2 with fetal deaths in-utero, and 2 with abortions. The average age of patients was 34 years. The etiology of the original kidney disease was unknown in 44.4% of the cases, and only 22.2% of the patients maintained diuresis. Dialysis started in 8 cases before the diagnosis of pregnancy. The average gestational age at diagnosis was 14 weeks. We modified the prescription of dialysis in 4 patients by increasing the frequency of the dialysis sessions to 6 per week and in 3 by increasing the duration of each session to 6 hours. Anemia was present in all the cases; 3 patients received erythropoietin and 4 patients required transfusion. The pregnancy was com-plicated in 44% of the cases by a polyhydramnios. The average time at delivery was 33 weeks and it was achieved in 80% of pregnancies through vaginal route. The average weight of newborns was to 2380 g. We conclude that pregnancy in women on hemodialysis is possible. The success of pregnancy may be influenced by the residual diuresis and early diagnosis to improve the quality of dialysis by increasing the dialysis dose. PMID:20587867
Bahadi, Abdelali; El Kabbaj, Driss; Guelzim, Khalid; Kouach, Jaouad; Hassani, Mohammed; Maoujoud, Omar; Aattif, Mohammed; Kadiri, Mouncif; Montassir, Dina; Zajjari, Yassir; Alayoud, Ahmed; Benyahia, Mohammed; Elallam, Mostapha; Oualim, Zouhir
Full Text Available Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialysis treatment. We reviewed the course and outcome of 9 pregnancies occurred in women on chronic hemodialysis in our center from 1999-2007; 5 of them ended with delivery of alive newborns, 2 with fetal deaths in-utero, and 2 with abortions. The average age of patients was 34 years. The etiology of the original kidney disease was unknown in 44.4% of the cases, and only 22.2% of the patients maintained diuresis. Dialysis started in 8 cases before the diagnosis of pregnancy. The average gestational age at diagnosis was 14 weeks. We modified the prescription of dialysis in 4 patients by increasing the frequency of the dialysis sessions to 6 per week and in 3 by increasing the duration of each session to 6 hours. Anemia was present in all the cases; 3 patients received erythropoietin and 4 patients required transfusion. The pregnancy was com-plicated in 44% of the cases by a polyhydramnios. The average time at delivery was 33 weeks and it was achieved in 80% of pregnancies through vaginal route. The average weight of newborns was to 2380 g. We conclude that pregnancy in women on hemodialysis is possible. The success of pregnancy may be influenced by the residual diuresis and early diagnosis to improve the quality of dialysis by increasing the dialysis dose.
Full Text Available SciELO Public Health | Language: Spanish Abstract in spanish 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.
Luis, Durán-Arenas; Paula D, Ávila-Palomares; Rodrigo, Zendejas-Villanueva; María Magaly, Vargas-Ruiz; Laura L, Tirado-Gómez; Malaquías, López-Cervantes.
Full Text Available SciELO Mexico | Language: Spanish Abstract in spanish 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.
Luis, Durán-Arenas; Paula D, Ávila-Palomares; Rodrigo, Zendejas-Villanueva; María Magaly, Vargas-Ruiz; Laura L, Tirado-Gómez; Malaquías, López-Cervantes.
Full Text Available Zulfitri A Mat Daud,1 Boniface Tubie,2 Marina Sheyman,2 Robert Osia,2 Judy Adams,2 Sharon Tubie,2 Pramod Khosla1 1Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA; 2Great Lake Dialysis Clinic, LLC, Detroit, MI, USA Purpose: Chronic hemodialysis patients experience accelerated atherosclerosis contributed to by dyslipidemia, inflammation, and an impaired antioxidant system. Vitamin E tocotrienols possess anti-inflammatory and antioxidant properties. However, the impact of dietary intervention with Vitamin E tocotrienols is unknown in this population. Patients and methods: A randomized, double-blind, placebo-controlled, parallel trial was conducted in 81 patients undergoing chronic hemodialysis. Subjects were provided daily with capsules containing either vitamin E tocotrienol-rich fraction (TRF (180 mg tocotrienols, 40 mg tocopherols or placebo (0.48 mg tocotrienols, 0.88 mg tocopherols. Endpoints included measurements of inflammatory markers (C-reactive protein and interleukin 6, oxidative status (total antioxidant power and malondialdehyde, lipid profiles (plasma total cholesterol, triacylglycerols, and high-density lipoprotein cholesterol, as well as cholesteryl-ester transfer protein activity and apolipoprotein A1. Results: TRF supplementation did not impact any nutritional, inflammatory, or oxidative status biomarkers over time when compared with the baseline within the group (one-way repeated measures analysis of variance or when compared with the placebo group at a particular time point (independent t-test. However, the TRF supplemented group showed improvement in lipid profiles after 12 and 16 weeks of intervention when compared with placebo at the respective time points. Normalized plasma triacylglycerols (cf baseline in the TRF group were reduced by 33 mg/dL (P=0.032 and 36 mg/dL (P=0.072 after 12 and 16 weeks of intervention but no significant improvement was seen in the placebo group. Similarly, normalized plasma high-density lipoprotein cholesterol was higher (P<0.05 in the TRF group as compared with placebo at both week 12 and week 16. The changes in the TRF group at week 12 and week 16 were associated with higher plasma apolipoprotein A1 concentration (P<0.02 and lower cholesteryl-ester transfer protein activity (P<0.001. Conclusion: TRF supplementation improved lipid profiles in this study of maintenance hemodialysis patients. A multi-centered trial is warranted to confirm these observations. Keyword: vitamin, tocotrienol-rich fraction, lipid profiles, hemodialysis, end-stage renal disease, nutrition intervention
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 c, 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)
Pruritus affects many patients undergoing hemodialysis (HD). In this study, pruritus and its relationship to morbidity, quality of life (QoL), sleep quality, and patient laboratory measures were analyzed in a large sample of Japanese patients undergoing HD. Severity of patient-reported pruritus symptoms experienced during a 4-week period was collected from 6480 Japanese patients undergoing HD in three phases of the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996-2008; 60-65 study facilities/phase). Adjusted linear and logistic regressions were used to identify associations of pruritus with treatment parameters and QoL outcomes. Adjusted Cox regressions examined the influence of pruritus severity on mortality. Moderate to extreme pruritus was experienced by 44% of prevalent patients undergoing HD in the Japanese Dialysis Outcomes and Practice Patterns Study. Many patient characteristics were significantly associated with pruritus, but this did not explain the large differences in pruritus among facilities (20-70%). Pruritus was slightly less common in patients starting HD than in patients on dialysis >1 year. Patients with moderate to extreme pruritus were more likely to feel drained (adjusted odds ratio?=?2.2-5.8, P?0.0001), have poor sleep quality (adjusted odds ratio?=?1.9-3.7, P?0.0001), and have QoL mental and physical composite scores 2.3-6.7 points lower (P?0.0001) than patients with no/mild pruritus. Pruritus in patients undergoing HD was associated with a 23% higher mortality risk (P?=?0.09). The many poor outcomes associated with pruritus underscore the need for better therapeutic agents to provide relief for the 40-50% of prevalent patients undergoing HD substantially affected by pruritus. Pruritus in new patients with end-stage renal disease likely results from uremia or pre-existing conditions (not HD per se), indicating the need to understand development of pruritus before end-stage renal disease. PMID:24766224
Kimata, Naoki; Fuller, Douglas S; Saito, Akira; Akizawa, Tadao; Fukuhara, Shunichi; Pisoni, Ronald L; Robinson, Bruce M; Akiba, Takashi
Full Text Available SciELO Peru | Language: Spanish Abstract in spanish 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 undergo
Percy, Herrera Añazco; Miriam Giovanna, Díaz Sánchez; Melisa, Palacios Guillén; Luisa, Núñez Talavera; Alfonzo, López Herrera; José, Valencia Rodríguez; Manuela, Silveira Chau.
Full Text Available Hemodialysis access recirculation occurs when dialyzed blood returning through the venous needle reenters the extracorporeal circuit through the arterial needle rather than returning to the systemic circulation. It is important to meausre hemodialysis access recirculation for two reasons: The reentry of dialyzed blood into the extracorporeal circuite reduces solute concentration gradients across the dialysis membrane by mixing already dialyzed with undialyzed blood. As a result, the efficiency of dialysis is reduced. High degrees of recirculation can lead to a significant discrepancy between the amount of hemodialysis prescribed (prescribed Kt/V urea and the amount of hemodialysis delivdred (delivered Kt/V urea.High degrees of access recirculation indicate the presence of access stenoses, the most common cause of access thrombosis. Prospective identification and treamtnet of access stenoses improves long-term access patency rate.
Background and objectives: Treatment without catheter replacement (catheter salvage) has been described for bacteremia associated with tunneled venous catheters in hemodialysis patients, but few data are available on which to base an estimation of the likelihood of treatment success.
Ashby, Damien R.; Power, Albert; Singh, Seema; Choi, Peter; Taube, David H.; Duncan, Neill D.; Cairns, Tom D.
A destructive spondyloarthropathy is reported in four patients undergoing maintenance hemodialysis for chronic renal disease. In a separate investigation a controlled, prospective radiographic study of the cervical spine revealed this spondyloarthropathy in 4 (15%) of 26 long-term dialysis patients. A single disk level was involved in three patients, and two disc levels were involved in one patient. This spondyloarthropathy correlated with the duration of dialysis but not with the radiographic evidence of renal osteodystrophy or severity of laboratory abnormalities associated with hyperparathyroidism. Three of these four patients also had discovertebral erosions or destruction involving the lumbar spine. Cervical spine flexion views revealed evidence of ligamentous laxity or instability in three (12%) dialysis patients, all with vertebral resorption and disc space narrowing. It is postulated that this instability may contribute to the development of cervical discovertebral lesions or be a secondary manifestation of disc destruction.
Kerr, R.; Feinstein, E.I.; Bjorkengren, A.; Bielecki, D.K.; Resnick, D.
The clearance of Tc-99m DTPA was studied in 14 patients undergoing hemodialysis (HD) or peritoneal dialysis (PD). Mean Tc-99m DTPA clearance during HD was 37.8% +/- 10.1 of creatinine clearance. Mean Tc-99m DTPA clearance in PD was 65.1% +/- 10.3 of creatinine clearance. Tc-99m DTPA, with a larger molecular weight than that of creatinine, is cleared relatively better during PD than during HD. Thus Tc-99m DTPA may be used in the assessment of the effectiveness of different dialytic treatments for substances of similar molecular weight. In addition, our study shows that clearance of DTPA both in HD and PD is sufficiently high to allow the removal of this chelating agent in patients with renal failure
The mechanism of hypoxemia during hemodialysis was investigated by the multiple inert gas elimination technique in anesthetized, paralyzed, mechanically ventilated dogs. Profound leukopenia occurred in the first hour of a 2-h hemodialysis with a cuprophan membrane and dialysate that contained acetate. Arterial partial pressure of O2 and CO2 and oxygen consumption remained unchanged during dialysis. Pulmonary carbon dioxide elimination and lung respiratory exchange ratio decreased with the ini...
Ralph, D. D.; Ott, S. M.; Sherrard, D. J.; Hlastala, M. P.
Abstract The evolution of home dialysis marked the main steps in the progress of renal replacement therapy. From the origins when home hemodialysis was often the only alternative to death, to the advent and widespread use of peritoneal dialysis, the dream of kidney transplant as a solution to all problems (at least in the young), and ultimately the profound social and organizational changes that have led to a drastic reduction of home hemodialysis, we arrive at the present with the redisco...
Piccoli, Giorgina Barbara
The repercussions of secondary hyperparathyroidism on the nutritional status of chronic renal failure patients have not been well established. Therefore, the aim of this study was to compare the nutritional indices of hemodialysis patients with and without secondary hyperparathyroidism. Sixteen hemodialysis patients with serum parathyroid hormone (PTH) levels higher than 420 pg/ml (hyperparathyroidism group) were matched for gender, age and length of dialysis treatment to 16 patients with ser...
Rezende, L. T. T.; Cuppari, L.; Carvalho, A. B.; Canziani, M. E. F.; Manfredi, S. R.; Cendoroglo, M.; Sigulem, D. M.; Draibe, S. A.
Several observational studies have demonstrated that serum levels of minerals and parathyroid hormone (PTH) have U- or J-shaped associations with mortality in maintenance hemodialysis patients, but the relationship between serum alkaline phosphatase (AlkPhos) and risk for all-cause or cardiovascular death is unknown. In this study, a 3-yr cohort of 73,960 hemodialysis patients in DaVita outpatient dialysis were studied, and the hazard ratios for all-cause and cardiovascular death were higher ...
Regidor, Deborah L.; Kovesdy, Csaba P.; Mehrotra, Rajnish; Rambod, Mehdi; Jing, Jennie; Mcallister, Charles J.; Wyck, David; Kopple, Joel D.; Kalantar-zadeh, Kamyar
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.
"nBackground: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO) synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO) can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer d...
Rahimi. A.; Maziar S; Ahmadi F; Shahriari S; Fattahi F; Jam S; Moradmand Badie B; Kourorian Z
This study aimed to evaluate the effects of maintenance IV iron sucrose vs oral iron gluconate on iron indices and hematological profile in pediatric hemodialysis patients. Twenty four children under regular hemodialysis (13 males and 11 females with median age 11 years) were enrolled in this study and had initial adequate iron stores and were maintained on oral iron gluconate daily and erythropoietin alpha (EPO) weekly for 3 months prior to study. They were randomly subdivided into two group...
Mohamed Ragab; Khaled Mahmoud; Amany Ragab
Objective: In this study, it was aimed to determine the relationship between erythropoietin (EPO) use and mean platelet volume (MPV) in the children undergoing dialysis. Methods: MPV values before and after EPO use in 36 patients (16 hemodialysis - HD, 20 peritoneal dialysis - PD) were retrospectively evaluated. Patients were divided into two groups according to weekly EPO need as; given less than 150 U/kg defined as low EPO and more than 150 U/kg as high EPO groups. The age, weight, prima...
Kadriye Özdemir; Orhan Deniz Kara; Nida Dinçel; ?pek Kaplan Bulut; Ebru Y?lmaz; Sevgi Mir
Full Text Available Abstract Background Adequate anticoagulation is prerequisite for effective hemodialysis to prevent clotting in the extracorporeal circuit. We aimed providing first data on the efficacy and safety of the low-molecular-weight heparin certoparin in this setting. Methods Multicenter, open-label, 8-week trial. Patients received a single dose of 3,000 IU certoparin i.v. with additional titration steps of 600 IU and/or continuous infusion if necessary. Results 120 patients were screened, 109 enrolled (median age 71; range 26–90 years and 106 available for efficacy analyses. The percentage of unsatisfactory dialysis results at 8 weeks due to clotting or bleeding, was 1.9% (n?=?2/106; 95% confidence interval [CI] 0.23–6.65%; no major bleeding. 1.9% had moderate/severe clotting in the lines/bubble catcher and 2.8% in the dialyser at week 8. 15.7?±?14.3% of the dialysis filters’ visual surface area was showing redness. In subgroups of patients receiving median doses of 3000?±?0, 3000 (2400–6000 and 4200 (3000–6600 IU, plasma aXa levels at baseline, 4 and 8 weeks were 0.24 [95%CI 0.21–0.27], 0.33 [0.27–0.40] and 0.38 [0.33–0.45] aXa IU/ml at 2 h. C48h was 0.01 [0.01–0.02] aXa IU at all visits. At baseline and 4 weeks AUC0-48h was 2.66 [2.19–3.24] and 3.66 [3.00–4.45] aXa IU*h/ml. In 3.0% of dialyses (n?=?83/2724 prolonged fistula compression times were documented. Eight patients (7.34% had at least one episode of minor bleeding. 4 85.3% of patients had any adverse event, 9.2% were serious without suspected drug relation; and in 32 patients a drug-relation was suspected. Conclusions Certoparin appears effective and safe for anticoagulation in patients undergoing maintenance hemodialysis.
Abstract This the case of a 63 year-old man with end-stage renal disease (on chronic hemodialysis), unstable angina and significantly impaired myocardial contractility with low left ventricular ejection fraction, who underwent off-pump one vessel coronary bypass surgery. Combined continuous levosimendan and norepinephrine infusion (at 0.07 ?g/kg/min and 0.05 ?g/kg/min respectively) started immediately after anesthesia induction and continued for 24 hours. The levosimendan/norepine...
Siminelakis Stavros N; Tzimas Petros; Baikoussis Nikolaos G; Papadopoulos Georgios; Karanikolas Menelaos
Background: Bioimpedance analysis (BIA) is well established to assess body composition. Agreements between single- and multi-frequency bioimpedance (SF-BIA, MF-BIS) measurements in subjects undergoing 6 or 3 times/week hemodialysis (HD) were analyzed. Methods: Total body water (TBW) and intra- and extracellular fluid (ICF, ECF) of subjects enrolled in the Frequent Hemodialysis Network (FHN) Daily Trial (www.clinicaltrials.gov No. NCT00264758) were measured with a Hydra 4200 at baseline (BL) and at 5 months (M5). Volumes were computed using SF (at 50 kHz) and MF approaches. Agreement was assessed by means of linear regression and Bland-Altman analysis and treatment effects by t test. Results: 35 subjects (17 on the more frequent regimen, 26 males, 20 African-American, 48 ± 9 years, pre-HD weight 84 ± 19 kg) were studied. Assessments with SF-BIA and MF-BIS correlated significantly at BL and M5 in both arms. No proportional errors, but systematic biases over the entire range of values were found at BL and M5. Agreement did not differ between subjects randomized to either HD treatment arm at both time points. MF-BIS appears to have better precision than SF-BIA allowing the observation of a significant treatment effect by the intervention [-1.5 (95% CI -2.5 to -0.5) l] on ECF, not found for ECF SF-BIA. Precision also affected the statistical power of the SF-BIA data in the current analysis. Conclusion: Both methods showed agreement without significant proportional errors regardless of HD frequency and can be used for longitudinal analyses. SF-BIA has lower precision which needs thorough consideration in the design of future trials with similar outcomes. © 2014 S. Karger AG, Basel. PMID:25402657
Raimann, Jochen G; Abbas, Samer R; Liu, Li; Zhu, Fansan; Larive, Brett; Kotanko, Peter; Levin, Nathan W; Kaysen, George A
Full Text Available Introduction. Vascular access blood flow rate of 100-350 cm/s and between 500 and 1000 ml/min, points to normal vascular access function and adequate hemodialysis. High blood flow through the arteriovenus fistula overloads the left ventricle inducing left ventricular remodeling. Material and methods. The aim of the study was to establish the degree of correlation between blood flow through the vascular access for hemodialysis and echocardiographic parameters for the assessment of left ventricular hypertrophy and left ventricular dilatation and left ventricular function. The research included 115 patients (M:F 71:44, average age 53.30±12.17 years, average length of dialysis 4.51 ± 4.01 years and average Kt/Vsp index 1.17±0.23. Results. The average blood flow through the vascular access for hemodialysis was 662.27±301.59 ml/min, EDDLV 54.52±6.42 mm, and EDVi 100.80±34.62 ml/m2. There is a statistically significant positive correlation between blood flow through vascular access for hemodialysis and EDDLV and EDVi. Conclusion. High blood flow through the vascular access for hemodialysis is an independent risk factor for the development of cardiovascular complications in patients on hemodialysis. .
Mortality is markedly elevated in hemodialysis (HD) patients. Between 30 and 50% of prevalent patients have elevated serum levels of inflammatory markers such as C-reactive protein and IL-6. The presence of inflammation, chronic or episodic, has been found to be associated with increased mortality risk. The causes of inflammation are multifactorial and include patient-related factors, such as underlying disease, comorbidity, oxidative stress, infections, obesity, and genetic or immunologic factors, or on the other side, HD-related factors, mainly depending on the membrane biocompatibility and dialysate quality. The adequate knowledge of these causes and their prevention or treatment if possible may contribute to improving the inflammatory state of patients who are on HD and possibly their mortality. PMID:17130274
Jofré, Rosa; Rodriguez-Benitez, Patrocinio; López-Gómez, Juan M; Pérez-Garcia, Rafael
There is increasing interest of the worldwide kidney community in home hemodialysis (HHD). This is due to emerging evidence of its superiority over conventional hemodialysis (HD), largely attributed to improved outcomes on intensive schedule HD, best deployed in patient's own homes. Despite published work in this area, universal uptake remains limited and reasons are poorly understood. All those who provide HD care were invited to participate in a survey on HHD, initiated to understand the beliefs, attitudes, and practice patterns of providers offering this therapy. The survey was developed and posted on the Nephrology Dialysis Transplantation-Educational (NDT-E) website. Two hundred and seventy-two responses were deemed suitable for complete analysis. It is apparent from the survey that there is great variability in the prevalence of HHD. Physicians have a great deal of interest in this modality, with majority viewing home as being the ideal location for the offer of intensive HD schedules (55%). A significant number (21%) feel intensive HD may be offered even outside the home setting. Those who offer this therapy do not see a financial disadvantage in it. Many units identify lack of appropriately trained personnel (35%) and funding for home adaptation (50.4%) as key barriers to widespread adoption of this therapy. Despite the interest and belief in this therapy among practitioners, HHD therapy is still not within reach of a majority of patients. Modifiable organizational, physician, and patient factors exist, which could potentially redefine the landscape of HHD provision. Well-designed systematic research of national and local barriers is needed to design interventions to help centers facilitate change. PMID:24814711
Jayanti, Anuradha; Morris, Julie; Stenvinkel, Peter; Mitra, Sandip
Coronary heart diseases (CHD) are the main cause of mortality in hemodialysis patients. Lipid profile abnormality in hemodialysis patients including hypertriglyceridemia , normal total cholesterol, modest decline in HDL rise in LDL are effected by omega 3 speculative. The purpose of this study was to investigate the effects of omega 3 fatty acid on lipid profile in hemodialysis patients. this clinical trial was performed on 16 hemodialysis patients with hypertriglyceridemia. They were asked t...
Taziki, O.; Lesan Pezeshki, M.
Malnutrition and inflammation are the most important causes of cardiovascular disease in hemodialysis patients. This study was conducted to evaluate the effect of increase in hemodialysis frequency on C-reactive protein (CRP) level and nutritional markers in contrast to previous routine method. 18 hemodialysis patients with a mean age of 53±16 years were randomly selected in this before-and-after clinical trial. The patients under a standard hemodialysis of 3 times/4 h per week were converte...
Shokooh Sarbolouki; Hassan Nikoueinejad; Ali Reza Soleimani; Ali Akbar Rashidi
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
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
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.
West Kenneth A
Estudo comparativo de osteotomias nasais laterais contínua e por microperfuração em pacientes submetidos à rinoplastia primária / Comparative study of continuous lateral osteotomy and microperforating osteotomy in patients undergoing primary rhinoplasty
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese INTRODUÇÃO: As osteotomias laterais têm papel importante na rinoplastia e podem ser realizadas através de diferentes técnicas. OBJETIVO:Este trabalho visa comparar o resultado final de estreitamento do dorso e base nasal por meio de dois tipos de osteotomia laterais, via microperfuração e contínua. [...] MÉTODO: Foram selecionados 74 pacientes submetidos à rinoplastia, em Curitiba, 37 pacientes tiveram osteotomia lateral realizada por microperfuração e os outros 37 por osteotomia contínua, todos pelo mesmo cirurgião. Analisados fotografias frontais, pré-operatórias e pós-operatórias de 6 meses, avaliando a largura do dorso e base nasal. Estudo retrospectivo. RESULTADOS E CONCLUSÃO: Por meio de análise estatística t de Student, concluímos que, em ambas as técnicas de osteotomia lateral há uma diferença estatística significativa no estreitamento do dorso e base nasal pós-operatório e não há diferença estatística entre os dois tipos de osteotomias. Abstract in english INTRODUCTION: Lateral osteotomies play an important role in rhinoplasty and can be performed with different techniques. OBJECTIVE: To compare the results of narrowing of the nasal dorsum and base through 2 types of lateral osteotomy: continuous and microperforating. METHOD: We selected 74 patients u [...] ndergoing rhinoplasty: 37 patients underwent lateral continuous osteotomy and the other 37 underwent microperforating osteotomy, all performed by the same surgeon. We analyzed frontal photography from the pre- and post-operative (6 months) periods, evaluating the width of the nasal dorsum and base. This was a retrospective study. RESULTS AND CONCLUSION: Using Student's t-test, statistical analysis concluded that there was a statistically significant difference in the post-operative narrowing of the nasal dorsum and base following both osteotomy techniques, and there was no statistically significant difference between the 2 techniques.
Diego Sherlon, Pizzamiglio; Cezar Augusto Sarraf, Berger.
Several studies suggest that there is a correlation between dose of dialysis and machine maintenance. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or patient outcome, and machine maintenance. In order to evaluate the impact of hemodialysis machine maintenance on dialysis adequacy Kt/V and session performance, data were processed on 134 patients on 3-times-per-week dialysis regimens by dividing the patients into four groups and also dividing the hemodialysis machines into four groups according to their year of installation. The equilibrated dialysis dose eq Kt/V, urea reduction ratio (URR) and the overall equipment effectiveness (OEE) were calculated in each group to show the effect hemodialysis machine efficiency on the overall session performance. The average working time per machine per month was 270 hours. The cumulative number of hours according to the year of installation was: 26,122 hours for machines installed in 1998; 21,596 hours for machines installed in 1999, 8362 hours for those installed in 2003 and 2486 hours for those installed in 2005. The mean time between failures (MTBF) was 1.8, 2.1, 4.2 and 6 months between failures for machines installed in 1999, 1998, 2003 and 2005, respectively. Statistical analysis demonstrated that the dialysis dose eq Kt/V and URR were increased as the overall equipment effectiveness (OEE) increases with regular maintenance procedures. Maintenance has become one of the most expedient approaches to guarantee high machine dependability. The efficiency of dialysis machine is relevant in assuring a proper dialysis adequacy. PMID:19112219
Azar, Ahmad Taher
Full Text Available Several studies suggest that there is a correlation between dose of dialysis and machine maintenance. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or patient outcome, and machine maintenance. In order to evaluate the impact of hemodialysis machine maintenance on dialysis adequacy Kt/V and session performance, data were processed on 134 patients on 3-times-per-week dialysis regimens by dividing the patients into four groups and also dividing the hemodialysis machines into four groups according to their year of installation. The equilibrated dialysis dose eq Kt/V, urea reduction ratio (URR and the overall equipment effectiveness (OEE were calculated in each group to show the effect hemodialysis machine efficiency on the overall session performance. The average working time per machine per month was 270 hours. The cumulative number of hours according to the year of installation was: 26,122 hours for machines installed in 1998; 21,596 hours for machines installed in 1999, 8362 hours for those installed in 2003 and 2486 hours for those installed in 2005. The mean time between failures (MTBF was 1.8, 2.1, 4.2 and 6 months between failures for machines installed in 1999, 1998, 2003 and 2005, respectively. Statistical analysis demonstrated that the dialysis dose eq Kt/V and URR were increased as the overall equipment effectiveness (OEE increases with regular maintenance procedures. Maintenance has become one of the most expedient approaches to guarantee high machine dependability. The efficiency of dialysis machine is relevant in assuring a proper dialysis adequacy.
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.
Background: Fatigue is considered as a major problem in hemodialysis patients and can impair their quality of life. The purpose of this study was to investigate the effectiveness of acupressure on fatigue in hemodialysis patients. Materials and Methods: This is a clinical trial study in which 96 hemodialysis patients participated. Patients were randomly assigned into acupressure, placebo, and control groups (32 subjects fulfilling the inclusion criteria assigned to each group). The measures included the form of demographic characteristics, visual analog scale of fatigue, and Piper Fatigue Scale. Patients in the acupressure and placebo groups received acupressure intervention during the early 2 h of dialysis on six acupoints with massage for 20 min/day, 3 days per week for 4 weeks. In the placebo group, acupressure intervention was performed as mentioned above with a distance of 1 cm away from the actual intervention site. Patients in the control group received routine unit care only. Chi- quare test, Kruskal-Wallis, paired t-test, one-way analysis of variance (ANOVA), and Duncan test were used for data analysis. Results: One-way ANOVA tests showed significant differences in the total mean score of fatigue and fatigue mean scores in the behavioral, emotional, sensory, and cognitive dimensions in the acupressure, placebo, and control groups. Conclusion: The results of this study showed that acupressure may reduce fatigue in hemodialysis patients, and use of this non-pharmacologic technique for hemodialysis nurses is suggested. PMID:24554938
Sabouhi, Fakhri; Kalani, Leila; Valiani, Mahboubeh; Mortazavi, Mojgan; Bemanian, Mahboobeh
The quality of life of patients with end-stage renal disease is an important indicator of disease burden. To achieve a better quality of life, some medical treatment might be replaced by other approaches. The aim of this study was to compare the quality of life of renal-transplanted and hemodialysis patients in Iran. Two hundred hemodialysis and 200 renal transplantation patients were recruited from 5 major hospitals and renal patients' support society in Tehran, Iran. The data were collected using the Persian versions of the Ferrans and Powers Quality of Life Index-Dialysis and Transplantation Version. The quality-of-life mean scores of renal transplantation patients were significantly better compared with those of the hemodialysis patients (21.36 [SD, 4.06] vs 20.35 [SD, 5.14]; P = .03). The questionnaire demonstrated significant differences in health/functioning and familial subscale of quality of life between the transplanted and hemodialysis patients (p < .05). The better quality of life of transplant patients, in comparison with hemodialysis patients, is an important reason for advising kidney transplants in renal failure patients. To improve the patients' quality of life, kidney transplantation might be effective for the end-stage renal disease. With regard to socioeconomic problem in most of the patients with renal failure, comprehensive insurance and referral to renal and transplanted patients' support society are suggested for those who have undergone different renal replacement therapies. PMID:21248544
Rambod, Masoume; Shabani, Maryam; Shokrpour, Nasrin; Rafii, Forough; Mohammadalliha, Jaleh
Improved patient outcomes have led to increased international interest in daily home hemodialysis as a kidney replacement therapy. Daily home hemodialysis often requires the assistance of a caregiver during and between treatments. Understanding the needs and concerns of caregivers of persons on daily home hemodialysis will inform the design of supportive interventions to improve caregiver retention and maintain their health and well-being. Using a descriptive qualitative design, the purpose of this study was to identify and describe the needs, concerns, strategies, and advice of family caregivers. Twenty-one caregivers were interviewed; five of these individuals were former caregivers of patients who had returned to outpatient hemodialysis. Data were collected via audio-recorded telephone interviews following a semistructured interview guide with five open-ended questions. A content analysis approach was used to code and analyze the data. Caregivers described needs, concerns, and strategies and offered advice in five predetermined major categories. Major findings included a need for respite services and a need for interventions to manage the emotional responses to caregiving. This study provides valuable information about relevant areas to consider when developing an intervention program for daily home hemodialysis caregivers. PMID:23876991
Welch, Janet L; Thomas-Hawkins, Charlotte; Bakas, Tamilyn; McLennon, Susan M; Byers, Doris M; Monetti, Catherine J; Decker, Brian S
Full Text Available 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 excluded. 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
Jaime Duclos H
Efeitos de diferentes FiO2 sobre variáveis ecocardiográficas em cães submetidos à infusão contínua de propofol Effects of several FiO2 on the echocardiographic parameters in dogs undergoing continuous infusion of propofol
Full Text Available Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO2 em cães anestesiados com infusão contínua de propofol e mantidos em ventilação espontânea sobre os parâmetros ecocardiográficos, obtidos em modo M. Oito cães adultos foram submetidos a cinco protocolos anestésicos diferenciando um do outro pela FiO2 fornecida ao paciente. Formaram-se cinco grupos denominados G100 (FiO2=1, G80 (FiO2=0,8, G60 (FiO2=0,6, G40 (FiO2=0,4 e G20 (FiO2=0,21. Os animais foram induzidos à anestesia com propofol na dose necessária para intubação e, ato contínuo, iniciou-se a infusão do fármaco. Os cães receberam oxigênio conforme a FiO2 determinada para cada grupo. As primeiras mensurações foram efetuadas antes da administração do fármaco (M0, aos 30 minutos (M30 após o início da infusão do anestésico e a cada 15 minutos (M45, M60, M75 e M90 durante 60 minutos. Para espessura do septo interventricular ao final da sístole (ESIVs registrada em M60, a média de G100 foi maior do que as obtidas de G60 e G20. Em M30, o espessamento fracional da parede livre do ventrículo esquerdo (ELPVE de G100 foi menor que de G80, e, em M75, G80 foi maior que G40. Em relação ao índice de volume ventricular esquerdo ao final da sístole (IVVEFs, em M45, G40 foi maior que G80. Conclui-se que as variáveis ecocardiográficas estudadas não são afetadas pelo emprego de diferentes FiO2.The effects of several inspired oxygen fractions (FiO2 on the echocardiographic parameters by M-mode were evaluated in eight adult spontaneously breathing mongrel dogs anesthetized with continuous infusion of propofol. Each animal underwent five anesthesia procedures. In each procedure, the patient was allowed to breath a different FiO2, thereby resulting in five groups, namely: G100 (FiO2 = 1, G80 (FiO2 = 0.8, G60 (FiO2 =0.6, G40 (FiO2 = 0.4, and G20 (FiO2 = 0.21. To induce anesthesia, propofol was given until the animals allowed orotracheal intubation, followed by immediate continuous infusion of propofol. The initial measurement (M0 was performed before any drug administration, the second was recorded 30 minutes after the infusion of propofol (M30, and additional recordings were performed at 15-minute intervals (M45, M60, M75, and M90, during 60 minutes. At M60, for the end-systolic interventricular septum thickness (IVSs, the mean of G100 was greater than G60 and G20. Regarding left ventricular wall fractional thickness (LVWF at M30, G100 was lower than G80; and at M75, G80 was greater than G40. In relation to left ventricular end-systolic volume index (ESVI, at M45, G40 was greater than G80. In conclusion, different FiO2 does not impair echocardiographic parameters.
Efeitos de diferentes FiO2 sobre variáveis ecocardiográficas em cães submetidos à infusão contínua de propofol / Effects of several FiO2 on the echocardiographic parameters in dogs undergoing continuous infusion of propofol
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO2) em cães anestesiados com infusão contínua de propofol e mantidos em ventilação espontânea sobre os parâmetros ecocardiográficos, obtidos em modo M. Oito cães adultos foram submetidos a cinco protocolos anesté [...] sicos diferenciando um do outro pela FiO2 fornecida ao paciente. Formaram-se cinco grupos denominados G100 (FiO2=1), G80 (FiO2=0,8), G60 (FiO2=0,6), G40 (FiO2=0,4) e G20 (FiO2=0,21). Os animais foram induzidos à anestesia com propofol na dose necessária para intubação e, ato contínuo, iniciou-se a infusão do fármaco. Os cães receberam oxigênio conforme a FiO2 determinada para cada grupo. As primeiras mensurações foram efetuadas antes da administração do fármaco (M0), aos 30 minutos (M30) após o início da infusão do anestésico e a cada 15 minutos (M45, M60, M75 e M90) durante 60 minutos. Para espessura do septo interventricular ao final da sístole (ESIVs) registrada em M60, a média de G100 foi maior do que as obtidas de G60 e G20. Em M30, o espessamento fracional da parede livre do ventrículo esquerdo (ELPVE) de G100 foi menor que de G80, e, em M75, G80 foi maior que G40. Em relação ao índice de volume ventricular esquerdo ao final da sístole (IVVEFs), em M45, G40 foi maior que G80. Conclui-se que as variáveis ecocardiográficas estudadas não são afetadas pelo emprego de diferentes FiO2. Abstract in english The effects of several inspired oxygen fractions (FiO2) on the echocardiographic parameters by M-mode were evaluated in eight adult spontaneously breathing mongrel dogs anesthetized with continuous infusion of propofol. Each animal underwent five anesthesia procedures. In each procedure, the patient [...] was allowed to breath a different FiO2, thereby resulting in five groups, namely: G100 (FiO2 = 1), G80 (FiO2 = 0.8), G60 (FiO2 =0.6), G40 (FiO2 = 0.4), and G20 (FiO2 = 0.21). To induce anesthesia, propofol was given until the animals allowed orotracheal intubation, followed by immediate continuous infusion of propofol. The initial measurement (M0) was performed before any drug administration, the second was recorded 30 minutes after the infusion of propofol (M30), and additional recordings were performed at 15-minute intervals (M45, M60, M75, and M90), during 60 minutes. At M60, for the end-systolic interventricular septum thickness (IVSs), the mean of G100 was greater than G60 and G20. Regarding left ventricular wall fractional thickness (LVWF) at M30, G100 was lower than G80; and at M75, G80 was greater than G40. In relation to left ventricular end-systolic volume index (ESVI), at M45, G40 was greater than G80. In conclusion, different FiO2 does not impair echocardiographic parameters.
P.C.F., Lopes; N., Nunes; M.G., Sousa; D.P., Paula; R., Carareto; C.T.D., Nishimori; P.S.P., Santos; A.A., Camacho.
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.
Hemodialysis catheters are a necessary evil. They provide an immediate and effective lifeline for hemodialysis patients, and their use is steadily increasing. This increasingly important role has lead to the development of many generations of dialysis catheters. Some aspects of novel designs have shown potential to reduce complications, while others provide options for physician insertion preference. The two major biomaterials for catheter construction are currently polyurethane and silicone, while copolymers such as carbothane are becoming more widespread. Catheter coatings such as heparin, antibiotics, and silver ion are designed to minimize thrombosis and infection. Finally, many lumen and tip designs are also available. These new features were designed to address common problems, including maintenance of adequate flow rate and prevention of thrombosis, fibrin sheath, and catheter-related infection. However, reliable data directly comparing these different designs and coatings are currently lacking. This communication reviews current hemodialysis catheters, including materials, design, and advanced features. PMID:19100948
Tal, Michael G; Ni, Nina
Neurological complications frequently affect chronic kidney disease patients. They are important causes of morbidity and mortality. We present a review of neurological complications affecting hemodialysis patients, focusing on classical and new aspects. Neurological complications can be classified as central or peripheral, but they also include other conditions such as muscle and autonomic disorders. Neurological complications in hemodialysis patients are often underdiagnosed and undertreated. Dialysis treatment can modify the clinical pattern and the course of neurological complications, but it may also directly induce some specific, dialysis-related complications. A strict collaboration between nephrologists, neurologists and other specialists can potentially improve prevention and management of these disorders and improve quality of life for hemodialysis patients. PMID:22241633
Rizzo, Maria Antonietta; Frediani, Fabio; Granata, Antonio; Ravasi, Barbara; Cusi, Daniele; Gallieni, Maurizio
Full Text Available "nBackground: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer durations of hemodialysis are possible factors contributing to the reduced need for rHuEPO in these patients. The present study is designed to asses the relationship between the plasma levels of leptin and the reduced EPO need. "nMethods: Fifty eligible hemodialysis patients with hemoglobin levels higher than 11 mg/dl were enrolled in the cross-sectional study. The information on age, sex, hemodialysis duration and the cause of renal dysfunction were extracted from the files. The baseline plasma levels of Leptin and albumin were measured. The patients BMI and the weekly need for rHuEPO were also calculated. "nResults: There was no correlation between the weekly need for rHuEPO and sex, BMI, the cause of renal dysfunction and the plasma levels of albumin and leptin; it, however, was related with age and the duration of dialysis. While age negatively influences the weekly need, the duration of dialysis has a positive effect on the need. "nConclusion: The plasma levels of leptin are not directly correlated with the required amounts of rHuEPO, indicating that leptin is not an effective factor in erythropoiesis. Conversely, older age and shorter hemodialysis durations are accompanied by reduced need for rHuEPO.
Bacteremia in hemodialysis patients with cuffed tunneled catheters is a significant cause of morbidity and mortality. Native arteriovenous fistulas or vascular prostheses are preferred forms of vascular access, but their creation may not always be possible. Catheter-related bacteremia is due primarily to Gram-positive organisms, but Gram-negative infections are of increasing importance. Bacteremia in patients with catheters results from luminal or extraluminal contamination and may be perpetuated by infected fibrin sheaths associated with the catheter. Bacteremic patients require antibiotic therapy and catheter removal. Guide wire catheter exchange is appropriate in stable patients, but catheter removal and later reinsertion of a new catheter is indicated for tunnel infection or frank sepsis. Late diagnosis or ineffective therapy predisposes to vascular and extravascular infectious complications. Catheter-related bacteremia may be minimized with appropriate sterile technique at insertion, meticulous exit site care, and antibiotic lock solutions. Early recognition and treatment minimize morbidity and mortality, but the optimal solution remains the placement of permanent access. PMID:18091368
Sullivan, Robert; Samuel, Vinny; Le, Carol; Khan, Mohammad; Alexandraki, Irene; Cuhaci, Bulent; Nahman, N Stanley
Intradialytic hypotension (IDH) is the most common adverse complication during hemodialysis. Its early prediction and prevention will dramatically improve the quality of life for patients with an end stage renal disease. In a recent study, changes in the normalized envelope of the test statistic of the photoplethysmograpic (PPG) signal were found to predict acute symptomatic IDH. In the present study, the PPG-based predictor is generalized to include a patient-dependent threshold which incorporates on-line information on heart rate variability and heart rate turbulence. From datasets with patients prone and resistant to IDH, the results show that symptomatic IDH could be correctly predicted in 9 out of 14 cases, while 5 out of 24 were falsely predicted. In a subset of the data containing only patients prone to IDH, acute symptomatic IDH could be correctly predicted in 5 out of 5 cases, with one false prediction out of 14. When testing the robustness of the predictor, no significant changes were observed in the test statistic when controlled changes occurred in dialysis fluid temperature, ultrafiltration rate and body position. PMID:25154735
Sandberg, Frida; Bailón, Raquel; Hernando, David; Laguna, Pablo; Martínez, Juan Pablo; Solem, Kristian; Sörnmo, Leif
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.
Medication adherence was assessed in 89 patients on hemodialysis (HD) at the King Abdul Aziz Medical City using an Arabic version of the Morisky Medication Adherence Scale (MASS-8). The results of the study revealed that 31.46% and 40.45% of the participants showed low and medium adherence, respectively, while 28.09% showed high medication adherence. Accordingly, 71.91% of the patients visiting the dialysis unit were considered medication non-adherent. While being of older age (P = 0.012), being married (P = 0.012) increased the level of adherence, being of medium level of education (P = 0.024) decreased adherence levels. On the other hand, gender, presence of a care-giver, number of members in the household and employment status seems to have no effect on the level of medication adherence. These results call upon the practitioners in HD units to develop intervention programs that can increase the level of medication adherence. PMID:24969185
Alkatheri, Abdulmalik M; Alyousif, Sarah M; Alshabanah, Najla; Albekairy, Abdulkareem M; Alharbi, Shemylan; Alhejaili, Fayze F; Alsayyari, Abdullah A; Qandil, Abeer Ma; Qandil, Amjad M
The purpose of this study was to determine the value of preoperative vascular imaging (PVI) in the selection of an arteriovenous fistula (AVF) for hemodialysis with respect to site selection, maturation, patency, and functionality. We retrospectively evaluated 482 AVFs and arteriovenous grafts (AVGs) created in 321 patients who were regularly undergoing hemodialysis at our university's hemodialysis centers. The patients were divided into two groups according to PVI status. The patients in group 1 (n = 260) underwent Doppler ultrasonographic evaluation and venographic studies as well as physical examination before operation. The patients in group 2 (n = 222) underwent only physical examination before operation. Both groups were compared with respect to vascular access type, access maturation rate, and duration of access patency. In group 1, central veins were also evaluated for possible stenosis, and significant asymptomatic stenosis was treated with interventional techniques. The patients in group 1 were significantly older than those in group 2 and had a significantly higher mean number of previous central venous catheterizations and vascular access sites. At the initiation of the study, 234 of the vascular access sites had matured with a success rate of 90% in group 1. In group 2, however, 152 (68.5%) of the vascular access sites had matured. AVGs of the vascular access type were created in 31.5% of patients in group 1 and in 12.6% of patients in group 2. The mean duration of primary patency in group 1 overall (i.e., AVFs and AVGs) was 14.7 +/- 16.8 months, and the 6-month and 12-month patency rates were 72% and 46%, respectively. The mean duration of primary patency in group 2 overall was 11.9 +/- 9.4 months, and the 6-month and 12-month patency rates were 71% and 41%, respectively. Patients in group 1 had a significantly longer mean primary patency time than did those in group 2 (P = 0.024). Sixty-six cases of central vein stenosis were detected during PVI studies and treated interventionally. After those interventions, 38 AVFs and 28 AVGs were created, and all matured sufficiently without exception. As an adjunct to physical examination, PVI evaluations (venography, Doppler ultrasonography) can be used to determine the likelihood of the maturation of vascular access sites and can reveal problems such as central vein stenosis, which can then be treated promptly with percutaneous intervention. In patients with end-stage renal disease, these interventions should lead to a decrease in morbidity and mortality and improved quality of life. PMID:17379478
Karakayali, Feza; Ekici, Yahya; Görür, Sarp K; Arat, Zübeyde; Boyvat, Fatih; Karakayali, Hamdi; Haberal, Mehmet
A sympathetic skin response (SSR) test was performed in diabetic and nondiabetic patients undergoing regular hemodialysis and the results correlated with nerve conduction studies (NCS): sensory conduction velocity (SCV) and motor conduction velocity (MCV). Comparisons were made between diabetic and nondiabetic patients and between cuprophane and polyacrylonitrile membrane dialyzed patients. Six nondiabetic uremic patients (30%) and all diabetic patients had no SSR. Eight nondiabetic uremic patients (40%) had a mildly impaired response. Nondiabetic patients with a normal response were younger (31.1+/-16.4 years) than the patients with abnormal SSR, whether mildly impaired response (58.3+/-20.3 years; p<0.05, Anova) or absent response (65.3+/-13.8 years; p<0.01, Anova). SCV, MCV, and SSR values were reduced (p<0.01) in uremic patients with respect to normal subjects. Severity and frequencies of sensory NCS abnormalities in nondiabetic patients were: normal 20%, mildly impaired 75%, and severely impaired 5%. Severity and frequencies of motor conduction abnormalities were: normal 80%, mildly impaired 20%, severely impaired 0%. The SSR abnormality incidence in patients with a normal NCS was similar to that in patients with either mildly or severely impaired NCS (chi-square test). There was a positive linear correlation between the SSR amplitude and SCV (r = 0.52, p<0.01) and MCV (r = 0.49, p<0.01). The SSR latency was also significantly related to SCV (r = 0.66, p<0.01) and MCV (r = 0.61, p<0.01). A significant negative correlation was found between age and SSR parameters, amplitude (r = -0.56, p<0.01) and latency (r = -0.66, p<0.01). No correlation was found between duration of hemodialysis or Kt/V and SSR. No differences were found in SSR, NCS, or Kt/V values between cuprophane membrane and polyacrylonitrile membrane dialyzed patients (Student's t test). The relationship between NCS and SSR in uremic patients was confirmed. Old age and diabetes mellitus, but not the dialysis membrane used, were confirmed as synergistic factors of neuropathic impairment. It appeared that SSR is more sensitive than NCS in detecting polyneuropathy in uremic patients on hemodialysis. PMID:10224478
Robles, N R; Solis, M; Albarran, L; Esparrago, J F; Roncero, F; Sanchez-Casado, E
Hemodialysis (HD) patients are under recurrent circulatory stress, and hemodialysis has a high mortality rate. The characteristics of plasma proteomes in patients surviving long-term HD remain obscure, as well as the potential biomarkers in predicting prognoses. This study reports the proteome analyses of patient plasma from non-diabetic long-term HD (LHD, dialysis vintage 14.9±4.1 years, n?=?6) and the age/sex/uremic etiology-comparable short-term HD (SHD, dialysis vintage 5.3±2.9 year...
Lin, Yao-ping; Yang, Chih-yu; Liao, Chen-chung; Yu, Wen-chung; Chi, Chin-wen; Lin, Chao-hsiung
Flow cytometric reticulocyte analysis is widely utilized because of its sensitivity, precision, and high throughput of analysis as compared to manual reticulocyte counting. With this automated method reticulocytes can be classified into three groups according to the fluorescence intensity that reflects maturity of reticulocytes. In this study, changes in red cell parameters, reticulocyte percentage, absolute reticulocyte count, and reticulocyte maturity index were evaluated 13 hemodialysis patients with renal anemia after single administration of recombinant human erythropoietin. The reticulocyte count and reticulocyte maturity index were elevated significantly (P reticulocyte maturity index could be an early indicator of the effect of erythropoietin in hemodialysis patients. PMID:9343995
Han, Y S; Kishimoto, T
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.
Circulating monocytes of patients undergoing chronic hemodialysis are triggered to produce interleukin-1 (IL-1) in vivo. Intradialytic induction of IL-1 is associated with complement activation in patients dialyzed with first-use cellulose membranes. Chronic stimulation of IL-1 production occurs because of an yet unidentified mechanism in patients dialyzed with high permeability membranes. The present study demonstrates that intact bacterial lipopolysaccharide (LPS) molecules may cross cuprophan, AN69 and polysulfone membranes under in vitro conditions simulating in vivo hemodialysis. The experiments used purified LPS from Neisseria meningitidis and LPS from Pseudomonas testosteroni, a bacterial strain grown out from a clinically used dialysate. LPS were purified to homogeneity and radiolabeled. Transmembrane passage of 3H-labeled LPS was observed within the first five minutes of dialysis. A total of 0.1 to 1% of 3H-labeled LPS were recovered in the dialysate compartment after one hour of dialysis. High amounts of LPS, representing 40 to 70% of the amount originally present in the dialysate, were absorbed onto high permeability membranes. Low amounts of LPS were absorbed onto cuprophan membranes. The amount of LPS absorbed decreased with the concentration of LPS in the dialysate. LPS recovered from the blood compartment exhibited the same molecular weight as that used to contaminate the dialysate. Biochemically detectable transmembrane passage of LPS was not associated with that of material detectable using the limulus amebocyte lysate (LAL) assay. An IL-1-inducing activity was, however, detected in the blood compartment upon dialysis with high permeability membranes, as previously found by others with cuprophan membranes.
Laude-Sharp, M.; Caroff, M.; Simard, L.; Pusineri, C.; Kazatchkine, M.D.; Haeffner-Cavaillon, N. (INSERM U 28, Hopital Broussais, Paris (France))
Full Text Available BACKGROUND: Markers of an acute phase reaction, such as C-reactive protein (CRP or tumor necrosis factor-alpha (TNF-ÃŽÂ± and interleukin (IL-6, are predictive for cardiovascular morbidity and mortality in normal subjects and in chronic renal failure patients. In this study, we aimed to investigate serum TNF-ÃŽÂ±, IL-6, IL-10 and CRP levels in continuous ambulatory peritoneal dialysis (CAPD and hemodialysis (HD patients.
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
Full Text Available A prevalência de desnutrição protéico-energético em pacientes com insuficiência renal crônica submetidos à terapia de hemodiálise é elevada. Dentre os diversos parâmetros disponíveis para a avaliação do estado nutricional, a albumina tem sido o mais comumente utilizado para este fim visto a sua estreita associação com a morbidade e mortalidade nesta população. No entanto, vários fatores como idade, comorbidades, hipervolemia e perdas corpóreas podem influenciar as concentrações séricas de albumina. Além disso, na vigência de inflamação, condição comumente presente neste grupo de pacientes, o metabolismo da albumina pode encontrar-se alterado, influenciando os seus níveis plasmáticos. Sendo assim, esta comunicação tem como objetivo abordar os aspectos gerais da albumina e discutir a sua utilização na avaliação do estado nutricional de pacientes com insuficiência renal crônica submetidos à hemodiálise.The prevalence of protein-energy malnutrition is high in patients with chronic renal failure on long-term hemodialysis therapy. Among several parameters available for the assessment of nutritional status, albumin has been the most commonly used given its strong association with morbidity and mortality in those patients. However, many factors such as age, comorbidities, hypervolemia and body losses, can affect the serum albumin concentration. Furthermore, the albumin metabolism can be altered in the presence of inflammation, a common condition in this group of patients. Thus, this communication aimed to address the general aspects of albumin and discuss its usefulness for assessing nutritional status in chronic renal failure patients undergoing hemodialysis.
Nelma Scheyla José dos Santos
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese O declínio da atividade física no doente renal crônico (DRC) é conhecido pela perda de força muscular ou pela redução progressiva no condicionamento e na funcionalidade.¹ Por conta dessas manifestações, o tratamento do doente renal crônico, além de aumentar a sobrevida, também deve incluir reabilita [...] ção física.² Cada vez mais estudos revelam que a participação da fisioterapia intradialítica é parte significativa dessa reabilitação. O estudo de Corrêa et al., "Efeito do treinamento muscular periférico na capacidade funcional e qualidade de vida nos pacientes em hemodiálise",³ vem, mais uma vez, confirmar que o DRC se beneficia com essa intervenção em sua rotina. Abstract in english The decline in physical activity of patients with chronic kidney disease (CKD) is well known, due to either loss of muscle strength or progressive reduction in conditioning and function.¹ Therefore, treatment of CKD besides increasing survival, should also include physical rehabilitation.² More and [...] more studies have shown that exercise training during hemodialysis plays a significant role in such rehabilitation. Corrêa et al., in their study "Effect of peripheral muscle training on functional capacity and quality of life in patients undergoing hemodialysis",³ have confirmed the benefits of that intervention in the routine of CKD patients.
Raquel Jeanty de, Seixas; Cristiane Mecca, Giacomazzi; Ana Elizabeth Prado Lima, Figueiredo.
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.
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.
Salman Saleh Mohammad
Bone scintigrams from a total of 75 hemodialysis patients using /sup 99m/Tc-methylene-diphosphonate (MDP) were classified into two groups; Group I (56 patients) in which the uptake of the radioactivity appeared to be relatively high in the soft tissue and low in the bone, and Group II (19 patients) in which high uptake in the bone and low uptake in the soft tissue were observed. Patients in Group I were further classified into two subgroups; Group I sub(A) (articular type, 21 patients) which was characterized by relatively high uptake into the joint, and Group I sub(B) (reduction type, 35 patients) where uptake was faint in the whole region of the bone. The classification of patients in Group II was also performed; Group II sub(A) (spinal type, 14 patients) where high spinal uptake was observed, and Group II sub(B) (cranio-facial type, 5 patients) where high uptake into the cranio-facial region was observed. The results were compared with 146 subjects with normal bone scintigram in terms of the ratio of bone to soft tissue uptake (B/S ratio) for the cranial bone, jaw bone, lumbar vertebra and femoral bone, and the ratio of epiphysis to diaphysis uptake (E/D ratio) for the femoral bone. The B/S ratio was low in Group I and high in Group II for the bone studied, and the E/D ratio was markedly high in Group I sub(A). Histobiochemical examination indicated that patients in Group I sub(A) and Group II may have osteomalacia and secondary hyperparathyroidism, respectively. It was considered that the visual classification and semiquantitative study as described here were useful for evaluating the pathological condition of renal osteodystrophy.
Ishibashi, Kazunari; Miyamae, Tatsuya
Dialysis-dependent chronic kidney disease (CKD) is an expanding problem for healthcare systems worldwide. The prevalence of end-stage renal disease (ESRD) has increased by 20% since 2000 and stands at 1699 per million people in the USA. ESRD is associated with an increased risk of cardiovascular comorbidity, increased severity of cardiovascular disease, and an adjusted all-cause mortality rate that is 6.4-7.8-fold higher than the general population. These patients may present electively or emergently for surgery related to, or remote from, the CKD. In any perioperative setting, the patient with hemodialysis-dependent CKD represents a significant clinical challenge, and successful management of these patients requires effective cooperation and communication between nephrology, anesthesia, and surgical staff. The ESRD patient's nephrologist will have the best knowledge of their medical history, comorbidities, and future management goals and may have been the clinician who instigated the referral for the surgery, e.g., for parathyroidectomy, vascular access surgery, nephrectomy or renal transplantation. As such, they are in an ideal position to contribute to, or coordinate, early preoperative medical optimization of the patient and also to provide advice during postoperative recovery and rehabilitation. In this article, we provide an overview of some of the key aspects of managing these patients successfully during the perioperative period. We propose the integration of cardiopulmonary exercise testing and cardiovascular optimization into the care of these high-risk patients and provide an overview of the importance of maintaining microvascular perfusion and the role of viscosity in preserving the capillary perfusion network. PMID:21435000
Trainor, Dominic; Borthwick, Emma; Ferguson, Andrew
Full Text Available A taxa de mortalidade entre os pacientes em hemodiálise (HD é extremamente elevada. A expectativa de vida restante de um paciente ao iniciar HD é apenas cerca de um quarto daquela da população geral com a mesma idade. O esquema convencional de HD, com três sessões semanais de cerca de quatro horas, foi estabelecido de maneira empírica há cerca de quatro décadas e merece ser reavaliado criticamente. Desde a falha do Estudo HEMO em demonstrar benefícios clínicos com o aumento do Kt/V de ureia nos pacientes em esquema convencional de HD, tem havido um crescente interesse pelos esquemas alternativos de HD com o intuito de prover um tratamento associado com uma melhor sobrevida. Dentre os esquemas mais promissores, destacam-se a HD diária de curta duração e a HD noturna prolongada. As limitações econômicas que inibem a aplicação dos conhecimentos emergentes nesta área devem ser vencidas.The mortality rate among patients on hemodialysis (HD is extremely high. Remaining life expectancy for a patient initiating HD is only approximately one quarter of that of the general population at the same age bracket. The conventional HD regimen based on four-hour sessions three times a week was empirically established nearly four decades ago and needs to be revisited. Since the failure of the HEMO Study to demonstrate the clinical benefits of higher urea Kt/V for patients on conventional HD, an increasing interest for alternative HD regimens has emerged aiming at providing a treatment for improving survival rates. Short daily HD and long nocturnal HD stand out as the most promising alternative regimens. Economical obstacles which could hinder the clinical application of emerging knowledge in the field should be overcome.
Jorge Paulo Strogoff de Matos
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.
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%) sexuawork (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)
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.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.
Patients with renal insufficiency who are hemodialyzed 3 times a week either through a cuprophane membrane or through a polyacrylonitrile (PAN) membrane have the same transcortin and cortisol levels as patients with renal insufficiency who are not dialyzed. Moreover, hemodialysis did not influence acutely the latter transcortin levels. PMID:3927790
De Moor, P; Faict, D; Verberckmoes, R
The capacity of charcoal to absorb endogenous and exogenous toxins is well established. It removes substances of higher molecular weight than standard dialysis membranes. The regular use of charcoal hemoperfusion as an adjunct to hemodialysis in chronic uremia is a real prospect capable of improving the patient's clinical and laboratory condition and/or reducing the weekly time of treatment. In line with our previous experience, 5 consenting informed patients on regular dialysis treatment from 9 to 35 months (residual creatinine clearance 0-1.8 ml/min, mean diuresis 350 ml) were treated without interruption for 5-8 months according to a schedule including two combined hemodialysis/hemoperfusion procedures instead of the previous three hemodialysis sessions. Patients were on adequate dialysis and their clinical, metabolic and laboratory conditions were stable. In the hemodialysis/hemoperfusion procedure a cartridge containing 150 g of methacrylate-coated activated charcoal with high biocompatibility was inserted in the dialysis circuit in series with a flat plate or hollow fiber dialyzer. Clinical, laboratory and metabolic conditions remained unchanged in all patients despite the one third reduction in dialysis hours per week. The tolerance of treatment was good: platelets, white cells and fibrinogen were unaffected. The marked reduction in weekly time of treatment led to a more satisfactory personal and social rehabilitation, enabling more patients to be treated with the same facilities. PMID:6804167
Stefoni, S; Feliciangeli, G; Colì, L; Prandini, R; Bonomini, V
Some ?-blockers are efficiently removed from the circulation by hemodialysis ("high dialyzability") whereas others are not ("low dialyzability"). This characteristic may influence the effectiveness of the ?-blockers among patients receiving long-term hemodialysis. To determine whether new use of a high-dialyzability ?-blocker compared with a low-dialyzability ?-blocker associates with a higher rate of mortality in patients older than age 66 years receiving long-term hemodialysis, we conducted a propensity-matched population-based retrospective cohort study using the linked healthcare databases of Ontario, Canada. The high-dialyzability group (n=3294) included patients initiating atenolol, acebutolol, or metoprolol. The low-dialyzability group (n=3294) included patients initiating bisoprolol or propranolol. Initiation of a high- versus low-dialyzability ?-blocker was associated with a higher risk of death in the following 180 days (relative risk, 1.4; 95% confidence interval, 1.1 to 1.8; P<0.01). Supporting this finding, we repeated the primary analysis in a cohort of patients not receiving hemodialysis and found no significant association between dialyzability and the risk of death (relative risk, 1.0; 95% confidence interval, 0.9 to 1.3; P=0.71). ?-Blocker exposure was not randomly allocated in this study, so a causal relationship between dialyzability and mortality cannot be determined. However, our findings should raise awareness of this potentially important drug characteristic and prompt further study. PMID:25359874
Weir, Matthew A; Dixon, Stephanie N; Fleet, Jamie L; Roberts, Matthew A; Hackam, Daniel G; Oliver, Matthew J; Suri, Rita S; Quinn, Robert R; Ozair, Sundus; Beyea, Michael M; Kitchlu, Abhijat; Garg, Amit X
Objective: This study was aimed to investigate the psychological symptoms in the healthcare providers of patients with hemodialysis. Material and Methods: 77 health proffessionals were participated in this study. All subjects were asessed with Maslach Burnout Inventory, Brief Seymptom Inventory, Traumatic Stres Inventory Turkish versions. Results: Burnout, traumatic stres and other psychopathological symptoms were determined in healthcare providers. Doctors and nurses had higher psychopatholo...
Ufuk Sezgin; Tamer Aker, A.; Asl? Ye?il
Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 70% of United States dialysis patients. A decision tree model was constructed to reflect progression from hemodialysis initiation. Patients were classified into one of three vascular access choices: maintain CVC, attempt fistula, or attempt graft. We explicitly modeled probabilities of primary and secondary patency for each access type, with success modified by age, sex, and diabetes. Access-specific mortality was incorporated using preexisting cohort data, including terms for age, sex, and diabetes. Costs were ascertained from the 2010 USRDS report and Medicare for procedure costs. An AV fistula attempt strategy was found to be superior to AV grafts and CVCs in regard to mortality and cost for the majority of patient characteristic combinations, especially younger men without diabetes. Women with diabetes and elderly men with diabetes had similar outcomes, regardless of access type. Overall, the advantages of an AV fistula attempt strategy lessened considerably among older patients, particularly women with diabetes, reflecting the effect of lower AV fistula success rates and lower life expectancy. These results suggest that vascular access-related outcomes may be optimized by considering individual patient characteristics. PMID:25063436
Drew, David A; Lok, Charmaine E; Cohen, Joshua T; Wagner, Martin; Tangri, Navdeep; Weiner, Daniel E
Introduction/objective: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. Methods and materials: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. Results: Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. Discussions and conclusion: Th maneuvers. Discussions and conclusion: The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis
Introduction/objective: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. Methods and materials: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. Results: Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. Discussions and conclusion: The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.
Sofocleous, Constantinos T. E-mail: email@example.com; Schur, Israel; Koh, Elsie; Hinrichs, Clay; Cooper, Stanley G.; Welber, Adam; Brountzos, Elias; Kelekis, Dimitris
Central venous catheterization occupies an important place in the treatment of end stage renal disease pending the creation of an arteriovenous fistula. However, this procedure is not devoid of complications. We report a case of late pneumomediastinum revealed by an acute pulmonary edema in a young patient on hemodialysis, and we discuss its characteristics. PMID:24656891
El Amrani, Mohamed; El Kabbaj, Driss; Benyahia, Mohammed
Full Text Available Hepatitis B has proved to be a major health hazard in hemodialysis patients. In order to investigate the hepatitis B virus (HBV infection profile in the hemodialysis population of Goiânia city - Central Brazil, all dialysis patients (N=282 were studied. The prevalence of any HBV marker (HBsAg, anti-HBs, and anti-HBc was 56.7% (95% CI: 51.1-62.7, ranging from 33.3% to 77.7% depending on dialysis unit. HBV-DNA was detected in 67.6% and 88.2% of the HBsAg-positive serum samples, in 91.3% and 100% of the HBsAg/HBeAg-positive samples, and in 18.2% and 63.6% of the HBsAg/anti-HBe-reactive sera by hybridization and PCR, respectively. The length of time on hemodialysis was significantly associated with HBV seropositivity. Only 10% of the patients reported received hepatitis B vaccination. The findings of a high HBV infection prevalence in this population and the increased risk for HBV infection on long-term hemodialysis suggest the environmental transmission, emphasizing the urgent need to evaluate strategies of control and prevention followed in these units.
TELES Sheila A.
Full Text Available Hypermagnesemia is rarely seen in peritoneal dialysis (PD patients because PD can lower the plasma magnesium (Mg concentration effectively. In this report, a continuous ambulatory peritoneal dialysis (CAPD patient with life-threatening hypermagnesemia treated by hemodialysis (HD is presented. A 52-year-old male patient on PD treatment was admitted to our clinic with complaints of fatigue and muscle weakness. Decrease in deep tendon reflexes (DTR, decrease in muscle strength at bilateral upper and lower extremities, and increased level of magnesium (7.7 mg/dl were detected. Bradycardia, prolongation of the P-R interval, and an increase in Q-T interval were found on the electrocardiography. HD was performed two times. After HD, all the signs and symptoms of the patient improved. HD is a dialysis modality that should be preferred in the treatment of symptomatic patients with hypermagnesemia, because of providing more rapid clearance of Mg.
Objective and importance The use of argatroban during hemodialysis in a patient receiving warfarin is not established. We present a case of heparin-induced thrombocytopenia in a patient on hemodialytic therapy who successfully received argatroban concomitantly to warfarin during renal replacement therapy. Clinical presentation A 46-year-old male patient with autosomal dominant polycystic kidney disease presented with heparin-induced thrombocytopenia (HIT) arised during dialytic procedures. Intervention After the acute episode requiring argatroban and warfarin therapy, the patient continued to receive argatroban during the hemodialytic session concomitantly to warfarin. Conclusion The administration of argatroban in the dialytic circuit of a patient on oral anticoagulant therapy can be considered an effective and safe approach. PMID:24580134
Vianello, Fabrizio; Furian, Lucrezia; Nordio, Maurizio; Treleani, Martina; Fabris, Fabrizio
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.
Full Text Available Tumor markers are widely used for screening certain tumors, however, their use in chronic hemodialysis (HD patients in hemodialysis has been a controversial issue. To determine the reliability of the tumor markers, CA 15-3, CA 19-9, CA 125, Alpha-Fetoprotein and Carcinoem-bryonic antigen (CEA, in chronic HD patients, and the impact of active hepatitis C on the variation of tumor markers values, we studied 30 patients (16 men and 14 women aged from 40 to 78 years old (mean age: 54 ± 5 years, on intermittent hemodialysis (with a mean duration of 10.5 years, and clinically free from neoplastic disease. The control group included 30 healthy volunteers. All subjects were of Greek origin and residents of the Korinthos region. The tumor markers were measured once in the control group and before and afterwards the hemodialysis, in the study group. Alpha fetopro-tein was within normal limits in all the study patients, CA 125 was slightly increased in one (3.3% patient, CA 15-3 levels were twice normal in 4 (13% patients, CA 19-9 levels were twice normal in 5 (16% patients, and CEA levels were twice normal in 4(13% patients. More than half (7/13 of anti HCV positive and all Australian antigen positive patients had abnormal serum levels of CA 15-3 and CA 125 after hemodialysis treatment. We conclude that measurement of some tumor markers such as alfa-fetoprotein may be beneficial in HD patients. However, the elevated levels of other markers including CA 15-3 and CA 125 are not specific for neoplasms and related to active hepatitis C.
Full Text Available Munir Akar Ayub,1 Marcelo Rodrigues Bacci,2 Fernando Luiz Affonso Fonseca,3 Ethel Zimberg Chehter4 1Department of Infectology, 2Department of General Practice, 3Department of Morphology, 4Department of Gastroenterology, Faculdade de Medicina do ABC, Santo André-São Paulo, Brazil Abstract: Hepatitis B is responsible for the development of half of hepatocellular carcinoma cases and is a major cause of hepatic insufficiency. The vaccine against hepatitis B virus does not exhibit the same high efficacy in patients on hemodialysis as it does in immunocompetent individuals. The medical literature recommends vaccination with four doses (40 mg each of the hepatitis B virus vaccine before beginning hemodialysis; however, approximately one-third of hemodialysis patients do not respond to this vaccination schedule. A new serologic test should be performed each year for individuals who respond adequately, whereas a booster dose should be offered to those with antibody titers below 10 mIU/mL. In this study, we followed 83 hemodialysis patients and collected quantitative serologic measurements every 2 months over a 1-year period. We made the measurements 1 month after the vaccination period. We found that 41% of the patients had antibody titers below 10 mIU/mL (nonresponders, 21.7% had antibody titers between 10 mIU/mL and 100 mIU/mL (poor responders, and 37.3% had antibody titers higher than 100 mIU/mL (good responders. Patients with diabetes and/or hypertension exhibited worse response to vaccination. All subjects displayed decreasing antibody titers during the observation period. The group of poorly responsive patients had antibody titers below 10 mIU/mL at the 6-month follow-up period. Keywords: hepatitis B vaccination, chronic kidney disease, hemodialysis
Deranged calcium-phosphate metabolism contributes to the burden of morbidity and mortality in dialysis patients. This study aimed to assess the association of the phosphaturic hormone fibroblast growth factor 23 (FGF23) and soluble Klotho with all-cause mortality. We measured soluble Klotho and FGF23 levels at enrolment and two weeks later in 239 prevalent hemodialysis patients. The primary hypothesis was that low Klotho and high FGF23 are associated with increased mortality. The association between Klotho and atrial fibrillation (AF) at baseline was explored as secondary outcome. AF was defined as presence of paroxysmal, persistent or permanent AF. During a median follow-up of 924 days, 59 (25%) patients died from any cause. Lower Klotho levels were not associated with mortality in a multivariable adjusted analysis when examined either on a continuous scale (HR 1.25 per SD increase, 95% CI 0.84–1.86) or in tertiles, with tertile 1 as the reference category (HR for tertile two 0.65, 95% CI 0.26–1.64; HR for tertile three 2.18, 95% CI 0.91–2.23). Higher Klotho levels were associated with the absence of AF in a muItivariable logistic regression analysis (OR 0.66 per SD increase, 95% CI 0.41–1.00). Higher FGF23 levels were associated with mortality risk in a multivariable adjusted analysis when examined either on a continuous scale (HR 1.45 per SD increase, 95% CI 1.05–1.99) or in tertiles, with the tertile 1 as the reference category (HR for tertile two 1.63, 95% CI 0.64–4.14; HR for tertile three 3.91, 95% CI 1.28–12.20). FGF23 but not Klotho levels are associated with mortality in hemodialysis patients. Klotho may be protective against AF. PMID:24991914
Artunc, Ferruh; Serra, Andreas L.; Breidthardt, Tobias; Twerenbold, Raphael; Peter, Myriam; Mueller, Christian
Full Text Available Objective: Cardiovascular disease is the leading cause of morbidity and mortality in patientsundergoing hemodialysis. Increased arterial stiffness is an independent predictor of cardiovascularmortality in end stage renal disease (ESRD. We hypothesized that the hemodialysis procedure itself,through alterations in electrolytes and blood volume, could contribute to the increased cardiovascular riskencountered in ESRD. Material and methods: 28 chronic hemodialysis patients were evaluated before andafter hemodialysis. We determined serum calcium, arterial stiffness (using pulse wave analysis andhemodynamic parameters. Results: Serum calcium increased significantly during the dialysis treatment(P<0.01. Also, significant increase in stiffness index occurred at the end of dialysis (P=0.02. Bothincrements were correlated with ultrafiltration. No significant changes in systolic blood pressure, diastolicblood pressure or heart rate were noticed during hemodialysis. Arterial stiffness significantly increasedafter hemodialysis, unrelated to hemodynamic parameters. Conclusion: This vascular response may bean explanation for greater vulnerability regarding cardiovascular events in ESRD patients.
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.
Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish 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.
Manuel Conrado, Domínguez Valdés; Mayra, Pacheco García; Bárbara Regla, Montero Torres; Milena, Rodríguez Carrillo; Jorge Félix, Rodríguez Ramos.
The quality of life of adults with chronic renal disease (ESRD) under hemodialysis treatment is compromised due to factors that limit the functionality and performance of occupational roles. According to the Brazilian Nephrology Society, the 2008 dialysis census showed that there are approximately 41,500 users of dialysis treatment and that 89.4% of them are under hemodialysis treatment. Hemodialysis can be classified as a traumatic experience which generates dependency and negative impacts i...
Fernanda Dellê Madalosso; Milton Carlos Mariotti
This study aimed to compare the erythropoietin- independent hemodialysis patients who had hepatitis with those who did not. Hemodialysis patients with or without hepatitis who were able to maintain nearly normal hemoglobin levels of 12 g/dL or over, without the administration of recombinant human erythropoietin for at least one year were analyzed retrospectively. Forty-three of the 534 hepatitis-negative hemodialysis patients (8%) and 20 (8 with HbsAg, 12 with HCV) of the ...
Introduction: Malnutrition is a common problem in maintenance hemodialysis patients and isassociated with increased mortality and morbidity. This study was carried out to determine the effectsof dialysis frequency on nutritional markers hemodialysis patients in Kashan(Iran).Materials and Methods: This before and after clinical trials was carried out on 18 hemodialysispatients (12 female, 6 male). In this study, the standard hemodialysis regime of patients, which it was3times per week and 4 ho...
Ali Akbar Rashidi; Ali Reza Soleimani; Fariba Seyedi
Overall and cardiovascular mortality are significantly higher in hemodialysis patients with elevated C-reactive protein (CRP). The aim of study was to determine whether CRP, low albumin and troponin are markers of overall and cardiovascular mortality in hemodialysis patients. 138 stable hemodialysis patients were divided into 2 groups n= 66 patients with coronary disease equivalent (known coronary or peripheral vascular disease or diabetes mellitus) and n= 72 patients without it. The two grou...
Bagheri Nazila; Taziki Omolbanin; Falaknazi Kianoosh
Background and Aims: Hepatitis E virus (HEV) is mainly the causative agent of waterborne epidemics, but some authors have found that patients on chronic hemodialysis have an increased risk of exposure to HEV. We conducted this study to reveal HEV seroprevalence in hemodialysis patients as a specific group in Iran, and to evaluate age, duration of hemodialysis, and the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in them..Methods: The presence of immunoglobulin...
Morteza Pourahmad; Abdol Reza Sotoodeh; Hamid Nasiri
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 ...
Pupim, Lara B.; Flakoll, Paul J.; Brouillette, John R.; Levenhagen, Deanna K.; Hakim, Raymond M.; Ikizler, T. Alp
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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. Abstract in english 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 di [...] sease. 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.
Cláudia Régia Dias de, Souza; Silvana Amado, Libério; Rosane Nassar Meireles, Guerra; Silvio, Monteiro; Éricka Janine Dantas da, Silveira; Antonio Luiz Amaral, Pereira.
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.
Cláudia Régia Dias de Souza
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.
Background and objectives: The severity of liver disease among hepatitis C patients on hemodialysis is controversial. The aim of this study was to compare the clinical, biochemical, and liver histologic characteristics of hepatitis C virus (HCV) in hemodialysis patients and in those with normal renal function. Design, setting, participants, & measurements: A case-control study was carried out with 36 HCV patients on hemodialysis and 37 HCV patients with normal renal function matched for gender, age at infection, and estimated time of infection. Results: HCV patients on hemodialysis had lower levels of alanina aminotransferase and lower viral load. Hepatic fibrosis was significantly higher in the patients with normal renal function (73%) than in hemodialysis patients (47.2%, P < 0.025); the same was observed for inflammatory activity (control group 59.5% versus hemodialysis patients 27.7%, P = 0.003). In addition, the risk of tissue inflammation was four times lower in hemodialysis patients (odds ratio = 0.23, P < 0.004), and severe inflammatory activity on biopsy was the only independent risk factor for fibrosis (P < 0.001). Conclusions: The lower biochemical and inflammatory activities observed in hemodialysis patients suggest that hemodialysis and uremia may have a protective role against progression of the disease caused by HCV. PMID:18650408
Trevizoli, Jose Eduardo; de Paula Menezes, Raissa; Ribeiro Velasco, Lara Franciele; Amorim, Regina; de Carvalho, Mauro Birche; Mendes, Liliana Sampaio; Neto, Columbano Junqueira; de Deus Macedo, José Roberto; de Assis, Francisco; Neves, Rocha
The aim of our study was to evaluate the changes of hemodialysis (HD) service and main demographic characteristics of HD patients in Lithuania during seven years period. From 1996 to 2003 we visited annually all HD centers in Lithuania and collected data about all HD patients. There was a sharp increase in the number of HD centers (from 17 to 37), HD stations (from 25 p. m. p. (per million population) to 87 p.m.p.; p<0.001), HD patients (from 60 p.m.p. to 264 p.m.p.; p<0.001) and incidence of new HD patients (from 54.3 p.m.p. to 92 p.m.p.; p<0.01). In 1996 all 17 HD centers in Lithuania were public. Private HD centers appeared in 1998 and reached 43.2% of all HD centers (n=16) in 2003. 44.8% of HD patients were dialyzed in private HD centers. The mean age of HD patients increased from 47.2+/-16.1 years in 1996 to 57.5+/-14.9 years in 2003 (p<0.001). HD population became older. The percentage of patients over 60 years old increased from 22.8% to 49.7% (p<0.001) and over 70 years old--from 54% to 21.9% (p<0.001). The main underlying disease of end-stage renal disease was chronic glomerulonephritis but its rate had decreased from 54.5% in 1996 to 26.5% in 2003 (p<0.001). During this period there was a statistically significant increase in the incidence of end-stage renal disease due to diabetics (from 7.1% to 18.0%; p<0.01), hypertensive nephropathy (from 3.1% to 9.4%; p<0.05), and chronic pyelonephritis (from 11.2% to 18.6%; p<0.01). In summary during the last seven years HD service in Lithuania expanded significantly, and rapid development of private HD was observed. The number of HD patients was rising continuously with predominance of diabetic, hypertensive and elderly patients. PMID:15901973
Ziginskiene, Edita; Kuzminskis, Vytautas; Stankuviene, Asta; Santockiene, Lina; Kybartiene, Sondra; Labutiene, Vilma; Makaraite, Alanta; Vainauskas, Vaclovas; Macius, Kazimieras; Sakalauskiene, Marija; Sirevicius, Virgilijus; Urbanaviciene, J?rate
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.
Full Text Available SciELO Public Health | Language: English Abstract in english 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
Julio, Valdivia; Carlos, Gutiérrez; Janete, Treto; Ernesto, Delgado; Daymiris, Méndez; Irma, Fernández; Anselmo, Abdo; Lourdes, Pérez; Mabel, Forte; Yanisbell, Rodríguez.
We evaluated the feasibility of MR angiography for hemodialysis fistula. Eleven patients with suspected stenosis or occlusion of an autogenous hemodialysis fistula in the forearm underwent MRA. MRA was obtained using both the 3D-PC method and 3D gadolinium contrast-enhanced (CE) method with a knee coil. The two methods were compared with DSA in seven patients. CE-MRA clearly demonstrated the entire dialysis fistula. However, signals of the stenotic area are effaced in PC-MRA. The diameter of the vessels evaluated in the CE-MRA was well correlated with angiography. CE-MRA demonstrated smaller collateral vessels more clearly than PC-MRA. CE-MRA provided useful information before the PTA procedure. (author)
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
Schiffl, H; Lang, S M
Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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.
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.
Full Text Available Objective: to investigate the incidence of infection related to the use of temporary double lumen Catheter (TDLC in chronic renal disease undergoing hemodialysis. Methodology: this is about a descriptive exploratory study, from quantitative, performed in a clinic of nephrology of Natal/RN after approval by the ethics committee (protocol number 67/2008, April-June 2008, with data collected through a semi-structured form. The data were categorized and processed through Microsoft Excel XP. Results: 47 patients participated in the study, 70.21% male, 40.42% in the age group 60 to 79 years, married (61.70%, primary school (38.30%. The main co-morbidity was associated with hypertension (31.91%. As for the local (51.06% catheters were implanted in the right jugular vein, mainly by loss of arteriovenous fistula (ACF (46.81%, followed by 44.68% who needed treatment immediately. As for the signs of infection were present in 38.30% patients, always a cause for withdrawal of the catheter. The maximum time of use was 120 days, but prevailed in the range 1 to 20 days with (40.43%. Conclusion: it was observed that the more permanent catheters increases the incidence of infection. Thus, the relevance of the educational activities of nurses, to patients with kidney, stimulating self-care, preventing and detecting early infection.
Analucia Filgueira Gouveia Barreto
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.
Patients with end stage renal diseases (ESRD) on hemodialysis (HD) have high morbidity and mortality due to multiple causes, one of which is dramatically higher fall rates than the general population. The mobility mechanisms that contribute to falls in this population must be understood if adequate interventions for fall prevention are to be achieved. This study utilizes emerging non-invasive, portable gait, posture, strength, and stability assessment technologies to extract various mobility parameters that research has shown to be predictive of fall risk in the general population. As part of an ongoing human subjects study, mobility measures such as postural and locomotion profiles were obtained from five (5) ESRD patients und