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Effects of oxymatrine on microinflammatory state in patients undergoing continuous hemodialysis: a randomized controlled trial  

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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,...

Zhou, Wen-xiang; Zheng, Wen-bin

2009-01-01

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

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

S Mohammad Alizadeh

2013-01-01

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Effects of oxymatrine on microinflammatory state in patients undergoing continuous hemodialysis: a randomized controlled trial  

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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.

Wen-xiang ZHOU

2009-08-01

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Valvular heart disease in patients undergoing chronic hemodialysis  

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

Loncar Daniela

2013-02-01

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Periodontal status in patients undergoing hemodialysis  

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

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

2012-01-01

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Ototoxicity Probably Due To Isoniazid in a Patient Undergoing Hemodialysis  

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

Deniz YERDELEN

2008-03-01

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

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Full Text Available SciELO Brazil | Language: English Abstract in english OBJECTIVE: The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis. PATIENTS AND METHODS: Twenty patients on p [...] eritoneal 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; Edmundo Pessoa de Almeida, Lopes; Maria Alina Gomes de Mattos, Cavalcante; Tiago Costa, Pinto; Izolda Fernades, Moura; Luiz, Loureiro Júnior.

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

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

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

2014-03-01

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Design and Construct an Optical Device to Determine Relative Blood Volume in Patients Undergoing Hemodialysis  

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Background: Occurrence of hypotension during hemodialysis in nearly 20-30% of patients, shows is the necessity of continuous monitoring the patients' blood pressure during hemodialysis. Since directly and non-invasively continuous blood pressure monitoring, is not easy, finding a parameter related to blood pressure, for indirect monitoring is of great value. Related blood volume (RBV) is one of the parameters, related to blood pressure and have a good potential to reflect the patient’s hemodynamic condition. Objectives: The main objective of this study was to design and construct an optical device to determine the RBV in patients undergoing hemodialysis, during the process. Materials and Methods: After initial studies in order to select a proper sensor, using the ORCAD software, an analog circuit was designed. The implementation and modification of the circuit was done by the clinical tests, using expired blood. Afterwards, for calculation the RBV, controlling the display, data storage and sending it to the computer, an ATmega16 microcontroller was used. For programing the microcontroller, CodeVision software and then Altium Designer software were used for the circuit compression, in order to design the printed circuit board. Finally, all parts of the analog and digital circuit, AC to DC converter and the LCD were embedded in a box. Results: After finalization of the device and before testing it in a real situation, expired blood was used for final evaluation. The evaluation was done by changing the blood concentration, at the start point by adding water to it. In fact, the device can track the changes in blood concentration and display the RBV. After this evaluation, the device was tested in a clinical situation. The results showed there are no interactions between this device and the other devices used in the dialysis section and it can work properly in order to measure the RBV. Conclusions: Considering the hypotension and its consequences in a patient on hemodialysis, solving this problem seems necessary. One method for preventing this, is to use the blood pressure related parameters and one of these parameters is the RBV. In this study, in order to measure the RBV, a device was designed and evaluated by expired blood and also tested in a clinical situation. Results showed that the device could work properly in order to measure the RBV. PMID:24910804

Dormanesh, Banafshe; Tofangchiha, Shahnaz; Abouei, Vahid; Sharifian, Hani

2014-01-01

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P-wave and QRS complex measurements in patients undergoing hemodialysis.  

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Hemodialysis (HD) has been associated with an increase in the amplitude of QRS complexes. Experience in a single patient with multiple measurements has shown that HD leads also to augmentation of P-wave amplitude. The objective of this investigation was to evaluate electrocardiogram (ECG) changes with HD in a cohort of patients undergoing this procedure with particular emphasis on the P-wave and QRS complex changes. The sum of amplitudes of P waves (OP) and QRS complexes (OQRS) in millimeters in the 12 leads of the ECG, along with a host of other ECG parameters, body weight, blood pressure, heart rate, electrolytes, and hemoglobin/hematocrit were measured before and immediately after HD in 47 patients. Hemodialysis resulted in a loss of a mean of 3 kg of weight and an increase in the SigmaP, SigmaQRS, mean QRS duration, maximum P-wave duration, and P-wave duration measured in lead II, whereas the changes in mean P-wave and corrected QT interval durations were not statistically significant. Percentage change (Delta%) in SigmaP and SigmaQRS correlated poorly with Delta% in electrolytes, hematocrit, blood pressure, heart rate, and weight. Values for SigmaP and SigmaQRS vs weight were r = 0.105, P = .48 and r = 0.09, P = .51, respectively. The Delta% in SigmaP correlated well with Delta% in SigmaQRS (r = 0.42, P = .003). Alterations in P-wave amplitudes and duration commensurate with the ones affecting the corresponding QRS complexes occur in patients undergoing HD and indicate that evaluation of measurements in serial ECGs should take this into account. The mechanisms of these phenomena continue to be elusive, and whether they represent cardiac and/or extracardiac influences has not as yet been unraveled. PMID:17027839

Drighil, Abbdenasser; Madias, John E; Yazidi, Asma; Bennani, Mohammed; Bennis, Ahmed; Ramdan, Beenyouness; Tahiri, Azzeddine

2008-01-01

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Noninvasive continuous monitoring of digital pulse waves during hemodialysis  

DEFF Research Database (Denmark)

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

Burkert, Antje; Scholze, Alexandra

2009-01-01

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Understanding of advance care planning by family members of persons undergoing hemodialysis.  

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The purpose of this qualitative descriptive study was to explore hemodialysis patients' family members' understanding of end-of-life decision-making processes. The project aimed to address (a) family members' constructions of advance care planning (ACP), including their roles and responsibilities, and (b) family members' perceptions of health care providers' roles and responsibilities in ACP. Eighteen family members of persons undergoing hemodialysis were recruited primarily from outpatient dialysis facilities and interviewed individually. Confirmed transcript data were analyzed, coded, and compared, and categories were established. Interpretations were validated throughout the interviews and peer debriefing sessions were used at a later stage in the analysis. The overarching construct identified was one of Protection. Family members protect patients by (a) Sharing Burdens, (b) Normalizing Life, and (c) Personalizing Care. Recommendations for future research include the need to explore ACP of persons undergoing hemodialysis who do not have a family support system. PMID:24326309

Calvin, Amy O; Engebretson, Joan C; Sardual, S Alexander

2014-11-01

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

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

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Interstitial irradiation for carcinoma of tongue complicated by chronic renal failure undergoing hemodialysis--a case report.  

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There has been some controversy concerning dose-time correction in continuous irradiation at low dose rates. We present the results of carcinoma of the tongue in a patient complicated by chronic renal failure, for which he was undergoing hemodialysis three times a week. This patient was treated with a single implant but with a doubling of 137Cs needles for double strength. The actual dose was given in a shorter treatment time than recommended, with the dose-time adjustment following the Paterson-Parker system. The patient has been alive and well for eight years. PMID:2608921

Hareyama, M; Saito, A; Nishio, M; Kagami, Y; Oouchi, A; Narimatsu, N; Sakurai, T; Morita, K

1989-01-01

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

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

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

2012-04-01

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SEN Virus Infection in Egyptian Patients With Chronic Hepatitis C and Patients Undergoing Hemodialysis  

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The SEN virus has been tentatively linked to transfusion-associated non-A to E hepatitis. The aim of the present study was to 1) determine the prevalence of SEN virus among Egyptian patients with hepatitis C virus (HCV)-related chronic liver disease and patients undergoing hemodialysis and 2) demonstrate the clinical effect of SEN virus infection on coexistent hepatitis C in terms of severity and probability of developing hepatocellular carcinoma. Polymerase chain reaction was used to detect SEN virus-D and SEN virus-H DNA in serum samples of 74 patients with HCV-related chronic liver disease, 45 uremic patients undergoing maintenance hemodialysis, and 28 healthy controls. SEN virus-D/H DNA was detected in 13.5% of patients with chronic liver disease, 11.1% of patients undergoing hemodialysis, and 7.1% of healthy controls, with no significant differences between patients and the control group. Clinical and biochemical measures did not significantly differ between SEN virus-infected and noninfected patients in the chronic liver disease group or the hemodialysis group. The rate of SEN virus infection was significantly higher in patients with chronic liver disease and hepatocellular carcinoma (33.3%) than in those with chronic liver disease only (8.5%) (P < .05). In conclusion, SEN virus does not seem to be a common infection in Egyptian patients. It has no apparent influence on the severity of coexistent HCV-related chronic liver disease but could be a risk factor for hepatocellular carcinoma in such patients. Further studies are needed to define the etiopathogenic role of SEN virus infection in the development of hepatocellular carcinoma. PMID:19242596

Omar, Maisa; El-Din, Samah Saad; Fam, Nevine; Diab, Manal; Shemis, Mohamed; Raafat, Manar; Seyam, Moataz; Hssan, Moataz; Badawy, Afkar; Akl, Maha; Saber, Mohamed

2008-01-01

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Pharmacokinetics of piperacillin in patients with moderate renal failure and in patients undergoing hemodialysis.  

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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.

1981-01-01

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

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

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

2014-05-01

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

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

Dimkovi? Nada

2006-01-01

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

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

El-Nakib GA

2013-08-01

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

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

Rias Pratiwi Safitri

2013-05-01

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Iodine toxicity treated with hemodialysis and continuous venovenous hemodiafiltration.  

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Continuous mediastinal irrigation with povidone-iodine is used commonly for treating severe postoperative mediastinitis. However, concurrent iodine toxicity has been reported, particularly in patients with renal dysfunction (likely because absorbed iodine is renally excreted). The authors were consulted on a 45-year-old patient with mediastinitis who had renal and hepatic dysfunction while being treated with mediastinal irrigation of povidone-iodine. The povidone-iodine irrigation was discontinued because he had toxic plasma iodine levels. Despite this, his condition worsened, and the iodine levels remained elevated. Thus, hemodialysis (HD) was initiated using high-flux membranes followed by continuous venovenous hemodiafiltration (CVVHDF; 2 L/h of hemofiltration and 2 L/h of HD). Plasma and effluent iodine levels were measured repeatedly to determine iodine clearance by these 2 modalities (HD, 120 mL/min; CVVHDF, 37 mL and 44 mL/min on days 1 and 2, respectively). Hepatic and renal functions improved with decreasing plasma iodine levels. Based on this experience and after reviewing the literature the authors conclude that: (1) iodine irrigation can increase blood iodine levels significantly, especially in the setting of renal failure, and lead to increased morbidity and mortality; (2) plasma iodine levels should be monitored in patients with renal insufficiency; and (3) HD and CVVHDF are effective at clearing iodine. The authors suggest that patients that are at high risk or already developing signs of iodine toxicity should have the iodine irrigation discontinued and may benefit from renal replacement therapy (RRT). Alternatively, concomitant RRT during iodine irrigation may be attempted to maintain the systemic iodine levels at nontoxic levels. PMID:12612997

Kanakiriya, Sharan; De Chazal, Ives; Nath, Karl A; Haugen, Eric N; Albright, Robert C; Juncos, Luis A

2003-03-01

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

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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.

Conzo Giovanni

2012-12-01

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Different response to human recombinant erythropoietin in patients undergoing hemodialysis treatment  

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Introduction. Treatment with recombinant human erythropoietin enabled the correction of anemia in the patients on regular hemodialysis but large individual differences in the dose required to achieve the target hemoglobin level were observed. In this study the erythropoietin resistance index was calculated in patients on hemodialysis in order to examine variations in the response to erythropoietin and factors that influence it. Material and Methods. The study included 48 patients (25 ma...

Petkovi? Nenad; Risti? Siniša; Stošovi? Milan; ?ukanovi? Ljubica

2013-01-01

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Use of a polysulfone hemodialysis membrane may prevent recurrent posterior reversible encephalopathy syndrome in a patient undergoing hemodialysis.  

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A 71-year-old woman underwent hemodialysis (HD) treatment for chronic kidney disease. During HD, she developed headache, abnormalities in visual perception, and generalized convulsion. Brain magnetic resonance imaging (MRI) showed T2-hyperintensity lesions in the posterior lobe, and an electroencephalogram showed slow waves in all areas. Twenty days later, the T2-hyperintensity lesions had vanished. Furthermore, perfusion computed tomography (CT) and single-photon emission CT with N-isopropyl[(123)I]-p-iodoamphetamine (IMP-SPECT) showed no significant abnormalities. The patient was diagnosed with posterior reversible encephalopathy syndrome (PRES) because she displayed typical clinical symptoms and MRI findings. Although several antihypertensive and antiseizure medications were administered, the patient experienced recurrent PRES. Therefore, we used a polysulfone dialyzer to reduce the oxidative stress and inflammation while preserving vascular endothelial function. After use of a polysulfone dialyzer membrane, the patient had no PRES episodes during the clinical course. This is the first study to demonstrate that use of a polysulfone dialyzer membrane instead of a cellulose membrane may prevent recurrent PRES. PMID:23568662

Mima, Akira; Matsubara, Takeshi; Endo, Shuichiro; Murakami, Taichi; Hashimoto, Yasuki

2014-01-01

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Oxidative stress and enzyme activity in ambulatory renal patients undergoing continuous peritoneal dialysis.  

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Some parameters indicating the possibility of oxidative stress in chronic renal failure patients (CRF) undergoing continuous ambulatory peritoneal dialysis (CAPD), are presented in this study. Oxidative stress appears to be lower than in hemodialysis patients. In a group of CRF patients and in a control group malondialdehyde (MDA) was determined as an indicator of red-blood-cell membrane lipid peroxidation. Also, the three glutathione forms, total (GST), oxidated (GSSG) and reduced (GSH) and the levels of glutathione peroxidase (GPX), the levels of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) have been measured. Significantly higher MDA values (p < .05) have been found in CRF patients when compared to controls. The three forms of glutathione and GPX are also significantly decreased in the CRF group (p < .05 and p < .001, respectively). The levels of SOD and CAT are increased with respect to the control group (p < .001). PMID:9509565

Martin-Mateo, M C; del Canto-Jafiez, E; Barrero-Martinez, M J

1998-01-01

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Different response to human recombinant erythropoietin in patients undergoing hemodialysis treatment  

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Full Text Available Introduction. Treatment with recombinant human erythropoietin enabled the correction of anemia in the patients on regular hemodialysis but large individual differences in the dose required to achieve the target hemoglobin level were observed. In this study the erythropoietin resistance index was calculated in patients on hemodialysis in order to examine variations in the response to erythropoietin and factors that influence it. Material and Methods. The study included 48 patients (25 males of mean age 67.5 years, who had been on regular hemodialysis in Šamac for 43.9 months on average. All were treated with erythropoietin from the beginning of hemodialysis treatment. Their response to erythropoietin therapy was estimated by the erythropoietin resistance index. Results. The use of erythropoietin enabled the correction of anemia but different doses were needed to achieve and maintain the target hemoglobin level. The individual weekly dose of erythropoietin ranged from 15 U/kg/week to 244 U/kg/week and the erythropoietin resistance index ranged from 0.13 U/kg/week/g/l to 2.46 U/kg/week/g/l. A satisfactory erythropoietin response with erythropoietin resistance index below 0.5 U/kg/week/g/l was found in 14 (30% patients, while 19 (40% patients had this index above 0.7 U/kg/week/g/l and 10 (21% above 0.9 U/kg/week/g/l. Multivariate linear regression analysis detected C-reactive protein as a significant predictor of erythropoietin resistance index. Conclusion. Target hemoglobin levels were achieved and maintained by different doses of erythropoietin in individual patients, which resulted in great individual differences in response as estimated by the erythropoietin resistance index. Multivariate analysis indicated C-reactive protein as a variable significantly associated with this index.

Petkovi? Nenad

2013-01-01

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

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Introduction. Hypertension is evident in 80%-85% of patients with chronic renal failure and antihypertensive therapy is needed in 25%-30% of patients. Apart from antihypertensive effect, ACEi’s decrease the left ventricular hypertrophy and mortality in dialysis patients. Even so, their use is limited due to hyperkalemia. Objective. The objective of the study was to compare the effect of fosinopril and enalapril on serum potassium level in hypertensive hemodialysis patients. Method. Prospect...

Dimkovi? Nada; ?or?evi? Tanja; Popovi? Jovan; Dimkovi? Siniša; Tirmenštajn-Jankovi? Biserka; Živanovi? Milenko; Žiki? Svetlana; Bobanovi?-Haskovi? Jasminka

2006-01-01

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

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To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3+-7.5) chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 C) temperature dialysis solution. During the study, all the dialysis conditions were maintained the same except cooling the dailysate from 37C to 35C. Hemodynamic parameters including SBP, DBP and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic and mean arterial pressure decreased significantly during standard compared to cool dialysis. Maximum decrease of systolic, diastolic and mean arterial pressure was observed during the third hour of dialysis and magnitude of decrease was 18, 17 and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialysis levels decreased significantly with cool and standard temperature dialysate (59+-5 vs. 37+-4, and 63+-7 vs. 41+-5, umol/L respectively, P<0.01). Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than increased serum nitric oxide levels may be involved in hemodialysis hypotension in this group of patients. (author)

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

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Full Text Available To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3 ± 7.5 chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 o C temperature dialysate solution. During the study, all the dialysis conditions were maintained the same except coo-ling the dialysate from 37 o C to 35°C. Hemodynamic parameters including SBP, DBP, and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic, and mean arterial pressure decreased significantly during standard temperature compared to cool dialysis. Maximum decrease of systolic, diastolic, and mean arterial pressure was observed during the third hour of dia-lysis and the magnitude of decrease was 18, 17, and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialy-sis levels decreased significantly with cool and standard temperature dialysate (59 ± 5 vs. 37 ± 4, and 63 ± 7 vs. 41 ± 5, µmol/L respectively, P< 0.01. Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than in-creased serum nitric oxide levels may be involved in hemodialysis hypotension in this group of patients.

Ghasemi Asghar

2008-01-01

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

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

Mehrdad Sheikhvatan

2010-05-01

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

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

Marcus Machado Ramos Souza de Souza

2012-02-01

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

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

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

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

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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

2012-10-01

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Efficacy of Sapheno-Femoral A-V Fistula in Cronic Renal Failure Patients Undergoing Hemodialysis  

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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

M Safaie

2005-04-01

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

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

Sasajima Koji

2008-11-01

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Fatigue Is a Predictor for Cardiovascular Outcomes in Patients Undergoing Hemodialysis  

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Background and objectives: Despite potential significance of fatigue and its underlying components in the occurrence of cardiovascular diseases, epidemiologic data showing the link are virtually limited. This study was designed to examine whether fatigue symptoms or fatigue's underlying components are a predictor for cardiovascular diseases in high-risk subjects with ESRD. Design, setting, participants, & measurements: 788 volunteer patients under hemodialysis therapy (506 male, 282 female) completed the survey between October and November 2005, with the follow-up period up to 26 months to monitor occurrence of fatal or nonfatal cardiovascular events. The questionnaire consisted of 64 questions, and promax rotation analysis of the principal component method conceptualized eight fatigue-related factors: fatigue itself, anxiety and depression, loss of attention and memory, pain, overwork, autonomic imbalance, sleep problems, and infection. Results: 14.7% of the patients showed fatigue scores higher than twice the SD of the mean for healthy volunteers. These highly fatigued patients exhibited a significantly higher risk for cardiovascular events (hazard ratio: 2.17; P < 0.01), with the relationship independent of the well-known risk factors, including age, diabetes, cardiovascular disease history, and inflammation and malnutrition markers. Moreover, comparisons of the risk in key subgroups showed that the risk of high fatigue score for cardiovascular events was more prominent in well-nourished patients, including lower age, absence of past cardiovascular diseases, higher serum albumin, and high non-HDL cholesterol. Conclusions: Fatigue can be an important predictor for cardiovascular events in patients with ESRD, with the relationship independent of the nutritional or inflammatory status. PMID:20185601

Fukuda, Sanae; Shoji, Tetsuo; Inaba, Masaaki; Tsujimoto, Yoshihiro; Tabata, Tsutomu; Okuno, Senji; Yamakawa, Tomoyuki; Okada, Shigeki; Okamura, Mikio; Kuratsune, Hirohiko; Fujii, Hisako; Hirayama, Yoshinobu; Watanabe, Yasuyoshi; Nishizawa, Yoshiki

2010-01-01

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

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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.

2013-03-01

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

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

ZHU Fusheng

2013-02-01

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Infection by the hepatitis C virus in chronic renal failure patients undergoing hemodialysis in Mato Grosso state, central Brazil: a cohort study  

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Full Text Available Abstract Background Hepatitis C virus (HCV is a significant problem for patients undergoing hemodialysis therapy. This situation has never been studied in Mato Grosso state, central Brazil. This study was conducted aiming to estimate the prevalence of the anti-HCV and the incidence of seroconversion in the main metropolitan region of the state. Methods 433 patients from the six hemodialysis units were interviewed and anti-HCV was tested by a third-generation enzyme immunoassay. An open cohort of patients who tested negative for anti-HCV at the entry of the study was created and seroconversions was assessed monthly. The staff responsible for the units were interviewed to assess whether the infection control measures were being followed. Logistic and Cox regression analysis were performed in order to assess risk factor to HCV. Results The entry on the study took place between January 2002 and June 2005. 73 out of 433 (16.9%, CI95%: 13.3–20.8 was found to be anti-HCV reactive. The multivariate analysis indicated as risk factors associated to anti-HCV the duration of the hemodialysis treatment, the number of transfusions received, and the unit of treatment. An open cohort of 360 patients who tested negative for anti-HCV was created, with a following average of 24 (± 15 months. Forty seroconversions were recorded corresponding to an incidence density of 4.6/1000 patient-months, ranges 0 to 30 among the units. Cox regression indicated the time of hemodialysis (RR = 2.2; CI95%: 1.1–4.6; p Conclusion The study demonstrated high prevalence and incidence of anti-HCV in some of the hemodialysis units. Time on hemodialysis therapy was an independent factor associated to HCV. Blood transfusion was associated with anti-HCV in initial survey but was not important in incident cases. Failure of applying control meaures was more evident in units with the highest HCV prevalence and incidence. The results suggest that nosocomial transmission was the main spread factor of HCV in the studied population.

Santos Marcelo AM

2007-03-01

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

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

Mohammad Rahimian

2006-01-01

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Successful chemotherapy for small-cell lung cancer in an elderly patient undergoing continuous ambulatory peritoneal dialysis.  

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A standard treatment has not yet been established for elderly small-cell lung cancer patients, especially when they have end-stage renal disease. We report the first case of successful chemoradiotherapy in an elderly small-cell lung cancer patient undergoing continuous ambulatory peritoneal dialysis. A 77-year-old Japanese man on continuous ambulatory peritoneal dialysis was diagnosed as having limited disease small-cell lung cancer. He received four monthly cycles of chemotherapy consisting of carboplatin at 240 mg/m(2) on day 1 and etoposide at 40 mg/m(2) on days 1 and 3. He underwent additional hemodialysis on days 1 and 3, while continuous ambulatory peritoneal dialysis continued as usual on the other days. Following chemotherapy, he underwent hyperfractionated radiotherapy to a total dose of 45 Grey, resulting in complete remission of the disease. A pharmacokinetic study showed an area under the concentration-time curve of carboplatin of 3.41 to 4.88 mg.min/mL, increasing gradually over the first three cycles, while etoposide did not show this gradual increase. The increased area under the concentration-time curve of carboplatin may have reflected a worsened renal function during chemotherapy. Despite dose reductions and favorable areas under the concentration-ime curve of carboplatin, the patient suffered grade 3-4 hematological toxicities, necessitating transfusions and a further dose reduction. The patient died of recurrent small-cell lung cancer 19 months after diagnosis. PMID:20558939

Tanizawa, Kiminobu; Fukunaga, Kentaro; Okumura, Noriko; Sugimura, Mitsuko; Tanaka, Eisaku; Hajiro, Takashi; Sakuramoto, Minoru; Minakuchi, Masayoshi; Hashimoto, Seishu; Yasuda, Takehiro; Kaji, Yusuke; Ikezoe, Kohei; Sato, Eizaburo; Nakajima, Toshifumi; Taguchi, Yoshio

2010-01-01

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

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

Rahimi A

2008-06-01

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Assessment of the frailty level of elderly people with chronic kidney disease undergoing hemodialysis / Avaliação do nível de fragilidade de idosos com doença renal crônica em tratamento hemodialítico  

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Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Avaliar o nível de fragilidade de idosos renais crônicos em tratamento hemodialítico. MÉTODOS: Trata-se de um estudo transversal desenvolvido com 60 participantes em uma Unidade de Terapia Renal Substitutiva. Foi utilizada como instrumento de pesquisa a Edmonton Frail Scale, traduzid [...] a e validada para a língua portuguesa. RESULTADOS: Cerca de 35,0% dos idosos não apresentou fragilidade, 26,7% estava vulnerável, 20,0% apresentou fragilidade leve, 13,3% fragilidade moderada e 5,0% fragilidade severa. CONCLUSÃO: O nível de fragilidade de idosos renais crônicos em tratamento hemodialítico foi elevado assim como foi alto o nível de idosos vulneráveis à fragilidade. Abstract in english OBJECTIVE: To assess the frailty level of elderly people with chronic kidney disease undergoing hemodialysis. METHODS: This is a cross-sectional study involving 60 participants and carried out at a Renal Replacement Therapy Unit. The Edmonton Frail Scale, translated and validated to Portuguese [...] , was used as the instrument of research. RESULTS: Around 35.0% of the elderly showed no frailty, 26.7% were vulnerable, 20.0% showed mild frailty, 13.3% moderate frailty and 5.0% severe frailty. CONCLUSION: The frailty level of elderly people with chronic kidney disease undergoing hemodialysis was high and the number of elderly people who are vulnerable to frailty was also high.

Fabiana de Souza, Orlandi; Gabriela Dutra, Gesualdo.

2014-01-01

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

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

Tepel, Martin

2010-01-01

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Anxiety, locus of control, and coping strategies among end-stage renal disease patients undergoing maintenance hemodialysis  

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End-stage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) have a lot of anxiety. Anxiety and coping are associated with the locus of control; the present investigation aimed to study the state and trait anxiety, locus of control, and active and passive coping among patients on MHD. Thirty MHD patients and 30 controls were administered State–Trait Anxiety Inventory, Rotter's Locus of Control Scale, and Coping Responses Inventory. There were significantly higher scores on sta...

Kohli, S.; Batra, P.; Aggarwal, H. K.

2011-01-01

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

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

Azar Baradaran

2005-12-01

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A new rapid and sensitive LC-MS assay for the determination of sorafenib in plasma: application to a patient undergoing hemodialysis.  

Science.gov (United States)

A simple liquid chromatography-mass spectrometry method was developed and validated for quantification of sorafenib (Nexavar) in human plasma. After a solid-phase extraction procedure, the separation was performed within 2 minutes using an isocratic flow of a mobile phase consisting of formic acid/acetonitrile applied on a C18 analytical column. The analyte was detected by mass spectrometry in the single-ion monitoring mode. The method was validated according to the recommendations of the US Food and Drug Administration. The method was linear (r² > 0.99) between 10 and 10,000 ng/mL. The lower limits of detection and quantification were 5 and 10 ng/mL, respectively. Within-day and between-day imprecisions were less than 10.4%, and inaccuracy did not exceed 8.7%. The mean extraction recovery was 92.2%. The method also provided satisfactory results in terms of time stability and dilution integrity. Sorafenib plasma concentrations of the studied patient ranged between 1831 and 3459 ng/mL. This new technique is rapid, sensitive, and was applied to the determination of sorafenib plasma concentrations in a patient undergoing hemodialysis. Our results indicate that sorafenib is not cleared from plasma by hemodialysis, although analysis should be delayed after dialysis to avoid erratic fluctuations. PMID:22105587

Bobin-Dubigeon, Christine; Heurgue-Berlot, Alexandra; Bouché, Olivier; Amiand, Marie-Bernadette; Le Guellec, Chantal; Bard, Jean-Marie

2011-12-01

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

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Full Text Available 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.

2004-03-01

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

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

Maria Ayako Kamimura

2004-03-01

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

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

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

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HEMODIALYSIS MEMBRANES: PAST, PRESENT AND FUTURE TRENDS  

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

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

2013-01-01

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

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

Vanessa, Sgnaolin; Ana Elizabeth Prado Lima, Figueiredo.

2012-06-01

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Evaluation of the Effects of Intravenous Ascorbic Acid on Correction of Anemia in Renal Failure Patients Undergoing Hemodialysis  

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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.

AA Shojaie

2006-04-01

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

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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.

2012-04-01

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Hemodialysis and Pain  

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Full Text Available OBJECTIVE: We aimed to determine the type, frequency, location, intensity and the characteristics of the pain in hemodialysis patients. MATERIAL and METHODS: Ninety-five hemodialysis patients were investigated using McGill- Melzack pain questionnaire. Location, nature, frequency and intensity of the pain were recorded according to this form. In addition, pain was classified with regard to duration as instant, acute and chronic. RESULTS: Sixty patients (63.1% reported a problem with pain, the others (35 patients - 36.8% reported not to have pain. When considering the relationship of pain with time; 24.1% of the patients had continuous, steady, fixed pain and 58.6% of the patients had rhythmic, periodic, intermittent pain while 17.2% had generalized, momentary, temporary pain. When the pain was evaluated in terms of severity, it was found that 31 patients (52% had mild and disturbing pain, while 29 patients (48% had severe or very severe (intolerable pain. It was also detected that 60 patients had instant pain, 25 had acute pain and 31 had chronic pain. CONCLUSION: Pain is a common and chronic problem in patients undergoing HD and it is seriously necessary to address treating the pain along with other systemic diseases in order to increase the quality of life of individuals.

Mehmet Serhan ER

2013-05-01

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

Scientific Electronic Library Online (English)

Full Text Available 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.

2011-03-01

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[Lipoprotein (a) in children with end stage renal failure on maintenance hemodialysis and continuous ambulatory peritoneal dialysis].  

Science.gov (United States)

The aim of this study was to evaluate serum lipid abnormalities, particularly lipoprotein (a) [Lp(a)] in children with end-stage renal failure undergoing chronic dialysis and to estimate the influence of treatment method on these disturbances. Studies were performed on 21 children aged +/- 14.8 years (10 girls, 11 boys) on maintenance hemodialysis and 10 children, aged 13.2 years (8 girls, 2 boys) on CAPD. Control group consisted of 27 healthy age-matched subjects. All children were tested for concentration of serum Lp(a), total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C). It was found a significantly increase in Lp(a), TG, TC, LDL-C and significantly decrease in HDL-C in all dialysed children compared to controls. CAPD patients had markedly elevated serum Lp(a) and TG compared to hemodialysed children. These results suggest that CAPD treatment may contribute to the pathogenesis of lipid abnormalities and increased risk of developing coronary heart disease. PMID:9380806

Zwoli?ska, D; Szprynger, K

1997-01-01

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

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Full Text Available INTRODUCTION: Vitamin D3 has diverse biological effects extending beyond the maintenance of calcium and phosphorus homeostasis and ensuring the proper functioning of the body. OBJECTIVES: This study evaluated the levels of vitamin D3 and its association with nutritional status, immunological activity, and selected markers of cardiovascular disease in patients on long?term hemodialysis (HD. PATIENTS AND METHODS: We measured 25?hydroxyvitamin D3 (25(OHD3 levels in a group of 84 patients (mean age, 65 years; average time on dialysis, 32.5 months and investigated correlations between 25(OHD3 levels and the following parameters: albumin, body mass index, hemoglobin (Hb, interleukin 6 (IL?6, interleukin 10, C?reactive protein, asymmetric dimethylarginine (ADMA, N?terminal pro?B?type natriuretic peptide (NT?proBNP, and comorbidity score. RESULTS: A mean 25(OHD3 level was 15.4 ±7.2 ng/ml and only 5% of patients had 25(OHD3 levels above the normal value of 30 ng/ml. There was no statistically significant difference in 25(OHD3 levels between women and men (P = 0.06. A negative correlation was observed between 25(OHD3 and IL?6 (R = –0.31, P = 0.009 and ADMA (R = –0.26, P = 0.03, as well as a positive correlation between 25(OHD3 and Hb (R= 0.21, P = 0.05. There was no association between 25(OHD3 levels and nutritional status. CONCLUSIONS: A significant vitamin D3 deficiency observed in the majority of patients undergoing long?term HD contributes to the development of chronic inflammation, anemia, and indirectly, to endothelial cell injury.

Anna Bednarek?Skublewska

2010-05-01

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

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These findings confirm a high prevalence of toxoplasma infection in hemodialysis patients. These patients are a risk group for toxoplasma infection. Moreover, it is recommended that hemodialysis patients who are susceptible to toxoplasma infections should be identified by T. gondii IgG and IgM specific serological tests. Therefore, patients undergoing hemodialysis should be screened for toxoplasma before dialysis to prevent the dissemination of this infection through the hemodialysis procedure.

Sabahattin Ocak

2005-09-01

 
 
 
 
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The Frequency of Osteoporosis in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients According to PTH Levels after Active Vitamin D Therapy during the Two Years Period  

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Full Text Available Aim: Osteoporosis is a skeletal disorder that is characterized by low bone mass, micro-structuraldegeneration of bone and high risk of fracture. In this study our aim was to detect the frequencyof osteoporosis in hemodialysis (HD and continuous ambulatory peritoneal dialysis (CAPDpatients according to Parathyroid Hormone (PTH after vitamin D therapy during the two yearsperiod.Materials and method: 18 HD patients (12 male, 6 female and 12 CAPD patients (8 male, 4female undergoing to dialysis therapy in dialysis center of Medicine Faculty Hospital in DicleUniversity were enrolled to the study. The patients were evaluated with bone mineral densitywhich was measured by left heel quantitative ultrasound before and after the active vitamin Dtherapy. The blood samples were collected for biochemical analysis in the morning after 12hours fasting period before and after the active vitamin D therapy. Results: After the therapy T and Z scores bone mineral density and ALP values were increasedin the group that PTH values were between 120-250 pg/ml and more than 250 pg/ml. But theseparameters were decreased in the group that PTH were lower than 120 pg/ml. Osteoporosispercentage were 23 % in PTH value 250 pg/ml in the initial measurement. After the therapy these were 30 %, 0% and 20 % relatively.Conclusion: Before the treatment there was not a statistical difference between T score of 3groups. After the treatment there was a statistically significant difference. Especially T scorewas better after the therapy in the second group that PTH values were between 120-250 pg/ml.

Ali Kemal KADIROGLU

2010-05-01

62

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1989-07-15

63

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

International Nuclear Information System (INIS)

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.

64

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

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

Diego Sherlon Pizzamiglio1,

2012-01-01

65

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

DEFF Research Database (Denmark)

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

Crawford, M E; MØiniche, S

1996-01-01

66

Elastase, ?1-proteinase inhibitor, and interleukin-8 in children and young adults with end-stage kidney disease undergoing continuous ambulatory peritoneal dialysis.  

Science.gov (United States)

Peritoneal dialysis is one of the main modality of treatment in end-stage kidney diseases (ESKD) in children. In our previous work in chronic kidney disease patients, in pre-dialyzed period and on hemodialysis, the neutrophils were highly activated. The aim of this study was to assess an inflammatory condition and neutrophil activation in ESKD patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Thirteen CAPD patients without infection, both sexes, aged 2.5-24 years, and group of healthy subjects (C) were studied. For comparative purposes the conservatively treated (CT) group of ESKD patients was included. Neutrophil elastase in complex with ?1-proteinase inhibitor (NE-?1PI; ELISA), ?1-proteinase inhibitor (?1PI; radial immunodiffusion) and interleukin-8 (IL-8; ELISA) were measured in the blood samples from CAPD, CT, and C group and in the peritoneal dialysate fluid (PDF) samples of patients on CAPD. A significantly increased plasma NE-?1PI levels (median 176.5 ?g/L, range 85.2-373.2 ?g/L; p PDF was 29.97, 8.24, and 4.48, respectively. There were significantly positive correlations between serum and PDF concentration of ?1PI and IL-8 (r = 0.613, p < 0.05; r = 0.59; p < 0.005, respectively). The results of our study demonstrate that neutrophils are highly activated in non-infected CAPD patients. The pivotal marker of this activation is NE-?1PI. It may contribute to chronic inflammation and tissues injury. PMID:24292797

Pola?ska, Bo?ena; Augustyniak, Daria; Makulska, Irena; Niemczuk, Maria; Jankowski, Adam; Zwoli?ska, Danuta

2014-06-01

67

Vitamin E-derived copolymers continue the challenge to hemodialysis biomaterials.  

Science.gov (United States)

Improving material biocompatibility has been a continuous effort and remains a major goal of dialysis therapy. In this respect, vitamin E-modified copolymers have been used to produce a generation of biomaterials that has offered new clinical challenges and the chance of further improving the quality of synthetic hemodialyser membranes. This mini review article describes the evolution of these copolymers that only recently have been adopted to develop new vitamin E-modified polysulfone hemodialysers. Biomaterial characteristics and clinical aspects of these membranes are discussed, starting from the most recent contributions that have appeared in the literature that are of interest for the community of nephrology and dialysis specialists, as well as biomaterial scientists. PMID:24175247

Galli, Francesco

2012-08-01

68

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

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

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

2010-01-01

69

Changes in plasma kynurenic acid concentration in septic shock patients undergoing continuous veno-venous haemofiltration.  

Science.gov (United States)

Kynurenic acid (KYNA) is one of the end products of tryptophan metabolism. The aim of this study was to analyse plasma KYNA concentration in septic shock patients (SSP) with acute kidney injury (AKI) undergoing continuous veno-venous haemofiltration (CVVH). Changes in KYNA content were compared to alterations in the levels of procalcitonin (PCT), C-reactive protein and lactate. Adult SSP with AKI were examined. Measurements were conducted at seven time points: before beginning CVVH and at 6, 12, 24, 48, 72 and 96 h after the beginning of CVVH. Based on clinical outcomes, the data were analysed separately for survivors and non-survivors. Twenty-seven patients were studied. CVVH was associated with reduced plasma KYNA concentration only in survivors. Plasma KYNA concentration correlated with the levels of lactate and PCT only in survivors. (1) CVVH reduced plasma KYNA concentration only in survivors; (2) lack of this reduction may predict fatal outcomes in SSP. PMID:24043287

Dabrowski, Wojciech; Kocki, Tomasz; Pilat, Jacek; Parada-Turska, Jolanta; Malbrain, Manu L N G

2014-02-01

70

Clinical study of cerebral infarction in hemodialysis patients  

International Nuclear Information System (INIS)

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

71

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

International Nuclear Information System (INIS)

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

72

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2005-10-15

73

HEMODIALYSIS MEMBRANES: PAST, PRESENT AND FUTURE TRENDS  

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

Gautham A

2013-06-01

74

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

Scientific Electronic Library Online (English)

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

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

2010-12-01

75

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

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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

2010-12-01

76

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

DEFF Research Database (Denmark)

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

Joffe, P; Olsen, F

1989-01-01

77

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

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

Azar Baradaran

2005-11-01

78

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

Scientific Electronic Library Online (English)

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.

2014-04-01

79

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

Scientific Electronic Library Online (English)

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.

80

Effects of continuous intravenous infusion of methoxamine on the intraoperative hemodynamics of elderly patients undergoing total hip arthroplasty.  

Science.gov (United States)

Background Hemodynamic disturbances are common during continuous epidural anesthesia in elderly patients undergoing total hip arthroplasty. This study aimed to investigate the effects of methoxamine on the intraoperative hemodynamics in elderly patients undergoing total hip arthroplasty under epidural anesthesia. Material and Methods This prospective study included 150 elderly patients undergoing elective total hip arthroplasty under epidural anesthesia. Patients were randomly assigned into 5 groups (n=30 per group): a control group receiving saline (Group C), a dopamine group receiving 7 µg/kg/min dopamine (Group D), and methoxamine groups receiving 1, 2, or 3 µg/kg/min methoxamine (Groups M1, M2, and M3, respectively). Hemodynamic parameters were assessed 10 min before anesthesia (T1); 10 min (T2), 20 min, (T3), 30 min (T4), and 60 min (T5) after anesthesia; and at the conclusion of surgery (T6). Results At T2-T6, the mean arterial pressure, central venous pressure, cardiac output, stroke volume, stroke volume ratio, and pulmonary vascular resistance were higher in Groups D, M2, and M3 compared to Group C (pHypertension occurred more frequently in Group M3 than in any other group. Conclusions Continuous intravenous infusion of 2 µg/kg/min methoxamine is safe and effective in maintaining hemodynamic stability in elderly patients undergoing total hip arthroplasty. PMID:25326008

Sun, Defeng; Wu, Yue; Yang, Lin; Han, Jun; Liu, Ruochuan; Wang, Lijie

2014-01-01

 
 
 
 
81

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

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

Khawaja AR

2013-01-01

82

Correlation between dialysis solution type and cardiovascular morbidity rate in patients undergoing continuous ambulatory peritoneal dialysis  

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Background/Aim. Peritoneal dialysis (PD) patients have an increased risk for cardiovascular diseases. The aim of the study was to evaluate the cardiovascular changes in patients undergoing chronic PD and the eventual existing differences depending on biocompatibility of dialysis solutions. Methods. After 3±2 years of starting PD, 21 PD patients on the treatment with bioincompatible dialysis solutions (conventional glucose- based solutions: PDP-1), average age 47.43±12.87 years, and 21 PD pa...

Stankovi?-Popovi? Verica; Maksi? ?oko; Vu?ini? Žarko; Lepi? Toplica; Popovi? Dragan; Mili?i? Biljana

2008-01-01

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Hemoperitoneum in patients receiving hemodialysis.  

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Acute abdominal pain in chronic hemodialysis patients has well-known causes, including acute pancreatitis, mesenteric arterial insufficiency, or complicated duodenal ulcer. Others, such as hemoperitoneum, are far less common. Although hemoperitoneum occurs in patients receiving peritoneal dialysis, dialysis is seldom if ever the direct cause of the bleeding. Hemoperitoneum is often related to menses or ovulation, particularly to ovarian cyst rupture; therefore, it is more common in young women. In most cases, no specific treatment is required. Hemoperitoneum is rarely considered as the cause of acute abdominal pain in chronic hemodialysis patients. In this report of hemoperitoneum confirmed by emergency laparotomy in 3 women, bleeding was not related to gynecologic origin. All of the women were younger than age 50 and undergoing long-term hemodialysis. All patients had a history of acute abdominal pain associated with shock. The cause of bleeding was always an organ lesion: hepatic amyloidosis with suspected portal hypertension or sclerosing peritonitis and acute hemorrhagic pancreatitis. Coagulation abnormalities and the use of anticoagulants during hemodialysis sessions may have been aggravating factors in all three patients. Hemoperitoneum is difficult to diagnose, particularly in the minor forms, and consequently its incidence may be underestimated. Therefore, it should be considered whenever a chronic hemodialysis patient presents with persistent acute abdominal pain. PMID:10922332

Stolz, A; Fourcade, J; Klisnick, A; Souweine, B; Abergel, A; Baguet, J C; Deteix, P

2000-08-01

84

Cross-sectional assessment of nutritional and immune status in renal patients undergoing continuous ambulatory peritoneal dialysis.  

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Malnutrition prevalence and immunocompetence were assessed in uremic patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Forty-two males and twenty-four females with kidney disease treated with CAPD were distributed into three groups according to the length of time they had been undergoing dialysis. Group 0 included patients beginning dialysis; group 1, patients undergoing CAPD for 30 mo. Body weight and body mass index were greater in patients who had been undergoing CAPD for longer periods of time (approximately 11% in males and 14% in females), which was accompanied by higher fat stores and muscle mass when assessed through triceps skinfold thickness and arm muscle measurements. These differences were more apparent in females than in males. Immunoglobulin M values were lower in patients in groups 1 and 2 than in group 0, whereas retinol binding protein, fibronectin, and C4 were higher. Estimated protein intake was higher in predialysis patients (1.31 g.d-1.kg-1) than in the other groups (approximately 0.95 g.d-1.kg-1). The percentage of B cells decreased with time on dialysis. Although no changes in total or helper T cells were found, a significant rise was noted for the T cell subpopulation with assumed suppressor and cytotoxic activities and for natural killer cells in those patients undergoing longer periods of CAPD treatment. Alterations in immune cell numbers in immunoglobulins and complement proteins might be responsible for immunologic disturbances and infectious processes occurring in patients with chronic renal failure and undergoing CAPD. PMID:9250138

Palop, L; Martínez, J A

1997-08-01

85

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

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

Claudinei José Gomes Campos

2003-10-01

86

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

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

Claudinei José Gomes, Campos; Egberto Ribeiro, Turato.

87

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

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Full Text Available 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.

2010-12-01

88

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

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Full Text Available 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.

89

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

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

Humberto Kukhyun Choi

2003-01-01

90

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  

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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.

91

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  

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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.

2013-12-01

92

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

International Nuclear Information System (INIS)

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

93

Correlation between dialysis solution type and cardiovascular morbidity rate in patients undergoing continuous ambulatory peritoneal dialysis  

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Full Text Available Background/Aim. Peritoneal dialysis (PD patients have an increased risk for cardiovascular diseases. The aim of the study was to evaluate the cardiovascular changes in patients undergoing chronic PD and the eventual existing differences depending on biocompatibility of dialysis solutions. Methods. After 3±2 years of starting PD, 21 PD patients on the treatment with bioincompatible dialysis solutions (conventional glucose- based solutions: PDP-1, average age 47.43±12.87 years, and 21 PD patients on the treatment with biocompatible dialysis solutions (neutral solutions with lower level of glucose degradation products, lower concentration of Ca2+ and neutral pH: PDP-2, average age 68.62±13.98 years, participated in the longitudinal study. The average number of episodes of peritonitis was similare in both groups: 1 episode per 36 months of the treatment. The control group included 21 patients with preterminal phase of chronic renal failure (Glomerular Filtration Rate: 22.19±10.73 ml/min, average age 65.29± 13.74 years. All the patients underwent transthoracal echocardiography (in order to detect: eject fraction (EF, left ventricular hypertrophy (LVH, and valvular calcification (VC and B-mode ultrasonography of common carotid artery (CCA: IMT, lumen narrowing, and plaque detection. Results. The values of EF were: in PDP-1 group 62.05±5.65%, in PDP-2 group 53.43±7.47%, and in the control group 56.71±8.12% (Bonferroni test, p = 0.001. The recorded LVH was: in PDP-1 group in 47.6% of the patients; in PDP-2 group in 61.9% of the patients; and in control the group in 52.4% (?2 test; p = 0.639. The detected VC was: in PDP-1 in 52.4% of the patients, in PDP-2 group in 42.9% of the patients, and in the control group in 23.8% of the patients (?2 test; p = 0.776. The IMT was: in PDP-1 group 1.26±0.54 mm, in PDP-2 group 1.23±0.32, and in the control group 1.25±0.27 mm (Bonferroni test; p = 0.981. An average lumen narrowing was: in PDP-1 group 13.78±18.26%, in PDP-2 group 18.57±22.98%, and in the control group 25.00±28.02% (Kruskal Wallis test; p = 0.413. Calcified plaques of CCA were detected in PDP-1 group in 61.9% of the patients, in PDP-2 group in 85.7%, of the patients and in the control group in 81% of the patients (?2 test; p = 0.159. Conclusion. Generally, PD had a significant influence on cardiovascular morbidity in the treated patients, especially on the left ventricular function and peripherial atherosclerosis. The age of the patients had more influence on acceleration of atherosclerosis than the length of dialysis or biocompatibility of dialysis solutions.

Stankovi?-Popovi? Verica

2008-01-01

94

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

International Nuclear Information System (INIS)

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

95

Pharmacokinetics of amphotericin B lipid complex in critically ill patients undergoing continuous venovenous haemodiafiltration.  

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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 contributedpharmacokinetics 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

2013-10-01

96

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

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Full Text Available OBJECTIVE: To assess mood and quality of life in male hemodialysis patients, and to correlate mood swings with the different domains of the quality of life questionnaire. METHOD: Forty-seven male patients undergoing regular hemodialysis for more than six months were included in the study. The Hamilton Rating Scale for Depression and the Kidney Disease Quality of Life Questionnaire, in a version translated into and adapted to Portuguese, were used. RESULTS: The patients' 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 OBJETIVO: Avaliar o estado de humor e a qualidade de vida de homens em tratamento hemodialítico, correlacionar as alterações observadas no humor com os diferentes domínios do questionário de qualidade de vida. MÉTODO: Foram incluídos 47 homens em tratamento hemodialítico estável há mais de seis meses. Foram aplicadas a Escala de Hamilton de depressão e o Kidney Disease Quality of Life Questionnaire, questionário de qualidade de vida relacionado à saúde, em 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 < 0,001. Entre os domínios genéricos, o estado de humor apresenta correlação negativa significativa com a saúde geral (rs = -0,475; p < 0,001, o bem-estar emocional (rs = -0,354; p = 0,015, a função social e a energia/fadiga (rs = -0,518; p < 0,001. Para os demais parâmetros do Kidney Disease Quality of Life Questionnaire não foram observadas relações significativas com a escala de Hamilton. CONCLUSÃO: O estado de humor apresentou correlação negativa com diversos escores de qualidade de vida avaliados pelo Kidney Disease Quality of Life Questionnaire, sugerindo possível influência do estado de humor na qualidade de vida dos pacientes renais em hemodiálise.

Thales Weber Garcia

2010-12-01

97

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  

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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.

2013-12-01

98

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

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

Donnelly Maria B

2011-08-01

99

Depression, Anxiety Levels and Coping Strategies with Stress in Continuous Ambulatory Peritoneal Dialysis (CAPD and Hemodialysis (HD Patients in a University Hospital  

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Full Text Available Objective: This study is aimed to evaluate depression and anxiety levels and coping strategies with stress in continuous ambulatory peritoneal dialysis (CAPD and hemodialysis (HD patients.Method: Study which was planned as a descriptive cross-sectional research has been made among patients who were under treatment with CAPD or HD for chronic renal failure in Cumhuriyet University Hospital in 01-31 August 2007. Questions were asked to determine the demographic profile, tobacco and alcohol use patterns and psychological status of the patients. Beck Depression Inventory and State-Trait Anxiety Inventory I-II (STAI-I, STAI-II and Coping Strategies With Stress Inventory (COPE were used for psychological evaluation.Results: Depression rate was 33.3% in CAPD patients and 61.3% in HD patients. Beck Depression Inventory and State-Trait Anxiety Inventory I-II (STAI-I, STAI-II scores were 14.1±8.4, 39.3±4.7, 47.6±5.1 and 19.9±9.9, 41.0±3.7, 49.5±6.2 in CAPD and HD patients respectively. CAPD patients’ depression scores were significantly lower than HD patients’ (p0.05. In both groups the most frequently used coping strategy was religious coping followed by positive reinterpretation and development methods. The only significant difference between groups were in “to laugh it off” and “not to worry about it” strategies. Conclusion: Depression and anxiety appeared frequently in all dialysis patients, but depression was more frequent in HD patients. Therefore it is considered necessary for dialysis patients (CAPD and HD to be under regular psychiatric evaluation. (Archives of Neuropsychiatry 2008; 45: 78-84

Selma ÇET?NKAYA

2008-10-01

100

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

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

Carolina Costa Valcanti

2012-08-01

 
 
 
 
101

Leukotriene B4 in hemodialysis.  

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Leukotrienes are eicosanoids arising from arachidonic acid via 5 lipooxygenase, an enzyme essentially present in leukocyte cells. Leukotriene B4 might be an indicator of neutropolymorphonuclear leukocyte activation when there is contact with artificial membranes. The level of plasmatic leukotriene B4 was measured at three different times during the hemodialysis treatment in several patients undergoing dialysis on three different membranes (one cellulosic and two synthetics). A moderate increase of leukotriene B4 was observed early (at 15 min), comparable among the three membranes, but levels returned to baseline at 180 min. Leukotriene B4 production proved leukocyte activation and was probably related to a direct interaction with dialysis membrane. Nevertheless, complement intervention could not be excluded. Leukotriene B4 is one molecule more among the group of inflammatory mediators produced during hemodialysis treatment. PMID:2173529

Tridon, A; Albuisson, E; Deteix, P; Marquès Verdier, A; Gaillard, G; Bétail, G; Baguet, J C

1990-10-01

102

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

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

Mohammad Reza Tamadon

2011-07-01

103

[Evaluation of serum sialic acid concentration in chronic renal failure children on continuous ambulatory peritoneal dialysis and hemodialysis].  

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In various pathological conditions elevated serum sialic acid level, as the result of increased metabolism of glycoproteins and glycolipids, is observed. The study aimed at the evaluation of sialic acid concentration in serum of children on continuous ambulatory peritoneal dialysis (CAPD) and maintenance haemodialysis (HD). Examination was performed in 27 end-stage renal disease (ESRD) children including 11 on CAPD, 16 on HD treatment. Ten healthy children served as the control group (K). In CAPD group assessment was carried out during the routine monthly check up, in HD group--before (HD-1) and after (HD-2) dialysis session. Sialic acid concentration was determined using method of Shamberger. In CAPD children we obtained significantly increased serum sialic acid concentration comparing to controls and HD children. Increased serum sialic acid concentration was also found in HD children comparing to controls. There was no significant difference between the sialic acid concentrations before and after dialysis session. Analysis of correlation revealed positive correlation of sialic acid concentration with haemoglobin concentration and hematocrit in CAPD group. In children on HD treatment we showed positive correlation of sialic acid level with renal replacement therapy duration and creatinine concentration after HD. Elevated serum sialic acid concentration in dialysed children could be the result of non-specific organism response, characterised by tissue and organ damage, towards the materials of extracorporeal circulation (HD) or the presence of dialysis solution in peritoneal cavity (CAPD). PMID:11070713

Szprynger, K; Szczepa?ska, M; Mazur, B; Dyduch, A; Zwoli?ska, D; Morawiec-Knysak, A; Makulska, I

2000-07-01

104

Hemodialysis-related headaches  

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Full Text Available Background/Aim. Hemodialysis (HD is a therapeutic procedure used to partially correct homeostatic disorders and prevent complications of uremia to appear in the terminal stage of renal insufficiency. The aim of this study was to evaluate and analyze the incidence and features of headaches in patients undergoing hemodialysis. Methods. A total of 143 patients, 50 women and 93 men, undergoing hemodialysis, were questioned about their problems with headache using a questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. The patients were separated into two groups: the patients without headache and the patients with repeated headaches. Afterwards, the patients with headaches were further divided into subgroups: the patients who had the headaches before the beginning of HD and patients who experienced repeated headaches with the beginning of HD headache (HDH. In the group of patients with headaches we analyzed characteristics of headache according to which diagnoses of headaches were made, as well as the effects of HD on headaches. We also analyzed features of HDH. The patients with headache were compared to the patients without headache regarding sex, age, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure and serum concentration of hemoglobin, urea nitrogen, creatinine, sodium and potassium. The results were statistically compared. Results. In the group of 143 patients examined, 27 (18.9% patients had headaches. There were no statistically significant differences between the group of patients with headaches and those without headache regarding to sex, age, duration of HD, causes of end-stage renal disease, serum concentration of hemoglobin, urea nitrogen, creatinine, sodium and potassium. The patients with headaches showed significantly higher mean values of systolic blood pressure during HD in comparison to the patients without headaches (p = 0.029. There was no statistically significant difference between the two groups regarding the mean values of diastolic blood pressure. Nineteen (13.3% patients had had headache before starting HD. HD did not have any effect on the characteristics of headaches in more than a half of these patients. In 8 (5.6% patients we diagnosed HDH using the diagnostic criteria of the International Headache Classification of Headache Disorders from 2004. HDH showed similar characteristics in all the patients: it appeared mostly in men, during the 4th hour of HD, lasted less than four hours, it was localized bilaterally in the frontal parts of the head, strong in intensity, throbbing and without the associated symptoms. Conclusion. The results of our study clearly showed that HDH was a particular entity of headache, not only because of its connection with HD, but because it had similar characteristics in all the patients in which it had appeared. Finding out the pathophysiological mechanisms of their occurrence would significantly improve the quality of life style of patients on hemodialysis. .

?uri? Marija

2007-01-01

105

Endoplasmic reticulum remains continuous and undergoes sheet-to-tubule transformation during cell division in mammalian cells  

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The endoplasmic reticulum (ER) is a multifaceted cellular organelle both structurally and functionally, and its cell cycle–dependent morphological changes are poorly understood. Our quantitative confocal and EM analyses show that the ER undergoes dramatic reorganization during cell division in cultured mammalian cells as mitotic ER profiles become shorter and more branched. 3D modeling by electron tomography reveals that the abundant interphase structures, sheets, are lost and subsequently transform into a branched tubular network that remains continuous. This is confirmed by observing the most prominent ER subdomain, the nuclear envelope (NE). A NE marker protein spreads to the mitotic ER tubules, although it does not show a homogenous distribution within the network. We mimicked the mitotic ER reorganization using puromycin to strip the membrane-bound ribosomes from the interphase ER corresponding to the observed loss of ribosomes normally occurring during mitosis. We propose that the structural changes in mitotic ER are linked to ribosomal action on the ER membranes. PMID:18056408

Puhka, Maija; Vihinen, Helena; Joensuu, Merja; Jokitalo, Eija

2007-01-01

106

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

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

Dinaldo Cavalcanti de Oliveira

2009-07-01

107

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

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Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: analisar a relação entre a esperança e a espiritualidade de pacientes renais crônicos em tratamento hemodialítico. MÉTODO: trata-se de estudo correlacional, de corte transversal. A amostra foi composta por 127 sujeitos em tratamento em uma Unidade de Terapia Renal Substitutiva. Os da [...] dos foram coletados por meio de entrevista individual, utilizando-se os instrumentos: caracterização dos sujeitos, Escala de Esperança de Herth e Escala de Espiritualidade de Pinto Pais-Ribeiro. RESULTADOS: o escore médio da Escala de Esperança de Herth foi de 38,06 (±4,32) e da Escala de Espiritualidade de Pinto Pais-Ribeiro nas dimensões "crenças" foi de 3,67 (±0,62) e "esperança/otimismo", 3,21 (±0,53). O coeficiente de Spearman indicou a existência de correlação positiva, de moderada magnitude entre a Escala de Esperança de Herth e as dimensões da Escala de Espiritualoidade de Pinto Pais-Ribeiro: "crenças" (r=0,430; p Abstract in spanish OBJETIVO: analizar la relación entre la esperanza y la espiritualidad de pacientes renales crónicos en tratamiento de hemodiálisis. MÉTODO: se trata de un estudio de correlación, de corte transversal. La muestra fue compuesta por 127 sujetos en tratamiento en una Unidad de Terapia Renal Substi [...] tutiva. Los datos fueron recolectados, por medio de entrevista individual, utilizando los instrumentos: caracterización de los sujetos, Escala de Esperanza de Herth (EEH) y Escala de Espiritualidad de Pinto Pais-Ribeiro (EEPP-R). RESULTADOS: el puntaje promedio de la EEH fue 38,06 (±4,32) y de la EEPP-R en las dimensiones "creencias" 3,67 (±0,62) y "esperanza/optimismo" 3,21 (±0,53). El coeficiente de Spearman indicó la existencia de correlación positiva, de moderada magnitud entre la EEH y las dimensiones de la EEPP-R: "creencias" (r=0,430; p Abstract in english OBJECTIVE: to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis. METHOD: this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through ind [...] ividual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS). RESULTS: the average HHI score was 38.06 (±4.32) while the average PP-RSS score was 3.67 (±0.62) for "beliefs" and 3.21 (±0.53) for "hope/optimism". Spearman's coefficient indicated there was a moderate positive correlation between the HHI and PP-RSS dimensions of "beliefs" (r=0.430; p

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

2014-04-01

108

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  

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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.

109

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

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Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: analisar a relação entre a esperança e a espiritualidade de pacientes renais crônicos em tratamento hemodialítico. MÉTODO: trata-se de estudo correlacional, de corte transversal. A amostra foi composta por 127 sujeitos em tratamento em uma Unidade de Terapia Renal Substitutiva. Os da [...] dos foram coletados por meio de entrevista individual, utilizando-se os instrumentos: caracterização dos sujeitos, Escala de Esperança de Herth e Escala de Espiritualidade de Pinto Pais-Ribeiro. RESULTADOS: o escore médio da Escala de Esperança de Herth foi de 38,06 (±4,32) e da Escala de Espiritualidade de Pinto Pais-Ribeiro nas dimensões "crenças" foi de 3,67 (±0,62) e "esperança/otimismo", 3,21 (±0,53). O coeficiente de Spearman indicou a existência de correlação positiva, de moderada magnitude entre a Escala de Esperança de Herth e as dimensões da Escala de Espiritualoidade de Pinto Pais-Ribeiro: "crenças" (r=0,430; p Abstract in spanish OBJETIVO: analizar la relación entre la esperanza y la espiritualidad de pacientes renales crónicos en tratamiento de hemodiálisis. MÉTODO: se trata de un estudio de correlación, de corte transversal. La muestra fue compuesta por 127 sujetos en tratamiento en una Unidad de Terapia Renal Substi [...] tutiva. Los datos fueron recolectados, por medio de entrevista individual, utilizando los instrumentos: caracterización de los sujetos, Escala de Esperanza de Herth (EEH) y Escala de Espiritualidad de Pinto Pais-Ribeiro (EEPP-R). RESULTADOS: el puntaje promedio de la EEH fue 38,06 (±4,32) y de la EEPP-R en las dimensiones "creencias" 3,67 (±0,62) y "esperanza/optimismo" 3,21 (±0,53). El coeficiente de Spearman indicó la existencia de correlación positiva, de moderada magnitud entre la EEH y las dimensiones de la EEPP-R: "creencias" (r=0,430; p Abstract in english OBJECTIVE: to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis. METHOD: this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through ind [...] ividual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS). RESULTS: the average HHI score was 38.06 (±4.32) while the average PP-RSS score was 3.67 (±0.62) for "beliefs" and 3.21 (±0.53) for "hope/optimism". Spearman's coefficient indicated there was a moderate positive correlation between the HHI and PP-RSS dimensions of "beliefs" (r=0.430; p

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

110

Thrombocytopenia in the Setting of Hemodialysis Using Biocompatible Membranes  

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Thrombocytopenia is a known potential side effect of hemodialysis, however, it is rarely seen in patients who undergo hemodialysis using biocompatible membranes. This case demonstrates hemodialysis-associated thrombocytopenia with use of biocompatible dialysis membranes that expose blood directly to polysulfone. The thrombocytopenia resolved in this patient when the dialysis membrane was changed to a biocompatible model with a polyethylene glycol barrier layer preventing direct interaction between patient blood and polysulfone. The calculated Naranjo ADR score of 9 indicates a highly probable adverse reaction. PMID:23093969

Muir, Kathryn B.; Packer, Clifford D.

2012-01-01

111

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

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Abstract Background Staphylococcus aureus, particularly methicillin resistant (MRSA), is a common pathogen among patients receiving hemodialysis. To evaluate nasal carriage, molecular characterization and effectiveness of decolonization of MRSA among patients receiving hemodialysis in Taiwan, we conducted this study. Methods From January to June 2011, two nasal samplings with a 3-month interval were obtained from patients undergoing hemodialysis in a me...

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

2012-01-01

112

Factors associated with complications of vascular access site in hemodialysis patients in Isfahan Aliasghar hospital  

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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

2014-01-01

113

Spontaneous splenic rupture in a hemodialysis patient.  

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Spontaneous splenic rupture (SSR) in a patient undergoing hemodialysis has been described as an extremely rare and potentially fatal complication. We report here spontaneous splenic rupture in a 52-year-old woman undergoing regular hemodialysis for end-stage renal disease (ESRD). She complained of colicky abdominal pain in the left upper quadrant area and dizziness when she assumed an upright posture. Her vital signs revealed low blood pressure and tachycardia, which was suggestive of hypovolemic shock. Abdomen CT scan showed splenic hematoma and hemoperitoneum. However, she had no history of any event triggering the splenic rupture. An exploratory laparotomy showed a ruptured spleen and an emergency splenectomy was performed. We suggest that spontaneous spleen rupture may be attributed to uremic coagulopathy and heparin-induced coagulopathy. PMID:15988818

Kim, Hyun Jung; Lee, Gyeong Won; Park, Dong Jun; Lee, Jong Deog; Chang, Se Ho

2005-06-30

114

Nutritional Assessment of Hemodialysis Patients  

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

Ali A. Alshatwi

2007-01-01

115

Spontaneous Renal Hemorrhage in Hemodialysis Patients  

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Dialysis patients have a tendency to bleed, and clinicians sometimes encounter cases with a significant amount of spontaneous hemorrhage. We herein report two cases of spontaneous renal hemorrhage in hemodialysis patients. Case 1 A 70-year-old male who had received hemodialysis for 8 years presented with right abdominal pain. He had a history of renal failure due to diabetes mellitus. CT showed a right perirenal hemorrhage. Angiography revealed a right renal artery hemorrhage, and catheter embolization was performed. Case 2 A 76-year-old male who had undergone 7 years of continuous ambulatory peritoneal dialysis and 1 year of hemodialysis presented with right abdominal pain. He had a history of renal failure due to IgA nephropathy. CT showed a right perirenal hemorrhage. He received a blood transfusion and was put on absolute bed rest. At 2 days after admission, his anemia was found to have improved. PMID:23197944

Kawahara, Takashi; Kawahara, Kimiko; Ito, Hiroki; Yamaguchi, Satoshi; Mitsuhashi, Hiroshi; Makiyama, Kazuhide; Uemura, Hiroji; Sakai, Masashi; Kubota, Yoshinobu

2011-01-01

116

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

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

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

2006-03-01

117

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

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

Yanet Parodis López

2006-03-01

118

Intravenous levosimendan-norepinephrine combination during off-pump coronary artery bypass grafting in a hemodialysis patient with severe myocardial dysfunction  

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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

2010-03-01

119

The Effect of Acupressure on Quality of Sleep in Hemodialysis Patients  

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

Razieh Khajeh- Kazemi

2011-01-01

120

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

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Full Text Available 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.

2012-09-01

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

Scientific Electronic Library Online (English)

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.

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Continuous noninvasive in vivo monitoring of intravascular plasma volume and hematocrit changes during hemodialysis in humans: direct comparison with the CRIT-LINE  

Science.gov (United States)

We report a new device and algorithm that allows simultaneous monitoring of the hematocrit and plasma volume fraction of blood within the intravascular space of an optically probed volume of skin. Skin is probed with a near infrared (NIR) laser and simultaneously collecting the Rayleigh and Mie scattered light as one raw signal and the undifferentiated Raman and fluorescence emission as the second raw signal. These signals are combined using six parameters that can be obtained by either direct calculation or empirical calibration to permit monitoring of the blood in human skin (e.g. fingertips). We tested a device based on the algorithm that might be useful in allowing the early detection of blood loss for people who have no external injury but may be hemorrhaging internally. IRB allowed experiments monitoring blood in human fingertip skin in vivo during routine hemodialysis demonstrated good agreement between the experimental device and the CRIT-LINE®, an FDA approved device that is built into the dialysis machine and applies the Twersky algorithm to blood in the dialysis machine (i.e. in vitro). Based on observation of 9 different test subjects, as dialysis removes fluid from the intravascular space causing an increase in hematocrit and a decrease in plasma volume, the CRIT-LINE response is closely emulated (typical per session linear correlation r2=0.78, N=87, p<0.0001) with the new device. Calibration across subjects, the measurement of absolute hematocrit, and potential confounding factors will also be discussed.

Deng, Bin; Kastner, Evan; Narsipur, Sriram S.; Goodisman, Jerry; Chaiken, J.

2014-02-01

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

Scientific Electronic Library Online (English)

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

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

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Carboplatin pharmacokinetics in a patient receiving hemodialysis.  

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With refinements and advances in hemodialysis techniques, survival for patients with end-stage renal disease has improved significantly. To our knowledge, however, no prospective trials have been performed in patients receiving hemodialysis who are also diagnosed with cancer and are candidates for chemotherapy. We describe a 73-year-old man who was diagnosed with high-grade neuroendocrine carcinoma, metastatic to the bone and lymph nodes, and was undergoing hemodialysis. Although cisplatin is more commonly used in the treatment of metastatic neuroendocrine cancers, it may not be the best option in patients who suffer from renal insufficiency. Carboplatin is a second-generation, nonnephrotoxic platinum analog that can be hemodialyzed, although no formal guidelines are available regarding the dosing for patients receiving hemodialysis. This case describes a patient who was treated with five cycles of combination carboplatin 115 mg/m(2) on day 1 and etoposide 50 mg/m(2) on day 1 and day 3 of a 28-day cycle. Dialysis was performed for 3.5 hours starting 90 minutes after completion of carboplatin on day 1. Pharmacokinetic assessments were performed at 1, 2, 4, and 12 hours after chemotherapy infusion on day 1 of cycle 1. Total carboplatin concentrations in plasma and platinum ultrafiltrate were measured. The plasma concentration of free platinum at the end of the infusion was 31,000 ng/ml, and the area under the plasma concentration-time curve was 2.9 minute·mg/ml. No significant carboplatin-related toxicities were reported. This case report indicates that carboplatin can be safely administered in patients receiving hemodialysis. PMID:24037992

Fong, Mei Ka; Fetterly, Gerald J; McDougald, Lori J; Iyer, Renuka V

2014-02-01

125

Continous venovenous hemodialysis (CVVHD): Report of 3 cases  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Some of ICU patients with Acute Renal Failure (ARF) require dialysis. Conventional or intermittent hemodialysis (HD) may cause hypotension and insufficient loss of fluids and toxins from blood. Peritoneal dialysis also my cause peritonitis and has lower efficiency than HD. We did continuous Venovenous Hemodialysis (CVVHD) for three ICU patients with ARF in Saint-Zahra Medical Center for the first time in our country. Method and Material: With a polysulfone membrane, blood pump, peritoneal dia...

Seirafian Sh; Bastani B

1998-01-01

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

CERN Document Server

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

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

2012-01-01

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

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Objectives: The purpose of the study was to evaluate a live and online training program for first year pharmacy students in implementing Continuing Professional Development (CPD) principles (Reflect, Plan, Act, and Evaluate), writing SMART learning objectives, and documenting learning activities prior to and during a hospital introductory professional practice experience.Design: Cohort Study. Setting: Introductory professional practice experience. Participants: First year (PY1) students at th...

Toyin Tofade, Ms; Brianna Franklin, Student; Bennett Noell, Student; Kim Leadon, Med

2011-01-01

128

[Chronic hemodialysis in children].  

Science.gov (United States)

The clinical features of eight patients, four females, aged 4 to 15 years under chronic hemodialysis for terminal renal failure (creatinine clearance 10 ml.min.1,73 m2 or less) are reported. Initial diseases were Alport syndrome, systemic lupus erythematosus, chronic glomerulonephritis (n = 2), bilateral polycystic kidney, prune belly syndrome and reflux nephropathy (n = 2). Distal vascular approach by means of arteriovenous fistulas was preferred for these patients and the kinetic urea model was used to evaluate the performance of the procedure. Patients required nine to twelve hours of hemodialysis per week for optimal results. Mean weight decreases of 1 to 3 kg and reductions in blood urea nitrogen and serum potassium of 40 mg.dl and 2,5 mEq.1, respectively, were observed. The main complications of hemodialysis were the disequilibrium syndrome, infections at the site of insertion of the arteriovenous fistulae and congestive heart failure. Three patients were submitted to renal transplantation with live donors homografts: one died and the other two remain alive but under chronic hemodialysis. Five children are attending school regularly, and two of them are waiting a kidney donor for transplantation. Despite encouraging results chronic hemodialysis in children constitutes only primary supportive therapy prior to renal transplantation. PMID:2087591

Delucchi, M A; Wolff, E; Cano, F; Varela, M; Rodríguez, E; Sandoval, L; Bustos, G

1990-01-01

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Ultrasound-guided bilateral paravertebral continuous nerve blocks for a mildly coagulopathic patient undergoing exploratory laparotomy for bowel resection.  

Science.gov (United States)

Regional anesthesia techniques commonly utilized in post-operative pain management are often considered contraindicated in coagulopathic patients. We report on successful postoperative pain control utilizing peripheral nerve blockade after exploratory laparotomy with small bowel resection in a mildly coagulopathic patient. In our case, complicated by abnormal PT, PTT and INR, a thromboelastogram (TEG) was performed before the procedure and found to be normal. An ultrasound-guided bilateral paravertebral blockade with continuous paravertebral catheters was then performed in this pediatric patient without complications. The patient expressed satisfaction with his pain control. More studies are needed to evaluate the validity of TEG in the prediction of bleeding risk and the safety of this regional technique in a mildly coagulopathic patients. PMID:21241416

Visoiu, Mihaela; Yang, Charles

2011-04-01

130

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

Directory of Open Access Journals (Sweden)

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

Toyin Tofade, MS, PharmD, BCPS, CPCC, Pharmacotherapy Director, Wake Area Health Education Center and Clinical Associate Professor, Division of Pharmacy Practice and Experiential Education

2011-01-01

131

The bioinstrumentation of hemodialysis.  

Science.gov (United States)

This paper is designed to introduce the nondialysis nurse to the world of the hemodialysis patient through an overview of its bioinstrumentation. The aim of this paper is not to make a dialysis specialist of all who read it, but rather to assist the nurse--through an understanding of the basic principles of dialysis, the artificial kidney machine, and its component parts--to feel comfortable around the dialysis machine. The outcome will be to improve the quality of care given to the patient who is receiving hemodialysis. PMID:252714

McNamara, R M

1978-12-01

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

Directory of Open Access Journals (Sweden)

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

2011-12-01

133

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

Scientific Electronic Library Online (English)

Full Text Available 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.

134

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

Scientific Electronic Library Online (English)

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

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

135

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

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

Md. Ashraf Abd Elmawgoud

2008-01-01

136

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  

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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.

137

Nosocomial infective endocarditis in hemodialysis.  

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There is an increased risk of infective endocarditis catheterization used for hemodialysis. We report a case of a young man who had endocarditis secondary to the use of a permanent jugular catheter for hemodialysis. Blood cultures were repeatedly negative, but vegetations were seen on the tricuspid valve on echocardiography. A high index of suspicion is recommended for this serious complication. PMID:17660659

Bhat, Abdul Wahid; Solangi, Shamus-Ud-Din; Murtada, Osman

2002-01-01

138

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

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Full Text Available 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.

2010-06-01

139

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

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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.

Ahmet Yilmaz

1992-01-01

140

Echocardiography in Hemodialysis Patients: Uses and Challenges.  

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Patients with end-stage renal disease undergoing hemodialysis have high rates of morbidity and mortality. Cardiovascular disease accounts for almost half of this mortality, with the single most common cause being sudden cardiac death. Early detection of abnormalities in cardiac structure and function may be important to allow timely and appropriate cardiac interventions. Echocardiography is noninvasive cardiac imaging that is widely available and provides invaluable information on cardiac morphology and function. However, it has limitations. Echocardiography is operator dependent, and image quality can vary depending on the operator's experience and the patient's acoustic window. Hemodialysis patients undergo regular hemodynamic changes that also may affect echocardiographic findings. An understanding of the prognostic significance and interpretation of echocardiographic results in this setting is important for patient care. There are some emerging techniques in echocardiographic imaging that can provide more detailed and accurate information compared with conventional 2-dimensional echocardiography. Use of these novel tools may further our understanding of the pathophysiology of cardiac disease in patients with end-stage renal disease undergoing hemodialysis. PMID:24751169

Chiu, Diana Y Y; Green, Darren; Abidin, Nik; Sinha, Smeeta; Kalra, Philip A

2014-11-01

 
 
 
 
141

Dose adjustment of carboplatin in patients on hemodialysis.  

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Carboplatin is one of the most prescribed cytotoxic drug, which is extensively used in the treatment regimens of several malignancies. The therapeutic efficiency of carboplatin has been found to correlate the area under curve (AUC). The Calvert formula has been extensively used to determine the dose of carboplatin for a fixed AUC and glomerular filtration rate (GFR). This formula has also been used in patients with end-stage renal disease on hemodialysis by assuming that the GFR is zero. This is applicable to patients who receive hemodialysis within 12-18 h after carboplatin infusion. After the first 24 h, a majority of the carboplatin is bound to proteins is not easily dialyzable and hence continues to remain in the blood stream despite repeated sessions of hemodialysis. We derive a correction factor to calculate the resultant AUC in such patients. The analysis done by using this correction factor shows that the AUC can increase by eightfold in patients who received the adjusted dose but whose hemodialysis was delayed beyond 24 h after infusion. The correction factor proposed here can also be used to calculate the dose adjustment required a priori in patients who may receive delayed hemodialysis. It is also useful to predict the AUC and estimate the resultant toxicity in such patients. PMID:24452283

Guddati, Achuta K; Joy, Parijat S; Marak, Creticus P

2014-03-01

142

Pulmonary hypertension is prevalent in catheter and arterio-venous access hemodialysis  

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Full Text Available Pulmonary hypertension (PH has been described in patients undergoing hemodialysis and proposed to arise from overflow in arterio-venous grafts or fistulae. Whether PH is prevalent in patients undergoing catheter-based dialysis is unknown. Patients undergoing hemodialysis with an echocardiogram in two urban dialysis centers over a four-year period were included. Demographic data, comorbidities, dialysis access, laboratory and echocardiographic data were collected. A right ventricular systolic pressure of ?45 mmHg defined PH. Forty out of ninety-one (44% patients met the criteria for PH. The prevalence of catheter-based hemodialysis was similar in the two groups (30% in the PH vs. 33% in the no-PH group. PH patients were more likely to have extended hemodialysis vintage (52.6±58.2 vs. 31.0±33.7 months, P less than 0.05. Advanced left heart disease was not more prevalent in patients with PH although they were more likely to have right atrial and right ventricular enlargement (P less than 0.05. Mean serum phosphate was lower in the PH group (4.7±1.4 vs. 5.5±1.8 mg/dL, P less than 0.05. On multivariate analysis, lower phosphate levels were associated with higher risk of PH. We concluded that PH is prevalent in hemodialysis regardless of access type and may be because of disordered calcium and phosphate metabolism.

Paul Hassoun

2010-11-01

143

Amyloid osteoarthropathy in long term hemodialysis patients  

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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

144

Carotid intima-media thickness and left ventricular hypertrophy in hemodialysis patients  

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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.

Rafieian-Kopaei Mahmoud

2013-10-01

145

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

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

Ehteram Sadat Ilali

2011-12-01

146

Correlation of Serum Magnesium with Serum Parathormone in Regular Hemodialysis Patients  

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Full Text Available To consider the relationship of serum magnesium with the activity of the parathyroid gland in maintenance hemodialysis patients we designed a study to investigate the role of serum magnesium in regulating the parathyroid secretion. The study was conducted on patients undergoing maintenance hemodialysis treatment. Predialysis serum calcium, phosphorus, magnesium, alkaline phosphatase, intact serum PTH (iPTH, serum 25-hydroxy vitamin D (25-OH Vit D and plasma HCO3– were measured. The Urea Reduction Rate, duration and dosage of hemodialysis treatment were calculated also. In this study no significant correlation of serum magnesium with duration of hemodialysis treatment, alkaline phosphatase, plasma HCO3–, serum calcium and phosphorus patients were seen. In all patients a near significant inverse correlation of serum magnesium with iPTH (r = -0.30 , p = 0.079 was found, also a significant positive correlation of serum magnesium with serum 25-hydroxy vitamin D levels ( r = 0.40, p = 0.009 was seen. Earlier research concluded that some factors other than serum magnesium may be more important in the regulation of parahormone secretion in hemodialysis patients. A positive and strong association between serum magnesium with 25-hydroxy vitamin D level, needs to more attention to this aspect of hemodialysis patients.

Hamid Nasri

2006-01-01

147

The Role of Interventional Radiology in a Comprehensive Hemodialysis Program: The Access Surgeon's View  

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The successful hemodialysis program addressing the complex needs of the dialysis patient population employs a collaborative effort among the medical nephrologist, access surgeon, and interventional radiologist. It is imperative that all team members understand the basic tenets of hemodialysis access and afford open and continuous communication to achieve the best results. This monograph will serve to highlight the access surgeon's view of the optimal integration of the interventional radiolog...

Katz, Daniel

2004-01-01

148

Biofeedback systems and adaptive control hemodialysis treatment  

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

Azar Ahmad

2008-01-01

149

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  

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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.

2014-04-01

150

Tandem hemodialysis and plasma exchange.  

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The combination of hemodialysis and plasma exchange as one tandem procedure was first described in 1999 by Siami et al. (ASAIO J 45:229-233), but larger pediatric case series were not described until 2012. Even in adults, there are only limited case series. If performed in sequence, up to 8 h of treatment time may be required. With the use of the tandem procedure in stable patients, the same procedures can be completed during the same time as a routine hemodialysis, which is more convenient for patients and may reduce healthcare costs. Little is known about the utilization of the combination of hemodialysis and plasma exchange in children. The purpose of this review is to summarize the adult and scarce pediatric experience. The results of a survey carried out by the authors using the Internet listserver "PedNeph" to obtain an overview of the current practice patterns of pediatric nephrologists are also presented. PMID:24022368

Filler, Guido; Clark, William F; Huang, Shih-Han S

2014-11-01

151

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

International Nuclear Information System (INIS)

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

152

Technical aspects of home hemodialysis  

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

Alhomayeed B

2009-01-01

153

Compartment effects in hemodialysis.  

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Compartment effects in hemodialysis are important because they reduce the efficiency of removal of the compartmentalized solute during dialysis. The dialyzer can only remove those waste products that are presented to it, and then only in proportion to the concentration of the solute in the blood. Classically a two-compartment system has been modeled, with the compartments arranged in series. Because modeling suggests that the sequestered compartment is larger than the accessible compartment, an assumption has been made that the sequestered compartment is the intracellular space. For urea and other solutes that move easily across many cell membranes, compartmentalization may be flow related, that is, related to sequestration in organs (muscle, skin, bone). Although mathematically urea rebound and mass balance can be described with either model, the flow-related model best explains data showing that urea rebound after dialysis is increased during ultrafiltration, diminished during high cardiac output states, and also reduced during exercise. Whether compartmentalization is increased in vasoconstricted intensive care unit patients receiving acute dialysis remains an open question. PMID:11489202

Schneditz, D; Daugirdas, J T

2001-01-01

154

Malnutrition in hemodialysis patients.  

Science.gov (United States)

Increasing attention has been paid recently to the problem of protein and energy malnutrition and its effects on mortality and morbidity in hemodialysis (HD) patients. Protein deficiency has received more attention than other nutritional problems, largely because its consequences are more easily measured and large population studies have demonstrated the adverse effects of even small decreases in serum albumin on patient's survival. This review discusses these findings and presents other indicators of early malnutrition, which range from static measurements of plasma constituents such as transferrin and insulin-like growth factor 1 (IGF-1), kinetic measurements of protein catabolic rate (PCR) derived from urea kinetic modeling, and noninvasive measurements of body composition. In addition, the predialytic and dialytic factors that influence nutritional status, including the adverse effects of uremia, inadequate dialysis, membrane bioincompatibility, and intercurrent illness requiring hospitalization, as well as socioeconomic factors, are discussed. While some of these are difficult to deal with, the review emphasizes simple interventions that are likely to benefit the patient, including the delivery of optimal dialysis, appropriate choice of medications, and dietary interventions. Once malnutrition is established, parenteral nutrition may reverse the objective evidence of malnutrition, but its effects on survival have not yet been documented. Finally, the review addresses the effects of therapeutic substances such as growth hormone (GH) and erythropoietin (EPO) in combination with nutrients that at present appear to be favorable but are still being evaluated. PMID:8430672

Hakim, R M; Levin, N

1993-02-01

155

Referral pattern of hemodialysis patients to nephrologists  

International Nuclear Information System (INIS)

To determine the referral pattern of dialysis patients to nephrologists and the effects of late referral on clinical, hematological and biochemical parameters in patients presenting for the first-time to dialysis center. This study was conducted on all patients of end stage renal diseases presenting for the first-time for undergoing hemodialysis at our center. Patients with acute renal failure were excluded from the study. At presentation, a history was taken from all the patients regarding seeking of nephrology services and referral pattern. Early and late referral was defined as the time of first referral or admission to a nephrologists greater or less than six months respectively before initiation of hemodialysis. All the patients were examined and their blood sample was drawn at the same time for routine hematological, biochemical parameters (urea, creatinine, serum potassium, calcium, phosphate and albumin) and viral markers (Anti HCV and HbsAg). In this study, 248 patients were enrolled, amongst them, 131 (52.8%) were male and 117 (47.2%) were female. Major causes of renal failure were diabetes mellitus, chronic glomerulonephritis and hypertension. Most of the patients were euvolemic and hypertensive. Sixty percent of patients were having very high urea (>200 mg/dl) and creatinine (>8.0 mg/dl). Most of the patients, 226 (91.1%), were anemic (Hemoglobin <11gm/dl) and 224 (90%) were hypoalbuminemic (serum albumin < 4gm/dl) on first presentation. Majority of 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)

156

Rising burden of Hepatitis C Virus in hemodialysis patients  

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

Naseemullah

2011-09-01

157

Negotiating living with an arteriovenous fistula for hemodialysis.  

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The purpose of this study was to examine how clients with end stage renal disease on hemodialysis negotiate living with an arteriovenous fistula. A fistula is the preferred access for hemodialysis, and clients must continually monitor and protect their fistula. In this qualitative, ethnographic study, data were collected during fieldwork and semistructured interviews. Constructivism and a cultural negotiation model provided frameworks for the study. Fourteen clients were interviewed; interviews lasted 1.5 to 4 hours. Results revealed new insights into informants'perspectives and experiences with a vascular access. The overarching theme was vulnerability, and underlying themes were body awareness, dependency, mistrust, and stigma. The response to vulnerability was to be continually vigilant and assertive to protect the holistic self Stigma of the vascular access was an important issue for informants and evoked the greatest emotional responses. PMID:20830944

Richard, Cleo J; Engebretson, Joan

2010-01-01

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ADIPONECTIN LEVELS AND ATHEROSCLEROTIC RISK FACTORS IN CHILDREN ON HEMODIALYSIS  

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

159

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

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Serum cholesterol binding reserve (SCBR, the capacity of the serum to solubilize additional cholesterol), high density lipoprotein cholesterol (HDL . Ch) and serum levels of cholesterol and triglycerides were measured in 53 chronically uremic patients (40 men and 13 women) undergoing maintenance hemodialysis. The values were compared with those of controls (149 men and 28 women) matched for serum lipid levels. Hypertriglyceridemia and decreased HDL . Ch were observed among the patients, confirming previous reports. SCBR values of the patients were not significantly different from those of controls except in a small subgroup of uremic diabeties, whose SCBR values were markedly decreased. There was a positive correlation between SCBR and the duration for which the patients had been maintained by hemodialysis. The results suggest that patients with higher SCBR values have a better prospect for surviving long duration of hemodialysis. PMID:7429416

Perez, G O; Hsia, S L; Christakis, G; Burr, J

1980-09-01

160

Seasonal variation of blood pressure in maintenance hemodialysis  

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Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Variação sazonal na pressão arterial foi relatada em estudos com indivíduos hipertensos e normotensos. Porém, a influência de variação sazonal na pressão sangüínea de pacientes em hemodiálise não foi relatada. Neste estudo nós investigamos a variação sazonal da pressão sangüínea no Brasil, [...] um país tropical, em pacientes em programa de hemodiálise. TIPO DE ESTUDO: Estudo clínico prospectivo. LOCAL: Unidade de diálise de um centro médico terciário (Hospital de ensino da Faculdade de Medicina da Universidade de São Paulo ¾ São Paulo ). PACIENTES: 16 pacientes com insuficiência renal crônica em programa de hemodiálise. VARIÁVEIS: Registro da pressão arterial, peso corpóreo e temperatura ambiente durante seis sessões de hemodiálise, realizadas em 13 dias durante as quatro estações do ano. RESULTADOS: A pressão arterial diastólica foi menor no verão que no outono e inverno (95 ± 8 vs 107 ± 10 e 101 ± 10 mmHg, respectivamente; p Abstract in english CONTEXT: Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported. OBJECTIVE: To investigate the seasonal variation of blood press [...] ure in Brazil, a tropical country, in patients on hemodialysis. DESIGN: Prospective, cohort study. SETTING: Dialysis unit of a tertiary medical center (a teaching hospital of the University of São Paulo School of Medicine, São Paulo). PATIENTS: Sixteen patients with chronic renal failure undergoing hemodialysis. OUTCOMES: Blood pressure, body weight, and ambient temperature were evaluated during 6 hemodialysis sessions carried out on 13 days during the four seasons. RESULTS: The diastolic blood pressure was lower in summer than in fall and winter (95 ± 8 vs 107 ± 10 and 101 ± 10 mmHg, respectively; p

Manuel Carlos Martins de, Castro; Décio, Mion Jr.; Marcello, Marcondes; Emil, Sabbaga.

1774-17-01

 
 
 
 
161

Index of coexisting disease and old age as predictors of survival in hemodialysis patients  

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Full Text Available Objective: To identify the factors that may influence survival inpatients on chronic hemodialysis at a private hospital in Brazil.Methods: In this study, 99 patients in the CDE (Hemodialysis Unitof Hospital Albert Einstein undergoing chronic hemodialysis for atleast 3 months were evaluated retrospectively over the period fromFebruary 2000 to October 2006. The following patient characteristicswere evaluated as possibly having an influence on survival: cause ofchronic renal failure (with and without diabetes mellitus, sex, age,albumin levels, C-reactive protein (CRP, hemoglobin levels and ICED(Index of Coexisting Disease, an instrument to assess the presence andseverity of comorbidities. Statistical analysis: Survival curves werecalculated by the Kaplan-Meyer method and the differences betweenthe curves were evaluated by a log-rank test. Results: The mean ageof patients was 63.14 ± 16.18 years, 34% of them were female and40% of them presented diabetes mellitus as the cause of chronic renalfailure. Mean albumin and hemoglobin levels on admission were 3.44± 0.58 g/dl and 10.55 ± 1.51 g/dl, respectively, and median CRP levelwas 9.55 g/dl. The distribution of patients by ICED was mild (25%,moderate (36% and severe (38%. Thirty-three (33% patients died,24 (24% underwent renal transplantation, 5 (5% were transferredto another dialysis unit, 36 (36% continued dialysis treatment and1 (1% recovered renal function. One-year survival was 80% and themedian survival period was 42.34 months (95% CI: 28.06-54.84.In univariate analysis, the following variables were associated withsurvival of patients: CRP levels on admission (RR: 1.39; 95% CI: 1.04-1.85; p = 0.026, age (RR: 1.049; 95% CI: 1.017-1.082; p = 0.028and the level of ICED 3 compared with the level of ICED 1 (RR: 9.25;95% CI: 1.23-69.48; p = 0.03. In multivariate analysis, the followingvariables were associated with survival of patients: age (p = 0.0025and severe ICED compared with mild ICED (p = 0.0341. Conclusion:The factors associated with survival of patients were advanced ageand severity of comorbidities. The utilization of ICED enables stratifyingthe dialysis patients according to severity of their comorbidities andit is useful to identify the patients with a greater risk of death andhospitalization, as well as to aid in the forecast of and optimization ofresources necessary for their treatment.

Miguel Cendoroglo Neto

2007-09-01

162

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

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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.

163

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

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Fourty three patients with chronic renal failure undergoing chronic hemodialysis in Division of Nephrology and Hypertension, Faculty of Medicine, University of Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, since October 2003 until February 2004, were examined for echocardiography (2-D, M-mode, Doppler imaging).Diastolic dysfunction was found in 58.1 % of chronic renal failure patients on hemodialysis. There was no significant difference between left ventricular mass in the group with or ...

Idrus Alwi; Harun, S.; Prabowo, H.; Soehardjono Soehardjono; Trisnohadi, Hb B.; Rahman, A. M.; Dasnan Ismail

2006-01-01

164

Traditional versus early-access grafts for hemodialysis access: a single-institution comparative study.  

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In those patients requiring urgent hemodialysis, the use of early-access grafts may reduce the need for temporary hemodialysis catheters and their resultant complications such as infection and central venous stenosis. We review a consecutive group of patients undergoing placement of a traditional polytetrafluoroethylene (PTFE) graft as compared with a cohort of patients who underwent insertion of a trilaminate PTFE vascular graft (TPVG). During the period from January 2008 to December 2009, 65 sequential patients received a traditional PTFE graft with 78 subsequent patients having a TPVG inserted. Factors examined included use of temporary hemodialysis catheters during the period of graft maturation, incidence of infection, and primary and secondary graft patency. For all patients, incidence was reported as observed during the first year after graft insertion. With the use of the TPVG, need for temporary hemodialysis catheters was reduced from 91 to 32 per cent, and 1-year overall graft patency was improved from 36 to 77 per cent (P hemodialysis catheters, decreased overall graft complication rates, and significantly improved 1-year patency. PMID:24480215

Scarritt, Thomas; Paragone, Christine M; O'Gorman, Ronald B; Kyriazis, Dimitris K; Maltese, Carl; Rostas, Jack W

2014-02-01

165

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

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

Jacek Rysz

2005-04-01

166

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

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

Hamid Nasri M.D.

2006-01-01

167

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

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

Nakao, Kaoru; Mochizuki, Hidenori

2009-05-01

168

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

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

Sepehrvand Nariman

2010-01-01

169

Urea biosensor for hemodialysis monitoring  

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An electrochemical sensor capable of detecting and quantifying urea in fluids resulting from hemodialysis procedures. The sensor is based upon measurement of the pH change produced in an aqueous environment by the products of the enzyme-catalyzed hydrolysis of urea. The sensor may be fabricated using methods amenable to mass fabrication, resulting in low-cost sensors and thus providing the potential for disposable use. In a typical application, the sensor could be used in treatment centers, in conjunction with an appropriate electronics/computer system, in order to determine the hemodialysis endpoint. The sensor can also be utilized to allow at-home testing to determine if dialysis was necessary. Such a home monitor is similar, in principle, to devices used for blood glucose testing by diabetics, and would require a blood droplet sample by using a finger prick.

Glass, Robert S. (Livermore, CA)

1999-01-01

170

Urea biosensor for hemodialysis monitoring  

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This research discloses an electrochemical sensor capable of detecting and quantifying urea in fluids resulting from hemodialysis procedures. The sensor is based upon measurement of the pH change produced in an aqueous environment by the products of the enzyme-catalyzed hydrolysis of urea. The sensor may be fabricated using methods amenable to mass fabrication, resulting in low-cost sensors and thus providing the potential for disposable use. In a typical application, the sensor could be used in treatment centers, in conjunction with an appropriate electronics/computer system, in order to determine the hemodialysis endpoint. The sensor can also be utilized to allow at-home testing to determine if dialysis was necessary. Such a home monitor is similar, in principle, to devices used for blood glucose testing by diabetics, and would require a blood droplet sample by using a finger prick. 9 figs.

Glass, R.S.

1999-01-12

171

Production of cytokines in hemodialysis.  

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Tumor necrosis factor (TNF-alpha) and interleukin-1 (IL-1 beta) are cytokines primarily produced by monocytes/macrophages when stimulated by endotoxin, complement-derived anaphylatoxins and the specific antigen. In the present study, the plasma levels of TNF-alpha and IL-1 beta were evaluated before and after hemodialysis with cuprophane membrane (in 9 patients) and hemodiafiltration (in 9 patients) using three high-permeability membranes such as polymethylmethacrylate, polyacrylonitrile (AN-...

Camussi, Giovanni; Vercellone, Antonio; Segoloni, Giuseppe

1990-01-01

172

Current international status of home hemodialysis.  

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Three times weekly home hemodialysis (HHD) was introduced shortly after the initiation of chronic hemodialysis (HD) treatment in 1960. HHD eliminates the need of transportation to and from the dialysis unit and by allowing patients to set their own dialysis schedule, decreases the burden of treatment on their personal and professional lives. HHD has been found more economical and more highly associated with better patient survival than in-center dialysis. Nevertheless, the global prevalence of HHD decreased between 1980 and 2000 due to the increased availability of dialysis units and continuous ambulatory peritoneal dialysis, advances in cadaveric kidney transplantation, and several other factors. However, the availability of HHD at a frequency of more than 3 times/week, the typical frequency of conventional HD (CHD), in such forms as brief HD sessions of 2-3 h 5-6 days/week and nocturnal HD (NHD) has led to reversals in this trend. Frequent HHD, such as short daily HD (SDHD) and NHD instead of 3 times/week CHD, has been found to significantly improve hypertension, left ventricular mass, renal anemia, quality of life and mortality. On the other hand, NHD has been found to significantly improve hypertension, left ventricular mass, renal anemia, quality of life, malnutrition, mortality and phosphate clearance. Many observational clinical studies and one randomized controlled trial of SDHD and/or NHD have been conducted, and compact and convenient dialysis machines have been developed and used for HHD. The most recent data reported in the national and local registries of selected countries indicate that the prevalence of HHD among all dialysis patients from 2008 to 2010 varied from 0 to 3.3% except in New Zealand and Australia, where it was 16.3 and 9.3%, respectively. As HHD appears to be a more effective and economical dialysis modality than in-center CHD, its prevalence is likely to increase in the future. PMID:22613921

Saito, Akira; Ohta, Yoriko; Sato, Kazuhiro; Ichinose, Mayuri; Arii, Tatsuro; Toyama, Katsuhide

2012-01-01

173

Colonization of temporary hemodialysis catheters  

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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.

?eref Yüksel

2006-01-01

174

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

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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.

2014-06-01

175

Maintenance Intravenous Iron Sucrose Therapy in Children Under Regular Hemodialysis  

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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.

Mohamed Ragab

2007-01-01

176

Continous venovenous hemodialysis (CVVHD: Report of 3 cases  

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Full Text Available Some of ICU patients with Acute Renal Failure (ARF require dialysis. Conventional or intermittent hemodialysis (HD may cause hypotension and insufficient loss of fluids and toxins from blood. Peritoneal dialysis also my cause peritonitis and has lower efficiency than HD. We did continuous Venovenous Hemodialysis (CVVHD for three ICU patients with ARF in Saint-Zahra Medical Center for the first time in our country. Method and Material: With a polysulfone membrane, blood pump, peritoneal dialysis solution, heparin, and a fix nurse, HD was done for 12-24 hours. Results: 1 Urea clearance was 18-50 ml/h. 2 Ultrafiltration was 160-1000 ml/h. 3 With dialysis, hemorrhage, coagulation disorder, and oxygenation recovered. 4 All of patients developed hyperglycemia and hypothermia. 5 All of patients died (two with septicemia and one with hypotension. Conclusion: In the absence of hemodialysis or peritoneal dialysis, CVVHD with present preliminary equipments is suitable and can excrete more toxins and fluids.

Seirafian Sh

1998-07-01

177

Prevalence of nursing diagnosis of fluid volume excess in patients undergoing hemodialysis / Prevalência do diagnóstico de enfermagem Volume de líquidos excessivo em pacientes submetidos à hemodiálise* / Prevalencia del diagnóstico de enfermería exceso de volumen de líquidos en pacientes sometidos a hemodiálisis  

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Full Text Available SciELO Brazil | Language: English Abstract in spanish Objetivo: Identificar la prevalencia del diagnóstico de enfermería Exceso de volumen de líquidos y sus características definitorias en pacientes sometidos a hemodiálisis y verificar la asociación entre ambos. Método: Estudio transversal, realizado en dos etapas. Se entrevistaron 100 pacientes, entre [...] los meses de diciembre de 2012 y abril de 2013, de un hospital universitario y de una clínica de hemodiálisis. La inferencia diagnóstica fue realizada por enfermeros diagnosticadores, entre julio y septiembre de 2013. Resultados: El diagnóstico estudiado fue identificado en 82% de los pacientes. Las características que presentaron asociación estadística fueron: agitación, congestión pulmonar, distensión de la yugular, edema, electrolitos alterados, aumento de peso, ingesta mayor a las pérdidas y sonidos adventicios. Entre estos, el edema y el aumento de peso presentan mayor relación para la formulación del diagnóstico. Conclusión: Se concluye que el diagnóstico analizado es prevalente en esta población y que presentó asociación significativa con ocho características.? Abstract in english Objective: To identify the prevalence of nursing diagnosis of fluid volume excess and their defining characteristics in hemodialysis patients and the association between them. Method: Cross-sectional study conducted in two steps. We interviewed 100 patients between the months of December 2012 and Ap [...] ril 2013 in a teaching hospital and one hemodialysis clinic. The inference was performed by diagnostician nurses between July and September 2013. Results: The diagnostic studied was identified in 82% of patients. The characteristics that were statistically associated: bounding pulses, pulmonary congestion, jugular vein distention, edema, change in electrolytes, weight gain, intake greater than output and abnormal breath sounds. Among these, edema and weight gain had the highest chances for the development of this diagnostic. Conclusion: The analyzed diagnostic is prevalent in this population and eight characteristics presented significant association.?

Maria Isabel da Conceição Dias, Fernandes; Ana Beatriz de Almeida, Medeiros; Beatriz Medeiros de, Macedo; Ana Beatriz Ferreira, Vitorino; Marcos Venícios de Oliveira, Lopes; Ana Luisa Brandão de Carvalho, Lira.

178

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

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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.

Azar BARADARAN

2011-12-01

179

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

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Chronic kidney disease (CKD) is a worldwide public health problem and is associated with high morbidity and mortality. The majority of patients with CKD stage 5 (CKD-5), who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically created access sites. Native fistulae are preferred over grafts due to their longevity. More than half of these vital portals for dialysis access will fail over time. Screening procedures to select high-risk patients before thrombosis or ste...

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

2012-01-01

180

Hepatitis B Infection in Hemodialysis Patients in Tehran Province, Iran  

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Full Text Available Background and Aims: Hemodialysis (HD patients seem to be at considerable risk of acquiring HBV infection. This study was carried out to determine the seroprevalence of hepatitis B virus (HBV infection in hemodialysis patients living in the province of Tehran and to investigate the association between viral hepatitis B and the probable risk factors for HD patients..Methods: From June to August 2005, this study was done on the entire HD population of the province of Tehran (2630 patients; 1505 males and 1125 females, mean age: 53.4 years. Social and demographic data, date of onset of HD, length of time receiving HD services, history of a kidney transplant, multiple sex partners, and other probable risk factors were evaluated. Blood samples were tested for liver enzyme levels as well as human immunodeficiency virus (HIV 1, HIV 2, hepatitis B surface antigen (HBsAg, hepatitis B surface antibody (anti-HBs, and hepatitis C antibody (anti-HCV..Results: A total of 64 patients were HBsAg positive (2.4%. The male-to-female ratio was 45/19 for HBsAg-positive patients and 1462/1104 for the remaining patients (P = 0.03, respectively. Except for nationality (P < 0.001, previous kidney transplants (P < 0.001, age (P < 0.001, and transient HD (P < 0.001, no association was found between HBV infection and probable risk factors..Conclusions: Common erythropoietin administration, blood testing for transfusion purposes, implementation of universal precaution in dialysis units as well as the use of dedicated machines for HBV-infected patients has led to a decreasing trend of HBV infection. Periodic surveillance of HBV infection among patients undergoing hemodialysis is strongly recommended.

Mitra Mahdavimazdeh

2009-09-01

 
 
 
 
181

Quality of Life, Pain and Depression in Patients with Hemodialysis  

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Full Text Available Objective: We aimed to evaluate the quality of life, severity of pain and psychological states of patients with end stage chronic renal disease undergoing hemodialysis and to make a correlation analysis between subitems of Short Form-36 (SF-36 and severity of pain and depression. Materials and Methods: Fifty-two patients with hemodialysis and 54 controls were enrolled in the study. The social and demographic characterictics of the patients were evaluated by semi structured form. All of the patients and control cases underwent Visual Analog Scala (VAS, Beck Depression Inventory (BDI and SF-36.Results: There was no statistical difference between the patients and control cases according to demographical data (p>0.05. The SF-36 scores of the study patients were significantly lower than controls except in the Physical Role (PR score (p0.05 score (p<0.01. The pain by VAS score was found to negative correlate with the SF-36 subitems of PR (r=-0.37, p<0.01, Pain (r=-0.35, p<0.05 and Social Function (r=-0.35, p<0.01. Furthermore, it was found that a negative correlation between duration of dialysis and Physical Function score (r=-0.42, p<0.01 and positive correlation between duration of dialysis and vitality score (r= 0.35, p<0.05.Conclusion: The follow-up criteria of the patients with hemodialysis should be questioned by quality of life and emotional states. Depression should be evaluated and if present it should be treated properly.

Ferhan Canturk

2008-09-01

182

Recent advances in the management of hemodialysis patients: a focus on cardiovascular disease.  

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The number of patients requiring chronic hemodialysis is rapidly growing worldwide. Hemodialysis both greatly reduces quality of life and is associated with extremely high mortality rates. Management of care of patients requiring chronic hemodialysis is complex, and randomized controlled trials aimed at reducing primary outcomes of cardiovascular disease events, mortality, or both in this population have largely been unsuccessful. Topics of major concern in the management of maintenance hemodialysis patients as related to these outcomes include the overall cardiovascular disease burden, blood pressure control, anemia, abnormalities in mineral metabolism, and inflammation. The focus of this review is a discussion of these topics on the basis of current recommendations from major organizations, expert opinion, and the available randomized controlled trials to date. These issues are further complicated by sometimes conflicting observational and randomized controlled trial data. Overall, treatment options for reducing these endpoints in maintenance hemodialysis patients are limited, and future randomized controlled trials are essential to continuing to advance care in this population, with the goal of ultimately improving hard outcomes. Such trials should consider new therapies to better target these factors, additional risk factors that have not been well tested to date, and therapies with new targets, including inflammation. PMID:25165571

Jablonski, Kristen L; Chonchol, Michel

2014-01-01

183

B-type (brain natriuretic peptide and pruritus in hemodialysis patients  

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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

Shimizu Y

2014-08-01

184

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

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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)

185

Strong Inverse Association of Serum Parathormone with Plasma HCO3 in Female Hemodialysis Patients  

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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

2005-01-01

186

Hemodialysis-related arthropathy. A prospective MR study with SE and GRE sequences  

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Purpose: A prospective examination of hemodialysis-related arthropathy by MR imaging with SE and GRE sequences was undertaken to verify whether the low signal intensity on T2-weighted SE images is caused by a paramagnetic susceptibility effect derived from amyloid or from hemosiderin. Material and Methods: Twenty-seven joints (19 hip joints, 6 discovertebral joints of 5 lumbosacral spines and 1 cervical spine, 2 shoulder joints) in 14 patients undergoing long-term hemodialysis (duration 10-22 years, mean 17) were examined with SE T1-weighted, T2-weighted and GRE T2*-weighted sequences. Results: The signal intensity of the intraarticular and periarticular masses of the involved joints was basically isointense to the muscle in all 3 pulse sequences. No significantly low signal area was found on GRE T2*-weighted images. Conclusion: The low signal areas in the hemodialysis-related arthropathy on SE T2-weighted images are not caused by a paramagnetic susceptibility effect, but probably by the hypocellular and fibrous nature of amyloid-containing tissues. Therefore the GRE sequence can be helpful for differentiating hemodialysis-related amyloid arthropathy from chronic hemarthrosis or juxta-articular brown tumor. (orig.).

Karakida, O. [Shinshu Univ. School of Medicine, Dept. of Radiology, Matsumoto (Japan); Aoki, J. [Shinshu Univ. School of Medicine, Dept. of Radiology, Matsumoto (Japan); Kanno, Y. [Aizawa Hospital, Dept. of Haemodialysis, Matsumoto (Japan); Watanabe, T. [Saku Central Hospital, Dept. of Radiology, Saku (Japan); Tamura, K. [Shinonoi General Hospital, Dept. of Internal Medicine Nagano (Japan); Suk Seo, G. [Shinshu Univ. School of Medicine, Dept. of Radiology, Matsumoto (Japan); Sone, S. [Shinshu Univ. School of Medicine, Dept. of Radiology, Matsumoto (Japan)

1997-01-01

187

Radiology of the kidneys in patients under maintenance hemodialysis  

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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.)

188

Hemodialysis as a rite of transition  

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Full Text Available This article intends to explore the conceptual and practical application of the rites of transition model in the care of renal patients on hemodialysis treatment in our cultural environment. An ethnographic approach and narrative qualitative methodology were used, with an interpretation grounded in the constructivist paradigm. By convenient sampling, twelve patients on hemodialysis treatment were selected The immersion in hemodialysis culture and the observation process were done in the hemodialysis unit and also at patients’ home , where the in-depth interviews were carried out. The analysis of patients’ narratives shows the three stages of the rites of transition: separation, transition and reincorporation. The metaphoric usefulness of this model’s application and its possible influence on the quality of care offered to these patients is argued.

Esperanza Vélez Vélez

2006-03-01

189

Hemodialysis versus peritoneal dialysis: epidemiologic and demographic characteristics  

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Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: The preferred modality of dialysis is a controversial issue in nephrology. In this study we compare some demographic and epidemiological characteristics of hemodialysis and peritoneal dialysis patients in an attempt to analyze this issue."n"n Methods: The results of the research protocol "A survey of the epidemiological characteristics of chronic dialyzed patients in Khorassan province", was used to compare some demographic and epidemiological aspects of chronic hemodialysis and peritoneal dialysis patients in search of any statistically significant difference."n"n Results: A total of 836 chronic dialysis patients entered this study, 802 (95.9% of which were under chronic hemodialysis, and 34 (4.1% patients were undergoing peritoneal dialysis, with 339 (42.3% and 12 (35.3% being female, respectively. The mean age for each group was 47.57 and 46.75 years, respectively. The causes of end-stage renal disease in hemodialzed patients were most commonly hypertension (32.2%, followed by diabetes mellitus (22.3%, unknown causes (19.6% and chronic glomeru-lonephritis (10.2%. In the peritoneal dialysis group, chronic glomerulonephritis (32.4% was the most common reason for dialysis, followed by diabetes mellitus (26.5% and unknown causes (11.8%. The mean serum hemoglobin creatinine, calcium, and phosphorus levels for hemodialysis patients were 10.42, 8.5, 8.93, and 6.03 mg/dL, respectively, and those for peritoneal dialysis patients were 11.28, 8.52, 9.41 and 5.40 mg/dL. There were no statistical differences between the median age, sexual distribution and mean levels of Hgb, Ca, phosphorus, creatinine, HCV antibody and HbsAg of the hemodialysis patients and those of the peritoneal dialysis patients."n"n Conclusions: The results of our study show that hemodialysis and peritoneal dialysis are similarly effective treatments. "nKeywords: End stage renal disease, Diabetes Mellitus, epidemiology, demography, glomerulonephritis, Hypertention, creatinine.

Hekmat R

2008-10-01

190

High fluoride exposure in hemodialysis patients.  

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

Bello, V A; Gitelman, H J

1990-04-01

191

Hemodialysis patients' perceptions of home hemodialysis and self-care.  

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Home hemodialysis (HHD) is an optimal option for patients requiring renal replacement therapy. It has been noted through research that this type of therapy is more cost-effective than in-centre therapies, and the benefits to patients are well documented (Harwood & Leitch, 2006). As stated by the Ministry of Health and Long-Term Care (MoHLTC), a total of 40% of renal failure patients are expected to do home dialysis (either peritoneal dialysis or HHD) by the year 2010 (Kashani & Motiwala, 2007). Even though the literature indicates that the numbers of those doing home dialysis are declining every year, there is no evidence to demonstrate why the numbers are declining. A quantitative cross-sectional descriptive study was conducted using the Patient Perception Survey and the Jo Pre-Training Assessment Tool (JPAT) to assess in-centre hemodialysis patients' perceptions regarding home dialysis, as well as their self-care ability. The two frameworks utilized were the Theory of Planned Behavior and Orem's Theory of Self-Care. According to the Theory of Planned Behavior, the 26 patients out of 49 who had positive perceptions regarding home dialysis would be expected to participate in home dialysis. However, according to the patients' responses to the domains within the JPAT, only eight out of the 26 would be considered suitable to participate in home dialysis. Only two of the domains, communication and social support, were found to be significantly related to patients'perceptions regarding home dialysis. Health care professionals need to implement interventions that incorporate assessment of communication and social support when addressing home dialysis therapy with a patient with end-stage renal disease (ESRD). PMID:20642162

Visaya, Marie Angela

2010-01-01

192

Hyperhomocysteinemia and vascular access thrombosis in hemodialysis patients: a retrospective study  

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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

Saifan C

2013-07-01

193

Survival at 1, 3, and 5 Years in Diabetic and Nondiabetic Patients on Hemodialysis  

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Full Text Available We analyzed survival of 185 adult patients on maintenance hemodialysis (9 h/wk to 12 h/wk at Emam Khomini Hospital in Ahvaz, Iran. Patient survival at 1, 3, and 5 years was 89.2%, 69.2%, and 46.8%, respectively. There was no significant difference between diabetic and nondiabetic patients in 1-year survival (87.1% versus 89.7%, P = .66. But, 3- and 5-year survival rates of diabetic patients were significantly lower than those of nondiabetic patients (52.2% versus 73.8%, P = .04; zero versus 56.9%, P < .001; respectively. Based on our findings, the survival of diabetic patients undergoing hemodialysis was much worse than survival of nondiabetic patients. Thus, prevention of diabetic nephropathy should be more emphasized; and if end-stage renal disease is present, other renal replacement therapies such as kidney transplantation must be considered as soon as possible.

Seyed Seifollah Beladi Mousavi

2010-01-01

194

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

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

Claudinei José CJGC Gomes Campos

2007-12-01

195

Hemodialysis  

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196

The Effect of Frequent Hemodialysis on Nutrition and Body Composition: Frequent Hemodialysis Network Trial  

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We investigated the effects of frequency of hemodialysis on nutritional status by analyzing the data in the Frequent Hemodialysis Network Trial. We compared changes in albumin, body weight and composition among 245 patients randomized to 6- or 3-times per week in-center hemodialysis (Daily Trial) and 87 patients randomized to 6-times per week nocturnal or 3-times per week conventional hemodialysis, performed largely at home (Nocturnal Trial). In the Daily Trial, there were no significant differences between groups in changes in serum albumin or the equilibrated protein catabolic rate by 12 months. There was a significant relative decrease in pre-dialysis body weight of 1.5 ± 0.2 kg in the 6 times per week group at one month, but this significantly rebounded by 1.3 ± 0.5 kg over the remaining 11 months. Extracellular water decreased in the 6 times per week compared to the 3 per week hemodialysis group. There were no significant between-group differences in phase angle, intracellular water or body cell mass. In the Nocturnal Trial, there were no significant between-group differences in any study parameter. Any gain in “dry” body weight corresponded to increased adiposity rather than muscle mass but was not statistically significant. Thus, frequent in-center hemodialysis reduced extracellular water but did not increase serum albumin or body cell mass while frequent nocturnal hemodialysis yielded no net effect on parameters of nutritional status or body composition. PMID:22456602

Kaysen, George A.; Greene, Tom; Larive, Brett; Mehta, Ravindra, L.; Lindsay, Robert; Depner, Tom A.; Hall, Yoshio N.; Daugirdas, John T.; Chertow, Glenn M.

2012-01-01

197

The effect of frequent hemodialysis on nutrition and body composition: frequent Hemodialysis Network Trial.  

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We investigated the effects of frequency of hemodialysis on nutritional status by analyzing the data in the Frequent Hemodialysis Network Trial. We compared changes in albumin, body weight, and composition among 245 patients randomized to six or three times per week in-center hemodialysis (Daily Trial) and 87 patients randomized to six times per week nocturnal or three times per week conventional hemodialysis, performed largely at home (Nocturnal Trial). In the Daily Trial, there were no significant differences between groups in changes in serum albumin or the equilibrated protein catabolic rate by 12 months. There was a significant relative decrease in predialysis body weight of 1.5 ± 0.2 kg in the six times per week group at 1 month, but this significantly rebounded by 1.3 ± 0.5 kg over the remaining 11 months. Extracellular water (ECW) decreased in the six times per week compared with the three per week hemodialysis group. There were no significant between-group differences in phase angle, intracellular water, or body cell mass (BCM). In the Nocturnal Trial, there were no significant between-group differences in any study parameter. Any gain in 'dry' body weight corresponded to increased adiposity rather than muscle mass but was not statistically significant. Thus, frequent in-center hemodialysis reduced ECW but did not increase serum albumin or BCM while frequent nocturnal hemodialysis yielded no net effect on parameters of nutritional status or body composition. PMID:22456602

Kaysen, George A; Greene, Tom; Larive, Brett; Mehta, Ravindra L; Lindsay, Robert M; Depner, Tom A; Hall, Yoshio N; Daugirdas, John T; Chertow, Glenn M

2012-07-01

198

Perceived Social Support in Hemodialysis Patients  

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Full Text Available Background & Aim: Physical and psychosocial problems along with the changes in life style, put hemodialysis patients under pressure. It seems that social support decreases psychological stresses and improves quality of life. This study aimed to describe hemodialysis patients' perceptions on their social supports and related factors. Methods & Materials: This descriptive-correlational study is a part of a larger study. All patients (n=202 referred to the hemodialysis units of Iran University of Medical Sciences were recruited to the study during a four-months period. Data were collected using "Personal Resources Questionnaire" (PRQ 85-PART 2 and analyzed using SPSS v.14. Results: Findings revealed that the most patients (64.9% had perceived social support at high levels. There were significant relationships between social support with economic status, gender and marital status (P<0.05. Findings also indicated that the statements of "I enjoy doing little extra things that make another person's life more pleasant" and, "I belong to a group in which I feel important" had the highest and lowest scores respectively. Conclusion: Regarding the variety of perceptions in hemodialysis patients on social support and its related factors, nurses can prevent social isolation of these patients through identification of high risk groups and can also reduce their stresses and help them to improve their quality of life by providing adequate supportive interventions.   Key words: emotional support, hemodialysis patients, perceived social support

F Rafii(Ph.D

2009-08-01

199

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

Scientific Electronic Library Online (English)

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

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

200

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  

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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

2009-12-01

 
 
 
 
201

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

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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

2002-02-01

202

Utility of HCV core antigen elisa in the screening for Hepatitis C virus infection in patients on hemodialysis  

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Full Text Available 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 were positive for HCV core antigen and RNA, three patients were positive for HCV RNA, while two patients were positive only for core antigen but negative for RNA. In anti HCV antibody positive patients, the core antigen was negative while the viral RNA continued to be present. Hence, relying solely on a single HCV core antigen assay may not be useful for a definite diagnosis of early HCV infection. The sensitivity and specificity of the assay were 60% and 83% respectively, while the positive predictive value was 14.3%, negative predictive value was 97.7% and the efficiency was 81.9%.

Reddy A

2006-01-01

203

The London, Ontario, Daily/Nocturnal Hemodialysis Study.  

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The London Daily/Nocturnal Hemodialysis Study, a prospective, comparative, nonrandomized study, directly compared outcomes of quotidian (daily) hemodialysis patients with conventional thrice-weekly hemodialysis patients. Patients were assigned to either daily (short-hours) hemodialysis (n = 11) or nocturnal hemodialysis (n = 12) and followed up for 5-36 months; all data were directly compared with matched control patients receiving conventional hemodialysis (n = 22). Outcomes evaluated were adequacy (urea kinetics), nutrition, anemia management, blood pressure and volume control, calcium/phosphorus control, and patient quality of life. In addition, a detailed economic analysis was undertaken. The study showed that both quotidian hemodialysis regimens are more effective than conventional hemodialysis in improving weekly urea clearance. Significant clinical improvements were seen with quotidian therapy in the areas of nutrition (short-hours daily), blood pressure (both), volume control (short-hours daily), calcium/phosphorus control (nocturnal), and quality of life (both). A nonsignificant trend for improvement in anemia management was suggested. The economic analysis showed substantial savings in annualized cost per quality-adjusted life-year in changing from conventional hemodialysis (carried out in-center, in satellite units, or at home) to home quotidian hemodialysis. The substantial clinical benefits of home quotidian hemodialysis, combined with the economic advantage shown by this study, clearly justify its expansion. (The details of this study have recently been published in 11 articles in the American Journal of Kidney Diseases[2003;42(suppl 1)]. PMID:15043607

Lindsay, Robert M

2004-01-01

204

[Pharmacokinetics of sisomicin during hemosorption and hemodialysis].  

Science.gov (United States)

The effect of hemosorption and hemodialysis on the pharmacokinetics of sisomicin was studied in 17 patients with acute and chronic renal insufficiency. The value of the antibiotic extraction coefficient in hemosorption was almost 2 times higher than that in hemodialysis. In patients on hemosorption, extracorporeal elimination of the antibiotic was of the saturation nature. It was characterized by systematic diminishing of the extraction coefficient, while in patients on hemodialysis, it did not depend on the time (the value of the extraction coefficient was constant). In this connection it is recommended that the rate of diminishing of the extraction coefficient in hemosorption be estimated. Since sisomicin is rapidly absorbed by the column it is not advisable to administer sisomicin to patients before hemosorption. PMID:4026255

Firsov, A A; Treskina, O S; Umnova, L V; Cherniakov, V L; Vetchinnikova, O N

1985-05-01

205

Acute barium nitrate intoxication treated by hemodialysis.  

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A 22-year-old male was admitted to hospital with diarrhea and vomiting, cardiac arrhythmias, severe hypokalemia and gradual onset of muscular weakness. A potassium infusion was started, but for several hours serum potassium remained low. Evidence of toxic ingestion was initially lacking. When it became clear -- after a considerable delay -- that the patient had ingested barium nitrate, hemodialysis was started. This resulted in rapid clinical improvement with correction of hypokalemia and restored muscular function. Intoxication with barium causes hypokalemia, arrhythmias, muscular weakness and paralysis, often requiring respiratory support. This patient presented with symptoms typical of severe barium intoxication, non-responsive to potassium supplementation. There are few published reports on the use of hemodialysis in barium poisoning. This case confirms the possible benefit of hemodialysis in severe cases, where potassium supplementation alone is insufficient. PMID:15675995

Bahlmann, H; Lindwall, R; Persson, H

2005-01-01

206

Prevalence of fibromyalgia in hemodialysis patients.  

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This study sought to determine the prevalence of fibromyalgia syndrome and to identify whether fibromyalgia was associated with various clinical symptoms and laboratory parameters in hemodialysis patients. One hundred and forty-eight hemodialysis patients were examined for fibromyalgia symptoms according to the American College of Rheumatology criteria. Demographic characteristics, as well as causes of kidney failure, dialysis duration, and symptoms related to fibromyalgia were investigated. Of 148 patients, 18 (12.2%) were diagnosed with fibromyalgia. Patients with fibromyalgia had significantly poorer sleeping satisfaction than the control group (P = .02).The Beck Depression Inventory score was higher in 77.8% of the fibromyalgia patients than that in the control group (P = .006), but there was no significant difference in the anxiety score between the two groups (P = .86).In conclusion, there was a higher prevalence of fibromyalgia in hemodialysis patients than previously reported. Sleep disturbances and depression levels correlated with fibromyalgia. PMID:24878948

Samimagham, Hamidreza; Haghighi, Anousheh; Tayebi, Mehdi; Jenabi, Arya; Arabi, Mohsen; Kianmehr, Nahid

2014-05-01

207

Hemoglobin cycling in hemodialysis patients  

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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.

Christoph Wanner

2010-11-01

208

Serum IL-6 level and associated factors: hemodialysis patients  

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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

2008-07-01

209

Encapsulating peritoneal sclerosis with favorable outcome in hemodialysis: an unusual case with a literature review.  

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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

2014-04-01

210

Perioperative Management of Chronic Dialysis Patients Undergoing Cardiac Surgery  

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Full Text Available Introduction: Chronic kidney disease is associated with significant cardiovascular morbidity and mortality. Cardiac surgery in patients undergoing dialysis is still challenging due to increased perioperative complication rates and mortality. The aim of this study is to document the outcomes of cardiac surgery in end stage renal disease patients and analyze the impact of perioperative management strategies. Patients and Methods: Nineteen patients with end-stage renal disease undergoing hemodialysis (n= 17 or peritoneal dialysis (n= 2 operated between January 2011 and November 2012 were studied retrospectively. Isolated coronary bypass, coronary bypass concomitant with mitral valve procedures or mitral and/or tricuspid valve surgery were performed. Postoperative variables, mortality and survival rates were studied.Results: The mean age of the patients was 56.32 ± 12.97 years. Male to female ratio was 10/9. The mean duration of preoperative hemodialysis was 4.07 ± 1.89 and peritoneal dialysis was 1.5 ± 0.7 years. Mean cross-clamp time was 57.63 ± 21.56 minutes and cardiopulmonary bypass time was 87.89 ± 24.66 minutes. Mean amount of ultrafiltration performed intraoperatively was 1610.53 ± 607.26 mL. Three (15.8% in-hospital mortalities were noted. The median follow-up was 16 months and survival rate was 84.2%.Conclusion: A well planned surgical strategy and perioperative medical management including the timing of pre and postoperative hemodialysis, use or avoidance of cardiopulmonary bypass and the use of intraoperative ultrafiltration should be documented to decrease perioperative morbidity and mortality.

Ahmet Bar?? Durukan

2013-08-01

211

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

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Chronic kidney disease (CKD) is a worldwide public health problem and is associated with high morbidity and mortality. The majority of patients with CKD stage 5 (CKD-5), who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically created access sites. Native fistulae are preferred over grafts due to their longevity. More than half of these vital portals for dialysis access will fail over time. Screening procedures to select high-risk patients before thrombosis or stenosis appears have resulted in aggressive management. These patients are referred for angiographic evaluation and/or therapy. We present the patterns of dialysis-related interventions done in our institution. PMID:22623809

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

2012-01-01

212

Subphrenic Abscess as a Complication of Hemodialysis Catheter-Related Infection  

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We describe an unusual case of subphrenic abscess complicating a central venous catheter infection caused by Pseudomonas aeruginosa in a 59-year-old woman undergoing hemodialysis. The diagnosis was made through computed tomography, and Pseudomonas aeruginosa was isolated from the purulent drainage of the subphrenic abscess, the catheter tip and exit site, and the blood culture samples. A transesophageal echocardiography showed a large tubular thrombus in superior vena cava, extending to the right atrium, but no evidence of endocarditis or other metastatic infectious foci. Catheter removal, percutaneous abscess drainage, anticoagulation, and antibiotics resulted in a favourable outcome. PMID:25114817

Burguera, Victor; Fernandez-Lucas, Milagros; Teruel, Jose Luis; Quereda, Carlos

2014-01-01

213

[Hepatitis C virus antibodies (HCV) in patients treated with chronic hemodialysis].  

Science.gov (United States)

Patients undergoing chronic hemodialysis are frequently affected by nosocomial viral infections, as indicated by the high prevalence of HBV antibodies. The question, to what extent HCV is transmitted by blood transfusions (NANB-PTH), or acquired in a nosocomial manner, is still unanswered. We therefore evaluated the HCV antibody rate of 387 sera of dialysis patients on the "Eurotransplant" waiting list. The HCV antibody reactivity ranged from 5.4 to 12.0% between different dialysis centers. In highly immunized (HLA antibody positive) long-term dialysis patients 31.3% (vs. 8.3% in non-immunized patients) were HCV antibody positive. PMID:1703848

Kühnl, P; Roggendorf, M; Sibrowski, W; Deinhardt, F; Laufs, R; Bornhövd, K; Kalmar, G; Seidl, S; Böhm, B O

1990-01-01

214

The effect of initial local anesthetic dose with continuous interscalene analgesia on postoperative pain and diaphragmatic function in patients undergoing arthroscopic shoulder surgery: a double-blind, randomized controlled trial  

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Full Text Available Abstract Background Interscalene block (ISB is commonly performed using 20-40 mL of local anesthetic. Spread to adjacent structures and consequent adverse effects including paralysis of the ipsilateral hemidiaphragm are frequent. Pain ratings, analgesic requirements, adverse events, satisfaction, function and diaphragmatic excursion were compared following interscalene block (ISB with reduced initial bolus volumes. Methods Subjects undergoing arthroscopic rotator cuff repair were randomized to receive 5, 10, or 20 mL ropivacaine 0.75% for ISB in a double-blind fashion (N = 36. Continuous infusion with ropivacaine 0.2% was maintained for 48 h. Pain and diaphragmatic excursion were assessed before block and in the recovery unit. Results Pain ratings in the recovery room were generally less than 4 (0-10 NRS for all treatment groups, but a statistically significant difference was noted between the 5 and 20 mL groups (NRS: 2.67 vs. 0.62 respectively; p = 0.04. Pain ratings and supplemental analgesic use were similar among the groups at 24 h, 48 h and 12 weeks. There were no differences in the quality of block for surgical anesthesia. Dyspnea was significantly greater in the 20 mL group (p = 0.041. Subjects with dyspnea had significant diaphragmatic impairment more frequently (Relative risk: 2.5; 95%CI: 1.3-4.8; p = 0.042. Increased contralateral diaphragmatic motion was measured in 29 of the 36 subjects. Physical shoulder function at 12 weeks improved over baseline in all groups (baseline mean SST: 6.3, SEM: 0.6; 95%CI: 5.1-7.5; 12 week mean SST: 8.2, SEM: 0.46; 95%CI: 7.3-9.2; p = 0.0035. Conclusions ISB provided reliable surgical analgesia with 5 mL, 10 mL or 20 mL ropivacaine (0.75%. The 20 mL volume was associated with increased complaints of dyspnea. The 5 mL volume was associated with statistically higher pain scores in the immediate postoperative period. Lower volumes resulted in a reduced incidence of dyspnea compared to 20 mL, however diaphragmatic impairment was not eliminated. Compensatory increases in contralateral diaphragmatic movement may explain tolerance for ipsilateral paresis. Trial Registration clinicaltrials.gov. identifier: NCT00672100

Hartrick Craig T

2012-03-01

215

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

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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

2011-01-01

216

Sleep disorders in hemodialysis patients  

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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.

Sabry Alaa

2010-01-01

217

Hemostatic Complications in Hemodialysis Patients  

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Full Text Available Background. Disorder of hemostasis in hemodialysis patients is focused in two directions, towards the development of thrombosis and bleeding. Both complications make it difficult to treat and are life-threatening for the patient.  Monitoring of hemostatic parameters, it is possible to detect the first changes in the coagulation system and correct the factors that lead to changes and thus prevent or stop the further development of complications. Aim. To determine the hemostatic and dialysis parameters and their influence on the occurrence and development of complications. Patients and methods. From a total of 175 patients, 46 had signs of hemorrhagic syndrome and 16 of them had thrombosis. Parameters of primary and secondary hemostasis were determined and vascular access of ultrasound was examined. Results. In the patients with thrombosis D-dimer level was significantly higher and amounted to 4.18 mg / l, while AT III levels were decreased for 54%. Elevated level of APTT was significant for the patients who had bleeding. In 86% of patients with thrombosis, ultrasound findings correlated with findings of D-dimer. Both complications were more pronounced in the older age group above 46 years. Conclusion. Hemorrhagic syndrome is a frequent complication of thrombosis. The level of D-dimer is directly correlated with ultrasound detection of thrombotic formation. Elevated levels of APTT was in direct correlation with bleeding. The development of complica-tions are affected by other factors, such as: age, access type, type of dialysis membrane, the blood flow. Frequent control of hemostatic parameters is essential for early detection of complications. In the event of changes in coagulation system, type and dose of anticoagulant should be corrected and introducing additional oral anticoagulants should be considered.

Farid Ljuca

2011-07-01

218

Zinc supplementation alters plasma aluminum and selenium status of patients undergoing dialysis: a pilot study.  

Science.gov (United States)

End stage renal disease patients undergoing long-term dialysis are at risk for abnormal concentrations of certain essential and non-essential trace metals and high oxidative stress. We evaluated the effects of zinc (Zn) supplementation on plasma aluminum (Al) and selenium (Se) concentrations and oxidative stress in chronic dialysis patients. Zn-deficient patients receiving continuous ambulatory peritoneal dialysis or hemodialysis were divided into two groups according to plasma Al concentrations (HA group, Al > 50 g/L; and MA group, Al > 30 to ? 50 g/L). All patients received daily oral Zn supplements for two months. Age- and gender-matched healthy individuals did not receive Zn supplement. Clinical variables were assessed before, at one month, and after the supplementation period. Compared with healthy subjects, patients had significantly lower baseline plasma Se concentrations and higher oxidative stress status. After two-month Zn treatment, these patients had higher plasma Zn and Se concentrations, reduced plasma Al concentrations and oxidative stress. Furthermore, increased plasma Zn concentrations were related to the concentrations of Al, Se, oxidative product malondialdehyde (MDA), and antioxidant enzyme superoxide dismutase activities. In conclusion, Zn supplementation ameliorates abnormally high plasma Al concentrations and oxidative stress and improves Se status in long-term dialysis patients. PMID:23609777

Guo, Chih-Hung; Chen, Pei-Chung; Hsu, Guoo-Shyng W; Wang, Chia-Liang

2013-04-01

219

Zinc Supplementation Alters Plasma Aluminum and Selenium Status of Patients Undergoing Dialysis: A Pilot Study  

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Full Text Available End stage renal disease patients undergoing long-term dialysis are at risk for abnormal concentrations of certain essential and non-essential trace metals and high oxidative stress. We evaluated the effects of zinc (Zn supplementation on plasma aluminum (Al and selenium (Se concentrations and oxidative stress in chronic dialysis patients. Zn-deficient patients receiving continuous ambulatory peritoneal dialysis or hemodialysis were divided into two groups according to plasma Al concentrations (HA group, Al > 50 ?g/L; and MA group, Al > 30 to ? 50 ?g/L. All patients received daily oral Zn supplements for two months. Age- and gender-matched healthy individuals did not receive Zn supplement. Clinical variables were assessed before, at one month, and after the supplementation period. Compared with healthy subjects, patients had significantly lower baseline plasma Se concentrations and higher oxidative stress status. After two-month Zn treatment, these patients had higher plasma Zn and Se concentrations, reduced plasma Al concentrations and oxidative stress. Furthermore, increased plasma Zn concentrations were related to the concentrations of Al, Se, oxidative product malondialdehyde (MDA, and antioxidant enzyme superoxide dismutase activities. In conclusion, Zn supplementation ameliorates abnormally high plasma Al concentrations and oxidative stress and improves Se status in long-term dialysis patients.

Chia-Liang Wang

2013-04-01

220

[Home hemodialysis and peritoneal dialysis compared].  

Science.gov (United States)

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 rediscovery of the clinical, rehabilitative and economic advantages of home dialysis. Seven experts from five different centers with different expertise in home dialysis report their opinions on the future of home dialysis in a ''noncontroversial controversy''. Beyond the sterile competition between peritoneal dialysis and home hemodialysis, the shared opinion is that the two methods may complement each other, allowing a tailored treatment for each patient and a tailored organization in each setting. The organizational solutions are many; the authors underline the importance of longer survival and better rehabilitation, and the ethical need of offering each patient a choice among all available treatments. Add to this the importance of dedicated educational programs targeted to physicians, nurses and patients alike and focused on self-care and patient empowerment. A new generation of dialysis machines, easier technical solutions, and financial incentives may strengthen motivations and simplify problems; all these elements may in the near future be combined in a joint effort to increase peritoneal dialysis and revive home hemodialysis in Italy. PMID:22538945

Piccoli, Giorgina Barbara; Ferraresi, Martina; Caputo, Flavia; Quarello, Francesco; Viganò, Maria Rosa; Mascia, Franco; Gesualdo, Loreto

2012-01-01

 
 
 
 
221

Estudio piloto sobre entrenamiento físico durante hemodiálisis / A pilot study on physical training of patients in hemodialysis  

Scientific Electronic Library Online (English)

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.

222

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

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Full Text Available OBJETIVO. Estimar y comparar el costo por sesión de hemodiálisis dentro del sector público y privado en la Ciudad de México. MATERIAL Y MÉTODOS. Se calcularon los costos de los insumos utilizados en las hemodiálisis de cuatro hospitales públicos y dos privados de la Ciudad de México, mediante la estrategia de micro-costeo denominada PAATI. Para la obtención de los datos se utilizó el método de sombra; además, se empleó Excel para elaborar cédulas en las que se determina el PAATI para cada sesión. RESULTADOS. El costo anual promedio directo en el sector público por el tratamiento de un individuo en hemodiálisis es de $158 964.00 M. N., y el costo de atender a la población que podría demandar terapia de reemplazo renal se estima en $10 921 788 072.00 M. N. CONCLUSIÓN. La disponibilidad de recursos humanos e infraestructura en el país es muy limitada para el campo de la nefrología en general y, en particular, para ofrecer servicios de hemodiálisis, por lo que sería necesario inyectar más recursos para poder responder ante la demanda por insuficiencia renal terminal.OBJECTIVE. To estimate and compare direct costs per hemodialysis session in public and private units in Mexico City. MATERIAL AND METHODS. PAATI, a microcosting strategy, was used to determine total costs of four public and two private health hospitals in Mexico City. A "shadow study" approach was employed to collect the needed data. Charts containing the "PAATI" information for each session were developed in Microsoft Excel. RESULTS. The average annual cost per patient undergoing hemodialysis in public units is $158 964.00 MX. The estimated cost for the care of all population estimated in need of renal replacement therapy (via hemodialysis was estimated to be $10 921 788 072.00 MX. CONCLUSION. Human resources and infrastructure availability in México are very limited for nephrology, and in consequence for offering hemodialysis services.

Luis Durán-Arenas

2011-01-01

223

Erectile Dysfunction in Males on Hemodialysis  

International Nuclear Information System (INIS)

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)

224

Duration and Adverse Events of Non-cuffed Catheter in Patients With Hemodialysis  

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Renal Failure Chronic Requiring Hemodialysis; Central Venous Catheterization; Inadequate Hemodialysis Blood Flow; Venous Stenosis; Venous Thrombosis; Infection Due to Central Venous Catheter; Central Venous Catheter Thrombosis

2014-10-09

225

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

DEFF Research Database (Denmark)

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

2011-01-01

226

Validity and Reliability of Short Form-12 Questionnaire in Iranian Hemodialysis Patients  

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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

2011-04-01

227

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

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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.

Azar BARADARAN

2010-12-01

228

Intratympanic steroid injection for sudden sensorineural hearing loss in a patient on hemodialysis.  

Science.gov (United States)

Sudden sensorineural hearing loss (SSNHL) is being described with increasing incidence among patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). There are no widely accepted guidelines in the medical literature for the appropriate management of this medical emergency. Administration of systemic steroids remains the mainstay of the management of SSNHL in conjunction with the supportive treatment, in this vulnerable group of patients, as well. However, encouraged by the evolving evidence on the efficacy of the intratympanic steroid injections (ITSI) in the treatment of SSNHL among patients without renal disease--we successfully treated SSNHL in an elderly diabetic with sepsis due to bilateral pneumonitis undergoing regular HD treatment with multiple ITSI and antibiotics resulting in complete recovery of hearing function within 3 months of onset of the first symptoms. PMID:23782854

Wu, Rui-Xin; Chen, Chun-Chi; Wang, Chih-Hung; Chen, Hsin-Chien

2014-01-01

229

Complex central venous catheter insertion for hemodialysis.  

Science.gov (United States)

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

Powell, Steven; Belfield, Jane

2014-01-01

230

Sterilization of heparinized Cuprophan hemodialysis membranes  

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The effects of sterilization of dry heparinized Cuprophan hemodialysis membranes by means of ethylene oxide (EtO) exposure, gamma irradiation, or steam on the anticoagulant activity and chemical characteristics of immobilized heparin and the permeability of the membrane were investigated. Sterilization did not result in a release of heparin or heparin fragments from heparinized Cuprophan. Sterilization of heparinized Cuprophan by means of EtO exposure and gamma irradiation induced a slight, i...

Hoopen, H. W. M. Ten; Hinrichs, W. L. J.; Engbers, G. H. M.; Feijen, J.

1996-01-01

231

Relationship between platelet count and hemodialysis membranes  

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Full Text Available Rabih Nasr,1 Chadi Saifan,1 Iskandar Barakat,2 Yorg Al Azzi,2 Ali Naboush,2 Marc Saad,2 Suzanne El Sayegh1 1Department of Nephrology, Staten Island University Hospital, Staten Island, NY, USA; 2Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA Background: One factor associated with poor outcomes in hemodialysis patients is exposure to a foreign membrane. Older membranes are very bioincompatible and increase complement activation, cause leukocytosis by activating circulating factors, which sequesters leukocytes in the lungs, and activates platelets. Recently, newer membranes have been developed that were designed to be more biocompatible. We tested if the different “optiflux” hemodialysis membranes had different effects on platelet levels. Methods: Ninety-nine maintenance hemodialysis patients with no known systemic or hematologic diseases affecting their platelets had blood drawn immediately prior to, 90 minutes into, and immediately following their first hemodialysis session of the week. All patients were dialyzed using a Fresenius Medical Care Optiflux polysulfone membrane F160, F180, or F200 (polysulfone synthetic dialyzer membranes, 1.6 m2, 1.8 m2, and 2.0 m2 surface area, respectively, electron beam sterilized. Platelet counts were measured from each sample by analysis using a CBC analyzer. Results: The average age of the patients was 62.7 years; 36 were female and 63 were male. The mean platelet count pre, mid, and post dialysis was 193 (standard deviation ±74.86, 191 (standard deviation ±74.67, and 197 (standard deviation ±79.34 thousand/mm3, respectively, with no statistical differences. Conclusion: Newer membranes have no significant effect on platelet count. This suggests that they are, in fact, more biocompatible than their predecessors and may explain their association with increased survival. Keywords: platelet count, polysulfone membranes, complement activation, electron beam sterilized, cellulosic membranes, bioincompatible events

Nasr R

2013-08-01

232

"Quality of life in hemodialysis patients "  

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To determine quality of life and various factors affecting it , we conducted a cross-sectional survery among 103 hemodialysis patients in four teaching hospitals of Tehran University of Medical Sciences.A quality of life questionnaire (QLQ). Containing various items relating to physical, psychological and social aspects of life was filled by interviewing each patient and a total score ranging from 70 to 300 was assigned to denote overall life quality. We also determined the most common underl...

Nabaie B; Shahidzadeh A; Dabiran S

2001-01-01

233

Ultrasound Evaluation Before and After Hemodialysis Access  

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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.   

Daryoush Saedi

2009-01-01

234

Fusarium incarnatum/equiseti hemodialysis graft infection  

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Full Text Available Hemodialysis graft infections typically occur as a result of contamination by skin flora at the time of insertion or become secondarily infected after high-grade bacteremia. Infection of implanted vascular devices with filamentous fungi is rare. We report a case of infection of an implanted polytetrafluoroethylene dialysis graft with Fusarium incarnatum/equiseti that did not grow in cultures of tissue but was identified by molecular means.

Jeffery D. Punch

2010-08-01

235

Biofeedback systems and adaptive control hemodialysis treatment  

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On-line monitoring devices to control functions such as volume, body temperature, and ultrafiltration, were considered more toys than real tools for routine clinical application. However, bio-feedback blood volume controlled hemodialysis (HD) is now possible in routine dialysis, allowing the delivery of a more physiologically acceptable treatment. This system has proved to reduce the incidence of intra-HD hypotension episodes significantly. Ionic dialysance and the patient?s plasma con...

Azar Ahmad

2008-01-01

236

Malnutrition predicting factors in hemodialysis patients  

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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

2010-01-01

237

Hemodialysis Complications of Hydroxocobalamin: A Case Report  

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Hydroxocobalamin is a new antidote approved by the FDA for the treatment of cyanide poisoning. Our report describes a patient with cyanide poisoning who survived after treatment with hydroxocobalamin and complications we encountered with hemodialysis. A 34-year-old female presented to the emergency department after a syncopal event and seizures. Her systolic blood pressure was 75 mmHg, her QRS complex progressively widened, and pulses were lost. She was intubated and resuscitated with fluids...

Sutter, Mark; Tereshchenko, Nadia; Rafii, Rokhsara; Daubert, G. Patrick

2010-01-01

238

Malnutrition-Inflammation Score in Hemodialysis Patients  

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Full Text Available Background: Malnutrition is a prevalent complication in patients on maintenance hemodialysis. Malnutrition-inflammation score (MIS, comprehensive nutritional assessment tool, as the reference standard was used to examine protein-energy wasting (PEW and inflammation in hemodialysis patients. Materials and Methods: In this descriptive- analytical study, 48 hemodialysis patients were selected with random sampling. All the patients were interviewed and the MIS of the patients was recorded. This new comprehensive Malnutrition-Inflammation Score (MIS which involves 7 components from the SGA and the 3 additional non-SGA components of body mass index, serum albumin, and total iron-binding capacity (TIBC has 10 components, each with four levels of severity, from 0 (normal to 3 (very severe. These scores were compared with anthropometric measurements; laboratory measures. Data was analyzed with Chi-square and t-tests and Pearson correlation coefficiant. Results: In this study 25% of patients on hemodialysis were normal nourished, 54.3% of patients were mild malnourished, 20.8% were moderately malnourished and no one of them were not sever malnurished. Pearson correlation coefficients between MIS score and age (r=+0.332 was significant. There was no correlation between the malnutrition score and sex Chi-square test showed significant correlation between MIS score and dialysis period ?50 months (?²=9.09. Conclusion: In this study, no one of patients has severed malnutrition, and most of them were assigned to the mildly/moderately malnourished rating. On other hand, most of patients are the well-nourished. Correlation between MIS score and age and dialysis period was significant.

Behrooz Ebrahimzadehkor

2014-08-01

239

Bone Densitometric Analysis in Egyptian Hemodialysis Patients  

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End-stage renal failure (ESRF) is the ultimate consequence of chronic renal failure, and in such cases dialysis is generally required. Almost all dialysed patients have abnormal bone histology and lower values of glomerular filtration rate have been associated with lower bone mineral density (BMD) at all sites. The objective of the present study was to investigate the effect of hemodialysis (HD) on body-composition (BC), specially segmental and total BMD in Egyptian ESRF patients. Forty ESRF ...

Mohamed, Ehab I.; Khalil, Eman S. D.

2008-01-01

240

Computed tomography of kidneys with hemodialysis  

International Nuclear Information System (INIS)

Computed tomography (CT) of the kidneys was carried out in 134 chronic intermittent hemodialysis patients. A high incidence of cysts, calcification and tumor was found. The absorption value (Hounsfield units) of renal parenchyma, excluding visible cysts and calcification on CT, showed a very wide scatter compared to the controls. A low absorption value indicated a cyst too small to define by CT imaging of the excised kidney. Two of three adenocarcinomas were found by CT screening in sympton-free dialysis patients. (author)

 
 
 
 
241

Innovative strategy with potential to increase hemodialysis efficiency and safety  

Science.gov (United States)

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

2014-03-01

242

What is the evidence for intraluminal colonization of hemodialysis catheters?  

Science.gov (United States)

Hemodialysis catheter-related bloodstream infections are potentially devastating, leading to increased morbidity, mortality, and cost of care. Prospective studies published over the past 15 years shed light on the pathogenesis of these infections. The data suggest that the intraluminal microbial colonization of hemodialysis catheters often precedes bloodstream infection. This finding supports strategies aimed at preventing or eradicating intraluminal colonization. PMID:24402089

Mermel, Leonard A

2014-07-01

243

The impact of nocturnal hemodialysis on sexual function  

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Abstract Background Sexual dysfunction is common in patients with end stage renal disease (ESRD) and treatment options are limited. Observational studies suggest that nocturnal hemodialysis may improve sexual function. We compared sexual activity and responses to sexual related questions in the Kidney Disease Quality of Life Short Form questionnaire among patients randomized to frequent nocturnal or thrice weekly conventional hemodialysis. Methods We performed a...

Bass Adam; Ahmed Sofia B; Klarenbach Scott; Culleton Bruce; Hemmelgarn Brenda R; Manns Braden

2012-01-01

244

Transcatheter thrombolysis treatment for acute thrombosis in arteriovenous fistulas in hemodialysis patients  

International Nuclear Information System (INIS)

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)

245

Pharmacokinetics of Sulfobutylether-Beta-Cyclodextrin and Voriconazole in Patients with End-Stage Renal Failure during Treatment with Two Hemodialysis Systems and Hemodiafiltration?  

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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.

2010-01-01

246

Evaluation of therapeutic effect of capsaicin pomade(Caspian 0.03% in hemodialysis related pruritus  

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Full Text Available (Received 23 Jul, 2008 ; Accepted 12 Nov, 2008AbstractBackground and purpose: Pruritus is one of the common problems in hemodialysis patients with end stage renal disease. Approximately, 60% of these patients suffer from this condition. There are several causes for pruritus, thus, various treatments are applied in order to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in hemodialysis patients.Materials and methods: This randomized double blind cross over clinical trial study, was performed on 34 hemodialysis patients with uremic pruritus in 1386. All patients were divided in two groups. One group received Caspian 0.03%, while the other, placebo for four weeks. Treatment was stopped for two weeks and continued as cross over technique. Pruritus scores were analyzed with Paired t-test and Repeated measurement ANOVA.Results: In this study, the difference between Mean of pruritus score before capsian treatment and in weeks following 1 to 4 was statistically significant (P=0.0001. In placebo group, the difference between pruritus score before treatment and in weeks 1 to 4 was statistically significant (P=0.0001. There was no significant difference before treatment in two groups, however, after each week, the difference was significant (P=0.0001. Repeated measurement test showed that reduction in pruritus severity in capsian group was more than placebo group, during treatment period (P=0.0001.Conclusion: Although our study indicated the appropriate effects of Capsian in pruritus, the placebo also has a good effect in controlling hemodialysis related pruritus. Our placebo had emollient property; therefore, we can apply it to control the pruritus in these patients.J Mazand Univ Med Sci 2009; 19(69: 7-13 (Persian

Alireza Bari

2009-01-01

247

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

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The prevalence of chronic kidney disease continues to increase worldwide, especially in our country with a consequent increase in patients requiring renal replacement therapy by hemodialysis, either temporarily or for life in the absence of a solid draft kidney transplant in the future. However, hemodialysis and peritoneal dialysis treatment are very expensive, very demanding in resources such as water and electricity and generate a large amount of waste. The objective of our work is to put the item in the environmental aspects of dialysis and its impact on the environment. This is a descriptive cross-sectional study conducted in the department of nephrology dialysis. Our hemodialysis center has 13 generators with a private water treatment (mono osmosis). Our annual water consumption for a single hemodialysis generator for 10hours per day and 6days per week is estimated at 93.6m(3). The production volume of water discharged from the reverse osmosis system (concentrate rejected) is 12m(3)/day (66% of the volume of water treated by reverse osmosis) with physico-chemical and bacteriological parameters remaining in the standards of WHO/FAO irrigation potential. The living water treatment as well as our 13 generators need more than 156 KW/day for work. The waste generated is about 23.5 tons/year, classified as high risk because of the high rates of hepatitis C in our center (48%) and severity of bacterial flora that we have identified in the post-generator dialysate thrown directly into sewers. Our natural resources are valuable especially that we are among the world exposed to water shortages in the near future (Haut-Commissariat des eaux et forêts et à la désertification du Maroc, 2009), which leads us to develop new programs to recycle waste and rejected in order to concentrate the reuse in various areas (irrigation, watering, sanitation, sterilization of surgical instruments), and to encourage the use of solar energy especially in a sunny country like ours. PMID:24140175

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

2013-12-01

248

Posteriorly tunneled dialysis catheters for permanent use in cognitively impaired patients undergoing hemodialysis.  

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Cognitively impaired patients often pull at their dialysis catheters when the catheters are tunneled over the anterior chest. To potentially circumvent this, a technique was developed that tunnels the catheter posteriorly, over the patient's shoulder. A total of 32 posteriorly tunneled catheters were placed in 12 patients. The mean catheter use interval was 164 days, with a total of 5,248 catheter use days. Indications for nonelective catheter removals were catheter dysfunction (n = 7; 23.3%), removal by the patient (n = 7; 23.3%), infection (n = 5; 16.7%), and inadvertent dislodgment (n = 1; 3.3%). Only six of the 12 patients were able to dislodge their catheters. The procedure described here reduced catheter manipulation and extended catheter viability in these patients. PMID:25255948

Stroz, Marianne J; Nathoo, Bharat; Stroz, Peter M

2014-10-01

249

GB virus type C infection in hemodialysis patients considering co-infection with hepatitis C virus.  

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GB virus type C is a well-known viral agent with capability of infecting patients undergoing hemodialysis. Liver enzyme levels in infected individuals have been reported to remain within the normal range. Simultaneous infection of GBV-C and other viral agents may occur due to common routes of transmission. A total of 104 hemodialysis patients living in Tehran were included in this case-control study (53 patients with HCV infection, group I; and 51 with no HCV infection, group II). Diagnosis was made by detection Anti-E(2) protein using ELISA and HCV-RNA using RT-PCR. History of HBV-infection, organ transplantation, depression, malignancies, chemotherapy, diabetes mellitus, thyroid disorders and chronic cutaneous disorders were considered. Patients were evaluated for high- risk behaviors such as intravenous drug injection, addiction or substance abuse. A total of 14 patients (13.6%) were GBV-C-infected. Four of them were co-infected with HCV. All patients with GBV-C infection had viral genotype 2. Thirteen patients (12%) had a history of multiple blood transfusions. Mean (+/-SD) age of GBV-C-infected patients was 48.7+/-13.8 years. Among GBV-C infected patients, three patients had a history of organ transplantation and three had a co-morbidity of diabetes mellitus. This study as the first case-control study to evaluate the association between GBV-C and HCV infection, to our knowledge, shows hemodialysis patients living in Tehran are infected with GBV-C with intermediate level of frequency. The association of GBV-C transmission with other viral blood-borne agents might be necessary. PMID:18461616

Hosseini-Moghaddam, S M; Keyvani, H; Samadi, M; Alavian, S M; Mahdavimazdeh, M; Daneshvar, S; Razzaghi, Z

2008-07-01

250

[Are disinfectant residues remained after cleaning hemodialysis machine procedure safe for patients?].  

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The dialysis machine shall be cleaned and disinfected after each patient treatment or after every 72 hours break in working. An acceptable disinfectants such as Puristeril plus or Puristeril 340, Citrosteril, Diasteril and Sporotal are used for decontamination. Puristeril 340 is designed for cold disinfection and due to the low pH value, the necessary decalcification of hemodialysis machines is easily achieved. It can be used for all haemodialysis systems like hemodialysis machines, water treatment devices and circuit pipes. Diluted Puristeril decomposes in a non-toxic way. Degradation products of peracetic acid, which is main component of Puristeril are: hydrogen peroxide and acetic acid. Peracetic acid is widely used for disinfection due to its exceptionally broad spectrum of microbiocidal activity at low concentrations and short exposure times. After use Puristeril is easily removable by rinsing with water. This paper deals with the effect of the Puristeril toxicity on blood as a function of its concentration and incubation time. Concentration range of 3.5-70 ppm was used, with particular emphasis on concentrations close to 5 ppm, a value is the limit of sensitivity of strips of starch potassium iodide, the tests for detection of peracetic acid. There was a strong increase in autohaemolysis and malondialdehyde concentrations with increasing concentration of Puristeril. There were also changes in dependence on the parameters of the incubation time, with the greatest effects obtained after 2 hours incubation with Puristeril. The detection limit of peracetic acid used strips of starch potassium iodide does not guarantee the safety of a patient undergoing hemodialysis. Even the residual concentration of Puristeril plus cause increased lipid peroxidation of membrane, and therefore suggest the routine use of stripes on the lower limit of detection of peracetic acid or implement measurement of hydrogen peroxide residues performed with sensitivity 1 ppm. PMID:24003659

Szewczyk, Ma?gorzata; Grzeszczuk, Karolina; Walski, Tomasz; Suder, Marek; Komorowska, Ma?gorzata

2013-01-01

251

Staphylococcus lugdunensis BACTEREMIA IN HEMODIALYSIS PATIENTS  

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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.

2012-03-01

252

Carotid Atherosclerosis in Hemodialysis Patients:A Case Control Study  

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Full Text Available Background/Objective: Increase of intima-media"nthickness and plaque formation in the carotid"narteries mirror general atherosclerosis. The aim"nof this study was to study intima-media thickness"nand frequency of atherosclerotic plaques in carotid"narteries in patients with end-stage renal disease"non maintenance hemodialysis in comparison with"ncontrol group."nMaterials and Methods: Carotid artery intimamedia"nthickness (IMT and the frequency of carotid"nplaque were measured using high-resolution B-mode"nultrasound in 60 hemodialysis patients with a mean"nage of 42.6±15.9 years and 60 control subjects matched"nfor age, sex and the cardiovascular risk factors."nResults: The frequency of the carotid plaques was"nsignificantly higher in the hemodialysis patients."nThe mean IMT value of the carotid arteries was also"nhigher in hemodialysis patients than in controls. In"nhemodialysis patients, there was a relationship between"nage, diabetes and hypertension with mean IMT value."nWe found no relationship between IMT and duration"nof hemodialysis treatment. Conclusion: The results"nindicate that atherosclerotic changes and frequency"nof plaque formation in hemodialysis patients is more"ncompared with control subjects, which is suggestive of"nvascular intimal damage due to uremia."nKeywords: Atherosclerosis, Carotid Artery Disease,"nHemodialysis, Ultrasound

Masoud Pezeshki Rad

2011-05-01

253

SERUM TRACE ELEMENTS IN CHILDREN ON MAINTENANCE HEMODIALYSIS  

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

S. T. Esfahani

2007-08-01

254

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

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

M. Abbasi

2007-09-01

255

Cutaneous manifestions in chronic renal failure patients under hemodialysis in Shahid Mohammadi Hospital Dialysis Center in Bandar Abbas  

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Full Text Available "nBackground and Aim: Chronic renal failure is a clinical state which results in declining the kidney function. Chronic renal failure has numerous cutaneous manifestations, when the process of hemodialysis begins, new changes may appear as a result. The aim of this study was to assess the prevalence of cutaneous problems among patients with chronic renal failure undergoing hemodialysis in Bandar Abbas, Iran."n"nMethods: In this cross-sectional study, 60 patients with chronic renal failure under hemodialysis in Shahid Mohammadi Hospital Dialysis Center were examined by a dermatologist. The data were gathered and analyzed by SPSS software (version 16 using descriptive statistics, t and chi2 tests. P less than 0.05 was considered significant."n"nResults: The most common skin findings were dry skin (78.3%, followed by pallor (71.7% and pruritus (58.3%. Other common cutaneous manifestations were half-half nail (35%, idiopathic guttate hypomelanosis (33.3%, yellowish skin color change (31.7%, subungal hyperkeratosis (30%, onycholysis (20%, beau's line (15%, cherry angioma (15%, skin hyperpigmentation (15% and purpura (13.3%."n"nConclusion: Chronic renal failure is associated with various cutaneous manifestations caused by hemodiaysis or the disease itself. The most common ones are dry skin and pallor. The early diagnosis of cutaneous changes may decrease the morbidity and eventually lead to quality of life improvement in these patients.

Foroogh Mohammadi

2010-12-01

256

The serum vaspin levels are reduced in Japanese chronic hemodialysis patients  

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Full Text Available Abstract Background Visceral adipose tissue-derived serine proteinase inhibitor (vaspin is an adipokine identified in genetically obese rats that correlates with insulin resistance and obesity in humans. Recently, we found that 7% of the Japanese population with the minor allele sequence (A of rs77060950 exhibit higher levels of serum vaspin. We therefore evaluated the serum vaspin levels in Japanese chronic hemodialysis patients. Methods Healthy Japanese control volunteers (control; n?=?95, 49.9±6.91?years and Japanese patients undergoing hemodialysis therapy (HD; n?=?138, 51.4±10.5?years were enrolled in this study, and serum samples were subjected to the human vaspin RIA system. Results The measurement of the serum vaspin levels demonstrated that a fraction of control subjects (n?=?5 and HD patients (n?=?11 exhibited much higher levels (> 10?ng/ml; VaspinHigh group, while the rest of the population exhibited lower levels (Low group. By comparing the patients in the VaspinLow group, the serum vaspin levels were found to be significantly higher in the control subjects (0.87±0.24?ng/ml than in the HD patients (0.32±0.15?ng/ml (p? Conclusions The creatinine levels are negatively correlated with the serum vaspin levels and were significantly reduced in the Japanese HD patients in the VaspinLow group.

Inoue Junko

2012-12-01

257

Bone cyst of atlantoaxial joint in long-term hemodialysis patients  

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

258

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

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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)

1998-10-01

259

Systemic barriers to optimal hemodialysis access.  

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Arteriovenous fistulas (AVFs) are considered the gold standard for hemodialysis vascular access based on their superior patency, low complication rates, improved adequacy, lower costs to the health care system, and decreased risk of patient mortality. The goals of the Fistula First Breakthrough Initiative are to achieve a prevalent AVF use rate of at least 66% nationally, to decrease central venous catheter use, and to reduce overall vascular access complication rates among patients on hemodialysis. Achieving optimal vascular access is a complex process and, unlike other dialysis outcomes, requires patient involvement as well as collaboration among nephrologists, surgeons, interventionalists, dialysis facilities, primary care physicians, and hospital systems. In 2009, the Fistula First Breakthrough Initiative assembled a team from varied backgrounds and perspectives to discover the systemic root causes as to why the AVF use rate in the United States is significantly lower than that in other industrialized countries. Ultimately, the 139 latent root causes identified by the root cause analysis team fall into the categories of patient, physician, and system. This article summarizes the current controversies in regard to improving AVF placement and reducing central venous catheter use, related to each of these three categories. PMID:23217331

Donca, Ionel Z; Wish, Jay B

2012-11-01

260

Serum Protein Profile Alterations in Hemodialysis Patients  

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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

2003-11-18

 
 
 
 
261

Pregnancy during Hemodialysis: A Single Center Experience  

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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.

Bahadi Abdelali

2010-01-01

262

Medication knowledge of hemodialysis patients and influence of clinical pharmacist provided education on their knowledge  

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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.

Sathvik B

2007-01-01

263

Hemochromatosis (HFE) gene mutations in Brazilian chronic hemodialysis patients  

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

F.V., Perícole; M.A.V.R., Alves; S.T.O., Saad; F.F., Costa.

1321-13-01

264

Hemochromatosis (HFE gene mutations in Brazilian chronic hemodialysis patients  

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

Perícole F.V.

2005-01-01

265

Carbamylated hemoglobin as a therapeutic marker in hemodialysis.  

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Carbamylation requires isocyanic acid derived from urea. Carbamylation of hemoglobin (Hb) produces carbamylated Hb (carbHb), which could serve as a marker of posttranslational protein modification possibly associated with such uremic complications as atherosclerosis. Since relative carbHb levels are determined by mean urea concentration and duration of exposure, they could be used to assess the adequacy of a patient's hemodialysis (HD) regimen. We therefore determined the relationship between carbHb and urea kinetics in patients with chronic renal failure (CRF) undergoing maintenance HD. In pre-HD determinations as well as in nondialyzed subjects including healthy subjects and CRF patients without dialysis, carbHb correlated well with blood urea nitrogen (BUN) concentrations, especially with BUN averaged for the preceding 1-3 months. In HD patients, carbHb correlated significantly with urea kinetics (time-averaged concentration of urea, or TAC(urea), K(t)/V and urea reduction rate). The estimated mean urea concentration in HD patients calculated from the relationship between carbHb and averaged BUN over 3 months in the nondialyzed groups was lower than TAC(urea), suggesting that TAC(urea) may be an overestimate. Pre-HD BUN is not a good nutritional index since detrimental decreases in urea elimination from the body can elevate pre-HD BUN independently of nutrition. We therefore devised a new nutritional index, BUN/carbHb, which correlated significantly with serum albumin as well as the normalized protein catabolic rate. These results demonstrate that carbHb accurately reflects uremic control and the BUN/carbHb ratio could serve as an index of nutritional state in HD patients. PMID:12053058

Hasuike, Yukiko; Nakanishi, Takeshi; Maeda, Kiyo; Tanaka, Toshihiko; Inoue, Toru; Takamitsu, Yoshihiro

2002-06-01

266

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

Scientific Electronic Library Online (English)

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.

2013-07-01

267

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

International Nuclear Information System (INIS)

Due to various metabolic disorders, especially dyslipidemia, in patients undergoing dialysis, the prevailing reference values of indices for determining obesity may differ from those used in the general population. To clarify visceral fat levels indicating obesity in dialysis patients, we analyzed indices for determining obesity and lipid profiles, and compared the data between dialysis patients and control subjects with normal renal function. This study was conduced in 75 hemodialysis patients (HD group) aged 61.0 y on average and 58 control subjects (control group) aged 44.5 y on average. We calculated body mass index (BMI), waist circumference at the umbilical level (W), waist-height ratio (W/Ht) and evaluated visceral and subcutaneous fat areas using computed tomography (CT) at the level of the umbilicus. In addition, we measured postprandial total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) in the serum and calculated the ratios, (TC-HDL-C)/HDL-C and TG/TC. Visceral fat area, (TC-HDL-C)/HDL-C and TG/TC in HD group were 58.1 cm2, 2.31 and 0.74, which were significantly higher than those in the control group (37.4 cm2, 1.95 and 0.52), respectively. A significant positive correlation was found between visceral fat area and BMI, W, and W/Ht in both groups. In control subjects, visceral fat area was highly correlated with (TC-HDL-C)/HDL-C (r=0.532, p less than 0.0001), and with TG/TC (r=0.286, p=0.0296). In 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)

268

Hemodialysis membranes for acute and chronic renal insufficiency.  

Science.gov (United States)

As an incomplete renal replacement for the patients with either acute or chronic renal failure, membrane-based hemodialysis therapy is progressing rapidly. However, the mortality and morbidity remain unacceptably high. Much effort has been put into improving the biocompatibility of the hemodialysis membranes. To effectively remove small solutes and 'middle molecules' in compact cartridges, the hydraulic and permselective properties of the hemodialysis membranes have also been deeply investigated. An overview of recent progress of different kinds of hemodialysis membranes and their preparation technology, as well as their modification techniques, is presented. The advantages and deficiencies of many synthetic membranes, including cellulose, cellulose acetate (CA), chitosan (CS), polysulfone (PS), poly(ether sulfone) (PES), polyacrylonitrile (PAN), ethylene-vinyl alcohol copolymer (EVOH), poly (methyl methacrylate) (PMMA) and poly(vinyl alcohol) (PVA), etc. are elaborated upon. PMID:23782098

Yu, Jin-Gang; Yu, Lin-Yan; Jiang, Xin-Yu; Chen, Xiao-Qing; Tao, Li-Jian; Jiao, Fei-Peng

2013-08-01

269

Measurment of Arteriovenous Fistula Recirculation in Hemodialysis Patients  

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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.

M. Gholyaf

2004-07-01

270

Sublethal microcystin exposure and biochemical outcomes among hemodialysis patients  

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Cyanobacteria are commonly-occurring contaminants of surface waters worldwide. Microcystins, potent hepatotoxins, are among the best characterized cyanotoxins. During November, 2001, a group of 44 hemodialysis patients were exposed to microcystins via contaminated dialysate. Seru...

271

Measuring Plasma Conductivity to Detect Sodium Load in Hemodialysis Patients  

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Background: Sodium thiosulfate therapy has been proposed for calcific uremic arteriolopathy and nephrogenic systemic fibrosis in hemodialysis patients. The treatment brings 3.7 g (161 mmol) of sodium. How to counterbalance this sodium load was studied.

Mercadal, Lucile; Servais, Aude; Venditto, Marcia; Renault, Nathalie; Isnard-bagnis, Corinne; Deray, Gilbert; Petitclerc, Thierry

2008-01-01

272

Small bowel enteroclysis using a hemodialysis blood pump  

International Nuclear Information System (INIS)

The purpose of this study is to describe the usefulness of small bowel enteroclysis using a hemodialysis blood pump. Over 1 16 month period, 135 double contrast small bowel enteroclysis examinations were performed in 132 patients using a hemodialysis blood pump. Following incubation of the proximal jejunum, barium at a dilution of 50 % and 0.5 %-methylcellulose were infused at a constant rate using a hemodialysis blood pump and multiple spot films of the small intestine were obtained. Success rate, quality of radiographs, positive findings, fluoroscopic time and complications were evaluated. It spite of the long fluoroscopic time and invasiveness, double contrast small bowel enteroclysis is useful for the evaluation of small bowel disease. The infusion of barium and methylcellulose using a hemodialysis blood pump give radiographs of good quality. (author). 18 refs., 2 tabs., 10 figs

273

Oral Microflora in Patients on Hemodialysis and Kidney Transplant Recipients  

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Full Text Available Introduction. We aimed to determine oral microflora of patients on long-term hemodialysis and kidney transplant recipients, and to compare them with individuals without kidney disease.Materials and Methods. We studied on 3 groups including patients on at least 6 months of hemodialysis, kidney transplant recipients for more than 2 years, and controls with a normal kidney function. Staining and culture were applied for samples from the dorsum of the tongue and the oral floor in order to detect aerobic and anaerobic bacteria and Candida.Results. The participants were 49 patients on hemodialysis, 50 kidney transplant recipients, and 50 volunteers in the control group. The abundance of Candida was significantly higher in the hemodialysis and transplant groups compared with the control group. The mean of various microorganisms was found to be significantly higher in the hemodialysis group than the control group (P = .03; however, the frequency of these microorganisms in the transplant group was lower than that in the hemodialysis group. Adjusting for confounding factors, the odds of having Candida in the hemodialysis and transplant groups were 3.54 (95% CI, 1.21 to 10.41 and 3.49 (95% CI, 1.27 to 9.18 times higher compared to the control group, respectively.Conclusions. Hemodialysis and kidney transplantation could affect oral microflora. Candida was significantly more frequent in these patients compared to healthy adults. Streptococcus mutans, Lactobacilli, Porphyromonas, and Candida is seen slightly less frequently after kidney transplantation, which might be in favor of promising effects of kidney transplantation on oral microflora.

Azadeh Ahmadieh

2010-07-01

274

Hemodialysis-associated pseudoporphyria resistant to N-acetylcysteine  

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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.

Bahadi Abdellali

2011-01-01

275

Blood Pressure Guided Profiling of Ultrafiltration during Hemodialysis  

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Hemodialysis-induced hypotension is still a common complication in spite of the progress achieved in hemodialysis (HD) treatment. Due to its multifactorial nature, dialysis-induced hypotension cannot be reliably prevented by conventional profiling of ultrafiltration in open-loop systems since they are unable to adapt themselves to actual decreases in blood pressure. A blood pressure guided closed-loop system for prevention of dialysis-induced hypotension by biofeedback-controlled profiling of...

Schmidt Reinhard; Roeher Otfried; Hickstein Heiko; Korth Steffen

2001-01-01

276

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

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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.

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

1981-09-01

277

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

International Nuclear Information System (INIS)

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

278

Destructive spondyloarthropathy in hemodialysis patients. Report of four cases and prospective study  

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

Kerr, R.; Feinstein, E.I.; Bjorkengren, A.; Bielecki, D.K.; Resnick, D.

1988-04-01

279

Metformin induced severe hypophosphatemia in a patient on hemodialysis  

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Full Text Available A 67-year-old diabetic and hypertensive woman presented to us with very low serum phosphate levels (PO4 - =1.1 mg/dL about 40 days after initiation of hemodialysis (HD. The phosphate binders were discontinued, because they were thought to be the cause of hypo-phosphatemia. However, the serum phosphate levels continued to remain low during subsequent follow-up visits over one month (PO4 --- = 0.7 and 0.6 mg/dL respectively. The patient had been started on metformin hydrochloride (850 mg thrice a day about 18 days after the beginning of HD. The drug was stopped immediately (approximately 50 days after it was started and the serum phosphate levels increased progressively, reaching 4.3 mg/dL. During the period with hypophos-phatemia, the patient suffered from very intense fatigue and weakness (she was unable to walk, anorexia, diarrhea and tenesmus. There were no features suggestive of rhabdomyolysis, hemo-lysis, low blood pressure or hypoglycemia; she had low white blood cell and platelet counts. The patient was in good clinical condition 2-3 days after the discontinuation of metformin and she recovered totally 15 days later. This case is presented due to its rarity as well as the observation that despite the patient having severe hypophosphatemia, she showed only side effects of metformin. Hypophosphatemia caused only intense fatigue and no other symptoms.

Tsitsios Tilemachos

2010-01-01

280

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

Scientific Electronic Library Online (English)

Full Text Available 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.

 
 
 
 
281

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

Scientific Electronic Library Online (English)

Full Text Available 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.

2012-09-01

282

Blastocystis sp. and other intestinal parasites in hemodialysis patients  

Scientific Electronic Library Online (English)

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

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

2008-08-01

283

Blastocystis sp. and other intestinal parasites in hemodialysis patients  

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

Rose Anne Kulik

2008-08-01

284

Blastocystis sp. and other intestinal parasites in hemodialysis patients.  

Science.gov (United States)

Chronic renal insufficiency disease (CRI) leads to uremia in hemodialysis patients and induces a state of immunodepression that results in higher frequencies of infections and diarrhea. Hemodialysis patients resident in the city of Campo Mourão, Paraná, Brazil were analyzed from April 2006 through September 2007 for Blastocystis sp. and other intestinal parasites and for associated diarrhea. Fecal samples from 86 hemodialysis patients and 146 healthy (reference) persons were examined by standard methods for detecting ova, larvae and cysts, which included preservation in 10% formalin and the Kinyoun method. Thirty-three hemodialysis patients (45.1%) and 36 reference individuals (25.7%) were found to be parasitized. The differences in the percentages of parasitism and polyparasitism between the reference group and the chronic renal patients was significant (p= 0.0318 and 0.0019, respectively). Blastocystis sp. (18%-20.1%), Endolimax nana (14%-16.3%), Cryptosporidium sp. (4%-4.7%) and Entamoeba coli (4%-4.7%) were the most frequent protozoa found in the hemodialysis patients. Parasitism was not significantly associated with diarrhea (p=0.9947) or with decreased white blood cell counts (p=0.7046) in these individuals. Because parasitic infections may be an important comorbidity factor in hemodialysis patients, we suggest that parasitological stool examinations, especially for Blastocystis sp. and Cryptosporidium sp., be included in routine medical follow-up examinations of these patients. PMID:19030738

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

2008-08-01

285

Blastocystis sp. and other intestinal parasites in hemodialysis patients  

Scientific Electronic Library Online (English)

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

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

286

A multi-center, prospective, open-label, 8-week study of certoparin for anticoagulation during maintenance hemodialysis – the membrane study  

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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.

Dorsch Oliver

2012-06-01

287

Analysis of proteins eluted from hemodialysis membranes.  

Science.gov (United States)

To further investigate the types of interactions occurring between blood and hemodialysis membranes, proteins were sequentially eluted from used dialysers. Four different membranes (cuprophan, hemophan, cellulose acetate and polyacrylonitrile) were successively treated with a hydrogen bond cleaving agent (10 M urea), an ionic detergent destabilizing the hydrophobic interactions between apolar groups (SDS solution), and a hydroxylamine solution at alkaline pH to release postulated covalently bound C3 fragments. The eluted proteins were analyzed by SDS-PAGE and immunological techniques. Total protein determinations demonstrate different behaviour of the membranes as regards the 'protein cake'. Electrophoretic analysis suggests that qualitative and quantitative differences in the binding of the blood proteins are related to the membrane material. Complement fragment studies indicate that the complement activating potential of the dialysis membrane may not be determined by the availability of potential binding sites for activated C3b. An attempt is made to correlate these results with the biocompatibility concept. PMID:1772832

Françoise Gachon, A M; Mallet, J; Tridon, A; Deteix, P

1991-01-01

288

Complications from permanent hemodialysis vascular access.  

Science.gov (United States)

From 1981 to 1986 a total of 499 operations were performed for permanent hemodialysis vascular access in 230 patients. At least 1 year's follow-up was achieved in all cases. This series is divided into 326 primary procedures and 173 secondary procedures. Of the primary procedures, there were 160 autogenous fistulas and 166 expanded polytetrafluoroethylene (PTFE) fistulas. The 156 secondary procedures consisted of 124 thrombectomies, 20 repairs of pseudoaneurysm, 12 fistula ligations, and 17 fistula excisions. The infectious complication rate (29/482) was 6%. Mean length of patency was 3.1 years for autogenous wrist fistula, 2.6 years for elbow fistula, 1.9 years for forearm loop PTFE, 2.1 years for straight forearm PTFE, 1.6 years for femoral popliteal PTFE, and 1.4 years for femoral arteriovenous loop PTFE. A vascular steal syndrome occurred in 8% of patients with autogenous elbow fistulas (4/48), compared with 1.7% (2/112) of patients with wrist fistulas and 1.8% (3/166) of those with PTFE fistulas. All infected fistulas required excision, and all fistulas associated with the steal syndrome required ligation. Use of PTFE to construct permanent hemodialysis vascular access has a significantly higher incidence of thrombosis, infection, pseudoaneurysm formation, and limb loss (p less than 0.01 for all complications) and a significantly lower mean length of patency (p less than 0.0001) when compared with autogenous fistulas. Age, sex, hypertension, diabetes mellitus, and the use of perioperative antibiotics were not found to be related significantly to access complications. PMID:3175866

Zibari, G B; Rohr, M S; Landreneau, M D; Bridges, R M; DeVault, G A; Petty, F H; Costley, K J; Brown, S T; McDonald, J C

1988-10-01

289

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  

Scientific Electronic Library Online (English)

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.

2009-04-01

290

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  

Scientific Electronic Library Online (English)

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.

291

The effect of Omega 3 fatty acid on the lipid profile of hemodialysis patient  

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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.

2005-01-01

292

Survival after Acute Hemodialysis in Pennsylvania, 2005-2007: A Retrospective Cohort Study  

Science.gov (United States)

Background Little is known about acute hemodialysis in the US. Here we describe predictors of receipt of acute hemodialysis in one state and estimate the marginal impact of acute hemodialysis on survival after accounting for confounding due to illness severity. Materials and Methods This is a retrospective cohort study of acute-care hospitalizations in Pennsylvania from October 2005 to December 2007 using data from the Pennsylvania Health Care Cost Containment Council. Exposure variable is acute hemodialysis; dependent variable is survival following acute hemodialysis. We used multivariable logistic regression to determine propensity to receive acute hemodialysis and then, for a Cox proportional hazards model, matched acute hemodialysis and non-acute hemodialysis patients 1?5 on this propensity. Results In 2,131,248 admissions of adults without end-stage renal disease, there were 6,657 instances of acute hemodialysis. In analyses adjusted for predicted probability of death upon admission plus other covariates and stratified on age, being male, black, and insured were independent predictors of receipt of acute hemodialysis. One-year post-admission mortality was 43% for those receiving acute hemodialysis, compared to 13% among those not receiving acute hemodialysis. After matching on propensity to receive acute hemodialysis and adjusting for predicted probability of death upon admission, patients who received acute hemodialysis had a higher risk of death than patients who did not over at least 1 year of follow-up (hazard ratio 1·82, 95% confidence interval 1·68–1·97). Conclusions In a populous US state, receipt of acute hemodialysis varied by age, sex, race, and insurance status even after adjustment for illness severity. In a comparison of patients with similar propensity to receive acute hemodialysis, those who did receive it were less likely to survive than those who did not. These findings raise questions about reasons for lack of benefit. PMID:25141028

Ramer, Sarah J.; Cohen, Elan D.; Chang, Chung-Chou H.; Unruh, Mark L.; Barnato, Amber E.

2014-01-01

293

Ego strength and health: An empiric study in hemodialysis patients  

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Full Text Available Introduction: Ego strength represents an important variable that could be predictable about health and compliance in chronic diseases. In this study we propose a new questionnaire, E.F.E. “Ego Functioning Experience”, able to reveal the psychological functioning profile in Hemodialysis patients. The aim of this work, is to underline the existing relations between emotional profile and compliance, whit E.F.E., that may be predictive of a state of psychologycal health in hemodialysis patients. Methods: Study population included 90 hemodialysis patients. The study protocol was made by three psychological tests: the E.F.E. Questionnaire, the DMI, the Self-Liking and Self-Competence Scale. Results: Factor analysis extracts three factors: 1 “Need of Ego support”; 2 “Ego activity oriented to treatment”; 3 “Ego strength”. The correlation coefficients between the E.F.E. Questionnaire factors (three factors and other measures, showed a direct correlation with the first factor and “turning against object” TAO of the DMI test (correlation is significant at the 0.001 level and an inverse relation with set mechanisms of “Principalization”, PRN of the DMI (correlation is significant at the 0.005 level. The correlations of the second and the third factors with other measures, were not statistically significant. No relations were found about other variables. Conclusions: The E.F.E. questionnaire is a simple evaluation to detect hemo-dialysis patients who may need greater attention to the psychological health and therefore the need for treatment such as psychological support. In fact, lower presence of ego strength is indicative of poor compliance to clinical treatment in hemodialysis, but also of worsening of psychiatric symptoms such as demoralization and depressed mood. In conclusion, an increased social support is needed in hemodialysis patient in order to achieve better compliance and achieve a better state of psychological health in chronic hemodialysis patients.

Salvatore Settineri

2012-12-01

294

The influence of maintenance quality of hemodialysis machines on hemodialysis efficiency  

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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.

Azar Ahmad

2009-01-01

295

Needs, concerns, strategies, and advice of daily home hemodialysis caregivers.  

Science.gov (United States)

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

2014-12-01

296

Health Related Quality of Life among Egyptian Patients on Hemodialysis  

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Full Text Available The present research was carried out to evaluate the physical (PCS and mental (MCS component summary scales in hemodialysis patients as compared to healthy subjects at a baseline and two years later. 130 patients on hemodialysis (mean age 40.6±8.1 years were enrolled in the study between February 2003 to February 2005. The short-form with 36 (SF-36 questionnaire was given every 6 months to hemodialysis patients. Results were compared to the general population and changes in QoL over time were determined. Mean PCS was 34±15.46 and mean MCS was 38.80±15.17 compared to the general population there were significant decline in PCS and MCS at baseline and two years later. There was no significant correlation between causes of End-Stage Renal Disease (ESRD and Quality of Life (QoL, except for diabetes mellitus as regard MCS. High levels of serum albumin and hemoglobin was associated with highly significant quality of life. Serum albumin was a good predictor for quality of life in this study. Adequacy of dialysis treatment in hemodialysis patients was determined by serum albumin, hematocrit, KT/V and Urea Reduction Ratio (URR. Present results showed the negative impact that ESRD and hemodialysis treatment have on self-assessed physical and mental health and it is important to treat all factors that induce hypoalbuminemia as well as anaemia.

Heba Sayed Assal

2006-01-01

297

Relationship between fatigue and social support in hemodialysis patients.  

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The aim of this study was to evaluate the relationship between fatigue and social support in hemodialysis patients in Turkey. This study was conducted on 73 patients receiving hemodialysis treatment in a hemodialysis unit in the province of Malatya between July and November 2011. A questionnaire consisting of 16 questions for sociodemographic and disease data was used together with the Multidimensional Scale of Perceived Social Support (MSPSS) and the Fatigue Severity Scale (FSS). In statistical evaluation, the Mann-Whitney U-test, independent t-test, Kruskal-Wallis test, and Pearson's correlation analysis were used. Correlation analysis between severity of fatigue in hemodialysis patients and social support revealed a significant relationship in the negative direction between fatigue severity and support from family (r?=?-0.404, P?support from friends (r?=?-0.635, P?support from a special person (r?=?-0.638, P?support (r?=?-0.643, P?Patients with severe fatigue had low mean scores for support from family, friends, a special person and overall, whereas a high level of social support decreased the level of fatigue. When giving care to patients on hemodialysis, nurses should consider the effect of social support on fatigue and approach their patients from this perspective. PMID:23552015

Karadag, Ezgi; Kilic, Serap Parlar; Metin, Ozgur

2013-04-01

298

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

Scientific Electronic Library Online (English)

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

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

299

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

Directory of Open Access Journals (Sweden)

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

Vanessa Giendruczak da Silva

2011-03-01

300

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english PURPOSE: To evaluate alanine aminotransferase levels before and after a hemodialysis session and to correlate these values with the hematocrit rate and weight loss during hemodialysis. PATIENTS AND METHODS: The serum alanine aminotransferase levels, hematocrit rate and body weight were measured and [...] correlated before and after a single hemodialysis session for 146 patients with chronic renal failure. An receiver operating characteristic (ROC) curve for the serum alanine aminotransferase levels collected before and after hemodialysis was plotted to identify hepatitis C virus-infected patients. RESULTS: The mean weight loss of the 146 patients during hemodialysis was 5.3% (p

Edmundo Pessoa, Lopes; Luis Henrique B. C., Sette; Jorge Bezerra C., Sette; Carlos F., Luna; Amaro M., Andrade; Maviael, Moraes; Paulo C. A., Sette; Roberto, Menezes; Rui L., Cavalcanti; Sergio C., Conceição.

 
 
 
 
301

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

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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

2002-10-01

302

Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia.  

Science.gov (United States)

Substantial activation of platelets can occur in the course of hemodialysis. Platelet surface markers show evidence of platelet degranulation. Some activation occurs due to exposure of blood to the roller pump segment and microbubbles may play a role. Platelet activation seems to be reduced with reused dialyzers or with those containing synthetic versus cellulosic membranes. Nevertheless, a substantial degree of platelet activation can be demonstrated with polysulfone and other synthetic membranes; the amount of activation may differ substantially among polysulfone membranes, depending on the manufacturer and the polyvinylpyrrolidone content. Platelet-platelet and platelet-leukocyte aggregates have been detected in the dialyzer blood outflow line and the consequences of these to the microcirculation are unknown. Typically, the platelet count decreases slightly during the first hour of dialysis, but mostly returns to initial values by the end of dialysis. A number of chronic hemodialysis patient cases have been reported in which a marked decrease in platelet count (50% or more) during dialysis was observed, resulting in mild degrees of predialysis thrombocytopenia. In only one case was the decrease in platelet count associated with bleeding. Dialyzer hypersensitivity symptoms are infrequently associated with a fall in platelet count. Most recent cases of dialysis-associated thrombocytopenia have been with polysulfone membranes, especially polysulfone membranes sterilized by electron beam. The exact cause of these reactions remains unknown. PMID:22592187

Daugirdas, John T; Bernardo, Angelito A

2012-07-01

303

Disappearance of diabetic macular hard exudates after hemodialysis introduction.  

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Full Text Available

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

Matsuo,Toshihiko

2006-06-01

304

Tendinous and ligamentous hyperlaxity in patients receiving longterm hemodialysis.  

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Chronic renal insufficiency gives rise to osteoarticular and tendinous alterations, with tendinous rupture reaching 3.6% among patients receiving hemodialysis. To evaluate potential tendinous and ligamentous alterations, 39 consecutive patients receiving longterm hemodialysis (mean dialysis time 33 months) were studied prospectively by clinicoradiological methods. Of the 39 cases, atlantoaxial subluxation was found in 3 (7.7%). Tendinous or ligamentous hyperlaxity was present in 29 (74%) with patellar tendon elongation in 19 (49%), articular hypermobility in 20 (51%) and both in 10. Differences were significant (p less than 0.05) in patients with articular hypermobility with over 36 months' dialysis, and even more so (p less than 0.01) in those with over 48 months. Atlantoaxial subluxation was more frequent after 48 months' dialysis. Therefore, patients receiving longterm hemodialysis are prone to present tendinous or ligamentous hyperlaxity with atlantoaxial subluxation as well. PMID:1941829

Rillo, O L; Babini, S M; Basnak, A; Wainer, E; Balbachan, E; Cocco, J A

1991-08-01

305

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

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In this study, the polyvinylidene fluoride (PVDF) hollow fiber hemodialysis membranes were prepared by non-solvent induced phase separation (NIPS). The influences of PVDF membrane thickness and polyethylene glycol (PEG) content on membrane morphologies, pore size, mechanical and permeable performance were investigated. It was found that membrane thickness and PEG content affected both the structure and performance of hollow fiber membranes. The tensile strength and rejection of bovine serum albumin (BSA) increased with increasing membrane thickness, while the Ultrafiltration flux (UF) flux of pure water was the opposite. The tensile strength, porosity and rejection of BSA increased with increasing PEG content within a certain range. Compared with commercial F60S membrane, the PVDF hollow fiber membrane showed higher mechanical and permeable performance. It was proven that PVDF material had better hydrophilicity and lower BSA adsorption, which was more suitable for hemodialysis. All the results indicate that PVDF hollow fiber membrane is promising as a hemodialysis membrane. PMID:24957122

Zhang, Qinglei; Lu, Xiaolong; Zhao, Lihua

2014-01-01

306

Preparation of Polyvinylidene Fluoride (PVDF Hollow Fiber Hemodialysis Membranes  

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

Qinglei Zhang

2014-02-01

307

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

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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.

Daniel Ducuara

2013-05-01

308

Medication adherence among adult patients on hemodialysis.  

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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

2014-07-01

309

Malnutrition predicting factors in hemodialysis patients  

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Full Text Available 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 were classified as malnourished. According to DMS score, poor protein intake (r= -0.34, P< 0.01, comorbidities (r= -0.24, P< 0.05, poor energy intake (r= - 0.18, P< 0.005, and inflammation (r= -0.16, P< 0.05 were significant predictors of malnutrition in descending order of importance. Multiple regression analysis showed that only poor protein intake was the explanatory variable of anthropometric measurements decline including body mass index, triceps skin fold thick-ness, mid arm circumference, mid arm muscle circumference, fat free mass, fat mass, albumin, creatinine and transferrine. None of the mentioned factors predicted the decrease of biochemical markers. We conclude that the frequency of malnutrition is high in our population and poor protein intake is the primary contributing factor for this condition. There-fore, providing enough protein may be a simple and effective way in preventing malnutrition in these patients.

Jahromi Soodeh

2010-01-01

310

Biological vascular grafts for hemodialysis access.  

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Alternatives to autogenous arteriovenous hemodialysis (HD) access, such as synthetic arteriovenous bypass grafts and central venous catheters, are associated with a higher rate of complications. The evaluated article assessed the repeated cannulation challenges of HD in tissue-engineered blood vessels implanted in a bovine in vivo model (n = 15). Two groups were studied. A short-term group in which the graft was explanted and histologically examined (n = 7) and a second group in which the graft was left in for 6 months or until outflow venous stenosis occurred (n = 8). Two grafts from each group occluded 1-month postoperatively. Of the 11 remaining, cannulation was well tolerated with adequate hemostasis. Histological analysis demonstrated host cell repopulation of the outer surface in the short-term group (n = 5) and stable wall geometry in the long-term group. The authors concluded that their study proves the concept of using a scaffold-based approach to tissue-engineered blood vessels for HD access. PMID:23480086

Hossain, Mohammad A; Frampton, Adam E; Chowdhury, Tina T; Morsy, Mohamed

2013-03-01

311

Blood leptin levels and erythropoietin requirement in Iranian hemodialysis patients  

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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.

Rahimi A

2008-12-01

312

Sleep Quality and Spiritual Well-Being in Hemodialysis Patients  

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Background: Sleep disorders are considered as one of the most important problems in hemodialysis patients, making their everyday life a serious hazard. Sleep quality of hemodialysis patients and consequences of sleep disorders on other aspects of health such as spiritual well-being are important issues. Objectives: This study examined the relationship between spiritual well-being and quality of sleep in hemodialysis patients in Isfahan, Iran. Patients and Methods: This study was a correlation research, carried out on 190 hemodialysis patients. Data collection Questionnaires included demographic forms, Pittsburgh sleep quality index (PSQI), and Ellison and Paloutzian spiritual well-being scale. Data were analyzed using descriptive and inferential statistics (Pearson correlation and linear regression analysis) at P < 0.05 significance level, by SPSS software version 18. Results: Of 190 study participants, 163 (85.78%) with scores more than five index had sleep disturbances and 27 (14.12%) had no sleep disturbance; 3 (1.52%) had mild, 163 (85.78%) moderate, and 24 (12.30%) good spiritual health conditions. Pearson correlation test showed significant relationship between the sleep quality items of Pittsburg and spiritual well-being (P < 0.04, r = 0.149). Through the regression analyses of spiritual health, family, education, financial status, marital status, occupation, and use of sleep medication, the predictive power of these variables was found 0.417% and prediction of spiritual well-being was more than others (ß = 0.209). Conclusions: Considering bed as one of the most vital physical, mental, and emotional needs, it is very important in mental and spiritual well-being of hemodialysis patients as an influencing factor in mental relaxation and reducing disease tensions. Paying attention to sleep quality and spiritual well-being components of hemodialysis patients in formulating and promoting healthcare programs is recommended.

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

2014-01-01

313

Relationship between effective ionic dialysance and in vivo urea clearance during hemodialysis.  

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Effective ionic dialysance (EID) can be measured from dialyzer inlet and outlet conductivity changes following two steps of dialysate conductivity. Relationships between EID and in vivo urea clearances were studied four times per hemodialysis treatment in eight patients, each undergoing six hemodialysis treatments (192 data sets). Dialyzer blood flow was varied from 190 to 500 mL/min. Dialysate flow was constant (751 to 771 mL/min), and a standard dialyzer (700 HG; Cobe, Lakewood, CO) was used. Double samples were drawn for arterial, venous, and dialysate urea measurements. Two laboratory values were missing. Twelve unreliable laboratory values indicated by divergent results were excluded. Urea clearances were calculated by formulae converting whole-blood to blood-water urea clearances. EID was measured using Diascan (Gambro-Dasco, Medolla, Italy). Mass balance was checked by comparison of dialysate and blood-water urea clearances. Divergent results between dialysate and blood-water urea clearance values led to the exclusion of an additional three laboratory values. A small error (4.2%) in urea mass balance was found (dialysate greater than blood-water urea clearances). A total of 175 data sets were compared. EID showed excellent correlation with blood-water urea clearances (r = 0.92) over the line of identity, with a mean difference of -3.5 mL/min (-1%), and similarly with dialysate urea clearances (r = 0.92; mean difference, -13.4 mL/min; -5%). For both blood- and dialysate-side comparisons, differences increased with greater clearances. Because EID is an effective clearance and urea clearance is a measure of dialyzer clearance, the curves were corrected for cardiopulmonary recirculation; access recirculation was zero (Transonic monitor; Transonic Systems Inc, Ithaca, NY). For cardiopulmonary recirculation correction, cardiac output and access flows were assumed to be 6.4 L and 1.46 L/min. Corrected data show EID correlates with blood-side urea clearance (r = 0.92), with a mean difference of +7.3 mL/min (3.3%), and is constant over the range of clearances. EID correlated with dialysate urea clearance (r = 0.92) with virtually no difference. The difference on the blood side is consistent with the urea mass balance error found. These data indicate that EID using Diascan can provide an accurate indication of effective urea clearances obtained during hemodialysis and is of value in monitoring dialysis adequacy. PMID:11532690

Lindsay, R M; Bene, B; Goux, N; Heidenheim, A P; Landgren, C; Sternby, J

2001-09-01

314

Synthetic vascular access graft in hemodialysis patients: patency rate and complications  

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Full Text Available Background: Dialysis access procedures and complications are important causes of morbidity and hospitalization for chronic hemodialysis patients. Ideally, any patient undergoing hemodialysis should receive an autogenous fistula that can be accessed throughout the patient's life. In patients with primarily unsuitable or secondarily surgically-exhausted veins, a prosthetic graft can be performed. Several recently published studies report the outcome of prosthetic grafts. The conclusions of these studies differ dramatically. The aim of this prospective study was to determine the patency, infection and thrombosis rates using Poly-tetrafluoroethylene (PTFE in grafts for vascular access in hemodialysis patients. Methods: During this three-year prospective study, 84 patients underwent placement of vascular access graft at the Vascular Surgery Department of Sina Trauma and Surgery Research Center in Tehran. Demographics, complications, and subsequent treatment were recorded. Primary patency rates were estimated using the Kaplan-Meier method. Logrank tests were used to evaluate the statistical differences in survival distribution. Results: The mean patient age was 55 years (±12 years. Hypertension, diabetes and smoking were considered to be risk factors for atherosclerosis in 45, 26 and 19 cases, respectively. The patients were followed up for at least 24 months. The primary patency rates were 78%, 63.3% and 54.9% at 6, 12 and 18 months, respectively. There were 39 (46.4% access failures, which were related to infection in five cases (6%, thrombosis in 30 cases (35.7% and bleeding in two cases (2.4%. The patency rate in patients without hypertension and with hypertension were 62.2% and 29.7%, respectively (P<0.03. Patency rates for upper extremity and lower extremity grafts were 60% and 26%, respectively (P<0.05. Conclusion: A PTFE vascular graft seems to be an appropriate vascular access and is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. Additionally, good care and educating patients can further decrease the rate of complication and morbidity, thereby resulting in a better patency rate.Salimi J. *1 Rostamnejad M.1"nMeisami A.P.2"n1- Sina Trauma & Surgery"nResearch Center"n2- Department of Social Medicine"nTehran University of Medical"nSciences

Salimi J

2007-09-01

315

131I therapy for toxic adenoma in patient on hemodialysis  

International Nuclear Information System (INIS)

Treatment with radioactive iodine (131I) may be necessary for toxic adenoma of the thyroid in patients with end-stage renal disease (ESRD) who require hemodialysis (HD). Because 131I is cleared mainly by the kidneys in patients with normal renal function, many issues arise as in patients who require 131I treatment but who are on hemodialysis, as radiation safety considerations, contamination of equipment, lines and filter and disposal of wastes. This paper presents a case report of a patient on dialysis that required treatment with 131I. (author)

316

Measurement of tumor markers in chronic hemodialysis patients  

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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 ...

Tzitzikos G; Saridi M; Filippopoulou T; Makri A; Goulioti A; Stavropoulos T; Stamatiou K

2010-01-01

317

Intradialytic aerobic exercise training ameliorates symptoms of restless legs syndrome and improves functional capacity in patients on hemodialysis: a pilot study.  

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We present the first study on the influence of exercise training on restless legs syndrome (RLS) in patients on hemodialysis (HD). Restless legs syndrome has been treated pharmacologically with satisfactory results; however, side effects and rebound phenomena have been reported. Intradialytic exercise training effectively counteracts uremia-induced catabolism; nevertheless, it remains unknown whether patients with RLS undergoing HD benefit from such programs. The aims of the current study were to evaluate the effect of 16-weeks aerobic exercise training in the severity of RLS and in the functional capacity and the quality of life of patients with RLS on HD. Fourteen patients on HD (four female, mean age 59 +/- 16 years) with untreated RLS were assigned, according to their will, to either the exercise group (Ex-group, n = 7), and participated in a 16-week supervised intradialytic aerobic exercise training, or to the control group (Con-group, n = 7), and continued usual activities. Primary aim was to compare the International RLS (IRLS) study group rating scale, functional ability, and quality of life in baseline and the end of the 16 weeks. Exercise training reduced IRLS score by 42% (p = 0.02). Furthermore, it significantly improved indices of functional ability (p = 0.02), exercise capacity (p = 0.01), quality of life (p = 0.03), and sleep quality (p = 0.01). In the Con-group no changes were observed. In conclusion, aerobic exercise training is safe and efficacious in reducing RLS symptoms and improving quality of life in patients with RLS on HD. PMID:18356653

Sakkas, Giorgos K; Hadjigeorgiou, Georgios M; Karatzaferi, Christina; Maridaki, Maria D; Giannaki, Christoforos D; Mertens, Peter R; Rountas, Christos; Vlychou, Marianna; Liakopoulos, Vassilios; Stefanidis, Ioannis

2008-01-01

318

Heat shock proteins in children and young adults on chronic hemodialysis.  

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Chronic inflammation, lipid and autoimmune disorders are hallmarks of atherogenesis, and hemodialysis per se may be an additional factor predisposing to accelerated atherosclerosis. Elevated levels of heat shock proteins (HSP) and antibodies against these HSP have been described in adults with atherosclerotic lesions and cardiovascular events, but to date there has been a scarcity of investigations on these parameters in adult and pediatric patients on hemodialysis (HD). We have investigated the HSP profile in hemodialyzed children and the impact of a single HD session on those proteins and their correlations with known risk factors for atherosclerosis. The study group consisted of 17 children and young adults undergoing HD with polysulfone membranes. The control group comprised 15 age-matched subjects with normal kidney function. The serum concentrations of Hsp60, Hsp90alpha, anti-Hsp60, anti-Hsp70, and sE-selectin were assessed by an enzyme-linked immunosorbent assay, and serum concentration of high-sensitivity-C-reactive protein was assayed by nephelometry. The serum lipid profile [total cholesterol (CHOL), high-density lipoprotein-CHOL, low-density lipoprotein-CHOL, triglycerides] was also estimated. Compared to the control values, the median values of Hsp60 before the HD session were lower, whereas those of Hsp90alpha and anti-Hsp60 were higher. A single HD session raised the median values of Hsp60 and Hsp90alpha and decreased the concentrations of anti-Hsp60 and anti-Hsp70. In addition, the concentrations of HSPs and the antibodies against them correlated with the lipid markers both before and after HD. The altered HSP and anti-HSP concentrations in HD children, which correlated with the lipid profile and the endothelial markers, suggest a dysfunctional HSP system in this population and the possibility of HSPs being classified as new markers of atherosclerosis. PMID:19475432

Musia?, Kinga; Szprynger, Krystyna; Szczepa?ska, Maria; Zwoli?ska, Danuta

2009-10-01

319

Individualized reduction in dialysate sodium in conventional in-center hemodialysis  

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Recent studies have focused on the association between dialysate sodium (Na+) prescriptions and interdialytic weight gain (IDWG). We report on a case series of 13 patients undergoing conventional, thrice-weekly in-center hemodialysis with an individualized dialysate Na+ prescription. Individualized dialysate Na+ was achieved in all patients through a stepwise weekly reduction of the standard dialysate Na+ prescription (140 mEq/L) by 2–3 mEq/L until reaching a Na+ gradient of ?2 mEq/L (dialysate Na+ minus average plasma Na+ over the preceding 3 months). Interdialytic weight gain, with and without indexing to dry weight (IDWG%), blood pressure, and the proportion of treatments with cramps, intradialytic hypotension (drop in systolic blood pressure >30 mmHg) and intradialytic hypotension requiring an intervention were reviewed. At the beginning of the observation period, the pre-hemodialysis (HD) plasma Na+ concentration ranged from 130 to 141 mEq/L. When switched from the standard to the individualized dialysate Na+ concentration, IDWG% decreased from 3.4% ± 1.6% to 2.5% ± 1.0% (P = 0.003) with no change in pre- or post-HD systolic or diastolic blood pressures (all P > 0.05). We found no significant change in the proportion of treatments with cramps (6% vs. 1.3%), intradialytic hypotension (62% vs. 65%), or intradialytic hypotension requiring an intervention (29% vs. 33%). Individualized reduction of dialysate Na+ reduces IDWG% without significantly increasing the frequency of cramps or hypotension. PMID:22554224

ARRAMREDDY, Rohini; SUN, Sumi J.; MENDOZA, Jair MUNOZ; CHERTOW, Glenn M.; SCHILLER, Brigitte

2013-01-01

320

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

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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 associatesmembrane 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

 
 
 
 
321

Long-term antihypertensive effects of aliskiren, a direct renin inhibitor, in chronic hemodialysis patients.  

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The renin-angiotensin-aldosterone system is not necessarily suppressed in end-stage renal disease patients undergoing dialysis. Of all the inhibitors of this system, the clinical efficacy of the renin inhibitor, aliskiren, has not been well demonstrated in dialysis patients. We evaluated the antihypertensive effect of aliskiren, administered as a single daily dose of 150?mg for 24 weeks, in 23 chronic hemodialysis patients (age 65?±?12 years, 15 men and eight women) with blood pressure ?140/90?mm?Hg, and assessed the factors relating to blood pressure reduction. At 4 weeks, the average systolic blood pressure before the dialysis session was insignificantly reduced from 163?±?10?mm?Hg to 160?±?15?mm?Hg, while it was significantly lowered at 12 (154?±?13?mm?Hg) and 24 weeks (155?±?10?mm?Hg), although the pulse rate was not significantly altered. Serum K increased at 24 weeks from 4.9?±?0.6?mEq/L to 5.2?±?0.8?mEq/L. Only 10 out of 23 patients showed systolic blood pressure reduction by ?10?mm?Hg. Naturally, plasma renin immunoreactivity increased, while plasma renin activity, along with angiotensin II and aldosterone levels decreased. Basal levels of the components of the renin-angiotensin-aldosterone system were not significantly different in patients showing systolic blood pressure reduction by ?10?mm?Hg (n?=?10) vs. those with <10?mm?Hg changes (n?=?13). The reduction in systolic blood pressure in all 23 patients taken as a whole correlated with changes in plasma renin activity (r?=?-0.432, P?hemodialysis patients, aliskiren modestly lowers blood pressure over the long term, although the antihypertensive effect seems dependent on the changes, but not on the basal levels of plasma renin activity and angiotensin II. PMID:24107281

Ishimitsu, Toshihiko; Ohta, Satoshi; Ohno, Eri; Takahashi, Toshiaki; Numabe, Atsushi; Okamura, Atsushi; Ohba, Shuichi; Hashimoto, Akiko; Matsuoka, Hiroaki

2013-10-01

322

Lung ultrasonography for the assessment of rapid extravascular water variation: evidence from hemodialysis patients.  

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Chest ultrasonography is a useful tool to assess extravascular lung water at bedside. In presence of interstitial-alveolar imbibition, vertical artifacts arising from the pleura are detected; these are called B-lines. Although a positive linear correlation between B-lines and extravascular lung water has been shown in symptomatic heart failure patients, the subclinical phase of pulmonary imbibition and the clearance of B-lines after rapid body fluid removal have been less investigated. The aim of this study was to assess if chest ultrasound could detect lung water imbibition and its variations induced by dialysis, an experimental model of controlled rapid fluid loss. Forty-one patients undergoing hemodialysis were studied. Total number of B-lines from ultrasound chest scanning and vena cava diameters were measured before and after treatment. Before dialysis, most of the patients presented ultrasound signs of pulmonary imbibition despite the absence of dyspnea; the number of B-lines was associated with the accumulated weight before treatment (p < 0.05) as well as with the residual weight after dialysis (p < 0.01); B-lines and end-inspiratory and end-expiratory vena cava diameters were also significantly reduced after dialysis. Moreover, B-lines reduction was significantly related to weight loss. Ultrasound performed at the bedside can detect lung water and intravascular overload and their reduction after dialysis in yet asymptomatic patients. These observations add further evidence regarding the use of lung ultrasound and inferior vena cava measurement in estimating volume overload and monitoring the response to therapy both in hemodialysis and congestive heart failure patients. PMID:21590437

Trezzi, Matteo; Torzillo, Daniela; Ceriani, Elisa; Costantino, Giorgio; Caruso, Sabrina; Damavandi, Parham Tabaee; Genderini, Augusto; Cicardi, Marco; Montano, Nicola; Cogliati, Chiara

2013-08-01

323

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

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

Mourad B

2014-11-01

324

Impacto da hepatite C na mortalidade de pacientes em hemodiálise / Impact of hepatitis C in mortality in patients on hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: As causas mais importantes de mortalidade em pacientes com Doença Renal Crônica Terminal (DRCT) são as doenças cardiovasculares. No entanto, existem doenças infecciosas virais (hepatite B e C) que se tornaram uma questão de grande importância para pacientes em hemodiálise, pois afetam a su [...] a sobrevida aumentando a morbidade e a mortalidade. Nosso objetivo foi estudar a influência da hepatite C na mortalidade em pacientes em hemodiálise. MÉTODOS: Realizamos um estudo de coorte não concorrente durante 10 anos. RESULTADOS: Foram estudados 74 pacientes em cada coorte. A hepatite C não aumentou o risco de morte nos pacientes e a sobrevida dos pacientes com essa infecção foi melhor do que no grupo sem hepatite C. A sobrevida em pacientes não infectados no primeiro e quinto anos foi de 93,9% e 52,3%; e para os não infectados foi de 95,5% e 73,1%, respectivamente (Log Rank Mantel Cox, p = 0,02). CONCLUSÃO: Não encontramos aumento no risco de mortalidade. A hepatite C não se correlaciona com aumento de mortalidade em pacientes com DRCT em programa de hemodiálise. Abstract in english OBJECTIVE: Cardiovascular diseases are the most important causes of mortality in patients with end-stage renal disease. However, viral infections (hepatitis B and C) have acquired great importance for patients undergoing hemodialysis, because they affect patients' survival and increase morbidity and [...] mortality. This study aimed at assessing the influence of hepatitis C on the mortality of patients undergoing hemodialysis. METHODS: This is a non-concurrent cohort study during a period of ten years. RESULTS: Each cohort comprised 74 patients. Hepatitis C did not increase the risk of death, and the survival of infected patients was better than that of patients without hepatitis C. The one-year and five-year survivals of non-infected patients were 93.9% and 52.3%, respectively, while those of noninfected patients were 95.5% and 73.1%, respectively (Cox-Mantel log-rank, p = 0.02). CONCLUSION: No increase in mortality risk was observed. Hepatitis C did not correlate with an increase in mortality in patients with end-stage renal disease undergoing hemodialysis.

Cristian Paul Leon, Rabanal; Javier Cieza, Zevallos; Roberto Cieza, Cusato.

325

Impacto da hepatite C na mortalidade de pacientes em hemodiálise Impact of hepatitis C in mortality in patients on hemodialysis  

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Full Text Available OBJETIVO: As causas mais importantes de mortalidade em pacientes com Doença Renal Crônica Terminal (DRCT são as doenças cardiovasculares. No entanto, existem doenças infecciosas virais (hepatite B e C que se tornaram uma questão de grande importância para pacientes em hemodiálise, pois afetam a sua sobrevida aumentando a morbidade e a mortalidade. Nosso objetivo foi estudar a influência da hepatite C na mortalidade em pacientes em hemodiálise. MÉTODOS: Realizamos um estudo de coorte não concorrente durante 10 anos. RESULTADOS: Foram estudados 74 pacientes em cada coorte. A hepatite C não aumentou o risco de morte nos pacientes e a sobrevida dos pacientes com essa infecção foi melhor do que no grupo sem hepatite C. A sobrevida em pacientes não infectados no primeiro e quinto anos foi de 93,9% e 52,3%; e para os não infectados foi de 95,5% e 73,1%, respectivamente (Log Rank Mantel Cox, p = 0,02. CONCLUSÃO: Não encontramos aumento no risco de mortalidade. A hepatite C não se correlaciona com aumento de mortalidade em pacientes com DRCT em programa de hemodiálise.OBJECTIVE: Cardiovascular diseases are the most important causes of mortality in patients with end-stage renal disease. However, viral infections (hepatitis B and C have acquired great importance for patients undergoing hemodialysis, because they affect patients' survival and increase morbidity and mortality. This study aimed at assessing the influence of hepatitis C on the mortality of patients undergoing hemodialysis. METHODS: This is a non-concurrent cohort study during a period of ten years. RESULTS: Each cohort comprised 74 patients. Hepatitis C did not increase the risk of death, and the survival of infected patients was better than that of patients without hepatitis C. The one-year and five-year survivals of non-infected patients were 93.9% and 52.3%, respectively, while those of noninfected patients were 95.5% and 73.1%, respectively (Cox-Mantel log-rank, p = 0.02. CONCLUSION: No increase in mortality risk was observed. Hepatitis C did not correlate with an increase in mortality in patients with end-stage renal disease undergoing hemodialysis.

Cristian Paul Leon Rabanal

2010-12-01

326

Impacto da hepatite C na mortalidade de pacientes em hemodiálise / Impact of hepatitis C in mortality in patients on hemodialysis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: As causas mais importantes de mortalidade em pacientes com Doença Renal Crônica Terminal (DRCT) são as doenças cardiovasculares. No entanto, existem doenças infecciosas virais (hepatite B e C) que se tornaram uma questão de grande importância para pacientes em hemodiálise, pois afetam a su [...] a sobrevida aumentando a morbidade e a mortalidade. Nosso objetivo foi estudar a influência da hepatite C na mortalidade em pacientes em hemodiálise. MÉTODOS: Realizamos um estudo de coorte não concorrente durante 10 anos. RESULTADOS: Foram estudados 74 pacientes em cada coorte. A hepatite C não aumentou o risco de morte nos pacientes e a sobrevida dos pacientes com essa infecção foi melhor do que no grupo sem hepatite C. A sobrevida em pacientes não infectados no primeiro e quinto anos foi de 93,9% e 52,3%; e para os não infectados foi de 95,5% e 73,1%, respectivamente (Log Rank Mantel Cox, p = 0,02). CONCLUSÃO: Não encontramos aumento no risco de mortalidade. A hepatite C não se correlaciona com aumento de mortalidade em pacientes com DRCT em programa de hemodiálise. Abstract in english OBJECTIVE: Cardiovascular diseases are the most important causes of mortality in patients with end-stage renal disease. However, viral infections (hepatitis B and C) have acquired great importance for patients undergoing hemodialysis, because they affect patients' survival and increase morbidity and [...] mortality. This study aimed at assessing the influence of hepatitis C on the mortality of patients undergoing hemodialysis. METHODS: This is a non-concurrent cohort study during a period of ten years. RESULTS: Each cohort comprised 74 patients. Hepatitis C did not increase the risk of death, and the survival of infected patients was better than that of patients without hepatitis C. The one-year and five-year survivals of non-infected patients were 93.9% and 52.3%, respectively, while those of noninfected patients were 95.5% and 73.1%, respectively (Cox-Mantel log-rank, p = 0.02). CONCLUSION: No increase in mortality risk was observed. Hepatitis C did not correlate with an increase in mortality in patients with end-stage renal disease undergoing hemodialysis.

Cristian Paul Leon, Rabanal; Javier Cieza, Zevallos; Roberto Cieza, Cusato.

2010-12-01

327

The effects of peritoneal dialysis and hemodialysis on serum tumor necrosis factor-alpha, interleukin-6, interleukin-10 and C-reactive-protein levels  

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Full Text Available BACKGROUND: Markers of an acute phase reaction, such as C-reactive protein (CRP or tumor necrosis factor-alpha (TNF-α 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-α, IL-6, IL-10 and CRP levels in continuous ambulatory peritoneal dialysis (CAPD and hemodialysis (HD patients.

Ahmet Yilmaz

1992-01-01

328

Vascular access for hemodialysis: current perspectives  

Science.gov (United States)

A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure. There are three main types of access: native arteriovenous fistula (AVF), arteriovenous graft, and central venous catheter (CVC). AVF, described by Brescia and Cimino, remains the first choice for chronic HD. It is the best access for longevity and has the lowest association with morbidity and mortality, and for this reason AVF use is strongly recommended by guidelines from different countries. Once autogenous options have been exhausted, prosthetic fistulae become the second option of maintenance HD access alternatives. CVCs have become an important adjunct in maintaining patients on HD. The preferable locations for insertion are the internal jugular and femoral veins. The subclavian vein is considered the third choice because of the high risk of thrombosis. Complications associated with CVC insertion range from 5% to 19%. Since an increasing number of patients have implanted pacemakers and defibrillators, usually inserted via the subclavian vein and superior vena cava into the right heart, a careful assessment of risk and benefits should be taken. Infection is responsible for the removal of about 30%–60% of HD CVCs, and hospitalization rates are higher among patients with CVCs than among AVF ones. Proper VA maintenance requires integration of different professionals to create a VA team. This team should include a nephrologist, radiologist, vascular surgeon, infectious disease consultant, and members of the dialysis staff. They should provide their experience in order to give the best options to uremic patients and the best care for their VA. PMID:25045278

Santoro, Domenico; Benedetto, Filippo; Mondello, Placido; Pipito, Narayana; Barilla, David; Spinelli, Francesco; Ricciardi, Carlo Alberto; Cernaro, Valeria; Buemi, Michele

2014-01-01

329

Esquemas alternativos de hemodiálise / Alternative hemodialysis regimens  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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. Abstract in english 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; Jocemir Ronaldo, Lugon.

330

Perceived illness intrusion among patients on hemodialysis  

International Nuclear Information System (INIS)

Dialysis therapy is extremely stressful as it interferes with all spheres of daily activities of the patients. This study is aimed at understanding the perceived illness intrusion among patients on hemodialysis (HD) and to find the association between illness intrusion and patient demo-graphics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD) stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering sociodemographics and a 13 item illness intrusion checklist covering the various aspects of life was carried out. The study patients were asked to rate the illness intrusion and the extent. The data were analyzed statistically. The mean age of the subjects was 50.28 + - 13.69 years, males were predominant (85%), 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear families. The mean duration on dialysis was 24 + - 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%), work (70%) finance (55%), diet (50%) 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)

331

Esquemas alternativos de hemodiálise / Alternative hemodialysis regimens  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese 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. Abstract in english 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; Jocemir Ronaldo, Lugon.

2010-03-01

332

Telemedicine technology and applications for home hemodialysis.  

Science.gov (United States)

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

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

1999-10-01

333

Perceived illness intrusion among patients on hemodialysis  

Directory of Open Access Journals (Sweden)

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-eco