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  1. Tuberculosis in children undergoing hemodialysis

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    Gargah Tahar

    2010-04-01

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

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

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

    2015-02-01

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

  3. Prevalence of uremic itching in patients undergoing hemodialysis.

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    Kavurmac?, Mehtap

    2015-10-01

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

  4. Ototoxicity Probably Due To Isoniazid in a Patient Undergoing Hemodialysis

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    Deniz YERDELEN

    2008-03-01

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

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

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    Kaya, M.; Cermik, T.F.; Uestuen, F.; Sen, S.; Berkarda, S. [Trakya Univ., Edirne (Turkey). Medical Faculty

    2002-04-01

    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 {sup 99m}Tc 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 (T{sub max}) for the prestimulated period, the time of minimum radioactivity (T{sub min}), as an indicator of velocity of secretion after stimulation, and the Lem E{sub 5}% 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 T{sub max}, T{sub min} and Lem E{sub 5}% values for bilateral parotid glands, and T{sub min} values for bilateral submandibular glands (p<0.05), there were no statistically significant differences in T{sub max} and Lem E{sub 5}% values for bilateral submandibular glands. There were also significant differences in T{sub max} and Lem E{sub 5}% values for bilateral parotid glands between mild oral problems and severe oral problems in patients with CRF (undergoing hemodialysis). In this study, prolonged T{sub max} and T{sub min} values, and decreased Lem E{sub 5}% values for parotid glands and prolonged T{sub min} values for submandibular glands on salivary scintigraphy pointed out decreased parenchymatous and excretory function in patients with CRF undergoing hemodialysis. (author)

  6. Antiplatelet Therapy in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions

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    Summaria

    2015-07-01

    Full Text Available Context Coronary artery disease is highly prevalent among patients with end stage renal disease/hemodialysis (ESRD/HD and coronary percutaneous interventions (PCI has been increased by nearly 50% over the past decade. After PCI with stent placement, guidelines recommend dual antiplatelet therapy (DAPT, but no specifically tailored pharmacotherapy approach is outlined for this frail population, mostly excluded from large randomized clinical trials (RCTs. Evidence Acquisition We reviewed current evidences on the use of antiplatelet therapy in patients with ESRD/HD undergoing PCI, focusing on the efficacy and safety of specific agents and their indications for detailed clinical settings. Results Clinical setting in HD patients is the principal determinant of the type, onset, combination and duration of the DAPT. However, irrespective clinical setting, in addition to aspirin, clopidogrel is currently the most used antiplatelet agent even if no information derived from RCTs are available in ESRD. Due to the large experience acquired in routine clinical practice, the awareness of safety is higher for clopidogrel than newer antiplatelet agents. Because of lack of data, the use of prasugrel and ticagrelor is actually not recommended. However, in case of high ischemic and acceptable bleeding risk, they may be selectively used in ESRD/HD. Conclusions This investigation might contribute to delineate the best treatment options for this high risk population.

  7. HEARING ASSESSMENT IN CHRONIC RENAL FAILURE PATIENTS UNDERGOING HEMODIALYSIS

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    Arjun Singh

    2014-01-01

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

  8. Noninvasive continuous monitoring of digital pulse waves during hemodialysis

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    Burkert, Antje; Scholze, Alexandra; Tepel, Martin

    2009-01-01

    Intermittent hemodynamic instability during hemodialysis treatment is a frequent complication in patients with end-stage renal failure. A noninvasive method for continuous hemodynamic monitoring is needed. We used noninvasive digital photoplethysmography and an algorithm for continuous......, 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...

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

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

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

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

    2015-08-01

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

  11. Prevalence of hepatitis C in patients with renal disease undergoing hemodialysis treatment

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    Marcos Frank Bastiani

    2014-10-01

    Full Text Available 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.

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

    International Nuclear Information System (INIS)

    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 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

  13. The Investigation of Nail Disorders in Patients with Chronic Renal Failure Undergoing Hemodialysis

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    Perihan Öztürk

    2012-06-01

    Full Text Available Objective: Nail changes are often observed in patients with end-stage renal disease. These changes may occur due to chronic renal failure itself or to the treatment. This study aims to investigate the frequency of nail findings in patients undergoing hemodialysis therapy and to compare with healthy controls. Methods: One hundred and four patients with chronic renal failure treated with hemodialysis, and 104 healthy controls without any dermatological and sistemic diseases, were examined for nail signs. Groups were compared for the incidence of nail findings. Results: 74.4% of hemodialysis patients, and 51.9% of controls had at least one nail finding. The most common signs in hemodialysis patients were (58.7% absence of lunula, (40.5% streaking, (15.7% terry nail and (14.9% half and half nail. In the control group, the most common signs were vertical streaking (36.5%, absence of lunula (8.7% and coilonichi (2.9%. In hemodialysis patients, absence of lunula, beau lines, onycomycosis, terry nail, half and half nail and splinter hemorrhages were found to be significantly higher (p<0.05. Conclusion: The frequency of nail diseases in hemodialysis patients is higher than in the healthy control group. In our study, absence of lunula is the most frequently observed finding in hemodialysis patients. Although the second most common nail change was vertical streaking, it was not different from the control group statistically. We recommend that, when hemodialysis patients are examined, nail examination (as a part of physical examination should be performed. (Turk J Dermatol 2012; 6: 35-8

  14. The Investigation of Nail Disorders in Patients with Chronic Renal Failure Undergoing Hemodialysis

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    Murat Kalender

    2012-06-01

    Full Text Available Objective: Nail changes are often observed in patients with end-stage renal disease. These changes may occur due to chronic renal failure itself or to the treatment. This study aims to investigate the frequency of nail findings in patients undergoing hemodialysis therapy and to compare with healthy controls.Methods: One hundred and four patients with chronic renal failure treated with hemodialysis, and 104 healthy controls without any dermatological and sistemic diseases, were examined for nail signs. Groups were compared for the incidence of nail findings. Results: 74.4% of hemodialysis patients, and 51.9% of controls had at least one nail finding. The most common signs in hemodialysis patients were (58.7% absence of lunula, (40.5% streaking, (15.7% terry nail and (14.9% half and half nail. In the control group, the most common signs were vertical streaking (36.5%, absence of lunula (8.7% and coilonichi (2.9%. In hemodialysis patients, absence of lunula, beau lines, onycomycosis, terry nail, half and half nail and splinter hemorrhages were found to be significantly higher (p<0.05.Conclusion: The frequency of nail diseases in hemodialysis patients is higher than in the healthy control group. In our study, absence of lunula is the most frequently observed finding in hemodialysis patients. Although the second most common nail change was vertical streaking, it was not different from the control group statistically. We recommend that, when hemodialysis patients are examined, nail examination (as a part of physical examination should be performed.

  15. Management of Pain and Quality of Life in Patients with Chronic Kidney Disease Undergoing Hemodialysis.

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    Zyga, Sofia; Alikari, Victoria; Sachlas, Athanasios; Stathoulis, John; Aroni, Adamantia; Theofilou, Paraskevi; Panoutsopoulos, Georgios

    2015-10-01

    An important dimension that influences the quality of life of hemodialysis patients is the pain they experience. Quality of life and self-efficacy in pain can play an important role in chronic kidney disease and treatment outcomes. The purpose of the study was to examine self-efficacy in pain and quality of life among patients with end stage renal disease undergoing hemodialysis. Between April 2013 and June 2013, 224 hemodialysis patients completed the Missoula-VITAS Quality of Life Index-15 and the Pain Self-Efficacy Questionnaire. The study was conducted in four dialysis units in hospitals of the Peloponnese region. Sociodemographic data of patients and their individual medical history were recorded. Statistical analysis was performed using SPSS version 19. The more effective the self-efficacy in pain, the lower the quality of life enjoyed by hemodialysis patients. The majority of respondents described the overall quality of life as "moderate," while the self-efficacy in pain depended on comorbidity or complications that accompany the process of hemodialysis. The findings of this study can be used in the development and improvement of health services for the management of patients. Healthcare professionals should understand the concerns and treat the symptoms of patients that affect quality of life, providing thereby holistic health care. PMID:26162558

  16. A STUDY ON BIOCHEMICAL PARAMETERS OF MALNUTRITION IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING HEMODIALYSIS

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    Boppishetti Raja; Sangeeta ,; Sunanda De; Hari Priya; Prakash

    2015-01-01

    BACKGROUND: CKD is one of the leading cause morbidity and mortality worldwide Incidence of chronic kidney disease is raising which is likely to pose major problems for both health care and the economy of future years in India. Dialysis is a form of renal replacement therapy for severe kidney failure. Malnutrition is one of the common complications in patients with end stage ren al disease undergoing hemodialysis. AIM: The present study is aimed to ...

  17. A STUDY ON BIOCHEMICAL PARAMETERS OF MALNUTRITION IN CHRONIC KIDNEY DISEASE PATIENTS UNDERGOING HEMODIALYSIS

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    Boppishetti Raja

    2015-10-01

    Full Text Available BACKGROUND: CKD is one of the leading cause morbidity and mortality worldwide Incidence of chronic kidney disease is raising which is likely to pose major problems for both health care and the economy of future years in India. Dialysis is a form of renal replacement therapy for severe kidney failure. Malnutrition is one of the common complications in patients with end stage ren al disease undergoing hemodialysis. AIM: The present study is aimed to evaluate role of albumin and other biochemical parameters predicting malnutrition in CKD patients undergoing hemodialysis. MATERIAL AND METHODS: A group of 15 normal healthy subjects (c ontrol group and 30 CKD patients on hemodialysis (test group were enrolled in this study. Albumin, urea, creatinine, total cholesterol and CRP were estimated in serum sample collected from normal and CKD - HD subjects. RESULTS: Results were expressed as me an ±SD, student ‘t’ test applied and ‘p’ value was calculated ‘p’ value <0.005 was considered as statistically significant. We found decreased levels of serum albumin (p<0.001, increased levels of CRP (p<0.001, increased levels of urea (p<0.001, increase d levels of creatinine was observed in CKD - HD patients compared to controls with the ‘p’ value <0.001. Total cholesterol was decreased in CKD - HD patients but not significant when compared to controls. CONCLUSION: our study found decreased serum albumin can be used as a indictor for malnutrition in CKD - HD patients on hemodialysis. CRP levels indicate a chronic inflammation in CKD patients on hemodialysis.

  18. Prevalence and dynamics of cytomegalovirus infection among patients undergoing chronic hemodialysis

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    Vilibic-Cavlek, T.; Kolaric, B.; Ljubin-Sternak, S.; Kos, M.; Kaic, B.; Mlinaric-Galinovic, G.

    2015-01-01

    Cytomegalovirus (CMV) is an important pathogen in immunocompromised individuals. The aim of this study was to analyze prevalence and dynamics of CMV infection among patients undergoing chronic hemodialysis. From 2010 to 2012, a total of 162 patients and 160 control subjects were tested for the presence of CMV IgM and IgG antibodies using enzyme-linked immunosorbent assay. IgM/IgG reactive samples were further evaluated for IgG avidity to confirm or rule out recent primary CMV infection. The overall IgG seropositivity was higher in hemodialysis patients compared to controls (90.7% vs. 81.9%; crude odds ratio [OR] =2.02, 95% confidence interval [CI] =1.05–3.89; OR adjusted for age and gender = 2.18, 95% CI = 1.05–4.55). CMV IgG antibody titers were similar in both groups. There was no difference in CMV prevalence between males (87.9%) and females (96.3%). According to age, a progressive increase in seropositivity was observed in both hemodialysis patients and the control group. Three hemodialysis patients (1.9%) developed recurrent CMV infection (positive IgM with high avidity IgG antibodies). In one patient (2.9%), seroconversion was documented during the second year of the follow-up period indicating primary infection. In contrast, in the control group, recent primary CMV infection (positive IgM with low/borderline IgG avidity) was demonstrated in three subjects (1.9%), whereas one (0.6%) developed recurrent infection. On multivariate logistic regression, hemodialysis and older age were significant predictors for CMV seropositivity. PMID:25838647

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

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    Rias Pratiwi Safitri; Ria Safaria Sadif

    2013-01-01

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

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

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

    2014-01-01

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

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

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

    2014-05-01

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

  2. [The evaluation of the level of hope of elderly chronic kidney disease patients undergoing hemodialysis].

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

    2012-08-01

    The objective of the present study was to evaluate the level of hope of elderly chronic kidney disease patients undergoing hemodialysis, using the Herth Hope Scale (HHS). This cross-sectional descriptive study was performed at a Renal Replacement Therapy Unit located in upstate São Paulo. The sample consisted of 50 elderly patients currently undergoing hemodialysis treatment. After obtaining the participants' consent to participate, individual interviews were performed with the elderly individuals, utilizing a characterization instrument and the Herth Hope Scale. All of the ethical premises were complied with (protocol 512/2009). Regarding the results, most participants were male (60%) and their mean age was 70.20 (±6.1) years. The mean score on the Herth Hope Scale was 36.20 (±2.90). In conclusion, compared with the Brazilian study regarding the validation of the Herth Hope Scale, the subjects' level of hope was lower, thus indicating a need to intervene regarding this feeling. PMID:23018400

  3. Low plasma level of cathelicidin antimicrobial peptide (hCAP18) predicts increased infectious disease mortality in patients undergoing hemodialysis

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    Gombart, Adrian F; Bhan, Ishir; Borregaard, Niels; Tamez, Hector; Camargo, Carlos A; Koeffler, H Phillip; Thadhani, Ravi

    2009-01-01

    end-stage renal disease, we hypothesized that low hCAP18 levels would identify those who are at increased risk of death attributable to infection while undergoing hemodialysis. METHODS: We performed a case-control study nested in a prospective cohort of patients (n = 10,044) initiating incident...... hemodialysis. Case patients (n = 81) were those who died of an infectious disease within 1 year; control patients (n = 198) were those who survived at least 1 year while undergoing dialysis. RESULTS: Mean (+/-SD) baseline levels of hCAP18 in case patients and control patients were 539 +/- 278 ng/mL and 650...

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

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

    2015-04-01

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

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

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    Nurten KALENDER

    2015-09-01

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

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

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    Rias Pratiwi Safitri

    2013-05-01

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

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

    OpenAIRE

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

    2013-01-01

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

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

    International Nuclear Information System (INIS)

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

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

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

    2007-08-15

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

  10. Hope and spirituality among patients with chronic kidney disease undergoing hemodialysis: a correlational study1

    Science.gov (United States)

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

    2014-01-01

    Objective to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis. Method this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through individual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS). Results the average HHI score was 38.06 (±4.32) while the average PP-RSS score was 3.67 (±0.62) for "beliefs" and 3.21 (±0.53) for "hope/optimism". Spearman's coefficient indicated there was a moderate positive correlation between the HHI and PP-RSS dimensions of "beliefs" (r=0.430; p<0.001) and "hope/optimism" (r=0.376; p<0.001). Conclusion Since a relationship between the sense of hope and spirituality of patients with chronic kidney disease was found, these constructs should be taken into account at the time health professionals deliver care to help patients coping with the disease and treatment. PMID:26107832

  11. Salivary levels of interleukin-6 and tumor necrosis factor-? in patients undergoing hemodialysis

    Science.gov (United States)

    Khozeymeh, Faezeh; Mortazavi, Mojgan; Khalighinejad, Navid; Akhavankhaleghi, Mehrdad; Alikhani, Milad

    2016-01-01

    Background: Inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-?) are elevated in end-stage renal disease (ESRD). IL-6 and TNF-? are toxins which deteriorate renal function, and their pathogenic role has been confirmed in cardiovascular and oral diseases. This study was designed to investigate the salivary levels of IL-6 and TNF-? in patients with ESRD undergoing hemodialysis (HD). Materials and Methods: Twenty patients with ESRD who were treated with 4 h HD sessions, with low flux membrane were included in this cross-sectional study. Average Kt/V index in patients was 1.19 ± 0.1. Twenty age-sex-matched healthy controls with no infectious diseases during 1 month before saliva sampling were selected. Unstimulated whole saliva was collected and TNF-? and IL-6, concentrations were measured using human IL-6 and TNF-? ELISA kits. Independent t-test was used to analyze the data using SPSS (? = 0.05). Results: There was a significant difference between dialysis and control groups regarding the salivary levels of TNF-? (P = 0.034) and IL-6 (P = 0.001). Conclusion: Considering the results of this study and reported role of inflammatory cytokines in the pathogenesis of cardiovascular and oral diseases, measurement of salivary IL-6 and TNF-? in HD patients may help in risk stratification of HD patients and in planning pertinent preventive strategies.

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

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    Ana Carolina Ottaviani

    2014-04-01

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

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

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    Santos Paulo

    2012-08-01

    Full Text Available Abstract Background Sexual function among women undergoing hemodialysis (HD is under-studied and there is no consensus about the effect of sexual dysfunction (SD on their quality of life (QoL. We aimed to determine the prevalence of SD and to compare QoL between women undergoing maintenance HD with and without SD. Methods We included female end-stage renal disease (ESRD patients undergoing HD during June 2011 in the only renal unit in the north of Ceará state, northeastern Brazil. The criteria for inclusion were age between 18 and 55, at least three months on dialysis and being sexually active. Women using antidepressant medication were excluded. We used the Female Sexual Function Index (FSFI, which evaluates six domains of sexual function, including desire, arousal, lubrication, orgasm, satisfaction and pain. The patients were classified as presenting SD if the total FSFI score was less than 26. For QoL evaluation, we used the validated Brazilian version of SF-36. This is a widely used 36-item questionnaire covering eight dimensions of QoL. Demographic data, time on dialysis, underlying etiology of ESRD, and laboratory measures were assessed in unit records. Results Of a total of 58 women, 46 (79.3% presented SD. There were lower scores related to physical functioning (48.2 vs. 71.2; p?=?0.007, bodily pain (45 vs. 67.5; p?=?0.010, vitality (52.1 vs. 69.1; p?=?0.026 and social functioning (57.2 vs. 76.1; p?=?0.034 among women with SD compared to women without SD. Physical functioning and role-physical presented positive linear correlation with FSFI scores, respectively, r?=?0.322 (p?=?0.013 and r?=?0.345 (p?=?0.007. Conclusion The prevalence of SD among women on HD is very high, reaching nearly 80%. Women on HD with SD had worse QoL, especially physical aspects of QoL, when compared to women without SD. Therefore, approaches aiming to improve QoL among women undergoing HD should be considered.

  14. Sarcopenia in patients undergoing maintenance hemodialysis: incidence rate, risk factors and its effect on survival risk.

    Science.gov (United States)

    Ren, Hongqi; Gong, Dehua; Jia, Fengyu; Xu, Bin; Liu, Zhihong

    2016-04-01

    Background Sarcopenia is a degenerative syndrome mainly characterized by the atrophy of skeletal muscle, along with the decrease of muscle strength and function. However, there are currently few studies concerning sarcopenia in patients undergoing maintenance hemodialysis dialysis (MHD). This study was aimed to investigate the incidence of sarcopenia in MHD patients and its influencing factors, as well as its impact on survival risk. Method All 131 MHD patients enrolled in our study were tested with bioelectrical impedance analysis (BIA) and grip strength. Demographic data was collected and anthropometric measurement and laboratory examination were conducted. Results The total incidence of sarcopenia within the 131 MHD patients was 13.7% and the incidence of sarcopenia in patients over 60 years was 33.3%. The dialysis duration, with or without diabetes, serum phosphorus and pre-albumin levels of sarcopenic patients were significantly different from those of non-sarcopenicones; the modified quantitative subjective global assessment (MQSGA) scores of sarcopenic patients were higher than those without sarcopenia. Multivariate analysis showed that dialysis duration, diabetes and serum phosphorus level were independent risk factors for sarcopenia in MHD patients. Kaplan-Meier survival analysis showed a one-year survival of 88.9% in sarcopenic patients, which was significantly lower than non-sarcopenic patients. Conclusion The incidence of sarcopenia in MHD patients was high and increased gradually with age. Dialysis duration, diabetes, serum phosphorus level and malnutrition predisposed the patients to sarcopenia. One-year follow-up found that the mortality risk of sarcopenic patients was higher than that of non-sarcopenic patients. PMID:26738817

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

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    El-Nakib GA

    2013-08-01

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

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

    OpenAIRE

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

    2013-01-01

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

  17. A comparison of solute clearance during continuous hemofiltration, hemodiafiltration, and hemodialysis using a polysulfone hemofilter.

    Science.gov (United States)

    Reeves, J H; Butt, W W

    1995-01-01

    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

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

    OpenAIRE

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

    2014-01-01

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

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

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    Ghasemi Asghar

    2008-01-01

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

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

    International Nuclear Information System (INIS)

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

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

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    Mehrdad Sheikhvatan

    2010-05-01

    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.

  2. Vascular access-related infections in HIV patients undergoing hemodialysis: case description and literature review

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    Carlos E. Figueroa Castro

    2008-12-01

    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.

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

    Scientific Electronic Library Online (English)

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

    2012-02-01

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

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

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    Hamed Enas A

    2012-10-01

    Full Text Available Abstract Background Tissue injury due to hypoxia and/or free radicals is common in a variety of disease processes. This cross-sectional study aimed to investigate effect of chronic kidney diseases (CKD and hemodialysis (HD on hypoxia and oxidative stress biomarkers. Methods Forty pediatric patients with CKD on HD and 20 healthy children were recruited. Plasma hypoxia induced factor-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.

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

    Science.gov (United States)

    Burgin, Tucker; Johnson, Dean; Chung, Henry; Clark, Alfred; McGrath, James

    2015-01-01

    Hemodialysis involves large, periodic treatment doses using large-area membranes. If the permeability of dialysis membranes could be increased, it would reduce the necessary dialyzer size and could enable a wearable device that administers a continuous, low dose treatment of chronic kidney disease. This paper explores the application of ultrathin silicon membranes to this purpose, by way of analytical and finite element models of diffusive and convective transport of plasma solutes during hemodialysis, which we show to be predictive of experimental results. A proof-of-concept miniature nanomembrane dialyzer design is then proposed and analytically predicted to clear uremic toxins at near-ideal levels, as measured by several markers of dialysis adequacy. This work suggests the feasibility of miniature nanomembrane-based dialyzers that achieve therapeutic levels of uremic toxin clearance for patients with kidney failure. PMID:26729179

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

    Directory of Open Access Journals (Sweden)

    Tucker Burgin

    2015-12-01

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

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

    OpenAIRE

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

    2003-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sasajima Koji

    2008-11-01

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

  10. The efficacy of udenafil in end-stage renal disease patients undergoing hemodialysis.

    Science.gov (United States)

    Irkilata, Lokman; Aydin, Hasan Riza; Ozer, Ismail; Aydin, Mustafa; Demirel, Hüseyin Cihan; Moral, Caner; Atilla, Mustafa Kemal

    2016-04-01

    Introduction Erectile dysfunction (ED) is frequently observed in end-stage renal disease (ESRD) patients on hemodialysis (HD) compared to non-uremic patients. This situation causes severe psychogenic problems in patients and disrupts the quality of life. Different phosphodiesterase type 5 (PDE-5) inhibitors have been used, and efficacies revealed, for the treatment of ED in HD patients; however, there are no studies related to udenafil use or results for HD patients. This study retrospectively evaluated the efficacy and reliability of udenafil for HD patients. Materials and methods The laboratory findings, side effects after treatment, and International Index of Erectile Function (IIEF) scores before and after treatment were compared and evaluated for HD patients who applied to our urology clinic with ED complaints and were treated with udenafil. Results The results showed that in the HD patient group with ED, apart from ED, there were severe rates of other sexual dysfunction. In our patient group, there was a statistically significant improvement in all scores for erectile function (p = 0.033), orgasmic function (p satisfaction (p satisfaction (p < 0.001) after treatment. The reported side effects were headache in one patient and dyspepsia in one patient. Conclusion We concluded that udenafil is an effective and reliable treatment approach for HD patients; however, our results require support from prospective randomized crossover studies with sildenafil. PMID:26727286

  11. The relative trending accuracy of noninvasive continuous hemoglobin monitoring during hemodialysis in critically ill patients.

    Science.gov (United States)

    Yamada, Hiroshi; Saeki, Minako; Ito, Junko; Kawada, Kazuhiro; Higurashi, Aya; Funakoshi, Hiromi; Takeda, Kohji

    2015-02-01

    The pulse CO-Oximeter (Radical-7; Masimo Corp., Irvine, CA) is a multi-wavelength spectrophotometric method for noninvasive continuous monitoring of hemoglobin (SpHb). Because evaluating the relative change in blood volume (?BV) is crucial to avoid hypovolemia and hypotension during hemodialysis, it would be of great clinical benefit if ?BV could be estimated by measurement of SpHb during hemodialysis. The capability of the pulse CO-Oximeter to monitor ?BV depends on the relative trending accuracy of SpHb. The purpose of the current study was to evaluate the relative trending accuracy of SpHb by the pulse CO-Oximeter using Crit-Line as a reference device. In 12 patients who received hemodialysis (total 22 sessions) in the intensive care unit, ?BV was determined from SpHb. Relative changes in blood volume determined from SpHb were calculated according to the equation: ?BV(SpHb)=[starting SpHb]/[current SpHb] - 1. The absolute values of SpHb and hematocrit measured by Crit-Line (CL-Hct) showed poor correlation. On the contrary, linear regression analysis showed good correlation between ?BV(SpHb) and the relative change in blood volume measured by Crit-Line [?BV(CL-Hct)] (r=0.83; P?0.001). Bland-Altman analysis also revealed good agreement between ?BV(SpHb) and ?BV(CL-Hct) (bias, -0.77%; precision, 3.41%). Polar plot analysis revealed good relative trending accuracy of SpHb with an angular bias of 4.1° and radial limits of agreement of 24.4° (upper) and -16.2° (lower). The results of the current study indicate that SpHb measurement with the pulse CO-Oximeter has good relative trending accuracy. PMID:24793635

  12. Management of a severe carbamazepine overdose using albumin-enhanced continuous venovenous hemodialysis.

    Science.gov (United States)

    Askenazi, David J; Goldstein, Stuart L; Chang, I-Fen; Elenberg, Ewa; Feig, Daniel I

    2004-02-01

    Carbamazepine intoxication is common in the pediatric population. Highly protein-bound, carbamazepine is not removed efficiently through conventional hemodialysis. We describe the use of albumin-enhanced continuous venovenous hemodialysis (CVVHD) in a 10-year-old girl who developed coma and respiratory depression due to an intentional carbamazepine overdose (peak drug level of 44.8 microg/ml; therapeutic range: 8-12 microg/ml). Without intervention, the half-life of drug elimination is 25 to 60 hours in patients who are naive to carbamazepine and 12 to 20 hours in children on chronic carbamazepine therapy. In contrast, with albumin-enhanced CVVHD, we observed a half-life of 7 to 8 hours. The patient recovered rapidly and was discharged from hospital <4 days from the time of ingestion with no complications or neurologic impairment. Because the cost-benefit analysis was also favorable relative to other therapeutic options, albumin-enhanced CVVHD may be the optimal treatment of toxic-level ingestion of carbamazepine. PMID:14754959

  13. Pharmacokinetics of Carboplatin in a One-Year-Old Anuric Boy Undergoing Hemodialysis and a Review of the Literature.

    Science.gov (United States)

    Kamei, Koichi; Sako, Mayumi; Ishikawa, Tomoaki; Sato, Mai; Ogura, Masao; Uno, Teruaki; Kiyotani, Chikako; Mori, Tetsuya; Tanaka, Hideaki; Ito, Shuichi; Nakamura, Hidefumi

    2015-10-01

    There have been few reports of carboplatin-based chemotherapy for anuric infants. As we had a chance to treat a one-year-old anuric hepatoblastoma patient with carboplatin, we performed a pharmacokinetic analysis and examined the optimal treatment strategy. A one-year-old anuric boy under peritoneal dialysis was diagnosed with hepatoblastoma. Surgical resection was performed, and administration of carboplatin was scheduled postoperatively aiming at 5?mg·min/mL of the area under the curve from the time of dosing to the time of the last observation (AUC(0-t)). We set the initial dose at 50?mg, higher than that calculated by the Calvert formula (34?mg); the time from the end of carboplatin infusion to the initiation of hemodialysis at 2?h; and the hemodialysis duration at 24?h. The actual AUC0-t was 3.05?mg·min/mL because the elimination half-lives before and during hemodialysis were shorter than expected. The AUC(0-t) after the second dose (100?mg) and the third dose (80?mg) were 7.00 and 4.68?mg·min/mL, respectively. The Calvert formula is not suitable for hemodialysis patients because removal of platinum by hemodialysis is not taken into account. It appears that extrarenal clearance in anuric infants is different from that in adults. We obtained an optimal AUC(0-t) using a dose of 80?mg (200?mg/m(2)), setting the time from the end of carboplatin infusion to the initiation of hemodialysis at 2?h, and performing 8-h hemodialysis. Further accumulation of the pharmacokinetic data of carboplatin is necessary for anuric children. PMID:25916242

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

    Directory of Open Access Journals (Sweden)

    Wilson S

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Janssen IM

    2015-06-01

    Full Text Available Inger Miriam Janssen,1 Ansgar Gerhardus,2,3 Gero D von Gersdorff,4 Conrad August Baldamus,4 Mathias Schaller,4 Claudia Barth,5 Fueloep Scheibler6 1Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany; 2Department for Health Services Research, University of Bremen, Bremen, Germany; 3Health Sciences Bremen, University of Bremen, Bremen, Germany; 4Department of Internal Medicine II, University Hospital of Cologne, Cologne, Germany; 5KfH Kuratorium fuer Dialyse und Nierentransplantation e.V., Neu-Isenburg, Germany; 6Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Cologne, Germany Background: Chronic kidney disease is an increasing health problem worldwide and in its final stage (stage V can only be treated by renal replacement therapy, mostly hemodialysis. Hemodialysis has a major influence on the everyday life of patients and many patients report dissatisfaction with treatment. Little is known about which aspects of treatment are considered important by hemodialysis patients. The objective of this study was to rate the relative importance of different outcomes for hemodialysis patients and to analyze whether the relative importance differed among subgroups of patients.Patients and methods: Within the framework of a yearly questionnaire which is distributed among patients receiving hemodialysis by the largest hemodialysis provider in Germany, we assessed the relative importance of 23 outcomes as rated on a discrete visual analog scale. Descriptive statistics were used to rank the outcomes. Subgroup analyses were performed using Mann–Whitney U or Kruskal–Wallis tests.Results: Questionnaires of 4,518 hemodialysis patients were included in the analysis. The three most important outcomes were safety of treatment, health-related quality of life, and satisfaction with care. Further important outcomes were hospital stays, accompanying symptoms, hemodialysis duration, and the improvement or preservation of a good emotional state. Age, profession, and education had the strongest influence on relevant differences of preferences for outcomes; no relevant influence of sex or comorbidity was observed.Conclusion: Outcomes concerning the delivery or provision of care and aspects influencing quality of life are rated by patients to be at least as important as clinical outcomes. Many of the outcomes judged to be important by the patients are not regularly considered in research, evaluation studies, or quality programs. Keywords: patient-centered outcomes, preference elicitation, chronic disease, patient-centered research, rating scale

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

    Scientific Electronic Library Online (English)

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

    2014-10-01

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

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

    Czech Academy of Sciences Publication Activity Database

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

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Plasma paraoxonase (PON) is an enzyme that hydrolyzes organic phosphate and aromatic carboxylic acid esters. Reduced activity is associated with early events of atherogenesis. The relevance of PON phenotypes is not well characterized in hemodialysis patients. In a cross-sectional study we measured PON activity in 377 hemodialysis patients photometrically using the substrates 4-nitrophenylacetate and phenylacetate. The PON ratio was calculated from 4-nitrophenylacetate-derived activity divided by...

  19. Comparison of Anthropometric Data between End-stage Renal Disease Patients Undergoing Hemodialysis and Healthy Adults in Korea

    OpenAIRE

    Lee, Seoung Woo; Park, Geun Ho; Lee, Sun Young; Song, Joon Ho; Kim, Moon-Jae

    2005-01-01

    Protein-calorie malnutrition is prevalent in hemodialysis (HD) patients. The prevalence of obesity in healthy Korean adults has increased rapidly during the last 10 years. However, there are few large scale data collections available about the current weight status of Korean HD patients. The weight statuses of 10,304 HD patients (data from the Insan Memorial Dialysis Registry 2002, Korean Society of Nephrology) were compared to those of 12,436 control subjects (age > 18) by using body mass in...

  20. Frequency of restless leg syndrome in end stage renal disease patients undergoing hemodialysis and its association with diabetes mellitus

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of Restless Leg Syndrome (RLS) in End Stage Renal Disease (ESRD) patients receiving hemodialysis and its association with the most common cause of ESRD i.e. Diabetes mellitus (DM). Methodology: This cross sectional study was done in the dialysis unit of Nephrology of Shifa International Hospital, Islamabad, Pakistan from 10th August 2012 to 9th February 2013. A total of 140 patients with ESRD were included in study, who were 18 years of age or above, on regular hemodialysis. Patients were screened for the presence of RLS using International Restless Leg Syndrome Study Group (IRLSSG) diagnostic criteria. Those with RLS were checked for the presence of DM. Age, gender, presence of RLS and DM were recorded. Data were analyzed using SPSS 12. Results: Mean age was 53.54 years (range 18-80 years). 38.6% of the ESRD patients had RLS. p value for association of RLS with DM was not significant. Conclusion: RLS is frequently found in ESRD patients receiving hemodialysis. Diabetes Mellitus, which is the most common cause of ESRD, does not seem to have any association with the occurrence of RLS in these patients. (author)

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

    Scientific Electronic Library Online (English)

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

    2011-07-01

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

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

    Science.gov (United States)

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

    2002-09-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    Plasma paraoxonase (PON) is an enzyme that hydrolyzes organic phosphate and aromatic carboxylic acid esters. Reduced activity is associated with early events of atherogenesis. The relevance of PON phenotypes is not well characterized in hemodialysis patients. In a cross-sectional study we measure...... dialysis vintage (P...

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

    Directory of Open Access Journals (Sweden)

    Schmid H

    2009-06-01

    Full Text Available Abstract Objective Poor adherence to complex multimodal therapies is a widely recognized problem in the daily care of dialysis patients, contributing to excess morbidity and mortality of this population. While a few studies have been devoted to understanding patient nonadherence, their results were somewhat controversial. The goals of this review are to quantify nonadherence to certain oral medications, to raise awareness of factors that may cause problems in a patient's adherence to this treatment, and to describe strategies that may be used to improve adherence to prescribed pharmacotherapy. Methods A systematic literature review in the MEDLINE and PubMed database (1971-2008 was performed. Quantitative studies, which accurately indicated the total percentages of nonadherence to oral medication in adult patients receiving chronic hemodialysis, were identified. Results A total of 19 studies fulfilled the search criteria. Rates of nonadherence to the oral medication ranged from 3 - 80%. More than half of the included studies reported nonadherence rates of ? 50% (mean 67%. The use of phosphate binding therapy was the prevalent surveyed oral medication. Self reports, structured interviews, and predialysis serum phosphate levels were the most frequent assessment tools used to record adherence rates. Limitations of the reviewed studies included small patient cohorts, inconsistent definitions of adherence, and a lack of standardized methods for measuring nonadherence. Conclusions Nonadherence to oral medication in hemodialysis patients is still an underestimated, but life-threatening behaviour.

  5. HEMODIALYSIS MEMBRANES: PAST, PRESENT AND FUTURE TRENDS

    OpenAIRE

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

    2013-01-01

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

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

    Czech Academy of Sciences Publication Activity Database

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2012-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Gláucia Thaise Coimbra de Oliveira

    2012-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Krotin Mirjana

    2007-01-01

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

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

    DEFF Research Database (Denmark)

    Pakpour, Amir H.; Zedi, Isa mohammadi

    2011-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2011-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Xin LIU

    2015-10-01

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

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

    DEFF Research Database (Denmark)

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

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...... 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....

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

    Directory of Open Access Journals (Sweden)

    Anna Bednarek?Skublewska

    2010-05-01

    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.

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

    DEFF Research Database (Denmark)

    Joffe, P; Olsen, F; Heaf, J G; Gammelgaard, Bente; Pödenphant, J

    1989-01-01

    Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations in the...

  17. Age-related differences in the quality of life in end-stage renal disease in patients enrolled in hemodialysis or continuous peritoneal dialysis

    OpenAIRE

    Laudański, Krzysztof; Nowak, Zbigniew; Niemczyk, Stanisław

    2013-01-01

    Background The aim of the present study was to compare the experience elderly and younger patients in terms of emotional status, disease perception, methods of coping with the end-stage renal disease (ESRD) stress, and health-related quality of life in 2 different settings of renal replacement therapy: hemodialysis (HD) and continuous ambulatory peritoneal dialysis programs (CAPD). Specifically, we hypothesized that younger people will more frequently use goal-oriented strategies to cope with...

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

    OpenAIRE

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-07-15

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

  2. Acute effect of hemodialysis on arterial elasticity

    OpenAIRE

    Sa?, Saim; YE??LBURSA, Dilek; Abdulmecit YILDIZ; Kamil D?LEK; ?entürk, Tunay; SERDAR, Osman Ak?n; Aydinlar, Ali

    2015-01-01

    Reduced arterial elasticity is an independent predictor of cardiovascular mortality in patients with end-stage renal disease (ESRD). Hemodialysis (HD) treatment per se can bring additional risk factors for vascular disease. Our study was designed to determine whether a single hemodialysis session leads to an acute alteration in parameters of arterial elasticity in ESRD. Materials and methods: In this study, 58 patients undergoing chronic hemodialysis and 29 healthy controls were enrolled. L...

  3. Chronic Inflammation Increases Risk in Hemodialysis Patients

    OpenAIRE

    Razeghi Effat; Omati Homeira; Maziar Sima; Khashayar Patricia; Mahdavi-Mazdeh Mitra

    2008-01-01

    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. ...

  4. Abnormal electrical stimulus of an intra-aortic balloon pump with concurrent support with continuous veno-venous hemodialysis.

    Science.gov (United States)

    Sakiewicz, P G; Wright, E; Robinson, O; Mercer, R; Kickel, K; Paganini, E P

    2000-01-01

    Malfunction of electronic medical support apparatus utilized in the ICU usually causes system failure. We report several occurrences of a potentially dangerous interaction between a continuous veno-venous hemodialysis (CVVHD) system and an intra-aortic balloon pump (IABP) counterpulsation device in four patients requiring both systems. The patients had acute renal failure in the face of multi-organ failure and were dependent upon the balloon pump for pressure support. Electrical interference created by the roller pump action of the CVVHD system was identified by the balloon pump as cardiac in origin, and it responded by inflation and deflation. As the blood pump rate was reduced, the interference reduced to the point of complete cessation when the blood pump was shut down. Whereas one patient transiently had a significant drop of mean arterial pressure (from 70 +/- 4 to 40 +/- 2 mm Hg) the other observed occurrences had no clinically significant sequelae. Electrocardiogram (ECG) tracings identified the abnormal stimulus and systematic review identified as potential sources for the creation of this interference static electricity buildup, piezoelectric properties of the polyvinyl chloride tubing, and, possibly but less likely, radiofrequency interference. A newer generation ECG cable and advanced cardiac rhythm recognition software (CardioSync) have been introduced with the Datascope System 98, and the ECG interference, although still occasionally present, does not cause erratic inflation and deflation of the intra-aortic balloon pump. Interference between different electrical support systems may occur, and we suggest that the systems be tested for compatibility before combined use and that older equipment be more rigorously tested for potential clinically significant interference. PMID:10667733

  5. Indirect effector mechanisms on antibodies in hemodialysis patients

    OpenAIRE

    Koch, Till Jakob

    2015-01-01

    Patients suffering from chronic kidney failure undergoing regular hemodialysis (DP) have been shown to suffer from increased incidence of solid tumors (e.g. colorectal carcinoma), which indicates a reduced immune status. At the same time, their immune system is constantly activated to a state of slight inflammation, likely due to the continuous interaction of leukocytes with the foreign surface of the dialysis filters. In the last decades, several novel antibody drugs have been approved for t...

  6. Helicobacter Pylori IgG Antibodies in Association with Secondary Hyperparathyroidism in End-stage Renal Failure Patients Undergoing Regular Hemodialysis

    Directory of Open Access Journals (Sweden)

    Hamid Nasri

    2006-01-01

    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.

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-10-15

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

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

    Scientific Electronic Library Online (English)

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

    2015-01-01

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

  10. Clinical study of cerebral infarction in hemodialysis patients

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2010-06-01

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

  12. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ounissi M

    2009-01-01

    Full Text Available The dissecting aortic aneurysm (DAA is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.

  13. Dissecting aortic aneurysm in maintenance hemodialysis patients

    OpenAIRE

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

    2009-01-01

    The dissecting aortic aneurysm (DAA) is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.

  14. HEMODIALYSIS MEMBRANES: PAST, PRESENT AND FUTURE TRENDS

    Directory of Open Access Journals (Sweden)

    Gautham A

    2013-06-01

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

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

    Scientific Electronic Library Online (English)

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

    2010-12-01

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

  16. Home hemodialysis

    DEFF Research Database (Denmark)

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

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

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

    Directory of Open Access Journals (Sweden)

    Azar Baradaran

    2005-11-01

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

  18. Home Hemodialysis

    Science.gov (United States)

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

  19. 21 CFR 876.5860 - High permeability hemodialysis system.

    Science.gov (United States)

    2010-04-01

    ... Water Purification Components and Systems for Hemodialysis,” and (5) “Guidance for Hemodialyzer Reuse... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5860 High permeability hemodialysis system. (a) Identification. A high permeability hemodialysis system is a device intended for...

  20. 21 CFR 876.5665 - Water purification system for hemodialysis.

    Science.gov (United States)

    2010-04-01

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

  1. Anti-Brucella Antibodies in Chronic Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Esmaeli H

    2013-03-01

    Full Text Available Abstract Background and objective: Brucellosis is a zoonosis that can affect all the systems and organs in the body. Although brucellae have been recovered from the urine of patients with brucellosis, renal involvement appears to be uncommon. In this study, anti brucella antibodies were investigated among hemodialysis patients of Qom. Material & methods: Blood samples were obtained from 200 patients undergoing chronic hemodialysis in Kamkar Hospital, Qom city. All serum samples were tested by rose Bengal initially. Positive Samples in this test were examined by writing tests, 2 mercaptoethanol (2-ME and Coombs. Results: In this study, the Rose Bengal test of 6 patients (3 male and 3 female of these 200 patients, were positive. Wright and Coombs test was positive for 5 patients. Conclusion: Considering the significant prevalence of the disease in the country, especially in endemic areas, it is suggested further research in this area continues.

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

    Scientific Electronic Library Online (English)

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

    2014-04-01

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

  3. Depression in hemodialysis patients

    International Nuclear Information System (INIS)

    To measure the frequency of depression and its risk factors in patients under going hemodialysis. It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1/sup st/ January 2006 to 30/sup th/ April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory- II (BDI-II; adapted in Urdu) was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers (Anti HCV and HbsAg). Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) for correlation of psychological variables with clinical, hematological and biochemical parameters. Eighty nine patients were enrolled which included fifty two (58.4%) were male and seventy seven (86.5%) were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 +- 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty (56.1%) were moderately to severely depressed and there was no gender difference in the prevalence of depression. Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters. (author)

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

    Directory of Open Access Journals (Sweden)

    Khawaja AR

    2013-01-01

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

  5. Evaluation of Bone Mineral Density in Hemodialysis Patients

    OpenAIRE

    Mukadder Ay?e Bilgiç; Oya Özdemir

    2010-01-01

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

  6. Thrombocytopenia in the Setting of Hemodialysis Using Biocompatible Membranes

    OpenAIRE

    Kathryn B. Muir; Packer, Clifford D

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2010-12-01

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

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

    Scientific Electronic Library Online (English)

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

    2014-12-01

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

  10. Optimal Nutrition in Hemodialysis Patients

    OpenAIRE

    Ikizler, T Alp

    2013-01-01

    Protein energy wasting (PEW) is highly prevalent in patients undergoing maintenance hemodialysis (MHD) patients. Importantly, there is a robust association between the extent of PEW and the risk of hospitalization and death in these patients, regardless of the nutritional marker used. The multiple etiologies of PEW in advanced kidney disease are still being elucidated. Apart from the multiple mechanisms that might lead to PEW, it appears that the common pathway for all the derangements is rel...

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

    DEFF Research Database (Denmark)

    León Sobrino, Carlos; Kot, W.P.; Garrett, Roger Antony

    2015-01-01

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

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

    DEFF Research Database (Denmark)

    León Sobrino, Carlos; Kot, W.P.

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Humberto Kukhyun Choi

    2003-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2013-12-01

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

  15. Life Quality of Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Noorallah Tahery

    2013-05-01

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

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

    OpenAIRE

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

    2009-01-01

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

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

    International Nuclear Information System (INIS)

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

  18. Headache associated with hemodialysis

    Directory of Open Access Journals (Sweden)

    Niki? Petar M.

    2008-01-01

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

  19. Accuracy of continuous central venous oxygen saturation monitoring in patients undergoing cardiac surgery

    OpenAIRE

    Baulig, W; Dullenkopf, A; Kobler, A; Baulig, B; Roth, H R; Schmid, E R

    2008-01-01

    OBJECTIVE: Continuous assessment of central venous oxygen saturation (S(cevox)O(2)) with the CeVOX device (Pulsion Medical Systems, Munich, Germany) was evaluated against central venous oxygen saturation (S(cv)O(2)) determined by co-oximetry. METHODS: In 20 cardiac surgical patients, a CeVOX fiberoptic probe was introduced into a standard central venous catheter placed in the right internal jugular vein and advanced 2-3 cm beyond the catheter tip. After in vivo calibration of the probe, S(cev...

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

    Scientific Electronic Library Online (English)

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

    2013-12-01

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

  1. Music for Hemodialysis patients

    DEFF Research Database (Denmark)

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

    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...

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

    Science.gov (United States)

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

    2015-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Selma ÇET?NKAYA

    2008-10-01

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

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

    LENUS (Irish Health Repository)

    Spooner, Almath M

    2011-08-04

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

  5. The breath ammonia measurement of the hemodialysis with a QCM-NH3 sensor.

    Science.gov (United States)

    Ishida, Hitoshi; Satou, Toshio; Tsuji, Kiichi; Kawashima, Norimichi; Takemura, Hideo; Kosaki, Yasuhiro; Shiratori, Seimei; Agishi, Tetuzou

    2008-01-01

    Recently, expired gases are analyzed non-invasively for monitoring the substances in the blood. Breath ammonia has been shown to correlate with BUN (blood urea nitrogen) and Cr (creatinine), both of which are indicators of solute removal in hemodialysis. In this study, breath ammonia concentration was continuously measured using a crystal oscillator QCM (quartz crystal microbalance) during the expiration of patients undergoing dialysis treatment. The results show that NH3 (ammonia) decreased gradually as the treatment proceeded. A strong correlation was observed between changes in the frequency of the QCM gas sensor and both the pre-dialysis BUN level (r=0.71, pgas. These results suggest that continuous measurement of NH3 is useful to assess the status of solute removal during hemodialysis. PMID:18408261

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

    Scientific Electronic Library Online (English)

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

    2014-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Tamadon

    2011-07-01

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

  8. Hemodialysis-related headaches

    Directory of Open Access Journals (Sweden)

    ?uri? Marija

    2007-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2012-08-01

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

  10. 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

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    Denilson Fonseca Rodrigues

    2011-12-01

    Full Text Available Objetivo: Conhecer as vivências dos pacientes masculinos submetidos à hemodiálise acerca de sua sexualidade. Metodologia: Trata-se de uma investigação exploratória, descritiva, com abordagem qualitativa. Os sujeitos da pesquisa, realizada no primeiro semestre de 2004, foram oito pacientes masculinos que estavam em tratamento hemodialítico. O instrumento de coleta foi a entrevista semiestruturada, utilizando a análise categórica. Como cenário da pesquisa, um serviço de nefrologia, de um município da Região Sul do Brasil. Resultados: A partir da análise emergiram as seguintes categorias: Aspectos físicos e emocionais acerca do tratamento; As vivências dos pacientes renais crônicos acerca de sua sexualidade; As estratégias para lidar com as limitações relacionadas à sexualidade e A sexualidade dos pacientes renais crônicos após a hemodiálise. Discussão: O desgaste e o cansaço físico foram atribuídos ao tratamento hemodialítico. A vivência dos pacientes renais crônicos acerca de sua sexualidade está intimamente ligada à relação sexual saudável, tanto no biológico quanto no emocional. Os pacientes que buscam estratégias a fim de minimizar ou até mesmo resolver problemas relativos com sua sexualidade, em decorrência da condição crônica, enfrentam com maior facilidade os obstáculos vivenciados. Os sujeitos apresentaram modificações a respeito da sexualidade, no entanto, percebe-se a busca dos pacientes por estratégias que amenizem e até mesmo restabeleçam suas necessidades sexuais, dentro da dimensão biopsicológica. Considerações finais: Este estudo é relevante, pois existe necessidade de capacitar profissionais para trabalharem com a sexualidade humana, percebendo o paciente renal crônico sob uma visão holística.Palavras-chave: insuficiência renal crônica; diálise renal; enfermagem; sexualidade.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

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

    Scientific Electronic Library Online (English)

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

    2011-12-01

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

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

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    Dinaldo Cavalcanti de Oliveira

    2009-07-01

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

  13. Epidemiology of hemodialysis patients in Aleppo city

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    Moukeh Ghamez

    2009-01-01

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

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

    OpenAIRE

    Jacek Rysz; Piotr Bartnicki; Stolarek, Robert A.

    2005-01-01

    The human recombinant erythropoietin (hrEpo) is crucial in anemia treatment options in chronic renal failure patients undergoing regular hemodialysis therapy. However, the clinical characteristics of erythropoietin treatment prior to hemodialysis have not been thoroughly studied. This study was aimed to analyze in retrospective manner the results of hrEpo therapy in chronic renal failure prior to hemodialysis. The study included 42 patients (26 males and 16 females, 42.4±3.7 yrs old) with mea...

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

    Science.gov (United States)

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

    2011-01-01

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

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

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    Nadienka Rodríguez Ramos

    2010-12-01

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

  17. Can Vascular Access During Hemodialysis Cause Extremity Loss?

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    Nurkay KATRANCIO?LU

    2013-05-01

    Full Text Available There is always the possibility of complications of vascular access in patients with hemodialysis. The pseudoaneurysm related with accidental arterial puncture is one of the most important complications in patients with hemodialysis and it can cause severe clinic manifestations that may go all the way to limb loss. We describe a 78-year-old woman undergoing regular dialysis treatment with renal failure. The patient had severe left arm pain starting suddenly after hemodialysis, with rapidly progressing cyanosis, and compartment syndrome caused by brachial artery pseudoaneurysm. Urgent surgical procedure was performed. The pseudoaneurysm was successfully repaired, left arm arterial circulation reestablished, and fasciotomy performed on the left arm for compartment syndrome. In the second session, debridement was performed and dermal graft applied to the necrotic lesions. The patient was discharged with full recovery within 2 months following the treatment. In this case, we emphasize that vascular access during hemodialysis has some complications that can even cause extremity loss..

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

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    Francisca Monsalve-Castillo

    2012-02-01

    Full Text Available Over a two year period, the incidence of hepatitis C virus (HCV infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years, from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined using a fourth generation ELISA (Innotest HCV Ab IV kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III, both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080 in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.

  19. Xerostomia in patients on chronic hemodialysis.

    Science.gov (United States)

    Bossola, Maurizio; Tazza, Luigi

    2012-03-01

    Xerostomia is the subjective feeling of a dry mouth, which is relatively common in patients on chronic hemodialysis. Xerostomia can be caused by reduced salivary flow secondary to atrophy and fibrosis of the salivary glands, use of certain medications, restriction of fluid intake and old age. In patients undergoing hemodialysis, xerostomia is associated with the following problems: difficulties in chewing, swallowing, tasting and speaking; increased risk of oral disease, including lesions of the mucosa, gingiva and tongue; bacterial and fungal infections, such as candidiasis, dental caries and periodontal disease; interdialytic weight gain resulting from increased fluid intake; and a reduction in quality of life. Unfortunately, no effective treatment exists for xerostomia in patients on chronic hemodialysis. The stimulation of salivary glands by mechanical means (such as chewing gum) or pharmacological agents (such as pilocarpine and angiotensin-converting-enzyme inhibitors, the latter alone or in combination with angiotensin-receptor blockers), as well as saliva substitutes, are all ineffective, or effective only in the short term. Xerostomia remains a frustrating symptom for patients on hemodialysis, and further efforts should be made to find an effective treatment for it in the near future. PMID:22249779

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

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    Yanet Parodis López

    2006-03-01

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

  1. Hemodialysis Dose and Adequacy

    Science.gov (United States)

    ... Kt/V? Points to Remember Clinical Trials When kidneys fail, dialysis is necessary to remove waste products such as ... Methods for Kidney Failure: Hemodialysis Treatment Methods for Kidney Failure: Peritoneal Dialysis Treatment Methods for Kidney Failure: Kidney Transplantation Kidney ...

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

    Directory of Open Access Journals (Sweden)

    Luiz Carlos SEVERO

    1999-07-01

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

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

    Scientific Electronic Library Online (English)

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

    1999-07-01

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

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

    Scientific Electronic Library Online (English)

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

    2012-09-01

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

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

    Scientific Electronic Library Online (English)

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

    2003-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2015-06-01

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

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

    Science.gov (United States)

    Schulman, Gerald

    2004-01-01

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

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

    OpenAIRE

    Toyin Tofade, MS, PharmD, BCPS, CPCC, Pharmacotherapy Director, Wake Area Health Education Center and Clinical Associate Professor, Division of Pharmacy Practice and Experiential Education; Brianna Franklin, student, fourth professional year; Bennett Noell, student, fourth professional year 1; Kim Leadon, MEd, Clinical Assistant Professor and Director of Experiential Education, Division of Pharmacy Practice and Experiential Education

    2011-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2011-12-01

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

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

    Directory of Open Access Journals (Sweden)

    R. C. Noleto Magalhães

    2011-12-01

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

  11. Chronic Inflammation Increases Risk in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Razeghi Effat

    2008-01-01

    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.

  12. The economic burden of hemodialysis in Jordan

    Directory of Open Access Journals (Sweden)

    Emad Adel Al-Shdaifat

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

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

    2011-01-01

    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.

  14. Skeletal Health After Continuation, Withdrawal, or Delay of Alendronate in Men With Prostate Cancer Undergoing Androgen-Deprivation Therapy

    Science.gov (United States)

    Greenspan, Susan L.; Nelson, Joel B.; Trump, Donald L.; Wagner, Julie M.; Miller, Megan E.; Perera, Subashan; Resnick, Neil M.

    2008-01-01

    Purpose Androgen-deprivation therapy (ADT) for prostate cancer is associated with bone loss and osteoporotic fractures. Our objective was to examine changes in bone density and turnover with sustained, discontinued, or delayed oral bisphosphonate therapy in men receiving ADT. Patients and Methods A total of 112 men with nonmetastatic prostate cancer receiving ADT were randomly assigned to alendronate 70 mg once weekly or placebo in a double-blind, partial-crossover trial with a second random assignment at year 2 for those who initially received active therapy. Outcomes included bone mineral density and bone turnover markers. Results Men initially randomly assigned to alendronate and randomly reassigned at year 2 to continue had additional bone density gains at the spine (mean, 2.3% ± 0.7) and hip (mean, 1.3% ± 0.5%; both P < .01); those randomly assigned to placebo in year 2 maintained density at the spine and hip but lost (mean, −1.9% ± 0.6%; P < .01) at the forearm. Patients randomly assigned to begin alendronate in year 2 experienced improvements in bone mass at the spine and hip, but experienced less of an increase compared with those who initiated alendronate at baseline. Men receiving alendronate for 2 years experienced a mean 6.7% (± 1.2%) increase at the spine and a 3.2% (± 1.5%) at the hip (both P < .05). Bone turnover remained suppressed. Conclusion Among men with nonmetastatic prostate cancer receiving ADT, once-weekly alendronate improves bone density and decreases turnover. A second year of alendronate provides additional skeletal benefit, whereas discontinuation results in bone loss and increased bone turnover. Delay in bisphosphonate therapy appears detrimental to bone health. PMID:18802155

  15. Continuous Monitoring and Intrafraction Target Position Correction During Treatment Improves Target Coverage for Patients Undergoing SBRT Prostate Therapy

    International Nuclear Information System (INIS)

    Purpose: To compare the potential benefits of continuous monitoring of prostate position and intervention (CMI) using 2-mm displacement thresholds during stereotactic body radiation therapy (SBRT) treatment to those of a conventional image-guided procedure involving single localization prior to treatment. Methods and Materials: Eighty-nine patients accrued to a prostate SBRT dose escalation protocol were implanted with radiofrequency transponder beacons. The planning target volume (PTV) margin was 5 mm in all directions, except for 3 mm in the posterior direction. The prostate was kept within 2 mm of its planned position by the therapists halting dose delivery and, if necessary, correcting the couch position. We computed the number, type, and time required for interventions and where the prostate would have been during dose delivery had there been, instead, a single image-guided setup procedure prior to each treatment. Distributions of prostate displacements were computed as a function of time. Results: After the initial setup, 1.7 interventions per fraction were required, with a concomitant increase in time for dose delivery of approximately 65 seconds. Small systematic drifts in prostate position in the posterior and inferior directions were observed in the study patients. Without CMI, intrafractional motion would have resulted in approximately 10% of patients having a delivered dose that did not meet our clinical coverage requirement, that is, a PTV D95 of >90%. The posterior PTV margin required for 95% of the dose to be delivered with the target positioned within the PTV was computed as a function of time. The margin necessary was found to increase by 2 mm every 5 minutes, starting from the time of the imaging procedure. Conclusions: CMI using a tight 2-mm displacement threshold was not only feasible but was found to deliver superior PTV coverage compared with the conventional image-guided procedure in the SBRT setting

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

    Scientific Electronic Library Online (English)

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

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

  17. Catheter-Related Bloodstream Infections in Patients on Emergent Hemodialysis.

    Science.gov (United States)

    Rojas-Moreno, Christian A; Spiegel, Daniel; Yalamanchili, Venkata; Kuo, Elizabeth; Quinones, Henry; Sreeramoju, Pranavi V; Luby, James P

    2016-03-01

    OBJECTIVE This study had 2 objectives: (1) to describe the epidemiology of catheter-related bloodstream infections (CRBSI) in patients with end-stage renal disease (ESRD) who have no access to scheduled dialysis and (2) to evaluate whether a positive culture of the heparin-lock solution is associated with subsequent development of bacteremia. DESIGN Retrospective observational cohort design for objective 1; and prospective cohort design for objective 2. SETTING AND PARTICIPANTS The study was conducted in a 770-bed public academic tertiary hospital in Dallas, Texas. The participants were patients with ESRD undergoing scheduled or emergent hemodialysis. METHODS We reviewed the records of 147 patients who received hemodialysis between January 2011 and May 2011 and evaluated the rate of CRBSI in the previous 5 years. For the prospective study, we cultured the catheter heparin-lock solution in 62 consecutive patients between June 2012 and August 2012 and evaluated the incidence of CRBSI at 6 months. RESULTS Of the 147 patients on emergent hemodialysis, 125 had a tunneled catheter, with a CRBSI rate of 2.61 per 1,000 catheter days. The predominant organisms were Gram-negative rods (GNR). In the prospective study, we found that the dialysis catheter was colonized more frequently in patients on emergent hemodialysis than in those on scheduled hemodialysis. Colonization with GNR or Staphylococcus aureus was associated with subsequent CRBSI at 6 months follow-up. CONCLUSIONS Patients undergoing emergent hemodialysis via tunneled catheter are predisposed to Gram-negative CRBSI. Culturing the heparin-lock solution may predict subsequent episodes of CRBSI if it shows colonization with GNR or Staphylococcus aureus. Prevention approaches in this population need to be studied further. Infect. Control Hosp. Epidemiol. 2016;37(3):301-305. PMID:26607662

  18. Colonization of temporary hemodialysis catheters

    OpenAIRE

    ?eref Yüksel; Gürsel Acartürk; ?hsan Uslan; Mehmet Çölbay; Özcan Karaman; Zeki Arslan; Zafer Çetinkaya; Serap Demir

    2006-01-01

    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 ...

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

    OpenAIRE

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

    2013-01-01

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

  20. Effect of Hemodialysis on Serum Copper and Zinc Levels in Kidney Disease Patients

    OpenAIRE

    Bhogade, Rajashri B.; Suryakar, Adinath N.; Joshi, Nitin G.

    2013-01-01

    For human beings trace elements are essential nutrients with a gamut of functions. Available data regarding trace element status in hemodialysis patients are contradictory. The present study was aimed to investigate possible existence of trace element disturbances in uremic patients undergoing dialysis treatment. Blood samples of forty hemodialysis patients and twenty healthy controls were analyzed for quantitation of copper and zinc. The study revealed that serum copper and zinc ...

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

    OpenAIRE

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

    2011-01-01

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

  2. Effect of vitamin E supplementation on oxidative stress in hemodialysis patients

    OpenAIRE

    Bhogade, R. B.; Suryakar, A. N.; Joshi, N. G.; Patil, R. Y.

    2008-01-01

    Hemodialysis represents a chronic stress status for its recipients. Many hypotheses state that this may be associated with oxidative stress. Thus, there may be deficiency of antioxidants like erythrocytic superoxide dismutase, catalase, vitamin E or increased generation of free radicals like superoxide anions. A study was carried out to investigate oxidant and antioxidant status in chronic renal failure patients undergoing hemodialysis and effect of vitamin E supplementation on these two stat...

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

    OpenAIRE

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

    2011-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2012-08-01

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

  6. Evaluation of Bone Mineral Density in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Mukadder Ay?e Bilgiç

    2010-06-01

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

  7. Nosocomial infective endocarditis in Hemodialysis

    International Nuclear Information System (INIS)

    There is an increased risk of infective endocarditis catheterization usedfor Hemodialysis. We report a case of a young man who had endocarditissecondary to the use of a permanent jugular catheter for hemodialysis. Bloodcultures were repeatedly negative, but vegetations were seen on the tricuspidvalve on echocardiography. A high index of suspicion is recommended for thisserious complication. (author)

  8. Pharmacokinetics of amikacin during hemodialysis and peritoneal dialysis

    DEFF Research Database (Denmark)

    Regeur, L; Colding, H; Jensen, H; Kampmann, J P

    1977-01-01

    The pharmacokinetics of amikacin were examined in six bilaterally nephrectomized patients undergoing hemodialysis and in four patients with a minimal residual renal function undergoing peritoneal dialysis. The mean elimination half-life before the dialysis was 86.5 h in the anephric patients and 44.......3 h in the patients with minimal residual kidney function. The results from the anephric patients suggest that some extrarenal elimination of amikacin may occur. The mean volume of distribution was about 25% of the total body weight. This is in accordance with values reported from subjects with normal...... renal function. During hemodialysis the half-life decreased to less than 10% (5.6 h) of the pretreatment value. The effectiveness of peritoneal dialysis was less as the half-life decreased to only about 30% (17.9 h) of the pretreatment value. During the dialyses a significant correlation between the...

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

    Science.gov (United States)

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

    2016-04-01

    The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1?g 3/day?×?3 days and slow intravenous input sodium chloride 1000 ?1500 mL 3-12?h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4?h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251?umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients. PMID:26853771

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

    Directory of Open Access Journals (Sweden)

    Abbas Ghiasi

    2015-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-09-01

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

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

    Scientific Electronic Library Online (English)

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

    2010-06-01

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

  13. Topical Capsaicin Therapy for Uremic Pruritus in Patients on Hemodialysis

    Directory of Open Access Journals (Sweden)

    Atieh Makhlough

    2010-04-01

    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.

  14. Longitudinal study of leptin levels in chronic hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Averbukh Zhan

    2011-06-01

    Full Text Available Abstract Background The influence of serum leptin levels on nutritional status and survival in chronic hemodialysis patients remained to be elucidated. We conducted a prospective longitudinal study of leptin levels and nutritional parameters to determine whether changes of serum leptin levels modify nutritional status and survival in a cohort of prevalent hemodialysis patients. Methods Leptin, dietary energy and protein intake, biochemical markers of nutrition and body composition (anthropometry and bioimpedance analysis were measured at baseline and at 6, 12, 18 and 24 months following enrollment, in 101 prevalent hemodialysis patients (37% women with a mean age of 64.6 ± 11.5 years. Observation of this cohort was continued over 2 additional years. Changes in repeated measures were evaluated, with adjustment for baseline differences in demographic and clinical parameters. Results Significant reduction of leptin levels with time were observed (linear estimate: -2.5010 ± 0.57 ng/ml/2y; p Conclusions Thus leptin levels reflect fat mass depots, rather than independently contributing to uremic anorexia or modifying nutritional status and/or survival in chronic hemodialysis patients. The importance of such information is high if leptin is contemplated as a potential therapeutic target in hemodialysis patients.

  15. Nocturnal intermittent hemodialysis.

    Science.gov (United States)

    Thumfart, Julia; Müller, Dominik

    2015-05-01

    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

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

    OpenAIRE

    Gede Andry Nicolas

    2013-01-01

    Kidney failure is a clinical condition characterized by an irreversible decline in kidney function, to a degree that requires the permanent renal replacement therapy, in the form of dialysis or kidney transplantation. Dialysis consists of two major categories such as dialysis / hemodialysis intermittent and continuous dialysis / continuous renal replacement therapy (CRRT). SLEDD is the latest technique of renal replacement therapy that uses conventional hemodialysis equipment, but the therape...

  17. The effect of group training implemented on hemodialysis patients for their stress management, psychosocial adjustment and self-care strength

    OpenAIRE

    Hülya Fırat Kılıç; Sule Ecevit Alpar

    2016-01-01

    Purpose: The current study was made with the objective of determining the effect of group training implemented on hemodialysis patients for their stress management, psychosocial adjustment and self-care strength. Method and Material: The single group pre-experiment model with pre-test – post-test was used. The participants were selected from a group of 100 patients who were undergoing treatment in 2011, at the Hemodialysis Units of two state hospitals in North Cyprus. The sampling compose...

  18. Laparoendoscopic Single-Site (LESS) Retroperitoneal Radical Nephrectomy in a Patient with Renal Cell Carcinoma Receiving Hemodialysis

    OpenAIRE

    Mika Takahashi; Fuminori Sato; Takeo Nomura; Yasuhiro Sumino; Hiromitsu Mimata

    2011-01-01

    We present here the patient undergoing laparoendoscopic single-site (LESS) retroperitoneal radical nephrectomy while receiving hemodialysis. An 81-year-old man under hemodialysis for 6 years was incidentally discovered to have two left renal masses with acquired cystic disease of the kidney (ACDK). A 4-cm flank incision for GelPort was made. Three trocars were inserted into the retroperitoneum through GelPort. After division of the renal vessels and ureter, the kidney was placed into the extr...

  19. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis

    DEFF Research Database (Denmark)

    Fellström, Bengt C; Jardine, Alan G; Schmieder, Roland E; Holdaas, Hallvard; Bannister, Kym; Beutler, Jaap; Chae, Dong-Wan; Chevaile, Alejandro; Cobbe, Stuart M; Grönhagen-Riska, Carola; De Lima, José J; Lins, Robert; Mayer, Gert; McMahon, Alan W; Parving, Hans-Henrik; Remuzzi, Giuseppe; Samuelsson, Ola; Sonkodi, Sandor; Sci, D; Süleymanlar, Gultekin; Tsakiris, Dimitrios; Tesar, Vladimir; Todorov, Vasil; Wiecek, Andrzej; Wüthrich, Rudolf P; Gottlow, Mattis; Johnsson, Eva; Zannad, Faiez

    2009-01-01

    ). During a median follow-up period of 3.8 years, 396 patients in the rosuvastatin group and 408 patients in the placebo group reached the primary end point (9.2 and 9.5 events per 100 patient-years, respectively; hazard ratio for the combined end point in the rosuvastatin group vs. the placebo group, 0.......96; 95% confidence interval [CI], 0.84 to 1.11; P=0.59). Rosuvastatin had no effect on individual components of the primary end point. There was also no significant effect on all-cause mortality (13.5 vs. 14.0 events per 100 patient-years; hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P=0.51). CONCLUSIONS....... Secondary end points included death from all causes and individual cardiac and vascular events. RESULTS: After 3 months, the mean reduction in low-density lipoprotein (LDL) cholesterol levels was 43% in patients receiving rosuvastatin, from a mean baseline level of 100 mg per deciliter (2.6 mmol per liter...

  20. Cognitive function among hemodialysis patients in Japan

    Directory of Open Access Journals (Sweden)

    Saitoh Hisao

    2011-08-01

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

  1. Rethinking the restriction on nutrition during hemodialysis treatment.

    Science.gov (United States)

    Kistler, Brandon M; Fitschen, Peter J; Ikizler, T Alp; Wilund, Kenneth R

    2015-03-01

    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

  2. An unusual case of cocoon abdomen in a patient on hemodialysis

    Science.gov (United States)

    Jaryal, A.; Rathi, M.; Bal, A.; Goyal, A.; Ramachandran, R.; Kumar, V.; Kohli, H. S.; Gupta, K. L.

    2016-01-01

    “Cocoon abdomen” or sclerosing encapsulating peritonitis is a rare cause of intestinal obstruction. It has been described in patients on continuous ambulatory peritoneal dialysis. The exact etiology is unknown, but pathogenesis rests on chronic peritoneal inflammation. No case has been reported so far in patients on hemodialysis. We hereby report a case of cocoon abdomen presenting as refractory ascites with intestinal obstruction in a patient on maintenance hemodialysis.

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

    OpenAIRE

    Santos Paulo Roberto; Arcanjo Francisco Plácido Nogueira

    2013-01-01

    Abstract Background Several aspects linked to social are involved in the onset of depressive feelings. We aimed to find out if social adaptability and substance abuse predict depression among end-stage renal disease (ESRD) patients undergoing hemodialysis (HD). Methods We included 145 ESRD patients undergoing HD. Social adaptability was estimated by the Social Adaptability Index (SAI). Substance abuse was defined according to SAI. We screened for depression by applying the 20-item version of ...

  4. Variable pulmonary manifestations in hemodialysis patients

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2014-04-01

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

  6. Distance between residence and the dialysis unit does not impact self-perceived outcomes in hemodialysis patients

    OpenAIRE

    Santos Paulo; Arcanjo Francisco Plácido

    2012-01-01

    Abstract Background Patients have to travel long distances to undergo hemodialysis (HD) in some regions. We aimed to search for an association of the distance between patients’ residence and the dialysis unit with quality of life, depression and coping among end-stage renal disease (ESRD) patients undergoing maintenance HD. Methods We studied 161 ESRD patients undergoing HD during April 2009. Quality of life, depression and coping were assessed by the SF-36, the 10-item CES-D and the Jalowiec...

  7. Technical aspects of home hemodialysis

    Directory of Open Access Journals (Sweden)

    Alhomayeed B

    2009-01-01

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

  8. Referral pattern of hemodialysis patients to nephrologists

    International Nuclear Information System (INIS)

    To determine the referral pattern of dialysis patients to nephrologists and the effects of late referral on clinical, hematological and biochemical parameters in patients presenting for the first-time to dialysis center. This study was conducted on all patients of end stage renal diseases presenting for the first-time for undergoing hemodialysis at our center. Patients with acute renal failure were excluded from the study. At presentation, a history was taken from all the patients regarding seeking of nephrology services and referral pattern. Early and late referral was defined as the time of first referral or admission to a nephrologists greater or less than six months respectively before initiation of hemodialysis. All the patients were examined and their blood sample was drawn at the same time for routine hematological, biochemical parameters (urea, creatinine, serum potassium, calcium, phosphate and albumin) and viral markers (Anti HCV and HbsAg). In this study, 248 patients were enrolled, amongst them, 131 (52.8%) were male and 117 (47.2%) were female. Major causes of renal failure were diabetes mellitus, chronic glomerulonephritis and hypertension. Most of the patients were euvolemic and hypertensive. Sixty percent of patients were having very high urea (>200 mg/dl) and creatinine (>8.0 mg/dl). Most of the patients, 226 (91.1%), were anemic (Hemoglobin <11gm/dl) and 224 (90%) were hypoalbuminemic (serum albumin < 4gm/dl) on first presentation. Majority of patients were hyperkalemic, 139 (56.0%), hypocalcemic, 168 (67.7%) and serum phosphate level was high in only 117 (47%) patients. All the patients presented in emergency room to nephrologists at very late stage (100% late referral), when disease was very much advanced. All of them did not have permanent vascular access for hemodialysis on first presentation to dialysis center. Reasons for late referral were non-availability of nephrologists and nephrology services, non-renal doctors biased, unawareness and training of medical professionals for these patients, patients own denial for dialysis, fear and wrong perception about dialysis procedure, socioeconomic factors and use of non-evidenced based treatment modalities. (author)

  9. Accidental salicylate intoxication in a hemodialysis patient.

    Science.gov (United States)

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

    1988-10-01

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

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

    International Nuclear Information System (INIS)

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

  11. Effect of hemodialysis on intraocular lens power calculation.

    Science.gov (United States)

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

    2016-03-01

    Background To evaluate changes in ocular biometric parameters after hemodialysis (HD) in patients with end-stage renal disease (ESRD). Methods Forty eyes of 40 patients undergoing HD were included in this cross-sectional study. Keratometry (K) readings, white-to-white (WTW) distance, central corneal thickness (CCT), anterior chamber depth (ACD), pupil diameter, lens thickness (LT), axial length (AL), and intraocular lens (IOL) power calculation were measured with Lenstar LS 900 (Haag Streit AG, Koeniz, Switzerland) before and after hemodialysis. Intraocular pressure (IOP) was measured with a non-contact tonometer (Tonopachy NT-530P, Nidek Co., LTD, Tokyo, Japan). Main outcomes were changes in biometric parameters after HD. Reliability of the measurements (intraclass correlation coefficients (ICCs)) and the effect size (Cohen's d) were also calculated. Results Mean difference in AL before and after HD was -0.041 ± 0.022 mm with ICCs > 0.90 (p  0.90 (p = 0.041 and Cohen's d = 0.20). Hemodialysis had no significant effect on K readings, WTW distance, CCT, ACD, LT, or IOP. Conclusion Axial length and pupil diameter increase after HD with small effect size, while HD does not significantly affect IOL power calculations. PMID:26707804

  12. Paricalcitol reduces oxidative stress and inflammation in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Izquierdo María

    2012-11-01

    Full Text Available ABSTRACT Background Treatment with selective vitamin D receptor activators such as paricalcitol have been shown to exert an anti-inflammatory effect in patients on hemodialysis, in addition to their action on mineral metabolism and independently of parathyroid hormone (PTH levels. The objective of this study was to evaluate the additional antioxidant capacity of paricalcitol in a clinical setting. Methods The study included 19 patients with renal disease on hemodialysis, of whom peripheral blood was obtained for analysis at baseline and three months after starting intravenous paricalcitol treatment. The following oxidizing and inflammatory markers were quantified: malondialdehyde (MDA, nitrites and carbonyl groups, indoleamine 2,3-dioxygenase (IDO, tumor necrosis factor alfa (TNF-α, 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-α, 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.

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Francesca G. Iodice

    2014-06-01

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

  15. Fiberoptic monitoring of central venous oxygen saturation (PediaSat in small children undergoing cardiac surgery: continuous is not continuous [v2; ref status: indexed, http://f1000r.es/394

    Directory of Open Access Journals (Sweden)

    Francesca G. Iodice

    2014-04-01

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

  16. Fiberoptic monitoring of central venous oxygen saturation (PediaSat in small children undergoing cardiac surgery: continuous is not continuous [v1; ref status: indexed, http://f1000r.es/2q1

    Directory of Open Access Journals (Sweden)

    Francesca G. Iodice

    2014-01-01

    Full Text Available Background: Monitoring of superior vena cava saturation (ScvO2 has become routine in the management of pediatric patients undergoing cardiac surgery. The objective of our study was to evaluate the correlation between continuous ScvO2 by the application of a fiber-optic oximetry catheter (PediaSat and intermittent ScvO2 by using standard blood gas measurements. These results were compared to those obtained by cerebral near infrared spectroscopy (cNIRS. Setting: Tertiary pediatric cardiac intensive care unit (PCICU. Methods and main results: A retrospective study was conducted in consecutive patients who were monitored with a 4.5 or 5.5 F PediaSat catheter into the right internal jugular vein. An in vivo calibration was performed once the patient was transferred to the PCICU and re-calibration took place every 24 hours thereafter. Each patient had a NIRS placed on the forehead. Saturations were collected every 4 hours until extubation. Ten patients with a median age of 2.2 (0.13-8.5 years and a weight of 12.4 (3.9-24 kg were enrolled. Median sampling time was 32 (19-44 hours: 64 pairs of PediaSat and ScVO2 saturations showed a poor correlation (r=0.62, 95% CI 44-75; p<0.0001 and an average difference of -0.38 with a standard deviation of 13 and 95% limits of agreement from -26 to 25. Thirty-six pairs of cNIRS and ScVO2 saturations showed a fair correlation (r=0.79, 95% CI 0.60-0.89; p<0.0001 an average difference of -1.3 with a standard deviation of 7 and 95% limits of agreement from -15 to 12. Analysis of median percentage differences between PediaSat and ScvO2 saturation over time revealed that, although not statistically significant, the change in percentage saturation differences was clinically relevant after the 8th hour from calibration (from -100 to +100%. Conclusion: PediaSat catheters showed unreliable performance in our cohort. It should be further investigated whether repeating calibrations every 8 hours may improve the accuracy of this system. CNIRS may provide similar results with a lower invasiveness.

  17. Proteomic Investigations into Hemodialysis Therapy

    Directory of Open Access Journals (Sweden)

    Mario Bonomini

    2015-12-01

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

  18. Anthropometric Measurements in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Zeki AYDIN

    2015-09-01

    Full Text Available OBJECTIVE: In malnourished patients, in anthropometric measurements such as a decrease in the body-mass index (BMI, the triceps skinfold (TSF thickness and the mid-upper arm circumference (MUAC are often determined along with weight loss. Our aim in this study was to evaluate the nutritional status of chronic hemodialysis patients by taking anthropometric measurements. MATERIAL and METHODS: Fifty-three chronic hemodialysis patients (30 females were included in the study. The demographic, biochemical and hemodialysis data of the patients were recorded. BMI, TSF thickness, MUAC, waist and hip circumference measurements were made in all patients. RESULTS: Patients’ TSF and MUAC measurements above the 25th percentile were 73.6% and 75.5%, respectively. There was a strong positive correlation between the patients’ BMI and the TSF thickness and the MUAC; and between the TSF thickness and the MUAC. There was a positive correlation between the duration of the hemodialysis treatment and the waist and hip circumference. CONCLUSION: Not finding a MUAC difference although the TSF thickness was higher in females might be due to the fact that females have more subcutaneous adipose tissue and males have more muscle mass. These results confirm that the subcutaneous adipose tissue and muscle mass of the patients increase along with the increase in BMI and thus patients do not suffer from malnutrition.

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

    Scientific Electronic Library Online (English)

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

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

  20. Pulmonary hypertenstion ad leading factor in patients undergoing dialysis

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Sepehrvand Nariman

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jacek Rysz

    2005-04-01

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

  3. Increased Cerebral Water Content in Hemodialysis Patients

    OpenAIRE

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gede Andry Nicolas

    2013-04-01

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

  5. Prevention and management of hemodialysis catheter infections.

    Science.gov (United States)

    Ramanathan, Venkat; Darouiche, Rabih O

    2012-12-01

    Hemodialysis (HD) catheters are associated with blood stream infections, and catheter use continues to be high among incident and prevalent patients on maintenance HD. Migration of micro-organism along the external surface of the catheter is probably the most common route of infection, followed by the endoluminal route of contamination. Almost all HD catheters have biofilm formation on their surfaces and this serves as a good reservoir for micro-organisms. These active but protected microorganisms have been implicated in local and systemic infections associated with HD catheters. Good personal hygiene, exit-site care with topical antibiotics and antibiotic lock solution in the dialysis catheter reduce the incidence of catheter infection. In selected subgroup of patients, HD catheter is promptly removed after the diagnosis of blood stream infection. However, catheter guidewire exchange is an acceptable alternate strategy in some patients. The most important goal should be to increase the rate of incident arteriovenous fistula use in the HD population. PMID:23253322

  6. Urea biosensor for hemodialysis monitoring

    Science.gov (United States)

    Glass, Robert S. (Livermore, CA)

    1999-01-01

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

  7. Optimizing lithium dosing in hemodialysis

    DEFF Research Database (Denmark)

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

    2006-01-01

    We studied a 62-year-old female hemodialysis patient during initiation and maintenance of lithium carbonate therapy. Three different methods were applied to estimate the regimen: a scenario based on volume of distribution (V(d)), a scenario based on glomerular filtration rate (GFR), and a scenario...... loading dose estimates. Furthermore, the maintenance dose estimated from the central compartment (V1) led to plasma concentrations within the therapeutic range. Thus, a regimen where 12.2 mmol lithium was given after each hemodialysis session resulted in stable between-dialysis plasma lithium...... lithium administrated immediately postdialysis. Further observations are necessary to obtain robust long-term safety data and to optimize the monitoring schedule....

  8. Optimizing lithium dosing in hemodialysis

    DEFF Research Database (Denmark)

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

    2006-01-01

    We studied a 62-year-old female hemodialysis patient during initiation and maintenance of lithium carbonate therapy. Three different methods were applied to estimate the regimen: a scenario based on volume of distribution (V(d)), a scenario based on glomerular filtration rate (GFR), and a scenario in which we developed an algorithm based on a 2-compartment distribution without elimination. The GFR estimate led to plasma concentrations 3-4 times lower than those anticipated. In contrast, the esti...

  9. Temporary hemodialysis catheters: recent advances

    OpenAIRE

    Clark, Edward G; Barsuk, Jeffrey H

    2014-01-01

    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...

  10. Pulmonary Hypertension in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Mahdavi-Mazdeh Mitra

    2008-01-01

    Full Text Available The aim of this study was to evaluate the prevalence of primary pulmonary hypertension (PHT among hemodialysis patients and search for possible etiologic factors. The prevalence of PHT was prospectively estimated by Doppler echocardiogram in 62 long-term hemodialysis patients on the day post dialysis. PHT (> 35 mm Hg was found in 32 (51.6% patients with a mean systolic pulmonary artery pressure of 39.6 ± 13.3 mmHg. The hemoglobin and albumin levels were significantly lower in the PHT subgroup (11.1 ± 1.86 vs 9.8 ± 1.97 g/dL and 3.75 ± 0.44 vs 3.38 ± 0.32 g/dL, p = 0.01 and 0.02, respectively. Our study demonstrates a surprisingly high prevalence of PHT among patients receiving long-term hemodialysis. Early detection is important in order to avoid the serious consequences of the disease.

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

    Science.gov (United States)

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

    2015-10-01

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

  12. Thirty years survivor on hemodialysis: A case report

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    Konstantina Triga

    2014-01-01

    Full Text Available Hemodialysis is a widely performed and safe procedure; therefore, the numbers of long-term survivors on hemodialysis therapy have been increasing. We present a woman who had been on uninterrupted hemodialysis for 30 years and did well for much of her time on hemodialysis, despite a long-standing uneven course. The literature of extremely long-lived patients on un-interrupted hemodialysis is reviewed and the clinical characteristics and complications encountered in these patients are discussed.

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

    Science.gov (United States)

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

    2015-01-01

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

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

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    Azar BARADARAN

    2011-12-01

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

  15. Idiopathic erythrocytosis in a patient on chronic hemodialysis.

    Science.gov (United States)

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

    2015-03-01

    A 78-year-old man on hemodialysis presented to our hospital with erythrocytosis. He had started hemodialysis 4 years previously, with a hemoglobin level of 9.8 g/dL, and was administered erythropoiesis stimulating agents and ferrous sulfate. Two years previously, his hemoglobin level increased to 14.5 g/dL and the treatment for anemia was discontinued. He continued hemodialysis thrice weekly; however, the hemoglobin level had increased to 17.0 g/dL at the time of presenting to our hospital. His serum erythropoietin level was 31.4 mIU/mL (range, 3.7-31.5 mIU/mL), carboxyhemoglobin level was 0.6% (range, 0-1.5%), and oxygen saturation in ambient air was 95.4%. The JAK2 V617F mutation was not observed and other bone marrow abnormalities were not identified. The patient was diagnosed with bladder cancer and a transurethral resection was performed. Eight months after the treatment of bladder cancer, his hemoglobin level was 15.1 g/dL, and he was diagnosed with idiopathic erythrocytosis. PMID:26484022

  16. Cross-talk between inflammation, coagulation/fibrinolysis and vascular access in hemodialysis patients

    OpenAIRE

    Costa, Elísio; Rocha, Susana; Rocha-Pereira, Petronila; Castro, E.; Reis, Flávio; Teixeira, Frederico; Miranda, Vasco; Faria, Maria do Sameiro; Loureiro, Alfredo; Quintanilha, Alexandre; Belo, Luís; Santos-Silva, Alice

    2008-01-01

    This work aimed to study the association between fibrinolytic/endothelial cell function and inflammatory markers in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) and recombinant human erythropoietin (rhEPO) therapies, and its relationship with the type of vascular access (VA) used for the HD procedure. As fibrinolytic/endothelial cell function markers we evaluated plasminogen activator inhibitor type-1 (PAI-1), tissue plasminogen activator (tPA) and D-dimers, and as...

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

    OpenAIRE

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

    2009-01-01

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

  18. Ultrasound Thrombolysis in Hemodialysis Access: In Vitro Investigation

    International Nuclear Information System (INIS)

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

  19. Ultrasound thrombolysis in hemodialysis access: In vitro investigation

    International Nuclear Information System (INIS)

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

  20. 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

    Directory of Open Access Journals (Sweden)

    Ratul Basu

    2015-01-01

    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.

  1. Rosuvastatin in diabetic hemodialysis patients

    DEFF Research Database (Denmark)

    Holdaas, Hallvard; Holme, Ingar; Schmieder, Roland E; Jardine, Alan G; Zannad, Faiez; Norby, Gudrun E; Fellström, Bengt C; Ladefoged, Søren Daustrand

    2011-01-01

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

  2. Potassium Balances in Maintenance Hemodialysis

    OpenAIRE

    Choi, Hoon Young; Ha, Sung Kyu

    2013-01-01

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

  3. Cost-Effectiveness of Maintenance Hemodialysis in Japan.

    Science.gov (United States)

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

    2015-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Udayakumar P

    2006-01-01

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

  5. Hepatitis B Infection in Hemodialysis Patients in Tehran Province, Iran

    Directory of Open Access Journals (Sweden)

    Mitra Mahdavimazdeh

    2009-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Shimizu Y

    2014-08-01

    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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-01-01

    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.).

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

    International Nuclear Information System (INIS)

    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.)

  9. Radiology of the kidneys in patients under maintenance hemodialysis

    International Nuclear Information System (INIS)

    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.)

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

    International Nuclear Information System (INIS)

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

  11. Food intake in patients on hemodialysis

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    Inaiana Marques Filizola Vaz

    2014-12-01

    Full Text Available Objective: To evaluate the intake of energy and nutrients by individuals on hemodialysis, following especific recommendations for this population and according to Food Guide for the Brazilian Population. Methods: A cross-sectional study, 118 adult patients, considered stable from, ten dialysis centers in Goiânia, Goiás. Dietary intake was estimated by six 24-hour recalls, and classified as adequate or inadequate, according to specific recommendations for individuals undergoing dialysis and that recommended for a healthy diet. A descriptive analysis was performed. Results: Average dietary intake of 2022.40 ± 283.70 kcal/day; 31.18 kcal/kg/day; 55.03 ± 4.20% carbohydrate; 30.23 ± 3.71% lipid, 1.18 ± 0.23 g protein/kg/day. Important prevalences of inadequacy were observed for the intake of calories (39.0%, protein (39.0% and other nutrients such as retinol (94.9%, saturated fat (87.3%, cholesterol (61,9%, iron (61.0%, potassium (60.2% and zinc (45.0%. Patients had a low intake of fruit food group (1.22 ± 0.89 servings and vegetables (1.76 ± 1.01 servings, dairy products (0.57 ± 0.43 servings and high intake of food group of oils and fats (3.45 ± 0.95 servings, sugars and sweets (1.55 ± 0.77 servings. Conclusion: Observed food consumption imbalance, characterized by excess of oils and fats, especially saturated oils and cholesterol, sugars and sweets, parallel to low intake of fruits and vegetables and dairy products. A considerable percentage of patients did not intake the minimum recommended of calories, protein, retinol, iron, zinc and potassium.

  12. [A new bone anchored hemodialysis access].

    Science.gov (United States)

    Arnold, Andreas; Kruse, Anja; Wiedmer, Simona; Widmer, Matthias; Guignard, Jérémie; Schütz, Daniel; Guenat, Jean-Marc; Bachtler, Matthias; Caversaccio, Marco; Uehlinger, Dominik E; Frey, Felix J; Häusler, Rudolf; Stieger, Christof

    2015-08-01

    When classic arteriovenous fistulas or grafts fail, dialysis patients have a vital requirement for a catheter to ensure vascular access. Permanent central venous catheters penetrate the cervical and thoracic soft tissues and the skin without rigid fixation. The infection rate for such devices is high, often requiring explantation. Bone anchored hearing aids are an established treatment in patients with conductive hearing loss. The implant is firmly fixed on the temporal bone and the abutment permanently penetrates the skin. Severe infections requiring explantation are very rare. We suppose that one of the main reasons for the low complication rate is the firm fixation of the implant to the temporal bone, which minimizes the movement of the skin relative to the underlying bone. Based on the experience with implantable hearing devices we developed a percutaneous bone anchored port fixed to the skull in the region of the temporal bone. Such a bone anchored port could be a beneficial alternative to conventional central venous catheters for patients undergoing hemodialysis. In the course of the development process we investigated the individual anatomy to locate the correct implantation site with sufficient bone thickness; we studied screw stability in bone; we developed the titanium implant that houses the port system as well as the surgical tools and procedure for save implantation; we tested flow rate, leak tightness and purification on mockups; we defined the Seldinger-insertion of the catheter into the internal jugular vein via a small neck incision. Our results show the technical feasibility of a temporal bone anchored port and form the basis of a now-approved clinical pilot study. PMID:26227980

  13. Serum trypsin inhibitory capacity in hemodialysis patients

    International Nuclear Information System (INIS)

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

  14. The relevance of dietary sodium in hemodialysis

    Science.gov (United States)

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

    2013-01-01

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

  15. The relevance of dietary sodium in hemodialysis

    OpenAIRE

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

    2012-01-01

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

  16. Bicarbonate versus acetate hemodialysis in ventilated patients.

    Science.gov (United States)

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

    1987-09-01

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

  17. A positive correlation of serum homocysteine with leptin in maintenance hemodialysis patients

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    Hamid Nasri

    2006-09-01

    Full Text Available Introduction: Serum leptin is cleared principally by the kidneys and serum leptin concentrations are increased in patients with chronic renal failure and those undergoing a maintenance dialysis. Mild-to-moderate elevations in plasma total homocysteine (Hcy levels are also observed in the great majority of patients with end-stage renal disease who are undergoing a dialysis. A paradoxically inverse association between higher serum leptin and improved markers of the nutritional status was shown. Based on the above mentioned data regarding the associations of homocysteine and leptin with the nutritional status, we tested the hypothesis that the concentration of serum homocysteine and leptin in hemodialysis patients may have an association. Material and methods: In a cross-sectional analysis on 36 (F=15, M=21 stable hemodialysis (HD patients, consisting of 25 non-diabetic HD patients and 11 diabetics, serum homocysteine and serum leptin were measured. Results: In this study a significant positive correlation of serum leptin with homocysteine and a significant positive correlation of homocysteine with the body mass index (BMI and also a significant positive correlation of leptin with BMI were found. Conclusions: The positive correlations of serum homocysteine with leptin and also with BMI show its good correlation with the nutritional status of regular hemodialysis patients.

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-05-15

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

  20. Basilic Vein Transposition Used as a Tertiary Vascular Access for Hemodialysis: 15 Years of Experience

    Science.gov (United States)

    Novotný, Róbert; Slavíková, Marcela; Hlubocký, Jaroslav; Mitáš, Petr; Hrubý, Jan; Lindner, Jaroslav

    2016-01-01

    INTRODUCTION The quality of the life in patients requiring long term hemodialysis is directly proportional to the long-term patency of their vascular access. Basilic vein transposition for vascular access (BAVA) represents a suitable option for creating a tertiary native vascular access for hemodialysis on the upper extremities for patients requiring long term hemodialysis. The purpose of the study is to compare BAVAs with arteriovenous grafts (AVG). METHOD Data collection was based on selecting all of the patients with BAVA created in the time period in between January 1996 and August 2011. A questionnaire was created and sent to the selected hemodialysis centers. The resulting set of data was statistically analyzed and evaluated. RESULTS In the time period between 1 January 1996 and August 2011, arteriovenous access for hemodialysis was created in 6754 patients (7203 procedures in total). Out of these patients, 175 BAVAs were created. Our patient database of those undergoing the BAVA procedure consisted of 98 females (56%) and 77 males (44%) with an average age of 64.5 years. The prevalence of diabetes mellitus was 60% (105 patients). Primary patency after 12 months was 68.8%, 24 months 59.7%, 36 months 53.8, 48 months 53.8%, and 60 months 50%. Primary assisted patency after 12 months was 89.9%, 24 months 84.6%, 36 months 77.8%, 48 months 77.9%, 60 months 70.8%. Secondary patency after 12 months was 89.4%, 24 months 86.9%, 36 months 81%, 48 months 78.9%, 60 months 75.7%. Twenty-nine BAVAs (16.5%) were obliterated. CONCLUSION Patients benefit from this type of procedure due to the longer patency of a native arteriovenous access, as well as a lower incidence of infectious complications. PMID:26848275

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

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    Saifan C

    2013-07-01

    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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Claudinei José CJGC Gomes Campos

    2007-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Claudinei José CJGC Gomes Campos

    2007-09-01

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

  5. Antihypertensive Agents in Hemodialysis Patients: A Current Perspective

    OpenAIRE

    Inrig, Jula K

    2010-01-01

    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 medicatio...

  6. Hemodialysis

    Science.gov (United States)

    ... disease? In some cases of sudden or acute kidney failure, dialysis may only be needed for a short time ... disease progresses to kidney failure over time, your kidneys do not get better and you will need dialysis for the rest of your life unless you ...

  7. The cost of hemodialysis in a large hemodialysis center.

    Science.gov (United States)

    Al Saran, Khalid; Sabry, Alaa

    2012-01-01

    To assess the cost of hemodialysis (HD) delivered at our center according to the treatment protocols based on the current Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines, we analyzed our cost data during the period from 1st of January 2007 to 30th of June 2010. The methods were used to determine both direct costs (related to dialysis treatment such as dialysis disposables, dialysis related drugs, medical personnel, out-patient medications, laboratory and other ancillary services) and overhead costs (building, maintenance and engineering costs, housekeeping, and administrative personnel). During the study period, an average of 2,500 HD sessions per month were performed for 200 patients. The mean total cost per HD session was calculated as 297 US dollars (USD) [1,114 Saudi Riyals (SR)], and the mean total cost of dialysis per patient per year was 46,332 USD (173,784 SR). Direct costs contributed to 81.15% of the total cost from which the personnel cost represented 41.11% and dialysis disposables represented 13.64%, while medications (outpatient and intravenous dialysis related medications including albumin, erythropoiesis stimulating agents, iron and vitamin D?) accounted for 12.47% of the total cost. Our total cost level is well below the average cost in the industrialized countries. PMID:22237223

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

    OpenAIRE

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

    2002-01-01

    Background: Decreased bone mineral density (BMD) is a known complication for the uremic state antedating dialysis / renal transplantation (RTx). The issue of stabilized versus continued decrease of BMD especially on long-term basis, continues to be unresolved. Patients and Methods: !"#"hemodialysis (HD-#" $% " &'( )&'(-group) had been evaluated for metabolic bone changes by calcium homeostasis parameters (serum calcium, phosphorus, alkaline phosphatase "ALP" and vitamin D "calcitriol"), marke...

  9. Erectile dysfunction in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Imen Gorsane

    2016-01-01

    Full Text Available Erectile dysfunction (ED is a common problem seen among patients on hemodialysis (HD, but it is still a taboo subject in our country. The attention given to this sexual problem remained low, and the prevalence of ED among these patients has not been well characterized. We carried out this study in order to determine the prevalence and severity of ED in HD patients. We conducted a descriptive cross-sectional study in our HD unit in March 2013. ED was evaluated using the International Index Erection Function. Thirty patients with a mean age of 49.1 years were eligible for this study. The main causes of chronic kidney disease were hypertension (62.5% and diabetes (41.6%. The prevalence of ED was 80%, including 33.3% severe ED. Plasma levels of gonadotropins: luteinizing hormone (LH, follicule-stimulating hormone were in the standards except for one patient who had an elevated level of LH. Prolactin was elevated in four cases. ED was present in 8.4% of patients before the discovery of renal failure and in 91.6% of patients at the beginning of dialysis. For 19 patients (79.1%, the ED had increased during the dialysis sessions. A significant number of our HD patients presented with ED of varying degrees. Nephrologists should pay attention to the problem of ED in order to improve the quality of their life.

  10. Erectile dysfunction in hemodialysis patients.

    Science.gov (United States)

    Gorsane, Imen; Amri, Nadia; Younsi, Fathi; Helal, Imed; Kheder, Adel

    2016-01-01

    Erectile dysfunction (ED) is a common problem seen among patients on hemodialysis (HD), but it is still a taboo subject in our country. The attention given to this sexual problem remained low, and the prevalence of ED among these patients has not been well characterized. We carried out this study in order to determine the prevalence and severity of ED in HD patients. We conducted a descriptive cross-sectional study in our HD unit in March 2013. ED was evaluated using the International Index Erection Function. Thirty patients with a mean age of 49.1 years were eligible for this study. The main causes of chronic kidney disease were hypertension (62.5%) and diabetes (41.6%). The prevalence of ED was 80%, including 33.3% severe ED. Plasma levels of gonadotropins: luteinizing hormone (LH), follicule-stimulating hormone were in the standards except for one patient who had an elevated level of LH. Prolactin was elevated in four cases. ED was present in 8.4% of patients before the discovery of renal failure and in 91.6% of patients at the beginning of dialysis. For 19 patients (79.1%), the ED had increased during the dialysis sessions. A significant number of our HD patients presented with ED of varying degrees. Nephrologists should pay attention to the problem of ED in order to improve the quality of their life. PMID:26787562

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

    OpenAIRE

    Maryam Bakhtiari; Kianoosh Falaknazi; Mojgan Lotfi; Mohammad Noori; Alireza Naseri Saleh Abad

    2013-01-01

    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...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-02-01

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

  13. Oral Tori in Chronic Hemodialysis Patients

    OpenAIRE

    Pei-Jung Chao; Huang-Yu Yang; Wen-Hung Huang; Cheng-Hao Weng; I-Kuan Wang; Tsai, Aileen I.; Tzung-Hai Yen

    2015-01-01

    Background. This study investigated the epidemiology of torus palatinus (TP) and torus mandibularis (TM) in hemodialysis patients and analyzed the influences of hyperparathyroidism on the formation of oral tori. Method. During 2013, 119 hemodialysis patients were recruited for dental examinations for this study. Results. The prevalence of oral tori in our sample group was high at 33.6% (40 of 119). The most common location of tori was TP (70.0%), followed by TM (20.0%), and then both TP and T...

  14. USG-guided needle-directed pulse-spray pharmaco-mechanical thrombolysis of hemodialysis grafts/fistula: A novel technique.

    Science.gov (United States)

    Vikrama, Ks Amitha; Srivalli, N; Venkataramana, Raju S

    2015-01-01

    The incidence of end-stage renal disease is significantly increasing and most patients who require renal transplantation are undergoing hemodialysis through tunneled/non-tunneled dialysis catheters and arteriovenous fistulas. The greatest disadvantage of the hemodialysis access is the limited durability of the arteriovenous fistulas and grafts, which, on average, remain patent for technique of needle-directed thrombolysis is less expensive and can be done on an OPD basis in any primary healthcare setup. To the extent we have searched, no such technique has been published so far in the English literature. PMID:26288518

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

    Directory of Open Access Journals (Sweden)

    Seifi S, Mokhtari A

    2008-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Daniele Favaro Ribeiro

    2009-12-01

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

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

    Scientific Electronic Library Online (English)

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

    2009-12-01

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

  18. Sleep disorders in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Sabry Alaa

    2010-01-01

    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.

  19. Carotid-brachial bypass and simultaneous radiocephalic fistula for a patient on hemodialysis.

    Science.gov (United States)

    Yankovic, Willy; Mallios, Alexandros; Rafati, Fatemeh; Costanzo, Alessandro; Boura, Benoit; Combes, Myriam

    2012-10-01

    Patients undergoing long-term hemodialysis often suffer from obliterative arterial disease, which may lead to hand ischemia and/or access failure. We present the case of a 54-year-old female patient with multiple failures in obtaining vascular access. Computed tomography angiogram revealed a long occlusion of the axillary artery. Vein mapping through duplex scanning demonstrated a suitable cephalic vein in the left forearm. A left carotid-brachial bypass was performed with simultaneous radiocephalic arteriovenous fistula formation. Immediate results were excellent, and the postoperative course was uneventful. To our knowledge, this is the first report of such a combined approach. PMID:22944576

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

    OpenAIRE

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

    2009-01-01

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

  1. [Appropriate hemodialysis scheduling based on therapeutic drug monitoring of carboplatin in a patient with lung cancer and chronic renal failure].

    Science.gov (United States)

    Kamata, Hirofumi; Asano, Koichiro; Soejima, Kenzo; Shirahata, Toru; Nakatani, Michie; Inamoto, Hajime; Iketani, Osamu; Yamayoshi, Yasuko; Tanigawara, Yusuke; Ishizaka, Akitoshi

    2009-09-01

    A 69-year-old woman undergoing hemodialysis due to ANCA-associated nephritis and chronic renal failure developed lung adenocarcinoma and underwent radical surgery. Upon recurrence of her cancer, she received combination chemotherapy with carboplatin (CBDCA) 150 mg/m2 and docetaxel 35-70 mg/m2. Concentration of free CBDCA in serum was monitored for 6 days after drug administration. Hemodialysis was performed 1 hour after administration of CBDCA, and on day 4. Despite the lower maximum concentration, serum CBDCA levels 20-24 h after chemotherapy in this patient were 15 to 20 times higher than in subjects with normal renal function who received CBDCA at the area under the curve (AUC) of 5. She experienced moderate to severe nausea and vomiting which persisted for 12 days. During her second course of chemotherapy, hemodialysis was performed for 3 consecutive days after drug administration. The serum CBDCA levels on day 2 or later remained lower than in the first course, and the patient experienced fewer severe side effects. Based on the data from therapeutic drug monitoring of CBDCA, hemodialysis for 3 consecutive days after drug administration has been demonstrated to be useful for treatment of a patient with chronic renal failure receiving chemotherapy with CBDCA. PMID:19755826

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

    Directory of Open Access Journals (Sweden)

    Vasantha Janardhan

    2011-01-01

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

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

    Scientific Electronic Library Online (English)

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

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

  4. Erectile Dysfunction in Males on Hemodialysis

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

    2014-10-09

    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

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

    International Nuclear Information System (INIS)

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

  7. FGF-23 and cognitive performance in hemodialysis patients

    OpenAIRE

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

    2013-01-01

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

  8. Vascular Access Choice in Incident Hemodialysis Patients: A Decision Analysis

    OpenAIRE

    DREW, David A.; Lok, Charmaine E.; Cohen, Joshua T.; Wagner, Martin; Tangri, Navdeep; WEINER, Daniel E.

    2014-01-01

    Hemodialysis vascular access recommendations promote arteriovenous (AV) fistulas first; however, it may not be the best approach for all hemodialysis patients, because likelihood of successful fistula placement, procedure-related and subsequent costs, and patient survival modify the optimal access choice. We performed a decision analysis evaluating AV fistula, AV graft, and central venous catheter (CVC) strategies for patients initiating hemodialysis with a CVC, a scenario occurring in over 7...

  9. Topical Capsaicin Therapy for Uremic Pruritus in Patients on Hemodialysis

    OpenAIRE

    Atieh Makhlough; Shahram Ala; Zohreh Haj-Heydari; Zahra Kashi 1; Alireza Bari

    2010-01-01

    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 int...

  10. Development of practice guidelines for hemodialysis in Egypt

    OpenAIRE

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

    2010-01-01

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

  11. Lifestyle of Hemodialysis Patients in Comparison with Outpatients

    OpenAIRE

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

    2012-01-01

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

  12. Five months of physical exercise in hemodialysis patients

    DEFF Research Database (Denmark)

    Molsted, Stig; Eidemak, Inge; Sorensen, Helle Tauby; Kristensen, Jens Halkjaer

    2004-01-01

    BACKGROUND: The number of chronic renal failure patients treated by hemodialysis (HD) is continuously increasing. Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases. The aim of this study was to determine the effects of 5 months physical exercise of...... HD patients' physical capacity, self-rated health and risk factors for cardiovascular disease. METHODS: 33 HD patients were included in the study. INCLUSION CRITERIA: HD for more than 3 months, age >18 years. EXCLUSION CRITERIA: Diabetes mellitus, symptomatic cardiovascular disease, musculoskeletal...... aerobic capacity, '2-min stair climbing', 'squat test', self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. RESULTS: 20 patients completed the intervention. Attendance was 74...

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  14. An overlooked complication of hemodialysis: hoarseness.

    Science.gov (United States)

    Zumrutdal, Aysegul

    2013-10-01

    In hemodialysis patients, some degree of transient hoarseness may occur at the end of the dialysis, and it may be a wearisome, recurrent, and severe state for some hemodialysis patients. However, to date, it has not been a well-defined complication of hemodialysis. The aim of this study was to state this complication and to throw light on it. Four hundred fifty-nine hemodialysis patients were questioned about any change in voice quality during hemodialysis. The patients who had this complaint (n=70) were included in the study, and the group of patients who suffered hoarseness (subgroup 1: severe, subgroup 2: moderate, subgroup 3: mild) were compared with each other and with the control group, which did not suffer hoarseness (n=51). Hoarseness was found in 15.2% of the hemodialysis patients. The duration of their hoarseness was minimum 1 to maximum 24 hours. In the control group, coronary artery disease (P=0.056), congestive heart failure (P=0.049), autonomic neuropathy (P=0.001), severe intradialytic hypotensive attacks (P=0.000), heart valve abnormalities (P=0.000), and left ventricular diastolic dysfunction (P=0.000) were significantly lower than in hoarseness group. Older age (P=0.024), coronary artery disease (P=0.014), autonomic neuropathy (P=0.011), and intradialytic hypotensive attacks (P=0.0001), were associated with severe and moderate hoarseness. In the comparison of % change for systolic and diastolic blood pressure between the hoarseness subgroups, diastolic blood pressure change was not different (P=0.521), but systolic blood pressure change was statistically lower in mild group than moderate (P=0.033) and severe subgroup (P=0.029). Dialysis-induced hypotension may be the main contributor of transient hoarseness. Especially elderly and cardiovascularly compromised patients, who are vulnerable to rapid changes in volume status may experience it to serious extent and this complication may be mediated by autonomic nervous control related with volume depletion. PMID:23461740

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

    OpenAIRE

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

    2012-01-01

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

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

    DEFF Research Database (Denmark)

    Pakpour, Amir H.; Nourozi, Saeedeh

    2011-01-01

    INTRODUCTION: The aim of the study was to assess the validity and reliability of the SF-12 questionnaire in a sample of Iranian patients undergoing hemodialysis. MATERIALS AND METHODS: One hundred and forty-four hemodialysis patients were included from dialysis centers in Zanjan, Iran, and were asked to complete the SF-12 and SF-36 questionnaires. An initial test-retest reliability evaluation was performed on a sample of 70 patients from the total group, with a retest interval of 14 days. Reliability was estimated by internal consistency and validity was assessed using known-group comparisons and construct validity on the patient group as a whole. A linear regression analysis was used to assess any variation in the physical component summary and mental component summary scores of the SF-36 with the respective component summary scores of the SF-12. In addition, the factor structure of the questionnaire was extracted by performing a confirmatory factor analysis. RESULTS: Cronbach alpha for physical and mental component summaries were 0.89 and 0.90, respectively. The SF-12 showed a good discriminatory ability between subgroups of patients based on demographic and clinical variables. The confirmatory factor analysis for the original two-factor structure showed a good fit index (chi2 = 23.30, degrees of freedom = 13), goodness-of-fit index = 0.96, and root mean squared error of approximation = 0.079). CONCLUSIONS: In general, the SF-12 has good psychometric properties and can be used as a shorter version of the SF-36 questionnaire in future studies involving Iranian patients undergoing hemodialysis.

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

    Directory of Open Access Journals (Sweden)

    Azar BARADARAN

    2010-12-01

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

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

    Scientific Electronic Library Online (English)

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

    2013-07-01

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

  19. Complex central venous catheter insertion for hemodialysis.

    Science.gov (United States)

    Powell, Steven; Belfield, Jane

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Maria Isabel da Conceição Dias Fernandes

    2015-12-01

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

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

    LENUS (Irish Health Repository)

    Quinlan, Catherine

    2012-08-27

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

  2. Computed tomography of kidneys with hemodialysis

    International Nuclear Information System (INIS)

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

  3. Vascular access for hemodialysis: current perspectives

    OpenAIRE

    Santoro D; Benedetto F; Mondello P; Pipitò N; Barillà D; Spinelli F; Ricciardi CA; Cernaro V; Buemi M

    2014-01-01

    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...

  4. Hemodialysis through persistent left superior vena cava

    OpenAIRE

    Kute, V. B.; A V Vanikar; M. R. Gumber; Shah, P R; Goplani, K. R.; Trivedi, H. L.

    2011-01-01

    We report a case of end stage renal disease patient who displayed a persistent left superior vena cava (PLSVC) after placement of hemodialysis (HD) catheter through left internal jugular vein, as revealed by routine post-procedure X-ray chest. The diagnosis of PLSVC was confirmed by arterial blood gas, two-dimensional echocardiography, computed tomography thorax and angiographic examination. This anomaly is rather rare; few studies on safety of PLSVC for HD have been reported. The catheter wa...

  5. The economic burden of hemodialysis in Jordan

    OpenAIRE

    Emad Adel Al-Shdaifat; Mohd Rizal Abdul Manaf

    2013-01-01

    Background: Hemodialysis treatment is a costly procedure that requires specific resources. It has a considerable burden on patients, caregivers, and healthcare system. The aim of this study was to estimate the economic burden borne by the Ministry of Health (MOH) in Jordan, with a focus on direct medical, direct non-medical, and indirect cost. Materials and Methods:The study was conducted at MOH hospitals in Jordan, from August to November 2010. A total of 138 patients and 49 caregivers were ...

  6. Prevention and treatment of hemodialysis access thrombosis

    OpenAIRE

    Smits, Johannes Henricus Maria

    2001-01-01

    Thrombosis of the vascular access is the main problem in hemodialysis therapy for end-stage renal disease. In most cases, thrombosis is associated with the presence of one or more stenoses in the access. These stenoses are due to progressive neointimal hyperplasia. In this thesis, methods are described to timely identify patients at risk of thrombosis, to treat the stenoses timely with an angioplasty procedure, to depict the stenotic lesions with a new imaging modality, and to treat the throm...

  7. Malnutrition predicting factors in hemodialysis patients

    OpenAIRE

    Jahromi Soodeh; Hosseini Saeed; Razeghi Effat; Meysamie Ali; Sadrzadeh Haleh

    2010-01-01

    Malnutrition is a predictor of increased mortality in chronic hemodialysis (HD) patients. Various factors may contribute to malnutrition in these patients including energy and protein intake, inflammation, and comorbidity. To determine the importance of these factors in malnutrition of chronic HD patients, we studied 112 chronic HD patients in two centers was evaluated with the Dialysis Malnutrition Score (DMS) and anthropometric and biochemical indices. Seventy six (67.8%) patients we...

  8. Malnutrition-Inflammation Score in Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Behrooz Ebrahimzadehkor

    2014-08-01

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

  9. Postoperative Complications Following Hemodialysis Access Procedures

    OpenAIRE

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

    2010-01-01

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

  10. Ultrasound Evaluation Before and After Hemodialysis Access

    Directory of Open Access Journals (Sweden)

    Daryoush Saedi

    2009-01-01

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

  11. Relationship between platelet count and hemodialysis membranes

    Directory of Open Access Journals (Sweden)

    Nasr R

    2013-08-01

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

  12. Potential environmental toxicity from hemodialysis effluent.

    Science.gov (United States)

    Machado, Carla Keite; Pinto, Luciano Henrique; Del Ciampo, Lineu Fernando; Lorenzi, Luciano; Correia, Cláudia Hack Gumz; Häder, Donat Peter; Erzinger, Gilmar Sidnei

    2014-04-01

    Understanding the toxicity of certain potentially toxic compounds on various aquatic organisms allows to assess the impact that these pollutants on the aquatic biota. One source of pollution is the wastewater from hemodialysis. The process of sewage treatment is inefficient in inhibition and removal of pathogenic bacteria resistant to antibiotics in this wastewater. In many countries, such as Brazil, during emergencies, sewage and effluents from hospitals are often dumped directly into waterways without any previous treatment. The objective of this study was to characterize the effluents generated by hemodialysis and to assess the degree of acute and chronic environmental toxicity. The effluents of hemodialysis showed high concentrations of nitrites, phosphates, sulfates, ammonia, and total nitrogen, as well as elevated conductivity, turbidity, salinity, biochemical and chemical oxygen demand, exceeding the thresholds defined in the CONAMA Resolution 430. The samples showed acute toxicity to the green flagellate Euglena gracilis affecting different physiological parameters used as endpoints in an automatic bioassay such as motility, precision of gravitational orientation (r-value), compactness, upward movement, and alignment, with mean EC50 values of recalculate as 76.90 percent (±4.68 percent) of the undiluted effluents. In tests with Daphnia magna, the acute toxicity EC50 was 86.91 percent (±0.39 percent) and a NOEC value of 72.97 percent and a LEOC value 94.66 percent. PMID:24580820

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

    Science.gov (United States)

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

    2014-07-01

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

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

    Science.gov (United States)

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

    2009-01-01

    Cardiovascular diseases represent the main causes of death in patients affected by renal failure, and arrhythmias are frequently observed in patients undergoing hemodialysis. Dialytic treatment per se can be considered as an arrhythmogenic stimulus; moreover, uraemic patients are characterized by a "pro-arrhythmic substrate" because of the high prevalence of ischaemic heart disease, left ventricular hypertrophy and autonomic neuropathy. One of the most important pathogenetic element involved in the onset of intra-dialytic arrhythmias is the alteration in electrolytes concentration, particularly calcium and potassium. It may be very useful to monitor the patient's cardiac activity during the whole hemodilaytic session. Nevertheless, the application of an extended intradialytic electrocardiographic monitoring is not simple because of several technical and structural impairments. We tried to overcome these difficulties using Whealthy, a wearable system consisting in a t-shirt composed of conductors and piezoresistive materials, integrated to form fibers and threads connected to tissutal sensors, electrodes, and connectors. ECG and pneumographic impedance signals are acquired by the electrodes in the tissue, and the data are registered by a small computer and transmitted via GPRS or Bluetooth. PMID:19142814

  15. Growing bone cysts in long-term hemodialysis

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Zoran Vrucinic

    2015-07-01

    Full Text Available Introduction: Uremic pruritus (UP is a common and distressing complication of end-stage renal disease (ESRD. Aglobal cross-sectional study of 18,000 hemodialysis patientsreported a 42% prevalence of moderate or extreme UP, which was strongly associated with sleep disturbance, depression, impaired quality of life, and mortality. Pruritus is commonly encountered in individuals with end-stage renal disease (ESRD on hemodialysis (HD. Materials and Methods: This cross-sectional study was performed in order to find out the prevalence of pruritus in patients on regular maintenance hemodialysis (HD as well as to analyze its relationship to age, sex of the patient, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose, parameters in the beggining of the study and six months after. The data were analyzed by descriptive statistics- Wilcoxon Signed Rank Test and Chi-square test with Yates correction factor. Results: Sixty and two patients with ESRD (age ranging from 31 to 87years free from systemic, skin or psychiatric disorders and other secondary causes attributable to pruritis, undergoing maintenance HD (duration on HD 4-348months; mean 86.97 and median 79,5months at Fresenius dialysis center, Banja Luka, Bosnia and Herzegovina were evaluated for pruritus. Pruritus has been discovered in 21 out of 34males (54,8% and 6 out of 28females (22,2%. Our study as many others showed that pruritus is very common (45.2% in HD patients. Applying c2 test with Yates correction factor is highly statistically significant (c2 = 8.003, p = 0.005 by gender. Research of the gender revealed that pruritus appeared more in men analysis. There were no significant differences between other measured markers: to age, duration of hemodialysis in months per patient, serum levels of phosphate, PTH, KT/V (index of dialysis dose in patients with pruritus and in patients without pruritus. Conclusions:This first cross-sectional study describes key features UP in Republic of Srpska (Bosnia and Herzegovina and results that the UP is significantly more common in men. This study demonstrates that the serum level of PTH and phosphate isn’t associated with the incidence of pruritus in HD patients.

  17. Vitamin D deficiency in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Beena Bansal

    2012-01-01

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

  18. Safety of gadolinium contrast agent in hemodialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Okada, S. [Nippon Medical School, Chiba-Hokuso Hospital (Japan). Dept. of Radiology; Katagiri, K.; Kumazaki, T. [Nippon Medical School, Tokyo (Japan). Dept. of Radiology; Yokoyama, H. [Ishinkai Clinic, Chiba (Japan). Dept. of Urology

    2001-05-01

    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.

  19. Safety of gadolinium contrast agent in hemodialysis patients

    International Nuclear Information System (INIS)

    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

  20. Intradialytic Hypertension: A Less-Recognized Cardiovascular Complication of Hemodialysis

    OpenAIRE

    Inrig, Jula K

    2009-01-01

    Intradialytic hypertension, defined as an increase in blood pressure during or immediately after hemodialysis which results in postdialysis hypertension, has long been recognized to complicate the hemodialysis procedure, yet it is often largely ignored. In light of recent investigations which have suggested intradialytic hypertension is associated with adverse outcomes, this review will broadly cover the epidemiology, prognostic significance, potential pathogenic mechanisms, prevention, and p...

  1. Role of hemodialysis in baclofen overdose with normal renal function

    Directory of Open Access Journals (Sweden)

    Lorraine S Dias

    2011-01-01

    Full Text Available 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.

  2. Survival after Diphenhydramine Ingestion with Hemodialysis in a Toddler

    OpenAIRE

    McKeown, Nathanael J.; West, Patrick L.; Robert G. Hendrickson; Horowitz, B Zane

    2010-01-01

    A 13-month-old male who ingested 20 diphenhydramine (25 mg) tablets presented with seizures and ultimately progressed to status epilepticus and wide-complex tachycardia. Due to worsening clinical course, hemodialysis was performed with temporal resolution of his symptoms. Hemodialysis may be considered in critically ill diphenhydramine overdoses not responsive to conventional supportive care.

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

    Directory of Open Access Journals (Sweden)

    Teresa M. Salgado

    2011-11-01

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

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

    OpenAIRE

    Hafner, Verena; Czock, David; Burhenne, Jürgen; Riedel, Klaus-Dieter; Bommer, Jürgen; Mikus, Gerd; Machleidt, Christoph; Weinreich, Thomas; Haefeli, Walter E.

    2010-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Alireza Bari

    2009-01-01

    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

  6. Functional Status of Patients on Maintenance Hemodialysis

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    Akash Nabil

    1999-01-01

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

  7. Mechanical Thrombectomy of Hemodialysis Fistulae and Grafts

    International Nuclear Information System (INIS)

    In this article, the authors present approaches they use in performing dialysis access intervention-in particular clotted access. It is not meant to be a comprehensive review of dialysis access management. At our institution, mechanical thrombectomy is the primary mode of treatment for clotted hemodialysis access. We will present physical examination findings in clotted dialysis access and contraindications for mechanical thrombectomy in dialysis access. We will also discuss the devices for mechanical thrombectomy and the techniques we use. Finally, we will discuss the difficulties encountered in these procedures and their solutions

  8. The current status of hemodialysis in Baghdad

    OpenAIRE

    Al-Saedy Ali; Al-Kahichy Hayder

    2011-01-01

    This study aims to assess the different aspects of hemodialysis (HD) in Baghdad in-cluding the population on dialysis, dialysis dose, nutritional status, and comobidities. We studied the HD patients recruited from five major hospitals in Baghdad from July 2008 to February 2009. There were 86 patients (mean age 46.05 ± 14.28 years). We evaluated their social status, co-morbidities, adequacy of dialysis, and nutritional status. The mean duration of patients on HD was 2.2 years, only 14�...

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

    Brunelli, Steven M.; Waikar, Sushrut S.

    2012-01-01

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

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

    Science.gov (United States)

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

    2013-10-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

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

    Scientific Electronic Library Online (English)

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

    2014-06-01

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

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

    International Nuclear Information System (INIS)

    Typical indications for central venous catheters (CVCs) are hemodialysis (HD), apheresis, total parenteral nutrition, analgesia, chemotherapy, long-term antibiotic therapy and cases of difficult or absent peripheral venous access. One of the largest medical services requesting CVC insertion is nephrology for HD patients. Demographics dictate that the demand for CVCs will continue to grow over the next few decades, placing striking demands on interventional radiology departments. In our centre, interventional radiologists now place nearly all percutaneously inserted HD CVCs. Radiologists provide rapid access to CVC services with significantly fewer complications than CVCs placed by other clinicians. With the demand for CVC management increasing and available operating room time decreasing, many clinicians now refer CVC insertions to radiologists. As well, clinicians who ordinarily place their own lines often refer high-risk patients, such as those who are obese or uncooperative and those with burns or coagulopathy. Our experience, derived from over 7000 CVC insertions, manipulations and removals, has allowed us to continually progress and improve our techniques, many of which are summarized here. (author)

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

    Directory of Open Access Journals (Sweden)

    M. Abbasi

    2007-09-01

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

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

    OpenAIRE

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

    2010-01-01

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

  17. Serum Protein Profile Alterations in Hemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-11-18

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

  18. Hirudin as anticoagulant in experimental hemodialysis.

    Science.gov (United States)

    Markwardt, F; Nowak, G; Bucha, E

    1991-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Cheol Young; Goo, Dong Erk; Kim, Dae Ho; Hong, Hyun Suk; Lee, Hae Kyoung; Choi, Duk Lin; Yang, Sung Boo; Moon, Chul [College of Medicine, Soonchunhyang Univ., Chonan (Korea, Republic of)

    2002-04-01

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2015-05-01

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    F.V. Perícole

    2005-09-01

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

  4. 21 CFR 876.5820 - Hemodialysis system and accessories.

    Science.gov (United States)

    2010-04-01

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

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

    OpenAIRE

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

    2010-01-01

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

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

    OpenAIRE

    Schiffl, H.; Lang, S. M.

    2013-01-01

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

  7. Oral Microflora in Patients on Hemodialysis and Kidney Transplant Recipients

    OpenAIRE

    Azadeh Ahmadieh; Maryam Baharvand; Fatemeh Fallah; Hooman Djaladat; Medi Eslani

    2010-01-01

    Introduction. We aimed to determine oral microflora of patients on long-term hemodialysis and kidney transplant recipients, and to compare them with individuals without kidney disease.Materials and Methods. We studied on 3 groups including patients on at least 6 months of hemodialysis, kidney transplant recipients for more than 2 years, and controls with a normal kidney function. Staining and culture were applied for samples from the dorsum of the tongue and the oral floor in order to detect ...

  8. Oral Microflora in Patients on Hemodialysis and Kidney Transplant Recipients

    Directory of Open Access Journals (Sweden)

    Azadeh Ahmadieh

    2010-07-01

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

  9. Bone Marrow Pathology Predicts Mortality in Chronic Hemodialysis Patients

    OpenAIRE

    Cheng-Hao Weng; Kuan-Ying Lu; Ching-Chih Hu; Wen-Hung Huang; I-Kwan Wang; Tzung-Hai Yen

    2015-01-01

    Introduction. A bone marrow biopsy is a useful procedure for the diagnosis and staging of various hematologic and systemic diseases. The objective of this study was to investigate whether the findings of bone marrow studies can predict mortality in chronic hemodialysis patients. Methods. Seventy-eight end-stage renal disease patients on maintenance hemodialysis underwent bone marrow biopsies between 2000 and 2011, with the most common indication being unexplained anemia followed by unexplaine...

  10. Serum Alkaline Phosphatase Predicts Mortality among Maintenance Hemodialysis Patients

    OpenAIRE

    Regidor, Deborah L; Csaba P. Kovesdy; Mehrotra, Rajnish; Rambod,Mehdi; Jing, Jennie; McAllister, Charles J.; van Wyck, David; Kopple, Joel D; Kalantar-Zadeh, Kamyar

    2008-01-01

    Several observational studies have demonstrated that serum levels of minerals and parathyroid hormone (PTH) have U- or J-shaped associations with mortality in maintenance hemodialysis patients, but the relationship between serum alkaline phosphatase (AlkPhos) and risk for all-cause or cardiovascular death is unknown. In this study, a 3-yr cohort of 73,960 hemodialysis patients in DaVita outpatient dialysis were studied, and the hazard ratios for all-cause and cardiovascular death were higher ...

  11. Modifiable Risk Factors for Early Mortality on Hemodialysis

    OpenAIRE

    Rory McQuillan; Lilyanna Trpeski; Stanley Fenton; Lok, Charmaine E.

    2012-01-01

    Data of incident hemodialysis patients from 2001 to 2007 were abstracted from The Renal Disease Registry (TRDR) from central Ontario, Canada and followed until December 2008 to determine 90-day mortality rates for incident hemodialysis patients. Modifiable risk factors of early mortality were determined by a Cox model. In total, 876 of 4807 incident patients died during their first year on dialysis; 304 (34.7%) deaths occurred within the first 90 days of dialysis initiation. The majority of d...

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

    OpenAIRE

    MENEV?E, Esma

    2006-01-01

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

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

    OpenAIRE

    Matsuo, Toshihiko

    2006-01-01

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

  14. Hemodialysis-associated pseudoporphyria resistant to N-acetylcysteine

    Directory of Open Access Journals (Sweden)

    Bahadi Abdellali

    2011-01-01

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

  15. Hepatitis B Infection in Hemodialysis Patients in Tehran Province, Iran

    OpenAIRE

    Mitra Mahdavimazdeh; Seyed Mohammadmehdi Hosseini-Moghaddam; Seyed Moayed Alavian; Hooman Yahyazadeh

    2009-01-01

    Background and Aims: Hemodialysis (HD) patients seem to be at considerable risk of acquiring HBV infection. This study was carried out to determine the seroprevalence of hepatitis B virus (HBV) infection in hemodialysis patients living in the province of Tehran and to investigate the association between viral hepatitis B and the probable risk factors for HD patients..Methods: From June to August 2005, this study was done on the entire HD population of the province of Tehran (2630 patients; 15...

  16. Comparison of microbiologic assay methods for hemodialysis fluids.

    OpenAIRE

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

    1991-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    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...... shorter version of the SF-36 questionnaire in future studies involving Iranian patients undergoing hemodialysis....

  19. Infection of a subclavian venous stent in a hemodialysis patient.

    Science.gov (United States)

    Guest, S S; Kirsch, C M; Baxter, R; Sorooshian, M; Young, J

    1995-08-01

    Endovascular stent placement to prevent restenosis after angioplasty is being increasingly employed. A 63-year-old hemodialysis patient with a right forearm gortex graft developed ipsilateral arm edema, and a right subclavian vein stenosis was diagnosed. This vascular stenosis was presumably secondary to previous placement of temporary access catheters. The subclavian vein stenosis was treated with angioplasty, endovascular stenting, and warfarin, which resulted in resolution of the arm edema. Three weeks after stenting, the patient developed fever to 104 degrees F, chills, and right arm and shoulder edema. All blood cultures grew Staphylococcus aureus, and an Indium-labeled white blood cell scan was positive at the sight of the subclavian stent. Infectious disease consultants recommended urgent removal of the infected stent, but the extensive surgery required posed considerable risk of major morbidity. We elected to conservatively treat the patient. With loss of all upper-extremity access sites, the patient was converted to peritoneal dialysis. Despite the patient's ambulatory status, a femoral venous Hickman catheter was placed and tunneled through the abdominal subcutaneous soft tissue. The patient received 9 weeks of antibiotics by the Hickman catheter with an infusion pump, and warfarin was continued. There has been complete clinical resolution of infection and subclavian thrombosis. Endovascular stents are being used more commonly, and this is the first description, to our knowledge, of a stent infection. The stent infection was successfully managed without surgical removal. PMID:7645545

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

    OpenAIRE

    Mourad B; Hegab D; Okasha K; Rizk S

    2014-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2005-02-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  3. Urgent peritoneal dialysis or hemodialysis catheter dialysis.

    Science.gov (United States)

    Lok, Charmaine E

    2016-03-01

    Worldwide, there is a steady incident rate of patients with end-stage kidney disease (ESKD) who require renal replacement therapy. Of these patients, approximately one-third have an "unplanned" or "urgent" start to dialysis. This can be a very challenging situation where patients have either not had adequate time for education and decision making regarding dialysis modality and appropriate dialysis access, or a decision was made and plans were altered due to unforeseen circumstances. Despite such unplanned starts, clinicians must still consider the patient's ESKD "life-plan", which includes the best initial dialysis modality and access to suit the patient's individual goals and their medical, social, logistic, and facility circumstances. This paper will discuss the considerations of peritoneal dialysis and a peritoneal dialysis catheter access and hemodialysis and central venous catheter access in patients who require an urgent start to dialysis. PMID:26951906

  4. Genistein Modified Polymer Blends for Hemodialysis Membranes

    Science.gov (United States)

    Chang, Teng; Kyu, Thein; Define, Linda; Alexander, Thomas

    2012-02-01

    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.

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

    Directory of Open Access Journals (Sweden)

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

    2015-10-01

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

  6. The Evaluation of Increase in Hemodialysis Frequency on C-Reactive Protein Levels and Nutritional Status

    OpenAIRE

    Shokooh Sarbolouki; Hassan Nikoueinejad; Ali Reza Soleimani; Ali Akbar Rashidi

    2013-01-01

    Malnutrition and inflammation are the most important causes of cardiovascular disease in hemodialysis patients. This study was conducted to evaluate the effect of increase in hemodialysis frequency on C-reactive protein (CRP) level and nutritional markers in contrast to previous routine method. 18 hemodialysis patients with a mean age of 53±16 years were randomly selected in this before-and-after clinical trial. The patients under a standard hemodialysis of 3 times/4 h per week were converted...

  7. Factors Associated with Quality of Life among Hemodialysis Patients in Malaysia

    OpenAIRE

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

    2013-01-01

    Although hemodialysis treatment has greatly increased the life expectancy of end stage renal disease patients, low quality of life among hemodialysis patients is frequently reported. This cross-sectional study aimed to determine the relationship between medical history, hemodialysis treatment and nutritional status with the mental and physical components of quality of life in hemodialysis patients. Respondents (n=90) were recruited from Hospital Kuala Lumpur and dialysis centres of the Nation...

  8. Monitoring of hemodialysis quality-of-care indicators: why is it important?

    OpenAIRE

    Grangé, Steven; Hanoy, Mélanie; Le Roy, Frank; Guerrot, Dominique; Godin, Michel

    2013-01-01

    BACKGROUND: Meeting specific guideline targets is associated with improved survival rates and reduced hospitalizations in the dialysis population. This prospective work evaluated the adequacy of hemodialysis quality indicators in an in-center hemodialysis population with severe comorbidities, and assessed whether clinical practice could impact intermediate outcomes. METHODS: All the chronic hemodialysis patients treated in Rouen University Hospital hemodialysis Unit between January 2009 and A...

  9. Development of practice guidelines for hemodialysis in Egypt.

    Science.gov (United States)

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

    2010-10-01

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

  10. Variation of hemodialysis related arterial stiffness in patients with end stage renal disease

    OpenAIRE

    Ariana Condor; Elena Buzdugan; Sorin Cri?an; C?t?lin Pestrea

    2009-01-01

    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 ...

  11. Parameters of hemodialysis adequacy and patients’ survival depending on treatment modalities

    Directory of Open Access Journals (Sweden)

    ?uri? Petar S.

    2015-01-01

    Full Text Available Introduction. Retrospective studies showed that hemodiafiltration was associated with a reduced risk of mortality compared with standard hemodialysis in the patients with end-stage renal disease. Recently, a few prospective randomized clinical trials found no advantage in survival with hemodiafiltration as compared with high-flux hemodialysis and low-flux hemodialysis. The aim of this study was to compare the parameters of hemodialysis adequacy and two-year survival of patients depending on the modality of hemodialysis. Material and Methods. A total of 159 hemodialysis patients were divided into 3 groups according to the type of hemodialysis treatment: group A - lowflux hemodialysis, group B - high-flux hemodialysis, and group C - hemodiafiltration. All patients had the same duration of hemodialysis sessions. The analysis included average one-year biochemical parameters, and two-year survival of patients. Results. The patients on hemodiafiltration were significantly younger, they had longer dialysis vintage and higher index of dialysis adequancy as compared with the patients on low-flux hemodialysis and high-flux hemodialysis, but without a difference between the two latter groups. Compared to the patients on low-flux hemodialysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly higher hemoglobin value with less frequent erythropoietin stimulating agent use. According to Kaplan-Meier survival analysis, the patients on hemodiafiltration and high-flux hemodialysis had significantly better two-year survival than the patients on low-flux hemodialysis. Cox proportional hazards model confirmed that high-flux hemodialysis caused a significantly lower relative risk of mortality (56% reduction compared to low-flux hemodialysis (hazard ratio 0.44; P=0.026, and hemodiafiltration caused a 58% reduction in the relative risk of mortality compared to low-flux dialysis (hazard ratio 0.42; P=0.105, but without a statistical significance. Conclusion. This study has demonstrated two-year survival benefit with high-flux hemodialysis and hemodiafiltration compared with low-flux hemodialysis. There was no difference in survival between high-flux hemodialysis and hemodiafiltration groups.

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

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    Reza Hekmat

    2009-03-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

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    West Kenneth A

    2011-05-01

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

  15. Aspirin in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

    Devereaux, P J; Mrkobrada, Marko; Sessler, Daniel I; Leslie, Kate; Alonso-Coello, Pablo; Kurz, Andrea; Villar, Juan Carlos; Sigamani, Alben; Biccard, Bruce M; Meyhoff, Christian S; Parlow, Joel L; Guyatt, Gordon; Robinson, Andrea; Garg, Amit; Rodseth, Reitze N; Botto, Fernando; Lurati Buse, Giovanna; Xavier, Denis; Chan, Matthew T V; Tiboni, Maria; Cook, Deborah; Kumar, Priya A; Forget, Patrice; Malaga, German; Fleischmann, Edith; Amir, Mohammed; Eikelboom, John; Mizera, Richard; Torres, David; Wang, C Y; VanHelder, Tomas; Paniagua, Pilar; Berwanger, Otavio; Srinathan, Sadeesh; Graham, Michelle; Pasin, Laura; Le Manach, Yannick; Gao, Peggy; Pogue, Janice; Whitlock, Richard; Lamy, André; Kearon, Clive; Baigent, Colin; Chow, Clara; Pettit, Shirley; Chrolavicius, Susan; Yusuf, Salim; Wetterslev, Jørn; Gluud, Christian

    2014-01-01

    BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10......,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before the...... study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum...

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    The objectives of this study were to assess the prevalence of chronic obstructive pulmonary disease (COPD) in hemodialysis patients with spirometry and to examine the effects of fluid removal by hemodialysis on lung volumes. Patients ?18 years at two Danish hemodialysis centers were included...... frequent and underdiagnosed comorbidity in patients on chronic hemodialysis. Spirometry should be considered in all patients on dialysis in order to address dyspnea adequately. Hemodialysis induced a small fall in mean FEV1 and FVC, which was more pronounced in patients with little or no fluid removal, but...

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

    Scientific Electronic Library Online (English)

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

    2011-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Patrícia Falcão Pitombo

    2009-08-01

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

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

    Science.gov (United States)

    Mohamad, E H

    1999-09-01

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

  20. Phosphorus Removal in Low-Flux Hemodialysis, High-Flux Hemodialysis, and Hemodiafiltration.

    Science.gov (United States)

    Švára, František; Lopot, František; Valkovský, Ivo; Pecha, Ond?ej

    2016-01-01

    Phosphorus removal by hemoelimination procedure is a important mechanism to maintain phosphorus level in acceptable level in patients on dialysis. Phosphorus is removed by both diffusion and convection, but in clinical practice, it is not possible to differentiate the contribution of this two transport modalities. We used Gutzwiller formula to quantify the amount of removed phosphorus and compared it in low-flux hemodialysis (LFHD), high-flux hemodialysis (HFHD), and on-line hemodiafiltration (HDF). There were no significant differences in phosphorus predialysis concentration, duration of procedure, processed blood volume and ultrafiltration, e.g., factors, which could possibly influence phosphorus elimination. All three tested dialysis modes also did not differ in urea dialysis dose (Kt/V) as a parameter of small molecular weight removal (LFHD, 1.50 ± 0.04 vs HFHD, 1.5 ± 0.06 vs HDF, 1.5 ± 0.05). The amount of removed phosphorus in LFHD, HFHD, and HDF was 34.0 ± 1.2, 37.8 ± 1.6, and 38.3 ± 1.4 mmol, respectively. Statistically significant increase in phosphorus removal was seen only with use of high-flux membrane (HFHD and HDF) when compared with the low-flux one. No difference was, however, found between HFHD and HDF. It can thus be concluded that phosphorus removal in all three dialysis modes is a predominantly diffusive issue and contribution of convection to it is minor to negligible. PMID:26579979

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

    Directory of Open Access Journals (Sweden)

    Matsuo,Toshihiko

    2006-06-01

    Full Text Available

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

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

    Directory of Open Access Journals (Sweden)

    Qinglei Zhang

    2014-02-01

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

  3. [Follow up of patients in chronic hemodialysis].

    Science.gov (United States)

    Bares, C

    1979-03-01

    Stemming from the evident need of psychological aid for this patients and in order to alleviate the suffering that causes psychiatric syntoms which endanger the survival chances or even worsen a situation which is in itself discouraging, 102 cases were studied trying to determine the possible causes of pathological behavior. The bibliography on the subject was evaluated and the follow-up of the group from our own practice was described. The patients were followed-up with a psychosomatic approach considering each as a hole conducting periodical interviews and administering psychological treatment and drugs. Follow-up of the relatives was done according to necessity. It was observed that these patients need a high tolerance to frustration and to be able to establish a relation of close dependence with a relative and/or the physician. The greatest problem is in the adequate and proper handling of the agression generated by the characteristics of the treatment. The phsychological training of the specialists in hemodialysis and their contact with a team of psychiatrist is of great importance. All of the 22 patients that did not receive transplants presented depression reactions, 2 experienced sexual impotence and 4 were successful in their suicidal behaviours. PMID:547684

  4. Electrocardiographic manifestations of hyperkalemia in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Nemati Eghlim

    2010-01-01

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

  5. The current status of hemodialysis in Baghdad

    Directory of Open Access Journals (Sweden)

    Ali J.H. Al-Saedy

    2011-01-01

    Full Text Available This study aims to assess the different aspects of hemodialysis (HD in Baghdad in-cluding the population on dialysis, dialysis dose, nutritional status, and comobidities. We studied the HD patients recruited from five major hospitals in Baghdad from July 2008 to February 2009. There were 86 patients (mean age 46.05 ± 14.28 years. We evaluated their social status, co-morbidities, adequacy of dialysis, and nutritional status. The mean duration of patients on HD was 2.2 years, only 14% are currently employed, hepatitis was present in 43%, and other co-morbidities were present in 35%. Dialysis time was 6.4 ± 1.9 hours/week and Kt/V was 1.02 ± 0.2. Malnutrition was present in 63.5% of patients (moderate in 45.9% and severe in 17.6% with no significant sex difference. We conclude that dialysis in Baghdad is below the standards with low adequacy and frequency of sessions. Malnutrition is prevalent, especially the severe forms, and requires more attention and re-evaluation of the dialysis prescription.

  6. Malnutrition predicting factors in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Jahromi Soodeh

    2010-01-01

    Full Text Available Malnutrition is a predictor of increased mortality in chronic hemodialysis (HD patients. Various factors may contribute to malnutrition in these patients including energy and protein intake, inflammation, and comorbidity. To determine the importance of these factors in malnutrition of chronic HD patients, we studied 112 chronic HD patients in two centers was evaluated with the Dialysis Malnutrition Score (DMS and anthropometric and biochemical indices. Seventy six (67.8% patients were classified as malnourished. According to DMS score, poor protein intake (r= -0.34, P< 0.01, comorbidities (r= -0.24, P< 0.05, poor energy intake (r= - 0.18, P< 0.005, and inflammation (r= -0.16, P< 0.05 were significant predictors of malnutrition in descending order of importance. Multiple regression analysis showed that only poor protein intake was the explanatory variable of anthropometric measurements decline including body mass index, triceps skin fold thick-ness, mid arm circumference, mid arm muscle circumference, fat free mass, fat mass, albumin, creatinine and transferrine. None of the mentioned factors predicted the decrease of biochemical markers. We conclude that the frequency of malnutrition is high in our population and poor protein intake is the primary contributing factor for this condition. There-fore, providing enough protein may be a simple and effective way in preventing malnutrition in these patients.

  7. Intradialytic Hypoxemia in Chronic Hemodialysis Patients.

    Science.gov (United States)

    Campos, Israel; Chan, Lili; Zhang, Hanjie; Deziel, Sheila; Vaughn, Cheryl; Meyring-Wösten, Anna; Kotanko, Peter

    2016-01-01

    When kidney failure occurs, patients are at risk for fluid overload states, which can cause pulmonary edema, pleural effusions, and upper airway obstruction. Kidney disease is also associated with impaired respiratory function, as in central sleep apnea or chronic obstructive pulmonary disease. Hence, respiratory and renal diseases are frequently coexisting. Hypoxemia is the terminal pathway of a multitude of respiratory pathologies. The measurement of oxygen saturation (SO2) is a basic and commonly used tool in clinical practice. Both arterial oxygen saturation (SaO2) and central venous oxygen saturation (ScvO2) can be easily obtained in hemodialysis (HD) patients, SaO2 from an arteriovenous access and ScvO2 from a central catheter. Here, we give a brief overview of the anatomy and physiology of the respiratory system, and the different technologies that are currently available to measure oxygen status in dialysis patients. We then focus on literature regarding intradialytic SaO2 and ScvO2. Lastly, we present clinical vignettes of intradialytic drops in SaO2 and ScvO2 in association with different symptoms and clinical scenarios with an emphasis on the pathophysiology of these cases. Given the fact that in the general population hypoxemia is associated with adverse outcomes, including increased mortality, cardiac arrhythmias and cardiovascular events, we posit that intradialytic SO2 may serve as a potential marker to identify HD patients at increased risk for morbidity and mortality. PMID:26765143

  8. Trace elements in renal disease and hemodialysis

    International Nuclear Information System (INIS)

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

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

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    Raul Carlos Wahle

    2015-10-01

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

  10. Blood leptin levels and erythropoietin requirement in Iranian hemodialysis patients

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    Rahimi A

    2008-12-01

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

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

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    Johnson David W

    2011-10-01

    Full Text Available Abstract Background Nightly extended hours hemodialysis may improve left ventricular hypertrophy and function and endothelial function but presents problems of sustainability and increased cost. The effect of alternate nightly home hemodialysis (NHD on cardiovascular structure and function is not known. Methods Sixty-three patients on standard hemodialysis (SHD: 3.5-6 hours/session, 3-5 sessions weekly converted to NHD (6-10 hours/session overnight for 3-5 sessions weekly. 2Dimensional transthoracic echocardiography and ultrasound measures of brachial artery reactivity (BAR, carotid intima-media thickness (CIMT, total arterial compliance (TAC and augmentation index (AIX were performed post dialysis at baseline and 18-24 months following conversion to NHD. In 37 patients, indices of oxidative stress: plasma malonyldialdehyde (MDA and anti-oxidant enzymes: catalase (CAT, glutathione peroxidase (GPX and superoxide dismutase (SOD activity and total antioxidant status (TAS were measured at baseline, 3 and 6 months. Results Left ventricular mass index (LVMI remained stable. Despite significant derangement at baseline, there were no changes in diastolic function measures, CIMT, BAR and TAC. AIX increased. Conversion to NHD improved bone mineral metabolism parameters and blood pressure control. Interdialytic weight gains increased. No definite improvements in measures of oxidative stress were demonstrated. Conclusions Despite improvement in uremic toxin levels and some cardiovascular risk factors, conversion to an alternate nightly NHD regimen did not improve cardiovascular structure and function. Continuing suboptimal control of uremic toxins and interdialytic weight gains may be a possible explanation. This study adds to the increasing uncertainty about the nature of improvement in cardiovascular parameters with conversion to intensive hemodialysis regimens. Future randomized controlled trials will be important to determine whether increases in dialysis session duration, frequency or both are most beneficial for improving cardiovascular disease whilst minimizing costs and the impact of dialysis on quality of life.

  12. 131I therapy for toxic adenoma in patient on hemodialysis

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2015-11-01

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

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

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    Daniel Ducuara

    2013-05-01

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

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

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    Mehmet Akkaya

    2012-02-01

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

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

    International Nuclear Information System (INIS)

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

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

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    Mourad B

    2014-11-01

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

  18. Advantage of 123I-BMIPP myocardial scintigraphy for assessing coronary artery disease in maintenance hemodialysis patients

    International Nuclear Information System (INIS)

    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 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)

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

    Science.gov (United States)

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

    2015-10-01

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

  20. Perceived illness intrusion among patients on hemodialysis

    International Nuclear Information System (INIS)

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

  1. Esquemas alternativos de hemodiálise Alternative hemodialysis regimens

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    Jorge Paulo Strogoff de Matos

    2010-03-01

    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.

  2. Telemedicine technology and applications for home hemodialysis.

    Science.gov (United States)

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

    1999-10-01

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

  3. Restless legs syndrome in patients on hemodialysis

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    Saleh Mohammad Yaser Salman

    2011-01-01

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

  4. Peripheral Stent Placement in Hemodialysis Grafts

    International Nuclear Information System (INIS)

    The purpose of the present study was to evaluate the clinical outcome of peripheral stent placement after failed balloon angioplasty in patients with grafts who are on hemodialysis. We examined 30 Wallstents that were placed in 26 patients because balloon angioplasty failed or early restenosis (<3 months) occurred within 3 months. We retrospectively reviewed 267 consecutive balloon angioplasties performed in 71 patients with graft access between August 2000 and March 2007. Stent placements accounted for 30 (11.2%) of the 267 balloon angioplasties. The clinical success rate of stent placement was 93.3% (28 of 30 stent placements). The 3-, 6-, and 12-month primary patency rates were 73.3%, 39.3%, and 17.7%, respectively. The 1-, 2-, and 3-year secondary patency rates were 90.2%, 83.8%, and 83.8%, respectively. Primary patency was significantly prolonged by stent placement after early restenosis compared with previous balloon angioplasty alone (P = 0.0059). Primary patency after stent placement was significantly lower than after successful balloon angioplasty without indications for stent placement (P = 0.0279). Secondary patency rates did not significantly differ between stent placement and balloon angioplasty alone. The mean number of reinterventions required to maintain secondary patency after stent placement was significantly larger than that after balloon angioplasty alone (Mann-Whitney U test, P = 0.0419). We concluded that peripheral stent placement for graft access is effective for salvaging vascular access after failed balloon angioplasty and for prolonging patency in early restenosis after balloon angioplasty. However, reinterventions are required to maintain secondary patency after stent placement. Furthermore, peripheral stent placement for graft access cannot achieve the same primary patency as balloon angioplasty alone.

  5. Perceived illness intrusion among patients on hemodialysis

    Directory of Open Access Journals (Sweden)

    Bapat Usha

    2009-01-01

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

  6. Percutaneous treatment of complications occurring during hemodialysis graft recanalization

    International Nuclear Information System (INIS)

    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

  7. Percutaneous treatment of complications occurring during hemodialysis graft recanalization

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-09-01

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

  8. RECONSTRUCTIVE OPERATIONS ON THE PERMANENT VASCULAR ACCESS FOR HEMODIALYSIS

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    V. I. Lotts

    2010-06-01

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

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

    OpenAIRE

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

    2011-01-01

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

  10. Second-degree interatrial block in hemodialysis patients.

    Science.gov (United States)

    Enriquez, Andres; Marano, Marco; D'Amato, Anna; de Luna, Antoni Bayes; Baranchuk, Adrian

    2015-01-01

    Interatrial conduction delays manifest as a prolonged P-wave duration on surface ECG and the term interatrial block (IAB) has been coined. They are usually fixed, but cases of intermittent IAB have been described, suggesting functional conduction block at the Bachmann bundle region. We report 2 cases of patients on chronic hemodialysis therapy presenting with intermittent IAB. PMID:25755895

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Bonet J

    2013-09-01

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

  13. A comparison of oral and dental manifestations in diabetic and non-diabetic uremic patients receiving hemodialysis

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    Preethi Murali

    2012-01-01

    Full Text Available Background: The purpose of the study was to evaluate the oral and dental findings of uremic patients receiving hemodialysis and to compare the Results between diabetic and non-diabetic groups. Materials and Methods: A total of 100 patients undergoing hemodialysis were classified into diabetic and non-diabetic groups and examined for uremic oral manifestations, dental caries (DMFT, and periodontal status (CPITN. Mann-Whitney test of significance has been applied for analyzing DMFT score and chi-square test is used for analyzing CPITN score. Results: Of the study group, 46% were diabetic and only 11% of them did not have any oral manifestation. Oral manifestations observed were xerostomia and uremic odor, which contributed to 47 (23% and 37 (17%, respectively. Hyperpigmentation was present in 26 (12%, macroglossia in 23 (11%, and uremic tongue coating in 24 (11%. Mucosal petechiae were seen in 17 patients contributing to 8% of total patients. Eleven patients had tongue pallor (5%, 9 patients had glossitis with depapillation (4%, and 7 patients had dysgeusia (3%. Angular cheilitis and gingival swelling were seen in 5 patients (2%. Conclusion: The oral and dental manifestations were higher in prevalence in the study group. However, there was no significant difference between the two groups.

  14. Measurement of endotoxin levels in blood of hemodialysis Patients by 'Lal' test and comparision of its efficacy with blood culture

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    Gh Vazirzadeh

    2006-01-01

    Full Text Available Introduction: Presently, bacteremia is the principal cause of morbidity in patients undergoing hemodialysis. Gram-negative bacteria account for approximately 50 percent of documented infections. Endotoxins released during lysis of gram negative bacteremia result in inflammatory and defense response by the body and if not treated promptly result in septic shock and ultimately death of the patient. This study describes the detection of endotoxins in blood of patients with bacteremia due to gram - negative bacteria by LAL test. Method: Blood samples of 278 hemodialysis patients were analyzed in this study and pathogens were isolated from blood culture samples. Then, their antibiotic sensitivity was determined. In patients with positive blood culture, endotoxin levels were measured by LAL-test. Results: Frequency of bacteremia in patients was 13.6% . The prevalence of gram – negative bacteremia was 44.7%. E coli were the major pathogens, while staphylococcus aureus was the most common gram positive bacterium. Endotoxin was detected in 15 patients (3.8 ± 1.08 EU/ml . The sensitivity and specificity of endotoxins for gram – negative bacteremia were 88% and 95%, respectively. Conclusion: The results indicate that the LAL method is a fast, sensitive and simple method. There was no significant difference between the results of blood culture and LAL – test ( P > 0.05 .

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

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    Suzana Gabriela Rusa

    2014-12-01

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

  16. Comparison of markers of oxidative stress, inflammation and arterial stiffness between incident hemodialysis and peritoneal dialysis patients – an observational study

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    Ratanjee Sharad

    2009-03-01

    Full Text Available Abstract Background Patients on peritoneal and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. The atherosclerosis is associated with increased arterial stiffness, endothelial dysfunction and elevated oxidative stress and inflammation. The aims of this study are to investigate the effects of peritoneal and hemodialysis on arterial stiffness, vascular function, myocardial structure and function, oxidative stress and inflammation in incident patients with end stage kidney disease. Methods This is an observational study. Eighty stage five CKD patients will be enrolled and followed for one-year. Primary outcome measures will be changes in 1 arterial stiffness measured by aortic pulse wave velocity, 2 oxidative stress assessed by plasma F2 isoprostanes and 3 inflammation measured by plasma pentraxin-3. Secondary outcomes will include additional measures of oxidative stress and inflammation, changes in vascular function assessed using the brachial artery reactivity technique, carotid artery intimal medial thickness, augmentation index and trans thoracic echocardiography to assess left ventricular geometry, and systolic and diastolic function. Patients will undergo these measures at baseline (6–8 weeks prior to starting dialysis therapy, then at six and 12 months after starting dialysis. Discussion The results of this study may guide the choice of dialysis modality in the first year of treatment. It may also lead to a larger study prospectively assessing the effect of dialysis modality on cardiovascular morbidity and mortality. Trial Registration ACTRN12609000049279

  17. Albumina sérica como marcador nutricional de pacientes em hemodiálise Serum albumin as nutritional marker of hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Nelma Scheyla José dos Santos

    2004-09-01

    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.

  18. Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results

    Energy Technology Data Exchange (ETDEWEB)

    Won, Jong Yun; Lee, Kwang Hun; Lee, Do Yun [Dept. of Radiology, Research Institute of Radiological Science, Yensei University College of Medicine, Seoul (Korea, Republic of); Kim, Myoung Soo [Dept. of Radiology, Yensei University College of Medicine, Seoul (Korea, Republic of); Kang, Byung Chul [Dept. of Radiology, Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of); Kim, Seung Jung [Dept. of Internal Medicine, EwhaWoman' s University School of Medicine, Seoul (Korea, Republic of)

    2011-08-15

    To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.

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

    Directory of Open Access Journals (Sweden)

    Kang Yu-Chuan

    2012-11-01

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

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

    Scientific Electronic Library Online (English)

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

    2012-02-01

    Full Text Available Durante período de 2 anos, estudamos a incidência da infecção pelo vírus da hepatite C (VHC) em 29 pacientes em tratamento de diálise, com idades entre 15 e 75 anos (c ± DS; 45 ± 39,5 anos), procedentes da unidade de hemodiálise do Hospital Universitário de Maracaibo, Estado Zulia, Venezuela. Para a [...] detecção dos anticorpos contra o VHC (anti-VHC) utilizamos a técnica de imunoensaio enzimático (ELISA, Innotest HCV Ab IV) e em amostras reativas por ELISA, utilizamos o método de immunoblot recombinante de terceira geração (Inno-LIA HCV Ab III), ambos da casa comercial Innogenetics N.V., Bélgica. Os resultados demonstram ausência de soroconversão ao VHC nos pacientes hemodializados durante o período estudado, o que foi confirmado pelo método de imunoblot recombinante. Os fatores de risco ao VHC foram 0,327 (95% CI: 0,01323 - 8,080) nos pacientes submetidos ao tratamento de diálise. Nossos resultados sugerem ausência de fontes de infecção neste centro de hemodiálise e que as medidas universais de controle de infecção são cumpridas. Abstract in english Over a two year period, the incidence of hepatitis C virus (HCV) infection was evaluated in 29 hemodialysis patients, aged between 15 and 75 years (mean ± SD: 45 ± 39.5 years), from the University Hospital Hemodyalisis Unit, Maracaibo, Zulia State, Venezuela. Anti-HCV antibodies were determined usin [...] g a fourth generation ELISA (Innotest HCV Ab IV) kit and positive blood samples were tested using a recombinant assay kit (Inno-LIA HCV Ab III), both kits from Innogenetics N.V., Belgium. The findings indicate a lack of HCV seroconversion in the hemodialysis patients over the study period, confirmed by the recombinant assay. Risk factors for HCV infection were 0.3270 (95% confidence interval: 0.01323-8.080) in patients undergoing hemodialysis. The findings suggest a lack of significant sources for HCV infection due to the preventive measures to avoid its transmission in the hemodialysis unit.

  1. Hemodialysis and hepatitis B vaccination: a challenge to physicians

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    Ayub MA

    2014-02-01

    Full Text Available Munir Akar Ayub,1 Marcelo Rodrigues Bacci,2 Fernando Luiz Affonso Fonseca,3 Ethel Zimberg Chehter4 1Department of Infectology, 2Department of General Practice, 3Department of Morphology, 4Department of Gastroenterology, Faculdade de Medicina do ABC, Santo André-São Paulo, Brazil Abstract: Hepatitis B is responsible for the development of half of hepatocellular carcinoma cases and is a major cause of hepatic insufficiency. The vaccine against hepatitis B virus does not exhibit the same high efficacy in patients on hemodialysis as it does in immunocompetent individuals. The medical literature recommends vaccination with four doses (40 mg each of the hepatitis B virus vaccine before beginning hemodialysis; however, approximately one-third of hemodialysis patients do not respond to this vaccination schedule. A new serologic test should be performed each year for individuals who respond adequately, whereas a booster dose should be offered to those with antibody titers below 10 mIU/mL. In this study, we followed 83 hemodialysis patients and collected quantitative serologic measurements every 2 months over a 1-year period. We made the measurements 1 month after the vaccination period. We found that 41% of the patients had antibody titers below 10 mIU/mL (nonresponders, 21.7% had antibody titers between 10 mIU/mL and 100 mIU/mL (poor responders, and 37.3% had antibody titers higher than 100 mIU/mL (good responders. Patients with diabetes and/or hypertension exhibited worse response to vaccination. All subjects displayed decreasing antibody titers during the observation period. The group of poorly responsive patients had antibody titers below 10 mIU/mL at the 6-month follow-up period. Keywords: hepatitis B vaccination, chronic kidney disease, hemodialysis

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

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    Julio Valdivia

    2013-07-01

    Full Text Available INTRODUCTION: Knowledge of prognostic factors in end-stage renal disease patients has improved dialysis management and methods for reducing morbidity and mortality, underlining the importance of identification, prevention and control of these factors. OBJECTIVE: Identify factors affecting prognosis (survival or death in hemodialysis patients at the Medical-Surgical Research Center in Havana over a ten-year period. METHODS: Descriptive, prospective study of 81 end-stage renal disease patients who received hemodialysis at the Medical-Surgical Research Center from 1995 to 2004. Prognostic factors were identified at initiation of and during dialysis treatment, using chi square, t test, McNemar test, Kaplan Meier analysis, log-rank test and Cox regression model, with significance threshold set at p <0.05. RESULTS: Hypertension and diabetes were the leading causes of end-stage renal disease. Six patients were referred late. Mean survival was 4.4 years; with survival of 86.6%, 54.7% and 26.6% at one, three and five years respectively. Factors predictive of decreased survival that were most frequent at initiation of hemodialysis were hypertension and chronic anemia (both present in 95.9% of cases; malnutrition, hypoalbuminemia, cardiovascular disease and chronic liver disease increased during treatment while hypertension decreased. In multivariate analysis, prognostic factors that significantly predicted decreased survival were hypertension, inadequate vascular access and diabetes. Patients aged <60 years and those with malnutrition, hypoalbuminemia, anemia, cardiovascular disease or liver disease had lower survival figures at the end of the study period. Leading causes of death were infections (45.2% and cardiovascular disease (41.9%; the latter was present in 93.5% of deaths, independent of underlying cause of death. CONCLUSIONS: Survival of hemodialysis patients diminished at five years. Some negative predictive factors are present at initiation of hemodialysis, such as diabetes, hypertension and chronic anemia; others increased later, including malnutrition, hypoalbuminemia, cardiovascular disease and liver disease.

  3. TTV as A Risk Factor in Hemodialysis Process

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

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

    OpenAIRE

    Nowak, Zbigniew; Lauda?ski, Krzysztof

    2014-01-01

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

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

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    Masaru Shimazaki

    2008-01-01

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

  6. Variation of hemodialysis related arterial stiffness in patients with end stage renal disease

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    Ariana Condor

    2009-08-01

    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.

  7. Treatment of a common problem in Hemodialysis patients: Is the juice worth the squeeze?

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    Al-saran Khalid

    2009-01-01

    Full Text Available Chronic infection with hepatitis C virus (HCV is a serious public health problem affecting an estimated 2% of the world?s population. The natural history of HCV infection in hemodialysis patients remains incompletely understood and the management is difficult. HCV infection in hemodialysis patients is usually asymptomatic. Given the diminished life expectancy of hemodialysis patients, complications such as decompensated cirrhosis and hepatocellular carcinoma may not have time to develop. The frequency of advanced fibrosis or cirrhosis ranges from 0% to 28 %. We discuss in this presentation several aspects of HCV infection in chronic kidney disease (CKD patients such as relationship with glomerulopathy, renal allograft outcome, prevalence in hemodialysis patients in the kingdom of Saudi Arabia, treatment of HCV in hemo-dialysis patients in the kingdom of Saudia Arabia, and finally our experience at Prince Salman Center for kidney disease (PSCKD in the management of HCV infected hemodialysis patients.

  8. Ultrasound-guided cannulation in placement of Hemodialysis Access Catheters in Predialysis Patients

    OpenAIRE

    Yildar, Murat; Gurbuz, Orcun; Kumtepe, Gencehan; Basbug, Murat; Toprak, Omer

    2014-01-01

    Aim: Ultrasound (USG)-guided hemodialysis catheter placement is known to be superior to and more reliable than catheter insertion guided by anatomical landmarks. USG is used for vascular mapping (VM) before catheter placement, or real time. This study investigated the effect on outcomes of USG techniques used in patients with hemodialysis catheters inserted through the internal jugular vein (IJV) due to emergency hemodialysis indication while being monitored for Predialysis Renal Failure (PRF...

  9. Doppler Ultrasound Assessment of Well-Functioning Native Hemodialysis Access: Comparison with Sufficient Dialysis

    OpenAIRE

    A Alamdaran; F. Nazemian; Taheri, H

    2008-01-01

    Background/Objective: Malfunction of vascular accesses is a common cause of morbidity in hemodialysis patients. The purpose of the present study was to evaluate the flow volume and the diameter of the feeding artery in asymptomatic, well-functioning hemodialysis access with Doppler ultrasound."nPatients and Methods: From March 2006 to February 2007, we examined the functioning mature arteriovenous fistula (AVF) of 69 hemodialysis patients by Doppler ultrasound in Imam Reza hospital, Mash...

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

    OpenAIRE

    Kim, Hyerang; LIM, Hyunjung; Choue, Ryowon

    2015-01-01

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

  11. Low Resistin Level is Associated with Poor Hospitalization-Free Survival in Hemodialysis Patients

    OpenAIRE

    Chung, Wookyung; Jung, Eul Sik; Shin, Dongsu; Choi, Shung Han; Jung, Ji Yong; Chang, Jae Hyun; Lee, Hyun Hee; Kim, Dong Ki; Kim, Sejoong

    2012-01-01

    Malnutrition and inflammation are related to high rates of morbidity and mortality in hemodialysis patients. Resistin is associated with nutrition and inflammation. We attempted to determine whether resistin levels may predict clinical outcomes in hemodialysis patients. We conducted a prospective evaluation of 100 outpatients on hemodialysis in a single dialysis center (male, 46%; mean age, 53.7 ± 16.4 yr). We stratified the patients into 4 groups according to quartiles of serum resistin leve...

  12. Treatment of a common problem in Hemodialysis patients: Is the juice worth the squeeze?

    OpenAIRE

    Al-saran Khalid; Sabry Alaa; Shaheen Naila; Yehia Ahmed

    2009-01-01

    Chronic infection with hepatitis C virus (HCV) is a serious public health problem affecting an estimated 2% of the world?s population. The natural history of HCV infection in hemodialysis patients remains incompletely understood and the management is difficult. HCV infection in hemodialysis patients is usually asymptomatic. Given the diminished life expectancy of hemodialysis patients, complications such as decompensated cirrhosis and hepatocellular carcinoma may not have time t...

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

    OpenAIRE

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

    2002-01-01

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

  14. Hepatitis C in Hemodialysis Centers of Golestan Province, Northeast of Iran (2005)

    OpenAIRE

    Ali Jabbari; Sima Besharat; Behnaz Khodabakhshi

    2008-01-01

    Background and Aims: Nosocomial transmission of blood-borne pathogens is common in a dialysis setting. Hepatitis C virus (HCV) infection is a common problem that increases morbidity and mortality in hemodialysis patients. Blood transfusion and the duration of hemodialysis are the most important factors in HCV transmission. The aim of the study was to determine the incidence rate of HCV antibody in hemodialysis patients and its association with some factors. Methods: In this descriptive-analyt...

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

    OpenAIRE

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

    1982-01-01

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

  16. Changes of plasma ET, ANP and PRL levels in patients on chronic hemodialysis

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    Theodoros Eleftheriadis

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Cláudia Régia Dias de Souza

    2005-10-01

    Full Text Available OBJETIVOS/MÉTODOS: Avaliou-se a condição periodontal de 30 pacientes, em hemodiálise, através do índice de placa, índice gengival, índice de cálculo, PSR e quantidade de IgA na saliva, visando determinar a condição periodontal de doentes renais crônicos. RESULTADOS: Os resultados demonstraram que os índices de placa, índice gengival e índice de calculo foram considerados altos nestes pacientes. Com relação à necessidade de tratamento periodontal, observou-se que a maior parte dos pacientes em hemodiálise precisava de medidas de higiene bucal, raspagem supra e subgengival e fluoretação tópica (código 2. Em relação aos valores de IgA na saliva, somente três pacientes apresentaram densidade baixa. CONCLUSÃO: Concluiu-se que pacientes renais crônicos em hemodiálise apresentam maior acúmulo de placa bacteriana e elevada formação de cálculo dentário, necessitando de tratamento periodontal como raspagem supra e subgengival.OBJECTIVES AND METHODS: Thirty patients undergoing hemodialysis were evaluated for their periodontal condition through plaque, calculus and gingival indexes; PSR and IgA present in the saliva were also appraised in order to determine the periodontal condition of patients presenting chronic kidney disease. RESULTS: Results obtained demonstrated that in the studied group the plaque, calculus and gingival indexes were high. With regard to these patients' requirement to undergo periodontal treatment, most patients submitted to hemodialysis needed better oral hygiene, in addition to supra and sub gingival scraping and topic application of fluor (code 2. As to the IgA amount present in the saliva, only three patients showed a low density. CONCLUSIONS: Patients presenting chronic kidney disease disclosed a tendency for greater bacterial plaque concentration, high formation of dental calculus suggesting the need for periodontal treatment comprising supra and sub gingival scraping.

  19. 78 FR 38994 - Implanted Blood Access Devices for Hemodialysis; Draft Guidance for Industry and Food and Drug...

    Science.gov (United States)

    2013-06-28

    ... HUMAN SERVICES Food and Drug Administration Implanted Blood Access Devices for Hemodialysis; Draft... availability of the draft guidance entitled ``Implanted Blood Access Devices for Hemodialysis.'' This guidance was developed to support the reclassification of the Implanted Blood Access Devices for...

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

    Directory of Open Access Journals (Sweden)

    Maryam Bakhtiari

    2013-05-01

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

  1. Distance between residence and the dialysis unit does not impact self-perceived outcomes in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Santos Paulo

    2012-08-01

    Full Text Available Abstract Background Patients have to travel long distances to undergo hemodialysis (HD in some regions. We aimed to search for an association of the distance between patients’ residence and the dialysis unit with quality of life, depression and coping among end-stage renal disease (ESRD patients undergoing maintenance HD. Methods We studied 161 ESRD patients undergoing HD during April 2009. Quality of life, depression and coping were assessed by the SF-36, the 10-item CES-D and the Jalowiec Coping Scale, respectively. The sample was stratified in three groups: I-patients residing in Sobral (where the dialysis unit is located; II-patients residing in towns up to 100 km from Sobral; and III-patients residing in towns distant greater than 100 km from Sobral. Analysis of variance was used to detect differences in quality of life and coping scores between the groups. Logistic regression was used to test distance as a predictor of depression. Results There were 47 (29.2% patients residing in Sobral, 46 (28.6% up to 100 km away and 68 (42.2% greater than 100 km from Sobral. There were no differences related to quality of life and coping scores between the groups. Distance was not a predictor of depression. Conclusions Social and cultural factors may explain the lack of differences. Studies from other regions are needed to clarify the distance effects on self-perceived outcomes among HD patients.

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

    Directory of Open Access Journals (Sweden)

    abdoreza Sotoodeh Jahromi

    2011-05-01

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

  3. Effect of hemodialysis on intra-abdominal pressure Efeito da hemodiálise sobre a pressão intra-abdominal

    OpenAIRE

    Roberta Fernandes Bonfim; Andréia Grigório Goulart; Carolina Fu; Jamili Anbar Torquato

    2007-01-01

    OBJECTIVE: To study the effect of hemodialysis on intra-abdominal pressure. METHODS: Five patients admitted between July and November of 2003 were evaluated in the intensive care unit. Intra-abdominal pressure was measured before and after hemodialysis, maintaining the ventilatory parameters except for PEEP (positive-end expiratory pressure). RESULTS: Intra-abdominal pressure was significantly reduced by hemodialysis in all the 5 patients. CONCLUSION: Hemodialysis significantly reduced intra-...

  4. Early open surgery for the accidental insertion of a hemodialysis catheter into the carotid artery: a case report

    OpenAIRE

    Yosuke Moteki; Koji Yamaguchi; Akitsugu Kawashima; Shinsuke Sato; Yoshikazu Okada

    2014-01-01

    Insertion of a hemodialysis catheter into the internal jugular vein is a commonly performed procedure for intermittent hemodialysis. However, arterial misplacement of the hemodialysis catheter can occur and lead to serious complications, such as major stroke due to intra-arterial thrombus. Here, we report a case in which open surgery was performed to avoid major stroke following the accidental insertion of a hemodialysis catheter into the common carotid artery. We suggest that early open surg...

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

    Science.gov (United States)

    Schiffl, H; Lang, S M

    2013-11-01

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

  6. MR angiography of hemodialysis access fistula. Evaluation before PTA procedure

    Energy Technology Data Exchange (ETDEWEB)

    Morimoto, Atsuko; Yoshimura, Hirohide; Hosokawa, Chisa; Yoshida, Toshiko [Yodogawa Christian Hospital, Osaka (Japan)

    2000-08-01

    We evaluated the feasibility of MR angiography for hemodialysis fistula. Eleven patients with suspected stenosis or occlusion of an autogenous hemodialysis fistula in the forearm underwent MRA. MRA was obtained using both the 3D-PC method and 3D gadolinium contrast-enhanced (CE) method with a knee coil. The two methods were compared with DSA in seven patients. CE-MRA clearly demonstrated the entire dialysis fistula. However, signals of the stenotic area are effaced in PC-MRA. The diameter of the vessels evaluated in the CE-MRA was well correlated with angiography. CE-MRA demonstrated smaller collateral vessels more clearly than PC-MRA. CE-MRA provided useful information before the PTA procedure. (author)

  7. MR angiography of hemodialysis access fistula. Evaluation before PTA procedure

    International Nuclear Information System (INIS)

    We evaluated the feasibility of MR angiography for hemodialysis fistula. Eleven patients with suspected stenosis or occlusion of an autogenous hemodialysis fistula in the forearm underwent MRA. MRA was obtained using both the 3D-PC method and 3D gadolinium contrast-enhanced (CE) method with a knee coil. The two methods were compared with DSA in seven patients. CE-MRA clearly demonstrated the entire dialysis fistula. However, signals of the stenotic area are effaced in PC-MRA. The diameter of the vessels evaluated in the CE-MRA was well correlated with angiography. CE-MRA demonstrated smaller collateral vessels more clearly than PC-MRA. CE-MRA provided useful information before the PTA procedure. (author)

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

    Scientific Electronic Library Online (English)

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

    2013-07-01

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

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

    OpenAIRE

    Ratnamani, M. S.; Rao, Ratna

    2013-01-01

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

  10. Analytical Solution of Multicompartment Solute Kinetics for Hemodialysis

    OpenAIRE

    Przemys?aw Korohoda; Daniel Schneditz

    2013-01-01

    Objective. To provide an exact solution for variable-volume multicompartment kinetic models with linear volume change, and to apply this solution to a 4-compartment diffusion-adjusted regional blood flow model for both urea and creatinine kinetics in hemodialysis. Methods. A matrix-based approach applicable to linear models encompassing any number of compartments is presented. The procedure requires the inversion of a square matrix and the computation of its eigenvalues ?, assuming they are a...

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

    OpenAIRE

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

    2010-01-01

    The vancomycin dose for hemodialysis (HD) patients should be adjusted by monitoring drug serum concentrations. However, this procedure is not available in most health services in Brazil, which usually adopts protocols based on published studies. The trials available are controversial, and several have not been conducted with current dialyzers. This study aimed at assessing the suitability of vancomycin serum concentrations in HD patients at a public hospital. Blood samples of HD patients were...

  12. Combined Hemoperfusion and Hemodialysis Treatment of Poisoning with Cholinesterase Inhibitors

    OpenAIRE

    Durakovic, Zijad

    1993-01-01

    Three patients with cholinesterase inhibitor poisoning have been presented. The patients were in a deep coma and, in one of them, artificial mechanical respiration was instituted. All three cases were treated by a procedure combining hemodialysis and hemoperfusion with Amberlite resin (XAD-4), and the clinical picture improved over a short period of time. After the end of procedure, the platelet count was approximately 41% of normal, some aspects of these intoxications are discussed.

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

    OpenAIRE

    Hammes, Mary S.

    2004-01-01

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

  14. Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients

    OpenAIRE

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

    2010-01-01

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

  15. Rosiglitazone Is Associated with Mortality in Chronic Hemodialysis Patients

    OpenAIRE

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

    2009-01-01

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

  16. Prevalence of Parasitic Infections in Iranian Stable Hemodialysis Patients

    OpenAIRE

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

    2011-01-01

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

  17. Pulmonary Hypertension and Predisposing Factors in Patients Receiving Hemodialysis

    Directory of Open Access Journals (Sweden)

    Seyed Alijavad Mousavi

    2009-04-01

    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.

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

    OpenAIRE

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

    1993-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

  20. Malnutrition Markers and Serum Ghrelin Levels in Hemodialysis Patients

    OpenAIRE

    Montazerifar, Farzaneh; Karajibani, Mansour; Gorgij, Farnia; Akbari, Ommolbanin

    2014-01-01

    Objective. The aim of study was to investigate the changes levels of serum ghrelin in HD patients and its relationship to some malnutrition markers compared with healthy controls. Methods. Forty-five patients on hemodialysis and forty healthy controls were studied. Biochemical parameters and serum ghrelin levels were measured. Both daily dietary intakes and body mass index (BMI) assessments were performed for evaluation of nutritional status. Results. Ghrelin concentrations were significantly...

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

    OpenAIRE

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

    2012-01-01

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

  2. Biochemical nutritional parameters and their impact on hemodialysis efficiency

    OpenAIRE

    Abbas Hasan; Rabbani Malik; Safdar Nilofer; Murtaza Ghulam; Maria Qamaruddin; Ahamd Aasim

    2009-01-01

    To determine the nutritional status of chronic hemodialysis (HD) patients and the association of changes in serum albumin levels, C-reactive protein (CRP), Low Density Lipoprotein (LDL) cholesterol and body mass index (BMI) as indicators of nutritional status with the urea reduction ratio (URR) during dialysis, we studied 201 chronic HD patients (97 males and the mean age was 51 ± 15 years). Diabetes was the cause of chronic kidney disease (CKD) in 34% of the pa-tients, hypertensi...

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

    OpenAIRE

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

    2013-01-01

    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...

  4. Metabolic Acidosis in Maintenance Hemodialysis Patients: Clinical Impact and Intervention

    OpenAIRE

    Kim, Ho-Jung; Han, Sang-Woong

    2007-01-01

    Metabolic acidosis has been considered as one of the reverse epidemiologic factors for the morbidity and mortality in maintenance hemodialysis patients (MHP). Expectedly, in the recent large scale epidemiologic study (The Dialysis Outcome Practice Pattern Study, DOPPS), a mild to moderate degree of predialysis metabolic acidosis has shown better nutritional status and lower relative risk for mortality and hospitalization in MHP. Similarly, another recent study of the largest sample size of MH...

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

    OpenAIRE

    Nikić, Petar M.; Andrić, Branislav R.; Stojimirović, Biljana B.; Jasna Trbojevic-Stanković; Zoran Bukumirić

    2014-01-01

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

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

    OpenAIRE

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

    2015-01-01

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

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

    OpenAIRE

    Qinglei Zhang; Xiaolong Lu; Lihua Zhao

    2014-01-01

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

  8. Predialysis Systolic BP Variability and Outcomes in Hemodialysis Patients

    OpenAIRE

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

    2014-01-01

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

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

    OpenAIRE

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

    2009-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

  11. [Vascular access validity and treatment efficiency in hemodialysis].

    Science.gov (United States)

    Ferrari, G; Talassi, E; Baraldi, C; Lambertini, D; Tarchini, R

    2003-01-01

    The vascular access is the "Achille's heel" of the modern hemodialysis. In order to obtain a good depuration, the blood flow in dialysis must be of 250-300 mL/min, at least. The procedures for the preparation and their complications are cause of the 25% of the hospital admissions in patients with chronic uremia in substitutive therapy. Gold standard is still represented from the distal arteriovenous fistulas of Cimino and Brescia. The alternatives to the native veins as the syntetic graft and the tunneled central venous catheteters or the Dialock system, revealed useful in the patients that have exausted the superficial veins, but are of second choice. The native fistula has an advanced validity, demonstrated from lower risk of mortality in the patients who use it, diabetic or not. These affirmations come just from USA, where the arteriovenous grafts prevail and the percentage of central venous catheters is elevated. Thrombosis, infections and reduced depurative efficiency are the main causes. In the Dialysis Unit of Mantova we adopted an aggressive approach to the construction of distal fistula. Out of 172 patients in chronic hemodialysis, 165 use an arterovenous fistula, 4 an arterovenous grafts (PTFE) and 3 a tunnelled central venous catheters (2 Permcath and 1 Tesio). The surgical activity between 1987 and 2001 included 858 procedures on 516 patients (medium ages 59.1 years): Among these, 815 are created from native veins, 28 by arterovenous graft fistulas and 15 with tunnelled hemodialysis catheters. Our current strategy recommended to candidate to permanent venous catheter only patients on chronic hemodialysis with exhausted periferal vascular bed and only when peritoneal dialisys is'nt possible. Generally, the management of the vascular access must preview one tight collaboration between nephrologists, nurses, patient, vascular surgeons and radiologists. PMID:12851917

  12. Segregation, Income Disparities, and Survival in Hemodialysis Patients

    OpenAIRE

    Kimmel, Paul L.; Fwu, Chyng-Wen; Eggers, Paul W.

    2013-01-01

    Social and ecologic factors, such as residential segregation, are determinants of health in the general population, but how these factors associate with outcomes among patients with ESRD is not well understood. Here, we examined associations of income inequality and residence, as social determinants of health, with survival among black and white patients with ESRD. We merged U.S. Renal Data System data from 589,036 patients who started hemodialysis from 2000 through 2008 with race-specific me...

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

    Directory of Open Access Journals (Sweden)

    Lim Su-Ho

    2013-02-01

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

  14. Complications of arteriovenous hemodialysis fistulas: angiographic findings and interventional treatments

    International Nuclear Information System (INIS)

    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

  15. Prevalence of malnutrition and associated factors in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ana Tereza Vaz de Souza Freitas

    2014-06-01

    Full Text Available OBJECTIVE: To assess the prevalence of malnutrition and associated factors in hemodialysis patients. METHODS: This is a cross-sectional study of 344 hemodialysis patients from Goiânia, Goiás aged 18 years or more. The dependent variable, malnutrition, was investigated by the Subjective Global Assessment. The independent variables included socioeconomic, demographic, and lifestyle data, clinical history, and energy and protein intakes. The patients underwent anthropometric measurements and laboratory tests. Multiple Poisson regression determined the associated factors (p60 months (PR=1.08, 95%CI=1.01-1.16, Kt/V>1.2 (RP=1.12, 95%CI=1.03-1.22, calorie intake <35 kcal/kg/day (PR=1.22, 95%CI=1.10-1.34, and normalized protein nitrogen appearance <1.0 g/kg/day (PR=1.13, 95%CI=1.05-1.21. CONCLUSION: The prevalence of malnutrition in this population was high, corroborating the literature. The prevalence was higher in patients aged less than 29 years and those with low family income, longer hemodialysis vintage, higher Kt/V, and inadequate protein and calorie intakes. Strategies to reverse this situation should include more nutritional care.

  16. Prevalence of Secondary Hyper Parathyroidism in Hemodialysis Patients

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    F Behzad

    2007-04-01

    Full Text Available Introduction: Osteodystrophy is one of the long term complications of chronic renal failure and is expressed in two forms;low turn over and high turn over. It is an important cause of morbidity in patients with renal failure and if diagnosed and managed properly, many problems of these patients can be resolved. In this study we evaluated the prevalence of hyperparathyroidism in hemodialysis patients and its correlation with different factors. Methods: This study was an analytic, observational study that was done by the cross- sectional method. We formatted a questionnaire for hemodialysis patients who were enrolled in the study over a period of 6 months. Fasting blood samples (5-10c.c were drawn to measure levels of PTH(parathyroid hormone ,calcium, phosphorous and alkaline phosphatase. Skull and wrist X-rays were also taken and the radiologist evaluated them with regards to hyperparathyroidism. Results: In the 80 patients studied, prevalence of hyperparathyroidism was 45% (36 patients. 44 patients were diabetics. Among different factors, hyperparathyroidism did not correlate with frequency and duration of dialysis, age, sex ,familial history, diabetes, hypertension , bone pains, muscle weakness, purities and level of calcium and phosphorous. But there was a significant relationship between hyperparathyroidism and alkaline phosphatase levels and radiological findings. Conclusion: We can use alkaline phosphatase levels and/or radiographic changes for evaluation of renal osteodystrophy in hemodialysis patients and prevent complications by early diagnosis and proper management.

  17. Maintenance hemodialysis patients have high cumulative radiation exposure.

    LENUS (Irish Health Repository)

    Kinsella, Sinead M

    2010-10-01

    Hemodialysis is associated with an increased risk of neoplasms which may result, at least in part, from exposure to ionizing radiation associated with frequent radiographic procedures. In order to estimate the average radiation exposure of those on hemodialysis, we conducted a retrospective study of 100 patients in a university-based dialysis unit followed for a median of 3.4 years. The number and type of radiological procedures were obtained from a central radiology database, and the cumulative effective radiation dose was calculated using standardized, procedure-specific radiation levels. The median annual radiation dose was 6.9 millisieverts (mSv) per patient-year. However, 14 patients had an annual cumulative effective radiation dose over 20 mSv, the upper averaged annual limit for occupational exposure. The median total cumulative effective radiation dose per patient over the study period was 21.7 mSv, in which 13 patients had a total cumulative effective radiation dose over 75 mSv, a value reported to be associated with a 7% increased risk of cancer-related mortality. Two-thirds of the total cumulative effective radiation dose was due to CT scanning. The average radiation exposure was significantly associated with the cause of end-stage renal disease, history of ischemic heart disease, transplant waitlist status, number of in-patient hospital days over follow-up, and death during the study period. These results highlight the substantial exposure to ionizing radiation in hemodialysis patients.

  18. Eating habits and nutritional status of hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Juliane Meyer

    2011-06-01

    Full Text Available Hemodialysis (HD is a blood filtration process that removes excess of fluid and metabolites. The major determinants of morbidity and mortality in HD are the patients’ nutritional status and dialysis adequacy. Probably there is a significant interrelationship between these two factors, as well as patients receiving adequate dialysis have a higher overall wellness and consequently better food intake. The aim of this study was to identify eating habits and nutritional status of patients registered in the hemodialysis program in the city of Foz do Iguaçu-PR. Thirty-four patients were selected, 70.5% men and 29.5% women, in average 45 years old. To characterize the nutritional status were used Body Mass Index (BMI, total cholesterol, and Reduction Percentage Calculation of Urea (RPU. Dietary habits were investigated through a questionnaire on eating frequency. The results showed a predominance of normal individuals, according to BMI (47%, total cholesterol (60% and RPU (80% and the dietary habits showed that the results were not expected due to the socioeconomic level of patients. These results suggested that special attention must be given to maintaining the nutritional status of hemodialysis patients.

  19. Hemodialysis Catheter Heat Transfer for Biofilm Prevention and Treatment.

    Science.gov (United States)

    Richardson, Ian P; Sturtevant, Rachael; Heung, Michael; Solomon, Michael J; Younger, John G; VanEpps, J Scott

    2016-01-01

    Central line-associated bloodstream infections (CLABSIs) are not easily treated, and many catheters (e.g., hemodialysis catheters) are not easily replaced. Biofilms (the source of infection) on catheter surfaces are notoriously difficult to eradicate. We have recently demonstrated that modest elevations of temperature lead to increased staphylococcal susceptibility to vancomycin and significantly soften the biofilm matrix. In this study, using a combination of microbiological, computational, and experimental studies, we demonstrate the efficacy, feasibility, and safety of using heat as an adjuvant treatment for infected hemodialysis catheters. Specifically, we show that treating with heat in the presence of antibiotics led to additive killing of Staphylococcus epidermidis with similar trends seen for Staphylococcus aureus and Klebsiella pneumoniae. The magnitude of temperature elevation required is relatively modest (45-50°C) and similar to that used as an adjuvant to traditional cancer therapy. Using a custom-designed benchtop model of a hemodialysis catheter, positioned with tip in the human vena cava as well as computational fluid dynamic simulations, we demonstrate that these temperature elevations are likely achievable in situ with minimal increased in overall blood temperature. PMID:26501916

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

    Directory of Open Access Journals (Sweden)

    Walber Pinto Vieira

    2005-12-01

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

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

    Scientific Electronic Library Online (English)

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

    2005-12-01

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

  2. The role of xanthine oxidase in hemodialysis-induced oxidative injury: relationship with nutritional status.

    Science.gov (United States)

    Miric, Dijana; Kisic, Bojana; Stolic, Radojica; Miric, Bratislav; Mitic, Radoslav; Janicijevic-Hudomal, Snezana

    2013-01-01

    The role of xanthine oxidase (XOD) in patients undergoing chronic hemodialysis treatment (HD) is poorly understood. Geriatric nutritional risk index (GNRI) ? 90 could be linked with malnutrition-inflammation complex syndrome. This study measured XOD, myeloperoxidase (MPO), superoxide dismutase (SOD), lipid hydroperoxides, total free thiol groups, and advanced oxidation protein products (AOPP) in 50 HD patients before commencing (pre-HD) and immediately after completion of HD session (post-HD) and in 22 healthy controls. Pre-HD serum hydroperoxides, AOPP, XOD, and SOD were higher and total thiol groups were lower in patients than in controls (P 90 (P = 0.002). In a multiple regression analysis, post-HD serum XOD activity was independently associated with GNRI ? 90 ( ? ± SE: 0.398 ± 0.151; P = 0.012) and HD vintage ( ? ± SE: -0.349 ± 0.139; P = 0.016). These results indicate that an upregulated XOD may be implicated in HD-induced oxidative injury contributing to accelerated protein damage in patients with GNRI ? 90. PMID:23819009

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

    Science.gov (United States)

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

    2015-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Adelina Mih?escu

    2011-12-01

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

  5. 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

    Directory of Open Access Journals (Sweden)

    Marina Stela Cunha

    2009-06-01

    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 pacientes 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.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. Sixteen 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.

  6. Heart Rate Variability Change Before and After Hemodialysis is Associated with Overall and Cardiovascular Mortality in Hemodialysis

    OpenAIRE

    Szu-Chia Chen; Jiun-Chi Huang; Yi-Chun Tsai; R. N. Hsiu-Chin Mai; Jui-Hsin Chen, R. N.; Po-Lin Kuo; Jer-Ming Chang; Shang-Jyh Hwang; Hung-Chun Chen

    2016-01-01

    Low heart rate variability (HRV) has been recognized to correlate with adverse cardiovascular (CV) outcomes in hemodialysis (HD) patients. It has been reported that HRV might be improved after HD, but whether the improved HRV after HD predicts a better CV prognosis remains to be determined. This study examined the ability of the change in HRV before and after HD in predicting overall and CV mortality in HD patients. This study enrolled 182 patients under maintenance HD. HRV was examined to as...

  7. Changes in serum asymmetric dimethylarginine and endothelial markers levels with varying periods of hemodialysis.

    Science.gov (United States)

    Yaman, Alper; Karabag, Funda; Demir, Serap; Koken, Tulay

    2014-08-01

    Asymmetric dimethylarginine (ADMA) as a uremia toxin is accumulated in end-stage renal disease (ESRD) patients. Elevated ADMA level has been shown to be predictive of cardiovascular diseases (CVDs) and all-cause mortality in ESRD. Therefore, we investigated the effect of prolonged hemodialysis (HD) treatment on the levels of serum ADMA, arginine, nitric oxide (NO), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1). Seventy-five patients (M/F?=?40/35) with chronic renal failure (CRF) and who were on HD were divided into five groups with differing treatment periods of HD; from 6 to 24 months to 97-120 months. Fifteen apparently healthy subjects acted as controls. The serum levels of ADMA, sICAM-1 and sVCAM-1 were increased in all patient groups compared to the control group. No significant difference was observed when the patient groups were compared in terms of HD treatment periods. Nitric oxide levels were lower in the three groups who were treated for periods of 49-72, 73-96, 97-120 months compared to the control group. The L-arginine to ADMA ratio was decreased in all patient groups compared to controls. Consequently, our investigations have shown that in HD continued for more than 4 years NO levels began to decrease significantly and the levels of serum ADMA, sICAM-1 and sVCAM-1 levels increased although this increase was not affected by the period in which hemodialysis treatment was applied. PMID:25117882

  8. The efficacy of carotid ultrasonography in estimating coronary artery stenosis in patients receiving hemodialysis

    International Nuclear Information System (INIS)

    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 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)

  9. A Patient-Centered Approach to Hemodialysis Vascular Access in the Era of Fistula First.

    Science.gov (United States)

    Kalloo, Sean; Blake, Peter G; Wish, Jay

    2016-03-01

    The primary vascular access options for the hemodialysis population are arteriovenous fistulas (AVF), arteriovenous grafts, and cuffed central venous catheters (CVC). AVFs are associated with the most favorable outcomes with respect to complications, interventions required to maintain functionality and patency, and overall cost. These population-based outcomes, in conjunction with the efforts of the Fistula First Breakthrough Initiative, have propelled the prevalence of AVFs in the US hemodialysis population. While this endeavor remains steadfast in assuring the continued dominance of this policy for AVF preference, it fails to take into account a subset of the dialysis population who will fail to see the benefits of an AVF. This subset of patients may include the elderly, those with poor vasculature anatomy, those with slowly progressive CKD who are more likely to die than progress to ESRD, and those with an overall poor long-term prognosis and shortened life expectancy. Thus, in an effort to avoid numerous unnecessary surgical and interventional procedures with minimal to no gains in clinical outcomes, an individualized patient approach must be adopted. The Centers for Medicare and Medicaid Services-instituted quality incentive program is designed to reward high AVF prevalence while also penalizing high CVC prevalence. The current model is devoid of case-based adjustment, thus penalties are disbursed to dialysis providers in accordance with a "one-size-fits-all" fistula only approach. The most suitable access for a patient remains the one that takes into account the characteristics unique to the individual patient with a primary focus on patient comfort, satisfaction, quality of life, and clinical outcomes. PMID:26756825

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

    Directory of Open Access Journals (Sweden)

    Santos Paulo Roberto

    2013-01-01

    Full Text Available Abstract Background Several aspects linked to social are involved in the onset of depressive feelings. We aimed to find out if social adaptability and substance abuse predict depression among end-stage renal disease (ESRD patients undergoing hemodialysis (HD. Methods We included 145 ESRD patients undergoing HD. Social adaptability was estimated by the Social Adaptability Index (SAI. Substance abuse was defined according to SAI. We screened for depression by applying the 20-item version of the Center for Epidemiologic Studies Depression Scale. A score ? 24 classified the patients as depressed. Comparisons between depressed and non-depressed patients were carried out and logistic regression was performed to test gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable (yes/no as predictors of depression. Results There were 36 (24.8% depressed patients. There were no differences regarding demographic and laboratory data between the depressed and non-depressed patients. Mean SAI among depressed and non-depressed patients was, respectively, 6.1 ± 1.6 vs. 6.2 ± 1.9 (p=0.901. The percentage of patients with or without substance abuse among depressed patients was, respectively, 13.8% vs. 13.9% (p=1.000. Gender, age, total SAI, SAI without the substance abuse item, only the substance abuse score and substance abuse as a categorical variable did not predict depression. Conclusions Social adaptability and substance abuse did not predict depression in HD patients. We propose that aspects related to socioeconomic status not comprised in SAI items should be ruled out as predictors of depression.

  11. Renal transplantation vs hemodialysis: Cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Perovi? Saša

    2009-01-01

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

  12. Initial Experience during Balloon Angioplasty Assisted Surgical Thrombectomy for Thrombosed Hemodialysis Grafts

    OpenAIRE

    Po-Jen Ko; Yun-Hen Liu; Hung-Chang Hsieh; Jaw-Ji Chu; Pyng Jing Lin

    2003-01-01

    Background: Access failure in hemodialysis patients is commonly encountered by vascularsurgeons. Researchers have reported various solutions for dealing withclotted grafts, including thrombectomy, thrombolysis, interposition grafting,angioplasty, or a combination of these methods. Surgical thrombectomy hasbeen the standard procedure for dealing with thrombosed hemodialysis graftsin the cardiovascular department of Chang Gung Memorial Hospital.However, to correct associated stenotic lesions an...

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

    Directory of Open Access Journals (Sweden)

    R Ghanei Gheshlagh

    2012-10-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  15. Markers of bone pain in the hemodialysis patients with renal insufficiency

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2011-01-01

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

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

    Science.gov (United States)

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

    2014-10-01

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

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

    Science.gov (United States)

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

    2012-10-01

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

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

    International Nuclear Information System (INIS)

    To study serum leptin level in chronic renal failure (CRF) hemodialysis patients and the relationship between serum leptin level and residue renal function, body composition, and indices of malnutrition, 31 end-stage CRF hemodialysis patients and 38 healthy people were enrolled. Serum leptin levels were detected by radioimmunoassay. BMI, %Fat and LBM were measured by bioelectrical impedance analysis device. Alb, Chol, Hgb, BUN, SCr and Ccr of the patients were also examined. Results showed that Serum leptin level in end-stage CRF hemodialysis patients was markedly higher than that in healthy controls (P0.05). Conclusion: Hyperleptinemia existed in end-stage CRF hemodialysis patients and might cause the loss of LBM. The leptin level was not correlated with residue renal function, but it could reflect the fat content. However, serum leptin did not play a significant role in protein malnutrition in end-stage CRF hemodialysis patients

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

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    O. Taziki

    2005-01-01

    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

  1. Impact of the Fukushima Daiichi Nuclear Power Plant accident on hemodialysis facilities: an evaluation of radioactive contaminants in water used for hemodialysis.

    Science.gov (United States)

    Kamei, Daigo; Kuno, Tsutomu; Sato, Sumihiko; Nitta, Kosaku; Akiba, Takashi

    2012-02-01

    Following the crisis at the Fukushima Daiichi Nuclear Power Plant caused by the 2011 Tohoku earthquake and tsunami, radioactive substances ((131) I, (134) Cs, (137) Cs) were detected in tap water throughout eastern Japan. There is now concern that internal exposure to radioactive substances in the dialysate could pose a danger to hemodialysis patients. Radioactive substances were measured in three hemodialysis facilities before and after purification of tap water for use in hemodialysis. Radioactive iodine was detected at levels between 13 and 15 Bq/kg in tap water from the three facilities, but was not detected by reverse osmosis membrane at any of the facilities. We confirmed that the amount of radioactive substances in dialysate fell below the limit of detection (7-8 Bq/kg) by reverse osmosis membrane. It is now necessary to clarify the maximum safe level of radiation in dialysate for chronic hemodialysis patients. PMID:22248201

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

    Scientific Electronic Library Online (English)

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

    2007-09-01

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

  3. Early open surgery for the accidental insertion of a hemodialysis catheter into the carotid artery: a case report

    Directory of Open Access Journals (Sweden)

    Yosuke Moteki

    2014-12-01

    Full Text Available Insertion of a hemodialysis catheter into the internal jugular vein is a commonly performed procedure for intermittent hemodialysis. However, arterial misplacement of the hemodialysis catheter can occur and lead to serious complications, such as major stroke due to intra-arterial thrombus. Here, we report a case in which open surgery was performed to avoid major stroke following the accidental insertion of a hemodialysis catheter into the common carotid artery. We suggest that early open surgery should be performed as soon as possible if the accidental insertion of a hemodialysis catheter into the carotid artery is recognized.

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2012-08-01

    Full Text Available FUNDAMENTO: Pacientes com doença renal crônica (DRC) em hemodiálise possuem altas taxas de morbidade e mortalidade cardiovascular. Apesar de alterações ecocardiográficas estruturais e funcionais em pacientes submetidos à hemodiálise terem sido objeto de diversos estudos de análise de sobrevida, o va [...] lor prognóstico destas alterações ainda não está bem estabelecido na literatura. OBJETIVO: Determinar o valor prognóstico de parâmetros ecocardiográficos em pacientes com DRC em hemodiálise. MÉTODOS: Sessenta pacientes consecutivos com DRC em tratamento hemodialítico foram avaliados clinicamente e submetidos ao ecodopplercardiograma, sendo acompanhados durante 19 ± 6 meses. Os desfechos avaliados foram eventos cardiovasculares fatais e não fatais e mortalidade geral. O valor preditivo das variáveis ecocardiográficas foi avaliado pelo modelo de regressão de Cox, as curvas de sobrevida foram construídas pelo método de Kaplan-Meier e o teste log rank foi utilizado para compará-las. RESULTADOS: As taxas de sobrevida livre de eventos cardiovasculares, de mortalidade cardiovascular e de mortalidade global em dois anos foram de 79,4%, 88,5% e 83%, respectivamente. Diabetes, diagnóstico prévio de doença cardiovascular (DCV), fração de ejeção, fração de encurtamento, diâmetro sistólico do ventrículo esquerdo e relação E/e' foram preditores de desfecho cardiovascular na análise univariada. Na análise multivariada, história prévia de DCV (HR = 6,17; IC 95% 1,7 - 22,2; p = 0,005) e disfunção diastólica moderada a grave (HR = 3,76; IC 95% 1,05 - 13,4; p = 0,042) foram fatores de risco independentes para eventos cardiovasculares. CONCLUSÃO: Disfunção diastólica de moderada a grave é um preditor independente de eventos cardiovasculares em pacientes em hemodiálise. Abstract in english BACKGROUND: Patients with chronic kidney disease (CKD) on hemodialysis have high rates of cardiovascular morbidity and mortality. Although structural and functional echocardiographic alterations in patients undergoing hemodialysis ha