Full Text Available Gargah Tahar1, Goucha-Louzir Rim2, Lakhoua Mohamed Rachid11Department of Pediatric Nephrology, 2Department of Nephrology, Charles Nicolle Hospital, Tunis, TunisiaAbstract: Tuberculosis (TB remains a public health problem in Tunisia. Its incidence is higher in immunocompromised hosts than in the general population. In children and during hemodialysis, TB is characterized by the frequency of extrapulmonary localizations and diagnostic difficulties. The aim of this retrospective study is to evaluate the incidence of TB in Tunisian children undergoing hemodialysis and to determine its clinical features as well as the results of chemotherapy.Method: This retrospective study includes seven TB children among 112 children on hemodialysis at the pediatric nephrology department in Charles Nicolle Hospital from 2002 to 2008. The diagnosis of TB was established by a combination of clinical, radiological, biochemical, microbiological, and histological examinations. Treatment with anti-TB drugs, the results of therapy, and the outcome of patients were noted.Results: There were four girls and three boys aged 10 to 16 years (mean, 13 years. They had been on hemodialysis for 2 to 5 years (mean, 3 years. Noted clinical features were weight loss and fever in five cases, chest pain in one case, cervical lymph node in one case, and spinal pain in one case. The organ systems involved were pleural in two cases, pulmonary in one case, peritoneal in one case, cervical lymphatic in one case, and spinal in one case. One patient was treated empirically with a good response. Diagnosis was made by isolation of mycobacterium TB in three cases, by specific histological signs observed in a lymph node biopsy in one case, in peritoneal biopsy in one case, and in discovertebral biopsy in one case. In the remaining patient, the clinical and radiological presentations were compatible with pulmonary TB. All patients received four anti-TB drugs: isoniazid, rifampicin, pyrazinamide, and ethambutol. One patient died with miliary TB. The other patients had favorable outcomes.Conclusions: TB in hemodialysis children has a nonspecific clinical presentation. Extrapulmonary locations are most common. Diagnosis is often difficult, but successful outcomes are possible when made at an early stage.Keywords: child, hemodialysis, tuberculosis
Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C
Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p < 0.01) or APD (60 %) (p < 0.04). Patients on APD were more likely to have RLS compared to those on HD or CAPD (p < 0.04) (50 vs. 23 vs. 33 %). No differences among the modalities were found in bruxism, EDS, sleepwalking, sleep hygiene, depression or anxiety. ESRD patients undergoing any one of the three dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established. PMID:25358390
Loncar Daniela; Tabakovic Mithat; Mulic-Bacic Suada; Hadzovic Djani; Brkic Esad; Smajic Elnur; Jasarevic Lejla; Jasarevic Amila
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 ...
The aim of this study was to evaluate the changes in salivary gland function in patients with chronic renal failure (CRF) undergoing hemodialysis. The group consisted of 23 patients with CRF (13 female, 10 male; mean age: 40±13 yr) and 14 healthy control subjects (mean age: 40±13 yr). All underwent dynamic salivary gland scintigraphy with gustatory stimulation. After intravenous administration of 99mTc pertechnetate, first, perfusion images at 2 seconds per frame were acquired for 1 minute, then dynamic images at 1 minute per frame were acquired for 45 minutes. At 30 minutes after injection , 10 ml lemon juice was given for 15 minutes as a gustatory stimulus. We obtained time-activity curves derived from regions of interest centered over the four major salivary glands. The following functional indices were calculated for each gland: the time of maximum radioactivity (Tmax) for the prestimulated period, the time of minimum radioactivity (Tmin), as an indicator of velocity of secretion after stimulation, and the Lem E5% value as an indicator of the secretion function. When the patients with CRF undergoing hemodialysis were compared to the controls, there were statistically significant differences in Tmax, Tmin and Lem E5% values for bilateral parotid glands, and Tmin values for bilateral submandibular glands (pmaxlly significant differences in Tmax and Lem E5% values for bilateral submandibular glands. There were also significant differences in Tmax and Lem E5% values for bilateral parotid glands between mild oral problems and severe oral problems in patients with CRF (undergoing hemodialysis). In this study, prolonged Tmax and Tmin values, and decreased Lem E5% values for parotid glands and prolonged Tmin values for submandibular glands on salivary scintigraphy pointed out decreased parenchymatous and excretory function in patients with CRF undergoing hemodialysis. (author)
Morishita, Yoshiyuki; Kusano, Eiji; Nagata, Daisuke
The renin-angiotensin-aldosterone system (RAAS) blockers have been widely used in chronic kidney disease patients undergoing hemodialysis; however, whether RAAS blockers have beneficial effects for cardiovascular disease in those patients has not been fully defined. This review focuses on the effects of RAAS blockers in chronic kidney disease undergoing hemodialysis for cardiovascular disease.
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.
Full Text Available OBJECTIVE: The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis. PATIENTS AND METHODS: Twenty patients on 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
Full Text Available OBJECTIVE: The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis. PATIENTS AND METHODS: Twenty patients on peritoneal dialysis and 40 on hemodialysis were assessed, and the patients were matched according to the length of time that they had been on dialysis. Blood samples were collected (both before and after the session for those on hemodialysis to measure the enzymes and the hematocrit. RESULTS: In the samples from the patients who were undergoing peritoneal dialysis, the aspartate and alanine aminotransferase levels were slightly higher compared with the samples collected from the patients before the hemodialysis session and slightly lower compared with the samples collected after the hemodialysis session. The levels of gamma-glutamyl transferase in the hemodialysis patients were slightly higher than the levels in the patients who were undergoing peritoneal dialysis. In addition, the levels of aminotransferases and gamma-glutamyl transferase that were collected before the hemodialysis session were significantly lower than the values collected after the session. The hematocrit levels were significantly lower in the patients who were on peritoneal dialysis compared with the patients on hemodialysis (both before and after the hemodialysis session, and the levels were also significantly lower before hemodialysis compared with after hemodialysis. CONCLUSION: The aminotransferase levels in the patients who were undergoing peritoneal dialysis were slightly higher compared with the samples collected before the hemodialysis session, whereas the aminotransferase levels were slightly lower compared with the samples collected after the session. The hematocrits and the aminotransferase and gamma-glutamyl transferase levels of the samples collected after the hemodialysis session were significantly higher than the samples collected before the session. Taken together, the present data suggest that hemodilution could alter the serum levels of liver enzymes.
Aksu, Hale Unal; Oner, Ender; Celik, Omer; Isiksacan, Nilgun; Aksu, Huseyin; Uzun, Sami; Yavuz, Derya; Ozturk, Savas; Gul, Mehmet; Uslu, Nevzat
The aim of this study was to evaluate the prevalence of aspirin resistance (AR) in patients undergoing hemodialysis (HD) and to assess the effect of HD on the results of the Multiplate test. A total of 54 patients undergoing HD were included in this study. Blood samples were taken just before and after the HD session. To determine AR, we used Multiplate test. Platelet aggregation values of the study population were 363.01 ± 225.69 aggregation unit (AU) × minutes before and 375.33 ± 254.05 AU × minutes after the HD (P = .597). There was strong correlation between the values before and after HD (R = .755, P < .0001). The AR status was changed in 9 (16.6%) patients after HD. Agreement of AR status before and after HD was substantial (? coefficient = .667, P < .0001). The prevalence of AR in patients undergoing HD seems higher than in most of the studied populations, and this study has shown that the AR statuses of a significant number of patients undergoing HD change after an HD session. PMID:23698727
Iwagami, Masao; Mochida, Yasuhiro; Ishioka, Kunihiro; Oka, Mochida; Moriya, Hidekazu; Ohtake, Takayasu; Hidaka, Sumi; Kobayashi, Shuzo
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
To study the frequency of restless legs syndrome in patients of end stage renal disease undergoing maintenance hemodialysis. Design: Cross sectional descriptive study. Place and Duration of Study: Department of medicine, CMH Multan from Nov 2010 to April 2011. Patients and Methods: One hundred and ninety four (n=194) patients of End stage renal disease who had been on maintenance hemodialysis for at least 3 months, were included in the study after full informed consent and using consecutive sampling. Patients having dementia, psychiatric illness, pregnancy, hypothyroidism, Parkinson's disease and alcoholics were excluded from the study. Patients who fulfilled all four diagnostic criteria for restless legs syndrome as proposed by International restless legs syndrome study group (IRLSSG), by direct questioning were diagnosed as having restless legs syndrome. Results: The frequency of restless legs syndrome was found to be 12.4% in patients undergoing hemodialysis (10.5% in males versus 16% in females). The mean duration of hemodialysis was higher among RLS positive patients (12.88 +- 5.543 months) as compared to RLS negative patients (6.94 +- 4.610 months). Conclusion: RLS is a frequent, under-diagnosed co-morbidity in patients undergoing maintenance hemodialysis. (author)
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
Leeming, Diana Julie; Karsdal, Morten A
The 7S domain of collagen type IV (P4NP_7S) assessed in plasma represents systemic collagen type IV formation. The objective of the study was to investigate the association of systemic collagen type IV formation with survival among patients undergoing hemodialysis.
Full Text Available Purpose: To consider the effect of serum parathormone on severity of hypertension in end-stage renal failure patients undergoing hemodialysis treatment. Patients and Methods: A cross-sectional study was performed on patients with end-stage renal disease undergoing maintenance hemodialysis treatment. Serum calcium, phosphorus, alkalene phosphatase, serum albumin and intact PTH levels were measured. Stratification of hypertensive patients was performed from stage one to three. A stage of zero means the absence of hypertension. Stages of hypertension were measured before treatment and at the beginning of the first hemodialysis treatment. Results: The total number of patients was 73 (F=28 M=45, including 58 non-diabetic (F=22 M=36 and 15 diabetic hemodialysis patients (F=6 M=9. The mean age of patients was 46.5±16 years. The mean period of time that patients had spent on hemodialysis was 21.5±23.5 months. Serum iPTH of total patients was 309±349 pg/ml and serum alkaline phosphatase of total patients was 413±348 IU/L. There was a significant positive correlation between the stages of hypertension and serum iPTH levels (r=0.200; p=0.045. There was no significant correlation between the stages of hypertension and serum alkalene phosphatase levels (r=0.135; p=0.128. A significant positive correlation between stages of hypertension with Ca x P products of patients (r = 0.231; p=0.027 was also seen. Conclusion: The relationship between serum iPTH and severity of hypertension in this group requires further research on nontraditional causes of hypertension in hemodialysis patients. Hypertension and secondary hyperparathyroidism both interact in the process of accelerated atherosclerosis in hemodialysis patients. This combination may aggravate the rapid progressive athrosclerosis process
Burkert, Antje; Scholze, Alexandra
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
Kitajima, Yukie; Takahashi, Taeko; Sato, Yuzuru; Nakaya, Yutaka
Lanthanum carbonate (LaC) is a non-calcium-based phosphate binder used to treat hyperphosphatemia in patients with chronic kidney disease. Oral administration of LaC is difficult in patients undergoing tube feeding or those who are of advanced age because it is essential to chew the LaC tablet sufficiently before swallowing it. We report two cases in whom crushed LaC was used in hemodialysis patients undergoing tube feeding. In both cases, previously crushed LaC was mixed into enteral nutrien...
Paul, Suman; Hamouda, Danae; Prashar, Rohini; Mbaso, Chiamaka; Khan, Abdur; Ali, Abdulmonam; Shah, Sarthi; Assaly, Ragheb
Dabigatran, a direct thrombin inhibitor, is increasingly used for stroke prevention in patients with non-valvular atrial fibrillation. Dabigatran has a stable pharmacokinetic profile with minimum drug interactions, and requires no routine laboratory evaluation to measure level of anticoagulation. This provides a huge advantage over warfarin, and has the potential to improve patient compliance. The disadvantages of dabigatran are the lack of a reversal agent to counter dabigatran-related bleeding and the absence of a widely available laboratory test that can quantify the extent of coagulopathy in dabigatran overdose. Hemodialysis can rapidly lower dabigatran levels and assist in controlling bleeding secondary to dabigatran overdose. However, in cases in which hemodynamic instability precludes the use of hemodialysis, alternative methods have to be utilized to control dabigatran-associated bleeding. Here we document a case of massive gastrointestinal bleeding secondary to dabigatran use that was successfully managed by continuous venovenous hemodialysis (CVVHD), along with supportive care with blood product transfusions. CVVHD reduces thrombin time and activated partial thrombin time, and causes a parallel decrease in amount of active bleeding. Finally, we show that compared to the rapid lowering of elevated thrombin time observed in hemodialysis, CVVHD requires several days to reduce thrombin time to normal range. PMID:25633777
Memory and cognitive abnormalities such as decreased attention span, impulsiveness, and slow reaction are common among chronic hemodialysis patients. We studied the changes these parameters in 38 hemodialysis patients before and after hemodialysis sessions via Conner?s continuous performance test. Mean age of the study patients was 38.0 ± 12.6 years. There was no significant difference before and after hemodialysis in the number of the successfully recognized matches, the number...
Rias Pratiwi Safitri; Ria Safaria Sadif
Hemodialysis is the process of separation and retention of excess fluid metabolic waste substances from the blood into the dialysis fluid through a membrane that is semi permiabel the dialysis machine by diffusion, ultrafiltration and convection so that the composition of substances and fluids in the near normal blood. Giving SEFT aims to determine the effectiveness SEFT to lower levels of depression in patients with chronic renal failure undergoing hemodialysis. Participants in the study wer...
Prajapati, Viken A; Galani, Varsha J; Shah, Pankaj R
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
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Sun, Wenxue; Sun, Mei; Zhang, Minghui; Liu, Yi; Lin, Xiaomin; Zhao, Sisi; Ma, Lulu
The purpose of this study was to investigate the correlation of conjunctival and corneal calcification (CCC) with cardiovascular calcification in patients undergoing maintenance hemodialysis (MHD). A total of 122 patients undergoing MHD in our hospital were included in this study. Conjunctival and corneal calcification was examined by slit lamp and graded. Abdominal aortic calcification (AAC), aortic valve calcification (AVC), and mitral valve calcification (MVC) were determined by X-ray or ultrasound. The correlation of CCC with AAC, AVC, and MVC was analyzed. Biochemical, hematological, and cardiovascular data were compared between patients with different severity of CCC or AAC. Mitral valve calcification was significantly associated with AAC in our patients. Conjunctival and corneal calcification positively correlated with AAC. We also found that patients with severe CCC exhibited significantly higher levels of serum calcium, phosphate, product of calcium and phosphate, serum copper, cystatin, intact parathyroid hormone, and vitamin D than patients with mild CCC. In addition to significantly increased levels of serum calcium, product of calcium and phosphate, serum copper, and cystatin, patients with severe AAC also had higher high-sensitivity C-reactive protein level and greater left ventricular posterior wall thickness and left ventricular end-diastolic interventricular septum thickness than patients with mild AAC. Our results suggest that patients undergoing MHD with severe CCC or AAC have high degree of mineral metabolism disorder, inflammation, and cardiovascular function disorder. The strong correlation between CCC and AAC indicates that CCC score might be used as an indirect indicator to predict cardiovascular risks in patients undergoing MHD. PMID:25377787
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
We wanted to evaluate the cerebral metabolites in patients with chronic renal failure (CRF) and who were undergoing hemodialysis by performing proton MR spectroscopy and were wanted to evaluate the correlation between the changes in the cerebral metabolite ratios and the duration after starting the initial hemodialysis. Proton MR spectroscopy was performed in 15 patients with CRF and who were undergoing hemodialysis and in ten healthy volunteers. The changes in N-acetylaspartate (NAA), choline-containing compounds (Cho), myo-inositol (Myo), glutamine/glutamate complex (Glx), and creatine (Cr) were analyzed. MR spectroscopy was performed before and after hemodialysis. For the patients with CRF before hemodialysis, the Cho/Cr ratio in the gray matter (? < 0.001) and the Myo/Cr ratio in both the gray and white matter (? < 0.01) were significantly elevated compared with those in the control subjects. For the patients with CRF after hemodialysis, their Cho/Cr ratios were significantly reduced in both the gray and white matter compared with that before hemodialysis (? < 0.05). There was a significant positive correlation between the Cho/Cr ratio and serum Cr in the gray matter of CRF patients after hemodialysis (r = 0.54, ? < 0.05). The cerebral metabolite ratios were not significantly correlated with the duration after starting the initial hemodialysis. The cerebral metabolite patterns are significantly different between the patients with CRF and who are undergoing hemts with CRF and who are undergoing hemodialysis and the normal controls. The cerebral metabolite ratios are not significantly correlated with the duration after starting the initial hemodialysis
Rias Pratiwi Safitri
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.
Full Text Available Abstract Background Sexual function among women undergoing hemodialysis (HD is under-studied and there is no consensus about the effect of sexual dysfunction (SD on their quality of life (QoL. We aimed to determine the prevalence of SD and to compare QoL between women undergoing maintenance HD with and without SD. Methods We included female end-stage renal disease (ESRD patients undergoing HD during June 2011 in the only renal unit in the north of Ceará state, northeastern Brazil. The criteria for inclusion were age between 18 and 55, at least three months on dialysis and being sexually active. Women using antidepressant medication were excluded. We used the Female Sexual Function Index (FSFI, which evaluates six domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction and pain. The patients were classified as presenting SD if the total FSFI score was less than 26. For QoL evaluation, we used the validated Brazilian version of SF-36. This is a widely used 36-item questionnaire covering eight dimensions of QoL. Demographic data, time on dialysis, underlying etiology of ESRD, and laboratory measures were assessed in unit records. Results Of a total of 58 women, 46 (79.3% presented SD. There were lower scores related to physical functioning (48.2 vs. 71.2; p?=?0.007, bodily pain (45 vs. 67.5; p?=?0.010, vitality (52.1 vs. 69.1; p?=?0.026 and social functioning (57.2 vs. 76.1; p?=?0.034 among women with SD compared to women without SD. Physical functioning and role-physical presented positive linear correlation with FSFI scores, respectively, r?=?0.322 (p?=?0.013 and r?=?0.345 (p?=?0.007. Conclusion The prevalence of SD among women on HD is very high, reaching nearly 80%. Women on HD with SD had worse QoL, especially physical aspects of QoL, when compared to women without SD. Therefore, approaches aiming to improve QoL among women undergoing HD should be considered.
Kay, T D; Playford, H R; Johnson, D W
Valproate intoxication is a relatively common clinical problem that can result in coma, respiratory depression, pancytopenia, hemodynamic instability and death [Fernandez et al. 1996, Franssen et al. 1999]. The drug's relatively low molecular weight, small volume of distribution and saturable protein-binding render it potentially amenable to extracorporeal removal (hemofiltration, hemodialysis or hemoperfusion), but published experience is scarce. This report describes a woman with a potentially fatal sodium valproate overdose, who did not respond to continuous veno-venous hemodiafiltration, but was successfully treated with low-flux hemodialysis. Based on our experience, we recommend hemodialysis for serious valproate intoxication. PMID:12572932
Canziani, M E; Cendoroglo Neto, M; Saragoça, M A; Cassiolato, J L; Ramos, O L; Ajzen, H; Draibe, S A
In this study we compared the influence of 2 different modalities of treatment, CAPD and hemodialysis, on the prevalence and severity of left ventricular hypertrophy and cardiac arrhythmias of chronic renal failure patients. We compared 27 patients on the CAPD program with 27 patients on the chronic hemodialysis matched for sex, age, and duration of dialysis treatment. The prevalence of hypertension was significantly lower in CAPD than in hemodialysis patient (41% vs. 81%, p = 0.0023). Blood pressure levels were also lower in CAPD than in hemodialysis patients (systolic pressure 124.9 +/- 4.7 vs. 154.8 +/- 4.6 mm Hg, p < 0.0001; diastolic pressure 77.5 +/- 2.9 vs. 93.3 +/- 2.8 mm Hg, p = 0.0001). Left ventricular hypertrophy (LVH) was present in 52% of CAPD and in 93% of hemodialysis patients (p = 0.0008). Severe cardiac arrhythmias (Lown 3-4) occurred in only 4% of CAPD and in 33% of the hemodialysis group (p = 0.0149). The lower frequency of LVH in CAPD might explain the lower incidence of severe arrhythmias. PMID:7779013
Background: The prevalence of hypothyroidism in persons with chronic kidney disease is documented to be higher, compared to the normal population. However, no data is available about the prevalence rate of hypothyroidism among hemodialysis patients in Nepal.
Azar Baradaran; Hamid Nasri
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) wer...
Hiramatsu, Rikako; Ubara, Yoshifumi; Tajima, Toshihiro; Usui, Takeshi; Namba, Kazutaka; Takeuchi, Yasuhiro; Sawa, Naoki; Hasegawa, Eiko; Takaichi, Kenmei
We describe a hemodialysis patient with hypoparathyroidism due to HDR (hypoparathyroidism, sensorineural deafness, and renal dysplasia) syndrome caused by GATA3 mutation. She presents tumoral calcinosis which is a rare complication of end-stage renal failure. A novel mutation of GATA3 is identified in this patient. PMID:25767699
Reeves, J H; Butt, W W
The clearance of urea, creatinine, amino acids, vancomycin, and phenytoin was measured in vivo in a small animal model during continuous venovenous (CVV) hemofiltration, CVV hemodiafiltration, and CVV hemodialysis using a 0.25 m2 polysulfone hemofilter. Six domestic piglets (weighing 6-11.8 kg) each received 1 hr of all three techniques in random order. Blood flow was 50 ml/min. During CVV hemofiltration, filtrate production was 500 ml/hr and dialysate flow was zero. During CVV hemodiafiltration, filtrate production was 250 ml/hr and dialysate flow was 250 ml/hr. During CVV hemodialysis, net filtrate production was zero and dialysate flow was 500 ml/hr. The ratio of concentration of solute in filter effluent to concentration in whole plasma was derived for each solute during each of the three techniques. Mean (SD) effluent:plasma ratio for urea during CVV hemofiltration was 0.957 (0.038), CVV hemodiafiltration 0.876 (0.109), and CVV hemodialysis 0.754 (0.123); creatinine 0.942 (0.05), 0.934 (0.056), and 0.814 (0.057); amino acids 0.996 (0.344), 0.904 (0.196), and 0.778 (0.18). For small unbound solutes, there is a decrease in clearance of 6% from CVV hemofiltration to CVV hemodiafiltration and a further decrease of 14% from hemodiafiltration to hemodialysis. The effluent:plasma ratio for vancomycin during CVV hemofiltration was 0.739 (0.082), CVV hemodiafiltration 0.643(0.063), and CVV hemodialysis 0.509 (0.081), corresponding to a decrease of 30% from CVV hemofiltration to CVV hemodialysis. The effluent:plasma ratio for phenytoin was 0.302 (0.028) during CVV hemofiltration and was not significantly different during CVV hemodiafiltration or CVV hemodialysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7727810
Kazem Navari; Hossein Farshidi; Fatemeh Pour-Reza-Gholi; Mohsen Nafar; Saeed Zand; Hamid Sohrab Pour; Tasnim Eqbal Eftekhaari
Introduction. End-stage renal disease causes impairment of all body organs including the heart and the lung. The main problems in the afflicted patients are pulmonary edema due to increased permeability of the capillaries, intravascular and interstitial volume overload, hypertension, and congestive heart failure. These changes cause altered physiologic and mechanical function of the lungs and subsequently increase in airway resistance. We aimed to study the impact of hemodialysis on spirometr...
To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3+-7.5) chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 C) temperature dialysis solution. During the study, all the dialysis conditions were maintained the same except cooling the dailysate from 37C to 35C. Hemodynamic parameters including SBP, DBP and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic and mean arterial pressure decreased significantly during standard compared to cool dialysis. Maximum decrease of systolic, diastolic and mean arterial pressure was observed during the third hour of dialysis and magnitude of decrease was 18, 17 and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialysis levels decreased significantly with cool and standard temperature dialysate (59+-5 vs. 37+-4, and 63+-7 vs. 41+-5, umol/L respectively, P<0.01). Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than increased serum nitric oxide levels may be involved in hm nitric oxide levels may be involved in hemodialysis hypotension in this group of patients. (author)
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.
Marcus Machado Ramos Souza de, Souza; Cassiano Augusto Braga, Silva; Edson Luiz, Paschoalin; José Andrade, Moura Júnior; Raphael Pereira, Paschoalin; Ernesto Pereira de, Oliveira.
Full Text Available Chryseobacterium indologenes é uma bactéria de baixa virulência, encontrada no meio ambiente, raramente associada às infecções não hospitalares. A maioria das infecções causadas por ela associa-se ao uso de dispositivos invasivos durante a permanência em hospital. O presente relato trata de paciente [...] renal crônico, diabético, apresentando episódios de bacteriemia durante sessões de hemodiálise ambulatorial por meio de cateter permcath. Abstract in english Chryseobacterium indologenes is a low-virulent bacterium found in the environment, which is rarely associated with non-nosocomial infections. Most infections caused by this pathogen are associated with the use of invasive devices in hospitalized patients. This study reports the case of a diabetic pa [...] tient with chronic renal disease presenting episodes of bacteremia undergoing ambulatory hemodialysis with permcath catheter.
Marcus Machado Ramos Souza de Souza
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.
Carlos E. Figueroa Castro
Full Text Available Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When infections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required.
Hamed Enas A
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.
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
Noh, Tae Ook; Chang, Sung-Wook; Ryu, Kyoung Min; Ryu, Jae Wook
Background Maintenance of adequate vascular access for hemodialysis is important in patients with end-stage renal disease. Once arteriovenous fistula (AVF) occlusion occurs, the patient should be treated with rescue therapy. This study was performed to evaluate the results of a rescue therapy for AVF occlusion. Methods From January 2008 to December 2012, 47 patients who underwent surgical rescue therapy for AVF occlusion after graft AVF formation, were enrolled in this study. The patients were divided into two groups, namely the graft repair group (group A, n=19) and the thrombectomy group (group B, n=28). Postoperative results of both groups were analyzed retrospectively. Results There were no statistically significant differences in the clinical characteristics between the two groups. In terms of the duration of AVF patency after the first rescue therapy, group A showed a longer AVF patency duration than group B (24.5±21.9 months versus 17.7±13.6 months), but there was no statistically significant difference (p=0.310). In terms of the annual frequency of AVF occlusion after the rescue therapy of group A was lower than that of group B (0.59 versus 0.71), but there was no statistically significant difference (p=0.540). The AVF patency rates at 1, 2, 3, and 5 years after the first rescue therapy in group A were 52.6%, 31.5%, 21.0%, and 15.7%, respectively, and those in group B, they were 32.1%, 25.0%, 17.8%, and 7.14%, respectively. There was no statistically significant difference (p=0.402). Conclusion Graft repair revealed comparable results. Although there was no statistically significant difference, the patent duration and annual frequency of AVF occlusion of group A were better than those of group B. Therefore, graft repair is considered as a safe and useful procedure for maintaining graft AVF. PMID:25705597
Lionezia dos Santos, Valle; Valéria Fernandes de, Souza; Alessandra Mussi, Ribeiro.
Full Text Available A deficiência renal crônica é uma doença sistêmica que provoca a perda da autonomia do paciente, levando-o a limitações físicas, restrições laborais e também a perdas sociais. Pacientes com esse tipo de patologia geralmente são submetidos a sessões regulares de hemodiálise, um tratamento rigoroso e [...] debilitante. O objetivo deste estudo foi investigar o nível de estresse e a ansiedade de pacientes submetidos à hemodiálise no Instituto do Rim de Natal, no estado do Rio Grande do Norte, Brasil. Para a coleta de dados, foram utilizados dois instrumentos: Inventário de Sintomas para Stress para Adultos de Lipp e Inventário de Ansiedade Traço-Estado. A amostra (n=100) apresentou homogeneidade em relação ao sexo, com média de idade de 46 anos e predominância de indivíduos casados, aposentados e com renda familiar baixa. Os resultados obtidos no primeiro instrumento revelaram que 71% dos pacientes encontravam-se estressados, dos quais 47% estavam na fase de resistência. Todos os pacientes entrevistados apresentaram ansiedade com níveis de moderado (66%) a severo (34%). Esses dados levam a descrever esse grupo de pacientes como altamente sujeitos ao estresse e à ansiedade. Abstract in english Chronic renal failure is a systemic disease that provokes the loss of autonomy of the patient leading to physical limitations, work restrictions, and social losses. Patients with this type of pathology are usually treated by hemodialysis, a rigorous and debilitating treatment. The goal of this study [...] was to assess levels of stress and anxiety in patients undergoing hemodialysis at the Instituto do Rim clinic in Natal in the state of Rio Grande do Norte, Brazil. The Lipp Stress Symptoms Inventory and the Trait-State Anxiety Inventory were used for the data collection. The sample (n=100) showed homogeneity in relation to gender, with a mean age of 46 and a predominance of married and retired individuals, with low family incomes. The results showed that the majority of the patients (71%) suffered high levels of stress, specifically in the resistance phase, and the incidence of psychological symptoms was greater than the physical manifestations. Furthermore, all the individuals presented moderate (66%) or high levels (34%) of anxiety. According to these data patients with chronic renal failure showed high levels of stress and anxiety.
Mohammad Rahimian; Farzaneh Najafi; Amirreza Goharian; Amir Bahrami Ahmadi
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 preva...
Focosi, Daniele; Pelosini, Matteo; Palla, Piero; Galimberti, Sara; Caracciolo, Francesco; Benedetti, Edoardo; Papineschi, Federico; Petrini, Mario
We report here a 50-years old female with multiple myeloma-associated chronic renal failure who underwent high-dose chemotherapy supported by autologous hematopoietic stem cell transplantation. She developed progressive encephalopathy on day 5 progressing to coma despite hemodialysis and no obvious organ failure. She finally recovered after a single 1-liter plasma exchange. The final diagnosis was metabolic encephalopathy due to hypercytokinemia, particularly high serum TNF levels. We discuss here the pathogenesis and raise an alert for monitoring cytokine levels in patients with renal failure undergoing high-dose chemotherapy. PMID:19539028
Marcos Frank, Bastiani; Graziella Gasparotto, Baiocco; Sandrine Comparsi, Wagner.
Full Text Available Introdução e objetivo: Este trabalho teve como objetivo determinar a prevalência de hepatite C em 649 pacientes diagnosticados com doença renal aguda ou crônica ? eles se submeteram a tratamento hemodialítico em uma unidade de hemodiálise de um hospital de grande porte de Porto Alegre-RS, de janeir [...] o a dezembro de 2012 ?, bem como relacionar os dados encontrados com os apresentados no censo nacional, relatar casos de coinfecção de hepatite C e vírus da imunodeficiência humana (HIV) e, finalmente, conhecer o perfil demográfico dos pacientes. Método: Realizou-se um estudo observacional do tipo transversal cujos dados foram obtidos por meio de informações dos prontuários eletrônicos dos pacientes. Resultado e Conclusão: A prevalência de hepatite C encontrada no presente estudo foi de 10,17% da população amostrada. Entretanto, seriam necessárias mais análises em outros centros a fim de estimar a real prevalência para infecção pelo vírus da hepatite C em pacientes submetidos a hemodiálise em Porto Alegre. Abstract in english Introduction and Objective: This study aimed at determining the prevalence of hepatitis C among 649 patients diagnosed with chronic or acute kidney disease ? patients were undergoing hemodialysis treatment at a large hemodialysis center in Porto Alegre-RS, from January through December, 2012 –, as [...] well as relating our data to that presented in the national census, reporting cases of coinfection by hepatitis C and human immunodeficiency virus (HIV), and defining the demographic profile of these patients. Method: An observational cross-sectional study was conducted and data was obtained from information in patients’ electronic medical records. Result and conclusion: The prevalence of hepatitis C in this study was 10.17% of the sampled population. However, further analysis of other liver centers would be required to estimate an accurate prevalence rate of infection caused by the hepatitis C virus in patients undergoing hemodialysis in Porto Alegre.
?íž, Milan; Kubala, Lukáš; ?ížová, Hana; Soška, V.; ?erný, J.; Lojek, Antonín
Roma, 2001. s. 87. [Meeting of the Society for Free Radical Research Europe SFRR 2001. 22.06.2001-24.06.2001, Roma] R&D Projects: GA ?R GA524/01/1219 Keywords : peroxyl radical-trapping * plasma * hemodialysis and kidney transplantation Subject RIV: BO - Biophysics
Cláudia Maria Pereira, Alves; Maria do Carmo Borges, Teixeira; Maria Cristina De, Martino.
Full Text Available INTRODUÇÃO: Pacientes com doença renal crônica (DRC) em diálise têm como principal causa de morte doença cardiovascular (DCV) aterosclerótica, tendo a inflamação e a disfunção endotelial relação direta com a aterosclerose. Além disso, a infecção pelo vírus da hepatite C (HCV), comum nestes pacientes [...] , seria outro fator de piora do estado inflamatório. Níveis aumentados de marcadores de disfunção endotelial são encontrados em pacientes com DRC e hepatite C, e poderiam ser importantes marcadores de aterosclerose nestes indivíduos. OBJETIVO: Comparar atividade endotelial de pacientes em hemodiálise com e sem hepatite C. METODOLOGIA: Selecionamos 28 pacientes em hemodiálise que foram divididos em dois grupos: 1-HCV(+): 18 pacientes (anti-HCV[+] e PCR[+]) e 2-HCV(-): 10 pacientes (anti-HCV[-]). Antes da primeira diálise da semana foi coletada amostra de sangue para dosagem sérica de molécula de adesão intercelular-1 (ICAM-1), fator de crescimento vascular endotelial (VEGF), aspartato alanina aminotransferase (ALT) e tempo de atividade da protrombina (TAP) dos grupos. RESULTADOS: Os níveis de ICAM-1 foram elevados em 60,71%, sendo maiores no grupo HCV(+), porém não estatisticamente significativos (p = 0,2024). Não houve correlação entre os níveis de ICAM-1 e tempo de diálise ou níveis de ALT em nenhum dos grupos. Já os níveis de VEGF foram normais em 92,85%; apenas dois pacientes HCV(+) tinham níveis elevados. Também não houve correlação com tempo de diálise ou níveis de ALT em nenhum grupo. CONCLUSÃO: Pacientes em hemodiálise possuem elevada lesão endotelial, porém a presença de infecção crônica pelo HCV não se mostrou um fator agravante deste quadro. Este resultado pode ter ocorrido por conta do pequeno número de pacientes, sendo necessárias análises com maior número de indivíduos para conclusões mais definitivas. Abstract in english INTRODUCTION: Chronic renal patients undergoing hemodialysis treatment have cardiovascular atherosclerotic disease as the main cause of death. Inflammation and endothelial dysfunction are directly associated with atherosclerosis. Furthermore, the infection resulting from hepatitis C virus, common am [...] ong such patients, would be another worsening factor of the inflammatory state. Increased levels of endothelial dysfunction markers are found in chronic renal disease and hepatitis C, which could be important markers of atherosclerosis among these subjects. OBJECTIVE: To compare endothelial activity in patients undergoing hemodialysis with and without hepatitis C. METHODOLOGY: We selected 28 patients undergoing hemodialysis and classified them into two groups: 1-HCV(+): 18 patients (anti-HCV[+] and PCR[+]) and 2-HCV(-): 10 patients (anti-HCV[-]). Before the first weekly dialysis, blood samples from both groups were collected for ICAM-1, VEGF, ALT and TAP serum dosage. RESULTS: ICAM-1 levels were high in 60.71%. The highest levels were found in HCV(+) group, though not statistically significant (p = 0.2024). There was no correlation between ICAM-1 levels and the hemodialysis time or ALT levels in any group. On the other hand, VEGF levels were normal in 92.85%. Only two patients HCV(+) had high levels. There was also no correlation between VEGF levels and the dialysis time or ALT levels. CONCLUSION: Patients undergoing hemodialysis have high endothelial lesion, nevertheless, the presence of HCV chronic infection did not prove to be an aggravating factor. This result may be due to the small number of patients, hence further analyses with a larger sample are required for definitive conclusions.
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.
Henning, Bernhard F; Holzhausen, Helge
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
Genoile Oliveira SANTANA
Full Text Available Racional - A prevalência da infecção pelo vírus da hepatite C em pacientes sob programa de hemodiálise tem sido amplamente variável. Objetivos -- Determinar a prevalência do anticorpo contra o vírus C da hepatite (anti-VHC em pacientes sob hemodiálise em Salvador, BA e sua associação com transfusão de sangue, duração de hemodiálise e elevação de alaninoaminotransferase. Métodos - Durante um período de 17 meses, foram avaliados todos os pacientes em programa de hemodiálise, totalizando 395 indivíduos, que responderam a questionário e forneceram soro para análise laboratorial (alaninoaminotransferase sérica e anti-VCH pelo ELISA II com confirmação pelo Immunoblotting (RIBA III. Resultados - O anti-VHC foi positivo em 23,8% (94/395. A presença de transfusão mostrou associação com o anti-VHC e quanto maior o número de transfusões, mais freqüente o anti-VHC. Dos pacientes que nunca foram transfundidos, 12,5% (6/48 foram anti-VHC positivos. A duração do tratamento dialítico foi de 53,44 ± 36,45 meses no grupo anti-VHC positivo e de 22,10 ± 22,75 meses no grupo negativo. A elevação de alaninoaminotransferase foi mais freqüente no grupo positivo para o anti-VHC. A positividade para as frações do RIBA III foi de 79,8%, 100%, 80,9% e 52,1% para o c100-3, c33, c22 e NS5, respectivamente. O anti-NS5 foi ainda menos freqüente no grupo com alaninoaminotransferase elevada. Conclusões - A prevalência do anti-VHC em pacientes sob hemodiálise crônica de Salvador, BA é elevada e está associada com transfusão de sangue, maior duração de tratamento dialítico e elevação de alaninoaminotransferase.Background -- Hepatitis C infection in hemodialysis units has been evaluated in different grographic regions. Aims - The prevalence of anti-HCV in patients undergoing hemodialysis program in the city of Salvador, State of Bahia, Brazil, was studied and its association with transfusions, duration of hemodialysis and ALT elevation. Method - During a period of 17 months, all patients undergoing dialytic treatment, were evaluated. The total number of patients was 395, all of whom completed a questionnaire and provided serum samples for laboratory analysis. Serological levels were measured for ALT and the samples were tested for anti-HCV using ELISA II with a further confirmation using RIBA III. Results - Anti-HCV was positive in 23,8% (94/395. The presence of transfusions was associated with anti-HCV and as the number of transfusions used increased, so did the frequency of anti-HCV. Of the patients who never received transfusions, 12,5% (6/48 were anti-HCV positive. The duration of dialytic treatment lasted from 53,44 ± 36,45 months in the anti-HCV positive group and 22,10 ± 22,75 months for the group testing negative. ALT elevation was more frequent in the anti-HCV positive group. Positivity for the RIBA III fractions was 79,8%, 100%, 80,9% and 52,1%, for c100-3, c33, c22 and NS5, respectively. The anti-NS5 was even less frequent in the group with elevated ALT. Conclusions - The prevalence of anti-HCV in patients undergoing chronic hemodialysis in Salvador, Bahia, is elevated and it is associated with transfusions, a longer duration of dialytic treatment and ALT elevation.
Abrahams, C; D'Cruz, I; Kathpalia, S
Examination of the heart at autopsy in patients who received long-term hemodialysis revealed the following two changes in the mitral valve apparatus previously almost completely overlooked: (1) fibrosis and thickening affecting chordae tendineae in four cases: in one, severe mitral regurgitation was documented by hemodynamic studies; (2) extensive calcification in the mitral anulus region in two cases, with calcification in the base of the mitral leaflets in one and in the papillary muscle and chordae tendineae in the other. The causes of these abnormalities is unclear. Rheumatic and other known causes all seem unlikely origins of the extensive fibrosis. Secondary hyperparathyroidism is probably responsible for the calcification. In all six patients, these abnormalities in the mitral valve apparatus, which may be associated with functional impairment, were diagnosed during life by M-mode and two-dimensional echocardiography. PMID:7125766
The time evolution of a squeezed coherent state conditioned by the results of a single and double heterodyne measurement is discussed. The mean values of quadratures as well as the dynamics of quadrature uncertainties have been obtained within the framework of the theory of continuous measurements based on filtration equations. It has been found that while the mean values depend on the measured noise, the uncertainties in the optical quadratures are deterministic. Explicit solutions for the latter have been provided. Finally, a time development of the squeeze parameter for the posterior squeezed coherent state has been found. -- Highlights: ? The theory of continuous quantum measurement is applied. ? The Belavkin linear filtering equation for the heterodyne observation is used. ? The posterior evolution of a squeezed coherent state is discussed. ? The posterior mean values of quadratures and their uncertainties are obtained. ? A time development of the posterior squeeze parameter is found.
Luiz Carlos SEVERO; Oliveira, Flávio de Mattos; GARCIA Clotilde Druck; UHLMANN Anelise; Alberto Thomaz LONDERO
A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection.
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.
Sanai, Toru; Tada, Hideo; Ono, Takashi; Fukumitsu, Toma
The serum bicarbonate (HCO3(-)) levels are decreased in chronic hemodialysis (HD) patients treated with sevelamer hydrochloride (SH). We assessed the effects of bixalomer on the chronic metabolic acidosis in these patients. We examined 12 of the 122 consecutive Japanese patients with end-stage renal disease on HD, who orally ingested a dose of SH (?2250?mg), and an arterial blood gas analysis and biochemical analysis were performed before HD. Patients whose serum HCO3(-) levels were under 18?mmol/L were changed from SH to the same dose of bixalomer. A total of 12 patients were treated with a large amount of SH. Metabolic acidosis (a serum HCO3(-) level under 18?mmol/L) was found in eight patients. These patients were also treated with or without small dose of calcium carbonate (1.2?±?1.1?g). The dose of SH was changed to that of bixalomer. After 1 month, the serum HCO3(-) levels increased from 16.3?±?1.4 to 19.6?±?1.7?mmol/L (P?0.05). Metabolic acidosis was not observed in four patients (serum HCO3(-) level: 20.3?±?0.7?mmol/L) likely because they were taking 3?g of calcium carbonate with SH. In the present study, the development of chronic metabolic acidosis was induced by HCl containing phosphate binders, such as SH, and partially ameliorated by calcium carbonate, then subsequently improved after changing the treatment to bixalomer. PMID:24980286
Puchades, Maria J; Saez, Guillermo; Muñoz, M Carmen; Gonzalez, Miguel; Torregrosa, Isidro; Juan, Isabel; Miguel, Alfonso
Oxidative stress (OS) is directly involved in the formation of atheroma plaque and has been shown to be present since the early stages of Chronic Kidney Disease (CKD); however, the net role that dialytica techniques may play in OS process is yet to be determined. We studied three groups: hemodialysis (HD, n = 30), peritoneal dialysis (PD, n = 31), predialysis (pre-D, n = 32), and one control group (C, n = 67). Using highresolution liquid chromatography columns (HPLC), the superoxide dismutase (SOD), glutathione oxidized/reduced ratio (GSSG/GSH), and nuclear, as well as mitochondrial 8-oxo-dG (8-oxo-dG mit) were measured in lymphocytes. Protein carbonyls and F2-isoprostanes were measured in plasma. The antioxidant enzyme activity was evaluated by a spectrophotometric assay of catalase, glutathione peroxidase (GPX), glutathione reductase (GSR), and superoxide dismutase (SOD). Compared to the control group, all groups had significantly higher levels of products derived from molecular oxidation with a significant decrease in antioxidant enzymes. Patients in the pre-D group showed higher values for most of the oxidized molecules. The PD group showed a better oxidative balance, with no significant differences in levels of mitochondrial 8-oxo-dG when compared to the control group. We speculated that the better control of OS observed in patients receiving PD might be explained by the fact that this technique is more biocompatible, and this might help reduce the risk of cardiovascular events. PMID:23782545
Gláucia Thaise Coimbra de, Oliveira; Eli Iola Gurgel, Andrade; Francisco de Assis, Acurcio; Mariângela Leal, Cherchiglia; Maria Isabel Toulson Davisson, Correia.
Full Text Available OBJETIVO: O presente trabalho tem como objetivo caracterizar o estado nutricional de pacientes submetidos à hemodiálise em centros de diálise de Belo Horizonte por meio da Avaliação Global Subjetiva (AGS) e associá-lo a variáveis socioeconômicas, sociodemográficas e clínicas. MÉTODOS: Foram avaliado [...] s 575 pacientes em 12 centros de diálise de Belo Horizonte. As variáveis socioeconômicas, sociodemográficas e clínicas foram coletadas em entrevistas por meio de questionários especificamente desenvolvidos para tal. O modelo de regressão logística foi utilizado para verificar o efeito ou influência de cada variável no estado nutricional. RESULTADOS: A prevalência de desnutrição foi significante (19,5%). A população avaliada apresentou, de modo geral, baixo nível socioeconômico, acesso limitado aos serviços de saúde particulares, alta taxa de comorbidades associadas e recebimento de grande número de recomendações nutricionais, não necessariamente adequadas. A idade > 60 anos, a renda igual ou inferior a um salário mínimo, a presença de depressão e o fato de ser aposentado foram fatores de risco para desnutrição, de acordo com a análise multivariada. CONCLUSÃO: A desnutrição é prevalente entre pacientes submetidos a hemodiálise. As diferenças nas características socioeconômicas, sociodemográficas, gerais e clínicas podem ser utilizadas para identificar pacientes que demandam mais atenção, em termos de risco para desnutrição - nesse caso, os idosos, os aposentados, aqueles com depressão e com baixo nível socioeconômico. Abstract in english OBJECTIVE: This study aims to assess the nutritional status of patients undergoing hemodialysis at dialysis centers in Belo Horizonte, MG, Brazil using the Subjective Global Assessment (SGA), and associate it with socioeconomic, demographic and clinical variables. METHODS: A total of 575 patients we [...] re evaluated at 12 dialysis centers in Belo Horizonte, MG, Brazil. Socioeconomic, demographic, and clinical variables were gathered through interviews using a questionnaire specifically developed for this purpose. The logistic regression model was used to determine the effect or influence of each variable on the nutritional status. RESULTS: Malnutrition was significantly prevalent (19.5%). Generally, the study population had low socioeconomic status, limited access to private health services, high rate of comorbidities, and received a large number of dietary recommendations, which were not necessarily appropriate. According to multivariate analysis, the risk factors for malnutrition were age over 60 years, family income at or below one minimum wage, presence of depression, and retirement. CONCLUSION: Malnutrition is prevalent among patients undergoing hemodialysis. Differences in socioeconomic, demographic, clinical, and general characteristics can be used to identify patients who require more attention due to the risk of malnutrition, particularly in the elderly, retirees, and those with depression and low socioeconomic status.
Zakharov, S.; Pelclová, D.; Navrátil, Tomáš; B?lá?ek, J.; Kurcová, I.; Komzák, O.; Šálek, T.; Latta, J.; Turek, R.; Bo?ek, R.; Ku?era, C.; Hubá?ek, J. A.; Fenclová, Z.; Pet?ík, V.; ?ermák, M.; Hovda, K. E.
Ro?. 86, ?. 1 (2014), s. 199-207. ISSN 0085-2538 Institutional support: RVO:61388955 Keywords : Intermittent hemodialysis * hemodiafiltration * methanol poisonings Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 8.520, year: 2013
Full Text Available Introduction. Patients with end-stage renal failure have high morbidity and mortality rates due to cardiovascular complications. Screening for coronary heart disease in these patients is of utmost importance. The aim of this study was to investigate the prognostic value of the dobutamine test in patients on hemodyalisis during a 5-year follow-up period. Material and methods. During the pretransplantation period, 24 patients on chronic hemodialysis underwent echocardiography and dobutamine echocardiography. The average age of patients was 51.50±7.35 years. The mean duration of dialysis was 74±40 months. Results. The dobutamine stress test was positive in 50% of patients, and undefined in 12.5%. The wall motion score index before the test was 1, and after the test it was 1.54±0.27. There were no serious complications. Left ventricular mass, diastolic and systolic dimension and posterior wall were significantly higher in patients with positive dobutamine stress results and they were associated with late cardiac morbidity and mortality. Five-year survival in patients with positive dobutamine stress results was 33.3% and 52.3% in patients with negative dobutamine results. Causes of mortality were as follows: cardiac 45.4%, cerebrovascular 18.1%, other causes 36.4%. Cardiogical complications were not the cause of death in any of the patients with negative dobutamine results. In dobutamine positive group 62.5% died from cardiological complications. During the 5-year period, cardiac death and manifest coronary disease occurred in 75% of patients with positive dobutamine stress results and only in one patient with negative dobutamine results. Sensitivity was 75%, specificity 89% and positive predictive value 90%. Conclusion. Dobutamine stress echocardiography has a good predictive value for future cardiac events in hemodyalisis patients, and in screening for coronary disease. .
Pakpour, Amir H.; Zedi, Isa mohammadi
Objective: Patients on dialysis have low physical activity levels. The aim of the study was to examine the validity of action planning and coping planning within the theory of planned behaviour framework, for predicting physical activity behaviour of patients on hemodialysis. Methods: One hundred and forty four patients who were undergoing emodialysis were selected from dialysis centers. The mean age of the patients was 56.61 (SD= 11.38) years. The patients completed a questionnaire including variables from the theory of planned behaviour, action planning and coping planning. Physical activity was prospectively assessed at 4-weeks with the validated International Physical Activity Questionnaire self-report measure. A hierarchical regression analysis was performed to examine the effects of action planning and coping planning on physical activity behaviour. Results: There was a main effect for coping planning but not for action planning. Moreover, the analyses resulted in a significant amount of incremental variance accounted for by the interaction of coping planning and intention. Conclusion: Results suggest the combination of high levels of coping planning and intention is associated with increases in physical activity.
Marcia Machado Cunha, Ribeiro; Melissa Luciana de, Araújo; Michele Pereira, Netto; Lucas Maciel, Cunha.
Full Text Available OBJETIVO: Analisar os efeitos do comportamento alimentar, entre o hábito de jantar ou não jantar, no perfil de ingestão de macronutrientes e micronutrientes de pacientes com insuficiência renal crônica em hemodiálise. MÉTODO: Estudo transversal em uma clínica de diálise de Belo Horizonte, em Minas G [...] erais. Participaram do estudo 90 pacientes em tratamento hemodialítico. Foram coletados dados pessoais, clínicos e dietéticos (registro alimentar de três dias). Foi considerado jantar uma refeição completa e não jantar a sua ausência ou substituição por lanches. As estimativas das quantidades de nutrientes ingeridos foram feitas em software específico Dietwin®. RESULTADOS: Os valores de carboidrato, tiamina, riboflavina, ácido ascórbico, cálcio e selênio ingeridos não apresentaram diferença entre os grupos de pacientes que jantavam e não jantavam (p > 0,05). Os valores de Índice de Massa Corporal (IMC), energia, proteína, lipídeos, niacina, ácido pantotênico, piridoxina, ácido fólico, cobalamina, potássio, fósforo, zinco e magnésio ingeridos apresentaram diferença entre estes mesmos grupos (p Abstract in english INTRODUCTION: To assess the effects of the habit of having evening dinner on the dietary macro- and micronutrient profile of chronic kidney failure patients on hemodialysis. METHODS: Cross-sectional study carried out at a dialysis clinic at the city of Belo Horizonte, state of Minas Gerais. The stud [...] y comprised 90 patients undergoing hemodialysis. Personal, clinical, and dietary (three-day food record) data were collected. The habit of having dinner was considered as having a complete evening meal, and the lack of that habit was considered as not having it or replacing it by a fast meal. The amounts of nutrient intake were estimated in the specific software Dietwin®. RESULTS: The carbohydrate, thiamine, riboflavin, ascorbic acid, calcium, and selenium intake values showed no difference between the group having a complete evening meal and that not having it (p > 0.05). Both groups did not differ in the following: body mass index, and energy, protein, lipid, niacin, pantothenic acid, pyridoxine, folic acid, cobalamin, potassium, phosphorus, zinc, and magnesium intake values (p
Ranganathan, D.; John, G. T.
Patients receiving conventional hemodialysis have high hospitalisation rates, poor quality of life and survival compared to the general population. Many centres around the world are providing longer hours of hemodialysis - short daily hemodialysis and nocturnal hemodialysis - with a view to improving patient survival and quality of life. Studies have shown that nocturnal haemodiaysis is more effective than conventional hemodialysis in clearing most small, middle and larger molecule toxins and...
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.
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)
Full Text Available The aim of present study was the assessment of relationships between PTH abnormalities and the parameter of Helicobacter pylori (H. pylori infection as expressed by concentration of IgG antibodies against H. pylori. The study was carried out on 44 (F = 17, M = 27 stable hemodialysis (HD patients with upper gastrointestinal symptoms. A significant positive correlations of H. pylori IgG antibody titers with serum iPTH and phosphorus also a significant inverse correlation of H. pylori IgG antibody titers with serum alkalin phosphatase was found. It is known that hyperparathyroidism is connected with stimulation of gastrin synthesis as well with increased acidity of gastric juice. Hypergastrinaemia induced stimulation of gastrin synthesis and resultant increased acidity of gastric juice could intensify the H. pylori infection in hemodialysis patients. We strongly propose to more study on the association of secondary hyperparathyroidism with H. pylori infection, because both dyspeptic symptoms and secondary hyperparathyroidism are quite common in chronic hemodialysis patients and in the meantime needs more attention toward control of high levels of parathormone in HD patients.
Crawford, M E; MØiniche, S
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.
Pregnancy in women undergoing hemodialysis: case series in a Southeast Brazilian reference center / Gestação em mulheres em tratamento hemodialítico: série de casos em um centro de referência do Sudeste do Brasil
Maria Beatriz Bracco, Suarez; Maria Laura, Costa; Mary Ângela, Parpinelli; Fernanda Garanhani, Surita.
Full Text Available OBJETIVOS: Descrever os resultados maternos e neonatais de mulheres grávidas que estavam em tratamento de hemodiálise em um centro de referência no Sudeste brasileiro. MÉTODOS: Estudo retrospectivo e descritivo, com revisão de prontuários de todas as gestações em hemodiálise, acompanhadas no p [...] ré-natal especializado da região Sudeste do Brasil. RESULTADOS: Entre as 16 mulheres identificadas, 2 foram excluídas devido à perda de seguimento. Das 14 descritas, a hipertensão foi a causa mais frequente de insuficiência renal crônica (50% dos casos). A maioria (71,4%) realizava tratamento de hemodiálise há mais de um ano e todas elas foram submetidas a 5 ou 6 sessões por semana. Onze mulheres tinham hipertensão crônica, 1 das quais também era diabética, e 6 eram fumantes. Em relação às complicações da gravidez, 1 das mulheres hipertensas desenvolveu hipertensão maligna (com restrição de crescimento fetal e parto prematuro com 29 semanas), 2 tiveram edema pulmonar agudo e 2 apresentaram descolamento prematuro de placenta. O tipo de parto foi cesariana em 9 mulheres (64,3%). Todos os recém-nascidos tiveram Apgar aos cinco minutos maior que 7. CONCLUSÕES: Para melhorar os resultados perinatais e maternos de mulheres em hemodiálise, é importante ter uma abordagem multidisciplinar em centro de referência, um controle rigoroso da uremia, hemoglobina e pressão arterial materna, bem como acompanhar de perto o bem-estar fetal e a morbidade materna. Outra estratégia importante é a orientação adequada para contracepção nessas mulheres. Abstract in english PURPOSE: To describe maternal and neonatal outcomes in pregnant women undergoing hemodialysis in a referral center in Brazilian Southeast side. METHODS: Retrospective and descriptive study, with chart review of all pregnancies undergoing hemodialysis that were followed-up at an outpatient clin [...] ic of high- risk prenatal care in Southeast Brazil. RESULTS: Among the 16 women identified, 2 were excluded due to follow-up loss. In 14 women described, hypertension was the most frequent cause of chronic renal failure (half of cases). The majority (71.4%) had performed hemodialysis treatment for more than one year and all of them underwent 5 to 6 hemodialysis sessions per week. Eleven participants had chronic hypertension, 1 of which was also diabetic, and 6 of them were smokers. Regarding pregnancy complications, 1 of the hypertensive women developed malignant hypertension (with fetal growth restriction and preterm delivery at 29 weeks), 2 had acute pulmonary edema and 2 had abruption placenta. The mode of delivery was cesarean section in 9 women (64.3%). All neonates had Apgar score at five minutes above 7. CONCLUSIONS: To improve perinatal and maternal outcomes of women undergoing hemodialysis, it is important to ensure multidisciplinary approach in referral center, strict control of serum urea, hemoglobin and maternal blood pressure, as well as close monitoring of fetal well-being and maternal morbidities. Another important strategy is suitable guidance for contraception in these women.
Marcos Antonio Rodrigues Martinez
Full Text Available FUNDAMENTOS: A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD, e compará-los com uma amostra pareada da população geral. MÉTODOS: Realizado um estudo caso- controle, pareado por gênero e idade, onde 2 grupos foram estudados com relação às alterações ungueais presentes. RESULTADOS: 86% dos pacientes em HD e 75% do grupo controle tiveram, pelo menos, uma alteração ungueal.Ausência de lúnula (62,9% e unha meio a meio (14,4% as alterações foram estatisticamente relevantes no grupo HD, em relação ao grupo controle (p BACKGROUND: Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. OBJECTIVES: To evaluate the spectrum and the frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. METHODS: A case-controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. RESULTS: At least one nail disorder was found in 86% of the hemodialysis patients and in 75% of subjects in the control group. Absent lunula (62.9% and half and half nails (14.4% were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p < 0.05. Longitudinal striae were more common in the control group compared to the hemodialysis group (24.1%. CONCLUSIONS: Absent lunula and half and half nails were the most common nail disorders found in patients on hemodialysis, corroborating the findings of previous studies. Longitudinal striae were more common in the control group and future studies may clarify whether structural abnormalities such as absent lunula may be related to this finding.
Marcos Antonio Rodrigues, Martinez; Carla Lobato, Gregório; Vanessa Pedrassi dos, Santos; Ronaldo Roberto, Bérgamo; Carlos D' Apparecida Santos, Machado Filho.
Full Text Available FUNDAMENTOS: A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a [...] frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD), e compará-los com uma amostra pareada da população geral. MÉTODOS: Realizado um estudo caso- controle, pareado por gênero e idade, onde 2 grupos foram estudados com relação às alterações ungueais presentes. RESULTADOS: 86% dos pacientes em HD e 75% do grupo controle tiveram, pelo menos, uma alteração ungueal.Ausência de lúnula (62,9%) e unha meio a meio (14,4%) as alterações foram estatisticamente relevantes no grupo HD, em relação ao grupo controle (p Abstract in english BACKGROUND: Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. OBJECTIVES: To evaluate the spectrum and the [...] frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. METHODS: A case-controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. RESULTS: At least one nail disorder was found in 86% of the hemodialysis patients and in 75% of subjects in the control group. Absent lunula (62.9%) and half and half nails (14.4%) were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p
Full Text Available The dissecting aortic aneurysm (DAA is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.
Hamid Nasri; Azar Baradaran
The aim of present study was the assessment of relationships between PTH abnormalities and the parameter of Helicobacter pylori (H. pylori) infection as expressed by concentration of IgG antibodies against H. pylori. The study was carried out on 44 (F = 17, M = 27) stable hemodialysis (HD) patients with upper gastrointestinal symptoms. A significant positive correlations of H. pylori IgG antibody titers with serum iPTH and phosphorus also a significant inverse correlation of H. pylori IgG ant...
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)
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.
Nadienka, Rodríguez Ramos; Juan Miguel, Rubio Cala; Osniel, Bencomo Rodríguez; Rosa Ángela, Alfonso Pérez; Julio Cesar, Camero Machín.
Full Text Available Fundamentación: La enfermedad cardiovascular constituye la principal causa de mortalidad en los pacientes en hemodiálisis y el principal predictor es la hipertensión arterial antes que la dislipemia y el consumo de tabaco. Objetivo: describir la prevalencia de hipertensión arterial y sus factores de [...] riesgos en pacientes hemodializados. Método: se realizó un estudio descriptivo, transversal en 22 pacientes con insuficiencia renal crónica, terminal en hemodiálisis del Hospital General Augusto César Sandino de junio a diciembre de 2009. Se estudiaron las variables sociodemográficas, clínicas y del estilo de vida y su relación con la presencia de hipertensión arterial. Se utilizó la técnica estadística de análisis de distribución de frecuencias para categoría de variables, además, se empleó el test de independencia para probar la hipótesis nula de asociación entre las variables; precisándose un nivel de significación á = 0.05. Resultados: la edad promedio fue de 53 años con un tiempo medio previo en hemodiálisis de 57 meses. Entre las principales causas por las cuales llegaron al tratamiento depurador los pacientes estuvieron las no relacionadas a la diabetes mellitus en el 86,4 %. En 14 pacientes, que representa el (63,6 %), se recogía la historia de hipertensión arterial prediálisis y en hemodiálisis. El análisis multivariado mostró que la hipertensión estaba asociada con la edad avanzada, el tiempo de vida media en hemodiálisis y la presencia de diabetes mellitus. Conclusiones: la hipertensión es altamente prevalente entre los pacientes en hemodiálisis crónica y está asociada a la hipervolemia, el envejecimiento y la diabetes mellitus. Abstract in english Background: The cardiovascular diseases constitutes the main one of cause of mortality in patient in hemodialysis and the main one predict is the hypertension still before that the dislipemia and the consumption of tobacco. Objective: Describe the prevalence and risk factors of hypertension among pa [...] tients on chronic hemodialysis. Methods: A transversal descriptive study was carried out in 22 patients with chronic kidney diseases in the nephrological service of Augusto Cesar Sandino Teaching Hospital of Pinar del Rio City, since June to December, 2009. Variables such as: age, etiology of the chronic renal failure, time elapsed in hemodialysis were included in the study. Information was gathered through surveys and from the morbimortality book of the nephrology unit. The statistical analysis of frequency distribution was used for each category of variables. The independence test was also used to test the association of variable null hypothesis. The level of significance was set at á = 0.05. Results: The age average went of 53 years with a half prior time in hemodialysis of 57 months. Among the main causes by which they arrived at the processing purifier the patient were the done not relate to the diabetes mellitus in the 86, 4 %. In 14 patients (63, 6%) history was collected of hypertension prediálisis and in hemodialysis. The analysis multivariado showed that the hypertension was associated with the age advanced, the average time of life in hypertension and the presence of diabetes mellitus. Conclusions: The hypertension is highly prevalence among patient in hypertension chronic and this associate to the hipervolemia, the hypertension and the diabetes mellitus.
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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.
Vanessa de Brito, Poveda; Juliana da Silva, Alves; Elaine de Freitas, Santos; Alessandra, Garcia Emerick Moreira.
Full Text Available Objetivo: determinar os diagnósticos de enfermagem mais frequentes em pacientes submetidos a tratamento hemodialítico, baseados na nomenclatura da North American Nursing Diagnosis Association-Internacional (NANDA-I) 2009-2011. Método: trata-se de estudo quantitativo, do tipo descritivo exploratório, [...] realizado em uma clínica de hemodiálise no interior do estado de São Paulo, com uma amostra de 50 pacientes. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade do Vale do Paraíba sob número H236/CEP/2009. Resultados: foram identificados 24 diagnósticos mais frequentes, sendo seis encontrados em 100% da amostra estudada: eliminação urinária prejudicada, integridade da pele prejudicada, risco de infecção, risco de perfusão renal ineficaz, mobilidade física prejudicada e risco de desequilíbrio eletrolítico. Conclusão: o estabelecimento dos diagnósticos de enfermagem comuns aos sujeitos submetidos a hemodiálise auxiliará o profissional de enfermagem envolvido no atendimento aos pacientes renais crônicos, fornecendo ferramentas para o planejamento da assistência. Abstract in spanish Objetivo: Determinar los más comunes diagnósticos de enfermería en pacientes sometidos a tratamiento de hemodiálisis, basados en la nomenclatura de la North American Nursing Diagnosis Association - International (NANDA-I) 2009-2011. Método: Este es un estudio cuantitativo, de tipo descriptivo explor [...] atorio, realizado en una clínica de hemodiálisis en el estado de São Paulo, Brasil, con una muestra de 50 pacientes. El estudio fue aprobado por el Comité de Ética de la Investigación de la Universidad del Vale do Paraíba, bajo el protocolo Nº H236/CEP/2009. Resultados: Se identificaron 24 diagnósticos más frecuentes, seis de los cuales se encontraron en 100% de la muestra estudiada; estos eran: eliminación urinaria afectada; integridad de la piel afectada; riesgo de infección; riesgo de perfusión renal ineficaz; movilidad física reducida; y riesgo de desequilibrio electrolítico. Conclusión: La determinación de los diagnósticos de enfermería comunes en los sujetos sometidos a hemodiálisis ayudará a los profesionales de enfermería en la atención a los pacientes renales crónicos proporcionando herramientas para la planificación de la asistencia. Abstract in english Objective: To determine the most common nursing diagnoses in patients under hemodialysis treatment, based on the nomenclature of the North American Nursing Diagnosis Association -International (NANDA-I) 2009-2011. Method: This is a quantitative, descriptive and exploratory study, accomplished in a h [...] emodialysis clinic in the State of São Paulo, Brazil, with a sample of 50 patients. The study was approved by the Committee of Ethics in Research of the University of Vale do Paraíba, under protocol No. H236/CEP/2009. Results: We identified 24 most frequent diagnoses, of which six were found in 100% of the sample studied; they were: impaired urinary elimination; impaired skin integrity; risk of infection; risk of ineffective renal perfusion; impaired physical mobility; and risk of electrolyte imbalance. Conclusion: Determining nursing diagnoses common to subjects submitted to hemodialysis will help nursing professionals deal with chronic renal patients care by providing tools for planning assistance.
Avaliação da qualidade de vida em idosos submetidos ao tratamento hemodialítico Evaluación de la calidad de vida en personas mayores sometidos a hemodiálisis Evaluation of quality of life in elderly undergoing hemodialysis
Angélica Yukari Takemoto
Full Text Available A hemodiálise afeta não só aspectos físicos, como psicológicos e sociais, com repercussão na vida pessoal e familiar. Considerando que no Brasil está ocorrendo um aumento da população idosa, esta pesquisa objetivou avaliar a qualidade de vida dos idosos com insuficiência renal crônica, submetidos ao tratamento hemodialítico. Trata-se de uma pesquisa quantitativa, de caráter descritivo exploratório, com idosos de um serviço especializado em hemodiálise de Guarapuava, Paraná. Os dados foram coletados entre maio a junho de 2010, através de um instrumento estruturado e, após, submetidos ao programa estatístico Statistica 7.1. Analisando os domínios do questionário, o maior escore diz respeito ao domínio social (70,42 e o menor, ao domínio físico (49,37. Assim, a qualidade de vida desses idosos apresentou-se baixa, com variações de acordo com o domínio analisado. Pesquisas voltadas à avaliação de qualidade de vida são relevantes e instrumentalizam a prática diária do cuidado.Hemodiálisis afecta aspectos física y psicológica y social, con repercusiones en la vida personal y familiar. Mientras que en Brasil está experimentando un aumento de la población de edad avanzada, este estudio tuvo como objetivo evaluar la calidad de vida de los pacientes ancianos con insuficiencia renal crónica sometidos a hemodiálisis. Se trata de un estudio cuantitativo, exploratorio descriptivo con pacientes ancianos en un centro especializado en hemodiálisis Guarapuava, Paraná, Brasil. Los datos fueron recogidos entre mayo y junio de 2010 a través de un instrumento estructurado y, después someterse el programa estadístico Statistica 7.1. Analizar los dominios del cuestionario, la puntuación más alta con respecto al ámbito social (70,42 y menor dominio físico (49,37. Lo tanto, la calidad de vida de estos ancianos tenían ser bajo, con variaciones según ámbito analizado. La investigación destinada a evaluar la calidad de vida son relevantes e instrumentalizar la práctica diaria de atención.Hemodialysis affects not only physical, and psychological and social, with repercussions on personal and family life. Whereas in Brazil is experiencing a increase in the elderly population, this study aimed to evaluate the quality of life of elderly patients with chronic renal failure undergoing hemodialysis. This is a quantitative, descriptive exploratory study with elderly patients at a facility specializing in hemodialysis Guarapuava, Paraná, Brazil. Data were collected between May and June 2010 through a structured instrument and, after undergoing the statistical program Statistica 7.1. Analyzing the domains of the questionnaire, the highest score with respect to the social domain (70.42 and the lowest physical domain (49.37. Thus, the quality of life of these elderly had to be low, with variations according to the analyzed field. Research aimed at assessing quality of life are relevant and instrumentalize daily practice of care.
To measure the frequency of depression and its risk factors in patients under going hemodialysis. It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1/sup st/ January 2006 to 30/sup th/ April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory- II (BDI-II; adapted in Urdu) was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers (Anti HCV and HbsAg). Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) for correlation of psychological variables with clinical, hematological and biochemical parameters. Eighty nine patients were enrolled which included fifty two (58.4%) were male and seventy seven (86.5%) were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 +- 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty (56.1%) were moderately to severely depressed and there was no gender difference in the prevalence of depression. Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiterac depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters. (author)
Kathryn B. Muir; Packer, Clifford D.
Thrombocytopenia is a known potential side effect of hemodialysis, however, it is rarely seen in patients who undergo hemodialysis using biocompatible membranes. This case demonstrates hemodialysis-associated thrombocytopenia with use of biocompatible dialysis membranes that expose blood directly to polysulfone. The thrombocytopenia resolved in this patient when the dialysis membrane was changed to a biocompatible model with a polyethylene glycol barrier layer preventing direct interaction be...
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
Thales Weber, Garcia; Joel Paulo Russomano, Veiga; Lucilia Domingues Casulari da, Motta; Flávio José Dutra de, Moura; Luiz Augusto, Casulari.
Full Text Available OBJETIVO: Avaliar o estado de humor e a qualidade de vida de homens em tratamento hemodialítico, correlacionar as alterações observadas no humor com os diferentes domínios do questionário de qualidade de vida. MÉTODO: Foram incluídos 47 homens em tratamento hemodialítico estável há mais de seis mese [...] s. Foram aplicadas a Escala de Hamilton de depressão e o Kidney Disease Quality of Life Questionnaire, questionário de qualidade de vida relacionado à saúde, em sua forma traduzida e adaptada para a língua portuguesa. RESULTADOS: A média da idade dos pacientes era 39,4 ± 8,9 anos. Na avaliação pela Escala de Hamilton, observou-se em 32 (68,1%) pacientes a presença de depressão. Encontramos correlação negativa significativa entre os resultados obtidos na escala de Hamilton e os seguintes parâmetros das dimensões específicas do Kidney Disease Quality of Life Questionnaire: lista de sintomas e problemas (rs = -0,399; p = 0,005), qualidade da interação social (rs = -0,433; p = 0,002) e sono (rs = -0,585; p Abstract in english OBJECTIVE: To assess mood and quality of life in male hemodialysis patients, and to correlate mood swings with the different domains of the quality of life questionnaire. METHOD: Forty-seven male patients undergoing regular hemodialysis for more than six months were included in the study. The Hamilt [...] on Rating Scale for Depression and the Kidney Disease Quality of Life Questionnaire, in a version translated into and adapted to Portuguese, were used. RESULTS: The patients' age was 39.4 ± 8.9 years (median ± SD). Depression was observed in 32 (68.1%) patients according to the Hamilton Rating Scale for Depression. A significant negative correlation was found between the results from the Hamilton Rating Scale for Depression and the following parameters of the specific dimensions of the Kidney Disease Quality of Life Questionnaire: list of symptoms and problems (rs = -0.399; p = 0.005), quality of social interaction (rs = -0.433; p = 0.002), and quality of sleep (rs = -0.585; p
The adaptation problems of patients undergoing hemodialysis: socio-economic and clinical aspects / Problemas adaptativos de pacientes en hemodiálisis: aspectos socioeconómicos y clínicos / Problemas adaptativos de pacientes em hemodiálise: aspectos socioeconômicos e clínicos
Cecília Maria Farias de Queiroz, Frazão; Jéssica Dantas de, Sá; Ana Beatriz de Almeida, Medeiros; Maria Isabel da Conceição Dias, Fernandes; Ana Luisa Brandão de Carvalho, Lira; Marcos Venícios de Oliveira, Lopes.
Full Text Available OBJETIVOS: identificar os problemas adaptativos de Roy em pacientes submetidos a hemodiálise e correlacioná-los aos aspectos socioeconômicos e clínicos. MÉTODO: estudo transversal, realizado através de um formulário. A amostra foi de 178 indivíduos. Efetuaram-se os testes qui-quadrado e U de M [...] ann-Whitney. RESULTADOS: os problemas adaptativos e os aspectos socioeconômicos e clínicos que apresentaram associações estatísticas foram: hipercalemia e idade; edema e renda; deficiência de um sentido primário: tátil e renda; falha no papel e idade; disfunção sexual e estado civil e sexo; deficiência de um sentido primário: visão e anos de estudo; intolerância à atividade e anos de estudo; dor crônica e sexo e anos de estudo; integridade da pele prejudicada e idade; hipocalcemia e acesso; potencial para lesão e idade e anos de estudo; nutrição menor que as necessidades do organismo e idade; deficiência de um sentido primário: audição e sexo e avaliação cinética da ureia; mobilidade andar e/ou coordenação restritas e meses de hemodiálise e perda de habilidade de autocuidado e meses de hemodiálise e meses de doença. CONCLUSÃO: problemas adaptativos da clientela hemodialítica podem sofrer influências de dados socioeconômicos/clínicos. Tais achados contribuem para o desenvolvimento da profissão, proporcionando reflexão por parte do enfermeiro acerca do cuidado. Abstract in spanish OBJETIVOS: identificar los problemas adaptativos de Roy en pacientes sometidos a hemodiálisis y correlacionarlos a los aspectos socioeconómicos y clínicos. MÉTODO: estudio transversal, realizado a través de un formulario. La muestra fue de 178 individuos. Se efectuaron las pruebas Chi-cuadrado [...] y U de Mann-Whitney. RESULTADOS: los problemas adaptativos y los aspectos socioeconómicos y clínicos que presentaron asociaciones estadísticas fueron: Hiperkalemia y edad; Edema y renta; Deficiencia de un sentido primario: táctil y renta; Fracaso en el papel y edad; Disfunción sexual y estado civil y sexo; Deficiencia de un sentido primario: visión y años de estudio; Intolerancia a la actividad y años de estudio; Dolor crónico y sexo y años de estudio; Integridad de la piel perjudicada y edad; Hipocalcemia y acceso; Potencial para lesión y edad y años de estudio; Nutrición menor que las necesidades del organismo y edad; Deficiencia de un sentido primario: audición y sexo y evaluación cinética de la urea; Movilidad andar y/o coordinación restringidas y meses de hemodiálisis; y, Pérdida de habilidad de autocuidado y meses de hemodiálisis y meses de enfermedad. CONCLUSIÓN: los problemas adaptativos de la clientela hemodialítica pueden sufrir influencias de datos socioeconómicos/clínicos. Esos hallazgos contribuyen para el desarrollo de la profesión, permitiendo la reflexión del enfermero acerca del cuidado. Abstract in english OBJECTIVES: to identify adaptation problems under Roy's Model in patients undergoing hemodialysis and to correlate them with the socioeconomic and clinical aspects. METHOD: a transversal study, undertaken using a questionnaire. The sample was made up of 178 individuals. The Chi-squared and Man [...] n-Whitney U tests were undertaken. RESULTS: the adaptation problems and the socioeconomic and clinical aspects which presented statistical associations were: Hyperkalemia and age; Edema and income; Impairment of a primary sense: touch and income; Role failure and age; Sexual dysfunction and marital status and sex; Impairment of a primary sense: vision and years of education; Intolerance to activity and years of education; Chronic pain and sex and years of education; Impaired skin integrity and age: Hypocalcemia and access; Potential for injury and age and years of education; Nutrition below the organism's requirements and age; Impairment of a primary sense: hearing and sex and kinetic evaluation of urea; Mobility in gait and/or coordination restricted, and months of hemodialysis; and, Loss of ability for self-care, and months of hemodialysis and
Jenabian, Niloofar; Ghazi Mirsaeed, Ali Mohammad; Ehsani, Hodis; Kiakojori, Amir
Background: Chronic renal failure patients undergoing hemodialysis are susceptible to periodontal diseases due to systemic complications of the disease and using different drugs. The present study investigated the periodontal status of patient’s who underwent hemodialysis, in Babol, northern Iran.
Ringe, Kristina Imeen; Galanski, Michael; Rosenthal, Herbert
We report on a patient with terminal renal insufficiency undergoing hemodialysis since four months. Imaging studies showed complete renal artery occlusion of a single kidney with collateral perfusion. Interventional recanalization of the renal artery was successful with a drop of serum creatinine from 1138 to 163 mol/l sparing the patient from further hemodialysis.
Full Text Available Catheter-related bacteremia is a frequent complication in patients undergoing hemodialysis. We report the first case of catheter-related bacteremia with Streptococcus dysgalactiae subsp equisimilis in a patient on hemodialysis. The organism was isolated from both the hemodialysis catheter and blood of the patient. Although the hemodialysis cathether was removed and ceftriaxone was given, the patient died of a subarachnoidal bleeding complicating end-stage renal disease.
P B, Sabitha; Khakha, D. C.; Mahajan, S.; Gupta, S.; Agarwal, M.; Yadav, S. L.
Pain during areteriovenous fistula (AVF) cannulation remains a common problem in hemodialysis (HD) patients. This study was undertaken to assess the effect of cryotherapy on pain due to arteriovenous fistula puncture in hemodialysis patients. A convenience sample of 60 patients (30 each in experimental and control groups) who were undergoing hemodialysis by using AVF, was assessed in a randomized control trial. Hemodialysis patients who met the inclusion criteria, were randomly assigned to ex...
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
Humberto Kukhyun Choi
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.
Avaliação da qualidade de vida em idosos submetidos ao tratamento hemodialítico / Evaluation of quality of life in elderly undergoing hemodialysis / Evaluación de la calidad de vida en personas mayores sometidos a hemodiálisis
Angélica Yukari, Takemoto; Patrícia, Okubo; João, Bedendo; Lígia, Carreira.
Full Text Available A hemodiálise afeta não só aspectos físicos, como psicológicos e sociais, com repercussão na vida pessoal e familiar. Considerando que no Brasil está ocorrendo um aumento da população idosa, esta pesquisa objetivou avaliar a qualidade de vida dos idosos com insuficiência renal crônica, submetidos ao [...] tratamento hemodialítico. Trata-se de uma pesquisa quantitativa, de caráter descritivo exploratório, com idosos de um serviço especializado em hemodiálise de Guarapuava, Paraná. Os dados foram coletados entre maio a junho de 2010, através de um instrumento estruturado e, após, submetidos ao programa estatístico Statistica 7.1. Analisando os domínios do questionário, o maior escore diz respeito ao domínio social (70,42) e o menor, ao domínio físico (49,37). Assim, a qualidade de vida desses idosos apresentou-se baixa, com variações de acordo com o domínio analisado. Pesquisas voltadas à avaliação de qualidade de vida são relevantes e instrumentalizam a prática diária do cuidado. Abstract in spanish Hemodiálisis afecta aspectos física y psicológica y social, con repercusiones en la vida personal y familiar. Mientras que en Brasil está experimentando un aumento de la población de edad avanzada, este estudio tuvo como objetivo evaluar la calidad de vida de los pacientes ancianos con insuficiencia [...] renal crónica sometidos a hemodiálisis. Se trata de un estudio cuantitativo, exploratorio descriptivo con pacientes ancianos en un centro especializado en hemodiálisis Guarapuava, Paraná, Brasil. Los datos fueron recogidos entre mayo y junio de 2010 a través de un instrumento estructurado y, después someterse el programa estadístico Statistica 7.1. Analizar los dominios del cuestionario, la puntuación más alta con respecto al ámbito social (70,42) y menor dominio físico (49,37). Lo tanto, la calidad de vida de estos ancianos tenían ser bajo, con variaciones según ámbito analizado. La investigación destinada a evaluar la calidad de vida son relevantes e instrumentalizar la práctica diaria de atención. Abstract in english Hemodialysis affects not only physical, and psychological and social, with repercussions on personal and family life. Whereas in Brazil is experiencing a increase in the elderly population, this study aimed to evaluate the quality of life of elderly patients with chronic renal failure undergoing hem [...] odialysis. This is a quantitative, descriptive exploratory study with elderly patients at a facility specializing in hemodialysis Guarapuava, Paraná, Brazil. Data were collected between May and June 2010 through a structured instrument and, after undergoing the statistical program Statistica 7.1. Analyzing the domains of the questionnaire, the highest score with respect to the social domain (70.42) and the lowest physical domain (49.37). Thus, the quality of life of these elderly had to be low, with variations according to the analyzed field. Research aimed at assessing quality of life are relevant and instrumentalize daily practice of care.
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
Ana Carolina Bonelá dos, Santos; Manuela do Carmo, Machado; Luciene Rabelo, Pereira; Juliana Lemos Pratti, Abreu; Marisa Barbosa, Lyra.
Full Text Available INTRODUÇÃO: A Doença Renal Crônica (DRC) e a hemodiálise (HD) provocam limitações na vida dos pacientes, interferindo na qualidade de vida e o cuidado nutricional é fundamental para no tratamento da doença. OBJETIVO: O objetivo da pesquisa é analisar a associação entre qualidade de vida com o uso do [...] instrumento SF-36 com consumo alimentar, estado nutricional em pacientes com DRC em HD por meio de pesquisa quantitativa e transversal. MÉTODOS: Realizou-se avaliação antropométrica, coleta dos resultados de exames bioquímicos, aplicação do questionário SF-36 e anamnese alimentar (recordatório alimentar de 24h). RESULTADOS: A amostra foi composta por 30 pacientes adultos com idade entre 28 a 76 anos. A doença relacionada com DRC mais encontrada foi hipertensão arterial sistêmica (53,3%), a média do Índice de Massa Corporal foi 25,04 ± 4,50 kg/m². Pela dobra cutânea do braço, 73,3% estavam em desnutrição. O diagnóstico nutricional final foi 80% de desnutrição entre os pacientes estudados. O tempo de diagnóstico de doença renal teve média de 4,84 ± 3,51 anos. Pela média dos exames bioquímicos, somente fósforo 5,51 ± 1,61 mg/dl e creatinina 10,84 ± 3,33 mg/dl estavam adequados. Nas médias das pontuações do SF-36, o menor valor encontrado foi para limitação por aspectos físicos (16,67 ± 29,60) e o maior para aspectos sociais (68,17 ± 33,67). CONCLUSÃO: O consumo energético e proteico médio esteve abaixo do recomendado. Obteve-se correlação positiva do consumo calórico, proteico, fibra, cálcio e carboidrato com qualidade de vida. Conclui-se, então, que a alimentação está associada à qualidade de vida do paciente renal hemodialítico. Abstract in english INTRODUCTION: The chronic kidney disease and undergoing hemodialysis (HD) cause limitation in patients' life interfering in their life's quality and the nutritional care is fundamental to the disease treatment. OBJECTIVE: The objective is the goal is to analyze the association between quality of lif [...] e through the instrument (SF-36) with dietary intake, nutritional status in patients with chronic kidney disease in HD through quantitative research and transversal. METHODS: Realized valuation anthropometric, collection of the results of biochemical tests, application of the questionnaire SF-36 and dietary anamnesis (food recall of 24h). RESULTS: The sample consisted of thirty adult patients with age between 28 to 76 years. The disease related with chronic kidney disease was found more hypertension systemic arterial (53.3%) The average body mass index was 25.04 ± 4.50 kg/m². By fold cutaneous arm, 73.3% were in malnutrition. The end nutritional diagnosis of malnutrition was 80% among the patients studied. The time of diagnosis of renal disease had a mean of 4.84 ± 3.51 years. By the middle of biochemical tests only phosphorus creatinine were adequate. In the mean the scores of SF-36 the lowest value found was limited to physical aspects (16.67 ± 29.60) and the largest for the social aspect (68.17 ± 33.67). CONCLUSION: The average energy consumption and protein was below the recommended. Got positive correlation of calories, protein, fiber, calcium and carbohydrate, with quality of life. It was concluded that feeding is associated with quality of life of renal patients undergoing hemodialysis.
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)
Chang, Don N; Dager, William E; Chin, Andrew I
Dabigatran is a newly available oral direct thrombin inhibitor approved for anticoagulation therapy to prevent strokes in patients with nonvalvular atrial fibrillation. Unlike warfarin, dabigatran's observed therapeutic window and minimal drug-to-drug interaction suggest that invasive laboratory testing and dose adjustment is not necessary. In circumstances of excessive anticoagulation, such as overdoses, decreased kidney function, or instances of significant bleeding, reversing dabigatran's effects may be necessary. Unlike warfarin, no rapid-acting antidote to reverse the effects of dabigatran is known. However, hemodialysis has been suggested as a method of removing dabigatran and thereby reducing its anticoagulant effect. We describe a case in which hemodialysis was used in an attempt to remove dabigatran in a patient with excessive anticoagulation from dabigatran and severe intracranial hemorrhage. Serial dabigatran levels suggested that hemodialysis removed the drug. However, given the large volume of distribution of dabigatran in the terminal phase of elimination, a rebound in drug level was noted. We suggest that a longer duration of therapy or more continuous modality of hemodialysis may be needed in conjunction with the initial hemodialysis treatment of dabigatran coagulopathy. PMID:23219111
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
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.
Full Text Available Estudo transversal, objetivando identificar os componentes do modelo teórico de Roy em pacientes submetidos à hemodiálise em um centro de diálise. Participaram 178 pacientes de um centro dialítico no Nordeste do Brasil. A coleta de dados ocorreu de outubro/2011 a fevereiro/2012, por entrevista e exa [...] me físico. Os componentes identificados foram: problemas adaptativos, comportamentos e estímulos. Os principais problemas adaptativos foram: retenção de líquido intracelular, hipercalemia, hipotermia, edema, intolerância à atividade. Os comportamentos foram: anúria, desequilíbrio hidroeletrolítico, aumento de peso em curto período, aumento do potássio sérico, temperatura corporal abaixo de 36°C, retenção de líquidos, fadiga, dificuldade em realizar atividades de vida diária. Os estímulos foram: lesão renal, circulação extracorpórea, hemodiálise, não seguimento da restrição hídrica, distúrbio eletrolítico, ambiente frio, efeitos adversos relacionados ao tratamento. Conclui-se que a identificação desses componentes, enquadrados no modo fisiológico, contribui para o planejamento de intervenções de enfermagem específicas e voltadas para a adaptação da clientela. Abstract in spanish Estudio transversal, objetivando identificar los componentes del modelo teórico de Roy en pacientes sometidos a hemodiálisis en un centro de diálisis. Participaron 178 pacientes de un centro de diálisis en el Noreste de Brasil. La recogida de datos ocurrió de octubre/2011 a febrero/2012 por entrevis [...] ta y examen físico. Los componentes identificados fueron: problemas de adaptación, comportamientos y estímulos. Los principales problemas adaptativos fueron: retención de líquido intracelular, hiperpotasemia, hipotermia, edema, intolerancia a la actividad. Los comportamientos fueron: anuria, desequilibrio electrolítico, aumento de peso en corto período de tiempo, aumento del potasio sérico, temperatura corporal por debajo de 36 °C, retención de líquidos, fatiga, dificultad para realizar actividades de la vida diaria. Los estímulos fueron: lesión renal, circulación extracorpórea, la hemodiálisis, no sigue restricción hídrica, alteración electrolítica, ambiente frío, efectos adversos relacionados con el tratamiento. Se concluye que la identificación de estos componentes, clasificados en el modo fisiológico, contribuye a la planificación de las intervenciones de enfermería específicas y dirigidas a la adaptación de esta clientela. Abstract in english Cross-sectional study aimed to identify the components of a Roy's adaptation model in patients undergoing hemodialysis at a dialysis center. 178 patients participated in a dialysis center in the Brazil Northeast region. Data collection occurred from October/2011 to February/2012 through the use of i [...] nterviews and physical examinations. The components identified were: adaptive problems, behaviors and stimuli. The main adaptive problems were: intracellular fluid retention, hyperkalemia, hypothermia, edema, intolerance for performing daily activities. The behaviors were: anuria, hydroelectrolyte imbalance, gain of weight in a short period of time, elevated serum potassium concentrations, body temperature below 36 ° C, fluid retention, fatigue, difficulty performing activities of daily living. The stimuli were: renal injury, cardiopulmonary bypass, hemodialysis, failure to observe fluid intake restriction, electrolyte disorder, cold environment, adverse effects related to treatment. We conclude that the identification of these components, classified as physiological mode, contribute to the planning of specific nursing interventions focused on the adaptation of the clientele.
Niki? Petar M.
Full Text Available INTRODUCTION Hemodialysis (HD is one of the most accessible methods for the treatment of the growing number of patients suffering from terminal-stage renal insufficiency. Although headache is the most frequently encountered neurological symptom during HD, there are few studies reporting its prevalence and clinical features. OBJECTIVE The objective of this study was to examine the frequency, demographic and clinical features of headache during HD, and to compare these parameters among patients with and without headache. METHOD The study involved 126 patients (48 female and 78 male with chronic renal failure on regular HD for at least six months, at the Dialysis Unit of Nephrology Department, Kruševac. All patients were inquired about their possible problems with headache using the standardized questionnaire designed according to the diagnostic criteria of the International Headache Classification of Headache Disorders, second edition, published in 2004 (ICHD-II. Subsequently, the patients were clinically evaluated and patients with headaches were further sub classified by a neurologist with special interest in headache disorders. Patients with headache were compared to the patients without headache regarding age, sex, duration of HD, causes of end-stage renal disease, arterial diastolic and systolic blood pressure, and serum values of the most important blood parameters such as sodium, potassium, urea and creatinine. In the group of patients with headache we analyzed the characteristics of specific headache type according to ICHD-II classification. We also analyzed the most important clinical features of hemodialysis headache (HDH. RESULTS In the group of 126 evaluated patients, 41 (32.5% patients had headaches. There were no statistically significant differences between the patients with headaches and those without headaches regarding sex, age, BMI, duration of HD, causes of end-stage renal disease, arterial blood pressure, red blood cell count, serum concentration of hemoglobin, blood urea nitrogen, creatinine, glucose, MCHC, total protein, sodium and potassium. Fourteen patients (34% of those with headaches experienced headache during the HD session and were sub classified as HDH using diagnostic criteria of the International Headache Society. Tension type headache (41% of those with headaches and migraine without aura (10% were most common in the primary headache group and headache due to arterial hypertension (7% was the most prevalent among the secondary headaches. Although there were some common clinical characteristics, we could not find a unifying clinical pattern in the patients with HDH. CONCLUSION Hemodialysis headache is the most common headache in patients undergoing hemodialysis, and despite some common symptoms, it does not appear to be uniform in its clinical characteristics.
Yamaguchi, Teppei; Isogai, Sumito; Okamura, Takuya; Uozu, Sakurako; Mieno, Yuki; Hoshino, Tami; Goto, Yasuhiro; Hayashi, Masamichi; Nakanishi, Toru; Imaizumi, Kazuyoshi
A 72-year-old man undergoing continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure and who had undergone right upper lobectomy for lung adenocarcinoma (pT2aN0M0) 2 years ago was admitted for recurrence of lung cancer presenting as multiple brain metastases. An epidermal growth factor receptor mutation analysis of his lung cancer revealed a deletion of 15 nucleotides (E746-A750) in exon 19. After whole-brain radiotherapy, we started daily administration of 250 mg gefitinib under the continuation of CAPD and performed a pharmacokinetic analysis. We speculated that the plasma concentration of gefitinib reached the steady state at least by day 16 after the start of gefitinib (626.6 ng/ml at trough level). On day 46, the plasma concentration was 538.4 ng/ml at trough level and the concentration in the peritoneal dialysis fluid was 34.6 ng/ml, suggesting that CAPD appeared to have little effect on the pharmacokinetics of gefitinib. During gefitinib therapy, there were no significant adverse events except for grade 2 diarrhea. Gefitinib could be safely administered to a patient undergoing CAPD. PMID:25848356
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
Ana Carolina, Ottaviani; Érica Nestor, Souza; Natália de Camargo, Drago; Marisa Silvana Zazzetta de, Mendiondo; Sofia Cristina Iost, Pavarini; Fabiana de Souza, Orlandi.
Full Text Available OBJETIVO: analisar a relação entre a esperança e a espiritualidade de pacientes renais crônicos em tratamento hemodialítico. MÉTODO: trata-se de estudo correlacional, de corte transversal. A amostra foi composta por 127 sujeitos em tratamento em uma Unidade de Terapia Renal Substitutiva. Os da [...] dos foram coletados por meio de entrevista individual, utilizando-se os instrumentos: caracterização dos sujeitos, Escala de Esperança de Herth e Escala de Espiritualidade de Pinto Pais-Ribeiro. RESULTADOS: o escore médio da Escala de Esperança de Herth foi de 38,06 (±4,32) e da Escala de Espiritualidade de Pinto Pais-Ribeiro nas dimensões "crenças" foi de 3,67 (±0,62) e "esperança/otimismo", 3,21 (±0,53). O coeficiente de Spearman indicou a existência de correlação positiva, de moderada magnitude entre a Escala de Esperança de Herth e as dimensões da Escala de Espiritualoidade de Pinto Pais-Ribeiro: "crenças" (r=0,430; p Abstract in spanish OBJETIVO: analizar la relación entre la esperanza y la espiritualidad de pacientes renales crónicos en tratamiento de hemodiálisis. MÉTODO: se trata de un estudio de correlación, de corte transversal. La muestra fue compuesta por 127 sujetos en tratamiento en una Unidad de Terapia Renal Substi [...] tutiva. Los datos fueron recolectados, por medio de entrevista individual, utilizando los instrumentos: caracterización de los sujetos, Escala de Esperanza de Herth (EEH) y Escala de Espiritualidad de Pinto Pais-Ribeiro (EEPP-R). RESULTADOS: el puntaje promedio de la EEH fue 38,06 (±4,32) y de la EEPP-R en las dimensiones "creencias" 3,67 (±0,62) y "esperanza/optimismo" 3,21 (±0,53). El coeficiente de Spearman indicó la existencia de correlación positiva, de moderada magnitud entre la EEH y las dimensiones de la EEPP-R: "creencias" (r=0,430; p Abstract in english OBJECTIVE: to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis. METHOD: this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through ind [...] ividual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS). RESULTS: the average HHI score was 38.06 (±4.32) while the average PP-RSS score was 3.67 (±0.62) for "beliefs" and 3.21 (±0.53) for "hope/optimism". Spearman's coefficient indicated there was a moderate positive correlation between the HHI and PP-RSS dimensions of "beliefs" (r=0.430; p
Wilson, A P; Lewis, C; O'Sullivan, H; Shetty, N; Neild, G H; Mansell, M
Exit site infection is a major risk factor for the development of peritonitis in continuous ambulatory peritoneal dialysis. The frequency of infection can be reduced by scrupulous exit site care with or without topical antiseptics. A randomized trial was performed of 149 catheters in 130 patients to assess any additional benefits conferred by the use of povidine iodine dry powder spray at dressing changes over an existing strict protocol of exit care. Exit infections occurred in 14 (18%) of 77 patients using spray and in 15 (21%) of 72 patients not using spray. The risk of peritonitis was also similar in each group. The proportion of infections caused by Staphylococcus aureus was reduced in the spray group, but those caused by Pseudomonas aeruginosa were increased. Rash occurred in 6% of those using the spray. The use of the spray did not therefore seem justified. PMID:9152821
Mohammad Reza Tamadon
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.
Spooner, Almath M
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
Vivências dos homens submetidos à hemodiálise acerca de sua sexualidade / Experience of men undergoing hemodialysis about their sexuality / Experiencias de los hombres sometidos a hemodiálisis acerca de su sexualidad
Denilson, Fonseca Rodrigues; Eda, Schwartz; Maria da Gloria, Santana; Juliana Graciela, Vestena Zillmer; Aline, da Costa Viegas; Bianca, Pozza dos Santos; Daiane, Lopes Leal Borda; Juyane, Felipette Lima.
Full Text Available Objetivo: Conhecer as vivências dos pacientes masculinos submetidos à hemodiálise acerca de sua sexualidade. Metodologia: Trata-se de uma investigação exploratória, descritiva, com abordagem qualitativa. Os sujeitos da pesquisa, realizada no primeiro semestre de 2004, foram oito pacientes masculinos [...] que estavam em tratamento hemodialítico. O instrumento de coleta foi a entrevista semiestruturada, utilizando a análise categórica. Como cenário da pesquisa, um serviço de nefrologia, de um município da Região Sul do Brasil. Resultados: A partir da análise emergiram as seguintes categorias: Aspectos físicos e emocionais acerca do tratamento; As vivências dos pacientes renais crônicos acerca de sua sexualidade; As estratégias para lidar com as limitações relacionadas à sexualidade e A sexualidade dos pacientes renais crônicos após a hemodiálise. Discussão: O desgaste e o cansaço físico foram atribuídos ao tratamento hemodialítico. A vivência dos pacientes renais crônicos acerca de sua sexualidade está intimamente ligada à relação sexual saudável, tanto no biológico quanto no emocional. Os pacientes que buscam estratégias a fim de minimizar ou até mesmo resolver problemas relativos com sua sexualidade, em decorrência da condição crônica, enfrentam com maior facilidade os obstáculos vivenciados. Os sujeitos apresentaram modificações a respeito da sexualidade, no entanto, percebe-se a busca dos pacientes por estratégias que amenizem e até mesmo restabeleçam suas necessidades sexuais, dentro da dimensão biopsicológica. Considerações finais: Este estudo é relevante, pois existe necessidade de capacitar profissionais para trabalharem com a sexualidade humana, percebendo o paciente renal crônico sob uma visão holística.Palavras-chave: insuficiência renal crônica; diálise renal; enfermagem; sexualidade. Abstract in spanish Objetivo: Conocer las experiencias de los pacientes masculinos sometidos a hemodiálisis acerca de su sexualidad. Metodología: Se trata de una investigación exploratoria, descriptiva, con enfoque cualitativo. Los sujetos de la investigación, realizada en el primer semestre de 2004, fueron ocho pacien [...] tes masculinos que se encontraban en tratamiento de hemodiálisis. El instrumento de compilación de datos fue una entrevista semiestructurada, utilizando el análisis categórico. El escenario de investigación fue un servicio de nefrología ubicado en un municipio de la Región Sur de Brasil. Resultados: A partir del análisis surgieron las siguientes categorías: Aspectos físicos y emocionales acerca del tratamiento; las vivencias de los pacientes renales crónicos acerca de su sexualidad; Las estrategias para lidiar con las limitaciones relacionadas con la sexualidad y la sexualidad de los pacientes renales crónicos después de la hemodiálisis. Discusión: El desgaste y el cansancio físico se atribuyeron al tratamiento de hemodiálisis. La experiencia de los pacientes renales crónicos acerca de su sexualidad está íntimamente vinculado con la relación sexual saludables tanto a nivel biológico como emocional. Los pacientes que buscan estrategias dirigidas a minimizar o incluso resolver problemas relativos a su sexualidad, como resultado de la condición crónica, enfrentan con mayor facilidad los obstáculos a los que hacen frente. Los sujetos presentaron modificaciones con respecto a la sexualidad, sin embargo, se percibe la búsqueda de los pacientes por estrategias que amenicen e incluso restablezcan sus necesidades sexuales, dentro de la dimensión bio-sicológica. Consideraciones finales: Este estudio es pertinente, ya que existe la necesidad de capacitar profesionales para que trabajen con la sexualidad humana, percibiendo al paciente renal crónico bajo una visión holística. Abstract in english Objective: To study the experiences of male patients undergoing hemodialysis about their sexuality. Methodology: This is an exploratory, descriptive research with a qualitative approach. The research was conducted in
Doença arterial coronariana subclínica em pacientes com Diabetes Mellitus tipo 1 em hemodiálise / Subclinical coronary artery disease in patients with type 1 Diabetes Mellitus undergoing hemodialysis / Enfermedad arterial coronaria subclínica en pacientes con Diabetes Mellitus tipo 1 en hemodiálisis
Dinaldo Cavalcanti de, Oliveira; Fabio Sandoli de, Brito Junior; Rosley Weber Alvarenga, Fernandes; João Roberto de, Sa; Valter Correia de, Lima.
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. Abstract in spanish 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. Abstract in english 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 chro [...] nic renal failure undergoing hemodialysis. M
Vivências dos homens submetidos à hemodiálise acerca de sua sexualidade Experiencias de los hombres sometidos a hemodiálisis acerca de su sexualidad Experience of men undergoing hemodialysis about their sexuality
Denilson Fonseca Rodrigues
Full Text Available Objetivo: Conhecer as vivências dos pacientes masculinos submetidos à hemodiálise acerca de sua sexualidade. Metodologia: Trata-se de uma investigação exploratória, descritiva, com abordagem qualitativa. Os sujeitos da pesquisa, realizada no primeiro semestre de 2004, foram oito pacientes masculinos que estavam em tratamento hemodialítico. O instrumento de coleta foi a entrevista semiestruturada, utilizando a análise categórica. Como cenário da pesquisa, um serviço de nefrologia, de um município da Região Sul do Brasil. Resultados: A partir da análise emergiram as seguintes categorias: Aspectos físicos e emocionais acerca do tratamento; As vivências dos pacientes renais crônicos acerca de sua sexualidade; As estratégias para lidar com as limitações relacionadas à sexualidade e A sexualidade dos pacientes renais crônicos após a hemodiálise. Discussão: O desgaste e o cansaço físico foram atribuídos ao tratamento hemodialítico. A vivência dos pacientes renais crônicos acerca de sua sexualidade está intimamente ligada à relação sexual saudável, tanto no biológico quanto no emocional. Os pacientes que buscam estratégias a fim de minimizar ou até mesmo resolver problemas relativos com sua sexualidade, em decorrência da condição crônica, enfrentam com maior facilidade os obstáculos vivenciados. Os sujeitos apresentaram modificações a respeito da sexualidade, no entanto, percebe-se a busca dos pacientes por estratégias que amenizem e até mesmo restabeleçam suas necessidades sexuais, dentro da dimensão biopsicológica. Considerações finais: Este estudo é relevante, pois existe necessidade de capacitar profissionais para trabalharem com a sexualidade humana, percebendo o paciente renal crônico sob uma visão holística.Palavras-chave: insuficiência renal crônica; diálise renal; enfermagem; sexualidade.Objetivo: Conocer las experiencias de los pacientes masculinos sometidos a hemodiálisis acerca de su sexualidad. Metodología: Se trata de una investigación exploratoria, descriptiva, con enfoque cualitativo. Los sujetos de la investigación, realizada en el primer semestre de 2004, fueron ocho pacientes masculinos que se encontraban en tratamiento de hemodiálisis. El instrumento de compilación de datos fue una entrevista semiestructurada, utilizando el análisis categórico. El escenario de investigación fue un servicio de nefrología ubicado en un municipio de la Región Sur de Brasil. Resultados: A partir del análisis surgieron las siguientes categorías: Aspectos físicos y emocionales acerca del tratamiento; las vivencias de los pacientes renales crónicos acerca de su sexualidad; Las estrategias para lidiar con las limitaciones relacionadas con la sexualidad y la sexualidad de los pacientes renales crónicos después de la hemodiálisis. Discusión: El desgaste y el cansancio físico se atribuyeron al tratamiento de hemodiálisis. La experiencia de los pacientes renales crónicos acerca de su sexualidad está íntimamente vinculado con la relación sexual saludables tanto a nivel biológico como emocional. Los pacientes que buscan estrategias dirigidas a minimizar o incluso resolver problemas relativos a su sexualidad, como resultado de la condición crónica, enfrentan con mayor facilidad los obstáculos a los que hacen frente. Los sujetos presentaron modificaciones con respecto a la sexualidad, sin embargo, se percibe la búsqueda de los pacientes por estrategias que amenicen e incluso restablezcan sus necesidades sexuales, dentro de la dimensión bio-sicológica. Consideraciones finales: Este estudio es pertinente, ya que existe la necesidad de capacitar profesionales para que trabajen con la sexualidad humana, percibiendo al paciente renal crónico bajo una visión holística.Objective: To study the experiences of male patients undergoing hemodialysis about their sexuality. Methodology: This is an exploratory, descriptive research with a qualitative approach. The research was conducted in the first half of 2004, and the subjects were eight ma
Rus, H G; Cristea, A; Gherman, M; Niculescu, F; Gavan, M
Parameters of humoral immunity were studied in 18 patients with chronic renal failure undergoing hemodialysis. IgG, IgA and IgM serum levels presented no differences compared with healthy donors. High immunoglobulins levels were found in 40 patients with chronic renal failure and conservative treatment. Complement components C1q, C4, C9, were normal, but C3 and C3A were significantly low prior to dialysis. During hemodialysis, the complement system showed an activation by the alternative pathway (AP). The cuprophan membrane was proved to be an important factor in this activation. The circulating immune complexes (CIC) were also high. Seven patients presented autoantibodies, 2 against smooth muscle and 5 against gastric parietal cells. Our results suggested a certain humoral immune alteration during chronic hemodialysis. PMID:6658343
Quale, J. M.; O Halloran, J. J.; Devincenzo, N.; Barth, R. H.
Levels of vancomycin in serum are traditionally believed to be unaffected by hemodialysis. By both in vivo and in vitro techniques, the effects of a newer, more permeable dialyzer membrane on vancomycin concentrations were investigated. Six patients who were receiving vancomycin and undergoing maintenance hemodialysis with polyacrylonitrile dialyzer membranes had postdialysis levels in serum that were 63% of predialysis levels; the intradialytic half-life was 5.7 h. Vancomycin concentrations ...
Full Text Available To determine the characteristics of the hemodialysis (HD patients in Aleppo city, we surveyed the hospitals representing the main dialysis centers in the city including private and community facilities during 2006. Personal patients? interviews and hospitals records were the source of data. The total number of patients in 2006 undergoing HD was 550 patients; 280 (50.9% were males, and the age ranged from 5-82 years with mean and median age 44.7 and 45 years, respectively. The incidence (IR and prevalence rate (PR for hemodialysis were 60 pmp and 226 pmp, respectively. The major primary renal diseases in the end-stage renal disease (ESRD patients included hypertension (HTN, glomerulonephritis (GN, and diabetes mellitus (DM, 21.1%, 20.5 %, and 19.45, respectively. The percent of Anti-HCV, HBV hepatitis and HBV vaccine were 54.4%, 7.8%, and 52.9%, respectively. This study suggests that the IR of hemodialysis was relatively low due to the high cost of treatment, and the PR for hemodialysis was also relatively low may be due to high mortality rate and low kidney transplantation rate in this country. There was an equal percentage of both genders in the hemodialysis population.
Adib-hajbagheri, Mohsen; Molavizadeh, Narjes; Alavi, Negin Masoodi; Abadi, Mahmood Hosseiny Mosa
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
There are few detailed data on cognition in patients undergoing dialysis. We evaluated the frequency of and risk factors for poor cognitive performance using detailed neurocognitive testing. In this cross-sectional cohort study, 314 hemodialysis patients from 6 Boston-area hemodialysis units underwe...
Gross, B; Ketema Wassie, F
Music for hemodialysis patients Background Patients starting a new regimen of dialysis often experience anxiety and other psychological disturbances. They struggle with the unknown situation, feelings of uncertainty and on top of that, a high level of sophisticated technological equipment. Music is known from literature to influence and dampen anxiety and tension and has been used for millennia in the treatment of illness. Here we report a study on the influence of music on patients undergoing dialysis and whether music has a potential for lowering discomfort in patients during first-time dialysis. Purpose To investigate whether music can reduce feelings of anxiety, tension and restlessness in patients new to dialysis treatment and make them more relaxed during the treatment. Method Twenty patients aged 42-84 were selected for participation in the study, which took place over two separate dialysis treatments. A crossover design was chosen and patients split in two groups. Group one would listen to music during the first treatment but not the second time. Group two would listen to music during the second treatment but not the first. Questionnaires and a special audio and music program created by the Danish composer Niels Eje were used. Results This study shows that patients undergoing their first dialysis can have a positive experience and lower level of discomfort from listening to music during dialysis. Analysis of the questionnaire showed that patients listening to music were unaffected by alarms given by the machine during dialysis. The musical genre used in the study was well suited for patients undergoing first-time dialysis, as 80% (n=16) of the patients were pleased with the music. Although this is only a preliminary study with a limited number of patients, it shows an indication of music having a positive effect on patient anxiety and tension during their first dialysis treatment. As a direct consequence, the department has purchased a music player for use both by patients undergoing first-time dialysis and by more experienced patients in dialysis showing anxiety during treatment. These results will be published in relevant professional connections.
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
Yanet, Parodis López; Betsy, Llerena Ferrer; Orestes, Benítez Llanes; Christian, Leyva; Alexis, Pérez Rodríguez; Midiala, Suárez.
Full Text Available Se presentó la evolución clínica de un paciente de 59 años de edad en hemodiálisis desde el año 1994, que llega a la insuficiencia renal crónica (IRC) terminal por la vía aparente de la hipertensión arterial, que luego de 11 años en el proceder dialítico desarrolla un aumento de tamaño de los riñone [...] s con grandes quistes, cuyo aspecto en la ecografía y en la tomografía es indistinguible de una poliquistosis renal dominante del adulto. Abstract in english The clinical evolution of a 59-year-old patient on hemodialysis since 1994 that apparently reaches the end-stage chronic kidney failure (CKF) by arterial hypertension is presented. After 11 years under the dialytic procedure, it is observed an increase of the size of the kidneys with large cysts, wh [...] ose aspect in the echography and in the tomography is undistinguishable from an adult dominant polycystic kidney disease.
Peritonitis by Scedosporium apiospermum in a patient undergoing continuous ambulatory peritoneal dialysis Peritonite por Scedosporium apiospermum em paciente sob diálise peritoneal ambulatorial continuada
Luiz Carlos SEVERO
Full Text Available A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection.É relatado caso de peritonite por Scedosporium apiospermum em menino sob diálise peritoneal ambulatorial continuada. O achado de formas teciduais sugestivas do fungo acelerou o diagnóstico da infecção.
Peritonitis by Scedosporium apiospermum in a patient undergoing continuous ambulatory peritoneal dialysis Peritonite por Scedosporium apiospermum em paciente sob diálise peritoneal ambulatorial continuada
Luiz Carlos SEVERO; Oliveira, Flávio de Mattos; GARCIA Clotilde Druck; UHLMANN Anelise; Alberto Thomaz LONDERO
A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection.É relatado caso de peritonite por Scedosporium apiospermum em menino sob diálise peritoneal ambulatorial continuada. O achado de formas teciduais sugestivas do fungo acelerou o diagnóstico da infecção.
Peritonitis by Scedosporium apiospermum in a patient undergoing continuous ambulatory peritoneal dialysis / Peritonite por Scedosporium apiospermum em paciente sob diálise peritoneal ambulatorial continuada
Luiz Carlos, SEVERO; Flávio de Mattos, OLIVEIRA; Clotilde Druck, GARCIA; Anelise, UHLMANN; Alberto Thomaz, LONDERO.
Full Text Available É relatado caso de peritonite por Scedosporium apiospermum em menino sob diálise peritoneal ambulatorial continuada. O achado de formas teciduais sugestivas do fungo acelerou o diagnóstico da infecção. [...] Abstract in english A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection. [...
Siminelakis Stavros N
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.
Papadopoulos, Georgios; Baikoussis, Nikolaos G; Tzimas, Petros; Siminelakis, Stavros N; Karanikolas, Menelaos
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 microg/kg/min and 0.05 microg/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. PMID:20196861
... an infection, or a scarred vein, causing the vein to narrow. However, if a patient needs to start hemodialysis ... an infection, or a scarred vein, causing the vein to narrow. All three types of vascular access can cause ...
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
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.
Full Text Available INTRODUÇÃO: O Comitê de Nutrição da Sociedade Brasileira de Nefrologia (SBN) realizou, em 2010, o primeiro Censo Brasileiro de Nutrição em pacientes em Hemodiálise. Dados multicêntricos contribuem para o desenvolvimento de condutas clínicas e intervenção nutricional. OBJETIVO: Descrever aspectos nut [...] ricionais e epidemiológicos de pacientes em hemodiálise. MÉTODO: Estudo transversal em 36 clínicas de diálise, 2.622 participantes selecionados aleatoriamente. Foram coletados: registros sociodemográficos, clínicos, bioquímicos e antropométricos. RESULTADOS: Dos pacientes, 60,45% era da região Sudeste, 13,53% Nordeste, 12,81% Sul, 10,33% Centro-Oeste e 2,86% Norte. Cerca de 58% eram homens e 63,1% tinham menos de 60 anos. Casados ou em união estável, 58,5% deles. Aproximadamente 80% dependia do Sistema Único de Saúde. O tabagismo apresentou diferença entre sexo e idade. As etiologias presuntivas foram nefroesclerose hipertensiva 26,4%, nefropatia diabética 24,6%, causas desconhecidas/não diagnosticadas 19,9%, glomerulopatias 13,6% e outros 11,2%. A hipertensão arterial e o Diabetes Mellitus acometiam aproximadamente 30% dos pacientes, principalmente aqueles acima de 60 anos. O Índice de Massa Corporal não diferiu entre sexos, embora tenha diferido entre grupos etários e quando utilizados critérios de avaliação distintos. A média de circunferência da cintura de homens e mulheres foi, respectivamente, 90,5 cm e 88,0 cm. O perfil lipídico não diferiu entre às faixas etárias, porém, houve diferenças entre sexos. Os valores de albumina estiveram menores nas mulheres e em pacientes com idade superior a 60 anos. CONCLUSÃO: O estudo caracterizou os pacientes em hemodiálise no Brasil em 2010, podendo subsidiar novos estudos para acompanhamento de transições nutricionais e epidemiológicas da população. Abstract in english INTRODUCTION: The Nutrition Committee of the Brazilian Society of Nephrology (SBN) held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention. OBJECTIVE: To describe epidemiological and nutritional aspe [...] cts of hemodialysis patients. METHOD: Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected. RESULTS: 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%), Diabetic Nephropathy (24.6%), unknown/undiagnosed causes (19.9%), Glomerulopathies (13.6%) and others (11.2%). Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years. CONCLUSION: This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.
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
Bárbara Margareth Menardi Biavo
Full Text Available INTRODUÇÃO: O Comitê de Nutrição da Sociedade Brasileira de Nefrologia (SBN realizou, em 2010, o primeiro Censo Brasileiro de Nutrição em pacientes em Hemodiálise. Dados multicêntricos contribuem para o desenvolvimento de condutas clínicas e intervenção nutricional. OBJETIVO: Descrever aspectos nutricionais e epidemiológicos de pacientes em hemodiálise. MÉTODO: Estudo transversal em 36 clínicas de diálise, 2.622 participantes selecionados aleatoriamente. Foram coletados: registros sociodemográficos, clínicos, bioquímicos e antropométricos. RESULTADOS: Dos pacientes, 60,45% era da região Sudeste, 13,53% Nordeste, 12,81% Sul, 10,33% Centro-Oeste e 2,86% Norte. Cerca de 58% eram homens e 63,1% tinham menos de 60 anos. Casados ou em união est??vel, 58,5% deles. Aproximadamente 80% dependia do Sistema Único de Saúde. O tabagismo apresentou diferença entre sexo e idade. As etiologias presuntivas foram nefroesclerose hipertensiva 26,4%, nefropatia diabética 24,6%, causas desconhecidas/não diagnosticadas 19,9%, glomerulopatias 13,6% e outros 11,2%. A hipertensão arterial e o Diabetes Mellitus acometiam aproximadamente 30% dos pacientes, principalmente aqueles acima de 60 anos. O Índice de Massa Corporal não diferiu entre sexos, embora tenha diferido entre grupos etários e quando utilizados critérios de avaliação distintos. A média de circunferência da cintura de homens e mulheres foi, respectivamente, 90,5 cm e 88,0 cm. O perfil lipídico não diferiu entre às faixas etárias, porém, houve diferenças entre sexos. Os valores de albumina estiveram menores nas mulheres e em pacientes com idade superior a 60 anos. CONCLUSÃO: O estudo caracterizou os pacientes em hemodiálise no Brasil em 2010, podendo subsidiar novos estudos para acompanhamento de transições nutricionais e epidemiológicas da população.INTRODUCTION: The Nutrition Committee of the Brazilian Society of Nephrology (SBN held in 2010 the first Brazilian Nutrition Census in hemodialysis patients. Multicenter data contribute to clinical development and nutritional intervention. OBJECTIVE: To describe epidemiological and nutritional aspects of hemodialysis patients. METHOD: Cross-sectional study in 36 dialysis clinics and 2,622 randomly selected participants. Socio-demographical, clinical, biochemical and anthropometric records were collected. RESULTS: 60.45% of the patients lived in the Brazilian Southeast. 13.53% came from Northeast region, while 12.81% from South, 10.33% from Midwest and 2.86% from North regions. Approximately 58% were male and 63.1% were below 60 years old. 58.5% of patients were married or in cohabitation. Around 80% of them depended on the government Unified Health System. Smoking showed a difference between gender and age. Presumptive etiologies were Hypertensive Nephrosclerosis (26.4%, Diabetic Nephropathy (24.6%, unknown/undiagnosed causes (19.9%, Glomerulopathies (13.6% and others (11.2%. Both Hypertension and Diabetes Mellitus affect approximately 30% of patients, especially over 60 years. Body Mass Index did not differ between genders, although it differed between age groups and when used different evaluation criteria. Men and women average waist circumference were respectively 90.5 and 88.0 cm. Lipid profile did not differ between age groups, but it did between genders. Albumin values were lower in women and in patients older than 60 years. CONCLUSION: This study characterized Brazilian hemodialysis patients in 2010, and may support further studies to monitor nutrition and epidemiological transitions of the population.
Full Text Available Abstract Background Low bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis. It can lead to serious bone health problems such as fragility fractures. The purpose of this study is to investigate the risk factors of low bone mass in the hemodialysis patients. Methods Sixty-three subjects on hemodialysis for at least 6 months were recruited from a single center for this cross-sectional study. We collected data by questionnaire survey and medical records review. All subjects underwent a bone mineral density (BMD assay with dual-energy x-ray absorptiometry at the lumbar spine and right hip. Data were statistically analyzed by means of descriptive analysis, independent t test and one way analysis of variance for continuous variables, Pearson product-moment correlation to explore the correlated factors of BMD, and stepwise multiple linear regression to identify the predictors of low bone mass. Results Using WHO criteria as a cutoff point, fifty-one subjects (81% had a T-score lower than -1, of them 8 subjects (13% had osteoporosis with the femoral neck most commonly affected. Regarding risk factors, age, serum alkaline phosphatase (ALP level, and intact parathyroid hormone (iPTH level had significant negative correlations with the femoral neck and lumbar spine BMD. On the other hand, serum albumin level, effective exercise time, and body weight (BW had significant positive correlations with the femoral neck and lumbar spine BMD. Age, effective exercise time, and serum albumin level significantly predicted the femoral neck BMD (R2 × 0.25, whereas BW and the ALP level significantly predicted the lumbar spine BMD (R2 × 0.20. Conclusion This study showed that advanced age, low BW, low serum albumin level, and high ALP and iPTH levels were associated with a low bone mass in the hemodialysis patients. We suggest that regular monitoring of the femoral neck BMD, maintaining an adequate serum albumin level and BW, and undertaking an exercise program are important to improve bone health in the patients undergoing hemodialysis.
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
Humberto Kukhyun, Choi; Fernando Saldanha, Thomé; Tobias, Orlandini; Elvino, Barros.
Full Text Available OBJETIVO: A hiperpigmentação cutânea é comumente encontrada em pacientes portadores de insuficiência renal crônica (IRC), sendo também uma das manifestações mais evidentes da Porfiria Cutânea Tarda (PCT). Essa doença, que tem sido relatada em pacientes em hemodiálise (HD), tem como um dos fatores pr [...] ecipitantes a infecção pelo vírus da hepatite C (HCV). Este estudo tem como objetivo avaliar a prevalência de hiperpigmentação cutânea difusa em pacientes com IRC infectados pelo HCV. MÉTODOS: Foi desenvolvido um estudo transversal com 47 pacientes (idade média de 50,35 ± 15,16 anos, 31 homens e 16 mulheres) que estavam realizando hemodiálise na Unidade de Diálise do Hospital de Clínicas de Porto Alegre. Os pacientes foram divididos em dois grupos: grupo 1, anti-HCV positivos (n=17), e grupo 2, anti-HCV negativos (n=30). RESULTADOS: A prevalência de pacientes com hiperpigmentação cutânea relacionada a HD foi de 36,2% (n=17). Havia 10 pacientes (58,8 %) no grupo 1 e sete pacientes (23,3%) no grupo 2 (Razão de Risco de 2,52 e Intervalo de Confiança de 95% de 1,18 a 5,4; p Abstract in english BACKGROUND: Skin pigmentation is commonly found in patients with chronic renal failure (CRF). This symptom is also one of the most evident features of Porphyria Cutanea Tarda (PCT). Hepatitis C virus (HCV) is an important precipitating agent of this disease, which has been described in patients unde [...] rgoing hemodialysis (HD). In this paper, we intend to evaluate the prevalence of difuse skin hyperpigmentation in patients with CRF infected with the HCV. METHODS: We developed a transversal study with 47 patients (mean age 50,35 + 15,16 years; 31 men and 16 women) who were on hemodialysis in march of 2001 at the Unit of Dialysis of Hospital de Clínicas de Porto Alegre. Patients were divided in two groups: group 1, anti-HCV positives (n=17), and group 2, anti-HCV negatives (n=30). RESULTS: The prevalence of skin hyperpigmentation related to HD was 36,2% (n=17). There were 10 patients (58,8%) in group 1 and 7 (23,3%) in group 2 (Odds Ratio of 2,52 and 95% Confidence Interval of 1,18-5,4; p
Objective: The purpose of this study was to determine if a relationship exists between nutrition status, and food security of patients on hemodialysis (HD). Design: A descriptive, correlation study. Setting: This study consisted of HD patients undergoing treatment at three northeast Louisiana dial...
Holden, Rachel M.; Harman, Gavin J.; Wang, Miao; Holland, David; Day, Andrew G.
Background and objectives: Few studies have examined risk factors for hemorrhage in hemodialysis patients. The contribution of warfarin and antiplatelet agent exposure to the incidence of first major bleeding episodes in hemodialysis patients was determined.
Mortalidade dos pacientes com doença renal crônica em hemodiálise de manutenção em um hospital público do Peru / Mortality in patients with chronic kidney disease undergoing hemodialysis in a public hospital of Peru
Percy, Herrera-Añazco; Vicente, Benites-Zapata; Adrian V., Hernandez; Edward, Mezones-Holguin; Manuela, Silveira-Chau.
Full Text Available Resumo Introdução: O Ministério da Saúde do Peru não tem um programa nacional de hemodiálise e os hospitais que oferecem este tipo de tratamento apresentam problemas de cobertura que podem resultar em aumento da mortalidade. Objetivo: Avaliar a mortalidade da população incidente em hemodiálise em um [...] hospital de Lima. Métodos: Análise da população acima de 18 anos que iniciou o tratamento entre 1 de janeiro de 2012 e 31 de dezembro de 2013, com data de corte final do acompanhamento em 31 de março de 2014. Foi realizada regressão logística bivariada e multivariada dos fatores associados com a mortalidade e usadas as curvas de Kaplan-Meier para determinar a probabilidade de sobrevivência durante o acompanhamento. Resultados: Foram incluídos 235 pacientes para estudo, com idade média de 56,4 ± 15,8 anos. A mediana de acompanhamento foi 0,6 anos (IQR 0,3 a 1,5). A pesquisa mostra que 50% dos pacientes abandonaram o tratamento durante o estudo por falta de vagas ou recursos econômicos. No final do terceiro mês, a mortalidade foi 37,7% (IC 95% 29,3 a 48,5) e 49,5% (IC 95% 38,8 a 61,4) ao sétimo mês. A mortalidade foi menor quando o paciente tinha mais de seis meses com diagnóstico de doença insuficiência renal crônica (OR = 0,39 [IC 95% 0,12-1,27]) e quando o paciente ingressava à diálise programada (OR = 0,28 [IC 95% 0,01 a 2,28]). Conclusão: Metade dos pacientes foi a óbito no sétimo mês de seguimento. Ter ingressado com diálise programada e ter mais tempo de diagnóstico foi associado à menor mortalidade. Abstract in english Abstract Introduction: The Peruvian Ministry of Health does not have a national program of hemodialysis and hospitals that offer it have coverage problems, which may result in increased mortality. Objective: We evaluated mortality of a population with incident hemodialysis in a Peruvian public hospi [...] tal as well as its associated factors. Methods: Retrospective and descriptive study of a population over 18 years-old who started treatment between January 1, 2012 and December 31, 2013 with the final follow-up day on31 March 2014. We used bivariate and multivariate logistic regression models to evaluate factors associated with mortality and Kaplan Meier curves were used to determine the probability of survival. Results: We included 235 patients with a mean age of 56.4 ± 15.8 years. Median follow-up was 0.6 years (IQR 0.3 to 1.5). 50% of years withdrew from therapy during the study for lack of financial resources or space available. The third month mortality was 37.7% (95% CI 4.7 to 48.5) and 49.5% (95% CI 5.8 to 61.4) at 7 months. There was a trend towards lower mortality when patients had more than 6 months with a diagnosis of chronic kidney disease (CKD) (OR = 0.39 [95% CI 0.12 to 1.27]) and when the patient was admitted with scheduled dialysis (OR = 0.28 [95% CI 0.01 to 2.28]). Conclusion: Half of patients died within seven months of follow-up. Scheduled dialysis and having longer time with CKD diagnosis tend to be associated with lower mortality
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
Jane Corrêa, Fonseca; Waleska Teixeira, Caiaffa; Mery Natali Silva, Abreu; Katia de Paula, Farah; Wânia da Silva, Carvalho; Silvana Spindola de, Miranda.
Full Text Available 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
Full Text Available Chronic inflammation is the cause of malnutrition and cardiovascular disease in hemodialysis patients. The purpose of this study was to assess C Reactive Protein (CRP as an inflammatory marker and to define the relationship between CRP and other inflammatory and nutritional factors in this group of patients. One hundred and fourteen hemodialysis patients undergoing chronic dialysis (3 times a week for at least 4 hours in two hemodialysis centers were enrolled in this cross-sectional study. Anthropometric and laboratory data including CRP, Il-6, hemoglobin, serum ferritin, triglyceride, cholesterol, albumin, total protein and transferrin were measured. The Kt/V for adequacy of dialysis was also calculated. There was a statistically signi-ficant correlation between the mean CRP and albumin, hemoglobin, and transferrin; while such relation was not found with BMI, ferritin, the length of dialysis, triceps skin fold thickness, mid arm circumference, mid arm muscle circumference, and Kt/V. We conclude that the negative relationship between CRP and albumin, transferrin, and hemoglobin suggests a correlation bet-ween inflammatory and nutritional factors.
... Language URL Español Treatment Methods for Kidney Failure: Hemodialysis Page Content On this page: When Your Kidneys ... the work of your failed kidneys. [ Top ] How Hemodialysis Works In hemodialysis, your blood is allowed to ...
Evaluación a largo plazo de la respuesta inmunológica a la vacuna de la hepatitis B en 136 pacientes en hemodiálisis / Long-term evaluation of inmune response to hepatitis b vaccine in 136 patients undergoing hemodialysis
M., Pin; M.T., Compte; P., Angelet; C., Gállego; C., Gutiérrez; A., Martínez Vea.
Full Text Available La respuesta inmunitaria a la vacuna de la hepatitis B (HB) está impedida en los pacientes en hemodiálisis (HD), y la persistencia de la inmunidad, la eficacia de la revacunación y la periodicidad de la realización de controles serológicos no están bien definidas. Presentamos la experiencia de un pr [...] otocolo de vacunación de la HB con tres dosis intramusculares de 40 µg de vacuna recombinante (Engerix®-B) en un grupo de 136 pacientes atendidos en una unidad de HD a lo largo de 18 años. Se realizaron controles anuales de anticuerpos anti-HB en todos los pacientes, y semestrales en 31; y se administraba anualmente una dosis doble de vacuna a los pacientes que no respondían o cuando los niveles de anticuerpos descendían por debajo de 10 UI/ml. Setenta y cuatro pacientes (54,4%) presentaron seroconversión, mientras que 62 pacientes no respondieron. La edad de los pacientes era superior en el grupo de no respondedores, pero no se observaron diferencias en el sexo ni en la etiología de la enfermedad renal. Un 32% de los pacientes respondedores perdió la memoria inmunológica al primer año de la vacunación, y tan sólo un 18% de los pacientes permaneció inmunizado a los seis años. El título de anticuerpos inmediatamente después de completar la vacunación fue predictor del mantenimiento de la memoria inmunológica: un 75% de los pacientes con títulos de anticuerpos >1.000 UI/ml mantuvo la seroprotección a los tres años en comparación con un 47% con títulos entre 100-999 (p = 0,08), y un 34% con títulos entre 11-99 (p = 0,02). La administración de dosis de refuerzo fue efectiva en un 24% de los pacientes no respondedores, y un 69% mantenía la respuesta inmunológica al final del primer año. Las dosis de refuerzo repetidas en pacientes no respondedores a una primera dosis consiguieron nuevas seroconversiones en un 19,6% de los pacientes. La práctica de controles semestrales podría haber permitido administrar dosis de recuerdo antes del período anual en un 16% de los pacientes respondedores. En conclusión, nuestros resultados demuestran que un protocolo de vacunación de la HB con un seguimiento serológico regular y dosis de refuerzo sucesivas consigue una aceptable seroprotección en los pacientes en hemodiálisis. Abstract in english Hemodialysis (HD) patients have an impaired response to hepatitis B (HB) vaccines, and the persistence of immunity, the efficacy of revaccination and the periodicity of postvaccination testing are not well defined. We present the experience during 18 years in an outpatient dialysis center of 136 HD [...] patients who completed a HB vaccination program consisting in 3 doses of 40 µg intramuscular recombinant B vaccine (Engerix-B). In all patients anti-HBs titers were determined annually and in 31 patients every 6 months. Nonresponders patients and responders patients that lost their antibodies (
Janardhan, Vasantha; Soundararajan, P.; Rani, N. Vanitha; Kannan, G.; Thennarasu, P.; Chacko, Rosney Ann; Reddy, C. Uma Maheswara
Malnutrition is widely prevalent among patients on hemodialysis. Malnutrition can be estimated using a fully quantitative scoring system Subjective Global Assessment-Dialysis Malnutrition Score which is simple, reliable and dynamic. The primary objective of the study was to assess the severity of malnutrition in patients with end stage renal disease and undergoing hemodialysis in a tertiary care teaching hospital in Chennai, using Subjective Global Asses sment-Dialysis Malnutrition Score and ...
Toyin Tofade, MS, PharmD, BCPS, CPCC, Pharmacotherapy Director, Wake Area Health Education Center and Clinical Associate Professor, Division of Pharmacy Practice and Experiential Education
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.
Yasemin TURGUT KURT
Full Text Available OBJECTIVE: This study aimed to investigate effect of salt and fluid restriction education for patients undergoing hemodialysis and nonadherent to fluid restriction treatment on blood pressure and weight gain.MATERIAL and METHODS: The study sample consisted of 100 patients, nonadherent to fluid restriction treatment, undergoing routine 3 times a week hemodialysis treatment at a hemodialysis center. Salt and fluid restriction education was given to patients once a week during two consecutive weeks. Pre and post-hemodialysis weight and means, interdialytic weight gain and means, predialysis systolic and diastolic blood pressures and means were measured.RESULTS: 67 male and 33 female patients were included. The average age was 56.2 ±13.5 years. Mean hemodialysis time was 54.7+-42.1 months. After education, there was a significant reduction in pre-dialysis weight means (p<0.001 and mean interdialytic weight gain (p:0.006. Also there was a decrease in pre-dialysis systolic blood pressure means (p:0.035 after the education. However, there was no reduction in pre-dialysis diastolic blood pressure means.CONLUSION: If patients undergoing hemodialysis are given sufficient education about salt and fluid restriction; they are eager to follow salt and fluid restriction treatment.
Anand, S.; TAMURA, M. KURELLA; CHERTOW, G. M
Nephrologists care for an increasing number of elderly patients on hemodialysis. As such, an understanding of the overlap among complications of hemodialysis and geriatric syndromes is crucial. This article reviews hemodialysis management issues including vascular access, hypertension, anemia and bone and mineral disorders with an attention towards the distinct medical needs of the elderly. Key concepts of geriatrics — frailty, dementia and palliative care — are also discussed, as nephrol...
Lee, Seoung Woo
Sodium is the principal solute in the extracellular compartment and the major component of serum osmolality. In normal persons in the steady state, sodium homeostasis is achieved by a balance between the dietary intake and the urinary output of sodium, whereas in intermittent hemodialysis patients, sodium balance depends on dietary intake and sodium removal during hemodialysis. Thus, the main goal of hemodialysis is to remove precisely the amount of sodium that has accumulated during the inte...
?eref Yüksel; Gürsel Acartürk; ?hsan Uslan; Mehmet Çölbay; Özcan Karaman; Zeki Arslan; Zafer Çetinkaya; Serap Demir
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 ...
Solak, Yalcin; Demircioglu, Sinan; Polat, Ilker; Biyik, Zeynep; Gaipov, Abduzhappar; Acar, Kadir; Turk, Suleyman
Heparin-induced thrombocytopenia (HIT) is caused by heparin exposure and presents with reduced platelet count. Patients undergoing hemodialysis (HD) treatment have increased risk of developing HIT due to prolonged exposure to unfractionated heparin or low-molecular weight heparin. We report a 79-year-old male patient with end-stage renal disease who developed type-II HIT during maintenance HD. Platelet count of the patient decreased gradually and antiplatelet factor IV antibody was found to be positive. The patient was treated with fondaparinux and continued heparin-free HD. Unfortunately, despite favorable initial response without any thrombotic episodes, the patient died due to severe sepsis complicated by gastrointestinal hemorrhage. PMID:22631215
Full Text Available Introduction: There are several potential explanations for the development of PH in patients with stable hemodialysis patients. Hormonal and metabolic derangement associated with end-stage renal failure might lead to pulmonary arterial vasoconstriction and an increase of the pulmonary vascular resistance. The aim of this study was to consider the association of pulmonary artery pressure (PAP with serum parathormone in end-stage renal disease (ESRD patients under regular hemodialysis treatment. Material and methods: This cross-sectional study was conducted on patients with end-stage renal disease undergoing maintenance hemodialysis treatment through an arteriovenous fistula which was created on the hand, and with acetate basis dialysate and polysulfone membranes. For all patients serum intact parathormone (iPTH was measured. For assessment of pulmonary artery pressure, all patients were subjected to two-dimensional and doppler echocardiographic studies that were done for the patients after their hemodialysis sessions. Results: The study comprised 102 patients (F=46, M=56 consisting of 73 non diabetic hemodialysis patients (F=33, M=40, and 29 diabetic hemodialysis patients (F=13, M=16. The duration of hemodialysis was 17.8±29 months. The mean ±SD of serum iPTH of total patients was 338±306 pg/ml. The mean ±SD of pulmonary artery systolic pressure (PAP was 41.5±12.6 mmHg. A significant positive correlation of PAP with the dosage (r=0.36, p=0.001 and duration of hemodialysis (r=0.35, p<0.001 was seen, also a significant positive correlation of pulmonary artery systolic pressure with serum intact parathormone (iPTH in hemodialysis patients was found. Conclusions: A significant positive correlation of serum intact parathormone with pulmonary artery pressure, which is a new aspect of uncontrolled secondary hyperparathyroidism implies the need for a better control of poorly controlled hyperparathyroidism disease in hemodialysis patients.
Mauri, Andreana; Brambilla, Marco; Chiarinotti, Doriana; Matheoud, Roberta; Carriero, Alessandro; Leo, Martino
Radiation exposure accompanying medical imaging associates with cancer risk. Patients with recurrent or chronic diseases may be especially at risk, because they may undergo more of these procedures. The aim of this study was to assess the individual cumulative effective doses (CEDs), which quantify radiation from medical imaging procedures, in a cohort of 106 hemodialysis patients during a median follow-up of 3 years. We retrospectively calculated individual radiation exposures by collecting ...
Mekawy, Mohamed A; Habashy, Deena M M; Abd El-Mohsen, Waleed A M
In patients with end-stage renal disease (ESRD), hemorrhagic complications are commonly encountered due to abnormalities in primary hemostasis, in particular, platelet (PLT) dysfunction and impaired PLT-vessel wall interaction. The pathogenesis of altered PLT function is considered multifactorial. Dialysis procedures had a favorable impact on bleeding complications in uremic patients. We aimed to evaluate the effect of hemodialysis on PLT function in patients with ESRD on a regular hemodialysis program. This study was carried on 40 ESRD Egyptian patients undergoing regular hemodialysis. Twenty healthy subjects were studied as a control group. Samples were assayed for PLT function by PLT function analyzer-100 (PFA-100) before and after the hemodialysis session. Prolonged closure time (CT) was found in 90% of patients before hemodialysis session and returned to normal ranges after hemodialysis session in 22% of those patients. The CT was longer among patients before and after hemodialysis session compared to controls (p?0.01 and p?=?0.02, respectively), while it was shorter among patients after hemodialysis session compared to before hemodialysis session (p?=?0.004). Hemoglobin (Hb) level and hematocrit (Hct) values were higher in control group compared to patient group before hemodialysis session (p?0.01 and p?=?0.001, respectively), patients after hemodialysis session (p?0.01 and p?=?0.02, respectively) and also in patients after hemodialysis compared to before hemodialysis session (p?=?0.001 and p?0.01, respectively). The percentage change in PLT count was positively correlated with that of Hb (p?=?0.01). We concluded that PLT dysfunction is encountered in ESRD Egyptian patients, and hemodialysis has the ability to correct some part of these hemostatic disturbances. PMID:24955720
W. Randolph Chitwood
Full Text Available The aim of this study was to examine racial differences in long-term survival among hemodialysis patients after coronary artery bypass grafting (CABG. To our knowledge this has not been previously addressed in the literature. Black and white hemodialysis patients undergoing first-time, isolated CABG procedures between 1992 and 2011 were compared. Survival probabilities were computed using the Kaplan-Meier product-limit method and stratified by race. Hazard ratios (HR and 95% confidence intervals (CI were computed using a Cox regression model. A total of 207 (2% patients were on hemodialysis at the time of CABG. White (n = 80 hemodialysis patients had significantly decreased 5-year survival compared with black (n = 127 patients (adjusted HR = 1.9, 95% CI = 1.2–2.8. Our finding provides useful outcome information for surgeons, primary care providers, and their patients.
McGill, Rita L; Blas, Alfredo; Bialkin, Steven; Sandroni, Stephen E; Marcus, Richard J
Heparin-free hemodialysis (HF-HD) has been increasingly used in patients at risk for bleeding, especially in the intensive care unit (ICU). Lack of heparin can reduce solute clearances in continuous hemofiltration; the effect on HD is undefined. Failure to recognize an effect of the anticoagulation strategy upon delivered clearance could contribute to the known problem of underdialysis in the ICU. In addition, the consequences of "locking" dialysis catheters with concentrated heparin solutions are also unclear. This study was designed to define the clinically relevant consequences of HF-HD and catheter locking. In part I, we performed 200 HD treatments on inpatients, of which 100 were performed with heparin, and 100 were performed as HF-HD. We calculated prescribed and delivered Kt/V and dialysis efficiency. In part II, a separate group of 14 patients undergoing HF-HD via central venous catheters had measurement of activated partial thromboplastin time (aPTT) during the last hour of dialysis, as well as 15, 60, and 240 min after catheters were locked with 1:5000 heparin. The prescribed Kt/V was 1.74+/-0.31 for standard HD with heparin vs. 1.66+/-0.36 for HF-HD (p=ns). The delivered Kt/V was 1.42+/-0.32 vs. 1.36+/-0.38 (p=ns). Efficiency was 0.82 vs. 0.84 (p=ns). Baseline aPTT was 28+/-5 s, and increased to 126+/-54 s, 15 min after locking (p<0.0001) and to 71+/-50 s, 60 min after locking (p=0.005). By 240 min, the mean aPTT had fallen to 33+/-9 s (p=0.03), although individual values were still as high as 50 s. The HF technique does not compromise delivery of dialysis to inpatients. Increased treatment time is not necessary. Locking catheters with heparin after HF-HD resulted in prolonged unintentional anticoagulation. PMID:16219060
Full Text Available Introduction. Pruritus is one of the common problems in patients on hemodialysis. There are several causes for pruritus, and different treatment modalities are applied to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in patients on hemodialysis.Materials and Methods. This randomized double-blinded cross-over clinical trial was performed on 34 patients on hemodialysis with uremic pruritus. The patients were divided into 2 groups, one group received capsaicin 0.03% and the other, placebo, for 4 weeks. Treatment was stopped for 2 weeks as washout period and continued as a cross-over technique. Pruritus scores were analyzed and compared.Results. Thirty-four patients on long-term hemodialysis, 14 men and 20 women with a mean age of 57.0 ± 18.6 years were studied. The mean of pruritus score before capsaicin treatment was 15.9 ± 6.3, which was reduced to 6.4 ± 3.9, 4.7 ± 3.1, 3.2 ± 2.9, and 2.5 ± 2.5 on weeks 1 to 4, respectively (P Conclusions. Capsaicin is a new safe and effective topical treatment for hemodialysis-induced pruritus in patients with end-stage renal disease.
Full Text Available Abstract Background The influence of serum leptin levels on nutritional status and survival in chronic hemodialysis patients remained to be elucidated. We conducted a prospective longitudinal study of leptin levels and nutritional parameters to determine whether changes of serum leptin levels modify nutritional status and survival in a cohort of prevalent hemodialysis patients. Methods Leptin, dietary energy and protein intake, biochemical markers of nutrition and body composition (anthropometry and bioimpedance analysis were measured at baseline and at 6, 12, 18 and 24 months following enrollment, in 101 prevalent hemodialysis patients (37% women with a mean age of 64.6 ± 11.5 years. Observation of this cohort was continued over 2 additional years. Changes in repeated measures were evaluated, with adjustment for baseline differences in demographic and clinical parameters. Results Significant reduction of leptin levels with time were observed (linear estimate: -2.5010 ± 0.57 ng/ml/2y; p Conclusions Thus leptin levels reflect fat mass depots, rather than independently contributing to uremic anorexia or modifying nutritional status and/or survival in chronic hemodialysis patients. The importance of such information is high if leptin is contemplated as a potential therapeutic target in hemodialysis patients.
Eini, Peyman; Mamani, Mojgan; Javani, Marzieh
Background: Previous studies have documented a high prevalence of hepatitis E among patients undergoing maintenance hemodialysis. Available studies reporting on the seroprevalence of hepatitis E in hemodialysis patients in Iran, an endemic region for the disease, are sparse. Objectives: The present study aimed to determine the prevalence rate of anti-hepatitis E antibody in hemodialysis patients in Hamadan, Iran. Patients and Methods: In this cross-sectional study, all 153 consecutive patients undergoing hemodialysis in two centers were enrolled. Patients’ demographic and clinical data were collected, using a standard questionnaire and from medical records. Serum immunoglobulin G concentrations against hepatitis E were determined using the enzyme linked immunosorbent assay method. Results: Thirty patients (19.2%), were seropositive. Seropositive patients were not significantly different from seronegative patients, with regard to age, sex, level of education, access to filtered water, and duration and frequency of hemodialysis. The proportions of patients with hepatitis B, C, and HIV infection were comparable between the two groups. Conclusions: One in five patients undergoing maintenance dialysis in Hamadan is seropositive for hepatitis E immunoglobulin G antibody. Future studies are needed to investigate the factors contributing to the observed high prevalence rate and the possibility of parenteral transmission of hepatitis E.
Shahgholian, Nahid; Dehghan, Mahlagha; Mortazavi, Mojgan; Gholami, Farzaneh; Valiani, Mahboobeh
BACKGROUND: Pruritus is one of the commonest problems in patients with end-stage renal failure undergoing hemodialysis. Pruritus is an irritating symptom which can directly affect the life quality of patients with chronic renal failure. However, available treatments have failed to relieve the symptom and kidney transplant remains the definite treatment of the problem. A recently proposed treatment for pruritus is the use of complementary medicine. Thus, the aim of this research is to study the effect of aromatherapy on pruritus relief in hemodialysis patients. METHODS: The study is a pre- and post-clinical trial, carried out in dialysis centers of Isfahan University of Medical Sciences in 2009. Sample was performed using convenient sampling method and the participants were selected from among the patient who received hemodialysis three times a week for 3-5 hours and had pruritus scores above 3. All the participants received seven minutes of hand massage in the non-fistulated hand with 3-5 ml of lavender, mint, and tea tree oils at 5% concentration for six sessions (two weeks). The data of the study were analyzed using descriptive and inferential statistics by SPSS software, version 16. RESULTS: Twenty patients with end-stage renal failure who had pruritus fulfilled the course of the study. Data analysis indicated that aromatherapy significantly relieved pruritus (p Aromatherapy can significantly relieve pruritus in hemodialysis patients. PMID:22049288
Uldall, P R; Woods, F; Bird, M; Dyck, R
A new silastic and teflon cannula has been developed for temporary hemodialysis access. It is introduced through the subclavian vein by the Seldinger technique. The cannula which is quick and easy to insert, can be used repeatedly for weeks or months without limiting the patient's mobility and without the need for repeated vessel punctures. Complications are few and largely preventable. Since introduction of the subclavian hemodialysis cannula at the Toronto Western Hospital in September 1977 no patient with end-stage renal failure has required insertion of a silastic-teflon shunt or temporary peritoneal dialysis, nor has hemodialysis had to be postponed because of lack of an arteriovenous fistula. PMID:552046
Sung, Su Ah; Ko, Gang Jee; Jo, Sang Kyung; Cho, Won Yong; Kim, Hyoung Kyu; Lee, So Young
Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing hemodialysis. Interleukin-10 (IL-10) and tumour necrosis factor-? (TNF-? ) are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular accessm failure and various inflammatory markers including the genetic polymorphisms of IL-10 and TNF-? . Seventy-five patients on hemodialysis with an arterioveno...
Thumfart, Julia; Müller, Dominik
Preemptive renal transplantation is the method of choice for end stage renal disease in childhood and adolescence. However, without preemptive transplantation, waiting time for kidney transplantation might exceed several years. The poor quality of life and the extremely high morbidity and mortality rates of dialysis patients have led to the development of intensified hemodialysis programs in which the modes of dialysis (short daily, nocturnal intermittent or daily nocturnal) are different. Such programs have been shown to significantly improve several uremia-associated parameters, such as blood pressure, phosphate control, anemia and growth retardation, in both adult and pediatric (children and adolescents) patients and lead to a reduction in medications, including phosphate binders, erythropoietin and antihypertensive agents. Fluid limitations and dietary restrictions can also be lifted. With respect to psychosocial rehabilitation and quality of life, nocturnal intermittent dialysis programs provide a reasonable compromise of all forms of intensified programs. Experiences and practical approaches of our own in-center nocturnal intermittent hemodialysis program in the light of the recent publications are described in this review. PMID:25103600
Soška, V.; Lojek, Antonín; ?íž, Milan; Sobotová, D.
Elsevier. Ro?. 144, ?. 1 (1999), s. 41-42. ISSN 0021-9150. [Congress of the European Atherosclerosis Society /71./. 26.05.1999-29.05.1999, Athens] Institutional research plan: CEZ:A17/98:Z5-004-9-ii Subject RIV: EC - Immunology
Kistler, Brandon M; Fitschen, Peter J; Ikizler, T Alp; Wilund, Kenneth R
The annual mortality rate for patients undergoing maintenance hemodialysis (MHD) treatment in the United States is 20%, a rate higher than most other countries in the world. Poor nutrition status in MHD patients contributes to this adverse outcome as well as poor quality of life. Providing oral nutrition to MHD patients, especially during hemodialysis (HD) treatment has many potential benefits including improvements in nutrition status and attenuating HD-related muscle wasting. However, this practice is generally restricted in the United States presumably because of concerns that include worsening hemodynamic instability, reductions in treatment efficiency, and increased gastrointestinal symptoms. Despite widespread restrictions, few studies have adequately examined the effect of eating during HD on these outcomes, leaving many questions unanswered. This review outlines the current evidence regarding the effects of feeding during HD and provides potential future directions to outline the best practices in this controversial area. PMID:25443693
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...
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
Cléssyo Tavares de Amorim, Cavalcanti; José Cândido de, Araújo Filho; Patrícia Érika de Melo, Marinho.
Full Text Available Este estudo objetivou avaliar a associação entre a presença de sintomas depressivos e o nível de atividade física (NAF) em pacientes renais crônicos submetidos à hemodiálise (HD). Estudo transversal constituído por 101 pacientes sob HD, com idade média de 47,4±12,5 anos. Foram coletados dados sociod [...] emográficos, econômicos, clínicos, avaliação de sintomas depressivos (Escala de Depressão de Beck - BDI), NAF (Questionário Internacional de Atividade Física - IPAQ), orientação para realização da atividade física (AF) e tempo de HD. A prevalência de sedentários e de sintomas depressivos foi 79,2% e 39,6%, respectivamente. Os sintomas depressivos foram observados em 47,5% dos pacientes sedentários (?2=10,029, p=0,002), sendo a razão de prevalência desses sintomas 5 vezes maior nesse grupo. Dos pacientes sob HD, 68,3% não receberam orientação para a prática de AF. Abaixo de 49 meses de tratamento hemodialítico, 63,8% dos sedentários (?2=3,011, p=0,083) e 57,5% dos pacientes com sintomas depressivos (?2=0,100, p=0,752) já apresentavam essas características. Embora pouco se conheça sobre a relação entre depressão e AF entre pacientes sob HD, o presente estudo verificou que os sintomas depressivos foram mais prevalentes entre os inativos. Os resultados deste estudo demonstram também que pacientes submetidos à HD apresentam baixo NAF, relativa presença de sintomas depressivos e elevada ausência de orientação quanto à realização de AF. Abstract in spanish Este estudio tuvo como objetivo evaluar la asociación entre la presencia de síntomas depresivos y el nivel de actividad física (NAF) en pacientes renales crónicos sometidos a hemodiálisis (HD). Estudio transversal constituido por 101 pacientes sob HD, con una edad media de 47,4±12,5 años. Se recogie [...] ron datos sociodemográficos, económicos, clínicos, evaluación de síntomas depresivos (Inventario de Depresión de Beck - BDI), NAF (Cuestionario Internacional de Actividad Física - IPAQ), orientación para la realización de actividad física (AF) y el tiempo de HD. La prevalencia de sedentarios y de síntomas depresivos fue 79,2% y 39,6 % , respectivamente. Se observaron síntomas depresivos en 47,5% de los pacientes sedentarios (?2=10,029, p=0,002), siendo la proporción de prevalencia de estos síntomas 5 veces mayor en este grupo. De los pacientes sob HD, 68,3% no recibieron ninguna orientación para la práctica de AF. Menos de 49 meses de tratamiento com hemodiálisis, 63,8% de los sedentarios (?2=3,011, p=0,083) y 57,5% de los pacientes con síntomas depresivos (?2=0,100, p=0,752) ya presentaban esas características. Aunque se sabe poco acerca de la relación entre la depresión y AF entre pacientes sob HD, el presente estudio verificó que los síntomas depresivos fueron más prevalentes entre los inactivos. Los resultados de este estudio también demuestran que los pacientes sometidos a HD tienen bajo NAF, relativa presencia de síntomas depresivos y alta falta de orientación sobre la realización de AF. Abstract in english This study aimed to evaluate the association between the presence of depressive symptoms and physical activity level (PAL) in patients with chronic kidney disease undergoing hemodialysis (HD). Cross-sectional study comprising 101 patients on HD, mean age 47.4±12.5 years. Sociodemographic data, econo [...] mic, clinical, assessment of depressive symptoms (Beck Depression Scale - BDI), PAL (International Physical Activity Questionnaire - IPAQ), guidance for performing physical activity (PA) and time of HD. The prevalence of sedentary and depressive symptoms was 79.2% and 39.6%, respectively. Depressive symptoms were observed in 47.5% of sedentary patients (?2=10.029, p=0.002), the ratio of prevalence of these symptoms five times higher in this group. 68.3% of patients on HD received no guidance for PA. Under 49 months of hemodialysis treatment, 63.8% of sedentary (?2=3.011, p=0.083) and 57.5% of patients with depressive symptoms (?2=0.100, p=0.752) alrea
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.
A wide variety of pulmonary disorders related to hemodialysis or pre-existing renal disease occurs in hemodialysis patients. The disorders may be classified as 1) pulmonary abnormalities associated with chronic renal failures; 2) pulmonary complications arising during hemodialysis; 3) pulmonary infection; or 4) pulmonary-renal syndrome. An awareness of the various possible pulmonary disorders arising in hemodialysis patients may be helpful for the proper and timely management of such patients. We describe and illustrate various radiographic and CT findings of variable pulmonary disorders in hemodialysis patients
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)
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.
Objective: To determine the frequency and leading factors of pulmonary hypertension among chronic hemodialysis patients. Study Design: Case series. Place and Duration of Study: Hemodialysis Unit, Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, from September 2011 to March 2012. Methodology: Patients of either gender aged between 16 to 60 years of age undergoing hemodialysis for at least 3 months not having pre-existing valvular heart disease, chronic lung disease or connective tissue disorder were included. Pulmonary hypertension was prospectively estimated by Doppler echocardiogram on patients undergoing dialysis. Pulmonary artery pressure was calculated on the post-dialysis day and leading factors were compared between patients with and without pulmonary hypertension. Results: A total of 178 patients were included in study with male to female ratio120/58 (2.06:1). The mean age was 33.84 +- 11.9 years. The mean duration of hemodialysis was 23.85 +- 22.48 months. Pulmonary hypertension was found in 76 (42.7%) patients. Out of the studied factors, low serum albumin ( 3.4 mg/dl, p = 0.01) was found to be statistically significant in patients with pulmonary hypertension. Conclusion: Pulmonary hypertension was frequently present in dialysis population (42.7%). This subset of patients had significantly lower albumin levels in serum. More research is needed in its pathogenesis to arrest its course. (author)
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)
Full Text Available ABSTRACT Background Treatment with selective vitamin D receptor activators such as paricalcitol have been shown to exert an anti-inflammatory effect in patients on hemodialysis, in addition to their action on mineral metabolism and independently of parathyroid hormone (PTH levels. The objective of this study was to evaluate the additional antioxidant capacity of paricalcitol in a clinical setting. Methods The study included 19 patients with renal disease on hemodialysis, of whom peripheral blood was obtained for analysis at baseline and three months after starting intravenous paricalcitol treatment. The following oxidizing and inflammatory markers were quantified: malondialdehyde (MDA, nitrites and carbonyl groups, indoleamine 2,3-dioxygenase (IDO, tumor necrosis factor alfa (TNF-?, interleukin-6 (IL-6, interleukin-18 (IL-18 and C-reactive protein (CRP. Of the antioxidants and anti-inflammatory markers, superoxide dismutase (SOD, catalase, reduced glutathione (GSH, thioredoxin, and interleukin-10 (IL-10 levels were obtained. Results Baseline levels of oxidation markers MDA, nitric oxide and protein carbonyl groups significantly decreased after three months on paricalcitol treatment, while levels of GSH, thioredoxin, catalase and SOD activity significantly increased. After paricalcitol treatment, levels of the inflammatory markers CRP, TNF-?, IL-6 and IL-18 were significantly reduced in serum and the level of anti-inflammatory cytokine IL-10 was increased. Conclusions In renal patients undergoing hemodialysis, paricalcitol treatment significantly reduces oxidative stress and inflammation, two well known factors leading to cardiovascular damage.
Atherosclerotic cardiovascular disease (ACVD) is the major cause of mortality in patients with end stage renal disease (ESRD) treated with hemodialysis (HD), even in children. Adiponectin (ADPN) is an adipocyte derived plasma protein having anti-atherogenic properties. ADPN levels are elevated in ESRD but it has been reported that ESRD patients with low plasma ADPN levels have a high risk of cardiovascular death. The aim of this study is to evaluate the relation between ADPN and atherosclerotic risk factors in children on hemodialysis.Twenty-eight children (17 boys and 11girls) with a mean age of 10.6 ± 3.34 years undergoing hemodialysis (HD) for a mean period of 11.96 ± 8.32 months (ranged from 6 to 36 months) and 10 healthy age and sex matched control subjects were enrolled in this study. The acute effect of a hemodialysis session on serum ADPN and other atherosclerotic risk factors , including blood pressure, serum lipids, C-reactive protein (CRP) and tumor necrosis factor-? (TNF-?) were assessed by comparison of pre- and post-hemodialysis determinations. Serum levels of ADPN and TNF-? were measured by enzyme linked immunosorbant assay (ELISA) while CRP was measured by the semi-quantitative latex agglutination assay.The data showed that serum ADPN levels were twice higher in the HD group as compared to the control subjects. Concerning the atherosclerotic risk factors, TNF-?, CRP and triglycerides levels showed significant elevation in the HD group. Meanwhile,levation in the HD group. Meanwhile, serum albumin, cholesterol and phosphorus levels showed significant decreases. The linear regression analysis showed that adiponectin was negatively correlated with glomerular filtration rate (GFR) (r = -0.68,P < 0.0001), and body mass index (r = -0.73, P < 0.0007); ADPN levels are directly related to HDL cholesterol levels (r = 0.76, P < 0.0001) and inversely related to triglycerides level (r = -0.63, P < 0.0003). No relationship was found between adiponectin and CRP.It could be concluded that patients on regular hemodialysis were at increased risk for premature atherosclerosis due to high levels of CRP, LDL-cholesterol and triglycerides. The elevated ADPN levels in the hemodialyzed patients may have a protective role against atherosclerosis
... Water purification system for hemodialysis. 876.5665 Section 876... Water purification system for hemodialysis. (a) Identification. A water purification system for hemodialysis is a device that is intended...
...2010-04-01 false High permeability hemodialysis system. 876.5860 Section...876.5860 High permeability hemodialysis system. (a) Identification. A high permeability hemodialysis system is a device...
Suri, Rita S.; Larive, Brett; Sherer, Susan; Eggers, Paul; Gassman, Jennifer; James, Sam H.; Lindsay, Robert M.; Lockridge, Robert S.; Ornt, Daniel B.; Rocco, Michael V; Ting, George O.; Kliger, Alan S
Frequent hemodialysis requires using the vascular access more often than with conventional hemodialysis, but whether this increases the risk for access-related complications is unknown. In two separate trials, we randomly assigned 245 patients to receive in-center daily hemodialysis (6 days per week) or conventional hemodialysis (3 days per week) and 87 patients to receive home nocturnal hemodialysis (6 nights per week) or conventional hemodialysis, for 12 months. The primary vascular access ...
Francesca G. Iodice
Full Text Available Background: Monitoring of superior vena cava saturation (ScvO2 has become routine in the management of pediatric patients undergoing cardiac surgery. The objective of our study was to evaluate the correlation between continuous ScvO2 by the application of a fiber-optic oximetry catheter (PediaSat and intermittent ScvO2 by using standard blood gas measurements. These results were compared to those obtained by cerebral near infrared spectroscopy (cNIRS. Setting: Tertiary pediatric cardiac intensive care unit (PCICU. Methods and main results: A retrospective study was conducted in consecutive patients who were monitored with a 4.5 or 5.5 F PediaSat catheter into the right internal jugular vein. An in vivo calibration was performed once the patient was transferred to the PCICU and re-calibration took place every 24 hours thereafter. Each patient had a NIRS placed on the forehead. Saturations were collected every 4 hours until extubation. Ten patients with a median age of 2.2 (0.13-8.5 years and a weight of 12.4 (3.9-24 kg were enrolled. Median sampling time was 32 (19-44 hours: 64 pairs of PediaSat and ScVO2 saturations showed a poor correlation (r=0.62, 95% CI 44-75; p<0.0001 and Bland Altman analysis for repeated measures showed an average difference of 0.34 with a standard deviation of 7,9 and 95% limits of agreement from -15 to 16. Thirty-six pairs of cNIRS and ScVO2 saturations showed a fair correlation (r=0.79, 95% CI 0.60-0.89; p<0.0001 an average difference of -1.4 with a standard deviation of 6 and 95% limits of agreement from -13 to 10. Analysis of median percentage differences between PediaSat and ScvO2 saturation over time revealed that, although not statistically significant, the change in percentage saturation differences was clinically relevant after the 8th hour from calibration (from -100 to +100%. Conclusion: PediaSat catheters showed unreliable performance in our cohort. It should be further investigated whether repeating calibrations every 8 hours may improve the accuracy of this system. CNIRS may provide similar results with a lower invasiveness.
Shervin Assari; Maryam Moghani Lankarani; Seyed Abbas Tavallaii
Although the revised dyadic adjustment scale (RDAS) has been widely used as an indicator of the quality of marital relationship, no report is available on the reliability of this measure in patients on hemodialysis. We examined the internal consistency of the RDAS in a group of Iranian patients undergoing maintenance hemodialysis. A translated Persian version of the RDAS was self-administered to 135 patients. The internal consistency of the RDAS was tested using the Chronbach ? coefficient wh...
Lau, A. H.; Chang, C. W.; Sabatini, S.
Metronidazole is now being used with increasing frequency for various infectious conditions in patients with renal failure. It is commonly administered to septic patients who have developed acute renal failure requiring hemodialysis. The hemodialysis clearances of metronidazole and its metabolites were evaluated in nine renal failure patients on maintenance hemodialysis. The mean +/- standard deviation clearance and the extraction ratio were 106.9 +/- 16.3 ml/min and 0.65 +/- 0.08, respective...
Kramer, T H; Gaar, G G; Ray, C G; Minnich, L; Copeland, J G; Connor, J D
A patient with an implanted artificial heart, acute, anuric renal failure, and disseminated influenza virus type A infection received intravenous ribavirin. Drug elimination by hemodialysis was measured. Plasma dialysis clearance averaged 93.9 +/- 8.6 ml/min. The maximum amount of ribavirin removed from the body during one period of hemodialysis was 79.1 mg. Ribavirin is not removed in important quantities by hemodialysis.
Glass, Robert S. (Livermore, CA)
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.
Saito, Akira; Ohta, Yoriko; Sato, Kazuhiro; Ichinose, Mayuri; Arii, Tatsuro; Toyama, Katsuhide
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
Sabry Alaa; Abo-Zenah Hamdy; Wafa Ehab; Mahmoud Khaled; El-Dahshan Khaled; Hassan Ahmed; Abbas Tarek; Saleh Abd El-Baset; Okasha Kamal
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 walk...
Holdaas, Hallvard; Holme, Ingar
A randomized, placebo-controlled trial in diabetic patients receiving hemodialysis showed no effect of atorvastatin on a composite cardiovascular endpoint, but analysis of the component cardiac endpoints suggested that atorvastatin may significantly reduce risk. Because the AURORA (A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) trial included patients with and without diabetes, we conducted a post hoc analysis to determine whether rosuvastatin might reduce the risk of cardiac events in diabetic patients receiving hemodialysis. Among the 731 participants with diabetes, traditional risk factors such as LDL-C, smoking, and BP did not associate with cardiac events (cardiac death and nonfatal myocardial infarction). At baseline, only age and high-sensitivity C-reactive protein were independent risk factors for cardiac events. Assignment to rosuvastatin associated with a nonsignificant 16.2% reduction in risk for the AURORA trial's composite primary endpoint of cardiac death, nonfatal MI, or fatal or nonfatal stroke (HR 0.84; 95% CI 0.65 to 1.07). There was no difference in overall stroke, but the rosuvastatin group had more hemorrhagic strokes than the placebo group (12 versus two strokes, respectively; HR, 5.21; 95% CI 1.17 to 23.27). Rosuvastatin treatment significantly reduced the rates of cardiac events by 32% among patients with diabetes (HR 0.68; 95% CI 0.51 to 0.90). In conclusion, among hemodialysis patients with diabetes mellitus, rosuvastatin might reduce the risk of fatal and nonfatal cardiac events.
Alhomayeed B; Lindsay R
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 ea...
Clark, Edward G; Barsuk, Jeffrey H.
The insertion of non-tunneled temporary hemodialysis catheters (NTHCs) is a core procedure of nephrology practice. While urgent dialysis may be life-saving, mechanical and infectious complications related to the insertion of NTHCs can be fatal. In recent years, various techniques that reduce mechanical and infectious complications related to NTHCs have been described. Evidence now suggests that ultrasound guidance should be used for internal jugular and femoral vein NTHC insertions. The imple...
Natália Fabiane Ridão, Curty; Lucilene Fagundes da Silva, Martins; Carmen Antônia Sanches, Ito; Marcelo, Schafranski; Dorelayne Aparecida, Brites; César Roberto, Busato.
Full Text Available INTRODUCTION: Renal replacement therapy is the treatment of end-stage chronic kidney disease and can be performed through dialysis catheters, arteriovenous fistulas/grafts, and peritoneal dialysis. Patients are usually immunocompromised and exposed to invasive procedures, leading to high rates of [...] infection and increased mortality. OBJECTIVES: To compare the prevalence of infection and related deaths, as well as the sensitivity profile of the putative bacteria in patients treated with peritoneal dialysis, arteriovenous fistula hemodialysis and catheter hemodialysis. METHODS: This is case-control study. Six hundred forty-four patients undergoing renal replacement therapy were selected. Patients were divided into three groups according to the modality of dialysis treatment: peritoneal dialysis (126 patients), arteriovenous fistula hemodialysis (326 patients), and catheter hemodialysis (192 patients). RESULTS: One hundred sixteen patients (18.01%) developed infection. There was a higher incidence of infection in the peritoneal dialysis group (44 patients; 34.92%; OR: 3.32; CI 95% = 2.13-5.17; p = 0.0001). In the catheter hemodialysis group, 48 patients (25%) had infection (OR: 1.88; CI 95%: 1.24-2.85; p = 0.0035). In the arteriovenous fistula hemodialysis group, 24 patients (7.36%) developed infection (OR: 0.19; CI 95%: 0.12-0.31; p = 0.0001). Five patients (4.31%) died due to infection (four in the peritoneal dialysis group and one in the catheter hemodialysis group). There were no deaths due to infection in the arteriovenous fistula hemodialysis group. CONCLUSIONS: Peritoneal dialysis is the treatment with greater risk of infection and mortality, followed by catheter hemodialysis. The lowest risk of infection and mortality was observed in arteriovenous fistula hemodialysis group.
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.
Caravaca, Fernando; Burguera, Victor; Ferna?ndez-lucas, Milagros; Teruel, Jose? Luis; Quereda, Carlos
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 r...
Objective: To analyze the effects of Astragalous Injection on oxidative stress and micro-inflammatory status in patients undergoing maintenance hemodialysis (MHD).Methods: Sixty MHD patients were included and randomized into treatment group and control group, with another 10 healthy volunteers as normal control. The patients in the treatment group were treated with Astragalous Injection and the patients in the control group were treated with normal saline for 12 weeks. A spectrophotometric me...
Soangra, Rahul; Lockhart, Thurmon E.; Lach, John; Abdel-Rahman, Emaad M
Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this p...
BARADARAN, Azar; Soleiman KHEIRI; Mohamad-Reza KIANMEHR; Mortazavi, Mojgan; Nasri, Hamid
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 ...
Adelina Mih?escu; Nicu Olariu; Alexandra Rusu; Claudiu Avram; Dan Gai??; Adalbert Schiller
Patients undergoing long-term hemodialysis have a high risk of cardiovascular disease. Arterial stiffness is highly prevalent in this type of patients. The aim of our study was to analyse the relationship between body composition, blood chemistries and arterial stiffness in a poorly fit population of chronic hemodialysed patients. Patients and methods involved measuring body composition and fitness score by multifrequence bioimpedance with the body composition analyzer InBody720 and arterial ...
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
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.
Full Text Available 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.?
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.
Chen, Betty C; Sheth, Nijal R; Dadzie, Kobena A; Smith, Silas W; Nelson, Lewis S; Hoffman, Robert S; Winchester, James F
Dabigatran is an oral direct thrombin inhibitor indicated for thromboembolism prophylaxis in patients with nonvalvular atrial fibrillation. Since its approval in the United States in 2010, dabigatran-associated hemorrhages have garnered much attention because bleeding rates were higher than initially expected. Additionally, reversing anticoagulation remains challenging. Traditional modes of reversing warfarin-associated coagulopathies are ineffective in reversing anticoagulation from dabigatran. Although hemodialysis is proposed as a method to accelerate dabigatran elimination, evidence supporting its clinical utility remains unproved. We report the case of an 80-year-old man who presented with worsening hemoptysis in the setting of unintentional ingestion of excess dabigatran. Despite transfusion of 2 units of fresh frozen plasma, he continued to bleed, although his international normalized ratio improved from 8.8 to 7.2. He underwent hemodialysis, and serum dabigatran concentration decreased from 1,100 to 18 ng/mL over 4 hours, with an initial extraction ratio of 0.97 and blood clearance of 291 mL/min. Although his serum dabigatran concentration rebounded to 100 ng/mL 20 minutes after the cessation of dialysis, his bleeding stopped and he improved clinically. Hemorrhage in the setting of dabigatran anticoagulation remains a therapeutic predicament. Hemodialysis may play an adjunct role in accelerating the elimination of dabigatran in bleeding patients. PMID:23597859
DREW, David A.; TIGHIOUART, Hocine; SCOTT, Tammy M.; LOU, Kristina V.; FAN, Li; SHAFFI, Kamran; WEINER, Daniel E.; SARNAK, Mark J.
Although cognitive impairment is common in hemodialysis patients, the etiology of and risk factors for its development remain unclear. Fibroblast growth factor 23 (FGF-23) levels are elevated in hemodialysis patients and are associated with increased mortality and left ventricular hypertrophy. Despite FGF-23 being found within the brain, there are no prior studies assessing whether FGF-23 levels are associated with cognitive performance. We measured FGF-23 in 263 prevalent hemodialysis patients in whom comprehensive neurocognitive testing was also performed. The cross-sectional association between patient characteristics and FGF-23 levels was assessed. Principal factor analysis was used to derive two factors from cognitive test scores, representing memory and executive function, which carried a mean of 0 and a standard deviation of 1. Multivariable linear regression adjusting for age, sex, education status, and other relevant covariates was used to explore the relationship between FGF-23 and each factor. Mean age was 63 years, 46% were women and 22% were African American. The median FGF-23 level was 3098 RU/mL. Younger age, lower prevalence of diabetes, longer dialysis vintage, and higher calcium and phosphorus were independently associated with higher FGF-23 levels. Higher FGF-23 was independently associated with a lower memory score (per doubling of FGF-23, ? = ?0.08 SD [95% confidence interval, CI: ?0.16, ?0.01]) and highest quartile vs. lowest quartile (? = ?0.42 SD [?0.82, ?0.02]). There was no definite association of FGF 23 with executive function when examined as a continuous variable (? = ?0.03 SD [?0.10, 0.04]); however, there was a trend in the quartile analysis (? = ?0.28 SD [?0.63, 0.07], P = 0.13, for 4th quartile vs. 1st quartile). FGF-23 was associated with worse performance on a composite memory score, including after adjustment for measures of mineral metabolism. High FGF-23 levels in hemodialysis patients may contribute to cognitive impairment. PMID:24164913
Purpose: To evaluate the effectiveness of ultrasound thrombolysis in occluded hemodialysis access shunts using an in vitro model.Methods: Thrombosed hemodialysis accesses were simulated by clotted bovine blood in a flow model (silicone tubing; inner diameters 4, 6, and 9 mm). After retrograde and antegrade sheath placement (7 Fr), mechanical thrombolysis was performed using an ultrasound probe (Acolysis, Angiosonics, Morrisville, NC, USA). The tip of the device measured 2.2 mm in diameter. During sonication, the catheter was moved slowly back and forth using an over-the-wire system. Thirty complete occlusions [tubing diameters 4 mm (n = 12), 6 mm (n = 12), 9 mm (n = 6)] were treated. Initial thrombus weights were 3.5 (± 0.76) g, 7.7 (± 1.74) g, and 19.4 (± 2.27) g for the three diameters. Maximum sonication time was 15 min for each probe.Results: With this device, we were able to restore a continuous lumen in all 12 occluded 4?mm silicone tubes. No wall-adherent thrombi remained after sonication for 3.5-9.6 min. In hemodialysis access models with diameters of 6 mm, thrombus fragments persisted in 25% (3/12 accesses). These were located in the medial portion of the access loop and near to the puncture sites. However, flow was re-established after 5.0-13.0 min of treatment in all settings. Mechanical dissolution of thrombus material failed in five of six access models with diameters of 9 mm, even though ultrasound energy was applied for the maximum of 15 min.Conclulied for the maximum of 15 min.Conclusion: In a clotted hemodialysis shunt model, successful ultrasound thrombolysis was limited to small access diameters and small amounts of thrombus
Purpose: To evaluate the effectiveness of ultrasound thrombolysis in occluded hemodialysis access shunts using an in vitro model.Methods: Thrombosed hemodialysis accesses were simulated by clotted bovine blood in a flow model (silicone tubing; inner diameters 4, 6, and 9 mm). After retrograde and antegrade sheath placement (7 Fr), mechanical thrombolysis was performed using an ultrasound probe (Acolysis, Angiosonics, Morrisville, NC, USA). The tip of the device measured 2.2 mm in diameter. During sonication, the catheter was moved slowly back and forth using an over-the-wire system. Thirty complete occlusions [tubing diameters 4 mm (n=12), 6 mm (n=12). 9 mm (n=6)] were treated, initial thrombus weights were 3.5 (±0.76) g, 7.7 (±1.74) g, and 19.4 (±2.27) g for the three diameters. Maximum sonication time was 15 min for each probe.Results: With this device, we were able to restore a continuous lumen in all 12 occluded 4?mm silicone tubes. No wall-adherent thrombi remained after sonication for 3.5-9.6 min. In hemodialysis access models with diameters of 6 mm, thrombus fragments persisted in 25% (3/12 accesses). These were located in the medial portion of the access loop and near to the puncture sites. However, flow was re-established after 5.0-13.0 min of treatment in all settings. Mechanical dissolution of thrombus material failed in five of six access models with diameters of 9 mm, even though ultrasound energy was applied for the maximum of 15 min.Conclusion: In the maximum of 15 min.Conclusion: In a clotted hemodialysis shunt model, successful ultrasound thrombolysis was limited to small access diameters and small amounts of thrombus.
Comparison of intra operative muscle relaxation and neuro muscular recovery from continuous infusion of vecuronium and atracurium in ASA grade I @ II patients undergoing midline and paramedian laparotomies
Full Text Available Background: Vecuronium and Atracurium are two muscle relaxants that come close to fulfill most of the criteria for using them as continuous infusion. In this study in sixty adult patients of either sex, 25-45 years of age, belonging to ASA physical status I&II, were chosen, who were scheduled for midline and paramedian laparotomies under GA. Objective: (1 To assess the recovery time from neuromuscular blockade on stopping the infusion of vecuronium and atracurium. (2 To assess the haemodynamic performance in peri operative period. Materials & Methods: Patients were randomly allocated into two equal groups and received either vecuronium 0.8-1 ?g/kg/min following a bolus dose of 0.1mg/kg or Atracurium 4-12 ?g/kg/min following a bolus dose of 0.5 mg/kg. Intravenous infusion of muscle relaxants were adjusted to maintain 90% of neuromuscular blockade monitored by stimulating ulnar nerve at the wrist by a peripheral nerve stimulator throughout surgery. Results: The median time & interquartile range which were taken from intravenous bolus dose to 10% recovery was less in Vecuronium group (23±2 min than atracurium group (25.± 2 min. Vecuronium (median 15.5 ± 3 min took less time to achieve steady state of block after starting infusion than atracurium (median 18 ± 3 min. Conclusions: Patients who received vecuronium recovered early from relaxant effect with more stable hemodynamics.
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
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)
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.)
The control of plasma phosphate concentration in a dialysis patient is important to prevent some bone diseases. There are, however, few studies for phosphate kinetics in dialysis patients. Although molecular weight of phosphatic ion, mainly exists in the intravascular compartment, is relatively low, removal dynamics of phosphatic ion from the patient by the hemodialysis treatment is not simple. A tendency of relatively lower reduction rate of plasma phosphate concentration with higher clearance of the dialyzer, therefore, was often shown in a typical dialysis patient. Establishment of a detailed kinetic modeling involving phosphate generation and transport between intra and extra vascular compartments is required for the phosphate dynamics during the dialysis treatment. PMID:15775445
The aim of this study was to evaluate the contrast enhancement, pharmacokinetics, dialyzability, and safety of gadodiamide in patients on hemodialysis. Thirteen hemodialysis patients with abdominal disease were examined after receiving intravenous gadodiamide (0.1 mmol/kg body weight) by magnetic resonance imaging (MRI) and were dialyzed at 1, 3, 5, and 8 days. Blood samples were obtained immediately before, during, and at the end of the first hemodialysis session and immediately before and at the end of the next three sessions. The complete blood count, blood biochemistry, ?2-microglobulin, and gadolinium were measured. Dialysis of urea, creatinine, and gadolinium during the first hemodialysis session was assessed. Precontrast and postcontrast MRI and Gd-enhanced MR angiography (MRA) images were reviewed and visually evaluated by two radiologists; their evaluation was based on consensus. Gadodiamide did not cause any changes in renal function. An average of 73.8%, 92.4%, and 98.9% of the gadodiamide dose was eliminated by the end of the first, second, and third hemodialysis sessions, respectively. The average half-time of gadodiamide was 1.93 h (SD 0.55). The mean clearance of gadodiamide during hemodialysis was 63.5 ml/min (SD 21.9). There were no side effects related to the injection of gadodiamide. In all cases, diagnosable MRI and MRA images were obtained after gadodiamide injection in the hemodialysis patients. In hemodialysis patients, gadodiamide a. In hemodialysis patients, gadodiamide achieves diagnosable images. It is dialyzable and can be used safely without measures to increase excretion. (author)
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.)
It has been established that overproduction of reactive oxygen species (ROS) occurs during hemodialysis causing oxidation of proteins. Alpha-1-antitrypsin is the major circulating anti-protease which contains methionine in the active site. The aim of the present study was to measure the level of serum trypsin inhibitory capacity (sTIC) in hemodialysis patients. This case-control study was performed in 52 hemodialysis patients and 49 healthy controls. sTIC was measured by enzymatic assay. The sTIC was significantly (P< 0.001) lower in hemodialysis patients (1.87 + - 0.67 micron mol/min/mL) than healthy controls (2.83 + - 0.44 micron mol/min/L). Reduction of sTIC may be due to the oxidation of methionine residue in the reactive site of alpha-1 antitrypsin. (author)
Bello, V A; Gitelman, H J
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
Kra?mer, Bernhard K.; Ulsho?fer, T. M.; Mu?ller, G. A.; Ress, K. M.; Risler, T.
In order to clarify the influence of serum potassium, serum sodium and plasma angiotensin II concentrations on aldosterone release during hemodialysis (HD), six chronic hemodialysis patients were studied during HD with varying dialysate sodium concentrations and different buffers. Plasma aldosterone concentrations were higher during acetate than bicarbonate HD, during low sodium compared to high sodium HD, and were correlated inversely to serum sodium concentrations. The decline in plasma ald...
There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. All patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33). Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries
Burmeister, Jayme Eduardo, E-mail: firstname.lastname@example.org [Universidade Federal de Ciências da Saúde de Porto Alegre - Programa de Pós-graduação em Ciências da Saúde, Porto Alegre, RS (Brazil); Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil); Mosmann, Camila Borges [Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil); Costa, Veridiana Borges [Universidade Federal de Ciências da Saúde de Porto Alegre - Faculdade de Medicina, Porto Alegre, RS (Brazil); Saraiva, Ramiro Tubino; Grandi, Renata Rech; Bastos, Juliano Peixoto [Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil); Gonçalves, Luiz Felipe [Universidade Federal do Rio Grande do Sul - Faculdade de Medicina, Porto Alegre, RS (Brazil); Hospital Mãe de Deus - Departamento de Nefrologia, Porto Alegre, RS (Brazil); Rosito, Guido Aranha [Universidade Federal de Ciências da Saúde de Porto Alegre - Programa de Pós-graduação em Ciências da Saúde, Porto Alegre, RS (Brazil); Universidade Luterana do Brasil - Curso de Medicina, Porto Alegre, RS (Brazil)
There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. All patients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 0.001, PR 1.96 - 95%CI: 1.45-2.63) were more frequent in women; and hypertension (p = 0.018, PR 1.06 - 95%CI: 1.01-1.11) and tobacco use (p = 0.006, PR 2.7 - 95%CI: 1.79-4.17) were more often found among patients under 65 years old. Sedentary lifestyle was independently associated with time in dialysis less than 12 months (p < 0.001, PR 1.23 - 95% CI: 1.14-1.33). Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries.
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
Comparison of analgesic efficacy of four-quadrant transversus abdominis plane (TAP) block and continuous posterior TAP analgesia with epidural analgesia in patients undergoing laparoscopic colorectal surgery: an open-label, randomised, non-inferiority trial.
Niraj, G; Kelkar, A; Hart, E; Horst, C; Malik, D; Yeow, C; Singh, B; Chaudhri, S
Posterior transversus abdominis plane blocks have been reported to be an effective method of providing analgesia after lower abdominal surgery. We compared the efficacy of a novel technique of providing continuous transversus abdominis plane analgesia with epidural analgesia in patients on an enhanced recovery programme following laparoscopic colorectal surgery. A non-inferiority comparison was used. Adult patients undergoing elective laparoscopic colorectal surgery were randomly assigned to receive continuous transversus abdominis plane analgesia (n = 35) vs epidural analgesia (n = 35), in addition to a postoperative analgesic regimen comprising regular paracetamol, regular diclofenac and tramadol as required. Sixty-one patients completed the study. The transversus group received four-quadrant transversus abdominis plane blocks and bilateral posterior transversus abdominis plane catheters that were infused with levobupivacaine 0.25% for 48 h. The epidural group received an infusion of bupivacaine and fentanyl. The primary outcome measure was visual analogue scale pain score on coughing at 24 h after surgery. We found no significant difference in median (IQR [range]) visual analogue scores during coughing at 24 h between the transversus group 2.5 (1.0-3.0 [0-5.5]) and the epidural group 2.5 (1.0-5.0 [0-6.0]). The one-sided 97.5% CI was a 0.0 (?-1.0) difference in means, establishing non-inferiority. There were no significant differences between the groups for tramadol consumption. Success rate was 28/30 (93%) in the transversus group vs 27/31 (87%) in the epidural group. Continuous transversus abdominis plane infusion was non-inferior to epidural infusion in providing analgesia after laparoscopic colorectal surgery. PMID:24641640
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Inrig, Jula K.
Hypertension affects most hemodialysis patients and is often poorly controlled. Adequate control of blood pressure is difficult with conventional hemodialysis alone but is important to improve cardiovascular outcomes. Nonpharmacologic interventions to improve blood pressure include educating patients about limiting sodium intake, ensuring adequate sodium solute removal during hemodialysis, and achieving target “dry weight.” However, most patients require a number of antihypertensive medic...
Reddy A; Dakshinamurty K; Lakshmi V
An enzyme immuno assay for hepatitis C core antigen was recently developed and its performance was compared with that of the hepatitis C virus (HCV) RNA in the screening of HCV infection in patients on hemodialysis. One hundred and eleven chronic renal failure patients undergoing haemodialysis between May 2003 and October 2004 were included in the study. All the patients were tested for anti HCV antibody, core antigen and RNA. Fifteen patients were anti HCV antibody positive, three patients w...
Maryam Bakhtiari,; Kianoosh Falaknazi; Mojgan Lotfi; Mohammad Noori; Alireza Naseri Saleh Abad
Please cite this article as: Bakhtiari M, Falaknazi K, Lotfi M, Noori M, Naseri Saleh Abad A. The relationship between Personality Traits, Anxiety and Depression, in Life Quality of patients under treatment by Hemodialysis [HD]. Novel Biomed 2013;1:1-7.Background: The purpose of this study is to examine personality traits in renal patients undergoing haemodialysis (HD) and its connection to depression, anxiety, and life quality. In this study we also aim to propose an intervention for treatme...
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%.
Rocco, Michael V; Lockridge, Robert S.; Beck, Gerald J.; Eggers, Paul W.; Gassman, Jennifer J.; GREENE, Tom; Larive, Brett; Chan, Christopher T; Chertow, Glenn M.; Copland, Michael; Hoy, Christopher D.; Lindsay, Robert M.; Levin, Nathan W; Ornt, Daniel B.; Pierratos, Andreas
Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/Vurea, a 1.74-fold higher average number of treatments per week, and a 2.45-fol...
Full Text Available Fourty three patients with chronic renal failure undergoing chronic hemodialysis in Division of Nephrology and Hypertension, Faculty of Medicine, University of Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, since October 2003 until February 2004, were examined for echocardiography (2-D, M-mode, Doppler imaging.Diastolic dysfunction was found in 58.1 % of chronic renal failure patients on hemodialysis. There was no significant difference between left ventricular mass in the group with or without left ventricular diastolic dysfunction. (Med J Indones 2006; 15:105-8Keywords: Left ventricular mass, diastolic function, chronic renal failure, hemodyalisis
Barazesh, Afshin; Fouladvand, Moradali; Tahmasebi, Rahim; Heydari, Ali; Fallahi, Jamal
Hemodialysis patients, due to a dysfunction of the immune response, are prone to a variety of opportunistic infections. Studies of intestinal parasitic infections in these patients are limited. Therefore, the present study was performed to determine the prevalence of these infections in patients on hemodialysis in Bushehr. In this cross-sectional study, fecal samples have been collected from all hemodialysis patients who were continuously referred from September 2011 to September 2012 to the dialysis center at Bushehr and tested using routine parasitological methods. From a total of 88 patients studied, 25 patients (28.4%) were infected with one or more intestinal parasites. Blastocystis hominis and Entamoeba coli with 13.6% and 6.7% prevalence had the highest prevalence among the patients, respectively. The age group 51-70 years had the highest rates of infection. Statistical analysis showed no relationship between sex and the risk of intestinal parasites. Seventeen percent of infected patients showed up with diarrhea and this relationship was statistically significant. Considering the high prevalence of intestinal parasitic infection among hemodialysis patients in Bushehr and also the high probability of infection in these patients, it is recommended that periodic examinations and screening patients during dialysis and before kidney transplantation should be a part of routine medical care. PMID:25643728
Seifi S, Mokhtari A
Full Text Available "nBackground: The annual amount of mortality in ESRD exceeds the expectation and represents the recent evidences of the inflammation as its etiology. The etiology of inflammation is not clearly known. Chronic inflammation is a dominant occurrence of ESRD which increases the risk of atherosclerosis, malnutrition and peripheral vascular disease. Inflammatory responses are orchestrated by cytokines. Some of the proinflammatory cytokines like IL-6 have a crucial role in this phenomenon. The IL-6 and its receptor activity is up regulated in ESRD patients and the increased level of IL-6 predicts cardiovascular mortality and morbidity in normal and CRF patients. This study devotes itself to determining the serum level of IL-6 and factors affecting it in patients undergoing chronic hemodialysis in Imam Khomeini Hospital which can represent the Iranian Society. By identifying factors affecting the serum level of IL-6 and high-risk patients we can provide treatment possibilities, a decrease in mortality and an improvement in its prognosis. "n"nMethods: In this study 42 patients in Imam Dialysis Center were chosen and their serum IL-6 levels were measured at 2 times at three month interval and at the same time blood sample analysis were done for the following: Alb CPR, Ca, P, PTH, TIBC, Ferritin, TG, Chol, LDL, HDL, Uric Acid, Hb, WBC and urea."n"nResults: The mean serum level of IL-6 in hemodialysis patients was 6.35±4.47pg/ml (minimum: 0.55, maximum: 18.25 with the normal range of 1.3±3.2pg/ml."n"nConclusions: The IL-6 level was higher than normal range in the 52% of the patients. The serum IL-6 level had a significant correlations with CPR, Ferritin, TIBC, WBC and their serum IL-6 level was significantly higher in patients with hypertension, but no significant correlation was observed between other parameters and IL-6
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
Daniele Favaro Ribeiro
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.
The authors reviewed hand and wrist films of 81 patients who had undergone hemodialysis for a minimum of 5 and a mean duration 7.5 years. The films of 32 patients showed arthritic changes consisting of articular erosions, joint space narrowings, periarticular cysts, and osteopenia. Five of these patients had subcutaneous or periarticular calcific deposits. The frequency and severity of the radiographic findings increased with increasing duration of dialysis. It appears that in addition to the well-recognized secondary hyperparathyroidism there is a second commonly occurring osteoarthropathy (40% in this series) related to long-term hemodialysis
Sowinski, Kevin M.; Magner, Stephanie J.; Lucksiri, Aroonrut; Scott, Meri K.; Hamburger, Richard J.; Mueller, Bruce A.
Background and Objectives: Aminoglycoside antibiotics are commonly used in chronic kidney disease stage 5 patients. The purpose of this study was to characterize gentamicin pharmacokinetics, dialytic clearance, and removal by hemodialysis and to develop appropriate dosing strategies.
Vaca Diez Busch, H; Touam, M; Zingraff, J; Juquel, J P; Bardin, T; Drüeke, T; Kuntz, D
Joint problems have been retrospectively analyzed in 10 uremic patients (mean age, 61.9 years; range, 50-70) undergoing long-term hemodialysis treatment for more than 10 years. All the patients suffered from arthralgias which were mainly localized in the shoulder region (9 patients). The arthralgias began 2-9 years after the initiation of intermittent hemodialysis. Eight out of the 10 patients had the carpal tunnel syndrome. Only three patients had evidence of marked secondary hyperparathyroidism but nine had aluminum intoxication. Juxta-articular calcium deposits were observed in 8 patients one of whom had pseudo-tumoral calcifications made of hydroxyapatite crystals. These soft tissue calcium deposits occurred 1-8 years after starting hemodialysis. Conspicuous X-ray abnormalities were found in 8 patients: destructive arthropathy in 5 cases, arthropathies of large joints in 5 cases consisting of sub-chondral lacunae and joint space narrowing or even disappearance. Prosthetic joint replacement was required in 4 patients: replacement of the hip in 3 and of the knee in 1. Massive amyloid deposits could be demonstrated in removed joints of 3 patients and in carpal tunnel of the 7 patients operated upon. They were located in the synovium, articular capsula and juxta-articular epiphyseal bone. It is probable that this is a new type of amyloidosis made of beta 2-microglobulin. The underlying pathogenetic mechanisms of these arthropathies remain to be defined by further studies. PMID:3796786
Full Text Available End-stage renal disease (ESRD patients frequently develop structural cardiac abnormalities, particularly left ventricular hypertrophy (LVH. The mechanisms involved in these processes are not completely understood. In the present study, we evaluated a possible association between parathyroid hormone (PTH levels and left ventricular mass (LVM in patients with ESRD. Stable uremic patients on intermittent hemodialysis treatment were evaluated by standard two-dimensional echocardiography and their sera were analyzed for intact PTH. Forty-one patients (mean age 45 years, range 18 to 61 years, 61% males, who had been on hemodialysis for 3 to 186 months, were evaluated. Patients were stratified into 3 groups according to serum PTH: low levels (280 pg/ml; group III = 21 patients. A positive statistically significant association between LVM index and PTH was identified (r = 0.34; P = 0.03, Pearson's correlation coefficient in the sample as a whole. In subgroup analyses, we did not observe significant associations in the low and intermediate PTH groups; nevertheless, PTH and LVM index were correlated in patients with high PTH levels (r = 0.62; P = 0.003. LVM index was also inversely associated with hemoglobin (r = -0.34; P = 0.03. In multivariate analysis, after adjustment for age, hemoglobin, body mass index, and blood pressure, the only independent predictor of LVM index was PTH level. Therefore, PTH is an independent predictor of LVH in patients undergoing chronic hemodialysis. Secondary hyperparathyroidism may contribute to the elevated cardiovascular morbidity associated with LVH in ESRD.
Yazdi, Zohreh; Sadeghniiat-Haghighi, Khosro; Kazemifar, Amir Mohammad; Kordi, Arash; Naghipour, Siavash
Restless leg syndrome (RLS) is a distressing sleep disorder that is commonly experienced by patients undergoing maintenance hemodialysis. The aim of this study was to assess the prevalence of RLS and its related factors among hemodialysis patients. This was an analytical cross-sectional study that was performed on hemodialysis patients of the Bu"Ali Hospital of Qazvin during 2009 and 2010. One hundred and twelve patients were selected by the census sampling method as the study sample. Data collection was performed using the Insomnia Severity Index (ISI), Pittsburg Sleep Quality Index (PSQI), Berlin, Epworth Sleepiness Scale (ESS) and International Restless Leg Syndrome Study Group criteria (IRRLS) questionnaires. Student's ttest and chi-square test were applied to analyze the collected data. RLS complaints were very common among patients on long-term dialysis therapy and were reported in about 42.9% of the patients. Patients with RLS had higher daytime sleepiness, insomnia complaints and poorer sleep quality. Percentage of patients in the high-risk group was higher in the RLS group. RLS symptoms appear to be correlated with age (P = 0.012) and use of sedative drugs (P = 0.035). RLS is common in dialysis patients and is associated with a higher prevalence of other sleep disturbances. Therefore, the effective assessment and management of this sleep disturbance has the potential to significantly enhance patient outcomes. PMID:26022045
McCormick, J. R.; Kreutzer, D. L.; Keating, H. J.; Hupp, J.; Despins, A.; Moore, M.
The systemic infusion of complement-derived anaphylatoxin ane chemotaxins during hemodialysis results in profound transient neutropenia and may be associated with subtle pulmonary dysfunction. The fact that these potent inflammatory peptides do not usually produce serious ill effects may be due in part to their rapid inactivation by the serum regulatory proteins anaphylatoxin inactivator (AI) and chemotactic factor inactivator (CFI). Accordingly, the authors investigated the effect of hemodialysis on circulating neutrophil counts and serum levels of AI and CFI activity in 10 patients. In all patients, circulating neutrophil counts plummeted by more than 50% within 5 minutes of the onset of dialysis and rose beyond control levels by 1 hour. AI activity significantly fell from 65 +/- 16 mU/ml before dialysis to 18.7 +/- 7.8 mU/ml within 5 minutes of its initiation; levels remained depressed throughout the procedure. In contrast, CFI gradually increased, achieving a level significantly different from the predialysis value by 15 minutes. These events contrasted with the observation that activation of the complement system in vitro results in a significant decline in both CFI and AI activities. We suggest that the maintenance of or increase in CFI activity in patients undergoing hemodialysis enhances the clearance of circulating chemotactins, preventing the persistent activation of neutrophils during the procedure and subsequent organ dysfunction. PMID:7180942
Gülperi Çelik, Orhan Özbek, Mümtaz Y?lmaz, Ipek Duman, Seda Özbek, Seza Apiliogullari
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.
Lin, Yi-Sheng; Hung, Szu-Chun; Wei, Yau-Huei; Tarng, Der-Cherng
Leukocyte 8-hydroxy-2?-deoxyguanosine (8-OHdG) is a surrogate marker of oxidant-induced DNA damage in patients undergoing maintenance hemodialysis (MHD). Glutathione S-transferase M1 (GST M1) is a member of the GST family of proteins, which protect cellular DNA against oxidative damage. This study tested the association of a common GST M1 gene polymorphism [GST M1(?)], known to produce a dysfunctional enzyme, with levels of 8-OHdG in peripheral blood leukocytes and all-cause mortality amo...
Caravaca, Fernando; Burguera, Victor; Fernández-Lucas, Milagros; Teruel, José Luis; Quereda, Carlos
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
Wang, J. W.; Xie, H.; Liang, L. R.; Zhang, W.; Peng, W.; Yu, Q. X.
A photoacoustic (PA) spectrometer based on a near-IR tunable fiber laser is developed and used for breath ammonia analysis. We successfully measured the breath ammonia level variation of six patients with end-stage renal disease while they were undergoing hemodialysis in the hospital. The measurement results showed that the initial concentration level of the breath ammonia were from 1600 to 2200 ppb before dialysis treatment, the levels decreased to 200-600 ppb in the end stage of dialysis, which close to the levels of healthy persons. Further improvement and applications of this PA spectrometer are discussed.
Bliwise Donald L; Kutner Nancy G; Parker Kathy P; Bailey James L; Rye David B
Abstract Background Although considerable progress has been made in the treatment of chronic kidney disease, compromised quality of life continues to be a significant problem for patients receiving hemodialysis (HD). However, in spite of the high prevalence of sleep complaints and disorders in this population, the relationship between these problems and quality of life remains to be well characterized. Thus, we studied a sample of stable HD patients to explore relationships between quality of...
Soyoral, Yasemin; SAYARLIO?LU, Hayriye; TUNCEL, Deniz; ?AH?N, Murat; DO?AN, Ekrem; ERKOÇ, Reha
Restless legs syndrome (RLS) is characterized by symptoms of spontaneous, continuous leg movements associated with unpleasant paresthesias. RLS is common among dialysis patients, with a reported incidence of 6.6 to 6.8 percent. This study is an attempt to find out the prevalence of RLS in our hemodialysis patients. We compared several demographic and clinical characteristics of RLS patients identified by the International Restless Legs Syndrome Study Group (IRLSSG) criteria with those of indi...
Full Text Available Although the revised dyadic adjustment scale (RDAS has been widely used as an indicator of the quality of marital relationship, no report is available on the reliability of this measure in patients on hemodialysis. We examined the internal consistency of the RDAS in a group of Iranian patients undergoing maintenance hemodialysis. A translated Persian version of the RDAS was self-administered to 135 patients. The internal consistency of the RDAS was tested using the Chronbach ? coefficient which was 0.898, 0.683, 0.779, 0.827, and 0.836 for the RDAS total score and the dyadic consensus, affective expression, dyadic satisfaction, and dyadic cohesion subdomains, respectively. All of the Chronbach ? scores were higher in patients with higher income and education level. Using the RDAS to examine marital relationship quality in patients on hemodialysis, the total score and almost all subscores except for dyadic consensus had adequate internal consistency.
...regenerated dialysate delivery system for hemodialysis. 876.5600 Section 876.5600...regenerated dialysate delivery system for hemodialysis. (a) Identification. A sorbent...regenerated dialysate delivery system for hemodialysis is a device that is part of...
María Soledad, Oliveros R; Marcelo, Avendaño; Daniel, Bunout; Sandra, Hirsch; María Pía, De La Maza; Cristian, Pedreros; Hans, Müller.
Full Text Available [...] 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.
Luis, Durán-Arenas; Paula D, Ávila-Palomares; Rodrigo, Zendejas-Villanueva; María Magaly, Vargas-Ruiz; Laura L, Tirado-Gómez; Malaquías, López-Cervantes.
Full Text Available OBJETIVO. Estimar y comparar el costo por sesión de hemodiálisis dentro del sector público y privado en la Ciudad de México. MATERIAL Y MÉTODOS. Se calcularon los costos de los insumos utilizados en las hemodiálisis de cuatro hospitales públicos y dos privados de la Ciudad de México, mediante la est [...] rategia de micro-costeo denominada PAATI. Para la obtención de los datos se utilizó el método de sombra; además, se empleó Excel para elaborar cédulas en las que se determina el PAATI para cada sesión. RESULTADOS. El costo anual promedio directo en el sector público por el tratamiento de un individuo en hemodiálisis es de $158 964.00 M. N., y el costo de atender a la población que podría demandar terapia de reemplazo renal se estima en $10 921 788 072.00 M. N. CONCLUSIÓN. La disponibilidad de recursos humanos e infraestructura en el país es muy limitada para el campo de la nefrología en general y, en particular, para ofrecer servicios de hemodiálisis, por lo que sería necesario inyectar más recursos para poder responder ante la demanda por insuficiencia renal terminal. Abstract in english OBJECTIVE. To estimate and compare direct costs per hemodialysis session in public and private units in Mexico City. MATERIAL AND METHODS. PAATI, a microcosting strategy, was used to determine total costs of four public and two private health hospitals in Mexico City. A "shadow study" approach was e [...] mployed to collect the needed data. Charts containing the "PAATI" information for each session were developed in Microsoft Excel. RESULTS. The average annual cost per patient undergoing hemodialysis in public units is $158 964.00 MX. The estimated cost for the care of all population estimated in need of renal replacement therapy (via hemodialysis) was estimated to be $10 921 788 072.00 MX. CONCLUSION. Human resources and infrastructure availability in México are very limited for nephrology, and in consequence for offering hemodialysis services.
Saifan, Chadi; El-Charabaty, Elie; El-Sayegh, Suzanne
Background 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. PMID:23898227
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.
Although metabolic syndrome confers an increased risk of cardiovascular disease in the general population, little is known about the alteration of abdominal adiposity and its association with adipocytokines in hemodialysis patients. We investigated the plasma high-molecular-weight (HMW) adiponectin level and its relationship to visceral fat area (VFA) and various markers of atherosclerosis in hemodialysis patients. In a cross-sectional study, conventional cardiovascular risk factors, plasma total and HMW adiponectin, the number of components of the metabolic syndrome and, using computed tomography, the distribution of abdominal adiposity were assessed in 144 hemodialysis patients (90 men and 54 women; mean age, 60.7 years) and 30 age- and sex-matched patients with chronic kidney disease (CKD). Plasma HMW adiponectin levels in hemodialysis patients were significantly higher than those in patients with CKD, negatively associated with VFA and serum triglycerides and positively associated with plasma total adiponectin, as well as the HMW-to-total adiponectin ratio in men and women (all P<0.05) in a simple regression analysis. In a multiple regression analysis, VFA was a significant determinant of HMW adiponectin in hemodialysis patients. Furthermore, after adjustment for classical risk factors, HMW adiponectin levels were significantly higher in patients undergoing treatment with renin-angiotensin system inhibitors or calcium channel blockers compared with patients not unnel blockers compared with patients not undergoing such treatment. This study shows that plasma HMW adiponectin levels were negatively associated with VFA and positively associated with treatment with blockade of the renin-angiotensin system and of the calcium channel. Therefore, these drugs might be effective for improving adipocytokine-related metabolic abnormalities in hemodialysis patients. (author)
Shrivastava, D; Lundin, A P; Dosunmu, B; Rao, T K; Beyer, M M; Friedman, E A
Jugular venous catheters (JVC) provide rapid, vascular access for both emergency and maintenance hemodialysis in both acute and end-stage renal disease. Clotting and occlusion of JVC is a common problem necessitating alternate vascular access. Urokinase will declot 80-90% of central venous catheters; however, recurrence of catheter occlusion is frequent. We successfully employed a guide wire insertion technique to salvage occluded JVC after failed urokinase infusion. In 24 patients JVCs, inserted for either temporary or permanent vascular access, clotted within 6-55 days of initiating hemodialysis. Urokinase (5,000 IU) instilled into both arterial and venous limbs of the catheter had been unsuccessful in restoring patency. In these patients, we inserted a soft-tipped guide wire into both lumina. In 21 of 24 patients (87.5%), guide wire insertion opened the occluded JVC, permitting immediate initiation of hemodialysis. We conclude that for clotted JVC unresponsive to urokinase infusion, guide wire insertion can salvage most catheters thereby facilitating hemodialysis. PMID:7991044
Tsai, Ming-Feng; Chen, Chen-Yin
Valproate-induced hyperammonemic encephalopathy is an unusual but serious complication that may occur in people with normal liver-associated enzyme levels, despite normal therapeutic doses and serum levels of valproate. Here, we describe an adolescent girl who had absence seizure and complained about progressive dizziness and general malaise several days after restarting valproate. Then, she presented vomiting and decreased consciousness three weeks after valproate use. Notably, her serum ammonia level was five times the upper limit of normal (184 micrommol/L), with normal liver-associated enzyme and supra-therapeutic valproate level. EEG showed continuous generalized slowing. The tandem mass analysis revealed carnitine deficiency. Consciousness improved after emergent hemodialysis. Ammonia level and EEG also returned to normal. Possible mechanisms, risk factors and the treatments of valproate-induced hyperammonemic encephalopathy are described. Physicians should consider this possibility when consciousness disturbance occurs in patients treated with valproate. PMID:18791959
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
Franssen, E J; van Essen, G G; Portman, A T; de Jong, J; Go, G; Stegeman, C A; Uges, D R
The toxicity and pharmacokinetic properties of a drug determine whether hemodialysis and/or hemoperfusion are indicated in acute intoxications. Valproic acid is considered unremovable by hemodialysis because of the high protein binding of 90%-95%. A 27-year-old male with a history of seizures was admitted to the emergency room because of coma, hypernatriemia, and respiratory failure caused by an intoxication with a large dose of valproic acid. At admission, the plasma valproic acid level was 1414 mg/L (9.9 mmol/L) (therapeutic range: 50-100 mg/L (350-700 micromol/ L). The anion gap was 26 mmol/L (normal hemodialysis and hemoperfusion was performed. The first session was done with a charcoal column and the second session with a resin column. The patient recovered during the course of treatment. The valproic acid plasma clearances during treatment were: 80 mL/min (hemodialysis); 40 mL/min (hemoperfusion by charcoal) and 80 mL/min (hemoperfusion by resin, only in the first hour). The protein binding of valproic acid in plasma was only 32% at the start and was 54% at the end of the two sessions. In this specific case of a severe valproic acid intoxication, saturated protein binding resulted in an increased fraction of unbound valproic acid. This made hemodialysis an effective treatment, while hemoperfusion was relatively less effective because of saturation of the column. In conclusion, the toxicokinetics of valproate are quite different from the pharmacokinetics at therapeutic levels. The anion gap and protein binding are important parameters in toxicokinetics. PMID:10365638
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)
Thyroxine (T4) concentration in dialysate in the course of hemodialysis was determined in 15 children. Concentrations were measured by a modified radioimmunoassay. During hemodialysis there was a slight increase in T4 concentration. At the end of hemodialysis T4 concentration was about 50% higher than soon after the onset of hemodialysis. The loss of T4 into dialysate during hemodialysis was 19.2 ?g; the loss of T3 was less than 75 ng. The amount of the daily loss of thyroid hormones into dialysate was found to be in the range of normal urinary excretion. The lowering of serum thyroid hormone concentrations in children on hemodialysis cannot be explained by the loss of these hormones into dialysate. (orig.)
Cantimur, A. C.
Full Text Available Objective: Temporary hemodialysis catheters are widely used in patients with renal failure for urgent hemodialysis. In this article, we aimed to reflect our experiences in temporary catheters. Patients and Methods: In our clinic, 50 cases in which temporary hemodialysis catheter had been applied were evaluated prospectively from October 2003 to June 2004. Results: Temporary hemodialysis catheters were inserted 78 times in 50 patients. The most frequent localization of insertion was internal jugular vein (n= 56. Complications occurred in early phase in 10 cases and in late phase in 13 cases. The most frequently seen complication was catheter dysfunction. Conclusion: Temporary hemodialysis catheters are directly proportional with higher rate of complications. Hence, applying permanent vascular access is an urgent necessisty in patients requiring hemodialysis.
Moghadasian, Sima; Sahebi Hagh, Mohammad Hasan; Aghaallah Hokmabadi, Leila
Introduction: Nowadays, the chronic diseases are known to be associated with lifestyle risk factors. Hemodialysis patients encounter considerable amount of physical, mental and social pressure. Lifestyle is important because it affects quality of life and has important role in prevention. This study aimed to compare the lifestyle of hemodialysis patients and outpatients in health clinics of Tabriz. Methods: This was a case-control study on 155 hemodialysis patients and 155 o...
Ahmed, A. M. A.; Allam, Mohd. F.; Habil, E. S.; Metwally, A. M.; Ibrahiem, N. A.; Radwan, M.; El-Gaafary, M. M.; Afifi, A; Gadallah, M. A.
Although hemodialysis is the main modaility of treatment of end-stage renal disease, no practice guidelines are available in Egypt. Applying international guidelines for hemodialysis would not be suitable or feasible, because of different health system and lack of resources. The aim of this project was the development of evidence- and consensus-based clinical practice guidelines for hemodialysis in Egypt. The Egyptian guidelines were adopted from the standards developed by The College of Phys...
Rose Anne Kulik; Dina Lúcia Morais Falavigna; Letícia Nishi; Silvana Marques de Araujo
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 sta...
Pakpour, Amir H.; Nourozi, Saeedeh
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.
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.
Full Text Available Background: While prevalence of Hepatitis B virus (HBV in patients with end-stage renal failure (ESRF who are undergoing dialysis has decreased significantly during the past few decades, it still remains a distinct clinical problem. The immunosuppressive nature of renal disease often leads to chronicity of the HBV infection and an opportunity for nosocomial spread of the infection among dialysis patients. Egypt is among the countries with intermediate endemicity of HBsAg (range, 2%–7%. Large-scale geographic heterogeneity in HBV prevalence has been reported worldwide and HBV prevalence is especially heterogeneous in Egypt.Objectives: To assess the prevalence of occult HBV infection (OBI in hemodialysis patients with or without chronic hepatitis C (HCV from Minia and Assuit, Upper Egypt, using HBV DNA assays.Patient and Methods: Sera from 145 hemodialysis patients with negative HbsAg were investigated for HBV DNA using real-time polymerase chain reaction (RT-PCR. Only serum samples with repeatedly detectable HBV DNA were considered positive. Patients were divided into 2 groups: HCV RNA positive and HCV RNA negative, based on the results of a third generation enzyme linked immunosorbent assay (ELISA anti-HCV test and HCV RNA PCR.Results: HBV DNA was detected in 6 of the 145 patients (4.1% and HBcAb was detected in 29/145 patients (20%. There were no statistically significant differences in the age, duration of hemodialysis, biochemical parameters, serological markers of HBV, or HBV DNA between patients with and without HCV infection.Conclusions: Four percent of the hemodialysis patients had OBI. There was no significant difference in the prevalence of OBI between hemodialysis patients with or without HCV co-infection.
Children on hemodialysis are at increased risk of thrombosis, especially when dialyzed via a central venous catheter (CVC); there are limited published data regarding the safety and efficacy of tinzaparin in this group. We conducted a retrospective chart review of all children in the National Pediatric Hemodialysis Centre for Ireland diagnosed with a CVC thrombus and treated with subcutaneous tinzaparin over a 10 year period. Seven children were treated with subcutaneous tinzaparin for 10 CVC thrombi. Tinzaparin was commenced at 175 IU\\/kg\\/day and the dose was titrated by measuring anti-factor Xa levels, aiming for levels of 0.3-1.0 IU\\/ml. Treatment was continued until resolution of the CVC thrombus. Restoration of normal flows during dialysis occurred within 3 days in all patients. There were no episodes of bleeding and all children tolerated the treatment well.
Johansson, O; Hilliges, M; Ståhle-Bäckdahl, M
The use of indirect immunohistochemistry in 12 patients on maintenance hemodialysis has shown weak or moderately strong neuron-specific enolase (NSE)-immunoreactive nerve terminals and fibres sprouting throughout the layers of the epidermis. No such terminals or fibres were found in any of 15 controls. There was no difference between uremic patients with pruritus and those without. Furthermore, NSE-positive nerve fibres with a normal appearance were seen in the dermis, at the epidermal-dermal junctional zone and sometimes entering the stratum basale in both patients and controls. The immunoreactive nerves were thin, smooth and, at their terminal fields, varicose. The immunoreactivity seemed to be associated chiefly with sensory nerves. Thus, our results suggest that uremic patients undergoing maintenance hemodialysis develop an abnormal pattern of cutaneous innervation. PMID:2657508
Percy, Herrera Añazco; Miriam Giovanna, Díaz Sánchez; Melisa, Palacios Guillén; Luisa, Núñez Talavera; Alfonzo, López Herrera; José, Valencia Rodríguez; Manuela, Silveira Chau.
Full Text Available Introducción: Los pacientes en diálisis tienen complicaciones crónicas que alteran su calidad de vida, como las oftalmológicas, producidas por comorbilidades de la ERC, o por efectos propios de la misma. Nuestro estudio pretendió describir los hallazgos oculares en una población en diálisis crónica [...] convencional en los aspectos de fondo de ojo, agudeza visual y presión intraocular. Material y Métodos: Estudio observacional descriptivo de corte transversal entre los pacientes en hemodiálisis crónica en el Servicio de Nefrología del Hospital Nacional 2 de Mayo de Lima - Perú. Resultados: Se estudiaron 31 pacientes cuya edad promedio fue 62.67±12.46 años; el 45.16% fueron varones. El 87.1% tenía HTA y el 45.16% Diabetes Mellitus. Los síntomas oculares más frecuentes fueron: Visión borrosa (67.74%), lagrimeo (38.71%), prurito (25.81%), ardor ocular (16.13%) y astenopia (6.41%). La presión intraocular promedio fue 14.5±5.28 mm Hg en el ojo derecho, y 14.23±4.78 mmHg en el ojo izquierdo. En el examen de agudeza visual se encontró ceguera en el 6.07% de los pacientes y baja visión en 39.39% de pacientes. Los hallazgos externos más frecuentes fueron: Depósitos córneo conjuntivales (41.94%), alteración en la película lagrimal (35.48%) e hiperpigmentación (35.48%).La alteración de refracción más frecuente fue hipermetropía y astigmatismo (80.77%). Las enfermedades oftalmológicas con diagnóstico definido más frecuentes fueron: Retinopatía diabética no proliferativa (37.93%) y degeneración macular relacionada con la edad (24.14%). En el análisis bivariado, entre los síntomas y el diagnóstico oftalmológico final, se encontró que los pacientes con visión borrosa presentaban menos retinopatía hipertensiva (p=0.002); y la ausencia de lagrimeo se asoció con menos retinopatía hipertensiva (p=0.03). Conclusión: Los hallazgos oftalmológicos anormales son frecuentes en nuestra población en diálisis crónica, siendo pocos los pacientes con agudeza visual normal. La evaluación ocular debería ser rutinaria en esta población. Abstract in english Introduction: Dialysis patients have chronic complications that impair their quality of life, such as eye involvement caused by chronic kidney disease (CKD) comorbidities, or because of specific CKD effects. This paper aims to describe funduscopy, visual acuity and intraocular pressure findings in a [...] population undergoing chronic conventional dialysis. Material and Methods: This is a descriptive and observational crosssectional study performed in patients undergoing chronic hemodialysis in the Nephrology Service of 2 de Mayo National Hospital in Lima - Peru. Results: Thirty-one patients were studied, their average age was 62.67 ± 12.46 years, 45.16% were male, 87.1% had hypertension, and 45.16% had diabetes mellitus 45.16%. The most common ocular symptoms were blurred vision (67.74%), tearing (38.71%), pruritus (25.81%), burning sensation in the eyes (16.13%) and asthenopia (6.41%). The average intraocular pressure was 14.5 ± 5.28 mm Hg in the right eye and 14.23 ± 4.78 mm Hg in the left eye. When visual acuity was examined, we found that 6.07% of patients were blind, and poor vision was found in 39.39% of patients. Most frequent external findings were corneal and conjunctival infiltrates (41.94%), tear film alterations (35.48%), and hyperpigmentation (35.48%). Most frequent refraction defects found were hyperopia and astigmatism (80.77%). Most common well-defined ophthalmological conditions were non-proliferative diabetic retinopathy (37.93%) and age-related macular degeneration (24.14%). A bivariate analysis performed relating symptoms and final ophthalmologic diagnoses, we found that patients with blurred vision developed hypertensive retinopathy less frequently (p = 0.002) and the absence of tearing was also associated with fewer cases of hypertensive retinopathy (p = 0.03). Conclusions: Abnormal ophthalmological findings are frequently found in persons undergoing hemodialysis, and only few patients have normal
Jin, Liang-bing; Li, Dong-sheng; Chen, Ai-jun
For the purpose of meeting the rapid development of blood purification in China, improve the level of blood purification treatment, and get rid of the plight of the foreign technology monopolization to promise patients' medical safety, a parameter-calibrator for the hemodialysis unit, which can detect simultaneously multi-parameter, is designed. The instrument includes a loop, which connects to the hemodialysis unit. Sensors are in the loop in series, so that the dialysis can flow through this loop and the sensors can acquisitive data of various parameters. In order to facilitate detection and carrying, the integrated circuit part modularly based on the ultralow-power microcontrollers,TI MSP430 is designed. High-performance and small-packaged components are used to establish a modular, high-precision, multi-functional, portable system. The functions and the key technical indexes of the instrument have reached the level of products abroad.
Carrizo, Aldo; Campbell, Sebastián
Dabigatran is an oral anticoagulant from the class of the direct thrombin inhibitors, indicated for prevention of thromboembolic events in patients with non valvular atrial fibrillation. Unlike warfarin, dabigatran has no known antidote. Hemodialysis has been suggested as a method for removing dabigatran and thereby reducing its anticoagulant effect. We report the case of a patient with a known history of atrial fibrillation, treated with dabigatran, who was admitted for emergency abdominal surgery. At six hours after the last dose received, coagulation studies were altered. In absence of an antidote to reverse its effects, it was decided to perform hemodialysis. After three hours of dialysis coagulation parameters were improved and the patient underwent surgery without showing abnormal bleeding during surgery or in the postoperative period. PMID:24736256
Bapat Usha; Kedlaya Prashanth; Gokulnath,
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 include...
Santoro D; Benedetto F; Mondello P; Pipitò N; Barillà D; Spinelli F; Ca, Ricciardi; Cernaro V; Buemi M
Domenico Santoro,1 Filippo Benedetto,2 Placido Mondello,3 Narayana Pipitò,2 David Barillà,2 Francesco Spinelli,2 Carlo Alberto Ricciardi,1 Valeria Cernaro,1 Michele Buemi11Department of Clinical and Experimental Medicine, Unit of Nephrology, 2Unit of Vascular Surgery, 3Unit of Infectious Disease, University of Messina, ItalyAbstract: A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure. There are three main types of access: na...
Friedman, David J.; Afkarian, Maryam; Tamez, Hector; Bhan, Ishir; Isakova, Tamara; Wolf, Myles; Ankers, Elizabeth; Jun YE; Tonelli, Marcello; Zoccali, Carmine; Kuro-o, Makoto; Moe, Orson; Karumanchi, S Ananth; Thadhani, Ravi
Patients with end-stage renal disease (ESRD) suffer exceptionally high mortality rates in their first year of chronic hemodialysis. Both vitamin D and fibroblast growth factor (FGF)-23 levels correlate with survival in these patients. Klotho is a protein in the vitamin D/FGF-23 signaling pathway that has been linked with accelerated aging and early mortality in animal models. We therefore hypothesized that genetic variation in the Klotho gene might be associated with survival in subjects with...
Sutter, Mark; Tereshchenko, Nadia; Rafii, Rokhsara; Daubert, G. Patrick
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...
Hüseyin Atl?; Mehmet Çölbay; Serap Demir; ?eref Yüksel; ?hsan Uslan; Gürcel Acartürk; Özcan Karaman; Tülay Köken; Mehmet Melek
Objective: The restless legs syndrome (RLS) is characterized by unpleasant sensations and pain in the legs, irresistible urge to move the legs, especially when resting and often accompanied by sleep disorders. RLS prevalence is up to 80% in hemodialysis patients. It is such an important clinical condition that is associated with increased mortality. Moreover etiopathogenesis is not clear. We aimed to evaluate vascular disorders, heart rate variability, oxidative stress parameter in hemodialys...
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.
KEÇEL?G?L, H.T.; KOLBAKIR, F.; ARIKAN, A.; S Canbaz
From July 1986 to September 1996, 322 arteriovenous fistulas were constructed in 250 patient for permanent hemodialysis: 315 autogenous and 7 graft fistulas (polytetraflouroethylen (PTFE)-4, dacron-3). 269 snuffbox (84%), 29 radiocephalic (8%), 24 brachiocephalic (7%) and 1 subclavian (0.3%) arteriovenous fistulas were performed. Successfull rate at first operations (255/322) was 79%. In the immediate postoperative period, 54 snuff box fistulas (20%) developed complications (52 early occlusio...
Nemati Eghlim; Taheri Saeed
This study was performed to evaluate whether any electrocardiogram (ECG) para-meter can predict the presence of hyperkalemia in patients on maintenance hemodialysis (HD). In January 2006, we conducted a cross-sectional study of 80 stable patients with end-stage renal disease from four university-based HD units of Tehran, Iran, receiving conventional thrice-weekly HD. Pre-HD serum electrolyte values and conventional 12-lead ECG were obtained from each pa-tient. Bivariate linear regression was ...
Albers, F J
Hemoaccess infections remain a substantial cause of morbidity in patients on hemodialysis, especially with the increasing reliance on prosthetic devices as the average age of the hemodialysis population increases. Access manipulation, either through needle puncture or secondary surgical procedures, is the primary etiology of infection. Other conditions such as access location, patient hygiene, and intravenous drug use can cause contamination. Local evidence of inflammation or infection, especially pain and purulence, are the most reliable signs of infection; however, the access can be infected and there may be minimal systemic symptoms. Medical therapy must be directed primarily against Staphylococcus aureus, with vancomycin being used most frequently. There are distinct conditions in which infection with gram-negative bacilli is also common. A coordinated effort between medical management and surgical intervention is essential to optimize therapy. Several situations, such as loss of vascular integrity or infection at anastomosis sites, mandate full excision of the graft. However, the access or at least the access site, can be preserved through creative surgical intervention along with aggressive medical treatment. Approaches to the diagnosis and treatment of infection in autologous arteriovenous fistulae, polytetrafluoroethylene arteriovenous conduits, and cuffed dual-lumen venous hemodialysis catheters are discussed. PMID:8827199
Hafner, Verena; Czock, David; Burhenne, Ju?rgen; Riedel, Klaus-dieter; Bommer, Ju?rgen; Mikus, Gerd; Machleidt, Christoph; Weinreich, Thomas; Haefeli, Walter E.
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...
Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh
A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management. PMID:21814378
Nasa, Prashant; Sehrawat, Deepak; Kansal, Sudha; Chawla, Rajesh
A case of severe sodium valproate overdose is presented in which medicinal management failed to reverse coma of the patient. High-flux hemodialysis was then used to eliminate sodium valproate. This case demonstrated the effectiveness of hemodialysis in not only decreasing valproate levels very rapidly but also as an effective anti-coma management.
Purpose: We evaluated the safety of a gadolinium (Gd) contrast agent in hemodialysis patients. Material and Methods: Seventy hemodialysis patients underwent contrast-enhanced MR examination. After the examination, the patients were hemodialyzed on a usual schedule, i.e., 3 times per week at 4 h each session. The hemodialysis was performed on the same day in 16 patients, the next day in 34, 2 days later in 14 and 3 days later in 6 patients. Serum Gd concentrations before and after the first to fourth hemodialysis sessions were analyzed in 11 patients. Cardiovascular, cutaneous, respiratory, psycho-neurological and digestive side effects were evaluated in all patients. Changes in liver and kidney functions, blood counts, and electrolytes were also checked. Results and Conclusion: Neither side effects nor blood changes were noted in any of the patients. Average excretory rates were 78.2%, 95.6%, 98.7% and 99.5% in the first to fourth hemodialysis sessions, respectively. These results suggest that Gd contrast agents can be used in hemodialysis patients if hemodialysis is carried out promptly after the examination. Key words: Renal failure, hemodialysis; contrast agent, gadolinium
Dias, Lorraine S.; Vivek, G.; Manthappa, M.; Acharya, Raviraja V
The treatment of baclofen overdose is primarily supportive. There have been case reports of hemodialysis being used in patients with chronic kidney disease with baclofen overdose. A case report of hemodialysis in a baclofen-overdose patient with normal renal function is presented. Review of literature has also been provided.
Arneson, Thomas J; Liu, Jiannong; Qiu, Yang; Gilbertson, David T.; Foley, Robert N.; Collins, Allan J.
Background and objectives: Fluid overload in hemodialysis patients sometimes requires emergent dialysis, but the magnitude of this care has not been characterized. This study aimed to estimate the magnitude of fluid overload treatment episodes for the Medicare hemodialysis population in hospital settings, including emergency departments.
Ng, P P; Leow, Y H; Ng, S K; Goh, C L
A patient with chronic renal failure on hemodialysis presented with dermatitis, particularly over the arteriovenous fistulae sites on the forearm. Patch testing revealed a positive reaction to epoxy resin present in the glue that fixed the needle of the hemodialysis cannula. PMID:9471990
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)
Lok, Charmaine E
Over the last 2 decades, hemodialysis catheter use has increased. Annually, approximately 30% of patients using a central venous catheter (CVC) experience a septic or bacteremic episode and are subsequently at risk of its associated long-term complications and mortality. Because of the serious clinical and financial impact of hemodialysis catheter-related bacteremias (HCRIs), standardized, validated definitions based on the hemodialysis patient population are necessary in order to better diagnose, monitor, and report HCRI for patient quality assurance and research purposes. The pathophysiology of HCRI involves a complex interaction between a triad that consists of the host patient, the infecting microorganism, and the vehicle catheter. Although the microorganism contribution in the pathogenesis of HCRI is likely most important, certain patient and catheter-related characteristics may be more amenable to manipulation. The key to managing HCRI is on prophylaxis against the initial microorganism catheter adherence and subsequent biofilm development. General and specific prophylactic maneuvers directed at both an intravascular and extraluminal route of microorganism entry are discussed including antibiotic- and silver-impregnated catheters and dressings, subcutaneous access devices, and topical prophylaxis at the exit site. In addition to systemic antibiotic use, the 3 methods of HRCI treatment using catheter salvage, guidewire exchange, and concurrent antibiotic lock are compared. The outcome and complications of HCRI may be serious and highlight the importance of careful, continual infection surveillance. Although the use of a multidisciplinary hemodialysis infection control team is desirable, staffing education and physician feedback have been shown to improve adherence to infection control guidelines and reduce HCRI. PMID:16815229
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
Full Text Available Background: Genotype G is the least common of all the hepatitis B virus (HBV genotypes. The existence of the genotype G strain of HBV was first noted in 2000 and little information is available on its global geographical distribution. Previous studies have demonstrated the dominance of genotype D in patients with HBV infections in Turkey.Objectives: To report for the first time in Turkey, the case of a 61 year old male patient who developed the HBV genotype G infection.Case report: According to HBV genotyping using phylogenetic analysis and an INNO-LiPA assay, the patient was infected with genotype G and G+A, respectively.Conclusions: The present clinical study suggests that the transmission of an HBV genotype other than genotype D, namely HBV genotype G, is possible in Turkey. Epidemiological and clinical information on genotype G infection is currently limited, and this is most likely due to its low prevalence throughout the world. Therefore, it may be important to determine the epidemiologic and molecular characteristics of the HBV genotype G as it relates to chronic hepatitis, to enable better understanding of its circulation and progression around the world.
Background: Genotype G is the least common of all the hepatitis B virus (HBV) genotypes. The existence of the genotype G strain of HBV was first noted in 2000 and little information is available on its global geographical distribution. Previous studies have demonstrated the dominance of genotype D in patients with HBV infections in Turkey.Objectives: To report for the first time in Turkey, the case of a 61 year old male patient who developed the HBV genotype G infection.Case report: According...
Koyama, Hidenori; 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
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.
Kouegnigan Rerambiah, Leonard; Essola Rerambiah, Laurence; Mbourou Etomba, Armel; Mouguiama, Rose Marlène; Issanga, Phanie Brunelle; Biyoghe, Axel Sydney; Batchilili, Batchelili; Akone Assembe, Sylvestre; Djoba Siawaya, Joel Fleury
Background and Objectives. There is no data analyzing the outcome of blood transfusions and oral iron therapy in patients with kidneys failure in sub-Saharan Africa. The present study aimed to fill that gap and assess the value of ferritin in the diagnosis of iron overload and deficiency. Design. From January to February 2012, we prospectively studied 85 hemodialysis patients (78% of males and 22% of females aged 20 to 79 years) attending the Gabonese National Hemodialysis Centre. Results. Correlation studies showed (a) a strong positive linear relationship between the number of blood transfusions and high serum ferritin in hemodialysis patient (Spearman r : 0.74; P value: 0.0001); (b) a weak association between the number of blood transfusions and serum iron concentrations (Spearman r : 0.32; P value: 0.04); (c) a weak association between serum ferritin and serum iron (Spearman r : 0.32; P value: 0.003). Also, the strength of agreement beyond chance between the levels of ferritin and iron in the serum was poor (? = 0.14). The prevalence of iron overload was 10.6%, whereas the prevalence of iron deficiency was 2.3%, comparing (1) patients with a maximum of one transfusion not on iron therapy; (2) patients with a maximum of one transfusion on iron therapy; (3) polytransfused patients not on iron therapy; and (4) polytransfused patients on oral iron therapy. The “Kruskal-Wallis test” showed that ferritin levels varied significantly between the groups (P value: 0.0001). Conclusion. Serum ferritin is not reliable as a marker of iron overload. For patients undergoing regular transfusion we recommend routine serum ferritin measurement and yearly measurement of LIC. PMID:25685597
Sixty-one patients at this hospital have been undergoing outpatient hemodialysis for 80 years of age, 10 who underwent conventional coronary angiography (CAG), and 13 who did not consent to participation in this study. Among the 32 patients, CT imaging demonstrated that 6 had coronary stenosis, and 20 did not have coronary stenosis. The remaining 6 patients were indeterminate (5, advanced calcification; 1, poor image quality). The average age of patients with coronary stenosis (67.3±9.5 years) and indeterminate cases (68.3±9.7 years) was significantly higher (p<0.05 and p<0.01, respectively) than that of those without coronary stenosis (54.0±11.8 years). The calcification score of indeterminate cases (1088±907) was significantly higher (p<0.05 and p<0.01, respectively) than that of patients with (351±356) or without (100±217) coronary stenosis. Four of the 6 coronary stenosis patients also had diabetes (67%), which was higher than the rate of 5/20 patients without coronary stenosis (25%), but the difference was not significant. Five of 6 patients with CT-detected coronary stenosis who underwent CAG had significant stenosis requiring treatment. One patient underwent coronary artery bypass surgery, 2 percutaneous coronary intervention (PCI), and the other 2 were ation (PCI), and the other 2 were administered drugs. One of 5/6 patients who were indeterminate on CT was found to have significant coronary artery stenosis, and PCI was performed. CT coronary artery screening detected coronary artery disease requiring treatment in 6/32 (19%) asymptomatic hemodialysis patients, on whom CAG was performed. Since 320-row CT coronary artery screening can detect untreated and latent coronary stenosis, it is useful to screen patients at the initiation of maintenance hemodialysis. (author)
Typical indications for central venous catheters (CVCs) are hemodialysis (HD), apheresis, total parenteral nutrition, analgesia, chemotherapy, long-term antibiotic therapy and cases of difficult or absent peripheral venous access. One of the largest medical services requesting CVC insertion is nephrology for HD patients. Demographics dictate that the demand for CVCs will continue to grow over the next few decades, placing striking demands on interventional radiology departments. In our centre, interventional radiologists now place nearly all percutaneously inserted HD CVCs. Radiologists provide rapid access to CVC services with significantly fewer complications than CVCs placed by other clinicians. With the demand for CVC management increasing and available operating room time decreasing, many clinicians now refer CVC insertions to radiologists. As well, clinicians who ordinarily place their own lines often refer high-risk patients, such as those who are obese or uncooperative and those with burns or coagulopathy. Our experience, derived from over 7000 CVC insertions, manipulations and removals, has allowed us to continually progress and improve our techniques, many of which are summarized here. (author)
Manuel Conrado, Domínguez Valdés; Mayra, Pacheco García; Bárbara Regla, Montero Torres; Milena, Rodríguez Carrillo; Jorge Félix, Rodríguez Ramos.
Full Text Available Introducción: el consentimiento informado supone un proceso que va más allá de la firma de un documento de autorización. Objetivo: determinar el nivel de conocimientos sobre la enfermedad renal crónica y el proceder de hemodiálisis de los pacientes del Hospital General Docente Abel Santamaría Cuadra [...] do de Pinar del Río en el período comprendido de marzo a mayo de 2012. Material y método: se realizó un estudio observacional, descriptivo, transversal y aplicado. El universo estuvo constituido por los pacientes que reciben hemodiálisis (N = 102). La muestra estuvo integrada por los pacientes que recibieron hemodiálisis el día escogido para aplicar la encuesta que debió coincidir con la segunda sesión de hemodiálisis de la semana, utilizando un método aleatorio simple (n= 85), a los que se aplicó una encuesta formulario. Para determinar la asociación entre variables se utilizó el estadígrafo ji cuadrado al 95 % de confianza. Resultados: la muestra resultó ser mayoritariamente joven, con bajo nivel educacional, siendo el dominio de la enfermedad bastante bajo, y aún más crítico el conocimiento sobre posibles complicaciones durante la hemodiálisis, cuestiones evitables de existir un documento informador previo a este proceder. Conclusiones: los pacientes con enfermedad renal crónica y con tratamientos depuradores, como la hemodiálisis, necesitan la existencia de un consentimiento informado, que sea adaptable a cada paciente, para prepararlos mejor y así lograr bienestar, confort y su total cooperación. Abstract in english Introduction: informed knowledge involves a process that goes beyond the signing of an authorization document. Objective: to determine the level of knowledge about the chronic kidney disease and the hemodialysis procedure by the patients of Abel Santamaría Cuadrado General Teaching Hospital of Pinar [...] del Río, in the period between March and May 2012. Material and method: an observational, descriptive, cross-sectional and applied study was performed. The universe was made up of the patients undergoing hemodialysis (n=120). The sample was composed by the patients who underwent hemodialysis on the days chosen for applying the survey, which should coincide with the second session of hemodialysis within the week, using the random simple method (n=85), whom were conducted the questionnaire-survey on. To determine association amongst variables, the statistical chi-square test was used at 95% of confidence. Results: the sample came to be mostly young, with low schooling, being also low their knowledge on the disease, and even more critical their knowledge about potential complications in hemodialysis, matters evitable to occur in an authorization document before this procedure. Conclusions: patients with chronic kidney disease and with purifying treatments, as hemodialysis, need to know about a proper informed concernment, applicable to each patient, in order to better prepare them and in doing so to achieve welfare, comfort and their total recovery.
Full Text Available Objective: The restless legs syndrome (RLS is characterized by unpleasant sensations and pain in the legs, irresistible urge to move the legs, especially when resting and often accompanied by sleep disorders. RLS prevalence is up to 80% in hemodialysis patients. It is such an important clinical condition that is associated with increased mortality. Moreover etiopathogenesis is not clear. We aimed to evaluate vascular disorders, heart rate variability, oxidative stress parameter in hemodialysis patients with RLS. Material and Methods: Study was conducted with hemodialysis patients. Twenty five patients diagnosed as RLS with International Restless Legs Study Group criteria, and twenty five patients without RLS (control group were included to the study. Patients were examined with complete blood count and biochemical assays, Kt/V, oxidative stress parameter such as malon dialdehyde and sulphydryl, lower extremity Doppler ultrasonography and 24 hour holter heart rate variability. Results: Patients with RLS had significantly lower hemoglobin and sodium levels (p:0.025 ve p:0.038. Tibialis posterior and anterior artery ?ow was significantly reduced in patients with RLS (p:0.011 ve p:0.010. There was significant correlation about low hemoglobin and sodium level and reduced tibialis posterior and anterior artery ?ow. With logistic regression analysis, only hemoglobin was determined as independent factor on RLS (OR 6.211 [%95 CI 1.368-26.176] p=0.018. Conclusion: It is concluded that hemoglobin is an important independent factor for progression to RLS. Therefore hemoglobin level must be maintained in normal range especially in patients with RLS.
Full Text Available Factors associated with physical well being were examined in adults with end-stage renal disease (ESRD in two large hemodialysis units of the Royal Medical Services in Jordan. Utilizing the Karnofski scale we measured the functional status of 200 Patients who had been on maintenance hemodialysis for at least 12 months. A Marnofski scale of less than 70 incidents frank disability (Inability to perform routine living activities without assistance, in addition current vocational status was assessed as well as any existing comorbid conditions. The mean age of the study group was 45.2 years (range 16 to 70 and included 108 (54% males and 92 (46% females, there were 39 (19.5% diabetic patients and 27 (13.5% patients were receiving erythropoietin (EPO. The mean hematocrit of the entire group was 27.8%. As measured by Karnofski scale, 64 (32% of the patients were unable to perform routine living activity without assistance; dependence on wheelchair was reported by 9 (4.5% patients. The mean comorbidity index of patients who scored less than 70 on the Karnofski scale was 1.5 compared to 0.7 for those who scored at least 70 on the same scale (p< 0.001. Analysis of factors showed that age and diabetes mellitus affected functional status. Of the laboratory variables measured, only serum albumin concentration correlated significant with Karnofski scale. Fourteen (21.8% of the patients who scored below 70, had serum albumin concentration above 40g/L compared to 66 (48.5% of the patients who scored at least 70 on the Karnofski scale (p< 0.001. We conclude that a significant proportion of patients on maintenance hemodialysis is functionally disabled. The elderly, diabetics, patients with high co-morbidity index and those with low serum albumin are most likely to have poor functional status.
S. T. Esfahani
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.
Bennett, Paul N; Schatell, Dori; Shah, Kamal D
Psychosocial aspects related to home hemodialysis (HD) play an important role in the success of home HD programs. Once patients commence HD at home, unique psychosocial issues related to patient and care partner burden can emerge. Proactive professional support, peer support, respite care, travel support, and financial support from the home HD health care team must be a priority for patient care. If the psychosocial aspects are not proactively addressed, patients receiving HD at home may return to in-center HD and the program may struggle as a result. This review provides a psychosocial guide for new start-up home HD programs. PMID:25925820
Mallappallil M.C., Moro Salifu, Yalemzewd Woredekal, Martin Kramer, Phillips A.R., Saurabh Malhorta, Khaled Abu-Lawi and Bluth M.H.
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.
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)
Jiang, Hong; Wang, Li; Zhang, Qian; Liu, De-xiang; Ding, Juan; Lei, Zhen; Lu, Qian; Pan, Fang
A growing number of studies have demonstrated the importance of marital quality among patients undergoing medical procedures. The aim of the study was to expand the literature by examining the relationships between stress, social support and family and marriage life among hemodialysis patients. A total of 114 participants, including 38 patients and their spouses and 38 healthy controls, completed a survey package assessing social support, stress, family functioning and marital satisfaction and quality. We found that hemodialysis patients and spouses were less flexible in family adaptability compared with the healthy controls. Patients and spouses had more stress and instrumental social support compared with healthy people. Stress was negatively associated with marital satisfaction. Instrumental support was not associated with family or marital outcomes. The association between marital quality and support outside of family was positive in healthy individuals but was negative in patients and their spouses. Family adaptability was positively associated with support within family as perceived by patients and positively associated with emotional support as perceived by spouses. In conclusion, findings suggest that social support may promote adjustment depending on the source and type. Future research should pay more attention to the types and sources of social support in studying married couples. PMID:24470353
Sung, Po-Hsun; Kan, Chung-Dann; Chen, Wei-Ling; Jang, Ling-Sheng; Wang, Jhing-Fa
For end-stage renal disease patients undergoing hemodialysis, thrombosis caused by stenosis hinders the long-term use of vascular access. However, traditional spectral bruit analysis techniques for detecting the severity of vascular access stenosis are not robust. Accordingly, the present study proposes an automated method for mimicking a trained practitioner in performing the auscultation process. In the proposed approach, the bruit obtained using a standard phonoangiographic method is transformed into the time-frequency domain, and two spectro-temporal features, namely the auditory spectrum flux and the auditory spectral centroid, are then extracted. The distributions of the two features are analyzed using a multivariate Gaussian distribution (MGD) model. Finally, the distribution parameters of the MGD model are used to detect the presence (or otherwise) of vascular access stenosis. The validity of the proposed approach is investigated using the phonoangiography signals obtained from 16 hemodialysis patients with straight arteriovenous grafts over the upper arm region. The results show that the MGD covariance matrix coefficient of the auditory spectral centroid feature yields an accuracy of 83.87 % in detecting significant vascular access stenosis. Thus, the proposed method has significant potential for the applications of vascular access stenosis detection. PMID:25681949
Hishida, Akira; Ohishi, Kazuhisa; Nagashima, Satoru; Kanamaru, Mitsutaka; Obara, Masao; Kitada, Ayako
The pharmacokinetics of cefdinir were investigated in six hemodialysis patients. For the present study, two tests were carried out, one with 4 h of hemodialysis and the other without hemodialysis. Cefdinir was given orally to each patient in a dose of 100 mg, and blood was collected serially for 48 h after dosing in the test without dialysis and for 72 h in the test with dialysis. In the test without dialysis, the maximum plasma concentration (Cmax) was 2.36 ± 0.53 ?g/ml (mean ± standard devi...
The aim of this study was to determine the spectrum of MR findings of presumed amyloid arthropathy of the hip joints in patients on long-term hemodialysis. We prospectively performed T1- and T2-weighted spin-echo imaging on 152 consecutive patients on hemodialysis. The duration of hemodialysis ranged from 5 months to 24 years, 2 months (mean: 8 years, 8 months). The frequency, location, and signal intensity of bone lesions were assessed. In 12 cases with contrast-enhanced MR examination, enhancement pattern of bone lesions, synovial lesions, and intra-articular lesions were characterized. Bone lesions presumed to be amyloid deposits were identified in 60 patients (39 %). Magnetic resonance imaging revealed that amyloid lesions were more extensive than anticipated by plain radiographs. All bone lesions showed decreased signal intensity on T1-weighted images. On T2-weighted images, bone lesions showed increased signal intensity in 32 patients (54 %), decreased signal intensity in 11 patients (18 %), and both increased and decreased signal intensity in 17 patients (28 %). Following intravenous injection of gadolinium-based contrast, all bone lesions showed moderate enhancement. Synovial thickening could not be identified on T1- and T2-weighted images. However, contrast-enhanced images showed thickened synovial membrane, which could be differentiated from joint fluid. Intra-articular nodules showed decreased or intermediate signal intensity on T1-weighted images and decre intensity on T1-weighted images and decreased signal intensity on T2-weighted images; the intra-articular nodules were contiguous with subchondral bone lesions. Magnetic resonance imaging is useful for evaluating the distribution and extent of amyloidosis of the hip joints in patients undergoing long-term hemodialysis. (orig.) (orig.)
Tuot, Delphine; Gibson, Suzanne; Caughey, Aaron B.; Frassetto, Lynda A
Pregnancy in chronic dialysis patients is unusual and associated with many complications. Infants are often born both prematurely and small for gestational age. We report a case of a 36-year-old diabetic hemodialysis patient G4P3 who had prolonged hyperemesis gravidarum, for whom intradialytic parenteral nutrition (IDPN) was started at week 14 and continued throughout her pregnancy. She delivered a 3.5-kg baby girl at the 36th week of gestation by cesarean section. We discuss the use of IDPN ...
Tuot, Delphine; Gibson, Suzanne; Caughey, Aaron B; Frassetto, Lynda A
Pregnancy in chronic dialysis patients is unusual and associated with many complications. Infants are often born both prematurely and small for gestational age. We report a case of a 36-year-old diabetic hemodialysis patient G4P3 who had prolonged hyperemesis gravidarum, for whom intradialytic parenteral nutrition (IDPN) was started at week 14 and continued throughout her pregnancy. She delivered a 3.5-kg baby girl at the 36th week of gestation by cesarean section. We discuss the use of IDPN as adjunct therapy for pregnant dialysis patients. PMID:19911296
F.V., Perícole; M.A.V.R., Alves; S.T.O., Saad; F.F., Costa.
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 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.
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.
Full Text Available To determine the frequency of hemodialysis (HD catheter related infection, causative microorganisms and predisposing factors contributing to these infections at our center, we con-ducted a prospective study in 2007 involving 57 (45.6% males patients in whom a temporary catheter was inserted for HD. The patients were followed for one month to document any episodes of hemodialysis catheter related infection (HCRI. There were 11 (19.3% patients who developed HCRI proven by blood culture; 5 patients were infected with more than one organism. Staphyloco-ccus Coagulase negative and Staphylococcus aureus (S. aureus remain the most common patho-gens. All the organisms were sensitive to antibiotics administered empirically, however, 3 patients developed multiple resistant S. aureus (MRSA. All the infected patients experienced previous epi-sodes of HCRI, which formed a risk factor in addition to low albumin when compared to the non-infected group (P=0.024 and P= 0.001, respectively. We conclude that the rate of HCRI and the causative organisms found in our study is comparable to previous reports. We still need to adopt measures to minimize the use of temporary vascular accesses by creation of fistulas in a timely fashion.
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)
Full Text Available Zulfitri A Mat Daud,1 Boniface Tubie,2 Marina Sheyman,2 Robert Osia,2 Judy Adams,2 Sharon Tubie,2 Pramod Khosla1 1Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA; 2Great Lake Dialysis Clinic, LLC, Detroit, MI, USA Purpose: Chronic hemodialysis patients experience accelerated atherosclerosis contributed to by dyslipidemia, inflammation, and an impaired antioxidant system. Vitamin E tocotrienols possess anti-inflammatory and antioxidant properties. However, the impact of dietary intervention with Vitamin E tocotrienols is unknown in this population. Patients and methods: A randomized, double-blind, placebo-controlled, parallel trial was conducted in 81 patients undergoing chronic hemodialysis. Subjects were provided daily with capsules containing either vitamin E tocotrienol-rich fraction (TRF (180 mg tocotrienols, 40 mg tocopherols or placebo (0.48 mg tocotrienols, 0.88 mg tocopherols. Endpoints included measurements of inflammatory markers (C-reactive protein and interleukin 6, oxidative status (total antioxidant power and malondialdehyde, lipid profiles (plasma total cholesterol, triacylglycerols, and high-density lipoprotein cholesterol, as well as cholesteryl-ester transfer protein activity and apolipoprotein A1. Results: TRF supplementation did not impact any nutritional, inflammatory, or oxidative status biomarkers over time when compared with the baseline within the group (one-way repeated measures analysis of variance or when compared with the placebo group at a particular time point (independent t-test. However, the TRF supplemented group showed improvement in lipid profiles after 12 and 16 weeks of intervention when compared with placebo at the respective time points. Normalized plasma triacylglycerols (cf baseline in the TRF group were reduced by 33 mg/dL (P=0.032 and 36 mg/dL (P=0.072 after 12 and 16 weeks of intervention but no significant improvement was seen in the placebo group. Similarly, normalized plasma high-density lipoprotein cholesterol was higher (P<0.05 in the TRF group as compared with placebo at both week 12 and week 16. The changes in the TRF group at week 12 and week 16 were associated with higher plasma apolipoprotein A1 concentration (P<0.02 and lower cholesteryl-ester transfer protein activity (P<0.001. Conclusion: TRF supplementation improved lipid profiles in this study of maintenance hemodialysis patients. A multi-centered trial is warranted to confirm these observations. Keyword: vitamin, tocotrienol-rich fraction, lipid profiles, hemodialysis, end-stage renal disease, nutrition intervention
Full Text Available The prevalence of anti-HCV antibodies among hemodialysis (HD patients was studied at King Fahad Hospital, Hofuf, Saudi Arabia. The records of 189 patients undergoing HD were reviewed. The overall prevalence of anti-HCV antibodies was 43.9%. Anti-HCV antibody prevalence was more common among female patients. There was no correlation between repeated blood transfusions and anti-HCV positivity as 4.8% of the patients who did not receive any blood transfusion during HD were positive for anti-HCV antibodies. A positive correlation was observed between the duration on dialysis and anti-HCV antibodies. An annual serocoversion rate of 6.8% was observed in this study.
M. Moini A. Shojaeefard
Full Text Available Arteriovenous fistula is considered as a prerequisite in patients with chronic renal failure undergoing hemodialysis. The purpose of this study was to compare the effectiveness and side effects if any of native vein and synthetic grafts in these patients. From April 2002 till July 2003, a total of 37 patients were referred to us for the utilization of these grafts. In 16 out of these patients we utilized native vein at the elbow joint, and in 21 patients we used polytetrafluoroethylene (PTFE graft. In the native group, the results were better and side effects minimal and economically was in the interest of the patients. We advocate native vein as far as possible and give it a top priority.
Johnson, L Z; Martinez, I; Fernández, M C; Davis, C P; Kasinath, B S
A 43-year-old woman took a large amount of depakote (divalproex, a slow-release form of valproate), became comatose, and developed severe hypotension refractory to fluid resuscitation and high-dose vasopressors. The serum valproic acid (VPA) concentration on admission was 1,380 microgram/mL (therapeutic range, 50 to 100 microgram/mL). She also had metabolic acidosis, thrombocytopenia, and normal renal and liver functions. Hemodialysis was initiated 4 hours after presentation. After 6 hours of hemodialysis with a high-flux dialyzer, her serum VPA concentration decreased from 940 microgram/mL to 164 microgram/mL, coincident with improvement in clinical status. The half-life of VPA was reduced to 2.4 hours with hemodialysis, whereas it was 7.2 hours before the procedure. Hemodialysis could be a valuable therapeutic intervention in VPA toxicity. PMID:10196025
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...
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
Ashby, Damien R.; Power, Albert; Singh, Seema; Choi, Peter; Taube, David H.; Duncan, Neill D.; Cairns, Tom D.
Background and objectives: Treatment without catheter replacement (catheter salvage) has been described for bacteremia associated with tunneled venous catheters in hemodialysis patients, but few data are available on which to base an estimation of the likelihood of treatment success.
Mercadal, Lucile; Servais, Aude; Venditto, Marcia; Renault, Nathalie; Isnard-bagnis, Corinne; Deray, Gilbert; Petitclerc, Thierry
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.
Yu, Jin-Gang; Yu, Lin-Yan; Jiang, Xin-Yu; Chen, Xiao-Qing; Tao, Li-Jian; Jiao, Fei-Peng
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
Sabahattin Ocak; Nizami Duran; Ali F. Eskiocak; Hasip Aytac
OBJECTIVES Toxoplasma is a globally distributed pathogen for humans and animals. In situations of immunodeficiency, Toxoplasma gondii (T. gondii) emerges as a life-threatening infection. Toxoplasma gondii is transmitted parenterally, flourish in state immunosuppression and, most toxoplasma infections are asymptomatic. In the present study, we aimed to investigate the prevalence of anti-T. gondii antibodies in hemodialysis patients with chronic renal failure. We undertook a prospective stud...
Misanovic, Verica; Jonuzi, Fedzat; Anic, Dusko; Halimic, Mirza; Rahmanovic, Samra
Introduction: Application of a central venous catheter (CVC), as a temporary or permanent vascular access for hemodialysis, has been continuous practice at the Sarajevo Pediatric Clinic, Department of Pediatric Intensive Care. The main goal of the article is to present our experiences with central venous catheters in the treatment of these patients. Material and methods: In the period from January 2009 to December 2014 a total of 41 patients were treated and a total of 56 catheters were placed. Results: The results show the prevalence of the femoral venous catheter (69,64%), with significantly smaller participation of jugular (28,57%) and symbolic participation of subclavian catheters (1,78%). Frequency of infections of 8,92% in our article is lower than the percentage contained in the data of the National Nosocomial Infections Surveillance System, which provided data related to 17% of catheter related infections. The most common agents of the catheter related infections in our patients are gram-negative bacteria from the Klebsiella pneumoniae group. Conclusion: The issue of the higher complication percentage during the treatment is linked with hemostasis related to bleeding into or around the catheters in 28,57% of patients, and to clotting disorder in terms of thrombosis in 10,71% of patients.
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.
Afshin Azhir; Jafar Nasiri; Alaleh Gheisari
OBJECTIVES To determine the prevalence and severity of anemia, and to identify independent predictors for anemia in children on hemodialysis. METHODS We conducted this cross sectional study on 25 children aged 7-20 years receiving hemodialysis from September 2005 to January 2006 in Isfahan University of Medical Sciences, Isfahan, Iran. RESULTS A total of 22 (82%) patients had hemoglobin (Hb) level of <11 g/dL (anemia) and 12 (48%) patients had Hb values <8 g/dL (severe an...
Although volume excess causes hypertension whether it also affects circadian patterns of arterial pressures among hemodialysis patients remains unknown. To test the notion whether volume overload is associated with a unique BP “signature” a post-hoc analysis was performed among 145 patients participating in the dry-weight reduction in hypertensive hemodialysis patients (DRIP) randomized controlled trial. Using 400 ambulatory BP recordings over 8 weeks comprising 35,302 measurements the tr...
Background: During hemodialysis, most of the elements must be kept in a rather narrow physiological range, otherwise life-threatening events may occur. Furthermore, lipid peroxidation in patients may be partly due to the trace element disturbances. It has been mentioned that there are relations between deficiency in trace elements and antioxidant levels. The present study aimed to determine whether there were differences between hemodialysis patients and a healthy group according to selenium,...
Lee, Chris P.; Zenios, Stefanos A; CHERTOW, GLENN M.
Published evidence suggests that frequent hemodialysis (more than three times per week) for patients with ESRD may improve health-related quality of life and has the potential to increase longevity and reduce hospitalization and other complications. Here, a Monte Carlo simulation model was used to compare varying combinations of in-center hemodialysis frequency (three to six treatments per week) and session length (2 to 4.5 h per session) with regard to unadjusted and quality-adjusted life-ye...
Rezende, L. T. T.; Cuppari, L.; Carvalho, A. B.; Canziani, M. E. F.; Manfredi, S. R.; Cendoroglo, M.; Sigulem, D. M.; Draibe, S. A.
The repercussions of secondary hyperparathyroidism on the nutritional status of chronic renal failure patients have not been well established. Therefore, the aim of this study was to compare the nutritional indices of hemodialysis patients with and without secondary hyperparathyroidism. Sixteen hemodialysis patients with serum parathyroid hormone (PTH) levels higher than 420 pg/ml (hyperparathyroidism group) were matched for gender, age and length of dialysis treatment to 16 patients with ser...
Myers, Orrin B.; Adams, Christopher; Rohrscheib, Mark R.; Servilla, Karen S.; Miskulin, Dana; Bedrick, Edward J.; Zager, Philip G.
Observational studies involving hemodialysis patients suggest a U-shaped relationship between BP and mortality, but the majority of these studies followed large, heterogeneous cohorts. To examine whether age, race, and diabetes status affect the association between systolic BP (SBP; predialysis) and mortality, we studied a cohort of 16,283 incident hemodialysis patients. We constructed a series of multivariate proportional hazards models, adding age and BP to the analyses as cubic polynomial ...
Marshall, Mark R; Young, Bessie A; Fox, Sally J; Cleland, Calli J; Walker, Robert J; Maskane, Ikuto; Herold, Aaron M
An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes. PMID:25925827
Eloá Angélica Koehnlein
Full Text Available Os pacientes em tratamento de hemodiálise são acometidos, frequentemente, por alterações do estado nutricional, associadas fortemente à elevada morbimortalidade nessa população. Este estudo teve como objetivo avaliar o estado nutricional e a adequaçãoda dieta dos pacientes em hemodiálise. Foram estudados 31 pacientes, por meio dos prontuários de uma clínica de nefrologia de Maringá, Estado do Paraná, do período de novembro de 2005 a fevereiro de 2006. A população foi composta de 61,29% de adultos e 38,71% de idosos. O índice de massa corporal apontou que 12,9% dos pacientesapresentavam baixo peso e 32,26% excesso de peso. A ingestão média de nutrientes estava adequada em carboidratos, proteínas, ferro, fósforo e potássio; deficiente em calorias, lipídios e cálcio e excedente em água e sódio. Dessa forma, evidencia-se que o acompanhamento nutricional é uma conduta de destaque, em virtude da elevada prevalência de distúrbios nutricionais e dietéticos nessa população.Patients undergoing hemodialysis are frequently subjected to alterations in their nutritional state, strongly associated with increased morbimortality in this population. This study had as objective to appraise the nutritional state and the adequacy of the diet of patients undergoing hemodialysis. We studied 31 patients by means of records from a nephrology clinic located in Maringá, Paraná State, from November 2005 to February 2006. The population wascomposed of 61.29% adults and 38.71% elderly patients. The body mass index indicated that 12.9% of patients had low weight and 32.26% were overweight. The average intake of nutrients was adequate for carbohydrates, protein, iron, phosphorus and potassium, butdeficient in calories, lipids and calcium, and excessive in water and sodium. As such, it is evidenced that nutritional evaluation is an essential activity, given the high prevalence of nutritional and dietary disorders observed in this population.
Michaud, Josée; Nolin, Thomas D; Naud, Judith; Dani, Mélina; Lafrance, Jean-Philippe; Leblond, Francois A; Himmelfarb, Jonathan; Pichette, Vincent
Cytochrome P450 (CYP) functional expression is reduced in uremia and normalized after restoration of kidney function via transplantation. The aim of this study was to evaluate the effect of conventional hemodialysis on the functional expression of CYP1A, 2C, and 3A. We also investigated the role of nuclear factor-kappaB (NF-kappaB) in CYP regulation during uremia. Primary cultures of normal rat hepatocytes were incubated with serum obtained from end-stage renal disease patients pre- and post-hemodialysis and healthy control subjects, in the presence and absence of the NF-kappaB inhibitor andrographolide. Uremic pre-hemodialysis serum caused significant reductions (Pserum, while dialyzed serum (i.e., obtained immediately post-hemodialysis) had no effect. CYP1A2, 2C11, and 3A2 mRNA expression, as well as CYP3A activity, were similarly impacted by uremic serum and were improved to >80% of control values after hemodialysis. NF-kappaB inhibition nearly eliminated the effect of uremic serum on CYP functional expression. This is the first study to demonstrate that conventional hemodialysis acutely improves altered CYP functional expression observed in rat hepatocytes incubated with uremic human serum. PMID:18845914
Rose Anne Kulik
Full Text Available Chronic renal insufficiency disease (CRI leads to uremia in hemodialysis patients and induces a state of immunodepression that results in higher frequencies of infections and diarrhea. Hemodialysis patients resident in the city of Campo Mourão, Paraná, Brazil were analyzed from April 2006 through September 2007 for Blastocystis sp. and other intestinal parasites and for associated diarrhea. Fecal samples from 86 hemodialysis patients and 146 healthy (reference persons were examined by standard methods for detecting ova, larvae and cysts, which included preservation in 10% formalin and the Kinyoun method. Thirty-three hemodialysis patients (45.1% and 36 reference individuals (25.7% were found to be parasitized. The differences in the percentages of parasitism and polyparasitism between the reference group and the chronic renal patients was significant (p= 0.0318 and 0.0019, respectively. Blastocystis sp. (18%-20.1%, Endolimax nana (14%-16.3%, Cryptosporidium sp. (4%-4.7% and Entamoeba coli (4%-4.7% were the most frequent protozoa found in the hemodialysis patients. Parasitism was not significantly associated with diarrhea (p=0.9947 or with decreased white blood cell counts (p=0.7046 in these individuals. Because parasitic infections may be an important comorbidity factor in hemodialysis patients, we suggest that parasitological stool examinations, especially for Blastocystis sp. and Cryptosporidium sp., be included in routine medical follow-up examinations of these patients.
Rose Anne, Kulik; Dina Lúcia Morais, Falavigna; Letícia, Nishi; Silvana Marques, Araujo.
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 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.
Siminelakis Stavros N; Tzimas Petros; Baikoussis Nikolaos G; Papadopoulos Georgios; Karanikolas Menelaos
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 com...
Gabbay, Ezra; Meyer, Klemens B.; Griffith, John L.; Richardson, Michelle M.; Miskulin, Dana C
Background and objectives: Health-related quality of life (HRQOL) is a measure of the well being of hemodialysis patients and an independent prognostic predictor. Our aim was to determine whether HRQOL among hemodialysis patients has changed over time.
Krane, Vera; Heinrich, Fritz; Meesmann, Malte; Olschewski, Manfred; Lilienthal, Jürgen; Angermann, Christiane; Störk, Stefan; Bauersachs, Johann; WANNER, CHRISTOPH; Frantz, Stefan
Background and objectives: In hemodialysis, applicable guidelines recommend regular electrocardiogram (ECG) recordings. However, respective systematic evaluations are absent. Thus, the authors investigated whether routine ECG findings add prognostic information to standard risk assessment in hemodialysis.
Chang, Teng; Kyu, Thein; Define, Linda; Alexander, Thomas
A soybean-derived phytochemical called genistein was used as a modifying agent to polyether sulfone/polyvinyl pyrrolidone (PES/PVP) blends to produce multi-functional hemodialysis membranes. With the aid of phase diagrams of PES/PVP/genistein blends, asymmetric porous membranes were fabricated by coagulating in non-solvent. Both unmodified and genistein modified PES/PVP membranes were shown to be non-cytotoxic to the blood cells. Unmodified PES/PVP membranes were found to reduce reactive oxygen species (ROS) levels, whereas the genistein modified membranes exhibited suppression for ˜60% of the ROS levels. Also, the genistein modified membranes revealed significant suppression of pro-inflammatory cytokines: IL-1?, IL-6, and TNF-?. Moreover, addition of PVP to PES showed the reduced trend of platelet adhesion and then leveled off. However, the modified membranes exhibited suppression of platelet adhesion at low genistein loading, but beyond 15 wt%, the platelet adhesion level rised up.
Al Shohaib, S; El Johary, M; Zawawi, T
Subclavian vein catheterization, the most commonly used temporary vascular access for hemodialysis, is associated with a variety of complications. This retrospective study was done on 96 patients who had 150 percutaneous subclavian vein catheterizations over a one year period using Quinton double lumen polyurethane catheters. A total of 56 complications were seen of which 12 were immediate and 44 delayed. Immediate complications seen were six cases of failure of insertion of catheter and three cases each of subclavian artery puncture and inadvertent entry of the catheter into the jugular vein. Delayed complications seen were infection in 33 cases, thrombosis of subclavian vein in six patients, delayed pneumothorax in four cases and hemothorax in one. One patient, who required repeated catheterizations since he refused creation of AV fistula, died of septicemia. The remaining patients responded well to the treatment of the respective complications. PMID:18583775
Full Text Available The objective of the study was to determine the level of ?2-microglobulin (?2-m in hemodialysis (HD patients and the factors affecting it. This cross sectional, hospital based study was conducted between September and December 2008 at the Hemodialysis unit of Shalamar Hospital, Lahore. All patients with end-stage renal disease (ESRD who were on main-tenance HD for more than three months were included in the study. Patients with acute renal failure and on dialysis for less than three months were excluded. Demographic data were collec-ted and details of dialysis (type of dialyzers, dialysate bath, membrane used were recorded. Blood samples of the patients were drawn for hematological (hemoglobin, hematocrit, bioche-mical (urea, creatinine, uric acid, albumin and ?2-m level measurement. The total number of patients studied was 50. The major causes of ESRD included diabetes mellitus and hypertension seen in 37 (74% and 10 patients (20%, respectively. The ?2-m levels were significantly elevated in the study patients; 92.6 ± 17.1 mg/L with a range of 54 to 130 mg/L as compared to 2.0 ± 1.29 mg/L in the control group. The patients? age had a statistically significant relationship with the ?2-m level. The major reason for increased ?2-m level was use of low-flux dialyzers. Synthetic polysulphone membrane, bicarbonate, ultra pure dialysate and duration on HD were not asso-ciated with high ?2-m levels. Also, we found an inverse relationship between ?2-m levels and serum albumin of the study patients. Our study suggests that the ?2-m levels are significantly high in dialysis patients. Use of low-flux dialyzer seems to be the major reason for the high ?2-m levels. Age and albumin have statistically significant relationship with ?2-m levels.
Jayanti, Anuradha; Morris, Julie; Stenvinkel, Peter; Mitra, Sandip
There is increasing interest of the worldwide kidney community in home hemodialysis (HHD). This is due to emerging evidence of its superiority over conventional hemodialysis (HD), largely attributed to improved outcomes on intensive schedule HD, best deployed in patient's own homes. Despite published work in this area, universal uptake remains limited and reasons are poorly understood. All those who provide HD care were invited to participate in a survey on HHD, initiated to understand the beliefs, attitudes, and practice patterns of providers offering this therapy. The survey was developed and posted on the Nephrology Dialysis Transplantation-Educational (NDT-E) website. Two hundred and seventy-two responses were deemed suitable for complete analysis. It is apparent from the survey that there is great variability in the prevalence of HHD. Physicians have a great deal of interest in this modality, with majority viewing home as being the ideal location for the offer of intensive HD schedules (55%). A significant number (21%) feel intensive HD may be offered even outside the home setting. Those who offer this therapy do not see a financial disadvantage in it. Many units identify lack of appropriately trained personnel (35%) and funding for home adaptation (50.4%) as key barriers to widespread adoption of this therapy. Despite the interest and belief in this therapy among practitioners, HHD therapy is still not within reach of a majority of patients. Modifiable organizational, physician, and patient factors exist, which could potentially redefine the landscape of HHD provision. Well-designed systematic research of national and local barriers is needed to design interventions to help centers facilitate change. PMID:24814711
Afshin Azhir; Jafar Nasiri; Alaleh Gheisari
BACKGROUNDS: This study was conducted to determine the prevalence and severity of anemia in children and adolescents on chronic hemodialysis, and to identify independent predictors of anemia in children on hemodialysis. METHODS: This cross-sectional study was performed between September 2005 and January 2006. The study population consisted of 25 patients aged 7?20 years on chronic hemodialysis from pediatric hemodialysis centers in Isfahan. RESULTS: A total of 22 (88%) patients ...
Reza Afshar; Hassan Ghasemi,; Hoda Shabpiray; Saeid Abdi; Ali Davati; Nikan Zerafatjou; Mani Khorsand Askari
Introduction. End-stage renal disease and hemodialysis affect intraocular pressure (IOP). This study aimed to evaluate the effects of a one session of hemodialysis on IOP. Materials and Methods. In this study, the IOP of 130 eyes of 65 hemodialysis patients (38 men and 27 women) was measured before and every 1 hour after the initiation of hemodialysis therapy. Patients with any glaucomatous conditions were excluded. Demographic information including age, gender, underling systemic or ocular d...
Shimamura, Shunsuke; Kimura, Ken; Katayama, Masaaki; MASHITA, Tadahisa; MAEDA, Kenichi; Kobayashi, Saori; Sato, Reeko; YASUDA, Jun
This study evaluated the number and function of neutrophils during 3 hr of hemodialysis in healthy dogs under anesthesia. Isolated neutrophils were used to assess neutrophil adhesion, phagocytosis and the oxidative burst. At 0.5 and 3 hr after the start of hemodialysis treatment, there was a decrease in neutrophil number. The phagocytic ability of neutrophils was decreased 3 hr after the start of hemodialysis. In conclusion, this study demonstrated that hemodialysis reduces ...
Song, Yeohan; Tai, Julie H.Y.; Bartsch, Sarah M; Zimmerman, Richard K; Muder, Robert R.; Lee, Bruce Y.
Staphylococcus aureus infections are a substantial problem for hemodialysis patients. Several vaccine candidates are currently under development, with hemodialysis patients being one possible target population. To determine the potential economic value of a Staphylococcus aureus vaccine among hemodialysis patients, we developed a Markov decision analytic computer simulation model. When Staphylococcus aureus colonization prevalence was 1%, the incremental cost-effectiveness ratio (ICER) of vac...
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.
Han, Seung Seok; Cho, Hyunjeong; Kim, Ho; Ryu, Dong-Ryeol; Kim, Hyunwook; Lee, Hajeong; Lee, Jung Pyo; Lim, Chun-Soo; Kim, Kyoung Hoon; Joo, Kwon Wook; Kim, Yon Su; Kim, Dong Ki
Background Weights assigned to comorbidities to predict mortality may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in incident hemodialysis patients (mCCI-IHD), thereby improving risk stratification for mortality. Methods Data on 24,738 Koreans who received their first hemodialysis treatment between 2005 and 2008 were obtained from the Korean Health Insurance dataset. The mCCI-IHD score were calculated by summing up the weights which were assigned to individual comorbidities according to their relative prognostic significance determined by multivariate Cox proportional hazards model. The modified index was validated in an independent nationwide prospective cohort (n=1,100). Results The Cox proportional hazards model revealed that all comorbidities in the CCI except ulcers significantly predicted mortality. Thus, the mCCI-IHD included 14 comorbidities with re-assigned severity weights. In the validation cohort, both the CCI and the mCCI-IHD were correlated with mortality. However, the mCCI-IHD showed modest but significant increases in c statistics compared with the CCI at 6 months and 1 year. The analyses using continuous net reclassification improvement revealed that the mCCI-IHD improved net mortality risk reclassification by 24.6% (95% CI, 2.5-46.7; P=0.03), 26.2% (95% CI, 1.0-51.4; P=0.04) and 42.8% (95% CI, 4.9-80.8; P=0.03) with respect to the CCI at 6 months and 1 and 2 years, respectively. Conclusions The mCCI-IHD facilitates better risk stratification for mortality in incident hemodialysis patients compared with the CCI, suggesting that it may be a preferred index for use in clinical practice and the statistical analysis of epidemiological studies. PMID:25984790
Kozlova, T V; Shilo, V Iu; Denisov, A Iu
The subjects of the study were 60 patients at the end stage of chronic renal failure of various origins, who were on program hemodialysis (PHD) in Dialysis Center of City hospital #20. The main group consisted of 25 patients, who were administered fragmin (Pfizer, USA), a low-molecular heparin, for hypocoagulation during the procedure of hemodialysis. The drug was administered in a bolus dose of 5000 aXa ICU into the arterial line after connecting it to a fistula needle. The control group (35 patients) received unfranctionated heparin (UFH) in a conventional way (a bolus of 2000 to 2500 IU before the beginning of the procedure, followed by 1200 to 1500 IU/h in a continuous infusion, stopped 1 hour prior to the end of the dialysis). The following parameters were measured at the beginning and the end of the procedure: the number of thrombocytes, hemoglobin and hematocrit levels, activated partial thromboplastin time, activated coagulation time, antithrombin III level, and anti-Xa factor activity. Standard regimen of UFH administration allowed satisfactory hypocoagulation, but the necessary dose was hard to select. A bolus dose of fragmin led to adequate hypocoagulation in all the patients: there were no fibrin or blood clots in the lines or the dialyzer, or hemorrhage from the sites of puncture after the procedure. Anti-Xa-factor activity grew after a bolus injection of fragmin. By the end of the procedure the inhibitory activity of fragmin towards Xa-factor remained at the level of 0.44 +/- 0.7 IU/ml. The results show that a single dose of fragmin is effective and safe during a standard procedure of hemodialysis lasting up to 5 hours. PMID:16279040
Vanessa Giendruczak da Silva
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.
Bone mineral content (BMC) in the total body and lumbar spine was evaluated in 126 hemodialysis patients (60 males, 66 females) by dual photon absorptiometry with the Norland DBD 2600. Measurements of: 1) total body BMC divided by lean body mass (BMCTB/LBM), 2) bone mineral density (BMD) of total body, 3) BMD of four regional sections (head, trunk, pelvis, and legs), and 4) BMD of lumbar spine, generally showed a significant decrease in the hemodialysis patients compared to the reference population. However, arm BMD did not show a significant difference between patients and control populations. The z-score of BMCTB/LBM declined significantly throughout the duration of hemodialysis, although that of the lumbar spine BMD did not. It should be noted that the degree of decrease in BMC was more prominent in the total body measurement than in the lumbar spine measurement. There was preferential osteopenia of the total body in the hemodialysis patients. Although the lumbar spine BMD showed a lower value than the control population, the lumbar spine is not the recommended region to monitor the BMD change in hemodialysis patients. (author)
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.
Full Text Available PURPOSE: To evaluate alanine aminotransferase levels before and after a hemodialysis session and to correlate these values with the hematocrit rate and weight loss during hemodialysis. PATIENTS AND METHODS: The serum alanine aminotransferase levels, hematocrit rate and body weight were measured and [...] correlated before and after a single hemodialysis session for 146 patients with chronic renal failure. An receiver operating characteristic (ROC) curve for the serum alanine aminotransferase levels collected before and after hemodialysis was plotted to identify hepatitis C virus-infected patients. RESULTS: The mean weight loss of the 146 patients during hemodialysis was 5.3% (p
Raquianestesia contínua em paciente submetido à gastrectomia parcial: relato de caso Raquianestesia continua en paciente sometido a la gastrectomía parcial: relato de caso Continuous spinal block in a patient undergoing partial gastrectomy: case report
Patrícia Falcão Pitombo
Full Text Available JUSTIFICATIVA E OBJETIVOS: Devido à alta incidência de complicações técnicas e neurológicas, a raquianestesia contínua foi abandonada por muitos anos. Com o surgimento dos cateteres intermediários, a técnica vem ressurgindo e ganhando simpatia no arsenal anestesiológico. O objetivo deste relato foi resgatar a utilidade da técnica como alternativa viável para procedimento de médio a grande porte. RELATO DO CASO: Paciente feminina, 58 anos, 62 kg, estado físico ASA I, com relato de enxaqueca, lombalgia e procedimentos cirúrgicos prévios sob raquianestesia sem intercorrências. Candidata à laparotomia exploradora por provável tumor pélvico. Após venóclise com cateter 18G, monitorização com cardioscópio, pressão arterial-não invasiva e oximetria de pulso, foi sedada com midazolam 2 mg e fentanil 100 ¼g e colocada em decúbito lateral esquerdo. Foi submetida à raquianestesia contínua por via mediana em L3-L4. Foram injetados 9 mg de bupivacaína hiperbárica a 0,5% e 120 ¼g de sulfato de morfina. Após inspeção da cavidade, verificou-se que o tumor era proveniente do estroma gástrico, sendo necessária ampliação da incisão e realização de gastrectomia parcial. Todo o procedimento foi realizado com pequena dose de solução hiperbárica e completa estabilidade hemodinâmica. Não houve necessidade de UTI no pós-operatório e a paciente evoluiu sem queixas e com alto grau de satisfação. Recebeu alta hospitalar após 72 horas sem nenhuma intercorrência. CONCLUSÕES: Os cateteres intermediários utilizados em raquianestesia contínua mostram-se promissores em tornar a técnica bastante atraente e de grande utilidade em operações de médio a grande porte, podendo inclusive ser alternativa eficaz no manuseio de pacientes em estado crítico, em que grandes repercussões hemodinâmicas podem ser deletérias.JUSTIFICATIVA Y OBJETIVOS: A causa de la elevada incidencia de las complicaciones técnicas y neurológicas, la raquianestesia continua fue abandonada durante muchos años. Con el surgimiento de los catéteres intermediarios, la técnica ha venido evolucionando nuevamente y obteniendo la simpatía en el arsenal anestesiológico. El objetivo de este relato, fue rescatar la utilidad de la técnica como una alternativa viable para el procedimiento de medio y gran porte. RELATO DEL CASO: Paciente femenina, 58 años, 62 kg, estado físico ASA I, con relato de jaqueca, lumbago y procedimientos quirúrgicos previos, bajo raquianestesia sin intercurrencias. Candidata a laparotomía exploradora por un probable tumor pélvico. Después de efectuada la venoclisis con catéter 18G, monitorización con cardioscopio, presión arterial no invasiva, y la oximetría de pulso, se le sedó con midazolam 2 mg y fentanil 100 ¼g y se le puso en decúbito lateral izquierdo. Se le sometió a la raquianestesia continua por vía mediana en L3-L4. Se le inyectaron 9 mg bupivacaína hiperbárica a 0,5% y 120 ¼g de sulfato de morfina. Después de la inspección de la cavidad, se verificó que el tumor era proveniente del estroma gástrico, siendo necesaria la ampliación de la incisión y la realización de gastrectomía parcial. Todo el procedimiento fue realizado con una pequeña dosis de solución hiperbárica y una completa estabilidad hemodinámica. No hubo necesidad de UCI en el postoperatorio y la paciente evolucionó sin quejarse y con un alto grado de satisfacción. Recibió el alta después de 72 horas sin ningún problema. CONCLUSIONES: Los catéteres intermediarios utilizados en la raquianestesia continua parecen ser promisorios en hacer con que la técnica sea bastante atractiva y de gran utilidad en operaciones de medio y gran porte, y puede incluso ser una alternativa eficaz en el manejo de pacientes en estado crítico, donde las grandes repercusiones hemodinámicas pueden ser perjudiciales.BACKGROUND AND OBJECTIVES: Due to the high incidence of technical and neurological complications, continuous spinal blocks were not performed for several years. With the advent of intermediate
Probing the dry weight (DW) was largely dependent on clinical subjective estimate until recently. New bedside non-invasive tools have been developed with the aim of providing more objective information on volume status and guiding physicians in the quest for DW. Among them, bioimpedance (BIA) appears to be very promising in the achievement of this goal. Resistance (R) and capacitance of tissue are the two basic properties in BIA. However, although impedance is an electrical property of tissues that can be directly used in body composition analysis, it is commonly embedded in predictive equations that are derived by correlation with criterion measures of body compartments. In recent studies continuous regional calf multifrequency BIA spectroscopy and wrist-to-ankle whole-body single-frequency BIA were used during dialysis sessions to assess DW. The latter was defined as the weight achieved after flattening of the R0/Rt slope (R0 is R at time 0 and Rt is R at at a given time t during the HD session) for a period of at least 20 minutes despite ongoing ultrafiltration, indicating no further decline in extracellular volume. Two are the main advantages of these methods: they use directly R, with no need for predictive equations; they do not depend on comparison with healthy subjects but mainly use patients as their own control to define DW as stabilization of the R0/Rt slope. In conclusion, clinical methods are fundamental in probing the DW. They must be supported by strict BIA protocols. BIA appears to be a (the) brilliant solution in solving the old problem of DW in hemodialysis patients. PMID:25774591
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.
To study the effect of ANF and iPTH on hypotension during hemodialysis, the serum ANF and iPTH levels of 36 maintenance hemodialysis patients were detected by radioimmunoassay and immunoradiometricassay. Results showed that both ANF and iPTH average levels in hemodialysis patients were markedly higher than those in normal controls (P<0.01), and decreased significantly after hemodialysis (P<0.01). Before hemodialysis, both ANF and iPTH levels in hypotensive patients were significantly higher than those in normotensive patients (P<0.05). After hemodialysis in hypotensive patients, ANF levels decreased significantly (P<0.05), and iPTH levels increased significantly (P<0.05). Conclusions: The high serum level of ANF and iPTH might be related to hypotension during hemodialysis
Schupp, Nicole; Dette, Eva Maria; Schmid, Ursula; Bahner, Udo; Winkler, Michaela; Heidland, August; Stopper, Helga
Hemodialysis patients have an elevated genomic damage in peripheral blood lymphocytes (PBLs) and an increased cancer incidence, possibly due to accumulation of uremic toxins like advanced glycation end products (AGEs). Because the vitamin B1 prodrug benfotiamine reduces AGE levels in experimental diabetes, and dialysis patients often suffer from vitamin B1 deficiency, we conducted two consecutive studies supplementing hemodialysis patients with benfotiamine. In both studies, genomic damage was measured as micronucleus frequency of PBLs before and at three time-points after initiation of benfotiamine supplementation. AGE-associated fluorescence in plasma, and in the second study additionally, the antioxidative capacity of plasma was analyzed. Benfotiamine significantly lowered the genomic damage of PBLs in hemodialysis patients of both studies independent of changes in plasma AGE levels. The second study gave a hint to the mechanism, as the antioxidative capacity of the plasma of the treated patients clearly increased, which might ameliorate the DNA damage. PMID:18509620
After intravenous administration of Gd-DTPA (0.1 mmol/kg) hemodialysis was performed five times within 6 days in a patient with endstage renal failure. During the fifth hemodialysis a blood sample of 5 ml was withdrawn and Gd-concentration was measured in plasma at 342.247 nm using the method of Inductively Coupled Plasma Atomic Emission Spectrometry. Gd-concentration measured in venous and arterial blood was 6x10-6 mol/liter, corresponding to 1.5 per cent of the dose administered. If these data can be confirmed in more patients with endstage renal failure, this is the proof of effective hemodialysis of Gd-DTPA in a clinical setting. (author). 14 refs.; 1 tab
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.
Daud, Zulfitri A Mat; Tubie, Boniface; Sheyman, Marina; Osia, Robert; Adams, Judy; Tubie, Sharon; Khosla, Pramod
Purpose Chronic hemodialysis patients experience accelerated atherosclerosis contributed to by dyslipidemia, inflammation, and an impaired antioxidant system. Vitamin E tocotrienols possess anti-inflammatory and antioxidant properties. However, the impact of dietary intervention with Vitamin E tocotrienols is unknown in this population. Patients and methods A randomized, double-blind, placebo-controlled, parallel trial was conducted in 81 patients undergoing chronic hemodialysis. Subjects were provided daily with capsules containing either vitamin E tocotrienol-rich fraction (TRF) (180 mg tocotrienols, 40 mg tocopherols) or placebo (0.48 mg tocotrienols, 0.88 mg tocopherols). Endpoints included measurements of inflammatory markers (C-reactive protein and interleukin 6), oxidative status (total antioxidant power and malondialdehyde), lipid profiles (plasma total cholesterol, triacylglycerols, and high-density lipoprotein cholesterol), as well as cholesteryl-ester transfer protein activity and apolipoprotein A1. Results TRF supplementation did not impact any nutritional, inflammatory, or oxidative status biomarkers over time when compared with the baseline within the group (one-way repeated measures analysis of variance) or when compared with the placebo group at a particular time point (independent t-test). However, the TRF supplemented group showed improvement in lipid profiles after 12 and 16 weeks of intervention when compared with placebo at the respective time points. Normalized plasma triacylglycerols (cf baseline) in the TRF group were reduced by 33 mg/dL (P=0.032) and 36 mg/dL (P=0.072) after 12 and 16 weeks of intervention but no significant improvement was seen in the placebo group. Similarly, normalized plasma high-density lipoprotein cholesterol was higher (P<0.05) in the TRF group as compared with placebo at both week 12 and week 16. The changes in the TRF group at week 12 and week 16 were associated with higher plasma apolipoprotein A1 concentration (P<0.02) and lower cholesteryl-ester transfer protein activity (P<0.001). Conclusion TRF supplementation improved lipid profiles in this study of maintenance hemodialysis patients. A multi-centered trial is warranted to confirm these observations. PMID:24348043
Full Text Available Objective: The aim of this study was to evaluate the effects of hemodialysis (HD on right ventricular echocardiographic parameters in patients with end-stage renal failure (ESRF. Methods: Forty-three uremic patients who underwent echocardiography before and 30 minutes after dialysis included in this prospective observational study. Right ventricular systolic function was evaluated using tricuspid annular plane systolic excursion (TAPSE by M-mode echocardiography and tricuspid lateral annular systolic velocity (Sa by tissue Doppler echocardiography whereas diastolic function was evaluated using tricuspid early (E and late (A diastolic flow velocities by conventional and tricuspid lateral annular early (Ea and late (Aa diastolic velocities by tissue Doppler echocardiography. Myocardial performance index was taken as an indicator of global functions. Paired t test or Wilcoxon test were used for statistical analysis where appropriate.Results: E decreased significantly (68±13 cm/s and 56±12 cm/s before and after HD, respectively; p<0.0001 but A did not (p=0.797.TAPSE was 1.84±0.34 cm before HD and showed a significant increase to 2.03±0.20 cm after HD (p=0.006. Right ventricular MPI, Sa and Aa did not change significantly by dialysis (p=0.504; p=0.118 and p=0.150 respectively whereas Ea decreased to 8.8±2.5 cm/s from 11.3±3.4 cm/s (p<0.001. Ea/Aa ratio also decreased significantly to 0.69±0.35 from 0.84±0.44 with HD (p=0.007.Conclusion: The results of this study indicates that parameters of right ventricular systolic function such as Sa and MPI are independent of preload whereas the conventional and tissue Doppler parameters of right ventricular diastolic function are preload dependent in patients with end-stage renal failure who undergo regular hemodialysis.
Sakurada, Tsutomu; Oishi, Daisuke; Shibagaki, Yugo; Yasuda, Takashi; Kimura, Kenjiro
Lanthanum carbonate (LC) has been administered in a chewable tablet form for patients with hyperphosphatemia undergoing dialysis. However, some patients have difficulty chewing the tablets. LC oral powder has recently been released in Japan. The purpose of this study was to clarify the efficacy of LC oral powder form compared with that of chewable tablet form. The efficacy and safety of LC oral powder was retrospectively assessed in hemodialysis patients who switched from chewable tablet form to oral powder form without dose modification. Thirty-six patients (mean age, 66.8 ± 10.5 years; male, 64%; 39% with diabetes; mean duration of dialysis treatment, 99.2 ± 95.6 months) were enrolled in this study between June and July of 2012. Changes in clinical data and adverse events after the switch to oral powder form were investigated. The average dose of LC was 1180 ± 520 mg/day. Serum phosphorus levels were significantly decreased after the switch from chewable tablet form to oral powder form (5.3 ± 1.7 mg/dL at baseline vs. 4.9 ± 1.2 mg/dL at after 1 month after, P = 0.038). In contrast, no significant differences were observed in serum calcium and parathyroid hormone levels. Furthermore, no significant differences were evident in weight gain after the switch to oral powder form (2.5 ± 1.2 kg at baseline vs. 2.4 ± 1.1 kg at 1 month after the switch, P = 0.29). No serious adverse events were recorded. Our results suggest that LC is more effective in oral powder form than chewable tablet form for hemodialysis patients. PMID:24134326
Trezzi, Matteo; Torzillo, Daniela; Ceriani, Elisa; Costantino, Giorgio; Caruso, Sabrina; Damavandi, Parham Tabaee; Genderini, Augusto; Cicardi, Marco; Montano, Nicola; Cogliati, Chiara
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
Insertion of a hemodialysis catheter into the superior vena cava (SVC) gives rise to complex flow patterns, which arise from the simultaneous injection and extraction of blood through different holes (ports) of the catheter. Techniques of high-image-density particle image velocimetry are employed in a scaled-up water facility. This approach allows characterization of both the instantaneous and time-averaged flow structure due to generic classes of side hole geometries. The trajectory of the injection jet is related to the ratio of the initial jet velocity to the mainstream velocity through the SVC, and to the type of distortion of the jet cross-section. Furthermore, the mean and fluctuating velocity and vorticity fields are determined. Significant turbulent stresses develop rapidly in the injection jet, which can impinge upon the wall of the simulated SVC. Immediately downstream of the injection hole, a recirculation cell of low velocity exists adjacent to the catheter surface. These and other representations of the flow structure are first evaluated for a steady throughflow, then for the case of a pulsatile waveform in the SVC, which matches that of a normal adult.
Full Text Available This study was performed to evaluate whether any electrocardiogram (ECG para-meter can predict the presence of hyperkalemia in patients on maintenance hemodialysis (HD. In January 2006, we conducted a cross-sectional study of 80 stable patients with end-stage renal disease from four university-based HD units of Tehran, Iran, receiving conventional thrice-weekly HD. Pre-HD serum electrolyte values and conventional 12-lead ECG were obtained from each pa-tient. Bivariate linear regression was used for assessing relationship of the study variables with hyperkalemia (K + > 5.2 mg/dL. Multivariable logistic regression was used for evaluating inde-pendent relationship between decreased T wave duration (? 170 ms and other variables. Bivariate correlation analysis showed a significant inverse correlation between serum potassium concentration and T wave duration (P < 0.05. None of the patients with serum potassium of ? 5.6 mg/dL had T wave duration > 200 ms. Multivariate logistic analysis, after adjustment for other factors, also showed a significant relationship between decreased T wave duration (? 170 ms and hyper-kalemia. We conclude that although hyperkalemia does not induce the usual ECG changes in HD patients, decreased T wave duration was found to be a good indicator of this lethal condition.
Tzitzikos G; Saridi M.; Filippopoulou T; Makri A; Goulioti A; Stavropoulos T; Stamatiou K
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 ...
McGill, Rita L; Bakos, Jane R; Ko, Tina; Sandroni, Stephen E; Marcus, Richard J
To recycle spent dialysate, a sorbent hemodialyzer uses a purification cartridge, adapted from water reclamation systems originally designed for the aerospace program. Increasing interest in home hemodialysis has driven a renewed examination of sorbent dialyzer technology, resulting in the development of a modern sorbent hemodialyzer and an array of new sorbent cartridges. Initial clinical experience with the Allient Hemodialysis System and the new sorbent cartridges is presented, with an emphasis on achievable clearances and ultrafiltration, as well as information about symptom profile and electrolyte balance. PMID:19033776
Al-Salman Mussaad; Fares Amr; Rabee Hussien; Ali Mohammed
The number of patients with end-stage renal disease maintained on chronic hemodialysis is increasing progressively. Arteriovenous fistula (AVF) is a common vascular access for hemodialysis, however, its effect on limb distal circulation has not been studied well. Palpation of pulse at the wrist is a crude method of clinical assessment. Over one year period, 26 AVFs were created; 16 at the wrist (61.5%) and ten fistulas at the elbow (38.5%). Six of the latter were through the bra...
Mourad, Basma; Hegab, Doaa; Okasha, Kamal; Rizk, Sarah
Introduction 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. PMID:25419152
Dorsch Oliver; Krieter Detlef H; Lemke Horst-Dieter; Fischer Stefan; Melzer Nima; Sieder Christian; Bramlage Peter; Harenberg Job
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 enrolle...
Full Text Available Josep Bonet1, Albert Martinez-Castelao2, Beatriz Bayés11Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 2Department of Nephrology, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, SpainPurpose: Metabolic syndrome is a cluster of biochemical abnormalities including cardiovascular and diabetes risk factors. The development of diabetes mellitus after renal transplant represents a major posttransplant complication that may adversely affect graft/patient survival. The aim of this study was to assess the role of metabolic syndrome in patients on hemodialysis as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant.Patients and methods: This was a prospective observational epidemiologic study carried out in adult nondiabetic patients undergoing chronic hemodialysis and on the renal transplant waiting list between November 2008 and April 2009. Patients were followed up from Visit 1 (baseline to 6 months after the renal transplant. The analysis of the role of metabolic syndrome in hemodialysis patients as a risk factor for the incidence of new-onset diabetes mellitus after renal transplant included the estimation of relative risk and its 95% confidence interval (CI.Results: A total of 383 evaluable patients were entered into the study (mean age, 52.7 years; male, 57.7%; Caucasian, 90.1%. The prevalence of metabolic syndrome on hemodialysis was 30.4% (95% CI, 25.8%–35.4%. Hypertension was the most prevalent criterion for metabolic syndrome (65.0%, followed by low levels of high-density lipoprotein cholesterol (52.7%, abdominal obesity (36.2%, hypertriglyceridemia (32.4%, and impaired glucose (8.9%. After the renal transplant, the prevalence of metabolic syndrome was still 25.8%. During the posttransplant period, the incidence of new-onset diabetes mellitus reached 13.0% (95% CI, 7.8%–20.6% and patients with pretransplant metabolic syndrome were 2.6 times (95% CI, 1.043–6.608 more likely to develop new-onset diabetes mellitus after the renal transplant than those without metabolic syndrome.Conclusion: The presence of metabolic syndrome in patients undergoing hemodialysis represents an independent risk factor for the incidence of new-onset diabetes mellitus after renal transplant.Keywords: dialysis, kidney transplantation, metabolic syndrome X, posttransplant diabetes
To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.
Nelma Scheyla José dos Santos
Full Text Available A prevalência de desnutrição protéico-energético em pacientes com insuficiência renal crônica submetidos à terapia de hemodiálise é elevada. Dentre os diversos parâmetros disponíveis para a avaliação do estado nutricional, a albumina tem sido o mais comumente utilizado para este fim visto a sua estreita associação com a morbidade e mortalidade nesta população. No entanto, vários fatores como idade, comorbidades, hipervolemia e perdas corpóreas podem influenciar as concentrações séricas de albumina. Além disso, na vigência de inflamação, condição comumente presente neste grupo de pacientes, o metabolismo da albumina pode encontrar-se alterado, influenciando os seus níveis plasmáticos. Sendo assim, esta comunicação tem como objetivo abordar os aspectos gerais da albumina e discutir a sua utilização na avaliação do estado nutricional de pacientes com insuficiência renal crônica submetidos à hemodiálise.The prevalence of protein-energy malnutrition is high in patients with chronic renal failure on long-term hemodialysis therapy. Among several parameters available for the assessment of nutritional status, albumin has been the most commonly used given its strong association with morbidity and mortality in those patients. However, many factors such as age, comorbidities, hypervolemia and body losses, can affect the serum albumin concentration. Furthermore, the albumin metabolism can be altered in the presence of inflammation, a common condition in this group of patients. Thus, this communication aimed to address the general aspects of albumin and discuss its usefulness for assessing nutritional status in chronic renal failure patients undergoing hemodialysis.
Full Text Available Introduction: Presently, bacteremia is the principal cause of morbidity in patients undergoing hemodialysis. Gram-negative bacteria account for approximately 50 percent of documented infections. Endotoxins released during lysis of gram negative bacteremia result in inflammatory and defense response by the body and if not treated promptly result in septic shock and ultimately death of the patient. This study describes the detection of endotoxins in blood of patients with bacteremia due to gram - negative bacteria by LAL test. Method: Blood samples of 278 hemodialysis patients were analyzed in this study and pathogens were isolated from blood culture samples. Then, their antibiotic sensitivity was determined. In patients with positive blood culture, endotoxin levels were measured by LAL-test. Results: Frequency of bacteremia in patients was 13.6% . The prevalence of gram – negative bacteremia was 44.7%. E coli were the major pathogens, while staphylococcus aureus was the most common gram positive bacterium. Endotoxin was detected in 15 patients (3.8 ± 1.08 EU/ml . The sensitivity and specificity of endotoxins for gram – negative bacteremia were 88% and 95%, respectively. Conclusion: The results indicate that the LAL method is a fast, sensitive and simple method. There was no significant difference between the results of blood culture and LAL – test ( P > 0.05 .
Won, Jong Yun; Lee, Kwang Hun; Lee, Do Yun [Dept. of Radiology, Research Institute of Radiological Science, Yensei University College of Medicine, Seoul (Korea, Republic of); Kim, Myoung Soo [Dept. of Radiology, Yensei University College of Medicine, Seoul (Korea, Republic of); Kang, Byung Chul [Dept. of Radiology, Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of); Kim, Seung Jung [Dept. of Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of)
To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.
Raquel Jeanty de Seixas
Full Text Available O declínio da atividade física no doente renal crônico (DRC é conhecido pela perda de força muscular ou pela redução progressiva no condicionamento e na funcionalidade.¹ Por conta dessas manifestações, o tratamento do doente renal crônico, além de aumentar a sobrevida, também deve incluir reabilitação física.² Cada vez mais estudos revelam que a participação da fisioterapia intradialítica é parte significativa dessa reabilitação. O estudo de Corrêa et al., "Efeito do treinamento muscular periférico na capacidade funcional e qualidade de vida nos pacientes em hemodiálise",³ vem, mais uma vez, confirmar que o DRC se beneficia com essa intervenção em sua rotina.The decline in physical activity of patients with chronic kidney disease (CKD is well known, due to either loss of muscle strength or progressive reduction in conditioning and function.¹ Therefore, treatment of CKD besides increasing survival, should also include physical rehabilitation.² More and more studies have shown that exercise training during hemodialysis plays a significant role in such rehabilitation. Corrêa et al., in their study "Effect of peripheral muscle training on functional capacity and quality of life in patients undergoing hemodialysis",³ have confirmed the benefits of that intervention in the routine of CKD patients.
Raquel Jeanty de, Seixas; Cristiane Mecca, Giacomazzi; Ana Elizabeth Prado Lima, Figueiredo.
Full Text Available O declínio da atividade física no doente renal crônico (DRC) é conhecido pela perda de força muscular ou pela redução progressiva no condicionamento e na funcionalidade.¹ Por conta dessas manifestações, o tratamento do doente renal crônico, além de aumentar a sobrevida, também deve incluir reabilita [...] ção física.² Cada vez mais estudos revelam que a participação da fisioterapia intradialítica é parte significativa dessa reabilitação. O estudo de Corrêa et al., "Efeito do treinamento muscular periférico na capacidade funcional e qualidade de vida nos pacientes em hemodiálise",³ vem, mais uma vez, confirmar que o DRC se beneficia com essa intervenção em sua rotina. Abstract in english The decline in physical activity of patients with chronic kidney disease (CKD) is well known, due to either loss of muscle strength or progressive reduction in conditioning and function.¹ Therefore, treatment of CKD besides increasing survival, should also include physical rehabilitation.² More and [...] more studies have shown that exercise training during hemodialysis plays a significant role in such rehabilitation. Corrêa et al., in their study "Effect of peripheral muscle training on functional capacity and quality of life in patients undergoing hemodialysis",³ have confirmed the benefits of that intervention in the routine of CKD patients.
Full Text Available Over a two year period, the incidence of hepatitis C virus (HCV infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years, from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III, both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080 in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.Durante período de 2 anos, estudamos a incidência da infecção pelo vírus da hepatite C (VHC em 29 pacientes em tratamento de diálise, com idades entre 15 e 75 anos (c ± DS; 45 ± 39,5 anos, procedentes da unidade de hemodiálise do Hospital Universitário de Maracaibo, Estado Zulia, Venezuela. Para a detecção dos anticorpos contra o VHC (anti-VHC utilizamos a técnica de imunoensaio enzimático (ELISA, Innotest HCV Ab IV e em amostras reativas por ELISA, utilizamos o método de immunoblot recombinante de terceira geração (Inno-LIA HCV Ab III, ambos da casa comercial Innogenetics N.V., Bélgica. Os resultados demonstram ausência de soroconversão ao VHC nos pacientes hemodializados durante o período estudado, o que foi confirmado pelo método de imunoblot recombinante. Os fatores de risco ao VHC foram 0,327 (95% CI: 0,01323 - 8,080 nos pacientes submetidos ao tratamento de diálise. Nossos resultados sugerem ausência de fontes de infecção neste centro de hemodiálise e que as medidas universais de controle de infecção são cumpridas.
Francisca, Monsalve-Castillo; Liliana, Gómez-Gamboa; Leonor, Chacín-Bonilla; Leticia, Porto-Espinoza; Luciana, Costa-León.
Full Text Available Durante período de 2 anos, estudamos a incidência da infecção pelo vírus da hepatite C (VHC) em 29 pacientes em tratamento de diálise, com idades entre 15 e 75 anos (c ± DS; 45 ± 39,5 anos), procedentes da unidade de hemodiálise do Hospital Universitário de Maracaibo, Estado Zulia, Venezuela. Para a [...] detecção dos anticorpos contra o VHC (anti-VHC) utilizamos a técnica de imunoensaio enzimático (ELISA, Innotest HCV Ab IV) e em amostras reativas por ELISA, utilizamos o método de immunoblot recombinante de terceira geração (Inno-LIA HCV Ab III), ambos da casa comercial Innogenetics N.V., Bélgica. Os resultados demonstram ausência de soroconversão ao VHC nos pacientes hemodializados durante o período estudado, o que foi confirmado pelo método de imunoblot recombinante. Os fatores de risco ao VHC foram 0,327 (95% CI: 0,01323 - 8,080) nos pacientes submetidos ao tratamento de diálise. Nossos resultados sugerem ausência de fontes de infecção neste centro de hemodiálise e que as medidas universais de controle de infecção são cumpridas. Abstract in english Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined usin [...] g a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.
Full Text Available Dialysis therapy is extremely stressful as it interferes with all spheres of daily acti-vities of the patients. This study is aimed at understanding the perceived illness intrusion among pa-tients on hemodialysis (HD and to find the association between illness intrusion and patient demo-graphics as well as duration of dialysis. A cross sectional study involving 90 patients with chronic kidney disease (CKD stage V, on HD was performed during the period from 2005 to 2006. The subjects included were above 18 years of age, willing, stable and on dialysis for at least two months. Patients with psychiatric co-morbidity were excluded. A semi-structured interview schedule covering socio-demographics and a 13 item illness intrusion checklist covering the various aspects of life was ca-rried out. The study patients were asked to rate the illness intrusion and the extent. The data were ana-lyzed statistically. The mean age of the subjects was 50.28 ± 13.69 years, males were predominant (85%, 73% were married, 50% belonged to Hindu religion, 25% had pre-degree education, 25% were employed and 22% were housewives. About 40% and 38% of the study patients belonged to middle and upper socio-economic strata respectively; 86% had urban background and lived in nuclear fami-lies. The mean duration on dialysis was 24 ± 29.6 months. All the subjects reported illness intrusion to a lesser or greater extent in various areas including: health (44%, work (70% finance (55%, diet (50% sexual life (38% and psychological status (25%. Illness had not intruded in areas of rela-tionship with spouse (67%, friends (76%, family (79%, social (40% and religious functions (72%. Statistically significant association was noted between illness intrusion and occupation (P= 0.02.
Jorge Paulo Strogoff de Matos
Full Text Available A taxa de mortalidade entre os pacientes em hemodiálise (HD é extremamente elevada. A expectativa de vida restante de um paciente ao iniciar HD é apenas cerca de um quarto daquela da população geral com a mesma idade. O esquema convencional de HD, com três sessões semanais de cerca de quatro horas, foi estabelecido de maneira empírica há cerca de quatro décadas e merece ser reavaliado criticamente. Desde a falha do Estudo HEMO em demonstrar benefícios clínicos com o aumento do Kt/V de ureia nos pacientes em esquema convencional de HD, tem havido um crescente interesse pelos esquemas alternativos de HD com o intuito de prover um tratamento associado com uma melhor sobrevida. Dentre os esquemas mais promissores, destacam-se a HD diária de curta duração e a HD noturna prolongada. As limitações econômicas que inibem a aplicação dos conhecimentos emergentes nesta área devem ser vencidas.The mortality rate among patients on hemodialysis (HD is extremely high. Remaining life expectancy for a patient initiating HD is only approximately one quarter of that of the general population at the same age bracket. The conventional HD regimen based on four-hour sessions three times a week was empirically established nearly four decades ago and needs to be revisited. Since the failure of the HEMO Study to demonstrate the clinical benefits of higher urea Kt/V for patients on conventional HD, an increasing interest for alternative HD regimens has emerged aiming at providing a treatment for improving survival rates. Short daily HD and long nocturnal HD stand out as the most promising alternative regimens. Economical obstacles which could hinder the clinical application of emerging knowledge in the field should be overcome.
Santoro, Domenico; Benedetto, Filippo; Mondello, Placido; Pipitò, Narayana; Barillà, David; Spinelli, Francesco; Ricciardi, Carlo Alberto; Cernaro, Valeria; Buemi, Michele
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
Full Text Available Domenico Santoro,1 Filippo Benedetto,2 Placido Mondello,3 Narayana Pipitò,2 David Barillà,2 Francesco Spinelli,2 Carlo Alberto Ricciardi,1 Valeria Cernaro,1 Michele Buemi11Department of Clinical and Experimental Medicine, Unit of Nephrology, 2Unit of Vascular Surgery, 3Unit of Infectious Disease, University of Messina, ItalyAbstract: A well-functioning vascular access (VA is a mainstay to perform an efficient hemodialysis (HD procedure. There are three main types of access: 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.Keywords: arteriovenous fistula, prosthetic grafts, central venous catheter, infection
Salman Saleh Mohammad
Full Text Available Restless legs syndrome (RLS is common among dialysis patients, with a reported prevalence of 6-60%. The prevalence of RLS in Syrian patients on hemodialysis (HD is not known. The purpose of this study is to determine the prevalence of RLS in patients on regular HD, and to find the possible correlation between the presence of RLS and demographic, clinical, and biochemical factors. One hundred and twenty-three patients (male/female = 70/53, mean age = 41.95 ± 15.11 years on HD therapy at the Aleppo University Hospital were enrolled into the study. RLS was diagnosed based on criteria established by the International Restless Legs Syn-drome Study Group (IRLSSG. Data procured were compared between patients with and without RLS. Applying the IRLSSG criteria for the diagnosis, RLS was seen in 20.3% of the study pa-tients. No significant difference in age, gender, and intake of nicotine and caffeine was found between patients with and without the RLS. Similarly, there was no difference between the two groups in the duration of end-stage renal disease (ESRD, the period of dialysis dependence, dialysis adequacy, urea and creatinine levels, and the presence of anemia. The co-morbidities and the use of drugs also did not differ in the two groups. Our study suggests that the high prevalence of RLS among patients on HD requires careful attention and correct diagnosis can lead to better therapy and better quality of life. The pathogenesis of RLS is not clear and further studies are required to identify any possible cause as well as to discover the impact of this syndrome on sleep, quality of life, and possibly other complications such as cardiovasculare disease.
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)
Neri, Sergio; Signorelli, S.S.; Scuderi, R.; Bruno, M.; Bertino, G.; Clementi, A.; Torrisi, I.; Fidone, F.; Pagano, A.B.; Malaguarnera, M.; Noto, R.
The prevalence of atherosclerotic cardiovascular disease in chronic hemodialysis (HD) patients has been demonstrated to be higher than in healthy people. Severe liver fibrosis is strongly associated with early carotid atherosclerosis and it might reduce the survival of patients who undergo both renal replacement therapy and transplantation. We wanted to assess whether nonalcoholic fatty liver disease (NAFLD) was associated with altered intima-media thickness (IMT) in HD patients as an independent marker of subclinical atherosclerosis. We enrolled 42 patients undergoing HD and 48 patients with normal renal function, all of them with high levels of aminotransferases and an ultrasonographic diagnosis of liver steatosis. The control group consisted of 60 healthy subjects. Laboratory tests for inflammatory and oxidative markers, ultrasonographic liver evaluation, carotid IMT measurement, and liver biopsy were performed. Different degrees of fibrosis were detected in our study cohort. Worse liver histopathological scores and higher plasmatic levels of C-reactive protein, reactive oxygen species, and vascular cell adhesion molecule-1 were found in HD patients. Carotid IMT was significantly higher (p?0.005) in patients with histological steatosis. HD patients may develop active and progressive chronic hepatitis faster than patients with normal renal function and the thickness of their carotid intima-media might be markedly increased. These two conditions seem to be independent on classical risk factors and on metabolic syndrome. They might be related to the high levels of oxidants and to the inflammatory state, which are typical of patients undergoing HD. Independently related with the traditional risk factors for cardiovascular disease, nonspecific inflammation and oxide-reductive imbalance may play an important role in the progression of NAFLD and atherosclerotic disease in HD patients. PMID:22942630
Holubek, William J; Hoffman, Robert S; Goldfarb, David S; Nelson, Lewis S
Extracorporeal removal techniques such as hemodialysis, charcoal hemoperfusion, and peritoneal dialysis have been used to remove toxins from the body. To define trends in the use of these techniques for toxin removal, we analyzed the 19,351 cases requiring extracorporeal removal reported to U.S. poison centers from 1985-2005. The number of such patients who received hemodialysis, excluding those with other medical indications, (normalized per million calls) increased from 231 to 707 whereas hemoperfusion decreased from 53 to 12 in the years 1985-2005. Peritoneal dialysis decreased from 2.2 in 1985 to 1.6 in 1991. The most common toxins removed by hemodialysis were lithium and ethylene glycol. There were more dialysis treatments for poisonings with valproate and acetaminophen in 2001-2005 than for methanol and theophylline, although hemodialysis for acetaminophen removal is generally not recommended. Theophylline was the most common toxin removed by hemoperfusion from 1985-2000, but carbamazepine became the most frequent toxin for removal during 2001-2005. Our study shows that the profile of toxins and the type of extracorporeal technique used to remove the toxins have changed over the years. PMID:18800032
Drew, David A; Lok, Charmaine E; Cohen, Joshua T; Wagner, Martin; Tangri, Navdeep; Weiner, Daniel E
Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 70% of United States dialysis patients. A decision tree model was constructed to reflect progression from hemodialysis initiation. Patients were classified into one of three vascular access choices: maintain CVC, attempt fistula, or attempt graft. We explicitly modeled probabilities of primary and secondary patency for each access type, with success modified by age, sex, and diabetes. Access-specific mortality was incorporated using preexisting cohort data, including terms for age, sex, and diabetes. Costs were ascertained from the 2010 USRDS report and Medicare for procedure costs. An AV fistula attempt strategy was found to be superior to AV grafts and CVCs in regard to mortality and cost for the majority of patient characteristic combinations, especially younger men without diabetes. Women with diabetes and elderly men with diabetes had similar outcomes, regardless of access type. Overall, the advantages of an AV fistula attempt strategy lessened considerably among older patients, particularly women with diabetes, reflecting the effect of lower AV fistula success rates and lower life expectancy. These results suggest that vascular access-related outcomes may be optimized by considering individual patient characteristics. PMID:25063436
Hemodialysis (HD) in infants is usually used when peritoneal dialysis (PD) has failed. We describe our experience with HD, outlining the morbidity, complications, and outcomes for infants weighing less than 10 kg managed with HD for more than 6 months over a 10-year period.
Montemuro, M; Mohide, E A; Martin, L S; Beecroft, M L; Jakobson, S; Porterfield, P; Ollinger, D
The purpose of this study was to determine chronic hospital-based hemodialysis patients' perceptions of control over selected aspects of hemodialysis care and to compare the patients' ratings with the global ratings of nurses caring for them. Two versions of a 14-item Hemodialysis Control Questionnaire (HCQ) were developed, one for patients (HCQ-P) and one for nurses (HCQ-N). Forty-seven patients and 32 nurses rated both perceived and desired control for each aspect of hemodialysis care on the HCQ. Reasons for their ratings were elicited and recorded. High test-retest reliability was established for both perceived and desired control on the HCQ-P and the desired control component of the HCQ-N. Patients rated their overall perceived and desired control as moderate, likewise the nurses' global score for desired control was rated as moderate. Item-by-item analysis revealed that nurses overestimated the patients' desired control over technical aspects of care but underestimated the patients' desire for more control over nontechnical aspects of care. The content analysis of the verbatim responses supported the quantitative findings. PMID:7872823
Introduction/objective: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. Methods and materials: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. Results: Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. Discussions and conclusion: Th maneuvers. Discussions and conclusion: The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis
Kubala, Lukáš; ?íž, Milan; Soška, V.; ?erný, J.; Lojek, Antonín
Ro?. 21, ?. 4 (2002), s. 367-380. ISSN 0231-5882 R&D Projects: GA MZd NA4796 Institutional research plan: CEZ:AV0Z5004920 Keywords : hemodialysis * phagocytes * reactive oxygen species Subject RIV: BO - Biophysics Impact factor: 0.719, year: 2002
Erhan Tatar; Tolgay Isikyakar; Kezban Pinar Yeniay; Hasan Huseyin Uzuner; Ebru Sevinc Ok
Hypothyroidism occurs relatively common and is a significant cause of morbidity and mortality during the course of chronic kidney disease. Rhabdomyolysis is a potentially life-threatening condition characterised by necrosis of muscular tissue and rarely associates with hypothyroidism. Here we describe a case of rhabdomyolysis due to severe hypothyroidism in a 56-year-old female hemodialysis patient.
Coan, Kathryn E; O'Donnell, Mark E; Fankhauser, Grant T; Bodnar, Zachary; Chandrasekaran, Krishnaswamy; Stone, William M
We present a 33-year-old dialysis-dependent female who presented with new onset split second heart sound. Following a failed left upper extremity dialysis fistula, a right upper extremity hemodialysis reliable outflow (HeRO) graft was performed in 2011. Her subsequent cadaveric renal transplant had delayed function necessitating concurrent use of hemodialysis. However, as renal function improved, hemodialysis was discontinued. Two weeks following transplantation, the HeRO graft occluded. Subsequent clinical and radiological assessment confirmed widespread pulmonary emboli. Following cessation of hemodialysis and subsequent HeRO graft occlusion, removal was deemed appropriate to reduce further thromboembolic phenomenon. Right atrial thrombi are complications associated with central venous catheters. However, their actual incidence varies significantly. Right heart thromboemboli are associated with a 4% to 6% pulmonary embolism rate. Katzman et al assessed 38 patients who underwent HeRO graft and reported 1 (2.6%) patient with right atrial emboli and likely pulmonary embolism. Although thrombotic complications remain rare, consideration of graft removal should always be evaluated particularly in the absence of an alternative thrombotic source. PMID:23567802
TELES Sheila A.
Full Text Available Hepatitis B has proved to be a major health hazard in hemodialysis patients. In order to investigate the hepatitis B virus (HBV infection profile in the hemodialysis population of Goiânia city - Central Brazil, all dialysis patients (N=282 were studied. The prevalence of any HBV marker (HBsAg, anti-HBs, and anti-HBc was 56.7% (95% CI: 51.1-62.7, ranging from 33.3% to 77.7% depending on dialysis unit. HBV-DNA was detected in 67.6% and 88.2% of the HBsAg-positive serum samples, in 91.3% and 100% of the HBsAg/HBeAg-positive samples, and in 18.2% and 63.6% of the HBsAg/anti-HBe-reactive sera by hybridization and PCR, respectively. The length of time on hemodialysis was significantly associated with HBV seropositivity. Only 10% of the patients reported received hepatitis B vaccination. The findings of a high HBV infection prevalence in this population and the increased risk for HBV infection on long-term hemodialysis suggest the environmental transmission, emphasizing the urgent need to evaluate strategies of control and prevention followed in these units.
Full Text Available Abstract Background The analysis of hemodialysis services is relevant for the quality of life of patient. In this study we investigated the profile of vascular access used for hemodialysis patients in our Unit. Methods We evaluated 219 patients of both genders aged over 18 years old who have undergone implant or manufacture of vascular hemodialysis access. We excluded patients on renal replacement therapy by peritoneal dialysis. Results Associated diseases were hypertension and diabetes mellitus. 161 had arteriovenous fistula, with 153 held by the same dialysis and nine of them were still maturing. 27 patients on dialysis used central venous catheter. 148 were indigenous and five were made using polytetrafluoroethylene prosthesis (PTFE. Among the 27 patients with central venous catheters, ten used short-term catheter and 17 used long-term catheter. The most frequent type of fistula use was on the radio distal cephalic, in 85 patients (52.5%, followed by radio cephalic proximal in 26 patients (16%. The number of fistulas in dialysis patients conducted by this kind of therapy ranged from one to ten and in 64 patients (41.83% fistula was the first and only to be made. Among the fistula for dialysis patients, the highest prevalence was radio cephalic fistula in 111 patients (72.5% and mean duration of use was 48.1 months, ranging from two months to 17 years. Conclusion Our Unit of hemodialysis is above the limits established by international norms.
Brown, Merideth; Polisetty, Radhika; Gracely, Edward J; Cuhaci, Bulent; Schlecht, Hans P
We evaluated weight-based loading doses of vancomycin and resulting initial prehemodialysis concentrations. Modeling demonstrated modest correlation between dose administered, age, and initial concentration achieved. Actual body weight-based loading of vancomycin predictably achieves therapeutic initial concentrations in patients who receive hemodialysis. PMID:21690623
Sofocleous, Constantinos T. E-mail: email@example.com; Schur, Israel; Koh, Elsie; Hinrichs, Clay; Cooper, Stanley G.; Welber, Adam; Brountzos, Elias; Kelekis, Dimitris
Introduction/objective: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. Methods and materials: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma. Results: Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers. Discussions and conclusion: The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.
De Moor, P; Faict, D; Verberckmoes, R
Patients with renal insufficiency who are hemodialyzed 3 times a week either through a cuprophane membrane or through a polyacrylonitrile (PAN) membrane have the same transcortin and cortisol levels as patients with renal insufficiency who are not dialyzed. Moreover, hemodialysis did not influence acutely the latter transcortin levels. PMID:3927790
The development of a cardiac insufficiency in hemodialysis patients justifies the indication for an examination of the dynamic myocardial function. 14 patients were examined with the help of sup(99m)Tc-HSA to find out if they had 'ejection fraction'. The result confirms the existence of cardiac insufficiency and shows a significant increase in the end-diastolic ejection fraction. (APR)
Full Text Available Hypermagnesemia is rarely seen in peritoneal dialysis (PD patients because PD can lower the plasma magnesium (Mg concentration effectively. In this report, a continuous ambulatory peritoneal dialysis (CAPD patient with life-threatening hypermagnesemia treated by hemodialysis (HD is presented. A 52-year-old male patient on PD treatment was admitted to our clinic with complaints of fatigue and muscle weakness. Decrease in deep tendon reflexes (DTR, decrease in muscle strength at bilateral upper and lower extremities, and increased level of magnesium (7.7 mg/dl were detected. Bradycardia, prolongation of the P-R interval, and an increase in Q-T interval were found on the electrocardiography. HD was performed two times. After HD, all the signs and symptoms of the patient improved. HD is a dialysis modality that should be preferred in the treatment of symptomatic patients with hypermagnesemia, because of providing more rapid clearance of Mg.
The association of TTV (transfusion transmitted virus) with both cryptogenic chronic liver diseases and post-transfusion hepatitis has been reported. Hemodialysis patients are at high risk for viral hepatitis due to blood born viral agents. The few data available concerning TTV infection among hemodialysis patients shows a high prevalence. This study was conducted on one hundred patients with end-stage renal disease (ESRD). They were attending the hemodialysis (HD) unit of Naser institute for performing hemodialysis for the first time (as a control group) and the same patients after recurrent HD for at least six months of regular HD (as a HD patient group). Patients and controls were subjected to the following laboratory investigations; 1) TTV DNA detection by PCR. 2) HBs Ag by ELISA technique. 3) HCV Ab by ELISA technique. 4) Liver enzymes include ALT, AST and ?GT. The study was done to detect TTV DNA by PCR in hemodialysis patients and to evaluate its clinical impacts, taking into account co-infection with other hepatitis viruses. The results of this work are:- 1- TTV is remarkably prevalent in HD patients. The prevalence of TTV infection in HD Egyptian patients was 45% and 9% in healthy volunteer from the same geographical area. 2- HCV was found to have highly significant association with HD patients while there was no association between HD patients and HBs Ag. 3- TTV infection was not found to be more prevalent in HD patients infected with HCV. 4- Abnormal liver enzymes were uncommon in HD patients infected with TTV alone, in contrast to patients with known hepatotropic viruses such as HCV. 5- TTV did not play a role in liver injury, but it might aggravate liver diseases caused by HCV.
Akcahuseyin, E; Nette, R W; Vincent, H H; van Duyl, W A; Krepel, H; Weimar, W; Zietse, R
Hypotension is the most frequent complication during hemodialysis. An important cause of hypotension is a decrease in the intravascular volume. In addition, a decrease in plasma osmolality may be a contributing factor. Modeling of sodium and ultrafiltration (UF) may help in the understanding of underlying relationships. We therefore simulated, in a mathematical model, the intercompartmental fluid shifts during standard hemodialysis (SHD), diffusive hemodialysis (DHD), and isolated ultrafiltration (IU). We analyzed the relative theoretical effect of hydration status, dialysate sodium concentration, the initial plasma concentrations of sodium and urea, and tissue permeation to solutes on the magnitude and direction of intracellular and intravascular volume changes. This theoretical analysis shows that the transcellular fluid shifts taking place during hemodialysis treatment are, to a great part, due to inhomogeneous distribution of regional blood flow and tissue fluid volumes. During hemodialysis treatment, the cellular fluid shifts in tissue groups with relatively high perfusion and small volume occur from the intra- to the extracellular spaces. However, the fluid shift in tissue groups with a low perfusion and large volume takes place in the opposite direction. The UF volume and rates, and the size of the sodium (Na+) gradient between the dialysate and blood side of the dialyzer membrane are the most important factors influencing the fluid shifts. Higher UF volumes and flow rates cause an increasing decline in the plasma volume in both SHD and IU. High dialysate sodium concentration (150 mEq L(-1)) helps plasma refilling slightly when compared with a normal dialysate sodium concentration (140 mEq L(-1)). However, a high dialysate sodium concentration is associated with a high plasma sodium rebound, which in turn may lead to interdialytic water intake resulting from thirst and may cause increased weight gain and hypertension. PMID:10667723
Nowak, Albina; Friedrich, Björn; Artunc, Ferruh; Serra, Andreas L; Breidthardt, Tobias; Twerenbold, Raphael; Peter, Myriam; Mueller, Christian
Deranged calcium-phosphate metabolism contributes to the burden of morbidity and mortality in dialysis patients. This study aimed to assess the association of the phosphaturic hormone fibroblast growth factor 23 (FGF23) and soluble Klotho with all-cause mortality. We measured soluble Klotho and FGF23 levels at enrolment and two weeks later in 239 prevalent hemodialysis patients. The primary hypothesis was that low Klotho and high FGF23 are associated with increased mortality. The association between Klotho and atrial fibrillation (AF) at baseline was explored as secondary outcome. AF was defined as presence of paroxysmal, persistent or permanent AF. During a median follow-up of 924 days, 59 (25%) patients died from any cause. Lower Klotho levels were not associated with mortality in a multivariable adjusted analysis when examined either on a continuous scale (HR 1.25 per SD increase, 95% CI 0.84-1.86) or in tertiles, with tertile 1 as the reference category (HR for tertile two 0.65, 95% CI 0.26-1.64; HR for tertile three 2.18, 95% CI 0.91-2.23). Higher Klotho levels were associated with the absence of AF in a muItivariable logistic regression analysis (OR 0.66 per SD increase, 95% CI 0.41-1.00). Higher FGF23 levels were associated with mortality risk in a multivariable adjusted analysis when examined either on a continuous scale (HR 1.45 per SD increase, 95% CI 1.05-1.99) or in tertiles, with the tertile 1 as the reference category (HR for tertile two 1.63, 95% CI 0.64-4.14; HR for tertile three 3.91, 95% CI 1.28-12.20). FGF23 but not Klotho levels are associated with mortality in hemodialysis patients. Klotho may be protective against AF. PMID:24991914
Full Text Available The hemodialysis procedure is thought to be a physical stressor in the majority of hemodialyzed patients. Previous studies suggest that elevated salivary amylase level may correlate with increased plasma norepinephrine level under psychological and physical stress conditions. In this study, we investigated biological stress reactivity during hemodialysis treatment using salivary amylase activity as a biomarker. Seven patients (male/female = 5/2, age:67.7+ /? 5.9 years who had been receiving regular 4 h hemodialysis were recruited. Salivary amylase activity was measured using a portable analyzer every hour during the hemodialysis session. Salivary amylase activity was shown to be relatively stable and constant throughout hemodialysis, whereas there were significant changes in systolic blood pressure and pulse rate associated with blood volume reduction. Our results show that hemodialysis treatment per se dose not affect salivary amylase activity.
Full Text Available Objective: Cardiovascular disease is the leading cause of morbidity and mortality in patientsundergoing hemodialysis. Increased arterial stiffness is an independent predictor of cardiovascularmortality in end stage renal disease (ESRD. We hypothesized that the hemodialysis procedure itself,through alterations in electrolytes and blood volume, could contribute to the increased cardiovascular riskencountered in ESRD. Material and methods: 28 chronic hemodialysis patients were evaluated before andafter hemodialysis. We determined serum calcium, arterial stiffness (using pulse wave analysis andhemodynamic parameters. Results: Serum calcium increased significantly during the dialysis treatment(P<0.01. Also, significant increase in stiffness index occurred at the end of dialysis (P=0.02. Bothincrements were correlated with ultrafiltration. No significant changes in systolic blood pressure, diastolicblood pressure or heart rate were noticed during hemodialysis. Arterial stiffness significantly increasedafter hemodialysis, unrelated to hemodynamic parameters. Conclusion: This vascular response may bean explanation for greater vulnerability regarding cardiovascular events in ESRD patients.
Cláudia Régia Dias de Souza
Full Text Available OBJETIVOS/MÉTODOS: Avaliou-se a condição periodontal de 30 pacientes, em hemodiálise, através do índice de placa, índice gengival, índice de cálculo, PSR e quantidade de IgA na saliva, visando determinar a condição periodontal de doentes renais crônicos. RESULTADOS: Os resultados demonstraram que os índices de placa, índice gengival e índice de calculo foram considerados altos nestes pacientes. Com relação à necessidade de tratamento periodontal, observou-se que a maior parte dos pacientes em hemodiálise precisava de medidas de higiene bucal, raspagem supra e subgengival e fluoretação tópica (código 2. Em relação aos valores de IgA na saliva, somente três pacientes apresentaram densidade baixa. CONCLUSÃO: Concluiu-se que pacientes renais crônicos em hemodiálise apresentam maior acúmulo de placa bacteriana e elevada formação de cálculo dentário, necessitando de tratamento periodontal como raspagem supra e subgengival.OBJECTIVES AND METHODS: Thirty patients undergoing hemodialysis were evaluated for their periodontal condition through plaque, calculus and gingival indexes; PSR and IgA present in the saliva were also appraised in order to determine the periodontal condition of patients presenting chronic kidney disease. RESULTS: Results obtained demonstrated that in the studied group the plaque, calculus and gingival indexes were high. With regard to these patients' requirement to undergo periodontal treatment, most patients submitted to hemodialysis needed better oral hygiene, in addition to supra and sub gingival scraping and topic application of fluor (code 2. As to the IgA amount present in the saliva, only three patients showed a low density. CONCLUSIONS: Patients presenting chronic kidney disease disclosed a tendency for greater bacterial plaque concentration, high formation of dental calculus suggesting the need for periodontal treatment comprising supra and sub gingival scraping.
Rayhaneh Rahgoshai; Raham Rahgoshai; Ardeshir Khosraviani; Amir Ahmad Nasiri; Mehrdad Solouki
Introduction. Despite many beneficial effects, hemodialysis may cause pulmonary dysfunction. On the other hand, patients with end-stage renal disease are potentially prone to lung edema and respiratory dysfunction. This study was conducted to evaluate the alterations of pulmonary function indicators after hemodialysis, measured by spirometry.Materials and Methods. A total of 26 patients on hemodialysis for at least 3 months were studied. They were all older than 18 years old. None of the pati...
Toepfer, Marcel; Schlosshauer, M.; Sitter, Thomas; Burchardi, Christian; Behr, T.; Schiffl, Helmut
To characterize the determinants of circulating levels of adrenomedullin (AM), the plasma levels of this peptide were measured in 58 patients with end-stage renal disease on hemodialysis, Predialysis plasma levels of AM were more than twice as high in patients on hemodialysis as compared to controls. In hemodialysis patients with heart failure (NYHA classes II-IV) or hypertensive HD patients plasma levels of AM were significantly higher than in patients with end-stage renal disease only. Plas...
MacKay Elizabeth; Zhang Jianguo; Barnieh Lianne; MacRae Jennifer M; Thomson Benjamin KA; Manning Megan A; Hemmelgarn Brenda R
Abstract Background Warfarin nomograms to guide dosing have been shown to improve control of the international normalized ratio (INR) in the general outpatient setting. However, the effectiveness of these nomograms in hemodialysis patients is unknown. We evaluated the effectiveness of anticoagulation using an electronic warfarin nomogram administered by nurses in outpatient hemodialysis patients, compared to physician directed therapy. Methods Hemodialysis patients at any of the six outpatien...
Devesa, M.; Khudyakov, Y. E.; Capriles, F.; Blitz, L.; Fields, H. A.; Liprandi, F.; Pujol, F. H.
Antibody reactivities to hepatitis C virus (HCV) antigens and to synthetic peptides derived from different parts of the HCV genome (core, NS4, and NS5) were evaluated in HCV-infected hemodialysis patients. In the RIBA 3 assay, NS5 was significantly less recognizable by sera of hemodialysis patients compared to other HCV-infected subjects. Among hemodialysis patients, those coinfected with hepatitis B virus (HBV) (positive for hepatitis B surface antigen [HBsAg+]) showed a reduction in reactiv...
Reza Afshar; Abbas Emany; Abbas Saremi; Nader Shavandi; Suzan Sanavi
Introduction. Sleep disorders are common in hemodialysis patients. They can affect their quality of life. The purpose of this study was to evaluate the effects of aerobic training on sleep quality, inflammatory status, and serum leptin levels in hemodialysis patients.Materials and Methods. Twenty-eight men in the age range of 28 to 74 years who were on maintenance hemodialysis and had sleep problems were enrolled in this study. They were randomly assigned into control and training groups (14 ...
Full Text Available Please cite this article as: Bakhtiari M, Falaknazi K, Lotfi M, Noori M, Naseri Saleh Abad A. The relationship between Personality Traits, Anxiety and Depression, in Life Quality of patients under treatment by Hemodialysis [HD]. Novel Biomed 2013;1:1-7.Background: The purpose of this study is to examine personality traits in renal patients undergoing haemodialysis (HD and its connection to depression, anxiety, and life quality. In this study we also aim to propose an intervention for treatment and prevention of these personality traits.Methods: This cross-sectional study was performed on 70 patients affected by chronic renal failure undergoing haemodialysis treatment. Patients were selected based on an accessible sample. Required data were gathered through questioners: Hospital Anxiety and Depression, NEO-FFL, and SF-36 Health Survey.Results: Based on the results obtained from this study 47.1% of patients undergoing HD treatment fall into the abnormal category according to the rate of depression. There is a positive meaningful correlation between conscientiousness and agreeableness and a negative correlation between extroversion, anxiety, and depression in life quality of renal patients.Conclusion: With respect to the correlation existing between the quality of life and the personality traits, anxiety and depression, in patients under HD treatment, life quality and treatment outcome can be improved if psychological problems are diagnosed early and psycho education and social interventions are presented.
Reinhard, Mark; Frystyk, Jan
Background Hemodialysis (HD) is a catabolic procedure that may contribute to the high frequency of protein-energy wasting among patients receiving maintenance HD. The present study investigated the additional effect of glucose and glucose-insulin infusion on liver protein synthesis during HD compared with a meal alone. Methods In a randomized cross-over study with three arms, 11 non-diabetic HD patients were assigned to receive a conventional HD session with either: • no treatment (NT) • IV infusion of glucose (G) • IV infusion of glucose-insulin (GI) During infusions blood glucose levels were maintained at 8.0-10.0 mmol/L by additional glucose infusion. Glucose and glucose-insulin infusions were commenced 2 h prior to HD and continued throughout the HD session. Fasting blood samples were collected at baseline before infusion and followed by the only meal allowed during the study. Results Blood glucose and insulin: The change in blood glucose differed significantly from baseline (-120 min) to end of HD (240 min) between the NT group and the G group (p=0.002); there was no significant difference in the change between the NT group and the GI group (p=0.06), or between the G group and the GI group (p=0.15). Fibrinogen and albumin: There was an overall increase in serum albumin (38.8±2.1 to 40.4±2.5 g/L, p<0.0001) and in serum fibrinogen (11.7±1.7 to 12.8±1.8 µmol/L, p<0.0001) from HD start (0 min) to 2 h post HD (360 min), but no significant difference in the change in either albumin (p=0.12) or fibrinogen (p=0.12) between the groups. IGFBP-1: During the first 4 h after baseline (-120 min) we observed an overall decrease in serum IGF-binding protein 1 (IGFBP-1) (from 267±147 to 140±84 µg/L, p<0.0001), but no difference in the change between groups (p=0.41). However, from 4 h after baseline to the end of the study there was a significant difference in the change in serum IGFBP-1 between the groups (p=0.003) with a significant increase in serum IGFBP-1 in the NT group (p<0.0001), but not in the G group or GI group (p=0.50 and p=0.07, respectively). Conclusions Compared with a meal neither glucose nor glucose-insulin infusion appear to have any extra effects on liver protein synthesis during HD.
Objective: To explore the changes of plasma endothelin (ET), atrial natriuretic peptide (ANP) and prolactin (PRL) levels in patients on chronic hemodialysis. Methods: Plasma ET, ANP and PRL levels were determined with RIA in 38 patients on chronic hemodialysis and 30 controls. Results: Before hemodialysis, plasma ET, ANP and PRL levels in patients with chronic renal failure were significantly higher than those in the controls (P0.05). Conclusion: Determination of plasma ET, ANP and PRL levels is clinically useful for understanding the effect of hemodialysis
El-Charabaty, Elie; Saifan, Chadi; Samarneh, Majed Mark; El-Sayegh, Suzanne
Background Hemodialysis patients are exposed to blood and blood products more than the general population and are also at higher risk for hepatitis B (HB) contamination. For these reasons, it is highly recommended that this patient population gets the HB vaccine. The efficacy of the vaccine is measured by measuring titers of antibody in the serum of the patient. A minimum titer of 10 mIU/mL is considered to be a response. The conversion rate in hemodialysis patients ranges from 50% to 80%, as compared to the general population where the conversion rate is over 95%. As opposed to the general population, end-stage renal patients on hemodialysis do not always respond to the vaccine. The main objective in this study was to try to identify factors that may hinder the response. Correction of these factors in the future may help non-responders. Methods This was a retrospective chart review at a single hemodialysis center to compare the laboratory and clinical differences between responders and non-responders. Inclusion criteria are hemodialysis patients who received the HB vaccine and patients with concomitant hepatitis C. Exclusion criteria are patients who refused the vaccine and patients who did not complete the vaccine course. Results There are a total of 108 subjects included in the study, out of which 44 (42.3%) are responders to the HB vaccine. A multivariate logistic regression was performed using the statistically significant risk factors as identified by the univariate logistic regression, including age range, albumin, hemodialysis vintage, vascular access and diabetes status. The results from the multivariate logistic regression show that advanced age (P = 0.005) and diabetes status (P = 0.003) are found to be strong independent risk factors of responder status. The type of vascular access (AVF or other types) is also marginally statistically significant (P = 0.05). Conclusions In this retrospective chart review comparing HB vaccine in responders versus non-responders, we found that advanced age and a history of diabetes are independent risk factors in predicting responder status. PMID:25780479
Avaliação da capacidade funcional e da qualidade de vida em pacientes renais crônicos submetidos a tratamento hemodialítico / Assessment of functional capacity and quality of life in chronic renal patients under hemodialysis treatment
Marina Stela, Cunha; Viviane, Andrade; Cristina A. Veloso, Guedes; Cristiane Helita Zorel, Meneghetti; Ana Paula de, Aguiar; Andréa Luciana, Cardoso.
Full Text Available Este estudo visou avaliar a capacidade funcional e a qualidade de vida em pacientes com incapacidade renal crônica (IRC) submetidos a tratamento hemodialítico e verificar possíveis correlações entre essas variáveis clínicas e idade, índice de massa corpórea (IMC) e tempo de hemodiálise. Dezesseis pa [...] cientes com IRC foram submetidos à avaliação da capacidade funcional pelo teste de caminhada de seis minutos (TC6'), mensuração das pressões inspiratória e expiratória máxima, e pela aplicação da escala de severidade da fadiga. Também responderam ao questionário SF-36, sobre qualidade de vida relacionada à saúde (QV). A capacidade funcional mostrou-se abaixo dos valores preditos no TC6' e na força dos músculos respiratórios (principalmente expiratórios); e todos apresentaram em média fadiga leve. Pacientes com mais de 60 anos e aqueles com menor tempo de hemodiálise apresentaram baixa capacidade funcional apenas quanto à distância caminhada, sem prejuízo das demais funções. O IMC não interferiu na capacidade funcional. O escore médio no SF-36 foi 72,3; dor e prejuízo na vitalidade foram indicados como os itens que mais interferem em sua QV, tendo os fatores idade, índice de massa corporal e tempo de hemodiálise não se mostrado relevantes na maioria dos domínios avaliados pelo SF-36. Os resultados sugerem que, com pouca interferência da idade e do tempo de hemodiálise, pacientes com IRC submetidos a tratamento hemodialítico apresentam prejuízos na capacidade funcional e na QV. Abstract in english This study aimed at evaluating the functional capacity and health-related quality of life in chronic renal insufficiency (CRI) patients undergoing hemodialysis treatment, also checking possible correlations between these clinical variables and age, body mass index (BMI), and hemodialysis time. Sixte [...] en patients were submitted to functional capacity assessment by means of the six-minute walk test (6WT), measures of maximal inspiratory and expiratory pressures, and by the fatigue severity scale (FSS). Patients also answered the SF-36 questionnaire. Functional capacity proved to be below predicted values at the 6WT and at respiratory, mainly expiratory muscles; mean FSS scores pointed to moderate fatigue. Patients over 60 years old and those with lesser hemodialysis time showed lower functional capacity only as to the distance walked at the 6WT. BMI did not interfere with functional capacity. Mean overall SF-36 scores were low; pain and lesser vitality were pointed as the SF-36 domains that most interfere in quality of life; age, BMI, and hemodialysis time have not shown to be relevant to most SF-36 domains. Results suggest that, with slight interference of age and hemodialysis time, patients with CRI undergoing hemodialysis treatment have poor functional capacity and health-related quality of life.
Full Text Available Objective: To analyze the effects of Astragalous Injection on oxidative stress and micro-inflammatory status in patients undergoing maintenance hemodialysis (MHD.Methods: Sixty MHD patients were included and randomized into treatment group and control group, with another 10 healthy volunteers as normal control. The patients in the treatment group were treated with Astragalous Injection and the patients in the control group were treated with normal saline for 12 weeks. A spectrophotometric method was used for the measurement of plasma concentrations of oxidative parameters including advanced glycation end products (AGEs, advanced oxidation protein product (AOPP, malondialdehyde (MDA and vitamin E (Vit E. The content of C-reactive protein (CRP was evaluated by enzyme-linked immunosorbent assay.Results: Compared with the normal control group, the plasma levels of AGEs, AOPP, MDA and CRP were significantly increased, while plasma level of Vit E was significantly decreased in MHD patients (P<0.01. After Astragalous Injection treatment, the plasma levels of AGEs, AOPP, MDA and CRP were decreased as compared with the control group (P<0.01, while there was no significant difference in plasma Vit E level between the treatment group and control group.Conclusion: There exist oxidative stress and micro-inflammation in MHD patients. Astragalous Injection can ameliorate the accumulation of oxidative products and micro-inflammatory status, but it has no significant effect on plasma Vit E level.
Gutiérrez-Adrianzén, O A; Moraes, M E A; Almeida, A P; Lima, J W O; Marinho, M F; Marques, A L; Madeiro, J P V; Nepomuceno, L; da Silva, J M S; Silva, G B; Daher, E F; Rodrigues Sobrinho, C R M
The pathophysiological mechanisms of arterial hypertension during hemodialysis (HD) in patients with end-stage renal disease (ESRD) are still poorly understood. The aim of this study is to investigate physiological, cardiovascular and neuroendocrine changes in patients with ESRD and its correlation with changes in blood pressure (BP) during the HD session. The present study included 21 patients with ESRD undergoing chronic HD treatment. Group A (study) consisted of patients who had BP increase and group B (control) consisted of those who had BP reduction during HD session. Echocardiograms were performed during the HD session to evaluate cardiac output (CO) and systemic vascular resistance (SVR). Before and after the HD session, blood samples were collected to measure brain natriuretic peptide (BNP), catecholamines, endothelin-1 (ET-1), nitric oxide (NO), electrolytes, hematocrit, albumin and nitrogen substances. The mean age of the studied patients was 43 ± 4.9 years, and 54.6% were males. SVR significantly increased in group A (Pdopamin and noradrenalin, before and after dialysis, between the two groups. The mean value of ET-1, post HD, was 25.9 pg ml(-1) in group A and 13.3 pg ml(-1) in group B (P = < 0.001). Patients with ESRD showed different hemodynamic patterns during the HD session, with significant BP increase in group A, caused by an increase in SVR possibly due to endothelial dysfunction, evidenced by an increase in serum ET-1 levels. PMID:25339292
Walber Pinto, Vieira; Kirla Wagner Poti, Gomes; Niedja Bezerra, Frota; José Eyorand Castelo Branco, Andrade; Rejane Maria Rodrigues de Abreu, Vieira; Francisca Edwiges Araújo, Moura; Francisco José Fernandes, Vieira.
Full Text Available As anormalidades musculoesqueléticas em pacientes submetidos à hemodiálise são numerosas e freqüentes, sendo mais prevalentes naqueles em tratamento dialítico de longa duração. A artralgia é o sintoma mais comum, ocorrendo em mais de 70% dos pacientes. O hiperparatireoidismo secundário é a principal [...] causa da doença renal óssea, e as manifestações clínicas são: dor óssea, artralgia e prurido. A amiloidose, decorrente da deposição de proteína beta2-microglobulina nos tecidos, manifesta-se pela presença de ombro doloroso, síndrome do túnel do carpo, dedo em gatilho, ruptura espontânea de tendão e fratura patológica. Outras manifestações musculoesqueléticas observadas são a artrite induzida por cristais, necrose avascular, artrite séptica, fraqueza muscular e cãibras musculares. Abstract in english Musculoskeletal manifestations in hemodialysis patients are numerous and frequent, being more prevalent in those undergoing long duration dialytic treatment. Arthralgia is the most commom symptom, occurring in more than 70% of patients. Secondary hyperparathyroidism is the main cause of bone renal d [...] isease, and clinical manifestations are bone pain, arthralgia and pruritus. Amyloidosis, due to beta2-microglobulin deposition in tissues, manifests as shoulder pain, carpal tunnel syndrome, trigger finger, spontaneous tendon rupture and pathological fractures. Other musculoskeletal manifestations observed are crystal-induced arthritis, avascular necrosis, septic arthritis, muscle weakness and muscle cramps.
Full Text Available Patients undergoing long-term hemodialysis have a high risk of cardiovascular disease. Arterial stiffness is highly prevalent in this type of patients. The aim of our study was to analyse the relationship between body composition, blood chemistries and arterial stiffness in a poorly fit population of chronic hemodialysed patients. Patients and methods involved measuring body composition and fitness score by multifrequence bioimpedance with the body composition analyzer InBody720 and arterial stiffness by the measurement of aortic Pulse Wave Velocity (PWVao and Aortic Augmentation Index (Aix using an oscillometric method on 65 HD patients; measurements were made before a midweek dialysis session. Results: PWVao correlated significantly with weight (p=0.01, r2=1.14, body fat mass (p=0.007, r2=0.14, abdominal circumference (p=0.01, r2=0.12 and with fitness score (p=0.01, r2=0.11. Aix correlated with weight (p<0.05, r2=0.25, intracellular, extracellular- and total body water (p<0.05, r2=0.24 with body protein, soft lean mass, minerals, fat free mass and skeletal muscle mass (p<0.05, r2= 0.3 and with serum calcium (p=0.005, r2=0.2. Conclusions: Arterial stiffness is a common feature of the hemodialysed patients, significantly related to the blood calcium, fitness score and the body composition, especially fat body mass.
Al Shohaib, S S; Abdelaal, M A; Zawawi, T H; Abbas, F M; Shaheen, F A; Amoah, E
The prevalence of antibody to hepatitis C virus (HCV) in hemodialysis (HD) patients is high and variable. One hundred and thirty nine patients undergoing maintenance HD at three different renal units in Jeddah, Kingdom of Saudi Arabia, were studied for prevalence of anti-HCV antibody. The overall prevalence in the group examined was 52.5% (73/139). There was a significant correlation between prevalence of anti-HCV and duration of HD; 53/ 74 (71.6%) in patients on HD for > 3 years as against 20/65 (30.8%) for patients on HD for < 3 years (P< 0.05). We were unable to demonstrate a correlation of anti-HCV positivity with history of blood transfusions, previous exposure to hepatitis-B virus, sex, age, or ethnic group. The very high prevalence of anti-HCV found in patients on maintenance HD and the positive correlation between anti-HCV reactivity and duration on dialysis suggest that factors within the dialysis unit might contribute to the spread of the virus. PMID:18583850
Ando, Itiro; Takeuchi, Kazuhisa; Oguma, Shiro; Sato, Hiroshi; Sekino, Hiroshi; Imai, Yutaka; Fujiwara, Masako
We used ¹H nuclear magnetic resonance (NMR) spectroscopy to assess metabolic responses in patients undergoing hemodialysis (HD). We collected 71 samples of plasma and dialysate from 10 patients before, during, and after HD. We used the dialysate as a possible substitute for blood plasma to quantify small metabolites by ¹H NMR. We confirmed TSP (sodium 3-(trimethylsilyl) propionate 2, 2, 3, 3-d4) as a reference of NMR intensity in dialysate. We examined TSP sensitivities in various dialysate spectra and the correlation between signal intensities and added quantities of TSP. We used integrations of signal areas on ¹H NMR spectra of plasma and dialysate to quantify concentrations of creatinine, lactate, alanine, and valine and calculate their ratios between plasma and dialysate. The ratios of metabolites in plasma to dialysate were 3.2±0.4 (creatinine), 3.6±0.5 (valine), 3.8±0.7 (alanine), and 4.0±0.8 (lactate) mM (mean±standard deviation [SD]). The broader distributions of ratios in levels of lactate and alanine suggested their de novo production during the HD session. Estimation of blood metabolite levels using dialysate is useful for quantitative analysis of metabolic status in blood during HD. PMID:23666155
Analucia Filgueira Gouveia Barreto
Full Text Available Objective: to investigate the incidence of infection related to the use of temporary double lumen Catheter (TDLC in chronic renal disease undergoing hemodialysis. Methodology: this is about a descriptive exploratory study, from quantitative, performed in a clinic of nephrology of Natal/RN after approval by the ethics committee (protocol number 67/2008, April-June 2008, with data collected through a semi-structured form. The data were categorized and processed through Microsoft Excel XP. Results: 47 patients participated in the study, 70.21% male, 40.42% in the age group 60 to 79 years, married (61.70%, primary school (38.30%. The main co-morbidity was associated with hypertension (31.91%. As for the local (51.06% catheters were implanted in the right jugular vein, mainly by loss of arteriovenous fistula (ACF (46.81%, followed by 44.68% who needed treatment immediately. As for the signs of infection were present in 38.30% patients, always a cause for withdrawal of the catheter. The maximum time of use was 120 days, but prevailed in the range 1 to 20 days with (40.43%. Conclusion: it was observed that the more permanent catheters increases the incidence of infection. Thus, the relevance of the educational activities of nurses, to patients with kidney, stimulating self-care, preventing and detecting early infection.
abdoreza Sotoodeh Jahromi
Full Text Available Homocysteine, folic acid and vitamin B12 serum levels in hemodialysis patients referring to hemodialysis unit of Jahrom hospitalSotoodeh Jahromi A1,2, Farjam MR*3, Shojaei M4Received: 09/25/2010Revised: 01/27/2011Accepted: 01/29/20111. Dept. of Immunology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran2. Research Center for Zoonotic Diseases, Jahrom University of Medical Sciences, Jahrom, Iran 3. Dept. of Biochemistry, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran4. Dept. of Internal Medicine, School of Medicine, Jahrom University of Medical Sciences, Jahrom, IranJournal of Jahrom University of Medical Sciences, Vol. 9, No. 1, Spring 2011 AbstractIntroduction:Homocysteine is an amino acid yielded from methionin to cysteine metabolism. Increased level of homocysteine can increase the risk of cardiovascular diseases. Several factors such as uremia, genetic factors, dialysis related factors and vitamin B group deficiency lead to increased plasma level of homocysteine in dialysis patients. This study aimed to evaluate plasma levels of homocysteine, vitamin B12 and folic acid in Jahrom hemodialysis patients.Materials and Methods:This cross-sectional study was carried out on a total of 43 hemodialysis patients and 43 age and sex matched healthy individuals without any underlying renal disease as control group during December 2008 and September 2009. The serum level of homocysteine was measured using ELISA method and the serum levels of vitamin B12 and folic acid were measured by radioimmunoassay method.Results:Comparing the patients with the control group, there were significant differences between the two groups in mean serum levels of homocysteine (22.709±5.765 µmol/L vs. 16.518±5.425 µmol/L, folic acid (513.814±15.378 ng/ml vs. 22.976±7.462 ng/ml and vitamin B12 (5366.814±1734.752 pg/ml vs. 868.907±251.484 pg/ml (P<0.001. A significant positive correlation was found between mean serum level of homocysteine and duration of hemodialysis therapy (r=0.893, P<0.001.Conclusion:Although in the present study the homocysteine level in the patients was more than that of the healthy subjects, it was lower than that of hemodialysis patients in other countries.
Julio, Valdivia; Carlos, Gutiérrez; Janete, Treto; Ernesto, Delgado; Daymiris, Méndez; Irma, Fernández; Anselmo, Abdo; Lourdes, Pérez; Mabel, Forte; Yanisbell, Rodríguez.
Full Text Available INTRODUCTION: Knowledge of prognostic factors in end-stage renal disease patients has improved dialysis management and methods for reducing morbidity and mortality, underlining the importance of identification, prevention and control of these factors. OBJECTIVE: Identify factors affecting prognosis [...] (survival or death) in hemodialysis patients at the Medical-Surgical Research Center in Havana over a ten-year period. METHODS: Descriptive, prospective study of 81 end-stage renal disease patients who received hemodialysis at the Medical-Surgical Research Center from 1995 to 2004. Prognostic factors were identified at initiation of and during dialysis treatment, using chi square, t test, McNemar test, Kaplan Meier analysis, log-rank test and Cox regression model, with significance threshold set at p
The usefulness of three-dimensional (3D) CT imaging of skeletal complications in hemodialysis patients was evaluated. In this study, CT HiLight Advantage from GE Medical Systems (Milwaukee, Wisconsin) was used. Since the 3D image can be manipulated in various ways, it is quite useful for the examination of anatomically complex areas such as hip joints and the spine. As a result, amyloid deposition in the femoral head and the pelvic bone, as well as a small pelvic fracture, were clearly demonstrated. Bone surface irregularity due to severe osteopenia was also evident with this method. 3D-CT imaging will enhance the accuracy of diagnoses of bone and joint diseases in hemodialysis patients. (author)
Ahn, Hye Shin; Yun, Jong Min; Lee, Yeong Bok; Ko, Yu Mi; Lee, Jung Eun; Won, Hye Sung; Kim, Sung Soo; Kim, Young Ok
Paraneoplastic hypercalcemia without bone metastasis occurs rarely in esophageal cancer. A 75-year-old man was admitted for general weakness and lethargy. Laboratory data showed high serum calcium level (corrected calcium 14.6 mg/dL), low parathyroid hormone level (3.3 pg/mL) and high parathyroid hormone-related peptide level (3.5 pmol/L). Esophagogastroscopy showed a malignant tumor in the esophagus. Histology showed moderately differentiated squamous cell carcinoma. Bone scan showed no evidence of bone metastasis. Since the patient's calcium levels remained high and mental state did not show improvement despite intravenous fluid therapy, diuretics and intravenous bisphosphonate, hemodialysis was started. After hemodialysis treatment, the serum calcium level subsequently normalized and his mental status improved. Herein, we report a rare case of paraneoplastic hypercalcemia in a patient with esophageal cancer. PMID:26087691
Saúl, Molina Alfonso; David, Orret Cruz; Yanet, Miranda Cona; Blas, Nuviola González.
Full Text Available Los aneurismas de fístulas arteriovenosas para hemodiálisis constituyen una complicación que aparece en algunos pacientes y que no siempre se toma una conducta con relación a ellos. En este trabajo presentamos un caso de una mujer de 29 años de edad con nueve años en hemodiálisis a través de una fís [...] tula arteriovenosa braquiocefálica izquierda que desarrolló aneurisma gigante con peligro de ruptura espontánea, la cual fue sometida a tratamiento quirúrgico. Se describe la técnica y se revisa la literatura al respecto. Abstract in english Hemodialysis arteriovenous fistula aneurisms represent a complication that we can observe in some patients and not always is taken a procedure in relation to them. Herein, we report the case of 29 year old woman with nine years of hemodialysis treatment through left brachiocephalic arteriovenous fis [...] tula which developed a giant aneurism with the possibility of spontaneous rupture. The patient was submitted to surgical treatment. The technique was described and the literature was review.
Full Text Available Abstract Background The relationship between intraocular pressure (IOP changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery. Case presentation A 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+ in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10–14 mmHg and no painful IOP spikes occurred during hemodialysis over the first postoperative year. Conclusion We present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility.
In patients with dialysis therapy, cardiovascular diseases have a great impact on morbidity and mortality. Because physicians have recently been encountering more patients with diabetes mellitus as well as more elderly patients, the importance of evaluating atherosclerosis has continuously increased. It has been reported that ischemic heart diseases or cerebrovascular diseases can be estimated using non-invasive ultrasonography. In addition, we can also diagnose coronary stenosis using computed tomography more easily than before. In this study, we in vestigated the efficacy of carotid ultrasonography in estimating coronary artery stenosis in patients with hemodialysis. One hundred and eight patients (58 men and 50 women with a mean age of 69±12 years, and a mean dialysis duration of 6.7±6.2 years) were enrolled in this study. We measured the maximum intima-media thickness (max-IMT), the distribution and the properties of plaque and plaque scores at carotid arteries using ultrasonography, and examined the degree of stenosis and the number of stenotic coronary arteries using computed tomography. As the max-IMT or plaque scores increased, the degree of stenosis became significantly more severe and multi-vessel disease was observed with significantly greater frequency. End stage renal disease is one of most significant cardiovascular risk factors. However, it is difficult to diagnose ischemic heart disease correctly in these patients because they sometimes have few sympnts because they sometimes have few symptoms due to diabetes and often show atypical electrocardiograms due to ventricular hypertrophy or electrolyte disorders. In this study, we clearly showed the correlation between atherosclerosis in the carotid arteries and stenosis in the coronary arteries. It is suggested that carotid ultrasonography is useful to estimate coronary artery stenosis, and effective for evaluating the risk of ischemic heart diseases non-invasively in patients with hemodialysis. (author)
Gamboa, Jorge L.; Pretorius, Mias; Todd-Tzanetos, Deanna R.; Luther, James M.; Yu, Chang; Ikizler, T Alp; Brown, Nancy J.
Biomarkers of oxidative stress and inflammation predict cardiovascular events in maintenance hemodialysis patients. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) reduce cardiovascular mortality in the general population, but their benefit in maintenance hemodialysis patients is not fully explored. To test whether ACE inhibitors and ARBs differentially affect markers of oxidative stress, inflammation, and fibrinolysis during hemodialysis, we conducted ...
Seyed Alijavad Mousavi
Full Text Available Introduction. The aim of this study was to evaluate the frequency of unexplained pulmonary hypertension (PHT among patients on hemodialysis at 2 centers and to evaluate possible predisposing factors.Materials and Methods. In this cross-sectional study, PHT was screened by Doppler echocardiography on the day after dialysis in 62 patients with end-stage renal disease receiving maintenance hemodialysis via arteriovenous access. Pulmonary hypertension was defined as a systolic pulmonary arterial pressure (PAP higher than 35 mm Hg, and the systolic PAP was calculated using the modified Bernoulli equation. Clinical variables were compared between patients with and without PHT.Results. A PAP higher than 35 mm Hg was found in 32 patients (49.3% receiving hemodialysis, with a mean systolic PAP of 39.58 ± 13.27 mm Hg. Blood hemoglobin level was significantly lower in the patients with PHT than those without PHT (9.8 ± 1.97 g/dL versus 11.07 ± 1.86 g/dL; P = .01. In addition, serum levels of albumin was lower in these patients (3.38 ± 0.32 g/dL versus 3.75 ± 0.44 g/dL; P = .02.Conclusions. This study demonstrates a surprisingly high prevalence of PHT among patients with end-stage renal disease receiving hemodialysis. We concluded that the best approach to this unrecognized complication that is associated with reduced survival is keeping it in mind and looking for it in the management of patients on dialysis.
Al Eissa, M.; Al Sulaiman, M.; Jondeby, M.; Karkar, A.; Barahmein, M.; F. A. M. Shaheen; Al Sayyari, A
Aim. To assess the degree of satisfaction among hemodialysis patients and the factors influencing this satisfaction. Methods. Patients were recruited from 3 Saudi dialysis centers. Demographic data was collected. Using 1 to 10 Likert scale, the patients were asked to rate the overall satisfaction with, and the overall impact of, their dialysis therapy on their lives and to rate the effect of the dialysis therapy on 15 qualities of life domains. Results. 322 patients were recruited (72...
Seyrafian, Shiva; Pestechian, Nader; Namdari, Nasrin; Aviani, Mahshid; Kerdegari, Maryam; Parvizian, Farzad; Kassaii, Leila; Eshaghian, Afrouz; Nasri, Hamid
Background: Hemodialysis (HD) patients are prone to infections as a result of impaired immune system. Early detection of disease helps to prevent complications. The aim of this study was to evaluate the prevalence of intestinal parasite infections in HD patients and compare it with control groups. Methods: In a cross sectional study, the stool sample of 155 HD patients, and 294 controls were examined for parasitic contaminations. Control groups included: 130 patients’ family, 16 staffs of t...
To evaluate the spectrum of mineral abnormalities and bone disease (BD) in hemodialysis patients at Jordan University Hospital (JUH), Amman, Jordan. A cross-sectional study was conducted among 63 patients (38 males and 25 females), mean age 44.19 years (range 17-76 years), with chronic kidney disease (CKD) on regular hemodialysis at JUH between November 2004 and April 2005. All patients have undergone complete blood count, chemistry profile, alkaline phosphatase, serum albumin, intact parathyroid hormone (iPTH) and plain x-rays. Bone disorders were identified in 45 patients on x-rays (70%). Osteopenia was found in 43 patients (68.3%), subperiosteal resorption in 24 patients (38.3%) and metastatic calcification in 22 patients (35%). Hypocalcemia was found in 28.6% and hypercalcemia in 7.9%. All patients were taking calcium carbonate, and 55.5% of patients were on vitamin D supplements. The calcium levels in 63.5% and the phosphorus levels in 50.8% of patients were within the recommended guidelines of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI). Serum i-PTH level was above 300 pg/ml high turnover bone disease in 24.6% of patients, 21.3% had iPTH of 150-300 pg/ml target, and 44.3% had i-PTH levels below 100 pg/mL suggesting a dynamic bone disease. Patients with severe bone disease had a statistically significant higher iPTH levels (p<0.005). Bone disease and mineral abnormalities are common in hemodialysis patients at JUH. Earlier din hemodialysis patients at JUH. Earlier detection of bone disease and better overall management strategy may reduce the frequency and severity of bone disease in CKD patients in Jordan. (author)
Timmy Lee; Charmaine Lok; Miguel Vazquez; Louise Moist; Ivan Maya; Michele Mokrzycki
The maintenance of tunneled catheter (TC) patency is critical for the provision of adequate hemodialysis in patients who are TC-dependent. TC dysfunction results in the need for costly and inconvenient interventions, and reduced quality of life. Since the introduction of TCs in the late 1980s, heparin catheter lock has been the standard prophylactic regimen for the prevention of TC dysfunction. More recently, alternative catheter locking agents have emerged, and in some cases have shown to be...
Chan, Kevin E.; Lazarus, J. Michael; Thadhani, Ravi; Hakim, Raymond M.
Many prescribe anticoagulants and antiplatelet medications to prevent thromboembolic events and access thrombosis in dialysis patients despite limited evidence of their efficacy in this population. This retrospective cohort study examined whether use of warfarin, clopidogrel, and/or aspirin affected survival in 41,425 incident hemodialysis patients during 5 yr of follow-up. The prescription frequencies for warfarin, clopidogrel, and aspirin were 8.3, 10.0, and 30.4%, respectively, during the ...
Petar M. Niki?; Branislav R. Andri?; Biljana B. Stojimirovi?; Jasna Trbojevic-Stankovi?; Zoran Bukumiri?
Objective. Coffee drinking is the main source of caffeine intake among adult population in the western world. It has been reported that low to moderate caffeine intake has beneficial effect on alertness and cognitive functions in healthy subjects. The aim of this study is to evaluate the impact of habitual coffee consumption on cognitive function in hemodialysis patients. Methods. In a cross-sectional study, 86 patients from a single-dialysis centre underwent assessment by the Montreal Cognit...
Gülperi Çelik, Bahar Oc, Inci Kara, Mümtaz Y?lmaz, Ali Yuceaktas, Seza Apiliogullari
Aim: The aim of this study was to compare the nutritional biochemical parameters, prealbumin levels, and bioimpedance analysis parameters of adult and elderly hemodialysis (HD) patients.Methods: This prospective cross-sectional study included 50 adult HD patients (42.0 % female). Nutritional status was assessed by post-dialysis multifrequency bioimpedance analysis (BIA), serum prealbumin and other nutritional biochemical parameters.Results: Mean age of patients was 57.4±15.1 years (range...
Silini, E; Bono, F; Cerino, A; Piazza, V.; Solcia, E.; Mondelli, M U
The clinical and epidemiological relevance of circulating antibodies to hepatitis C virus (HCV) in hemodialysis patients is uncertain, since clinical signs of infection are often mild or absent, with alanine aminotransferase (ALT) values that are virtually always normal, and liver biopsies are only rarely performed. Determination of HCV RNA in serum is therefore critical for distinguishing chronic HCV infection from previous exposure to the virus. We studied HCV viremia by reverse transcripti...
Gaweda, Adam E.; Aronoff, George R.; Jacobs, Alfred A.; Rai, Shesh N.; Brier, Michael E.
One-size-fits-all protocol-based approaches to anemia management with erythropoiesis-stimulating agents (ESAs) may result in undesired patterns of hemoglobin variability. In this single-center, double-blind, randomized controlled trial, we tested the hypothesis that individualized dosing of ESA improves hemoglobin variability over a standard population-based approach. We enrolled 62 hemodialysis patients and followed them over a 12-month period. Patients were randomly assigned to receive ESA ...
Qinglei Zhang; Xiaolong Lu; Lihua Zhao
In this study, the polyvinylidene fluoride (PVDF) hollow fiber hemodialysis membranes were prepared by non-solvent induced phase separation (NIPS). The influences of PVDF membrane thickness and polyethylene glycol (PEG) content on membrane morphologies, pore size, mechanical and permeable performance were investigated. It was found that membrane thickness and PEG content affected both the structure and performance of hollow fiber membranes. The tensile strength and rejection of bovine serum a...
Ivan, D. Maya; Smith, Tamorie; Allon, Michael
Background and objectives: Concentrated heparin solutions are instilled into the catheter lumens after each hemodialysis session to prevent catheter thrombosis. The heparin lock concentration at many centers has been decreased recently to reduce the risk of systemic bleeding and contain costs. However, the effect of this change on catheter patency is unknown. We compared catheter patency between two heparin lock solutions: 1000 versus 5000 units/ml.
Full Text Available Introduction. Valvular abnormalities frequently occur in patients with chronic kidney failure. This study evaluated the prevalence of heart valve calcification (HVC in hemodialysis patients and factors associated with it. Materials and Methods. Medical charts of 129 hemodialysis patients were reviewed retrospectively. Demographic features and laboratory analysis of the patients were systematically recorded. Echocardiographic findings were collected, including ejection fraction, aortic valve calcification (AVC, mitral valve calcification (MVC, left ventricle mass, left ventricle mass index, and pulmonary artery pressure. Results. Valvular abnormalities were found in 43 patients (33.3%; 30 patients (23.3% had MVC, 28 (21.7% had AVC, and 15 (11.6% had both MVC and AVC. Patients with HVC were older than other patients (P P = .002 and serum albumin level of patients with HVC was significantly diminished. Conclusions. This study failed to show an association between HVC in hemodialysis patients and calcium-phosphorus product and parathyroid hormone levels; however, age and diabetes mellitus could be regarded as risk factors. In addition, HVC may lead to increased left ventricle mass index and pulmonary artery pressure and decreased ejection fraction, and low albumin levels may be attributable to inflammation.
Zuidema, Mozow Y; Dellsperger, Kevin C
We discuss the current state of knowledge related to the pathogenesis of myocardial stunning as well as the potential mechanisms responsible for the clinical presentation of myocardial stunning in hemodialysis patients. We suggest future research areas for this critical and clinically important condition in this high-risk patient population. In consideration of acute and chronic changes secondary to dialysis, especially in patients with risk for coronary artery disease, the prevalence of myocardial stunning and its role in the natural history of these patients' disease progression is considered. We propose a paradigm: that the majority of the pathophysiologic mechanisms by which hemodialysis may induce myocardial stunning falls into two categories with (1) vascular and/or (2) metabolic contributions. In order to prevent eventual myocardial hibernation, myocardial remodeling, scarring, and loss of contractile function with aberrant electrical conductivity that could lead to sudden death, it is imperative to identify the risk factors associated with myocardial stunning during hemodialysis. Further understanding of these mechanisms may lead to novel clinical interventions and pharmacologic therapeutic agents. PMID:22851961
To analyze angiographic findings and to evaluate prognosis after interventional treatment of complication arteriovenous hemodialysis fistulas. We reviewed 19 patients of complicated arteriovenous hemodialysis fistulas between June 1993 and January 1995. The angiographic findings of 19 patients were analyzed and outcome and interventional treatment in 12 patients were evaluated. On angiography, there were 15 stenosis, 3 complete occlusion, and a poor arterialization of venous side. Two of there were combined with pseudoaneurym. Most common location and the lesion was cephalic vein (6/19) alone or with neighboring anastomosis(5/19). Other location included anastomosis(2/19), radial artery (1/19), radial artery with cephalic vein(2/19), and central vein(2/19). The percutaneous transluminal angioplasty was performed in 8 patients, thrombolysis in 3, and both procedures in 1. The overall success rate of the interventional treatment was 75%(8/12). It is suggested that the interventional procedures could replace the surgery as the primary choice for the treatment of complicated arteriovenous hemodialysis fistulas, considering its safety, high initial success rate and lower morbidity
Purpose: To evaluate thoracic CT findings of long-term hemodialysis patients. Material and methods: Thoracic CT findings of 117 umremic patients (61 men, 56 women) with complaints of cough, dyspnea, low-grade pyrexia, malaise, weight loss, and profuse perspiration were retrospectively documented. Results: Atelectasis (60%), cardiomegaly (60%), pleural effusion (51%), vascular congestion (44%), parenchymal consolidation (38%), parenchymal scarring-fibrosis (31%), and lymphadenopathy (29%) were the most common CT findings in the thoraces of the long-term hemodialysis patients. Staphylococcus aureus was detected in 13 patients (11%) who had parenchymal infiltration. Thoracid tuberculosis was identified in 15 patients (13%), 11 of these cases being confined to the lung parenchyma, 3 to the pleura, and 1 involving the pleura and pericardium. Conclusion: In patients under long-term hemodialysis treatment, parenchymal consolidation, secondary to infectious agents such as S. aureus and Mycobacterium tuberculosis, is the most important CT finding since these lesions can be detected and treated successfully if they are considered as etiologic factors early on. (orig.)
Full Text Available Introduction: Osteodystrophy is one of the long term complications of chronic renal failure and is expressed in two forms;low turn over and high turn over. It is an important cause of morbidity in patients with renal failure and if diagnosed and managed properly, many problems of these patients can be resolved. In this study we evaluated the prevalence of hyperparathyroidism in hemodialysis patients and its correlation with different factors. Methods: This study was an analytic, observational study that was done by the cross- sectional method. We formatted a questionnaire for hemodialysis patients who were enrolled in the study over a period of 6 months. Fasting blood samples (5-10c.c were drawn to measure levels of PTH(parathyroid hormone ,calcium, phosphorous and alkaline phosphatase. Skull and wrist X-rays were also taken and the radiologist evaluated them with regards to hyperparathyroidism. Results: In the 80 patients studied, prevalence of hyperparathyroidism was 45% (36 patients. 44 patients were diabetics. Among different factors, hyperparathyroidism did not correlate with frequency and duration of dialysis, age, sex ,familial history, diabetes, hypertension , bone pains, muscle weakness, purities and level of calcium and phosphorous. But there was a significant relationship between hyperparathyroidism and alkaline phosphatase levels and radiological findings. Conclusion: We can use alkaline phosphatase levels and/or radiographic changes for evaluation of renal osteodystrophy in hemodialysis patients and prevent complications by early diagnosis and proper management.
Kinsella, Sinead M
Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20 mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7 mSv, in which 13 patients had a total cumulative effective radiation dose over 75 mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients.
Samir M. Ibrahim,. Khalid H Abdel-Mageed, Magdi M El-Sharkawy
Full Text Available Background: Decreased bone mineral density (BMD is a known complication for the uremic state antedating dialysis / renal transplantation (RTx. The issue of stabilized versus continued decrease of BMD especially on long-term basis, continues to be unresolved. Patients and Methods: !"#"hemodialysis (HD-#" $% " &'( &'(-group had been evaluated for metabolic bone changes by calcium homeostasis parameters (serum calcium, phosphorus, alkaline phosphatase "ALP" and vitamin D "calcitriol", markers of bone formation (bone alkaline phosphatase "BAP", osteocalcin "OC", N-terminal propeptide of collagen type I "PINP", bone resorption markers (pyridoline "PYL" and deoxypyridoline "DPYL", and intact parathyroid hormone (iPTH. Also, BMD had been assessed by dual energy x-ray absorptiometry (DEXA twice, at inclusion time and * ! "" Results: comparing both groups regarding calcium homeostasis, markers of bone turnover and iPTH showed non significant difference. However, there was a significant drop of BMD (as evidenced by T-score at follow up in the HD group, compared to stabilization of T-score for the RTx-group. Furthermore, annual T-score change was significantly more in HD-group, compared to RTx-group. Results also showed that, the best marker correlating with T-score annual changes and iPTH to be PINP. Irrespective of normal calcium homeostasis parameters, low BMD is a prevalent disorder among patients on regular HD and renal transplants.Conclusion: Follow up for * ! " %+ ,- ." % """"!to continued bone loss in patients on regular HD. This could raise recommendation for calcium and calcitriol supplementation, especially in the predialysis period, early post transplantation period, and continued guided replacement for those on maintenance HD. Serum PINP showed best correlations with BMD changes and iPTH and could be considered a reliable marker reflecting bone formation in those patients. Keywords: hemodialysis, renal transplantation, markers of bone formation; bone alkaline phosphatase (BAP, osteocalcin (OC, N-terminal propeptide of collagen type I (PINP, markers of bone resorption; pyridoline (PYL, deoxypyridoline (DPYL, intact parathyroid hormone (iPTH, dual energy x-ray absorptiometry (DEXA, bone mineral density (BMD. Introduction and aim af aork: hyperparathyroidism, parathormone Chronic renal failure (CRF is a resistance of bone cells, vitamin D known cause of reduction of bone metabolic disorders, immobility of mineral density (BMD with subsequent patients, hypogonadism, amyloidosis enhanced bone fragility. The and toxic osteodystrophy by aluminum pathophysiological causes include or poor dialysis quality . In addition,
Devereaux, P J; Mrkobrada, Marko
BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and for 7 days in the continuation stratum, after which patients resumed their regular aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: The primary outcome occurred in 351 of 4998 patients (7.0%) in the aspirin group and in 355 of 5012 patients (7.1%) in the placebo group (hazard ratio in the aspirin group, 0.99; 95% confidence interval [CI], 0.86 to 1.15; P=0.92). Major bleeding was more common in the aspirin group than in the placebo group (230 patients [4.6%] vs. 188 patients [3.8%]; hazard ratio, 1.23; 95% CI, 1.01, to 1.49; P=0.04). The primary and secondary outcome results were similar in the two aspirin strata. CONCLUSIONS: Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.).
Ito, Kiyonori; Ookawara, Susumu; Ueda, Yuichiro; Goto, Sawako; Miyazawa, Haruhisa; Yamada, Hodaka; Kitano, Taisuke; Shindo, Mitsunobu; Kaku, Yoshio; Hirai, Keiji; Yoshida, Masashi; Hoshino, Taro; Nabata, Aoi; Mori, Honami; Yoshida, Izumi; Kakei, Masafumi; Tabei, Kaoru
Background Patients undergoing hemodialysis (HD) often develop cerebral disease complications. Furthermore, cerebral regional saturation of oxygen (rSO2) was previously reported to be significantly lower in HD patients than in healthy subjects. We aimed to identify the factors affecting the cerebral rSO2 in HD patients. Methods Fifty-four HD patients (38 men and 16 women; mean age, 67.7 ± 1.2 years, HD duration, 6.5 ± 1.9 years) were recruited. Cerebral rSO2 was monitored at the forehead before HD using an INVOS 5100C (Covidien Japan, Tokyo, Japan). Results The rSO2 levels were significantly lower in HD patients compared with healthy controls (49.5 ± 1.7% vs. 68.9 ± 1.6%, p <0.001). Multiple regression analysis showed that cerebral rSO2 independently associated with pH (standardized coefficient: -0.35), HD duration (standardized coefficient: -0.33), and serum albumin concentration (standardized coefficient: 0.28). Furthermore, the rSO2 was significantly lower in HD patients with diabetes mellitus (DM), compared with patients without DM (46.8 ± 1.7% vs. 52.1 ± 1.8%, p <0.05). Conclusions In HD patients, cerebral rSO2 was affected by multiple factors, including pH, HD duration, and serum albumin concentration. Furthermore, this is the first report describing significantly lower levels of rSO2 in HD patients with DM than in those without DM. PMID:25706868
Hemodialysis patients are at greater risk of cardiovascular disease. Higher than expected cardiovascular morbidity and mortality in this population has been attributed to dislipidemia as well as inflammation. The causes of inflammation in hemodialysis patients are multifactorial. Several markers were used for the detection of inflammatory reaction in patients with chronic renal disease.
Le?, Jaros?aw; Grzesiak, Joanna; ?abu?, Ma?gorzata; Kade, Grzegorz; Zelichowski, Grzegorz; Brzozowski, Krzysztof; Zukowski, Pawe?; Wa?kowicz, Zofia; Rybicki, Zbigniew
The aim of our report is description of the first in Poland translumbar cannulation of vena cava inferior used as an alternative vascular access for hemodialysis in 62 years old patient without further access for hemodialysis and no access for peritoneal dialysis. PMID:18634367
Rohrscheib, Mark R.; Myers, Orrin B.; Servilla, Karen S.; Adams, Christopher D.; Miskulin, Dana; Bedrick, Edward J.; Hunt, William C.; Lindsey, Douglas E.; Gabaldon, Darlene; Zager, Philip G.
Background and objectives: Despite the high prevalence of cardiovascular disease among hemodialysis patients, the relationship between age and blood pressure (BP) is not well understood. It was postulated that the relationship of BP to age differs among hemodialysis patients versus the general population and that there is significant variability in dialysis unit BP measurements.
Full Text Available Implication for health policy/practice/research/medical education:Primary arteriovenous fistula (AVF, failure remains a major problem for hemodialysis patients. Vascular access thrombosis prophylaxis needs to start early in the end-stage renal disease patient. Ticlopidine seems to be effective and safe for prevention of primary AVF failure in hemodialysis patients.
El Saleeby, Chadi M.; Allison, Kim J.; Knapp, Katherine M.; Walsh, Thomas J.; Hayden, Randall T.
We describe the case of a patient with improving invasive aspergillosis and paradoxically rising serum galactomannan levels in the presence of chronic renal failure and ongoing hemodialysis. Dialysate tested negative for galactomannan, demonstrating the inability of treatments such as hemodialysis to clear Aspergillus antigen from serum. In patients with renal failure and aspergillosis, rising serum galactomannan levels may not necessarily signify progressive infection.
Full Text Available Background/Aim. Chronic renal insufficiency (CRI, diabetes, hypertension, autosomal dominant polycystic kidney disease (ADPKD are the main reasons for starting dialysis treatment in patients having kidney function failure. At present, dialysis treatments are performed in about 4,100 patients at 46 institutions in Serbia, out of which 90% are hemodialyses. At end-stage renal disease (ESRD the only correct selection is kidney transplatation. The basic aim of the planned research was to compare ratio of costs and effects (Cost Effectiveness Analysis - CEA of hemodialysis and kidney transplantation in patients at ESRD. Methods. As the main issue of treatment in patients from both groups the life quality measured by the validated McGill Questionary, was used. The study included 150 patients totally, divided into two groups. The study group consisted of 50 patients with kidney transplantation performed at the Clinical Center of Serbia and the control group consisted of 100 patients on hemodialysis at Clinical Center of Serbia, Clinical Hospital Center Zemun, Clinical Hospital Center 'Zvezdara', Clinical Center Kragujevac and Health Center 'Studenica', Kraljevo, comparable with respect to sex, age and length of treatment with the study group. Results. Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in the form of incremental ratio of costs and effects (Incremental Cost-Effectiveness Ratio - ICER. It is clear from the enclosed tables that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of EUR 132,256.25 per one year of contribution Quality Adjusted Life Years (QALY within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, psychological symptoms, existential well-being and support, difference is statistically important in favor of transplant patents. Conclusion. The costs of patient therapy by hemodialysis at end-stage renal disease is far greater than by performing therapy of transplantation and maintenance, by almost three and a half times. Difference in total quality aspects of human life (physical, emotional, social, spiritual and financial between dialyzed and transplant patients is statistically significant and by 18.12% greater in transplant patients than in patients on hemodialysis.
Full Text Available CONTEXTO: A hiperfosfatemia tem um importante papel no desenvolvimento de anormalidades ósseas e minerais na insuficiência renal crônica terminal. OBJETIVO: Comparar o acetato de cálcio com o carbonato de cálcio quanto às suas propriedades quelantes de fósforo e efeitos hipercalcêmicos. TIPO DE ESTU [...] DO: Ensaio clínico randomizado, cruzado, duplo-cego. LOCAL: Centro de diálise hospitalar privado. PARTICIPANTES: 52 pacientes em hemodiálise regular três vezes por semana ([Ca] dialisado = 3,5 mEq/l). PROCEDIMENTOS: Metade deles recebeu 5,6 g/dia de acetato de cálcio e, após um período de "washout" de duas semanas, 6,2 g/dia de carbonato de cálcio. A outra metade seguiu protocolo inverso. VARIÁVEIS ESTUDADAS: Foram conduzidas entrevistas clínicas para monitorar efeitos colaterais e obtidas amostras sangüíneas para determinações da uréia sérica, cálcio, fósforo, hematócrito, Kt/V e gasometria arterial, antes e após cada tratamento. RESULTADOS: 33 pacientes completaram o estudo. Um aumento significativo nos níveis plasmáticos de cálcio só foi obtido após o tratamento com carbonato de cálcio [9,34 mg/dl (SD 0,91) vs. 9,91 mg/dl (SD 0,79), P Abstract in english CONTEXT: Hyperphosphatemia has an important role in the development of bone and mineral abnormalities in end-stage renal disease (ESRD). OBJECTIVE: To compare the phosphorus binding power and the hypercalcemic effect of calcium acetate and calcium carbonate in hemodialysis patients. TYPE OF STUDY: C [...] rossover, randomized, double-blind study. PLACE: A private hospital dialysis center. PARTICIPANTS: Fifty-two patients who were undergoing regular hemodialysis three times a week ([Ca++] dialysate = 3.5 mEq/L). PROCEDURES: Half of the patients were started on 5.6 g/day of calcium acetate and, after a 2 week washout period, received 6.2 g/day of calcium carbonate. The other half followed an inverse protocol. MAIN MEASUREMENTS: Clinical interviews were conducted 3 times a week to monitor for side effects. Determinations of serum urea, calcium, phosphorus, hematocrit, Kt/V and blood gas analysis were obtained before and after each treatment. RESULTS: Twenty-three patients completed the study. A significant increase in calcium plasma levels was only observed after treatment with calcium carbonate [9.34 mg/dl (SD 0.91) vs. 9.91 mg/dl (SD 0.79), P
Bahner, M.L.; Kaick, G. van [Deutsches Krebsforschungszentrum Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik und Therapie; Bommer, J.; Sommerer, C. [Heidelberg Univ. (Germany). Sektion Nephrologie
The kidneys of patients with chronic renal failure undergoing maintenance hemodialysis may show different variances or complications. Most common are secondarily acquired renal cysts, which my be found in as many as 92% of patients after 8 years of hemodialysis. Single (in 12.5% of patients) or multiple (8.3%) cysts with bleeding are common; additionally, hematuria or ruptured cysts may be found. Bleeding into cysts is more common in patients with autosomal dominant polycystic kidney disease. Due to the decreasing urinary production development of kidney stones is very uncommon, but calcification in or around cysts can be found in 71% of patients. Kidney tumors occur 41 times more often in patients with chronic renal failure than in patients without kidney disease. We detected tumors in 4.2% of our patients on long-term dialysis. Diagnostic differentiation of the relatively slow growing and fairly late metastasizing malignant tumors from adenomas is not possible. Nevertheless, we screen our patients every 3-4 years. Computed tomography is superior to ultrasonography for this purpose, because ultrasonography lacks the necessary sensitivity in this group of patients. (orig.) [Deutsch] An den Nieren von Patienten mit terminaler Niereninsuffizienz unter chronischer Haemodialyse koennen unterschiedliche Veraenderungen oder Komplikationen auftreten. Am haeufigsten sind sekundaere, erworbene Nierenzysten, die nach achtjaehriger Dialysedauer bei 92% der Patienten gefunden werden. Solitaere (bei 12,5% der Patienten) sowie multipel (8,3%) eingeblutete Nierenzysten sind haeufige Befunde, darueber hinaus kann es zu einer Haematurie oder zur Zystenruptur kommen. Hierbei sind Einblutungen bei Patienten mit familiaeren Zystennieren haeufiger und koennen dann auch multilokulaer auftreten. Konkremente der Nieren sind aufgrund der zunehmenden Oligurie selten, Verkalkungen im Bereich der Nierenzysten und Matrixsteine finden sich allerdings bei ca. 71% der Patienten. Tumoren sind 41fach haeufiger als bei Nierengesunden, im eigenen Kollektiv fanden sie sich bei 4,2% der Langzeitdialysepatienten. Differentialdiagnostisch koennen die relativ langsam wachsenden und spaet metastasierenden malignen Tumoren von den haeufiger auftretenden Adenomen nicht unterschieden werden. Dennoch fuehren wir ein regelmaessiges Screening im Abstand von drei bis vier Jahren mittels Computertomographie durch, da die Sonographie bei diesen Patienten nicht ausreichend sensitiv ist. (orig.)
Full Text Available Hisham Ismail1*, Mohamed Soliman2, Nahed Ismail31Department of Molecular Diagnosis, GEBR Institute, 2Department of Clinical Pathology, College of Medicine, Menoufia University, Menoufia, Egypt; 3Department of Pathology and Department of Microbiology and Immunology, Meharry Medical College, Nashville, Tennessee, USA *Current affiliation: College of Medicine, Qassim University, Saudi ArabiaAbstract: Hepatitis B virus (HBV and hepatitis C virus (HCV infections are frequent in patients with end-stage renal disease who are on maintenance hemodialysis. There are limited data about the prevalence of occult HBV infection in patients on long-term hemodialysis. Occult HBV is defined as positive HBV DNA in the blood in the absence of hepatitis B surface antigen in the serum. In this study, we determined the prevalence of occult HBV in hemodialysis patients with or without HCV infection. The study included 116 patients with end-stage renal disease on chronic hemodialysis, of whom 64 patients were HCV RNA positive (Group 1, and 52 were HCV RNA negative (Group 2. We found that four of 64 (6.3% hemodialysis patients with HCV infection (Group 1 had occult HBV, while only two of 52 (3.8% hemodialysis patients without HCV (Group 2 had occult HBV. We then examined whether gender-matched hemodialysis patients with positive HBV DNA in the two hemodialysis groups differed in specific parameters, ie, age, degree of liver dysfunction, and presence of coinfection with schistosomiasis, a common parasitic infection of the liver. We found no significant difference between the groups having positive HBV DNA with regard to serum levels of liver enzymes, aspartate transaminase, albumin, and hepatitis B core antigen (P > 0.05. However, we detected significantly higher levels of alanine transaminase, a prolonged duration of hemodialysis, and higher levels of schistosomal antibodies in Group 1 than in Group 2. Interestingly, we found that the presence of schistosomal antibodies, history of past blood transfusion, and longer hemodialysis duration could distinguish patients with occult HBV infection from those with HBV DNA negative infection in hemodialysis patients. In conclusion, the prevalence of occult HBV in chronic hemodialysis patients is low, and does not significantly differ between hemodialysis patients with or without HCV coinfection.Keywords: occult hepatitis B virus, hepatitis C virus, schistosomiasis, hemodialysis
Gavrani?, Bruna Brunetta; Basi?-Juki?, Nikolina; Kes, Petar
Heparin-induced thrombocytopenia type II (HIT) is a clinicopathologic syndrome in which one or more clinical events are temporally related to heparin administration and caused by HIT antibodies. There are at least five different types of clinical events that are associated with HIT: thrombocytopenia; thrombosis; skin necrosis at heparin injection site, venous limb gangrene; and an acute systemic reaction that occurs 5-30 min after intravenous bolus of heparin. HIT typically presents 5-14 days after initiation of heparin therapy, later onset is unusual. Heparin is a routine anticoagulant in hemodialysis but administration is different than in surgical and other medical population. Doses are lower and administered every other day, yet hemodialysis patients receive heparin for years. Relationship between dialysis vintage and HIT-antibody positivity has been analyzed in two studies. In national survey of HIT in hemodialysis population of the United Kingdom mean time between starting hemodialysis and development of HIT was 61 days (5-390 days). Japanese authors also found greatest incidence of HIT antibody positivity in patients who were on hemodialysis for less than 1 year, none of patients on hemodialysis for more than 10 years was HIT-antibody positive. We present a case of 70-years old female who developed HIT after 24 years of hemodialysis and exposure to heparin. First 22 years she was receiving unfractionated heparin for anticoagulation during hemodialysis sessions. Afterwards her therapy was changed to low molecular weight heparin. Last 12 years she has tunneled cuffed catheter which was also filled with unfractionated heparin. She had a history of severe renal osteodistrophy and severe aortal valve stenosis, hypothyreosis, thrombosis of both subclavian veins and partial colon resection due to mesenterial artery thrombosis. Her thrombocyte count was low, but despite extensive work-up which included HIT antibody detection, no cause could be identified. She started complaining of flushing, dyspnea and chest pain that developed several minutes after start of hemodialysis and stopped spontaneously during or after hemodialysis. Symptoms were attributed to her heart disease and she was hospitalized for cardiac reevaluation. Thrombosis of right superficial and commune femoral vein was diagnosed as well as further worsening of thrombocytopenia. HIT antibodies were assessed again and they were positive. Anticoagulation during hemodialysis was changed to fondaparinux and catheter filling to citrate. Afterwards symptoms during hemodialysis disappeared and thrombocyte count recovered. HIT type II is a rare but potentially fatal syndrome that can develop years after start of heparin therapy. To our knowledge, this is the patient with longest hemodialysis vintage and newly diagnosed HIT. This is also the first case of patient on hemodialysis that developed HIT in Croatia published to date. PMID:23513420
Thayse Mayara Aragão Siqueira
Full Text Available FUNDAMENTO: Pacientes com doença renal crônica (DRC em hemodiálise possuem altas taxas de morbidade e mortalidade cardiovascular. Apesar de alterações ecocardiográficas estruturais e funcionais em pacientes submetidos à hemodiálise terem sido objeto de diversos estudos de análise de sobrevida, o valor prognóstico destas alterações ainda não está bem estabelecido na literatura. OBJETIVO: Determinar o valor prognóstico de parâmetros ecocardiográficos em pacientes com DRC em hemodiálise. MÉTODOS: Sessenta pacientes consecutivos com DRC em tratamento hemodialítico foram avaliados clinicamente e submetidos ao ecodopplercardiograma, sendo acompanhados durante 19 ± 6 meses. Os desfechos avaliados foram eventos cardiovasculares fatais e não fatais e mortalidade geral. O valor preditivo das variáveis ecocardiográficas foi avaliado pelo modelo de regressão de Cox, as curvas de sobrevida foram construídas pelo método de Kaplan-Meier e o teste log rank foi utilizado para compará-las. RESULTADOS: As taxas de sobrevida livre de eventos cardiovasculares, de mortalidade cardiovascular e de mortalidade global em dois anos foram de 79,4%, 88,5% e 83%, respectivamente. Diabetes, diagnóstico prévio de doença cardiovascular (DCV, fração de ejeção, fração de encurtamento, diâmetro sistólico do ventrículo esquerdo e relação E/e' foram preditores de desfecho cardiovascular na análise univariada. Na análise multivariada, história prévia de DCV (HR = 6,17; IC 95% 1,7 - 22,2; p = 0,005 e disfunção diastólica moderada a grave (HR = 3,76; IC 95% 1,05 - 13,4; p = 0,042 foram fatores de risco independentes para eventos cardiovasculares. CONCLUSÃO: Disfunção diastólica de moderada a grave é um preditor independente de eventos cardiovasculares em pacientes em hemodiálise.BACKGROUND: Patients with chronic kidney disease (CKD on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established in literature. OBJECTIVE: To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis. METHODS: Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them. RESULTS: Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD, ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005 and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042 were independent risk factors for cardiovascular events. CONCLUSION: Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.
Thayse Mayara Aragão, Siqueira; Pedro Antônio Muniz, Ferreira; Francisco das Chagas, Monteiro Júnior; Natalino, Salgado Filho; Adalgisa de Souza Paiva, Ferreira; Eugênio dos, Santos Neto; Francival Leite de, Souza; Paulo de Tarso, Cardoso.
Full Text Available FUNDAMENTO: Pacientes com doença renal crônica (DRC) em hemodiálise possuem altas taxas de morbidade e mortalidade cardiovascular. Apesar de alterações ecocardiográficas estruturais e funcionais em pacientes submetidos à hemodiálise terem sido objeto de diversos estudos de análise de sobrevida, o va [...] lor prognóstico destas alterações ainda não está bem estabelecido na literatura. OBJETIVO: Determinar o valor prognóstico de parâmetros ecocardiográficos em pacientes com DRC em hemodiálise. MÉTODOS: Sessenta pacientes consecutivos com DRC em tratamento hemodialítico foram avaliados clinicamente e submetidos ao ecodopplercardiograma, sendo acompanhados durante 19 ± 6 meses. Os desfechos avaliados foram eventos cardiovasculares fatais e não fatais e mortalidade geral. O valor preditivo das variáveis ecocardiográficas foi avaliado pelo modelo de regressão de Cox, as curvas de sobrevida foram construídas pelo método de Kaplan-Meier e o teste log rank foi utilizado para compará-las. RESULTADOS: As taxas de sobrevida livre de eventos cardiovasculares, de mortalidade cardiovascular e de mortalidade global em dois anos foram de 79,4%, 88,5% e 83%, respectivamente. Diabetes, diagnóstico prévio de doença cardiovascular (DCV), fração de ejeção, fração de encurtamento, diâmetro sistólico do ventrículo esquerdo e relação E/e' foram preditores de desfecho cardiovascular na análise univariada. Na análise multivariada, história prévia de DCV (HR = 6,17; IC 95% 1,7 - 22,2; p = 0,005) e disfunção diastólica moderada a grave (HR = 3,76; IC 95% 1,05 - 13,4; p = 0,042) foram fatores de risco independentes para eventos cardiovasculares. CONCLUSÃO: Disfunção diastólica de moderada a grave é um preditor independente de eventos cardiovasculares em pacientes em hemodiálise. Abstract in english BACKGROUND: Patients with chronic kidney disease (CKD) on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis have been the subject of several survival analysis studies, the progn [...] ostic value of these alterations is not well established in literature. OBJECTIVE: To determine the prognostic value of echocardiographic parameters in patients with CKD on hemodialysis. METHODS: Sixty consecutive patients with CKD on hemodialysis were clinically evaluated and underwent Doppler echocardiography, being followed for 19 ± 6 months. The outcome measures were fatal and nonfatal cardiovascular events and overall mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log rank test to compare them. RESULTS: Rates of survival free of cardiovascular events, of cardiovascular and overall mortality in two years were 79.4%, 88.5% and 83% respectively. Diabetes, previous diagnosis of cardiovascular disease (CVD), ejection fraction, fractional shortening, left ventricular systolic diameter and E/e' ratio were predictors of cardiovascular outcome at univariate analysis. In the multivariate analysis, previous history of CVD (HR = 6.17, 95%CI: 1.7 - 22.2, p = 0.005) and moderate to severe diastolic dysfunction (HR = 3.76, 95%CI: 1.05 - 13.4, p = 0.042) were independent risk factors for cardiovascular events. CONCLUSION: Moderate to severe diastolic dysfunction is an independent predictor of cardiovascular events in hemodialysis patients.
To study serum leptin level in chronic renal failure (CRF) hemodialysis patients and the relationship between serum leptin level and residue renal function, body composition, and indices of malnutrition, 31 end-stage CRF hemodialysis patients and 38 healthy people were enrolled. Serum leptin levels were detected by radioimmunoassay. BMI, %Fat and LBM were measured by bioelectrical impedance analysis device. Alb, Chol, Hgb, BUN, SCr and Ccr of the patients were also examined. Results showed that Serum leptin level in end-stage CRF hemodialysis patients was markedly higher than that in healthy controls (P0.05). Conclusion: Hyperleptinemia existed in end-stage CRF hemodialysis patients and might cause the loss of LBM. The leptin level was not correlated with residue renal function, but it could reflect the fat content. However, serum leptin did not play a significant role in protein malnutrition in end-stage CRF hemodialysis patients
P.A. Marcel de Vries
Full Text Available A 72-year old woman on chronic hemodialysis developed cholesterol embolization syndrome after the discontinuation of statin therapy. Four months after starting hemodialysis, statin therapy had been discontinued because she developed aspecific abdominal complaints and wanted to reduce the daily amount of pills. Five months later she developed blue toe syndrome. After restarting lipid-lowering therapy (simvastatin/ezetimibe, the pain and skin lesions diminished and eventually disappeared. Many patients starting hemodialysis use a statin. However, the benefit of statins in patients on chronic hemodialysis is not completely clear. Discontinuation of statin treatment may confer so far unrecognized risks in hemodialysis patients with severe atherosclerosis. In this case, the blue toe syndrome disappeared after restarting cholesterol-lowering treatment.
Full Text Available 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 to consume 2 gr pearl omega 3 each day for 3 months. Lipid profile was obtained by enzymatic method before and after treatment with omega 3 and the data were analysed. Consumtion of omega 3 for 3 months lowered the serum triglyceride (p<0.05. HDL increased but there was no change in total cholesterol and LDL. Consumtion of omega 3 lowered the risk of CHD in hemodialysis patients by reducing the serum triglyceride
We propose in this work to assess the prevalence of cardiovascular risk factors in the chronic hemodialysis as well as diagnostic and prognostic performance of myocardial SPECT. We conducted a prospective study over a period of 5 years (1999-2004) assemble 52 chronic hemodialysis patients, 73 pour cent were treated at the hemodialysis unit of the principal Hospital Military - Tunis and 27 pour cent the hemodialysis unit of the polyclinic CNSS El Khadhra. The conventional periodic hemodialysis bicarbonate was the dialysis technique used in all our patients.
With the improvement of hemodialysis, the course of thc discase in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate: reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (carly and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodcirculation) but recovered after the hemodialysis, 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe du to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.
Full Text Available Abstract Background Vancomycin-resistant entrococci (VRE are increasing in prevalence at many institutions, and are often reported in dialysis patients. The aim of this cross-sectional prevalence study was to determine the prevalence and risk factors of VRE colonization in chronic hemodialysis patients in two hemodialysis centers in Shiraz, Iran. Methods Rectal swabs were obtained from all consenting patients and were streaked on the surface of Cephalexin-aztreonam-arabinose agar (CAA and incubated at 37°C in air for 24 h. The vancomycin susceptibility of each isolate was confirmed by disk susceptibility testing. The MICs of vancomycin and teicoplanin were confirmed by the E test. To identify risk factors, a questionnaire was completed for all the studied patients and the data of VRE positive and negative groups were compared using Man-Withney U test for continues data and the Fisher exact test for categorical data. Results Of 146 patients investigated, 9 (6.2% were positive for VRE. All VRE strains were genotypically distinguishable. Risk factors for a VRE-positive culture were "antimicrobial receipt within 2 months before culture" (P = 0.003 and "hospitalization during previous year" (P = 0.016. Conclusion VRE colonization is an under-recognized problem among chronic dialysis patients in Iran. VRE colonization is associated with antibiotic consumption and hospitalization.
Full Text Available Nien-Tzu Chang,1,2,* Yi-Hui Lee,2,3 Jiin-Chyr Hsu,4 Chien-Lung Chan,5 Guey-Shiun Huang,2 Jenn-Huei Renn,1,6,* Nan-Ping Yang1,4,* 1Community Health Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; 2Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; 3Department of Nursing, School of Nursing, Chang-Gang University, Taoyuan, Taiwan; 4Department of Medical Research and Biostatistics Office, Tao-Yuan General Hospital, Department of Health, Taoyuan, Taiwan; 5Department of Information Management, Yuan-Ze University, Taoyuan, Taiwan; 6Department of Orthopedics, Kaohsiung Veterans General Hospital, Executive Yuan, Kaohsiung, Taiwan*These authors contributed equally to this workBackground: The burden of chronic kidney disease (CKD is a growing concern worldwide. The prevalence of hemodialysis in Taiwan is the highest in the world, and this may increase the prevalence of orthopedic fractures. The aim of this study was to explore the incidences of various orthopedic injuries and the related risk factors.Methods: A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2004–2008. A total of 82,491 CKD patients were selected as the fixed cohort population. The International Classification of Diseases 9-CM diagnosis codes and treatment codes were identified as the inclusion criteria for orthopedic injury.Results: A total of 82,491 Taiwanese people with CKD were identified in 2004, and 4915 orthopedic injuries occurred during the 5-year follow-up period. The cumulative incidences of orthopedic injuries were 42.56‰ for lower limb fractures, and 12.93‰, 3.27‰, and 1.64‰ for upper limb fractures, vertebrae fractures, and joint dislocations, respectively. All three types of orthopedic fractures were more common in the oldest age stratum (?65 years old. In the CKD patients, the risk ratio of osteoporosis was 3.47 (95% confidence interval, 3.10–3.89 for all orthopedic injuries. Patients of advanced age, the female gender, and those with high comorbidity were also at significant risk of sustaining orthopedic fractures.Conclusion: The results from this Taiwanese CKD cohort support the strong influence of aging and osteoporosis on all kinds of orthopedic injuries. The postponing of osteoporosis may need to be taken into consideration for the prevention of orthopedic injury among CKD patients undergoing hemodialysis.Keywords: chronic kidney disease, renal osteodystrophy, hemodialysis, orthopedic injuries
Coronary artery disease (CAD) contributes to high mortality rate in end-stage renal disease (ESRD) patients. Single photon emission computed tomography (SPECT) using 201Thallium (Tl) or 99mTechnetium-labeled tracers has been used to detect CAD, but they require physical or pharmacological stress loading. Resting SPECT using an iodinated fatty acid analogue, 15-(p-[I-123]-iodophenyl)-3-(R,S) methylpentadecanoic acid (123I-BMIPP), can assess fatty acid metabolism in the myocardium. We investigated the ability of 123I-BMIPP SPECT to detect CAD in hemodialysis patients, and compared with 201Tl SPECT. We prospectively enrolled 130 ESRD patients undergoing hemodialysis with a mean duration of 88.6 months (male/female 77/53, mean age 63.8 years). Dual SPECT using 123I-BMIPP and 201Tl was performed, which was followed by coronary angiography (CAG). SPECT imaging was evaluated and graded in 17 segments using a five-point scale (0=normal, 4=absence). Final assessment was based on the summed score. On CAG, 71.5% of patients (93/130) showed a significant coronary stenosis (?75%), and 5 patients showed coronary spasm without coronary stenosis. When a BMIPP summed score of 6 or more was defined as abnormal. Its sensitivity, specificity, and accuracy for detecting CAD by BMIPP SPECT were 98.0, 65.6, and 90.0%, respectively. In contrast, these parameters for detecting CAD by Tl SPECT were 84.7, 46.9, and 7g CAD by Tl SPECT were 84.7, 46.9, and 75.0%, respectively, when a Tl summed score of 1 or more was defined as abnormal. In receiver operating characteristic (ROC) analysis, the area under the curve indicating the ability diagnose CAD was 0.895 in BMIPP and 0.727 in Tl SPECT. Resting BMIPP SPECT imaging is superior to Tl SPECT for detecting coronary lesions, and provides safe screening for CAD among maintenance hemodialysis patients. (author)
Rachel VV Calderaro
Full Text Available OBJETIVO: Relatar o processo de investigação da contaminação da água e a conseqüente avaliação do surto ocorrido no serviço de hemodiálise. MÉTODOS: Em setembro de 2000, 16 pacientes sob terapia de hemodiálise de um hospital em Minas Gerais apresentaram reações hemolíticas compatíveis a sintomas de intoxicação por cloro e cloramina em água. Foi feita a medição das concentrações de cloro e cloramina em amostras coletadas em diversos pontos do sistema de tratamento e distribuição de água do serviço inspecionado. A identificação dos casos ocorridos durante o período de estudo foi feita pela revisão das anotações de prontuários dos pacientes. Foi feita a revisão dos procedimentos da equipe técnica, médica e de enfermagem por meio de entrevistas. RESULTADOS: A taxa de sintomas foi significativamente alta (pOBJECTIVE: To investigate the process of water contamination and to assess the subsequent outbreak in the hemodialysis center. METHODS: In September 2000, sixteen patients undergoing chronic hemodialysis at a dialysis center in Minas Gerais, Brazil, experienced hemolytic reactions compatible with toxic symptoms due to chlorine and chloramine water contamination. Chlorine and chloramine concentrations in samples obtained from various sites of the dialysis center's water treatment and distribution system were measured. Case-patients were identified by reviewing medical records and nursing notes for all dialysis sessions carried out during the study period. Interviews with technicians, nursing and medical staff members were conducted. RESULTS: Reaction rate was significantly higher (p£0.5 mg/L for chlorine and £ 0.1 mg/L for chloramine. Individuals exposed to high chlorine and chloramine concentrations presented a relative risk of 2.58 (1.0-6.28 of having hemolytic reactions. CONCLUSION: There is a need to observe surveillance procedures to secure that the maximum allowable concentrations of regulated substances in the water used in the hemodialysis process are not exceeded.
Surto de reações hemolíticas associado a residuais de cloro e cloraminas na água de hemodiálise / Outbreak of hemolytic reactions associated with chlorine and chloramine residuals in hemodialysis water
Rachel VV, Calderaro; Léo, Heller.
Full Text Available OBJETIVO: Relatar o processo de investigação da contaminação da água e a conseqüente avaliação do surto ocorrido no serviço de hemodiálise. MÉTODOS: Em setembro de 2000, 16 pacientes sob terapia de hemodiálise de um hospital em Minas Gerais apresentaram reações hemolíticas compatíveis a sintomas de [...] intoxicação por cloro e cloramina em água. Foi feita a medição das concentrações de cloro e cloramina em amostras coletadas em diversos pontos do sistema de tratamento e distribuição de água do serviço inspecionado. A identificação dos casos ocorridos durante o período de estudo foi feita pela revisão das anotações de prontuários dos pacientes. Foi feita a revisão dos procedimentos da equipe técnica, médica e de enfermagem por meio de entrevistas. RESULTADOS: A taxa de sintomas foi significativamente alta (p Abstract in english OBJECTIVE: To investigate the process of water contamination and to assess the subsequent outbreak in the hemodialysis center. METHODS: In September 2000, sixteen patients undergoing chronic hemodialysis at a dialysis center in Minas Gerais, Brazil, experienced hemolytic reactions compatible with to [...] xic symptoms due to chlorine and chloramine water contamination. Chlorine and chloramine concentrations in samples obtained from various sites of the dialysis center's water treatment and distribution system were measured. Case-patients were identified by reviewing medical records and nursing notes for all dialysis sessions carried out during the study period. Interviews with technicians, nursing and medical staff members were conducted. RESULTS: Reaction rate was significantly higher (p£0.5 mg/L for chlorine and £ 0.1 mg/L for chloramine. Individuals exposed to high chlorine and chloramine concentrations presented a relative risk of 2.58 (1.0-6.28) of having hemolytic reactions. CONCLUSION: There is a need to observe surveillance procedures to secure that the maximum allowable concentrations of regulated substances in the water used in the hemodialysis process are not exceeded.
Fabiano Bichuette, Custodio; Emerson Quintino de, Lima.
Full Text Available Cerca de 10% dos pacientes em unidade de terapia intensiva que desenvolvem injúria renal aguda irão depender de terapia renal substitutiva. Embora não existam dados que comprovem redução da mortalidade, quando comparadas às terapias intermitentes, as terapias contínuas fornecem maiores doses de diál [...] ise cumulativa e maior estabilidade hemodinâmica. Contudo, apresentam custos elevados e não estão disponíveis em vários centros. Nesse contexto, a Hemodiálise Estendida ganha espaço na prática clínica, pois combina a tolerabilidade hemodinâmica, o controle de soluto lento e sustentado e as doses efetivas de diálise das terapias contínuas associadas aos custos reduzidos e facilidades logísticas das terapias intermitentes. Abstract in english About 10% of patients in the intensive care unit which develop acute renal failure will depend on renal replacement therapy. Although there are no data showing reduction in mortality when compared with intermittent therapy, continuous therapies provide higher cumulative doses of dialysis and greater [...] hemodynamic stability. However, have high costs and are not available in many centers. In this context the Extended Hemodialysis gaining ground in clinical practice because it combines the hemodynamic tolerability, slow and sustained solute control and effective doses of continuous dialysis therapies associated with reduced costs and logistics facilities of intermittent therapy.
Adas, Heba; Al-Ramahi, Rowa; Jaradat, Nidal; Badran, Rand
Adequacy of hemodialysis improves patient survival, quality of life and biochemical outcomes and minimizes disease complications and hospitalizations. This study was an observational cross-sectional study that was conducted in July 2012. Blood tests, weight and blood pressure were measured before and after hemodialysis. Single-pool Kt/V and urea reduction ratio (URR) were calculated. The targets based on the National Kidney Foundation Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines were Kt/V ? 1.2 and URR ? 65%. Of the 64 patients, 41 (64.1%) were males. The mean age of the patients was 58.13 ± 17.2 years. The mean body mass index (BMI) was 25.04 ± 5.01 kg/m 2 . The mean Kt/V and URR were 1.06 ± 0.05 and 54.4 ± 19.3, respectively. There was no significant difference between men and women (1.06 ± 0.47 versus 1.04 ± 0.55, P = 0.863) and (54.7 ± 19.59 versus 53.81 ± 19.17, P = 0.296). Only 25 (39.1%) patients achieved the Kt/V goal and only 22 (34.4%) had target URR, and there was no significant association between hemodialysis adequacy and any of the variables such as sex, age, presence of chronic diseases or BMI. Serum potassium levels post-dialysis were significantly lower in patients who reached the target Kt/V (mean = 3.44 ± 0.48 versus 3.88 ± 0.48, P = 0.001). Most patients were inadequately dialyzed and a large percentage of the patients did not attain the targets. Attempts to achieve the desired goals are necessary. It is important to calculate Kt/V or URR and individualize the dialysis doses for each patient. PMID:24626023
Full Text Available The repercussions of secondary hyperparathyroidism on the nutritional status of chronic renal failure patients have not been well established. Therefore, the aim of this study was to compare the nutritional indices of hemodialysis patients with and without secondary hyperparathyroidism. Sixteen hemodialysis patients with serum parathyroid hormone (PTH levels higher than 420 pg/ml (hyperparathyroidism group were matched for gender, age and length of dialysis treatment to 16 patients with serum PTH between 64 and 290 pg/ml (control group. The following parameters were assessed: anthropometric indices (body mass index, skinfold thickness, midarm muscle circumference and body fat, 4-day food diaries, protein catabolic rate, biochemical indices (blood urea nitrogen, serum creatinine, albumin, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, PTH, pH and HCO3 and dialysis efficiency. We did not observe differences in the anthropometric indices between the two groups. Only calcium intake was significantly different between groups (307.9 mg/day for the hyperparathyroidism group vs 475.8 mg/day for the control group. Protein catabolic rate tended to be higher in the hyperparathyroidism group compared to the control group (1.3 vs 0.9 g kg-1 day-1; P = 0.08. Except for blood urea nitrogen (86.4 vs 75.7 mg/dl, alkaline phosphatase (175 vs 65 U/l and PTH (898 vs 155 pg/ml, no other differences were found between groups in the biochemical indices studied. PTH was directly correlated with protein catabolic rate (r = 0.61; P<0.05 and length of dialysis (r = 0.53; P<0.05 only in the hyperparathyroidism group. Considering the indices used, we could not demonstrate the deleterious effect of high PTH levels on the nutritional status of hemodialysis patients. Indirect evidence, however, suggests an action of PTH on protein metabolism.
Rohani, Mohammad; Aghaei, Mahbubeh; Jenabi, Arya; Yazdanfar, Sharare; Mousavi, Delaram; Miri, Shahnaz
Restless legs syndrome (RLS) is a common sleep disorder that can present secondary to medical conditions such as renal failure. This study aimed to evaluate RLS frequency and its related factors in chronic renal failure patients treated with hemodialysis. In a cross-sectional design, 163 patients with chronic renal failure were consecutively enrolled from hemodialysis center at Rasool-Akram hospital. Demographics, clinical and laboratory data were recorded. Patients were screened for presence and severity of RLS according to the four International Restless Legs Syndrome Group (IRLSSG) diagnostic criteria and severity scale. Patients with and without RLS were compared using SPSS statistical software (Version 16.0). Sixty-one patients (37.4 %) were diagnosed with RLS. Mean age in RLS group was significantly higher (65.2 ± 9.3 years) than RLS-negative group (59.0 ± 14.7 years; P = 0.004). Serum creatinine level was significantly higher in patients with RLS (7.6 ± 2.1 mg/dl vs. 6.7 ± 1.8 mg/dl; P = 0.009). Glomerular filtration rate in RLS patients was lower than other patients (9.2 ± 3.1 ccs/min vs. 11.6 ± 4.8 ccs/min; P = 0.0001). Patients with RLS had shorter sleep duration, and higher incidence of insomnia, daytime sleepiness, and sedative-hypnotic medication usage (P < 0.05). There was no significant difference between RLS-positive and RLS-negative patients in terms of renal failure pathology, dialysis frequency per week, dose of dialysis, duration of dialysis, renal transplantation, and history of diabetes and hypertension. Hemodialysis patients have a high prevalence of RLS which deserves special attention and specific treatment. PMID:25471049
Tepel, Martin; Armbruster, Franz Paul
Background: It was shown that nonoxidized PTH (n-oxPTH) is bioactive, whereas the oxidation of PTH results in a loss of biological activity. Methods: In this study we analyzed the association of n-oxPTH on mortality in hemodialysis patients using a recently developed assay system. Results: Hemodialysis patients (224 men, 116 women) had a median age of 66 years. One hundred seventy patients (50%) died during the follow-up period of 5 years. Median n-oxPTH levels were higher in survivors (7.2 ng/L) compared with deceased patients (5.0 ng/L; P = .002). Survival analysis showed an increased survival in the highest n-oxPTH tertile compared with the lowest n-oxPTH tertile (?(2), 14.3; P = .0008). Median survival was 1702 days in the highest n-oxPTH tertile, whereas it was only 453 days in the lowest n-oxPTH tertile. Multivariable-adjusted Cox regression showed that higher age increased odds for death, whereas higher n-oxPTH reduced the odds for death. Another model analyzing a subgroup of patients with intact PTH (iPTH) concentrations at baseline above the upper normal range of the iPTH assay (70 ng/L) revealed that mortality in this subgroup was associated with oxidized PTH but not with n-oxPTH levels. Conclusions: The predictive power of n-oxPTH and iPTH on the mortality of hemodialysis patients differs substantially. Measurements of n-oxPTH may reflect the hormone status more precisely. The iPTH-associated mortality is most likely describing oxidative stress-related mortality.
Full Text Available As a consequence of the proinflammatory environment occurring in dialytic patients, cytokine overproduction has been implicated in hemodialysis co-morbidity. However, there are discrepancies among the various studies that have analyzed TNF-alpha synthesis and the presence of peripheral blood mononuclear cell (PBMC priming in this clinical setting. We measured bioactive cytokine by the L929 cell bioassay, and evaluated PBMC TNF-alpha production by 32 hemodialysis patients (HP and 51 controls. No difference in TNF-alpha secretion was observed between controls and HP (859 ± 141 vs 697 ± 130 U/10(6 cells. Lipopolysaccharide (5 µg/ml did not induce any further TNF-alpha release, showing no PBMC priming. Paraformaldehyde-fixed HP PBMC were not cytotoxic to L929 cells, suggesting the absence of membrane-anchored TNF-alpha. Cycloheximide inhibited PBMC cytotoxicity in HP and controls, indicating lack of a PBMC TNF-alpha pool, and dependence on de novo cytokine synthesis. Actinomycin D reduced TNF-alpha production in HP, but had no effect on controls. Therefore, our data imply that TNF-alpha production is an intrinsic activity of normal PBMC and is not altered in HP. Moreover, TNF-alpha is a product of de novo synthesis by PBMC and is not constitutively expressed on HP cell membranes. The effect of actinomycin D suggests a putative tighter control of TNF-alpha mRNA turnover in HP. This increased dependence on TNF-alpha RNA transcription in HP may reflect an adaptive response to hemodialysis stimuli.
Hedin, U; Engström, J; Roy, J
Formation of true and false aneurysms in vascular access for hemodialysis is a complication associated with an immediate or chronic threat to the patient, which jeopardizes access function for further dialysis. Although open surgical repair remains the established treatment of choice, during the last decade, endovascular procedures, largely utilizing stent grafts, have emerged as a viable option for treatment in emergencies as well as for elective cases. Here, basic concepts in vascular access aneurysm management are recapitulated and strategies for endovascular treatment of these complications discussed. PMID:25731859
Full Text Available Background. In hemodialysis patients the most common cause of vascular access failure is neointimal hyperplasia of vascular smooth muscle cells at the venous anastomosis of arteriovenous fistulas. Case report. We presented a 76-year old patient who had developed fistula thrombosis without the presence of known risk factors the eighth day after the initial function. A histopathological finding pointed to a significant rate of neointimal proliferation, as an initial reasons for the fistula stenosis and trombosis. Conclusion. Early pathohistological changes observed in ateriovenous fistula dysfunction are response to hemodynamic changed conditions.
Gerasimovska, V; Oncevski, A; Dejanov, P; Polenakovic, M
Femoral catheterization is fast and simple and associated with a low risk of complications. Those which occur can usually be managed easily. Femoral catheters are usually kept in place for a short period of a few days. We, instead, used femoral catheters (FC) as a temporary vascular access for a longer period of time (until the permanent vascular access matured) in inpatients and in outpatients on regular ambulatory hemodialysis who had a problem with their permanent access. We analyzed 59 patients with end-stage renal disease treated with hemodialysis (HD), divided into two groups. Of the group that started with hemodialysis (group I), only 16 patients were hospitalized during the maturation of native arterio-venous fistula (AVF). Duration time of the catheters was 15-47 days (average 32 days). The second group (group II) comprised 43 patients going on regular ambulatory hemodialysis who were discharged from hospital with femoral catheters. Duration time of catheters in this group was 13-183 days (average 44.2 days). Catheters were removed when AVF matured, or if a significant complication occured. We took blood culture from peripheral vein (BCP) and from catheter (BCC) on removal of the catheter, or when we suspected infection. Catheter tips (CT) were also sent for microbiological analysis. We monitored the clinical signs of infection. We compared microbiological results of BCP, BCC and CT from the two groups using chi-square test and we did not find any significant difference among the three types of findings (p<0.05). The FC was removed from one patient only from group II because of suspicion of catheter-related infection. Two pts were treated with antibiotics (AB) systemically and locally (AB was 'locked' in the catheter) because of febricity. When the catheters were removed the microbiological findings were sterile. We concluded that FC can be used without any problem for a longer period of time for ambulatory HD, with the provision of permanent care from a team specially trained for vascular access. PMID:17639456
Full Text Available The National Institutes of Health (NIH sponsored HEMO Study did not demonstrate that an increase in dialysis dose was associated with an improvement in patient mortality rates. Despite this negative result, there is ongoing interest in determining if still higher doses of dialysis may be of benefit to patients receiving chronic hemodialysis therapy. Testing this hypothesis requires the use of more fre-quent hemodialysis and/or a much longer duration for each dialysis session. "Short daily hemodialysis", actually six times per week hemodialysis for 1.5 to 3 hours per session, provides a significant increase in small molecule clearance as measured by urea kinetics. "Long nocturnal daily hemodialysis", actually six times per week hemodialysis for 6-8 hours per session, provides a significant increase in both small and large molecular weight clearance and often alleviates the need to take phosphate binders. Both forms of more frequent dialysis have been shown to improve control of blood pressure. One small randomized trial of nocturnal versus conventional home dialysis showed a decrease in left ventricular (LV mass at 6 months in the nocturnal arm only. Most clinical trials conducted in these dialysis modalities have been observational trials and have enrolled small numbers of patients. The National Institutes of Health is sponsoring two clinical trials via the Frequent Hemodialysis Network to determine the effect of these two more frequent dialysis modalities on intermediate outcomes. In the short daily study, 250 patients will be randomized to receive either six times per week HD, with a session length of 1.5 to 2.75 hours, or conventional in-center hemodialysis. In the nocturnal study, 150 patients will be randomized to receive either six times per week overnight dialysis, with a session length of at least 6 hours, or conventional home hemodialysis.
This work tries to make aware radioactive installations having Nuclear Medicine Services with radiation therapy or diagnosis on the importance of supplying information to patients undergoing ambulatory therapy
Zitzelsberger, Hilde; McKeever, Patricia; Peter, Elizabeth; Chambon, Adrienne; Morgan, Kathryn P; Spalding, Karen
Since the 1960s, hemodialysis has been a common intervention for children with end-stage renal disease, however little is known about how they experience hospital-based hemodialysis. A focused ethnography was undertaken to explore children?s perspectives of the time, space and technology of a hemodialysis unit at a Canadian pediatric urban hospital. The children?s temporal and socio-spatial positions were an effect of their technologically mediated embodiment and shaped their perspectives, evaluations and expectations. The findings suggest that further explorations are needed to envision ways to create with children an overall positive place that merges and balances technological care with child focused care. PMID:24594838
In 20 children on hemodialysis in vitro tests of thyroid function were made. Total T4, free T4 and total T3 were below the normal mean. The daily loss of T3 into feces was significantly higher in dialysis children than in healthy controls. The amount of hormonal iodine loss into feces was calculated. It was significantly higher in children on hemodialysis than in controls. It is concluded that the loss of thyroid hormones into feces is the major cause of low serum thyroid hormone levels in children on hemodialysis. (orig.)
Full Text Available Central venous catheter-related blood stream infection is a major cause of morbidity and mortality in patients with renal disease treated with hemodialysis. Antibiotic lock solutions can be effective in preventing this complication in patients with hemodialysis. Searching in Epistemonikos database, which is maintained by screening more than twenty databases, we identified eight systematic reviews including seventeen randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded that antibiotic lock solutions probably decrease catheter-related blood stream infection in hemodialysis patients.
Devereaux, P J; Sessler, Daniel I
BACKGROUND: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. METHODS: We performed a blinded, randomized trial with a 2-by-2 factorial design to allow separate evaluation of low-dose clonidine versus placebo and low-dose aspirin versus placebo in patients with, or at risk for, atherosclerotic disease who were undergoing noncardiac surgery. A total of 10,010 patients at 135 centers in 23 countries were enrolled. For the comparison of clonidine with placebo, patients were randomly assigned to receive clonidine (0.2 mg per day) or placebo just before surgery, with the study drug continued until 72 hours after surgery. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: Clonidine, as compared with placebo, did not reduce the number of primary-outcome events (367 and 339, respectively; hazard ratio with clonidine, 1.08; 95% confidence interval [CI], 0.93 to 1.26; P=0.29). Myocardial infarction occurred in 329 patients (6.6%) assigned to clonidine and in 295 patients (5.9%) assigned to placebo (hazard ratio, 1.11; 95% CI, 0.95 to 1.30; P=0.18). Significantly more patients in the clonidine group than in the placebo group had clinically important hypotension (2385 patients [47.6%] vs. 1854 patients [37.1%]; hazard ratio 1.32; 95% CI, 1.24 to 1.40; P<0.001). Clonidine, as compared with placebo, was associated with an increased rate of nonfatal cardiac arrest (0.3% [16 patients] vs. 0.1% [5 patients]; hazard ratio, 3.20; 95% CI, 1.17 to 8.73; P=0.02). CONCLUSIONS: Administration of low-dose clonidine in patients undergoing noncardiac surgery did not reduce the rate of the composite outcome of death or nonfatal myocardial infarction; it did, however, increase the risk of clinically important hypotension and nonfatal cardiac arrest. (Funded by the Canadian Institutes ofHealth Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.).
Gen, Shikou; Sasaki, Takaya; Saito, Kanako; Nobe, Kanako; Nodaira, Yuka; Ikeda, Naofumi
It has been reported that sevelamer hydrochloride, which is often used as a polymer phosphorus (P) binder for managing serum P concentration in dialysis patients, causes gastrointestinal adverse effects such as constipation, etc. The reason for this is thought to be that sevelamer hydrochloride has high water absorption, causing it to absorb water and swell in the gastrointestinal tract. In June 2012, the new polymer P binder bixalomer was launched in Japan. Since bixalomer has low swelling due to water absorption, it can be expected to alleviate adverse effects in the gastrointestinal system. In our study, for 21 cases of maintenance hemodialysis patients undergoing treatment with sevelamer hydrochloride at our hospital, the P binder was switched from sevelamer hydrochloride to the same dosage of bixalomer, and the concentrations of serum P, corrected calcium (Ca) and whole parathyroid hormone (PTH) before and one month after the switch were compared. In addition, gastrointestinal symptoms (acid reflux, abdominal pain, indigestion, diarrhea and constipation) were evaluated before and after the switch using a questionnaire based on the Japanese version of the Gastrointestinal Symptom Rating Scale (GSRS). By switching to bixalomer, serum P concentration was significantly reduced (P=0.024), but there were no significant changes observed for serum corrected Ca and whole PTH. Furthermore, there were no significant changes observed for all five of the evaluation items of the GSRS, before and after the switch. These results suggest that although bixalomer can more potently reduce the serum P concentration than sevelamer hydrochloride, there were no significant differences in the effects of both P binders on the gastrointestinal symptoms. PMID:24975889
Full Text Available Background: In hemodialysis (HD patients, zinc depletion caused by inadequate intake, malabsorption, and removal by HD treatment leads to erythropoiesis-stimulating agent (ESA hyporesponsiveness. This study investigated the effects of zinc supplementation in HD patients with zinc deficiency on changes in the erythropoietin responsiveness index (ERI. Methods: Patients on HD with low serum zinc levels (<65 ?g/dL were randomly assigned to two groups: The polaprezinc group (who received daily polaprezinc, containing 34 mg/day of zinc (n = 35 and the control group (no supplementation (n = 35 for 12 months. All the 70 patients had been taking epoetin alpha as treatment for renal anemia. ERI was measured with the following equation: Weekly ESA dose (units/dry weight (kg/hemoglobin (g/dL. Results: There were no significant changes in hemoglobin levels within groups or between the control and polaprezinc groups during the study period. Although reticulocyte counts were increased immediately after zinc supplementation, this change was transient. Serum zinc levels were significantly increased and serum copper levels were significantly decreased in the polaprezinc group after three months; this persisted throughout the study period. Although there was no significant change in the serum iron or transferrin saturation levels in the polaprezinc group during the study period, serum ferritin levels significantly decreased following polaprezinc treatment. Further, in the polaprezinc group, ESA dosage and ERI were significantly decreased at 10 months and nine months, respectively, as compared with the baseline value. Multiple stepwise regression analysis revealed that the change in the serum zinc level was an independent predictor of lowered ERI. Conclusions: Zinc supplementation reduces ERI in patients undergoing HD and may be a novel therapeutic strategy for patients with renal anemia and low serum zinc levels.
Cerebrovascular diseases are important causes of death in patients on maintenance hemodialysis. Recently, it has become clear that the presence of cerebral microbleeds (MBs) on T2*-weighted magnetic resonance imaging (MRI) is closely related to intracerebral hemorrhages. This study investigated the incidence of MBs in chronic dialysis patients and prospective hemorrhagic complications of chronic dialysis patients with old intracerebral hemorrhages. Eighty patients (34 males, 46 females) with chronic renal failure, whose mean age was 62.9±11.4 years, were examined by MRI. The mean duration of hemodialysis was 7.8±6.3 years. MBs were found in 28 patients (35%) by T2*-weighted MRI. Old intracerebral hemorrhages were seen in seven of the patients, and MBs were found in five (71%) of these seven patients. The frequency of old intracerebral hemorrhages was significantly higher in patients with MBs than in those without (p=0.048), and the numbers of MBs were significantly larger in patients with old intracerebral hemorrhages than in those without (p=0.0065). Three of the seven patients with old intracerebral hemorrhages had new hemorrhagic complications (two intracerebral hemorrhages and one cerebral microbleed) within a year. These intracerebral hemorrhages occurred in areas without MBs on the first T2*-weighted MRI. T2*-weighted MRI is useful for the detection of MBs, which may be a predictor of intracerebral hemorrhage. When actor of intracerebral hemorrhage. When a patient has a large number of MBs and old intracerebral hemorrhages, the risk of intracerebral hemorrhage undoubtedly increases. (author)
Harold, Joseph Planas; Lázaro Leopoldo, Capote Pereira; Mara, Herrera Almirola; Mariela, González Ramos; Eloísa, del Cueto de Inastría.
Full Text Available La amiloidosis asociada a la diálisis es una complicación frecuente en los pacientes con insuficiencia renal crónica terminal en hemodiálisis con más de 10 años de tratamiento. Se presentó un paciente que con tan solo 4 años en hemodiálisis tuvo un cuadro clínico de dolores articulares crónicos, en [...] las articulaciones de hombros, codos y rodillas, acompañados de aumento de volumen e impotencia funcional. Se le realizó punción y aspiración del contenido articular donde se halló un contenido proteináseo con características amiloides, Rojo Congo positivo. Este caso constituye el primero de amiloidosis por B2 microglubulina que se publica en una revista científico técnica de Cuba. Pone de manifiesto la posibilidad de que la susceptibilidad del paciente desempeña un importante papel en la patogenia de esta entidad. Abstract in english The dialysis-associated amyloidosis is a frequent complication in patients with end stage renal disease (ESRD) on hemodialysis with over 10 years of treatment. A patient was presented with only four years on hemodialysis had a clinical condition of chronic joint pain, at shoulder, elbow, and knees j [...] oints, accompanied by increased volume and loss of function. This patient underwent joint puncture and aspiration of content. Proteinase content with amyloid characteristics, positive Congo red was found. This case is the first of amyloidosis B2 macroglobulin published in a biomedical journal of Cuba. It highlights the possibility that the patient's susceptibility plays an important role in the pathogenesis of this entity.
Full Text Available Background: The prognosis of chronic dialysis patients is poor, in part due to the high incidence of cardiovascular disease and malnutrition. It has been recognized that 30-50% of hemodialysis patients have serological evidence of an activated inflammatory response. Chronic inflammation may cause malnutrition and progressive atherosclerotic cardiovascular disease. It would be obvious interest to study prevalence of inflammatory factors particularly CRP as prominent components of inflammatory syndrome in dialysis patients. The objective of this study was to study prevalence of inflammatory factors particularly C-reactive protein (CRP in hemodialysis patients. Methods: We studied 125 dialysis patients in a cross sectional study during summer of 2001 in two university hospitals. Serum CRP (agglutination method, albumin (bromocresol green method and ferritin (ELISA were measured in all patients. Results: One hundred and twenty five patients including 53 (44.1% men and 72 (55.9% women were enrolled in this study. Fourteen patients (11.2% had hypoalbuminemia, 81 (64.8% had high serum ferritin, and 57 subjects (45.6% were CRP positive. Conclusion: According to high prevalence of inflammatory factors especially C-reactive protein in dialysis patients, CRP and other inflammatory factors should be screened in this group of patients routinely because of their prognostic importance.
Jayme Eduardo, Burmeister; Camila Borges, Mosmann; Veridiana Borges, Costa; Ramiro Tubino, Saraiva; Renata Rech, Grandi; Juliano Peixoto, Bastos; Luiz Felipe, Gonçalves; Guido Aranha, Rosito.
Full Text Available Fundamentos: Há uma carência de dados epidemiológicos sobre o perfil de risco cardiovascular nos pacientes renais crônicos em hemodiálise no Brasil. Objetivo: O estudo CORDIAL foi planejado para avaliar fatores de risco cardiovascular e acompanhar a evolução de uma população em programa de hemodi [...] álise numa cidade metropolitana do Brasil. Métodos: Todos os pacientes em hemodiálise por doença renal crônica nos quinze centros de nefrologia de Porto Alegre foram considerados para inclusão na fase inicial do estudo CORDIAL. Dados clínicos, laboratoriais e demográficos foram obtidos nos registros médicos, e em entrevistas individuais estruturadas realizadas com todos os pacientes por pesquisadores treinados. Resultados: Foram incluídos 1215 pacientes (97,3% de todos os que estavam em hemodiálise na cidade de Porto Alegre). A média de idade era 58,3 anos, 59,5% eram homens e 62,8% eram brancos. A prevalência de fatores de risco cardiovascular encontrada foi 87,5% para hipertensão, 84,7% para dislipidemia, 73,1% para sedentarismo, 53,7% para tabagismo e 35,8% para diabetes. Em uma análise multivariada ajustada, sedentarismo (p = 0,032; RP 1,08 - IC95%: 1,01-1,15), dislipidemia (p = 0,019; RP 1,08 - IC95%: 1,01-1,14), e obesidade (p Abstract in english Background: There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. Objective: The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. Methods: All p [...] atients undergoing regular hemodialysis for chronic renal failure in all fifteen nephrology centers of Porto Alegre were considered for inclusion in the baseline phase of the CORDIAL study. Clinical, laboratory and demographic data were obtained in medical records and in structured individual interviews performed in all patients by trained researchers. Results: A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p
Hegbrant, Jörgen; Gentile, Giorgio; Strippoli, Giovanni F M
A large global dialysis provider's core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence-based guidelines and clinical protocols; consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner, incorporating information on interclinic and intercountry variations; and revising targets, guidelines and clinical protocols based on sound scientific data. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice; and auditing of clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety. PMID:21625088
Chien-Te Lee; Sarah Chua; Chung-Yao Hsu; Yu-Che Tsai; Hwee-Yeong Ng; Chien-Chun Kuo; Chien-Hsing Wu; Te-Chun Chen; Terry Ting-Yu Chiu; Yueh-Ting Lee
Background: Cardiovascular calcification, including arterial intimal and medial calcification (AIC and AMC) and valvular calcification (VC) are important predictors of outcome in chronic dialysis patients. We aimed to compare their prevalence and analyze respective risk factors in hemodialysis (HD) patients.
Objective: To investigate the clinical effect of percutaneous balloon angioplasty for the treatment of arteriovenous fistula stenosis or occlusion in upper extremity in hemodialysis patients. Methods: Percutaneous balloon angioplasty was performed in 14 hemodialysis patients with arteriovenous fistula stenosis or occlusion in upper extremity. The preoperative and post operative clinical manifestations, the color Doppler ultrasonographic findings, the blood flow during hemodialysis and the angiographic demonstrations were recorded and compared. Results: After balloon dilatation, th