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Continuous Performance Test in Iranian Patients Undergoing Hemodialysis  

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"nObjective: Memory and concentration may be affected by hemodialysis in "nend-stage renal disease. In this study, changes in cognitive function "nparameters such as attention, impulsiveness, and reaction time were "nmeasured and evaluated in the Iranian hemodialysing patients. "nMethods: In this analytic observational study, cognitive function of 38 "nhemodialysis patients was measured before and after hemodialysis sessions "nusing Conners' continuous performance test. "nResults: Mean a...

Mostafa Najafi; Hamid Nasri; Mohammad Ebrahim Rastegari

2006-01-01

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Continuous Performance Test in Iranian Patients Undergoing Hemodialysis  

Directory of Open Access Journals (Sweden)

Full Text Available "nObjective: Memory and concentration may be affected by hemodialysis in "nend-stage renal disease. In this study, changes in cognitive function "nparameters such as attention, impulsiveness, and reaction time were "nmeasured and evaluated in the Iranian hemodialysing patients. "nMethods: In this analytic observational study, cognitive function of 38 "nhemodialysis patients was measured before and after hemodialysis sessions "nusing Conners' continuous performance test. "nResults: Mean age of patients was 37.97 ± 12.58 years. There wasn't any "nsignificant difference between numbers of matches successfully recognized, "nnumber of Miss Faire and mean of reaction time of those matches "nsuccessfully recognized before and after hemodialysis. There weren't any "ndifferences between history of hemodialysis and number of matches "nsuccessfully, matches missed and mean reaction time of matches. "nEducational level of patients was significant effect on number of Miss Faire "nduring hemodialysis. "nConclusions: It has been concluded that hemodialysis did not have any "nsignificant impact on the cognitive function. However, this hypothesis needs "nto be checked and confirmed by careful selection of patients and other "ncognitive function tests.

Mohammad Ebrahim Rastegari

2006-08-01

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

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Full Text Available Background: Chronic microinflammatory state is common in the patients undergoing maintenance hemodialysis (MHD, which seriously affects the long-term survival rate of MHD patients. It is important to improve the microinflammatory state in MHD patients.Objective: To investigate the effects of oxymatrine on microinflammatory state in patients undergoing continuous hemodialysis.Design, setting, participants and interventions: Sixty MHD patients in Blood Purification Center, Wuhan No.1 Hospital, from June to September 2008, were randomized into treatment group (30 cases and control group (30 cases. Oxymatrine Capsule was orally administered to the patients in the treatment group 0.4 g once a day for 3 months, while the patients in the control group were not given oxymatrine. Main outcome measures: The serum concentrations of high-sensitivity C-reactive protein (hs-CRP, interleukin-1?(IL-1?, tumor necrosis factor-? (TNF-?, albumin (Alb, pre-albumin (PAB, total cholesterol (TC and triglyceride (TG were detected before and after 3-month treatment.Results: Three patients in the treatment group had a stomachache on the first day of treatment, and two out of the three quitted the trial. The stomachache disappeared in one patient after stopping taking the drug, and did not recur after continuing to receive the intervention. Two patients in the treatment group had skin rash with pruritus on the second day of treatment. The rash disappeared after the patients stopped taking the drug, and did not recur after continuing to receive the intervention. A total of 58 cases accessed to the statistical analysis, while 2 cases were excluded. In the treatment group, the concentrations of hs-CRP, IL-1? and TNF-? significantly decreased (P<0.01 and the mean values of Alb, PAB, TC and TG significantly increased after the treatment as compared with those before the treatment (P<0.01, but there were no significant differences in all parameters between before and after treatment in the control group. There were significant differences in all parameters between the treatment group and the control group after treatment (P<0.01, P<0.05.Conclusion: Oxymatrine can improve the microinflammatory state in the patients undergoing continuous hemodialysis.

Wen-xiang ZHOU

2009-08-01

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Prevalence of Pulmonary Hypertension in Patients Undergoing Hemodialysis  

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Introduction. Pulmonary hypertension (PH) is one of the most important accompanying comorbidities with hemodialysis in patients with end-stage renal disease. The prevalence of hemodialysis-induced PH is still a subject of debate. The goal of the present work was to determine the prevalence of PH in patients undergoing hemodialysis.Materials and Methods....

Abbas Fadaii; Homayoun Koohi Kamali; Bahador Bagheri; Fatemeh Hamidimanii; Bahar Taherkhanchi

2013-01-01

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[Echocardiographic alterations in patients with chronic kidney failure undergoing hemodialysis].  

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Changes in cardiac structure and function detected by echocardiography are common in patients with chronic kidney disease undergoing hemodialysis, and have been recognized as key outcome predictors. This review attempts to summarize recent evidence pointing to the usefulness of the method in the detection of clinical and subclinical cardiac dysfunction, stratification of cardiovascular risk and assessment of intervention strategies. PMID:20414538

Barberato, Silvio Henrique; Pecoits-Filho, Roberto

2010-01-01

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Ototoxicity Probably Due To Isoniazid in a Patient Undergoing Hemodialysis  

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

Deniz YERDELEN

2008-03-01

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

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Full Text Available SciELO Brazil | Language: English Abstract in english OBJECTIVE: The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis. PATIENTS AND METHODS: Twenty patients on p [...] eritoneal dialysis and 40 on hemodialysis were assessed, and the patients were matched according to the length of time that they had been on dialysis. Blood samples were collected (both before and after the session for those on hemodialysis) to measure the enzymes and the hematocrit. RESULTS: In the samples from the patients who were undergoing peritoneal dialysis, the aspartate and alanine aminotransferase levels were slightly higher compared with the samples collected from the patients before the hemodialysis session and slightly lower compared with the samples collected after the hemodialysis session. The levels of gamma-glutamyl transferase in the hemodialysis patients were slightly higher than the levels in the patients who were undergoing peritoneal dialysis. In addition, the levels of aminotransferases and gamma-glutamyl transferase that were collected before the hemodialysis session were significantly lower than the values collected after the session. The hematocrit levels were significantly lower in the patients who were on peritoneal dialysis compared with the patients on hemodialysis (both before and after the hemodialysis session), and the levels were also significantly lower before hemodialysis compared with after hemodialysis. CONCLUSION: The aminotransferase levels in the patients who were undergoing peritoneal dialysis were slightly higher compared with the samples collected before the hemodialysis session, whereas the aminotransferase levels were slightly lower compared with the samples collected after the session. The hematocrits and the aminotransferase and gamma-glutamyl transferase levels of the samples collected after the hemodialysis session were significantly higher than the samples collected before the session. Taken together, the present data suggest that hemodilution could alter the serum levels of liver enzymes.

Isabella Ramos de Oliveira, Liberato; Edmundo Pessoa de Almeida, Lopes; Maria Alina Gomes de Mattos, Cavalcante; Tiago Costa, Pinto; Izolda Fernades, Moura; Luiz, Loureiro Júnior.

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

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Full Text Available OBJECTIVE: The present study was designed to analyze the serum levels of aspartate and alanine aminotransferases, gamma-glutamyl transferase, and the hematocrit in patients with chronic kidney disease who were undergoing peritoneal dialysis or hemodialysis. PATIENTS AND METHODS: Twenty patients on peritoneal dialysis and 40 on hemodialysis were assessed, and the patients were matched according to the length of time that they had been on dialysis. Blood samples were collected (both before and after the session for those on hemodialysis to measure the enzymes and the hematocrit. RESULTS: In the samples from the patients who were undergoing peritoneal dialysis, the aspartate and alanine aminotransferase levels were slightly higher compared with the samples collected from the patients before the hemodialysis session and slightly lower compared with the samples collected after the hemodialysis session. The levels of gamma-glutamyl transferase in the hemodialysis patients were slightly higher than the levels in the patients who were undergoing peritoneal dialysis. In addition, the levels of aminotransferases and gamma-glutamyl transferase that were collected before the hemodialysis session were significantly lower than the values collected after the session. The hematocrit levels were significantly lower in the patients who were on peritoneal dialysis compared with the patients on hemodialysis (both before and after the hemodialysis session, and the levels were also significantly lower before hemodialysis compared with after hemodialysis. CONCLUSION: The aminotransferase levels in the patients who were undergoing peritoneal dialysis were slightly higher compared with the samples collected before the hemodialysis session, whereas the aminotransferase levels were slightly lower compared with the samples collected after the session. The hematocrits and the aminotransferase and gamma-glutamyl transferase levels of the samples collected after the hemodialysis session were significantly higher than the samples collected before the session. Taken together, the present data suggest that hemodilution could alter the serum levels of liver enzymes.

Isabella Ramos de Oliveira Liberato

2012-01-01

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Continuous monitoring of urea levels during hemodialysis.  

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An ammonium ion-specific electrode system is evaluated for analysis of blood urea nitrogen from serum, plasma ultrafiltrate, or hemodialyzer dialysate fluid. The electrode shows a high sensitivity over clinically useful concentration ranges. Free serum ammonia, volatile amines, or urea ammonia after hydrolysis can be measured. In a double blind study excellent correlation was found for 187 blood urea nitrogen samples measured with the electrode with standard auto-analyzer techniques. Continuous monitoring of urea in dialysate fluid is described. Urea clearances were measured from dialysate effluent from an in vitro dialysis using conventional equipment. These values show excellent correlation to those from stnadard analysis methods. A continuous urea sensor for on-line hemodialysis application which can provide quantification of therapy is described. PMID:357303

Klein, E; Montalvo, J G; Wawro, R; Holland, F F; Lebeouf, A

1978-05-01

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

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

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

2014-03-01

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Use of herbal remedies among patients undergoing hemodialysis.  

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This study aims to determine the prevalence, types, and associated factors for the use of herbal remedies in hemodialysis patients. Two hundred participants were selected by stratified sampling and were systematically interviewed. One hundred and twenty-six patients (63%) had used herbal remedies some time since their initiation of dialysis treatment. The users of herbal remedies had a significantly older age than nonusers, but no other significant differences were observed. The most prevalent complaints that led to herbal remedies use were gastroenterological complaints, flushing, and excessive thirst. Cichorium intybus, Borage officinalis, Mentha longifolia, and Matricaria recutita were the most prevalently used herbs in our patients. More study should be done on safety and efficacy of these herbs for hemodialysis patients. PMID:24241097

Roozbeh, Jamshid; Hashempur, Mohammad Hashem; Heydari, Mojtaba

2013-11-01

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Association of systemic collagen type IV formation with survival among patients undergoing hemodialysis  

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The 7S domain of collagen type IV (P4NP_7S) assessed in plasma represents systemic collagen type IV formation. The objective of the study was to investigate the association of systemic collagen type IV formation with survival among patients undergoing hemodialysis.

Leeming, Diana Julie; Karsdal, Morten A

2013-01-01

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Oral and salivary changes among renal patients undergoing hemodialysis: A cross-sectional study  

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We wanted to assess oral and salivary changes in end stage renal disease (ESRD) patients undergoing hemodialysis (HD) and to understand the correlation of such changes with renal insufficiency. The cross-sectional study was performed among 100 ESRD patients undergoing HD. Among these, 25 patients were randomly selected to assess the salivary changes and compared with 25 apparently healthy individuals who formed the control group. Total duration of the study was 15 months. Oral malodor, dry mo...

Kaushik, A.; Reddy, S. S.; Umesh, L.; Devi, B. K. Y.; Santana, N.; Rakesh, N.

2013-01-01

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Correlation of Serum Parathormone With Hypertension in Chronic Renal Failure Patients Undergoing Hemodialysis  

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Full Text Available Purpose: To consider the effect of serum parathormone on severity of hypertension in end-stage renal failure patients undergoing hemodialysis treatment. Patients and Methods: A cross-sectional study was performed on patients with end-stage renal disease undergoing maintenance hemodialysis treatment. Serum calcium, phosphorus, alkalene phosphatase, serum albumin and intact PTH levels were measured. Stratification of hypertensive patients was performed from stage one to three. A stage of zero means the absence of hypertension. Stages of hypertension were measured before treatment and at the beginning of the first hemodialysis treatment. Results: The total number of patients was 73 (F=28 M=45, including 58 non-diabetic (F=22 M=36 and 15 diabetic hemodialysis patients (F=6 M=9. The mean age of patients was 46.5±16 years. The mean period of time that patients had spent on hemodialysis was 21.5±23.5 months. Serum iPTH of total patients was 309±349 pg/ml and serum alkaline phosphatase of total patients was 413±348 IU/L. There was a significant positive correlation between the stages of hypertension and serum iPTH levels (r=0.200; p=0.045. There was no significant correlation between the stages of hypertension and serum alkalene phosphatase levels (r=0.135; p=0.128. A significant positive correlation between stages of hypertension with Ca x P products of patients (r = 0.231; p=0.027 was also seen. Conclusion: The relationship between serum iPTH and severity of hypertension in this group requires further research on nontraditional causes of hypertension in hemodialysis patients. Hypertension and secondary hyperparathyroidism both interact in the process of accelerated atherosclerosis in hemodialysis patients. This combination may aggravate the rapid progressive athrosclerosis process

Baradaran, A.

2006-01-01

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Lipoprotein (a) levels in patients undergoing continuous ambulatory peritoneal dialysis.  

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Most researchers have found increases of lipoprotein (a) [Lp(a)] in uremic patients, as well as in those undergoing hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). The mechanisms for this increase remain unclear. We studied 71 patients undergoing CAPD, 48 men and 23 women. According to the time spent on CAPD, the patients were divided into three groups: group 0: 29 patients at the starting off point of dialysis treatment; group I: 22 patients with an average stay of 15.2 months; group II: 20 patients with an average stay of 69.3 months on CAPD. We have only observed significant increases of Lp(a) levels in those patients initiating the dialysis, but no significant differences are found in the other groups undergoing CAPD for longer periods when compared to the control group. We found no significant relation between Lp(a) levels and peritoneal protein loss, and not with absorption of glucose from the dialysate either. We have found a positive and significant correlation between Lp(a) levels and urinary protein loss (r = 0.41; p < 0.001). It is possible that an element associated with proteinuria might have an effect on the metabolism of Lp(a) in CAPD patients. PMID:8728199

Guindeo, C; Vega, N; Fernandez, A M; Palop, L; Aguilar, J A; Moreda, A; Cia, P

1996-01-01

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Sonographic measurement of renal size in patients undergoing chronic hemodialysis: Correlation with residual renal function  

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Previous studies have reported that renal size may change when the function is compromised. However, it is not known whether sonographically measured renal size reflects the residual renal function (RRF) in patients undergoing chronic hemodialysis. A total of 140 patients undergoing chronic hemodialysis (?3 months) were investigated in the present study. The patients were divided into two groups according to the daily urine volume: Individuals with RRF (RRF+ group; ?200 ml; n=65) and without RRF (RRF? group; <200 ml; n=75). Renal sizes were measured using sonography and renal volumes were calculated with the ellipsoid formula. Univariable and multivariable stepwise forward logistic regression analyses were performed to examine the correlation between the presence of RRF and various variables. The results indicated that there were statistically significant differences (P<0.001) between the RRF+ and RRF? groups with regard to renal length, width, thickness and volume of the left (length, 7.9±1.2 vs. 6.8±1.2 cm; volume, 60.0±26.7 vs. 40.2±18.1 ml, respectively) and right (length, 7.6±1.2 vs. 6.7±1.2 cm; volume, 50.2±26.5 vs. 33.9±15.3 ml, respectively) sides of the kidney. Multivariable stepwise forward logistic regression analyses showed that the mean renal length or volume and hemodialysis duration were independent predictors of the presence of RRF. Therefore, renal size assessment by ultrasonography may be useful for RRF evaluation in patients undergoing chronic hemodialysis.

ZHANG, WU-XING; ZHANG, ZHI-MIN; CAO, BING-SHENG; ZHOU, WEI

2014-01-01

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Novel approach for bacteremia detection in patients with end-stage renal failure undergoing hemodialysis.  

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Severe systemic infections are one of the leading causes of death in patients with end-stage renal disease and are often associated with hospitalization. Since bacteria can be identified in used hemofilters in an ICU setting, it was investigated whether this method might be useful in patients undergoing regular intermittent hemodialysis. By analyzing used hemodialyzers in (n = 13) patients, we identified systemic bacteremia in two patients (15.4%) while corresponding blood cultures were negative. In two further patients, positive microbiological findings from hemodialyzers appeared to be of unclear clinical relevance. Cultures from hemodialyzers might be an add-on approach for the identification of bacteria in the blood stream of patients undergoing regular intermittent hemodialysis. PMID:23918272

Otto, Gordon P; Kropf, Madlen; Rödel, Jürgen; Lösche, Wolfgang; Rüster, Christiane; Claus, Ralf A; Sossdorf, Maik; Busch, Martin

2013-10-01

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

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

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

2012-08-01

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Expanded CD14+ CD16+ Monocyte Subpopulation in Patients with Acute and Chronic Infections Undergoing Hemodialysis  

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Infections are frequent complications in end-stage renal failure patients undergoing hemodialysis (HD), and peripheral blood monocytes are important cells in host defense against infections. The majority of circulating monocytes express high levels of lipopolysaccharide receptor antigen CD14 and are negative for the immunoglobulin Fc? receptor type III (CD16). We studied the occurrence of a minor subpopulation coexpressing low levels of CD14 together with CD16 in HD patients. In healthy cont...

Nockher, Wolfgang Andreas; Scherberich, Ju?rgen E.

1998-01-01

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Evaluation of Conner?s Continuous Performance Test in Hemodialysis Patients  

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Memory and cognitive abnormalities such as decreased attention span, impulsiveness, and slow reaction are common among chronic hemodialysis patients. We studied the changes these parameters in 38 hemodialysis patients before and after hemodialysis sessions via Conner?s continuous performance test. Mean age of the study patients was 38.0 ± 12.6 years. There was no significant difference before and after hemodialysis in the number of the successfully recognized matches, the number...

Najafi Mostafa

2008-01-01

 
 
 
 
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Effects on caregiver burden of education related to home care in patients undergoing hemodialysis.  

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Caring for a patient undergoing hemodialysis is highly stressful and can negatively affect a caregiver's physical and psychological well-being. This study was conducted to examine the effect of educational support concerning caregiver burden and given to the caregivers of hemodialysis patients. This experimental study was performed with 122 caregivers. Patients' data were collected by means of Personal Information Form and Zarit Caregiver Burden Scale (ZCBS). Characteristics of caregivers of hemodialysis patients were analyzed descriptively in terms of frequencies and percentages for categorical data, means, and standard deviations. Mann-Whitney U test, Kruskall-Wallis test, and percentages were used in the data analysis. The mean ZCBS score was 52.1?±?8.6 (range, 0-88). Among the caregivers, the mean score of the ZCBS was significantly higher in women, single, young, family relatives as "daughter/sister/brother/daughter-in-law and town/district, high educational level (P?caregivers who have health problems/diseases. In addition, this study explored the educational needs of home-based such as nutrition (35.2%), dialysis (27.8%), fistula care (20.4%), catheter care (18.8%), the information about chronic kidney disease (18.0%), blood pressure (17.2%), weight control (17.2%), hygiene (3.1%), and travel/exercise (6.5%). The post-educational mean scores (55.0?±?7.6) of caregiver burden were observed to be lower than the pre-educational scores (43.9?±?5.2), and the difference was found to be statistically significant. The home-based educational program demonstrated a decrease in the burden of hemodialysis caregivers. PMID:23279118

Mollao?lu, Mukadder; Kayata?, Mansur; Yürügen, Birsen

2013-07-01

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Spirometry Parameters in Patients Undergoing Hemodialysis With Bicarbonate and Acetate Dialysates  

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Full Text Available Introduction. End-stage renal disease causes impairment of all body organs including the heart and the lung. The main problems in the afflicted patients are pulmonary edema due to increased permeability of the capillaries, intravascular and interstitial volume overload, hypertension, and congestive heart failure. These changes cause altered physiologic and mechanical function of the lungs and subsequently increase in airway resistance. We aimed to study the impact of hemodialysis on spirometry parameters.Materials and Methods. In a cross-sectional study performed on 41 patients on maintenance hemodialysis, spirometry was done before and after the dialysis session. The patients were on either acetate or bicarbonate hemodialysis with the same method, dialysis machine, and duration of dialysis. Alterations in spirometry parameters including forced expiratory volume in the first second (FEV1, forced vital capacity (FVC, FEV1/FVC ratio, and maximal midexpiratory flow rate were determined and their relation with serum electrolytes, serum creatinine, blood urea nitrogen, and hemoglobin were analyzed.Results. Twenty-nine patients undergoing dialysis with bicarbonate dialysate and 21 on dialysis with acetate were compared. Improvement in spirometry parameters was only significant in patients undergoing dialysis with bicarbonate dialysate. All spirometry parameters showed significant increases in the bicarbonate group except for the FEV1/FVC ratio. Furthermore, significant increase in these parameters was only prominent in the men. Postdialysis weight reduction and laboratory indexes had no significant correlation with improvement of spirometry parameters. Conclusions. Dialysis with bicarbonate dialysate causes significant improvement in spirometry parameters in men on maintenance dialysis. This effect might be independent of the effect of removing the volume overload by dialysis.

Kazem Navari

2009-04-01

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

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

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

2014-05-01

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[Third-line therapy in a patient with recurrent colon cancer undergoing hemodialysis].  

Science.gov (United States)

A 68-year-old man undergoing hemodialysis (HD) was diagnosed with recurrence of colon cancer and liver metastasis. He was treated with oxaliplatin, folinic acid and 5-fluorouracil (FOLFOX4), folinic acid, 5-fluorouracil and irinotecan (FOLFIRI), FOLFIRI+bevacizumab (BV), and cetuximab+irinotecan (CPT-11) as third-line therapy. Each drug was adequately reduced over time, but cetuximab was administered at the standard dose. The patient died of methicillin-resistant Staphylococcus aureus (MRSA) meningitis during the course of cetuximab+CPT-11 therapy, but there was no relation between the meningitis and the therapy. Therefore, each regimen can be safely performed, and cetuximab+CPT-11 therapy showed a significant anti-tumor effect and hence may be an effective regimen. PMID:24196079

Matsuda, Masaki; Seyama, Yasuji; Inada, Kentaro; Miyata, Yoichi; Shida, Dai; Maeshiro, Tsuyoshi; Miyamoto, Sachio; Umekita, Nobutaka

2013-10-01

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

Science.gov (United States)

Introduction Anemia associated with chronic kidney disease is a serious complication necessitating expenditure of huge medical efforts and resources. This study investigates the role of alpha-lipoic acid (ALA) in end stage renal disease patients undergoing hemodialysis. By the virtue of its antioxidative effects, ALA is expected to act as an erythropoietin (EPO) adjuvant, and also has extended beneficial effects on endothelial dysfunction. Methods Forty-four patients undergoing hemodialysis and receiving EPO were randomized into two groups: the first group received ALA 600 mg once daily for 3 months; while the other group represented the control group. Parameters measured at baseline and at end of study were hemoglobin, EPO doses, EPO resistance index (ERI), iron store indices, malondialdehyde, oxidized low-density lipoprotein (ox-LDL), interleukin-6 (IL-6), tumor necrosis factor-? (TNF-?), and asymmetric dimethylarginine (ADMA), as well as routine laboratory follow-up. Results EPO doses and ERI were significantly decreased in the treatment group, while they did not change in the control group. Hemoglobin, iron store indices, malondialdehyde, oxidized ox-LDL, IL-6, TNF-?, and ADMA were similar in both treatment and control groups at baseline, and did not change by the end of study period. Likewise, routine laboratory measures were not affected by the treatment. Conclusion ALA could be used in hemodialysis patients to reduce requirements for EPO. However, larger and longer term studies are required to clarify the exact role of ALA in hemodialysis as well as in pre-hemodialysis patients.

El-Nakib, Gehad A; Mostafa, Tarek M; Abbas, Tarek M; El-Shishtawy, Mamdouh M; Mabrouk, Mokhtar M; Sobh, Mohammed A

2013-01-01

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Continuous arteriovenous hemodialysis: an alternative therapy for acute renal failure associated with critical illness.  

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Critically ill patients often cannot tolerate conventional hemodialysis because of hemodynamic instability. Continuous arteriovenous hemofiltration provides control of fluid and electrolyte balance but is inefficient in the management of azotemia. Continuous arteriovenous hemodialysis (CAVHD) combines dialysis with hemofiltration. We performed 15 CAVHD treatments of 2 or more days' duration in 12 critically ill patients aged 23 to 85 (mean 64.4) years who had acute oliguric renal failure as a...

Gibney, R. T.; Stollery, D. E.; Lefebvre, R. E.; Sharun, C. J.; Chan, P.

1988-01-01

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Evaluation of Conner?s Continuous Performance Test in Hemodialysis Patients  

Directory of Open Access Journals (Sweden)

Full Text Available Memory and cognitive abnormalities such as decreased attention span, impulsiveness, and slow reaction are common among chronic hemodialysis patients. We studied the changes these parameters in 38 hemodialysis patients before and after hemodialysis sessions via Conner?s continuous performance test. Mean age of the study patients was 38.0 ± 12.6 years. There was no significant difference before and after hemodialysis in the number of the successfully recognized matches, the number of the miss fires, and the mean of reaction time of matches. In addition, there was no significant effect of the duration of hemodialysis therapy on the number of successfully recognized matches, the number of missed matches, and the mean reaction time of matches. Educational level of patients did not significantly impact on the number of successfully recognized matches and the mean of reaction time of matches. However, this impact was significant on the number of miss fires during hemodialysis. (P = 0.04. We conclude from our results that hemodialysis did not significantly impact on the cognitive function. However, this hypothesis must be confirmed by other cognitive function tests on larger hemodialysis population.

Najafi Mostafa

2008-01-01

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

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

Rias Pratiwi Safitri

2013-05-01

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

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Full Text Available Abstract Introduction In the treatment of secondary hyperparathyroidism of chronic kidney disease, calcimimetics - allosteric modulators of the calcium-sensing receptor - inhibit glandular hyperplasia and significantly reduce circulating parathyroid hormone levels. They have a major impact on the management of secondary hyperparathyroidism. Case presentation We present the clinical case of a 41-year-old Caucasian man undergoing chronic hemodialysis, who had a parathyroidectomy to treat severe secondary hyperparathyroidism resistant to cinacalcet treatment. Preoperatively, 24 months after high-dose cinacalcet hydrochloride, we observed a persistently elevated intact parathyroid hormone serum level, and detected clear parathyroid gland hyperplasia regression on ultrasound. We performed a three-gland parathyroidectomy, which was assumed to be total, associated with a hemithyroidectomy. Our patient then entered a hypoparathyroid state. A histopathological examination showed that the removed parathyroid glands were of small size, with a total weight of 1g, associated with a multifocal small papillary thyroid cancer. Conclusion In the management of secondary hyperparathyroidism, cinacalcet hydrochloride effectively reduces total parathyroid gland hyperplasia. However, a persisting elevated intact parathyroid hormone serum level may be observed, demonstrating that reduced parathyroid hyperplastic tissue may still be associated with severe secondary hyperparathyroidism. Even if calcimimetics are very effective in secondary hyperparathyroidism treatment, further studies are necessary for a better understanding of their actions.

Conzo Giovanni

2012-12-01

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

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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.

Santos Paulo

2012-08-01

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Increased body aluminum. An independent risk factor in patients undergoing long-term hemodialysis?  

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The clinical course and aluminum status of 38 patients who had been receiving dialysis for at least eight years and were still undergoing dialysis in 1985 were evaluated. Twenty-nine had evidence of increased aluminum burden, although only three had evidence of overt aluminum toxicity, and nine did not have evidence of increased aluminum burden. The patients in both the high- and low-aluminum group were similar with regard to age, the cause of their renal failure, presence of hypertension or coronary artery disease, previous parathyroidectomy, and a number of biochemical parameters, along with the amount of prescribed aluminum. All patients were followed up for the next two years or until they died. The amount of ingested aluminum was reduced, and in selected patients, treatment with intermittent infusions of deferoxamine mesylate was instituted. There were no deaths in the low-aluminum group, but ten of 29 died in the high-aluminum group: seven of vascular disease and three of infection. In addition, morbidity as defined by hospitalization for coronary or cerebral vascular disease or infection occurred in only two of the nine patients in the low-aluminum group and in 19 of the 29 patients in the high-aluminum group. These observations imply that the occurrence of increased body aluminum, as suggested by aluminum blood levels or by results of bone biopsies in some patients, has an adverse effect on morbidity and mortality and should be considered as a possible independent risk factor in patients who are receiving long-term hemodialysis. PMID:3401104

Chazan, J A; Blonsky, S L; Abuelo, J G; Pezzullo, J C

1988-08-01

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Increased body aluminum. An independent risk factor in patients undergoing long-term hemodialysis  

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The clinical course and aluminum status of 38 patients who had been receiving dialysis for at least eight years and were still undergoing dialysis in 1985 were evaluated. Twenty-nine had evidence of increased aluminum burden, although only three had evidence of overt aluminum toxicity, and nine did not have evidence of increased aluminum burden. The patients in both the high- and low-aluminum group were similar with regard to age, the cause of their renal failure, presence of hypertension or coronary artery disease, previous parathyroidectomy, and a number of biochemical parameters, along with the amount of prescribed aluminum. All patients were followed up for the next two years or until they died. The amount of ingested aluminum was reduced, and in selected patients, treatment with intermittent infusions of deferoxamine mesylate was instituted. There were no deaths in the low-aluminum group, but ten of 29 died in the high-aluminum group: seven of vascular disease and three of infection. In addition, morbidity as defined by hospitalization for coronary or cerebral vascular disease or infection occurred in only two of the nine patients in the low-aluminum group and in 19 of the 29 patients in the high-aluminum group. These observations imply that the occurrence of increased body aluminum, as suggested by aluminum blood levels or by results of bone biopsies in some patients, has an adverse effect on morbidity and mortality and should be considered as a possible independent risk factor in patients who are receiving long-term hemodialysis.

Chazan, J.A.; Blonsky, S.L.; Abuelo, J.G.; Pezzullo, J.C.

1988-08-01

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Nutritional issues in peritoneal dialysis patients: how do they differ from that of patients undergoing hemodialysis?  

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It is important to understand the unique aspects vis-à-vis protein-energy wasting for patients undergoing PD. As a result of obligatory protein losses with the therapy, the serum albumin levels of patients undergoing PD are lower, as is the threshold serum albumin at which the risk for death is increased. Consequently, it is prudent to consider a lower threshold for serum albumin for the diagnosis of protein-energy wasting for patients undergoing PD. Likewise, it is important to consider the energy intake from obligatory nutrient absorption in the form of carbohydrates when estimating total energy intake (diet and dialysate) when evaluating patients for protein-energy wasting. The continuous nature of PD also has important therapeutic implications for protein-energy wasting. Such patients are more likely to have a complete correction of metabolic acidosis, and glucose absorption from the peritoneal dialysate has a protein-sparing effect, allowing some patients to maintain neutral nitrogen balances in the face of suboptimal protein intake. In contrast, clinical trials of amino-acid-based PD solutions have not met expectations and cannot be recommended for routine use for treatment of protein-energy wasting. In conclusion, it is important to consider these unique nutritional considerations when providing care to patients undergoing PD. PMID:23611553

Mehrotra, Rajnish

2013-05-01

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Randomized crossover study of the efficacy and safety of sevelamer hydrochloride and lanthanum carbonate in Japanese patients undergoing hemodialysis.  

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Insufficient control of serum calcium and phosphate levels in patients undergoing hemodialysis is associated with increased mortality. As commonly used calcium-containing phosphate binders can cause arterial calcification, newly developed calcium-free phosphate binders, such as sevelamer hydrochloride (SH) and lanthanum carbonate (LC), have received much attention. We assessed the efficacy and safety of SH and LC treatment in Japanese patients undergoing hemodialysis in a prospective randomized open blinded endpoint (PROBE) crossover study. Forty-two patients were randomized to receive SH or LC for 13 weeks, with the dosages adjusted every 2 weeks, followed by treatment with the other drug for another 13 weeks. The average daily doses of SH and LC were 2971 ± 1464 mg and 945 ± 449 mg, respectively. The mean dosage ratio of SH to LC was 3.05, which was maintained throughout the treatment period. SH and LC were similarly effective at controlling serum calcium and phosphate levels in the majority of patients (78-93%). A few serious adverse events (AEs) involving the biliary system occurred during the LC treatment period, but they were not considered to be treatment-induced. Although the incidence of constipation, the most common treatment-related AE, was higher during the SH period (27% vs. 5%; P < 0.05), no difference was observed in total treatment-related AEs. This study demonstrates that SH and LC are comparable treatments for controlling serum phosphate and calcium levels, and that both compounds are safe and well-tolerated in Japanese patients undergoing hemodialysis. PMID:22817122

Kasai, Satoshi; Sato, Kazuto; Murata, Yaeko; Kinoshita, Yasumichi

2012-08-01

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Pharmacokinetics of gentamicin in patients undergoing continuous ambulatory peritoneal dialysis.  

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Teh pharmacokinetics of gentamicin were studied in seven chronic renal failure patients undergoing continuous ambulatory peritoneal dialysis. Patients received 100 mg of gentamicin in 2 liters of dialysate during an initial pass, and serum and dialysate samples were collected for gentamicin determination. Approximately 49% of the amount introduced into the peritoneal cavity was absorbed systemically during a 6-h cycle. Subsequent clearance of gentamicin from the serum occurred slowly with an ...

Pancorbo, S.; Comty, C.

1981-01-01

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Intraperitoneal insulin in uraemic diabetics undergoing continuous ambulatory peritoneal dialysis.  

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The kinetics of absorption of intraperitoneally administered insulin were studied in nine uraemic insulin-dependent diabetics undergoing continuous ambulatory peritoneal dialysis (CAPD). In each of three studies 20 U of regular insulin was directly injected as a bolus into the peritoneal cavity through an indwelling Tenckhoff catheter. In two procedures the insulin injection was followed by the instillation of either 2 litres of 1.5% dextrose dialysates or 2 litres of 4.5% dextrose dialysate....

Balducci, A.; Slama, G.; Rottembourg, J.; Baumelou, A.; Delage, A.

1981-01-01

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Different response to human recombinant erythropoietin in patients undergoing hemodialysis treatment  

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

Petkovi? Nenad

2013-01-01

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

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

Ghasemi Asghar

2008-01-01

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

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

Mehrdad Sheikhvatan

2010-05-01

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

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

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

 
 
 
 
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Sexual dysfunction associated with hyperprolactinemia in males and females undergoing hemodialysis.  

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Fifty-nine uremic patients (38 males and 21 females) maintained on chronic hemodialysis (CHD) served as the subjects in a study of the relationship between sexual dysfunction and serum prolactin levels (SPL). Sexual desire and activity were evaluated by a self-report sexual function rating scale (SFRS). About half the population of this study reported sexual dysfunction. Males and females reporting disturbance of sexual function had significantly higher SPL than those with normal sexual function. Bromocriptine treatment in five hyperprolactinemic patients reduced SPL to normal range and improved the sexual function. Association between sexual dysfunction and hyperprolactinemia in uremic patients is suggested. PMID:6611804

Weizman, R; Weizman, A; Levi, J; Gura, V; Zevin, D; Maoz, B; Wijsenbeek, H; Ben David, M

1983-06-01

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

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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.

Carlos E. Figueroa Castro

2008-12-01

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

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Full Text Available Abstract Background Tissue injury due to hypoxia and/or free radicals is common in a variety of disease processes. This cross-sectional study aimed to investigate effect of chronic kidney diseases (CKD and hemodialysis (HD on hypoxia and oxidative stress biomarkers. Methods Forty pediatric patients with CKD on HD and 20 healthy children were recruited. Plasma hypoxia induced factor-1? (HIF-1?, vascular endothelial growth factor (VEGF were measured by specific ELISA kits while, total antioxidant capacity (TAC, total peroxide (TPX, pyruvate and lactate by enzymatic/chemical colorimetric methods. Oxidative stress index (OSI and lactate/pyruvate (L/P ratio were calculated. Results TAC was significantly lower while TPX, OSI and VEGF were higher in patients at before- and after-dialysis session than controls. Lactate and HIF-1? levels were significantly higher at before-dialysis session than controls. Before dialysis, TAC and L/P ratio were lower than after-dialysis. In before-dialysis session, VEGF correlated positively with pyruvate, HIF-1? and OSI correlated positively with TPX, but, negatively with TAC. In after-dialysis session, HIF-1? correlated negatively with TPX and OSI; while, OSI correlated positively with TPX. Conclusions CKD patients succumb considerable tissue hypoxia with oxidative stress. Hemodialysis ameliorated hypoxia but lowered antioxidants as evidenced by decreased levels of HIF-1? and TAC at before- compared to after-dialysis levels.

Hamed Enas A

2012-10-01

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

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

Sasajima Koji

2008-11-01

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Effect of Vitamin C Supplementation on C-reactive Protein Levels in Patients Undergoing Hemodialysis: A Randomized, Double Blind, Placebo-Controlled Study  

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Background: Chronic inflammation is the most important cause of cardiovascular disease in patients undergoing hemodialysis, and vitamin C as a major antioxidant which could be effective to suppress inflammation. Objectives: This study was performed to evaluate the effect of vitamin C supplementation on C-reactive protein levels in patients undergoing hemodialysis. Patients and Methods: This randomized, placebo-controlled and double-blind trial was conducted on 151 patients on hemodialysis who were divided randomly by lottery method to three identical groups. In the intervention group, 250 mg of vitamin C was injected intravenously immediately at the end of each hemodialysis session three times a week for 8 weeks in a row. In the control group 1, same term of placebo saline was injected, and in the control group 2, no intervention was performed. Results: A total of 86 (61%) male and 55 female patients with mean hemodialysis duration of 39.74 ± 45.5 months, and a mean age of 61.36 ± 11.46 years-old, participated in this study. Hypertension and diabetes were the most common underlying diseases (79.4%). Median baseline CRP in the intervention, control 1 and control 2 groups were 16.8, 17.8, and 19.4 mg/L respectively. After 2 months, median CRP reduced significantly in the vitamin C group to 10.7 (P = 0.04) vs. 22.6, and 30.6 mg/L in control groups. Conclusions: Our findings demonstrated that vitamin C supplementation modifies the levels of CRP in patients on hemodialysis.

Biniaz, Vajihe; Sadeghi Shermeh, Mehdi; Ebadi, Abbas; Tayebi, Ali; Einollahi, Behzad

2013-01-01

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Fatigue Is a Predictor for Cardiovascular Outcomes in Patients Undergoing Hemodialysis  

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

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

2010-01-01

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The efficacy of mupirocin ointment and chlorhexidine body scrubs in the eradication of nasal carriage of Staphylococcus aureus among patients undergoing long-term hemodialysis  

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Patients undergoing long-term hemodialysis have a high prevalence of Staphylococcus aureus nasal carriage, which may lead to serious infections. Mupirocin ointment has been used intranasally to eradicate S. aureus carriage in health human volunteers and health care workers. Chlorhexidine, an antiseptic with excellent antistaphylococcal activity, is widely used for handwashing and skin cleansing. METHODS: Anterior nares cultures were obtained from patients older than 18 years who were undergoi...

Watanakunakorn, C.; Brandt, J.; Durkin, P.; Santore, S.; Bota, B.; Stahl, C. J.

1992-01-01

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Radiation safety implications of 131I treatment in a patient with Grave's disease undergoing home hemodialysis.  

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The radiation safety implications following the administration of 131I for the treatment of Grave's disease to a patient undergoing home-based renal dialysis was investigated. External dose-rate measurements from the patient revealed a peak value at around day 2, post administration. The effective half-life was determined as 6.5 d. From day 3, the clearance of 131I was observed to be fairly constant and equated to 2.7% per day or 5.4% per dialysis session. From this the biological half-life was determined as 15 d. Radiation monitoring of the dialysis unit, disposables, and bed linen found no detectable contamination. For the purpose of useful protection, at a distance of 1 m from the patient, the average dose rate over the effective treatment duration was determined to be 8 microSv h(-1) and at 2 m distance, 2.6 microSv h(-1). Thus, in order to keep below a level of dose constraint of 3 mSv the total allowable time spent at 1 m would be 375 h or 15 h per day. To comply with a 1-mSv constraint, the average daily exposure allowable at 1 m would be 5 h per day. Neither of these time limits would be difficult to achieve for the majority of situations with fairly modest behavioral constraints. Initial discharge concentration rates into the waste water system are estimated at 200 MBq m(-3) and therefore might need to be considered depending upon the regulatory environment. PMID:17099400

Simpson, J B; Godwin, G A

2006-12-01

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

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

ZHU Fusheng

2013-02-01

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

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

Rahimi A

2008-06-01

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Squeezed coherent state undergoing a continuous nondemolition observation  

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The time evolution of a squeezed coherent state conditioned by the results of a single and double heterodyne measurement is discussed. The mean values of quadratures as well as the dynamics of quadrature uncertainties have been obtained within the framework of the theory of continuous measurements based on filtration equations. It has been found that while the mean values depend on the measured noise, the uncertainties in the optical quadratures are deterministic. Explicit s...

Dabrowska, A.; Staszewski, P.

2012-01-01

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

Scientific Electronic Library Online (English)

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

Fabiana de Souza, Orlandi; Gabriela Dutra, Gesualdo.

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Safety analysis of intermittent hemodialysis in patients with continuous flow left ventricular assist devices.  

Science.gov (United States)

Dialysis centers adopt a cautious approach when it comes to performing intermittent hemodialysis (HD) on patients with continuous flow (CF) left ventricular assist devices (LVADs) because of the potential for volume flux-related complications and absence of pulsatile blood pressure for monitoring. Many patients have to remain hospitalized because of the inability of the dialysis centers to accept them for outpatient dialysis. In this study, the effect of HD was observed in such patients. Between June 2009 and October 2012, 139 patients received LVADs, of which 10 patients (7%) required intermittent HD postoperatively. The mean age of the patients was 53?±?14 years and 90% were men. A total of 281 dialysis sessions were administered amounting to 1025 hours of dialysis. The mean systolic blood pressure monitored with Doppler device was 97?±?18?mmHg. Dialysis durations averaged 218?±?18 minutes. Mean blood flow rate was 334?±?38?cc/min, and 2.6?±?1.1?L was ultrafiltrated during each session. Only 15 (5.3%) sessions were interrupted or terminated in six patients. The reasons for termination were symptomatic hypotension--6 (2.1%), asymptomatic hypotension--3 (1%), ventricular tachycardia--1 (0.36%), dialysis machine malfunction--2 (0.7%), low phosphorus--2 (0.7%), and abdominal cramps--1 (0.36%). Volume expansion was necessary on three occasions. Low-flow device alarms were registered during two (0.71%) sessions. The results showed no serious adverse effects or deaths. PMID:23901838

Quader, Mohammed A; Kumar, Dhiren; Shah, Keyur B; Fatani, Yahya I; Katlaps, Gundars; Kasirajan, Vigneshwar

2014-01-01

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Pharmacokinetics of combination chemotherapy with paclitaxel and carboplatin in a patient with advanced epithelial ovarian cancer undergoing hemodialysis  

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Few reports delineate the pharmacokinetics of combination chemotherapy with paclitaxel and carboplatin in hemodialysis (HD) patients with epithelial ovarian cancer. However, the optimal carboplatin dose and the timing of HD have yet to be elucidated. We presented a case of an advanced-stage epithelial ovarian cancer patient with chronic renal failure requiring HD. After 4 courses of combination chemotherapy consisting of paclitaxel and carboplatin, a partial response was obtained; therefore, ...

Kodama, Junichi; Sasaki, Aiko; Masahiro, Satoko; Seki, Noriko; Kusumoto, Tomoyuki; Nakamura, Keiichiro; Hongo, Atsushi; Hiramatsu, Yuji

2010-01-01

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

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

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

2011-01-01

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

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

Azar Baradaran

2005-12-01

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Assessment of Adequacy of Dialysis in Patients under Continuous Hemodialysis in Kamkar and Hazrat Vali Asr Hospitals, State of Qom, 2006  

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Background and objectives

Hemodialysis is one of the therapeutic modalities of the end stage renal disease (ESRD). As inadequate dialysis is considered a risk factor leading to higher morbidity and mortality, determination of adequacy of dialysis is necessary. This study was conducted to determine adequacy of dialysis in continuous hemodialysis patients in Kamkar and Hazrat Vali Asr Hospitals in the state of Qom, Iran.

...

Mousavi Movahed, S. M.

2012-01-01

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

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

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

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

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Full Text Available Introduction: Hemodialysis patients often develop resistance to recombinant human erythropoietin due to functional Iron Deficiency. In these patients iron therapy can be hazardous leading to hemosiderosis. Recent studies have suggested that intravenous ascorbic acid may be able to improve this hyporeponsiveness. The aim of this study was to evaluate the effect of intravenous ascorbic acid on functional iron deficiency and whether it results in better correction of anemia or not. Methods: Forty hemodialysis patients with serum ferritin >300ug/l, hemoglobin less than 10 gm/dl, and transferrin saturation less than 20% were selected. The reticulocyte index and KT/V was also calculated. Patients were later administered 500 mg intravenous ascorbic acid three times a week for three months. At the end of study, serum ferritin, transferrin saturation, hemoglobin, reticulocyte index and KT/V were rechecked and compared with the base line values by before and after method. Results: Serum ferritin decreased significantly (median base line ferritin 480.45 ug/dl as compared to final ferritin level of 363.78 (P=0.0001, whereas there was a significant rise in hemoglobin concentration (median baseline hemoglobin 8.92 gm/dl compared to 9.88gm/dl (P=0.0001. Transferrin saturation was also significantly raised (median baseline transferrin saturation 17.35% as compared to final level of 25.12% (P= 0.0001. KT/V before and after treatment with ascorbic acid had no significant change (P =0.396. Finally, the rate of decrease in serum ferritin and increase in hemoglobin according to age and duration of dialysis was studied. The effect of ascorbic acid was found to be significantly greater in older patients and those with longer duration of dialysis (P <0.05; but there was no significant relationship between transferrin saturation increase and age or duration of dialysis. Conclusion: Intravenous ascorbic acid may partially correct functional iron deficiency, although anemia is not totally corrected.

AA Shojaie

2006-04-01

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

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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. .

Krotin Mirjana

2007-01-01

 
 
 
 
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Chlamydia-Infected Cells Continue To Undergo Mitosis and Resist Induction of Apoptosis  

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Both anti- and proapoptotic activities have been reported to occur during chlamydial infection. To reconcile the apparent controversy, we compared host cell apoptotic responses to infection with 17 different chlamydial serovars and strains. None of the serovars caused any biologically significant apoptosis in the infected host cells. Host cells in chlamydia-infected cultures can continue to undergo DNA synthesis and mitosis. Chlamydia-infected cells are resistant to apoptosis induction, altho...

Greene, Whitney; Xiao, Yangming; Huang, Yanqing; Mcclarty, Grant; Zhong, Guangming

2004-01-01

62

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)

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

Pakpour, Amir H.; Zedi, Isa mohammadi

2011-01-01

63

Determination of endotoxin levels and their impact on interleukin-1 generation in continuous ambulatory peritoneal dialysis and hemodialysis.  

Science.gov (United States)

Endotoxins represent a family of ubiquitous bacterial lipopolysaccharides found in water and raw materials. These substances have the ability to generate interleukin-1 (IL-1) and induce fever, as well as other acute phase phenomena. A study was undertaken to determine levels of background endotoxin in (1) continuous ambulatory peritoneal dialysis solution, (2) spent dialysate subsequent to overnight dwell, (3) hemodialysis solution, and (4) Limulus amebocyte lysate-reactive material (LAL-RM) in hemodialyzers and patient plasma. Levels of endotoxin in all of the above cases were less than thought to be required to induce biological activity, such as pyrogenicity, through IL-1 generation. Although nanogram amounts of LAL-RM are associated with some hollow-fiber membranes as well as the plasma of patients on those membranes, this material per se does not appear to produce IL-1 in vitro. PMID:3293624

Pearson, F C; Dubczak, J; Weary, M; Anderson, J

1988-01-01

64

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

Scientific Electronic Library Online (English)

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

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

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

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

Anna Bednarek?Skublewska

2010-05-01

66

Microrganismos cariogênicos em pacientes com insuficiência renal crônica em hemodiálise / Cariogenic microorganisms in patients with chronic renal failure undergoing hemodialysis therapy  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Neste estudo comparativo, avaliaram-se a prevalência de cárie, o índice de cálculo, o fluxo salivar e as quantificações de microrganismos cariogênicos na saliva, em pacientes com insuficiência renal crônica submetidos à hemodiálise e em indivíduos normais, pareados quanto a idade e sexo. Não houve d [...] iferença significante entre os grupos em relação aos índices CPOD e CPOS, ao fluxo de saliva total estimulada ou às contagens de estreptococos mutans e lactobacilos em meios seletivos. Notável foi a verificação da grande necessidade de tratamento odontológico e de instruções para o controle de placa pelos pacientes. Estes apresentaram índices de superfícies e dentes cariados e perdidos significantemente maiores, índices de superfícies e dentes restaurados significantemente menores e índice de cálculo significantemente maior do que os indivíduos normais, demonstrando a necessidade da realização de um programa preventivo e curativo para esse grupo de pacientes especiais. Abstract in english Prevalence of dental caries, calculus index, stimulated salivary flow rate and levels of cariogenic microorganisms in saliva of patients with chronic renal failure undergoing hemodialysis were compared to those of normal subjects matched as to age and sex. No significant difference was detected rega [...] rding to DMF indexes, whole saliva flow or mutans streptococci and lactobacilli levels. However, when compared to the controls, patients showed a great need for dental treatment and dental plaque control instruction. They had higher indexes of decayed and missing surfaces and teeth; their filled surfaces and teeth indexes were lower and their calculus index was higher, demonstrating the necessity of a preventive and curative program to these special patients.

FUJIMAKI, Mitsue; ROSA, Odila Pereira da Silva; TORRES, Sérgio Aparecido.

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

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

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

1989-07-15

68

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.

1989-07-01

69

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

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

Ali Kemal KADIROGLU

2010-05-01

70

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

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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 u...

2008-01-01

71

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

Science.gov (United States)

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

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

2014-06-01

72

Comparison of continuous ambulatory peritoneal dialysis and hemodialysis patient survival with evaluation of trends during the 1980s.  

Science.gov (United States)

To evaluate the mortality of continuous ambulatory peritoneal dialysis (CAPD) patients relative to hemodialysis (HD) patients, all Michigan residents 20 to 59 yr of age who initiated therapy for ESRD during the 1980s (N = 4,288) were studied. The study population was stratified by primary renal diagnosis (glomerulonephritis, hypertension, diabetes, other), and analyses were conducted within each group by Cox proportional hazards methods controlling for age, race, sex, and year in which chronic dialysis was initiated. Intent-to-treat (ITT) and treatment history (RxHx) censoring criteria were used. For patients with hypertension or other reported causes of ESRD, there was no significant difference in CAPD and HD patient mortality (relative risk (RR) = 0.99 and 1.05, respectively). In the ITT analysis, both glomerulonephritic (RR = 0.73; P = 0.10) and diabetic patients using CAPD experienced mortality rates lower than their HD counterparts. Among diabetics, this difference ranged from a RR of 0.40 to 0.70, being lowest for younger diabetics and statistically significant (P ITT--RxHx; RR = 1.22 to 1.27; P ITT--RxHx, RR = 1.34 to 1.44; P < 0.001). Differences in mortality by sex and race were not found among nondiabetics, but mortality did increase significantly with age in all groups.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1482753

Nelson, C B; Port, F K; Wolfe, R A; Guire, K E

1992-11-01

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

Science.gov (United States)

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

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

2014-02-01

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

DEFF Research Database (Denmark)

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

Joffe, P; Olsen, F

1989-01-01

75

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

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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.Pacientes em estágio final de doença renal têm duas opções terapêuticas, diálise e...

2005-01-01

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Fiberoptic monitoring of central venous oxygen saturation (PediaSat) in small children undergoing cardiac surgery: continuous is not continuous  

Science.gov (United States)

Background: Monitoring of superior vena cava saturation (ScvO 2) has become routine in the management of pediatric patients undergoing cardiac surgery. The objective of our study was to evaluate the correlation between continuous ScvO 2 by the application of a fiber-optic oximetry catheter (PediaSat) and intermittent ScvO 2 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.

Ricci, Zaccaria

2014-01-01

77

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

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Full Text Available FUNDAMENTOS: A insuficiência renal crônica atinge quase todos os sistemas do organismo, inclusive pele e anexos. As alterações ungueais mais observadas nos pacientes com insuficiência renal crônica são: unhas meio a meio, ausência de lúnula e hemorragia em estilhas. OBJETIVOS: Avaliar o espectro e a frequência de alterações ungueais nos pacientes com IRC, submetidos à hemodiálise (HD, e compará-los com uma amostra pareada da população geral. MÉTODOS: Realizado um estudo caso- controle, pareado por gênero e idade, onde 2 grupos foram estudados com relação às alterações ungueais presentes. RESULTADOS: 86% dos pacientes em HD e 75% do grupo controle tiveram, pelo menos, uma alteração ungueal.Ausência de lúnula (62,9% e unha meio a meio (14,4% as alterações foram estatisticamente relevantes no grupo HD, em relação ao grupo controle (p BACKGROUND: Chronic renal failure affects almost all the systems of the body, including the skin and appendages. The nail disorders most commonly found in patients with chronic renal failure are half and half nails, absent lunula and splinter hemorrhages. OBJECTIVES: To evaluate the spectrum and the frequency of nail disorders in patients with chronic renal failure submitted to hemodialysis and compare them with a paired sample from the general population. METHODS: A case-controlled study paired for gender and age was conducted in which nail disorders were investigated in the two groups. RESULTS: At least one nail disorder was found in 86% of the hemodialysis patients and in 75% of subjects in the control group. Absent lunula (62.9% and half and half nails (14.4% were more common in the hemodialysis group compared to the control group and this difference was statistically significant (p < 0.05. Longitudinal striae were more common in the control group compared to the hemodialysis group (24.1%. CONCLUSIONS: Absent lunula and half and half nails were the most common nail disorders found in patients on hemodialysis, corroborating the findings of previous studies. Longitudinal striae were more common in the control group and future studies may clarify whether structural abnormalities such as absent lunula may be related to this finding.

Marcos Antonio Rodrigues Martinez

2010-06-01

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Association of Serum Homocysteine with Anemia in Maintenance Hemodialysis Patients  

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To investigate the relationship between homocysteine level and anemia in maintenance hemodialysis patients, a cross-sectional study that was conducted on patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis treatment. The study was carried out on 39 (F=15 M=24) stable hemodialysis HD patients. Mean ages of patients were 46?18 years. The length of the time patients had been on hemodialysis was 30?35 months (median: 18 months). The value of serum homocyste...

2005-01-01

79

Hemodialysis and water quality.  

Science.gov (United States)

Over 383,900 individuals in the U.S. undergo maintenance hemodialysis that exposes them to water, primarily in the form of dialysate. The quality of water and associated dialysis solutions have been implicated in adverse patient outcomes and is therefore critical. The Association for the Advancement of Medical Instrumentation has published both standards and recommended practices that address both water and the dialyzing solutions. Some of these recommendations have been adopted into Federal Regulations by the Centers for Medicare and Medicaid Services as part of the Conditions for Coverage, which includes limits on specific contaminants within water used for dialysis, dialysate, and substitution fluids. Chemical, bacterial, and endotoxin contaminants are health threats to dialysis patients, as shown by the continued episodic nature of outbreaks since the 1960s causing at least 592 cases and 16 deaths in the U.S. The importance of the dialysis water distribution system, current standards and recommendations, acceptable monitoring methods, a review of chemical, bacterial, and endotoxin outbreaks, and infection control programs are discussed. PMID:23859187

Coulliette, Angela D; Arduino, Matthew J

2013-01-01

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Assessment of Adequacy of Dialysis in Patients under Continuous Hemodialysis in Kamkar and Hazrat Vali Asr Hospitals, State of Qom, 2006  

Directory of Open Access Journals (Sweden)

Full Text Available Background and objectivesHemodialysis is one of the therapeutic modalities of the end stage renal disease (ESRD. As inadequate dialysis is considered a risk factor leading to higher morbidity and mortality, determination of adequacy of dialysis is necessary. This study was conducted to determine adequacy of dialysis in continuous hemodialysis patients in Kamkar and Hazrat Vali Asr Hospitals in the state of Qom, Iran.Methods This cross sectional descriptive-analytic study was conducted in 2006. The study variables were age, gender, height, weight and duration of dialysis. Data were collected by a questionnaire and URR, dKt/V, eKt/V and pKt/V were calculated. For statistical analysis, t-test, Fisher’s exact test and Pearson correlation were employed. Results Of 238 patients, 51.7% and 48.3% were males and females respectively. The average age was 55.27 ± 16.79 years. Mean values of dKt/V, eKt/V, pKt/V and URR were 1.03 ± 0.232, 0.89 ± 0.196, 1.18 ± 0.254, and 57.46 ± 8.42 respectively. The percent of adequate dialysis in eKt/V, pKt/V and URR were 26.5%, 44.5% and 21% respectively. The mean age of insufficient eKt/V group was higher than adequate eKt/V group and t test showed a significant statistical correlation. Fisher’s exact test showed a significant correlation between adequate eKt/V and female gender, and also between eKt/V and URR. But chi-square test did not show a significant correlation between eKt/V and underling disease.Conclusion We found that hemodialysis is inadequate in a high number of patients. Further studies with larger sample numbers are recommended to determine the underlying cause of this inadequacy. Keywords: Hemodialysis, Dialysis, End Stage Renal Disease

S. M. Mousavi Movahed

2007-07-01

 
 
 
 
81

Dissecting aortic aneurysm in maintenance hemodialysis patients  

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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.

Ounissi M

2009-01-01

82

Case of Peritonitis Caused by Ewingella americana in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis  

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Reports of serious infections caused by Ewingella americana have been rare. A case of E. americana peritonitis in a patient receiving continuous ambulatory peritoneal dialysis is described. This is the first report of E. americana causing such an infection.

Kati, Chryssa; Bibashi, Evangelia; Kokolina, Elisabeth; Sofianou, Danai

1999-01-01

83

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

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

Azar Baradaran

2005-11-01

84

Assessment of Adequacy of Dialysis in Patients under Continuous Hemodialysis in Kamkar and Hazrat Vali Asr Hospitals, State of Qom, 2006  

Directory of Open Access Journals (Sweden)

Full Text Available

Background and objectives

Hemodialysis is one of the therapeutic modalities of the end stage renal disease (ESRD. As inadequate dialysis is considered a risk factor leading to higher morbidity and mortality, determination of adequacy of dialysis is necessary. This study was conducted to determine adequacy of dialysis in continuous hemodialysis patients in Kamkar and Hazrat Vali Asr Hospitals in the state of Qom, Iran.

Methods

 This cross sectional descriptive-analytic study was conducted in 2006. The study variables were age, gender, height, weight and duration of dialysis. Data were collected by a questionnaire and URR, dKt/V, eKt/V and pKt/V were calculated. For statistical analysis, t-test, Fisher’s exact test and Pearson correlation were employed.

Results

 Of 238 patients, 51.7% and 48.3% were males and females respectively. The average age was 55.27 ± 16.79 years. Mean values of dKt/V, eKt/V, pKt/V and URR were 1.03 ± 0.232, 0.89 ± 0.196, 1.18 ± 0.254, and 57.46 ± 8.42 respectively. The percent of adequate dialysis in eKt/V, pKt/V and URR were 26.5%, 44.5% and 21% respectively. The mean age of insufficient eKt/V group was higher than adequate eKt/V group and t test showed a significant statistical correlation. Fisher’s exact test showed a significant correlation between adequate eKt/V and female gender, and also between eKt/V and URR. But chi-square test did not show a significant correlation between eKt/V and underling disease.

Conclusion

 We found that hemodialysis is inadequate in a high number of patients. Further studies with larger sample numbers are recommended to determine the underlying cause of this inadequacy.

S.M Mousavi Movahed

2012-05-01

85

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

Scientific Electronic Library Online (English)

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

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

86

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

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

Khawaja AR

2013-01-01

87

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

1991-01-01

88

Alterações ecocardiográficas em pacientes com insuficiência renal crônica em programa de hemodiálise Alteraciones ecocardiográficas en pacientes con insuficiencia renal crónica en programa de hemodiálisis Echocardiographic alterations in patients with chronic kidney failure undergoing hemodialysis  

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Full Text Available Alterações de estrutura e função cardíacas detectadas pela ecocardiografia são comuns em pacientes com doença renal crônica em hemodiálise e predizem um pior prognóstico. Esta revisão aborda recentes evidências da utilidade do método na detecção da disfunção cardíaca clínica e subclínica, estratificação do risco cardiovascular e avaliação das estratégias de intervenção terapêutica.Alteraciones de estructura y función cardíacas detectadas por ecocardiografía son comunes en pacientes con enfermedad renal crónica en hemodiálisis y predicen un peor pronóstico. Esta revisión aborda recientes evidencias de la utilidad del método en la detección de la disfunción cardíaca clínica y subclínica, estratificación del riesgo cardiovascular y evaluación de las estrategias de intervención terapéutica.Changes in cardiac structure and function detected by echocardiography are common in patients with chronic kidney disease undergoing hemodialysis, and have been recognized as key outcome predictors. This review attempts to summarize recent evidence pointing to the usefulness of the method in the detection of clinical and subclinical cardiac dysfunction, stratification of cardiovascular risk and assessment of intervention strategies.

Silvio Henrique Barberato

2010-01-01

89

Water-soluble vitamin levels in patients undergoing high-flux hemodialysis and receiving long-term oral postdialysis vitamin supplementation.  

Science.gov (United States)

The prescription of multivitamin supplements for dialysis patients is routine practice, but the doses prescribed differ greatly from one dialysis center to another. Few data are available concerning long-term vitamin supplementation and its effects on patients either on high-flux hemodialysis or receiving postdialysis supplementation. For several years, we have systematically prescribed to our patients an oral postdialysis multivitamin supplement containing thiamine hydrochloride 100 mg, riboflavin 20 mg, pyridoxine hydrochloride 50 mg, folic acid 6 mg, and ascorbic acid 500 mg. The aim of this study was to perform a cross-sectional long-term evaluation of the vitamin levels in patients who received this vitamin supplement for at least 12 months. We also were interested in investigating the plasma oxalic acid and total homocysteine levels associated with the long-term prescription of these vitamin supplements. Thirty-three patients on high-flux dialysis were studied. Vitamin levels and/or vitamin-dependent enzymatic activities were within the normal range (N) in all patients. The mean results (+/-SD) were plasma ascorbic acid 13.6 +/- 6.4 mg/L (N > 4), plasma folate 14.1 +/- 1.1 microg/L (N > 3), for vitamin B1, alpha-ETK 1.02 +/- 0.02 (N 70), for vitamin B2, alpha-EGR 1.00 +/- 0.07 (N 672), and for vitamin B6, alpha-EGOT 1.34 +/- 0.10 (N 228). Plasma oxalic acid was higher than normal in all patients (mean = 61 +/- 15 micromol/L, N < 33). However, all patients had oxalic acid levels within the range reported in the literature for patients not taking extra ascorbic acid. Mean total homocysteine was 24 +/- 8 micromol/L with only 4 patients (12%) having normal levels (N < 15). In conclusion, the postdialysis supplement given provides adequate vitamin levels in almost all patients in the long term. Postdialysis prescription allows an optimal compliance with the treatment, is well accepted by the patients, and is cost-effective. PMID:11091166

Descombes, E; Boulat, O; Perriard, F; Fellay, G

2000-10-01

90

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

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

Claudinei José Gomes Campos

2003-10-01

91

Plasma aluminum levels (unstimulated and stimulated): clinical and biochemical findings in 185 patients undergoing chronic hemodialysis for 4 to 95 months.  

Science.gov (United States)

Plasma aluminum levels (unstimulated and stimulated by deferoxamine infusion), along with signs and symptoms associated with aluminum overload, were evaluated in 185 patients (97 men, 88 women; mean age, 58 +/- 8 years) who had been undergoing dialysis for 4 to 95 months and who were still receiving treatment in 1985 at a free-standing dialysis facility which has always used water purified by reverse osmosis. Monthly water aluminum levels never exceeded 15 micrograms/L; therefore, the major source of aluminum in these patients was oral phosphate binders. Unstimulated plasma aluminum levels ranged from 7 to 392 micrograms/L, averaged 81.5 +/- 56.4, and did not correlate with the duration of dialysis (r = 0.07; P greater than 0.31) or frequency of symptoms. Stimulated plasma aluminum levels increased in a linear fashion (r = 0.57; P less than 0.0001) with time on dialysis; however, there was no statistical association between the stimulated aluminum levels and a variety of nonspecific musculoskeletal or CNS symptoms, evidence of hyperparathyroidism, hematocrit, or calcium or phosphorus levels. These findings suggest that total body aluminum, as reflected in deferoxamine-stimulated serum aluminum levels, increases as a function of time undergoing dialysis. PMID:2705446

Chazan, J A; Abuelo, J G; Blonsky, S L

1989-04-01

92

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

LENUS (Irish Health Repository)

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

Spooner, Almath M

2011-08-04

93

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

Directory of Open Access Journals (Sweden)

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

Donnelly Maria B

2011-08-01

94

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)

2008-01-01

95

Cutaneous oxalosis after long-term hemodialysis.  

Science.gov (United States)

A 27-year-old woman undergoing long-term hemodialysis developed cutaneous calcifications on her fingers. A skin biopsy specimen showed that the deposits were calcium oxalate. To our knowledge, only one previous article has reported pathologic and crystallographic studies on calcifications of the skin resulting from dialysis oxalosis. We speculate that vitamin C supplements, liberal tea consumption, an increased serum ionized calcium concentration, and the long duration of hemodialysis contributed to the production of these deposits. PMID:1627032

Abuelo, J G; Schwartz, S T; Reginato, A J

1992-07-01

96

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

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

Humberto Kukhyun Choi

2003-01-01

97

Rescue from hemodialysis by late recanalization of renal artery occlusion  

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We report on a patient with terminal renal insufficiency undergoing hemodialysis since four months. Imaging studies showed complete renal artery occlusion of a single kidney with collateral perfusion. Interventional recanalization of the renal artery was successful with a drop of serum creatinine from 1138 to 163 mol/l sparing the patient from further hemodialysis.

Ringe, Kristina Imeen; Galanski, Michael; Rosenthal, Herbert

2011-01-01

98

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)

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

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

99

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

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

Selma ÇET?NKAYA

2008-10-01

100

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

International Nuclear Information System (INIS)

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

2007-03-01

 
 
 
 
101

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

Directory of Open Access Journals (Sweden)

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

Carolina Costa Valcanti

2012-08-01

102

Effect of hemodialysis on circulating cystatin c levels in patients with end stage renal disease  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Plasma cystatin C is an emerging parameter to assess kidney function. Its utility in assessing the adequacy of hemodialysis in patients with end-stage-renal disease has however not been established with certainty. This study was therefore carried out to assess the usefulness of serum cystatin C estimation in patients undergoing low flux membrane hemodialysis. Serum creatinine and cystatin C were estimated in 20 patients before and after undergoing hemodialysis. The mean serum creatinine decre...

Krishnamurthy, N.; Arumugasamy, K.; Anand, U.; Anand, C. V.; Aruna, V.; Venu, G.; Gayathri, R.

2010-01-01

103

Therapeutic effectiveness of sustained low-efficiency hemodialysis plus hemoperfusion and continuous hemofiltration plus hemoperfusion for acute severe organophosphate poisoning.  

Science.gov (United States)

There is no report on the effects of sustained low-efficiency dialysis (SLED) plus hemoperfusion (HP) (SLED?+?HP) in patients with acute severe organophosphate (OP) poisoning (ASOPP). This study was designed to compare the therapeutic effectiveness between SLED?+?HP and continuous hemofiltration (CHF) plus HP (CHF?+?HP) in patients with ASOPP. In order to assess the two treatment methods, 56 patients with ASOPP were divided into CHF?+?HP group and SLED?+?HP group. The biochemical indicators, in-hospital duration, hemodynamic parameters, Acute Physiology, and Chronic Health Evaluation (APACHE II) score, and survival and mortality rates were compared. In both groups after treatment, the levels of serum creatine kinase isozyme MB, creatine kinase, creatinine, glutamic-oxalacetic transaminease, and glutamate-pyruvate transaminase, and the APACHE II scores on the first, second, and seventh day decreased (P??0.05). In conclusion, SLED has similar hemodynamic stability to CHF and the two treatment methods have similar effects on ASOPP patients. More importantly, SLED plus HP is relatively economical and convenient for patients with ASOPP in clinical practice. PMID:23957329

Hu, Shou-liang; Wang, Dan; Jiang, Hong; Lei, Qing-feng; Zhu, Xiao-hua; Cheng, Jun-zhang

2014-02-01

104

Continuous renal replacement therapy (CRRT) or intermittent hemodialysis (IHD)--what is the procedure of choice in critically ill patients?  

Science.gov (United States)

Although at present there is no prospective randomized study which could show significantly better survival of patients on continuous procedures, the majority of intensivists advocate this technique of renal function replacement due to generally accepted opinion that it has less effect on circulation of already hemodynamically unstable patients. In our prospective randomized study with 104 patients, we also did not observe any difference in 28 days survival, in total survival, as well as in circulatory instability between two treatment modalities. Even in subgroup of 80 patients with sepsis and septic shock there were no difference in survival. Sepsis was the underlying disorder in 52 and septic shock in 28 patients out of 104 patients analyzed in this study. Our prospective randomized study did not show a statistically significant difference between the two methods of renal replacement therapy. Survival rates were not affected and neither was the occurrence of hemodynamic instability. We believe that both methods are complementary; IHD for faster elimination of electrolytes and waste products elimination, CRRT for regulation of higher calories requirements and for hemodynamically unstable patients. The expectations that one method is superior to the other in the term of better survival have not been corroborated by the current data available in the literature. The choice of the method should be individualized. ARF, which is an integral part of MOF, is a problem frequently encountered in critically ill patient treated in the ICU, but outcome of these patients depends closely on the control of basic event. Evaluation of each of the supportive procedures is therefore hindered by the fact that the underlying disease has the crucial effect on survival and the type of supportive procedure less so. PMID:14575293

Gasparovi?, Vladimir; Filipovi?-Grci?, Ina; Merkler, Marijan; Pisl, Zoran

2003-09-01

105

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

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This prospective double blinded study was designed to compare the effect of magnesium or fentanyl addition to ropivacaine in continuous femoral nerve block in patients undergoing elective total knee replacement under general anesthesia. Sixty patients undergoing elective TKR under general anesthesia, were randomly allocated into three equal groups, Group (R): given 30 mL Ropivacaine 0.2%. Group (R+F): given 30 mL Ropivacaine 0.2% and 4 ?g mL-1 fentanyl. Group (R+M): given 30...

Md. Ashraf Abd Elmawgoud; Ahmed Badawy; Samaa Abu Elkassem; Doaa Rashwan

2008-01-01

106

Cognitive function among hemodialysis patients in Japan  

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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 f...

Odagiri Gen; Sugawara Norio; Kikuchi Atsuhiro; Takahashi Ippei; Umeda Takashi; Saitoh Hisao; Yasui-Furukori Norio; Kaneko Sunao

2011-01-01

107

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)

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

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

108

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)

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

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

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

Denilson Fonseca Rodrigues

2011-12-01

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: analisar a relação entre a esperança e a espiritualidade de pacientes renais crônicos em tratamento hemodialítico. MÉTODO: trata-se de estudo correlacional, de corte transversal. A amostra foi composta por 127 sujeitos em tratamento em uma Unidade de Ter [...] apia Renal Substitutiva. Os dados 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<0,001) e "esperança/otimismo" (r=0,376; p<0,001). CONCLUSÃO: confirmou-se a existência de relação entre o nível de esperança e de espiritualidade do paciente renal crônico, portanto, tais constructos deverão ser considerados na assistência prestada pelos profissionais de saúde, para auxiliar no enfrentamento da doença e do tratamento. 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 Unida [...] d de Terapia Renal Substitutiva. 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<0,001) y "esperanza/optimismo" (r=0,376; p<0,001). CONCLUSIÓN: se confirmó la existencia de relación entre el nivel de esperanza y de espiritualidad del paciente renal crónico, así esos constructos deberán ser considerados en la asistencia prestada, por los profesionales de la salud, para auxiliar en el enfrentamiento de la enfermedad y del tratamiento. 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<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.

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

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

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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 concentr...

2011-01-01

112

Removal of vancomycin by high-flux hemodialysis membranes.  

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Levels of vancomycin in serum are traditionally believed to be unaffected by hemodialysis. By both in vivo and in vitro techniques, the effects of a newer, more permeable dialyzer membrane on vancomycin concentrations were investigated. Six patients who were receiving vancomycin and undergoing maintenance hemodialysis with polyacrylonitrile dialyzer membranes had postdialysis levels in serum that were 63% of predialysis levels; the intradialytic half-life was 5.7 h. Vancomycin concentrations ...

Quale, J. M.; O Halloran, J. J.; Devincenzo, N.; Barth, R. H.

1992-01-01

113

Early mobility activities during continuous renal replacement therapy.  

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Continuous renal replacement therapy (CRRT) is a therapeutic technique used to support critically ill patients with acute renal failure in intensive care units. CRRT is preferred over hemodialysis for patients who cannot tolerate the rapid fluid and electrolyte shifts associated with hemodialysis because of their tenuous hemodynamic state. Traditionally, such patients have not been candidates for mobilization and have remained on strict bed rest. Mobilization is now being initiated on patients undergoing CRRT in intensive care units. This case study chronicles the successful mobilization of a patient undergoing CRRT. This experience suggests that CRRT patients who are appropriate candidates may be mobilized safely and therefore should not automatically be excluded from mobilization therapies. PMID:24986178

Brownback, Cherylynn A; Fletcher, Patricia; Pierce, Lynelle N B; Klaus, Susan

2014-07-01

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Association between left atrium enlargement and intradialytic hypotension: role of diastolic dysfunction in the hemodynamic complications during hemodialysis.  

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Symptomatic intradialytic hypotension (IH) continues to be an important complication of hemodialysis treatment. It has been suggested that patients with left ventricular (LV) diastolic dysfunction may be more sensitive to the effects of reduced cardiac filling. Left atrial volume index (LAVi) reflects the chronicity of exposure to elevated LV filling pressures. The aim of this study was to identify the association between echocardiographic disease, in particular left atrium enlargement, and IH. Echocardiograms obtained in 172 patients undergoing hemodialysis in sinus rhythm and with no significant valvular or pericardial disease were analyzed. The independent association between LAVi and IH was assessed using multivariate logistic regression. IH was identified in 27 patients (16%). The patients who experienced the hypotensive episodes had a greater prevalence of previous heart failure (59% vs 22%, P 35 mL/m(2) (59% vs 32%, P = 0.008). No differences were noted for age, gender, body mass index, duration of dialysis, blood pressure, use of drugs, and proportions of arterial hypertension, diabetes, LV hypertrophy and diastolic dysfunction by Doppler. After multivariate analysis, only heart failure and LAVi > 35 mL/m(2) were seen to be independent predictors of IH. The finding of left atrium enlargement in patients undergoing hemodialysis may be useful in the clinical prediction of IH. PMID:19486120

Barberato, Silvio H; Misocami, Marcio; Pecoits-Filho, Roberto

2009-08-01

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Nutritional Assessment of Hemodialysis Patients  

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

Ali A. Alshatwi

2007-01-01

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

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

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

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

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

Bárbara Margareth Menardi Biavo

2012-09-01

118

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

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

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

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

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

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

2014-02-01

120

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

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

Md. Ashraf Abd Elmawgoud

2008-01-01

 
 
 
 
121

Factors associated with low bone mass in the hemodialysis patients – a cross-sectional correlation study  

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Full Text Available Abstract Background Low bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis. It can lead to serious bone health problems such as fragility fractures. The purpose of this study is to investigate the risk factors of low bone mass in the hemodialysis patients. Methods Sixty-three subjects on hemodialysis for at least 6 months were recruited from a single center for this cross-sectional study. We collected data by questionnaire survey and medical records review. All subjects underwent a bone mineral density (BMD assay with dual-energy x-ray absorptiometry at the lumbar spine and right hip. Data were statistically analyzed by means of descriptive analysis, independent t test and one way analysis of variance for continuous variables, Pearson product-moment correlation to explore the correlated factors of BMD, and stepwise multiple linear regression to identify the predictors of low bone mass. Results Using WHO criteria as a cutoff point, fifty-one subjects (81% had a T-score lower than -1, of them 8 subjects (13% had osteoporosis with the femoral neck most commonly affected. Regarding risk factors, age, serum alkaline phosphatase (ALP level, and intact parathyroid hormone (iPTH level had significant negative correlations with the femoral neck and lumbar spine BMD. On the other hand, serum albumin level, effective exercise time, and body weight (BW had significant positive correlations with the femoral neck and lumbar spine BMD. Age, effective exercise time, and serum albumin level significantly predicted the femoral neck BMD (R2 × 0.25, whereas BW and the ALP level significantly predicted the lumbar spine BMD (R2 × 0.20. Conclusion This study showed that advanced age, low BW, low serum albumin level, and high ALP and iPTH levels were associated with a low bone mass in the hemodialysis patients. We suggest that regular monitoring of the femoral neck BMD, maintaining an adequate serum albumin level and BW, and undertaking an exercise program are important to improve bone health in the patients undergoing hemodialysis.

Huang Guey-Shiun

2009-06-01

122

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

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Full Text Available BACKGROUND: Spinal anesthesia for cesarean delivery may cause severe maternal hypotension and a decrease in cardiac output. Compared to assessment of cardiac output via a pulmonary artery catheter, the FloTrac/Vigileo™ system may offer a less invasive technique. The aim of this study was to evaluate cardiac output and other hemodynamic measurements made using the FloTrac/Vigileo™ system in patients undergoing spinal anesthesia for elective cesarean section. METHODS: A prospective study enrolling 10 healthy pregnant women was performed. Hemodynamic parameters were continuously obtained at 15 main points: admission to surgery (two baseline measurements, after preload, after spinal anesthesia administration and 4 time points thereafter (4, 6, 8 and 10 min after anesthesia, at skin and uterine incision, newborn and placental delivery, oxytocin administration, end of surgery, and recovery from anesthesia. Hemodynamic therapy was guided by mean arterial pressure, and vasopressors were used as appropriate to maintain baseline values. A repeated measures ANOVA was used for data analysis. RESULTS: There was a significant increase in heart rate and a decrease of stroke volume and stroke volume index up to 10 min after spinal anesthesia (P < 0.01. Importantly, stroke volume variation increased immediately after newborn delivery (P < 0.001 and returned to basal values at the end of surgery. Further hemodynamic parameters showed no significant changes over time. DISCUSSION AND CONCLUSIONS: No significant hemodynamic effects, except for heart rate and stroke volume changes, were observed in pregnant women managed with preload and vasopressors when undergoing elective cesarean section and spinal anesthesia.

José Otavio Costa Auler Junior

2010-06-01

123

Carboplatin pharmacokinetics in a patient receiving hemodialysis.  

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

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

2014-02-01

124

Hypercalcemia, inappropriate calcitriol levels, and tuberculosis on hemodialysis.  

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We describe a female patient undergoing hemodialysis who developed tuberculosis, hypercalcemia, and inappropriately elevated calcitriol levels. These findings suggest ectopic production of calcitriol by tuberculous granulomas. Successful treatment of tuberculosis led to a substantial decrease in the levels of calcium and calcitriol. PMID:11095092

Peces, R; Pobes, A; Díaz-Corte, C; Gago, E

2000-08-01

125

Association of Serum Homocysteine with Anemia in Maintenance Hemodialysis Patients  

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Full Text Available To investigate the relationship between homocysteine level and anemia in maintenance hemodialysis patients, a cross-sectional study that was conducted on patients with end-stage renal disease (ESRD undergoing maintenance hemodialysis treatment. The study was carried out on 39 (F=15 M=24 stable hemodialysis HD patients. Mean ages of patients were 46?18 years. The length of the time patients had been on hemodialysis was 30?35 months (median: 18 months. The value of serum homocysteine of all patients was 5?2 ?mol/L (median : 4.5 ?mol/L. Mean?SD of hemoglobin and hematocrit level of all patients were 9?2 g/dl (median : 9 g/dl, and 28?6% median: 29% respectively. In this study, we assessed for the first time the positive relation of serum homocysteine with anemia in patients on maintenance hemodialysis. In addition, in male HD patients a significant positive correlation of serum homocysteine with serum ferritin and a significant inverse correlation of serum homocysteine with serum total iron binding capacity (TIBC were seen. It is possible that the high levels of serum homocysteine in some conditions may increases the micro inflammatory state of uremia in hemodialysis patients and had a role in intensification of anemia. In the meantime more research needs to confirm our conclusion.

M.D. Hamid Nasri

2005-01-01

126

Age and Dialysis Adequacy in Maintenance Hemodialysis Patients  

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Full Text Available Aim: The issue of optimal dialysis dose and frequency has been a central topic in the delivery of dialysis treatment. We aimed to consider the effects of age on some hemodialysis parameters specially dialysis adequacy by urea reduction rate (URR and to compare these parameters between diabetics and non diabetic HD(hemodialysis patients. Material and Method: Patients with end-stage renal disease (ESRD, undergoing maintenance hemodialysis treatment were considered. The urea reduction rate and body mass index were calculated. Results: The total patients were 60 (F=21 M=39, consisting of 44 non diabetic hemodialysis patients (F=15 M=29, and 16 diabetic hemodialysis patients (F=6 M=10. A significant difference of dialysis adequacy between non-diabetics and diabetics was observed with lower values in diabetic group and a significant difference of dialysis adequacy and creatinine was observed in patients, with ages below and more than 50 years old with lower values in older patients. A significant negative correlation of age with dialysis adequacy in total hemodialysis patients and a significant negative correlation of age with serum creatinine were observed. Discussion: The negative effect of age on dialysis adequacy needs more attention to this aspect  to reduce the dialysis complications which is frequently observed in older patients.

Hamid Nasri

2013-11-01

127

Are the complications of arteriovenous fistulas associated with an abnormal ankle-brachial index in hemodialysis patients?  

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The peripheral artery disease is frequent among patients undergoing hemodialysis much more than in the general population. The ankle-brachial index (AB!) is a potent tool to screen this pathology. We analysed the relationship between ABI abnormal values and arteriovenous fistulas (AVF) complications such as stenosis and thrombosis among chronically hemodialysis pat ients (HD).

Xhignesse, Patricia; Saint-remy, Annie; Dubois, Bernard; Philips, Jean-christophe; Krzesinski, Jean-marie

2010-01-01

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

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

R. C. Noleto Magalhães

2011-12-01

129

Vascular access profile in maintenance hemodialysis patients.  

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Introduction. The aims of this study was to evaluate maintenance hemodialysis population in a tertiary care hospital based dialysis unit for vascular access (VA) types, to compare native arteriovenous fistula (AVF) and arteriovenous graft (AVG) survival, and to assess risk factors for access failure. Materials and Methods. A total of 182 patients on maintenance hemodialysis were evaluated and followed up in terms of VA type and VA outcomes. Results. Among 103 prevalent patients, 15.5% initiated dialysis with AVF. At the time of the study, 67.9% of the prevalent patients had an AVF and 29.1% had AVG. Of 79 incident patients, 64% were followed up for more than 3 months by nephrologists before initiation of dialysis. Among these patients, 13.6% were initiated with AVF. There were 25 primary failures and 50 secondary failure episodes. Of the 50 secondary failures, 15 were AVF failures and 31 AVG failures. Vascular access survival was significantly superior with AVF as compared with AVG (P = .03). With longer dialysis periods, failure rates were higher. Follow-up with nephrologists prior to initiation of dialysis had a major influence on VA. Conclusions. Arteriovenous fistula is the best VA for maintenance hemodialysis. However, when the vasculature is not ideal for AVF, AVG should be constructed. A small percentage of our patients had fistula at initiation of dialysis. This is mainly due to late nephrology referrals and also due to reluctance of patients to undergo surgical access placement when they are relatively asymptomatic. PMID:24878945

Gowda, Anoop; Pavan, Malleshappa; Babu, Kishore

2014-05-01

130

Outcomes of patients with end-stage renal disease (ESRD) under chronic hemodialysis requiring continuous renal replacement therapy (CRRT) and patients without ESRD in acute kidney injury requiring CRRT: a single-center study.  

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In most continuous renal replacement therapy (CRRT) studies, end-stage renal disease (ESRD) patients were excluded and the outcomes of patients with ESRD treated with chronic hemodialysis (HD) were unknown. The purposes of this study were to (1) evaluate short-term patient survival and (2) compare the survival of conventional HD patients needing CRRT with the survival of non-ESRD patients in acute kidney injury (AKI) requiring CRRT. We evaluated adults (>18 years) requiring CRRT who were treated in the intensive care unit (ICU) at Kosin University Gospel Hospital from January 1, 2009 to December 31, 2010. A total of 100 (24 ESRD, 76 non-ESRD) patients underwent CRRT during the study period. Patients were divided into two major groups: patients with ESRD requiring chronic dialysis and patients without ESRD (non-ESRD) with AKI. We compared the survival of conventional HD patients requiring CRRT with the survival of non-ESRD patients in AKI requiring CRRT. For non-ESRD patients, the 90-day survival rate was 41.6%. For ESRD patients, the 90-day survival rate was 55.3%. Multivariate Cox proportional hazards analyses demonstrated that conventional HD was not a significant predictor of mortality (hazard ratio [HR]: 0.334, 95% confidence interval [CI]: 0.063-1.763, P?=?0.196), after adjustment for age, gender, presence of sepsis, APACHE score, use of vasoactive drugs, number of organ failures, ultrafiltration rate, and arterial pH. The survival rates of non-ESRD and ESRD patients requiring CRRT did not differ; ESRD with conventional HD patients may be not a significant predictor of mortality. PMID:22541135

Jung, Yeon Soon; Lee, Junseop; Shin, Ho Sik; Rim, Hark

2012-10-01

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

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

Fabiana de Souza Orlandi

2012-08-01

132

Appropriateness of anemia management in hemodialysis patients  

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The anemia of end stage renal disease (ESRD) is common and often severe complication that can be managed successfully by erythropoiesis-stimulating agents (ESA) administration. Aims To investigate current practice of anemia management in hemodialysis patients and to assess the appropriateness of anemia management by comparing observed practice to the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline recommendations. Settings and design The study was conducted at two hemodialysis centers in Riyadh, Saudi Arabia. Data on anemia parameters, comorbidities, ESA dosing and iron supplementation were collected. The data were collected for 7 months retrospectively from April to the end of May 2008 and prospectively from June to October 2008. Patients who were over 18 years of age with ESRD undergoing hemodialysis were included. Patients were excluded if they have cancer or receiving chemotherapy or radiotherapy. Results Data were collected from 87 patients. Mean Hgb value for those patients was 11.16 ± 0.97 g/dL. Thirty-nine patients (45%) had mean Hgb values between 11.0 and 12.0 g/dL the target range recommended by KDOQI guideline. The mean weekly prescribed dose of erythropoietin was 8099 ± 5946 IU/Week (135 ± 99 IU/kg/Week). Information on ferritin concentrations was available for 48 (55%) patients. The mean serum ferritin concentration for those patients was 693 ± 420.5 ng/mL. Fifty-two patients had transferrin saturation (TSAT) values recorded. The mean TSAT value was 38.5 ± 19.7%. Conclusions: There is an opportunity to improve anemia management in hemodialysis patients particularly thorough evaluation of causes of inadequate response rate and better monitoring and management of iron status.

Al-Ageel, Nahla A.; Al-Aqeel, Sinaa A.; Abanmy, Norah O.; Alwakeel, Jamal S.; Sabry, Alaa; Alsaran, Khalid A.

2011-01-01

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Calcium acetate versus calcium carbonate in the control of hyperphosphatemia in hemodialysis patients  

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CONTEXT: Hyperphosphatemia has an important role in the development of bone and mineral abnormalities in end-stage renal disease (ESRD). OBJECTIVE: To compare the phosphorus binding power and the hypercalcemic effect of calcium acetate and calcium carbonate in hemodialysis patients. TYPE OF STUDY: Crossover, randomized, double-blind study. PLACE: A private hospital dialysis center. PARTICIPANTS: Fifty-two patients who were undergoing regular hemodialysis three times a week ([Ca++] dialysate =...

2000-01-01

134

Effect of vitamin E supplementation on oxidative stress in hemodialysis patients  

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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...

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

2008-01-01

135

Suicidal incised wound of a fistula for hemodialysis access in an elderly woman: case report.  

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A very rare case of suicide by stab wound of a fistula for hemodialysis access in an elderly woman is reported. The incidence of suicide attempts in people undergoing hemodialysis is well known. Nevertheless, suicide means do not usually include stab wounds of the arteriovenous access. Various pattern differences between homicidal and suicidal stab wounds, characteristics of suicide in the elderly, and approaches to the investigation of such cases are briefly discussed. PMID:10990291

Marc, B; Baudry, F; Zerrouki, L; Ghaith, A; Garnier, M

2000-09-01

136

ORIGINAL PAPER Pulmonary artery pressure in association with serum parathormone in maintenance hemodialysis patients  

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Full Text Available Introduction: There are several potential explanations for the development of PH in patients with stable hemodialysis patients. Hormonal and metabolic derangement associated with end-stage renal failure might lead to pulmonary arterial vasoconstriction and an increase of the pulmonary vascular resistance. The aim of this study was to consider the association of pulmonary artery pressure (PAP with serum parathormone in end-stage renal disease (ESRD patients under regular hemodialysis treatment. Material and methods: This cross-sectional study was conducted on patients with end-stage renal disease undergoing maintenance hemodialysis treatment through an arteriovenous fistula which was created on the hand, and with acetate basis dialysate and polysulfone membranes. For all patients serum intact parathormone (iPTH was measured. For assessment of pulmonary artery pressure, all patients were subjected to two-dimensional and doppler echocardiographic studies that were done for the patients after their hemodialysis sessions. Results: The study comprised 102 patients (F=46, M=56 consisting of 73 non diabetic hemodialysis patients (F=33, M=40, and 29 diabetic hemodialysis patients (F=13, M=16. The duration of hemodialysis was 17.8±29 months. The mean ±SD of serum iPTH of total patients was 338±306 pg/ml. The mean ±SD of pulmonary artery systolic pressure (PAP was 41.5±12.6 mmHg. A significant positive correlation of PAP with the dosage (r=0.36, p=0.001 and duration of hemodialysis (r=0.35, p<0.001 was seen, also a significant positive correlation of pulmonary artery systolic pressure with serum intact parathormone (iPTH in hemodialysis patients was found. Conclusions: A significant positive correlation of serum intact parathormone with pulmonary artery pressure, which is a new aspect of uncontrolled secondary hyperparathyroidism implies the need for a better control of poorly controlled hyperparathyroidism disease in hemodialysis patients.

Hamid Nasri

2006-03-01

137

21 CFR 876.5665 - Water purification system for hemodialysis.  

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... Water purification system for hemodialysis... Water purification system for hemodialysis. (a) Identification. A water purification system for hemodialysis is...inorganic substances and microbial contaminants...

2009-04-01

138

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

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OBJECTIVES: In this study, we aimed to investigate plasma homocysteine (Hcy) and serum C-reactive protein (CRP) levels in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, and the relation among them.

Ali Borazan; Selim Aydemir; Mehmet Sert; Ahmet Yilmaz

1992-01-01

139

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

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Full Text Available OBJECTIVES: In this study, we aimed to investigate plasma homocysteine (Hcy and serum C-reactive protein (CRP levels in hemodialysis (HD and continuous ambulatory peritoneal dialysis (CAPD patients, and the relation among them.

Ahmet Yilmaz

1992-01-01

140

Nosocomial infective endocarditis in Hemodialysis  

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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)

2002-01-01

 
 
 
 
141

Depression in Chronic Kidney Disease and Hemodialysis Patients  

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Depression is the most common psychiatric condition in Chronic Kidney Disease (CKD), but there are few studies that analyzed this condition in patients in different phases of disease. This article aims to evaluated depression in CKD patients, comparing patients in different phases of disease. Methods: We evaluated 134 patients with CKD submitted to conservative ambulatory treatment, and 36 patients with end-stage renal disease undergoing hemodialysis (HD). To evaluate depression, we used the ...

Andrade, C. P.; Sesso, R. C.

2012-01-01

142

Evaluation of secondary hyperparathyroidism in patients undergoing hemodialysis.  

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Renal osteodystrophy is a complication of chronic kidney disease (CKD) that present in low and high turnover patterns. This disorder has a key role in the disability of CKD patients in whom early diagnosis and treatment can result in better outcome. We studied hyperparathyroidism prevalence and its relationship with renal osteodystrophy in our advanced CKD population. We included 80 patients (of whom 44 (55%) were diabetic) during 6 months period. The patients answered a questionnaire about symptoms related to bone disease and blood levels of parathormone (PTH), calcium, phosphorus, and alkaline phosphatase were obtained, in addition to hand and skull radiographs in all the study patients. Prevalence of clinically evident hyperparathyroidism in our patients was 45%. Hyperparathyroidism had significant relationship with alkaline phosphatase and radiological findings, but did not have a significant relationship with dialysis duration, age, sex, familial history, diabetes mellitus, or hypertension. We conclude that secondary hyperparathyroidism is prevalent in our dialysis population and has high correlation with serum alkaline phosphatase levels and radiological changes. PMID:18087140

Rahimian, Mohammad; Sami, Ramin; Behzad, Fariba

2008-01-01

143

Anxiety, depression and suicidal ideation in Lebanese patients undergoing hemodialysis.  

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Anxiety, depression and suicidal thoughts are highly prevalent comorbidities of end-stage-renal-disease (ESRD). There are no studies in Lebanon on the prevalence of these symptoms in Lebanese end-stage-renal-disease patients. Moreover, the association between ESRD on one hand, and anxiety, depression and suicidal ideation on the other has never been established in Lebanon. Groups of patients at a high-risk of development of these symptoms are not determined. The Hospital Anxiety and Depression Score and M.I.N.I (module C) were used to measure the prevalence of anxiety, depression and suicidal ideation in 51 patients from the dialysis center of Hotel-Dieu de France Hospital in Lebanon. In our sample, 45% of included patients suffered from symptoms of anxiety and 50% presented symptoms of depression.The prevalence of suicidal ideation as detected by the M.I.N.I. is at 37%. No patients presented with a high risk of suicide. There was a statistically significant correlation between the existence of organic comorbidities and the presence of symptoms of depression and suicidal ideation. As for anxiety, the association was marginally significant. The results obtained by our study are consistent with those found in studies performed in other societies. The profile of depression- and suicidal ideation-prone patients has been determined. It consists of patients with at least one medical comorbidity to the ESRD. This, in turn, should lead to increased awareness and better treatment of these psychiatric ailments, considering their impact on morbidity and mortality in ESRD. PMID:24337520

Macaron, Gabrielle; Fahed, Mario; Matar, Dany; Bou-Khalil, Rami; Kazour, Francois; Nehme-Chlela, Dania; Richa, Sami

2014-02-01

144

Uremic pruritus in chronic hemodialysis patients.  

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Skin itching (pruritus) affects 50%-90% of patients undergoing peritoneal dialysis or hemodialysis and the symptoms range from localized and mild to generalized and severe. Among the dermatological abnormalities associated with end-stage renal disease, pruritus is the most prevalent. Of all systemic disorders, uremia is the most important cause of pruritus. The mechanism underlying uremic pruritus is poorly understood: secondary hyperparathyroidism, divalent-ion abnormalities, histamine, allergic sensitization, proliferation of skin mast cells, iron-deficiency anemia, neuropathy and neurological changes, or a combination of these have been hypothesized. Severe pruritus not only affects the quality of life but is also associated with poor outcome in chronic hemodialysis patients. No specific, effective treatment is currently available for uremic pruritus. Further studies are necessary to evaluate the long-term efficacy and safety of a novel kappa-opioid agonist, nalfurafine. Early diagnosis and treatment of uremic pruritus focusing on general strategies that include the optimization of dialysis dose, erythropoiesis-stimulating agents, and management of secondary hyperparathyroidism is recommended. PMID:18446709

Narita, Ichiei; Iguchi, Seitaro; Omori, Kentaro; Gejyo, Fumitake

2008-01-01

145

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

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

Ehteram Sadat Ilali

2011-12-01

146

Interleukin-10 and Tumor Necrosis Factor-? Polymorphisms in Vascular Access Failure in Patients on Hemodialysis: Preliminary Data in Korea  

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Neointimal hyperplasia causes vascular stenosis and subsequent thrombosis, which result in vascular access failure in patients undergoing hemodialysis. Interleukin-10 (IL-10) and tumour necrosis factor-? (TNF-? ) are involved in this inflammatory process. The aim of this study was to investigate the relationship between vascular accessm failure and various inflammatory markers including the genetic polymorphisms of IL-10 and TNF-? . Seventy-five patients on hemodialysis with an arterioveno...

Sung, Su Ah; Ko, Gang Jee; Jo, Sang Kyung; Cho, Won Yong; Kim, Hyoung Kyu; Lee, So Young

2008-01-01

147

Combined angiotensin-converting enzyme inhibition and receptor blockade associate with increased risk of cardiovascular death in hemodialysis patients  

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To compare the relative effectiveness of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in reducing cardiovascular mortality in chronic hemodialysis patients, we conducted an observational analysis of all patients initiated on ACEI or ARB therapy undergoing chronic hemodialysis at a large dialysis provider. Survival curves with mortality hazard ratios (HR) were generated using the Kaplan-Meier method and Cox regression. Outcomes were compared using i...

Chan, Kevin E.; Ikizler, T. Alp; Gamboa, Jorge L.; Yu, Chang; Hakim, Raymond M.; Brown, Nancy J.

2011-01-01

148

Cognitive function among hemodialysis patients in Japan  

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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.

Saitoh Hisao

2011-08-01

149

Burnout levels of hemodialysis nurses.  

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Abstract Background: Previous studies have found significant stressors experienced by nurses working in hemodialysis units. The purpose of this study was to determine the burnout levels of hemodialysis nurses working in hemodialysis units and their relation with some sociodemographic variables. Methods: The study was conducted between July 2012 and Sept 2012 in hemodialysis units of four hospitals, including one university, one public and two private hospitals, in the province of Erzurum. The population of the study consisted of 32 nurses rendering service in hemodialysis units of the related hospitals. Information forms, which were prepared by researchers in accordance with the literature, and aimed at determining the personal characteristics of nurses and Maslach Burnout Inventory were used for the data collection. Results: Examining mean scores obtained by nurses from the Maslach Burnout Inventory, it is observed that they scored 17.07?±?8.29 from subscale of emotional exhaustion, 5.89?±?4.13 from subscale of depersonalization and 20.64?±?4.10 from subscale of personal accomplishment. Conclusion: The results of the study revealed that nurses working in hemodialysis units experience a medium-level burnout in terms of subscales of emotional exhaustion, depersonalization, and a high-level burnout in terms of the subscale of personal accomplishment. PMID:24831740

Kavurmac?, Mehtap; Cantekin, I??n; Tan, Mehtap

2014-08-01

150

Randomized controlled trial of clopidogrel to prevent primary arteriovenous fistula failure in hemodialysis patients  

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The optimal vascular access for chronic maintenance hemodialysis is the arteriovenous fistula (AVF). Several studies suggest a role for antiplatelet agents in the prevention of primary AVF failure. A double-blind, randomized trial was conducted to assess the efficacy and safety of clopidogrel in hemodialysis patients. Ninety three patients were randomized to receive 75 mg/daily of clopidogrel or placebo. The treatment was initiated 7–10 days prior to scheduled access surgery and continued u...

2009-01-01

151

Correlation of Serum Magnesium with Serum Parathormone in Regular Hemodialysis Patients  

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

Hamid Nasri

2006-01-01

152

The Role of Various Filters in Hypoxemia Levels of Hemodialysis Patients  

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Full Text Available Introduction: One of the main complications of hemodialysis in patients with chronic renal failure is hypoxemia which is related to several factors including the type of filter. The aim of this study was to evaluate the hypoxemia levels in patients undergoing hemodialysis with focus on the type of filter. Methods: In a crossover clinical trial, 29 patients from emodialysis ward of Fatemieh hospital were enrolled in the study. The patients were randomly divided in two groups (allocation. First group was hemodialyzed using Polysulfone filters while the second group was hemodialyzed by Hemoph an filters for one month. After a period of 24 hours washout, filter was changed and hemodialysis was done for another month. Arterial blood O2 saturation at different times, before and after hemodialysis was determined and amount of decrement was measured and compared in both groups. Results: Mean decrease in the arterial blood O2 saturation during 5, 30, 60 and 120 minutes after initiation of hemodialysis was higher in Hemophan filter than Polysulfone filter (p<0.001. In both groups, peak of decreasing levels were 30 and 60 minutes after initiation of hemodialysis. Conclusion: As use of polysulfone filters causes lesser decrease in arterial blood oxygen saturation, it is recommended in igh risk, especially cardiopulmonary disease patients

Sh Mousavi

2008-04-01

153

Pruritus in hemodialysis patients  

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Full Text Available Abstract Background Pruritus is one of the most bothersome symptoms in patients on maintenance hemodialysis (HD, however little progress is seen in our understanding of its pathogenesis. The aim of this study was to evaluate the frequency of pruritus in HD patients in Tehran, Iran, and to correlate its presence and intensity with relevant clinical and laboratory parameters. Methods One hundred sixty-seven patients on maintenance HD at three out-patient HD units were enrolled in the study. Itch intensity was scored as mild, moderate and severe. Some relevant clinical and laboratory parameters (age, sex, xerosis, presence of neuropathy, duration of dialysis, history of atopy and laboratory findings including hematocrit, creatinine, urea, calcium, phosphorus, parathyroid hormone [PTH] and alkaline phosphatase were evaluated. Results Pruritus was found in 41.9% of patients. The intensity of itching was mild, moderate and severe, in 51.4%, 11.4% and 37.7% of patients, respectively. In 22 patients (31.4% pruritus intensified during and after dialysis. There was no significant difference in the serum levels of creatinine, blood urea nitrogen, calcium, phosphorus, alkaline phosphatase, PTH and hematocrit between patients with and without pruritus. Age, sex, xerosis, underlying renal disease, history of atopy and duration of haemodialysis were not significantly different between the two groups. However, neuropathy was significantly more common in the pruritic group (63.8% versus 42.1% (pv = 0.006. Conclusion Clinical neuropathy was the only significant finding in the pruritic group in our study. This finding justifies further research on nerve function and neurotransmitters in hemodialysis patients and the introduction of new drugs targeting neuropathy.

Khamesan Behnaz

2005-06-01

154

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

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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 a...

Santos Paulo Roberto; Arcanjo Francisco Plácido Nogueira

2013-01-01

155

Safety and efficacy of nicotinamide in the management of hyperphosphatemia in patients on hemodialysis  

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Hyperphosphatemia is an important modifiable risk factor for death and cardiovascular events in patients on hemodialysis (HD). As nicotinamide has been shown as an inhibitor of sodium–dependent phosphate co–transport in rat renal tubule and small intestine, we examined whether nicotinamide reduces hyperphosphatemia in patients undergoing HD. The study was conducted in 30 end-stage renal disease (ESRD) patients [20 (66.7%) males and 10 (33.3%) females; mean age 54 ± 14.9 years] undergoing...

Vasantha, J.; Soundararajan, P.; Vanitharani, N.; Kannan, G.; Thennarasu, P.; Neenu, G.; Reddy, C. Umamaheswara

2011-01-01

156

Biofeedback systems and adaptive control hemodialysis treatment  

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

Azar Ahmad

2008-01-01

157

Continuous Renal Replacement Therapy  

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It is a mode of renal replacement therapy for hemodynamically unstable ;fluid overloaded; catabolic septic patients and finds its application in management of acute renal failure especially in the critical care /intensive care unit setting. The popularity of ?slow continuous therapies? for the treatment of critically ill patients with renal failure is increasing. The techniques most commonly used are slow continuous hemodialysis and hemodiafiltration. Slow continuous hemofiltration and slow c...

Dr. Manish Chaturvedi

2004-01-01

158

Olfactory function improves following hemodialysis.  

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Olfactory function has been shown to be affected in chronic kidney disease; however, studies are contradictory and little is known on the effects of dialysis. To resolve these issues we tested olfactory function in 24 healthy controls and in 28 patients with chronic kidney disease receiving hemodialysis (20 patients) or peritoneal dialysis (the other 8). As assays for olfactory function we measured smell identification, n-butanol and acetic acid thresholds, Kt/V urea, percentage reduced urea, and weights before and after dialysis. Olfactory function was also self-rated by the participants. Compared to healthy controls, predialysis olfactory function was moderately but significantly decreased in the two dialysis groups, with hemodialysis patients being more affected. Patients self-rated olfactory function similar to that of healthy controls, suggesting that patients are unaware of the olfactory decrease. Olfactory function was significantly improved by one hemodialysis session. Neither body mass index, total volume loss, nor any other dialysis parameter correlated with olfactory function or its restitution following hemodialysis. The observed pattern of improvement suggests underlying mixed peripheral and central mechanisms. Thus, olfactory dysfunction in patients with chronic kidney disease is readily reversible by hemodialysis. PMID:21697812

Landis, Basile N; Marangon, Nicola; Saudan, Patrick; Hugentobler, Marianne; Giger, Roland; Martin, Pierre-Yves; Lacroix, Jean-Silvain

2011-10-01

159

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

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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)

2007-06-01

160

Rising burden of Hepatitis C Virus in hemodialysis patients  

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

Naseemullah

2011-09-01

 
 
 
 
161

Infectious complications of prosthetic arteriovenous grafts for hemodialysis: prevention is better than cure.  

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Synthetic arteriovenous grafts for hemodialysis constitute the second choice in comparison with native arteriovenous fistulas. Lower patency rates and significantly more frequent infections are the main disadvantages of hemodialysis grafts over fistulas. Infectious complications could vary between a simple local erythema at a puncture site that resolves easily with antibiotics to septicemia and death. As a corollary, this kind of complications continue to be among the most important causes of morbidity and mortality in end-stage renal disease patients receiving long-term hemodialysis. The cornerstone is prevention of infections. It is generally accepted that following simple measures during the intervention of graft insertion and consecutively in every hemodialysis session could consistently reduce the risk of infection. PMID:24512170

Galanopoulos, Georgios; Lambidis, Constantinos

2014-05-01

162

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

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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. Rel...

Pakour, Amir H.; Nourozi, Saeedeh; Molsted, Stig; Harrison, Adrian P.; Nourozi, Khadije; Fridlund, Bengt

2011-01-01

163

Pulmonary Artery Pressure in Maintenance Hemodialysis Patients  

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Full Text Available To consider the prevalence of pulmonary artery pressure in End-stage Renal Disease (ESRD patients, a study was conducted on maintenance of hemodialysis patients and a group of normal subjects. For assessment of pulmonary artery pressure all participants were subjected to two-dimensional and doppler echocardiographic studies that for patients were done after their hemodialysis session. In this study a significant difference of Pulmonary Artery Systolic Pressure (PASP between patients and normal subjects with more values in hemodialysis patients was seen. A significant positive correlation of pulmonary artery pressure with age of control group and also significant positive correlation of pulmonary artery pressure with age of hemodialysis group were found. A significant positive correlation of PASP with duration and dosages of hemodialysis treatment were seen too. A high prevalence of pulmonary hypertension in hemodialysis needs more attention to this aspect of hemodialysis patients because pulmonary hypertension is a disease with poor prognosis.

M.D. Hamid Nasri

2006-01-01

164

Paricalcitol reduces oxidative stress and inflammation in hemodialysis patients  

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

Izquierdo María

2012-11-01

165

ADIPONECTIN LEVELS AND ATHEROSCLEROTIC RISK FACTORS IN CHILDREN ON HEMODIALYSIS  

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

2008-01-01

166

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

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

Miguel Cendoroglo Neto

2007-09-01

167

Acute effect of hemodialysis on serum levels of the proinflammatory cytokines.  

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Chronic inflammation is a common feature of end-stage renal disease, which carries a heightened risk of atherosclerosis and other co-morbid conditions. Dialysis treatment per se can bring additional risk factors for inflammation, such as increased risk of local graft and fistula infections, impure dialysate or bio-incompatible membranes. Our study was designed to determine whether a hemodialysis session leads to an acute substantial alteration in the plasma levels of the proinflammatory cytokines interleukin (IL)-6, IL-1beta and tumor necrosis factor (TNF)-alpha, the T-lymphocyte activation factor soluble IL-2 receptor (sIL-2R), and an inflammation mediator and chemotactic granulocyte factor, IL-8, in end-stage renal disease patients receiving chronic intermittent HD. In this study, 21 (12 male/nine female) patients undergoing chronic hemodialysis were enrolled. The acute effect of a hemodialysis session on serum cytokine concentrations was assessed by comparison of pre-hemodialysis and post-hemodialysis determinations. Serum IL-1beta, sIL-2R, IL-6, IL-8 and TNF-alpha levels were determined with chemiluminescence enzyme immunometric assays. A significant difference was not observed for IL-1beta, IL-6, TNF-alpha, and sIL-2R concentrations in pre-hemodialysis and post-hemodialysis specimens (p>0.05). Serum median (25th-75th percentiles) IL-8 concentration was 69.4 (34.9-110.3) pg/ml before hemodialysis, and decreased to 31.5 (18.0-78.8) pg/ml following hemodialysis (p: 0.006). Clearance of IL-8 increased by 0.47+/-0.08 pg/ml for each unit increase in pre-dialysis IL-8 (p<0.001) and decreased by 5.63+/-2.59 pg/ml for each unit increase in pre-dialysis urea mmol/l (p<0.05). In conclusion, the results of our study demonstrate that a hemodialysis session markedly decreases IL-8 concentration, which is significantly affected by pre-dialysis concentrations, indicating that removal of IL-8 is a concentration gradient-dependent action, but does not change the serum levels of IL-1beta, sIL-2R, IL-6, and TNF-alpha, underlining importance of the structural characteristics of the molecules.

Tarakcioglu, Mehmet; Erbagci, Ayse Binnur; Usalan, Celalettin; Deveci, Rukiye; Kocabas, Ramazan

2003-01-01

168

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

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

Mustafa Duran

2010-01-01

169

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

Scientific Electronic Library Online (English)

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

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

170

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

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

Sepehrvand Nariman

2010-01-01

171

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

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

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

2014-02-01

172

Evaluation of noninvasive tests for diagnosis of Helicobacter pylori infection in hemodialysis patients.  

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Background: Hemodialysis is the most common method of renal replacement therapy for treatment of acute and chronic kidney failure. Helicobacter pylori (H. pylori) plays a major role in development of peptic ulcer, gastric neoplasms, and lymphoma as well as increased risk of cardiovascular disorders in hemodialysis patients. Objectives: In this study the diagnostic values of noninvasive tests [i.e. urea breath test (UBT), helicobacter pylori stool antigen test (HPSA) and serology] in diagnosis of H. pylori infection in hemodialysis patients have been studied. Patients and Methods: All patients undergoing hemodialysis in Fatemieh Hospital, Semnan, Iran, were enrolled in the study, and their H. pylori status were assessed by using non-invasive tests including UBT, HPSA and serology. Patients with at least two out of 3 positive tests were considered infected with H. pylori. Results: The sensitivity, specificity, and positive and negative predictive values of the tests used in diagnosing H. pylori infection were 62.5%, 65.4%, 62.5% and 65.4% for UBT, 100%, 72.2%, 58.3% and 100% for serology, and 100%, 75%, 60.9% and 100% for fecal antigen test, respectively. Conclusions: This study showed that H. pylori serology and stool antigen tests have higher diagnostic values than UBT, and they are more reliable than UBT in diagnosis of H. pylori infection in hemodialysis patients. PMID:24475457

Tamadon, Mohamad Reza; Saberi Far, Morteza; Soleimani, Alireza; Ghorbani, Raheb; Semnani, Vahid; Malek, Farhad; Malek, Mojtaba

2013-10-01

173

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

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

Nakao, Kaoru; Mochizuki, Hidenori

2009-05-01

174

Acute gangrene that developed in the fingers of the hand with arteriovenous fistule in a chronic hemodialysis patient.  

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Finger gangrene developing due to arterial occlusive disease in the upper extremity is a rare pathology. Although rare, it can especially be seen in patients undergoing chronic hemodialysis. Although there are no established reasons in the etiology of gangrene occurring in the hand following chronic hemodialysis, certain high-risk factors have been defined. Awareness of these high-risk factors is important in the prevention of these types of undesired complications with high morbidity rates. In our study, we report an acutely developed finger necrosis as well as the possible etiologic factors causing the necrosis and its treatment. The necrosis developed in the hand (where an arteriovenous fistule formed) of a 60-year-old patient in menopause, with osteoporosis, diabetes, hypertension, and who was undergoing hemodialysis due to an eight-year history of end-stage renal disease. PMID:17052068

Cebesoy, Oguz; Baltaci, Enver Taner

2006-10-01

175

Effects of Zinc Supplementation on Plasma Copper/Zinc Ratios, Oxidative Stress, and Immunological Status in Hemodialysis Patients  

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Background: Patients undergoing hemodialysis (HD) have low plasma levels of zinc (Zn), high plasma levels of copper (Cu), and exhibit increased oxidative stress, inflammation, and immune abnormalities. We evaluated the effects of Zn supplementation on abnormal plasma Cu/Zn ratios and clinical outcomes in HD patients.

Guo, Chih-hung; Wang, Chia-liang

2013-01-01

176

Optimal timing of initiation of chronic hemodialysis?  

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Despite the availability of clinical guidelines for the timing of dialysis initiation in both the United States and Canada, patients continue to start dialysis at very low levels of predicted glomerular filtration rate (GFR). A cross-sectional study was performed to determine the demographic and clinical characteristics of patients who started hemodialysis, their level of GFR, and mortality at 1 and 2 years following the initiation of dialysis. Retrospective data were collected on all eligible patients who commenced chronic hemodialysis in 1 tertiary care center in Canada from March 2001 to February 2005. Only those patients who had been followed by a nephrologist in the chronic kidney disease clinic before dialysis initiation were included (n=271). Seventeen percent of patients started hemodialysis late (GFR<5 mL/min/1.73 m(2)). Compared with the group of patients who started dialysis earlier, the late start group were significantly younger (p=0.008), had more females (p=0.013), more employed (p=0.051), less cardiac (p<0.001), and peripheral vascular disease (p=0.031), and were taking medication for hypertension (p=0.041). Serum albumin was lower in the late start group (p=0.023). At year 1, there was no difference in mortality rate while at year 2, the earlier the dialysis, the greater the mortality rate (p=0.022). After adjustment for demographic variables and comorbidities, only antihypertensive use had an independent but weak association with the 2 year mortality. Adjustment for all these variables eliminated the significant association noted for the 2 year mortality in the early versus late dialysis start. The survival benefit for late versus early dialysis start appears to be multifactorial and relates to a preponderance of clinical and demographic factors favoring a lengthened survival occurring in the late dialysis group. Our survival benefit findings suggest the premorbid health condition is a more important determinant of 2 year survival than the timing of dialysis initiation. PMID:17403180

Wilson, Barbara; Harwood, Lori; Locking-Cusolito, Heather; Chen, Salina J; Heidenheim, Paul; Craik, Don; Clark, William F

2007-04-01

177

Depressive Symptomatology in Children and Adolescents with Chronic Renal Insufficiency Undergoing Chronic Dialysis  

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This paper presents a descriptive study, using the Birleson Scale to determine the frequency of depressive symptomatology in children and adolescents with chronic renal insufficiency (CRI) undergoing hemodialysis (HD) and chronic peritoneal dialysis (CPD). There were 67 patients (40 female and 27 male) with a mean age of 14.76 ± 2.71 years, duration of illness ?3?months, 43 (64.18%) patients with CPD and 24 (35.82%) undergoing HD. The frequency of high occurrence, low occurrence, and abs...

Hernandez, Edith G.; Loza, Reyner; Vargas, Horacio; Jara, Mercedes F.

2011-01-01

178

Urea biosensor for hemodialysis monitoring  

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

Glass, Robert S. (Livermore, CA)

1999-01-01

179

Maintenance Intravenous Iron Sucrose Therapy in Children Under Regular Hemodialysis  

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Full Text Available This study aimed to evaluate the effects of maintenance IV iron sucrose vs oral iron gluconate on iron indices and hematological profile in pediatric hemodialysis patients. Twenty four children under regular hemodialysis (13 males and 11 females with median age 11 years were enrolled in this study and had initial adequate iron stores and were maintained on oral iron gluconate daily and erythropoietin alpha (EPO weekly for 3 months prior to study. They were randomly subdivided into two groups. Group A included 12 patients (8 males and 4 females with median age 10 years and they continued to receive oral iron gluconate daily and EPO alpha and group B included 12 patients (5 males and 7 females with median age 12 years who received intravenous iron sucrose every 2 weeks and EPO alpha on same dose of group A for a study period of 3 months. There were significant increase in serum iron (p = 0.002, serum ferritin (p = 0.026 and transferrin saturation (p = 0.001 in (IV iron sucrose group than with oral iron gluconate group. In addition, hemoglobin and hematocrite were increased by 8 and 11.2%, respectively on group B. Iron overload was reported in two patients only of group B (16.7%. We concluded that IV iron sucrose is effective and safe preparation to be used in iron replete children under regular hemodialysis to maintain adequate iron stores and to ensure optimum response to EPO therapy.

Mohamed Ragab

2007-01-01

180

Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in Al-Hasa Region of Saudi Arabia  

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The prevalence of anti-HCV antibodies among hemodialysis (HD) patients was studied at King Fahad Hospital, Hofuf, Saudi Arabia. The records of 189 patients undergoing HD were reviewed. The overall prevalence of anti-HCV antibodies was 43.9%. Anti-HCV antibody prevalence was more common among female patients. There was no correlation between repeated blood transfusions and anti-HCV positivity as 4.8% of the patients who did not receive any blood transfusion during HD were positiv...

2001-01-01

 
 
 
 
181

The Role of Xanthine Oxidase in Hemodialysis-Induced Oxidative Injury: Relationship with Nutritional Status  

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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-H...

Miric, Dijana; Kisic, Bojana; Stolic, Radojica; Miric, Bratislav; Mitic, Radoslav; Janicijevic-hudomal, Snezana

2013-01-01

182

HDL Proteome in Hemodialysis Patients: A Quantitative Nanoflow Liquid Chromatography-Tandem Mass Spectrometry Approach  

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Aside from a decrease in the high-density lipoprotein (HDL) cholesterol levels, qualitative abnormalities of HDL can contribute to an increase in cardiovascular (CV) risk in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis (HD). Dysfunctional HDL leads to an alteration of reverse cholesterol transport and the antioxidant and anti-inflammatory properties of HDL. In this study, a quantitative proteomics approach, based on iTRAQ labeling and nanoflow liquid chromatography ...

Mange?, Alain; Goux, Aure?lie; Badiou, Ste?phanie; Patrier, Laure; Canaud, Bernard; Maudelonde, Thierry; Cristol, Jean-paul; Solassol, Je?ro?me

2012-01-01

183

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

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

Azar BARADARAN

2011-12-01

184

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.

2001-01-01

185

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

2001-01-01

186

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  

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

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

187

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

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

Daniele Favaro Ribeiro

2009-12-01

188

Cutaneous manifestations in patients with chronic renal failure on hemodialysis  

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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.

Udayakumar P

2006-01-01

189

Profile of PRMT-1 Gene Polymorphism in Hemodialysis Patients with Increased ADMA Levels.  

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Aim: to determine the distribution of PRMT-1 gene polymorphism and ADMA levels among continuing hemodialysis patients. Methods: genotyping of PRMT-1 polymorphism was performed in 57 hemodialysis patients at Al Irsjad Hospital. All participants were recruited for physical examination, questionnaire, and collection of 5 mL fasting venous blood. The blood was treated with phenol-chloroform extraction of genomic DNA. The candidate's single nucleotide polymorphisms (SNPs) were genotyped by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The ADMA plasma levels was determined by ELISA and all biochemical indicators of serum were examined. Results: fifty-seven hemodialysis patients participated in our study, 54 (95.4%) of them had increased ADMA plasma levels. DNA sequencing analysis of 13 patients showed a suspected PRMT-1 gene polymorphism at sequence 5837 as there were different genotypes between C and G. Conclusion: the increased levels of ADMA might be caused by PRMT-1 gene polymorphism. PMID:25053681

Thaha, Mochammad; Nilamsari, Wenny P; Yusuf, Mochammad; Amin, M

2014-04-01

190

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

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Full Text Available Secondary hyperparathyroidism(SHPTH is a common complication of chronic kidney disease and is characterized by elevated levels of serum parathyroid hormone (PTH and abnormalities in bone and mineral metabolism. This serious disorder could be aggravated by metabolic acidosis which is a common consequence of advanced chronic renal failure and in maintenance dialysis patients. To investigate factors influencing the intensity of secondary hyperparathyroidism (SHPTH in patients on chronic maintenance haemodialysis we tested the association of relative acidosis of hemodialysis patients with parathyroid gland activity. This is a cross-sectional study that was conducted on patients undergoing maintenance hemodialysis treatment with acetate basis dialysate and polysulfone membrane. Serum calcium (Ca, phosphorus (P, magnesium (Mg, alkaline phosphatase (ALP and intact serum PTH (iPTH and plasma HCO3 were measured. A significant positive correlation of plasma HCO3 with duration and dosage of hemodialysis were found. In all patients a significant inverse correlation of logarithm of serum iPTH with plasma HCO3 was seen while this association was very significant in female hemodialysis patients. A strong inverse association between plasma HCO3 and serum PTH in female gender may show the more aggressive form of SHPTH in this group.

M.D. Hamid Nasri

2005-01-01

191

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

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

1997-01-01

192

Metformin induced severe hypophosphatemia in a patient on hemodialysis  

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A 67-year-old diabetic and hypertensive woman presented to us with very low serum phosphate levels (PO4 - =1.1 mg/dL) about 40 days after initiation of hemodialysis (HD). The phosphate binders were discontinued, because they were thought to be the cause of hypo-phosphatemia. However, the serum phosphate levels continued to remain low during subsequent follow-up visits over one month (PO4 --- = 0.7 and 0.6 mg/dL respectively). The patient had been started on metformin hyd...

Tsitsios Tilemachos; Sotirakopoulos Nikolaos; Armentzioiou Karmen; Kalogiannidou Irini; Kolaggis Alexandros; Mavromatidis Konstantinos

2010-01-01

193

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.)

1999-05-01

194

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

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

Hartrick Craig T

2012-03-01

195

High fluoride exposure in hemodialysis patients.  

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

Bello, V A; Gitelman, H J

1990-04-01

196

Acid-Base Homeostasis in Hemodialysis.  

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Experiments with normal human subjects confirms that acetate metabolism can be described as a two compartment, first order elimination process and the fractional generation of bicarbonate from acetate is 100%. At TMP=0 DBic > DAc. During hemodialysis a me...

M. W. Weiner

1978-01-01

197

Spontaneous Renal Hemorrhage in Hemodialysis Patients  

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Dialysis patients have a tendency to bleed, and clinicians sometimes encounter cases with a significant amount of spontaneous hemorrhage. We herein report two cases of spontaneous renal hemorrhage in hemodialysis patients.

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

2011-01-01

198

Pseudo-blood leak? A hemodialysis mystery.  

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Hydroxocobalamin is a treatment for cyanide toxicity with few side effects. We report a case of a hemodialysis patient whose treatment was compromised by hydroxocobalamin interference with the blood leak detector. PMID:23537683

Avila, Jose; Prasad, Deepali; Weisberg, Lawrence S; Kasama, Richard

2013-04-01

199

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

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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.

Hamid Nasri

2006-09-01

200

Factors associated with peak oxygen uptake in hemodialysis patients awaiting renal transplantation.  

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The preoperative evaluation of pulmonary function is important in renal transplantation candidates. Exercise capacity determined by peak oxygen uptake (peak Vo(2)) is a predictor of perioperative mortality and survival. The aim of this study was to determine the factors associated with the peak Vo(2) among renal transplantation candidates undergoing hemodialysis. Thirty patients with chronic renal failure including 14 women and 16 men of mean age 40.2 +/- 10.3 years had a mean duration of dialysis of 133.1 +/- 63.3 months and were awaiting renal transplantation. None of the patients had signs or symptoms of active infection or inflammation. Each patient underwent pulmonary function and symptom-limited cardiopulmonary exercise tests. Despite the absence of clinically evident inflammation, a malnutrition inflammation score was calculated for each patient to assess comorbid conditions and the risk of atherosclerosis. Demographic and laboratory parameters were obtained from hospital records. The peak Vo(2) was positively correlated with the serum triglyceride level and negatively correlated with serum ferritin level and malnutrition inflammation score. On multiple linear regression analyses, which were performed to assess the potential predictors of the peak Vo(2), the malnutrition inflammation score was the only variable that independently correlated with the peak Vo(2) in hemodialysis patients awaiting renal transplantation. In conclusion, peak Vo(2) is associated with markers of nutrition and the malnutrition inflammation score. We suggest that chronic malnutrition and silent inflammation may be responsible for the preoperative decreased exercise capacity in renal transplantation candidates undergoing hemodialysis. PMID:17524838

Sezer, S; Elsurer, R; Ulubay, G; Ozdemir, F N; Haberal, M

2007-05-01

 
 
 
 
201

Systemic effects of a high-flow arteriovenous fistula for hemodialysis.  

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Purpose: Absolute treatment criteria for reducing the access volume of a high-flow access (HFA, access flow >2 L/min) are absent. Previous studies suggested that a HFA may influence the systemic circulation including blood pressure (BP) and heart rate (HR). The aim of this study was to determine these parameters after access clamping in hemodialysis patients undergoing flow-reducing access surgery.Methods: Systolic BP (SBP), diastolic BP (DBP) and HR in HFA patients undergoing flow-reducing surgery were measured intraoperatively before and after access clamping. Data were compared to values obtained in patients receiving surgery for severe hand ischemia due to an access (HAIDI, hemodialysis access-induced distal ischemia).Results: In 8 years, 34 patients underwent surgery for HFA (n=23) or HAIDI (n=11). Preoperative access flows in HFA were larger compared to HAIDI (3,026±147 vs 1,078±139 mL/min, respectively, p 2-2.5 L/min.Conclusions: HFA may influence systemic hemodynamics in some hemodialysis patients. The findings of this study may contribute to a tailored management of a high-flow fistula in this population. PMID:24170583

Vaes, Roel H; Tordoir, Jan H; Scheltinga, Marc R

2014-06-01

202

The relevance of dietary sodium in hemodialysis.  

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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

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

2013-04-01

203

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

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

Seyed-Moayed Alavian

2008-02-01

204

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

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Full Text Available Chadi Saifan, Elie El-Charabaty, Suzanne El-SayeghStaten Island University Hospital, Staten Island, NY, USABackground: Elevated total plasma homocysteine is an independent risk factor for arterial and venous thrombosis in patients with normal renal function. Patients on hemodialysis have a high prevalence of mild to moderate hyperhomocysteinemia. Conflicting retrospective analyses and prospective studies have been reported regarding the association between total homocysteine levels and hemodialysis vascular thrombosis. The purpose of this retrospective study was to investigate the relationship between hyperhomocysteinemia and vascular access thrombosis (VAT in patients on hemodialysis.Methods: One hundred and twenty-five patients undergoing dialysis were selected as subjects. The experimental group participants were identified as those having one or more VAT during the previous 13 months and the control group participants had no access thrombosis during the same period. Additional subgroup analysis included the presence of hypertension, diabetes, low-density lipoprotein levels, sex, and use of aspirin.Results: No statistically significant difference was found in total homocysteine levels between the two groups (P = 0.27. No association was found between VAT and sex (P = 0.09, VAT and hypertension (P = 0.96, VAT and diabetes (P = 0.49, nor VAT and low-density lipoprotein level (P = 0.04. A lower rate of VAT was associated with aspirin intake (P = 0.04.Conclusion: This study did not demonstrate a relationship between total homocysteine concentrations and risk of VAT in patients with end-stage renal disease on hemodialysis. There were no significant differences in the number of VAT across additional variables of sex and previous morbidity. Aspirin intake was associated with a lower incidence of VAT.Keywords: hyperhomocysteinemia, vascular access thrombosis, hemodialysis

Saifan C

2013-07-01

205

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

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Background There are scarce epidemiological data on cardiovascular risk profile of chronic hemodialysis patients in Brazil. Objective The CORDIAL study was designed to evaluate cardiovascular risk factors and follow up a hemodialysis population in a Brazilian metropolitan city. Methods All 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. Results A total of 1215 patients were included (97.3% of all hemodialysis patients in the city of Porto Alegre). Their average age was 58.3 years old, 59.5% were male and 62.8% were white. The prevalence of cardiovascular risk factors observed was 87.5% for hypertension, 84.7% for dyslipidemia, 73.1% for sedentary lifestyle, 53.7% for tobacco use, and 35.8% for diabetes. In a multivariate adjusted analysis, we found that sedentary lifestyle (p = 0.032, PR 1.08 - 95%CI: 1.01-1.15), dyslipidemia (p = 0.019, PR 1.08 - 95%CI: 1.01-1.14), and obesity (p < 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). Conclusion Hemodialysis patients in this southern metropolitan Brazilian city have a high prevalence of cardiovascular risk factors resembling many northern countries.

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

2014-01-01

206

[Changes in the biomechanic property of the skin after hemodialysis treatment].  

Science.gov (United States)

Skin extensibility in 21 subjects (belonging to two different age groups) undergoing hemodialysis has been investigated. Measurements have been performed on the forearm before and after two hours of dialytic treatment. A significant decrease of skin extensibility (P less than 0.02) has been recorded in the elderly prior to the dialytic procedure; the data is consistent with an increased dermal water content. Water removal during treatment led to normalization of extensometric levels (P less than 0.05). However, improvement of skin extensibility is not directly related to the amount of water withdrawn. The study support the importance of water in determining skin viscoelastic responses; hemodialysis is a useful model to monitor the effects of water on skin biomechanics. PMID:2630431

Berardesca, E; Brazzelli, V; Borroni, G; Cavagnino, A; Rabbiosi, G

1989-06-01

207

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

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Abstract Background Interscalene block (ISB) is commonly performed using 20-40 mL of local anesthetic. Spread to adjacent structures and consequent adverse effects including paralysis of the ipsilateral hemidiaphragm are frequent. Pain ratings, analgesic requirements, adverse events, satisfaction, function and diaphragmatic excursion were compared following interscalene block (ISB) with reduced initial bolus volumes. Methods Subjects undergoing arthroscopic rota...

Hartrick Craig T; Tang Yeong-Shih; Siwek Don; Murray Robert; Hunstad David; Smith Greg

2012-01-01

208

Skin Perfusion Pressure Is a Prognostic Factor in Hemodialysis Patients  

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Peripheral arterial disease (PAD) is common in hemodialysis patients and predicts a poor prognosis. We conducted a prospective cohort study to identify risk factors for PAD including skin perfusion pressure (SPP) in hemodialysis patients. The cohort included 373 hemodialysis patients among 548 patients who received hemodialysis at Oyokyo Kidney Research Institute, Hirosaki, Japan from August 2008 to December 2010. The endpoints were lower limb survival (peripheral angioplasty or amputation ev...

Shingo Hatakeyama; Masaaki Saito; Kumiko Ishigaki; Hayato Yamamoto; Akiko Okamoto; Yusuke Ishibashi; Hiromi Murasawa; Kengo Imanishi; Noriko Tokui; Teppei Okamoto; Yuichiro Suzuki; Naoki Sugiyama; Atsushi Imai; Shigemasa Kudo; Takahiro Yoneyama

2012-01-01

209

Antihypertensive Agents in Hemodialysis Patients: A Current Perspective  

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Hypertension affects most hemodialysis patients and is often poorly controlled. Adequate control of blood pressure is difficult with conventional hemodialysis alone but is important to improve cardiovascular outcomes. Nonpharmacologic interventions to improve blood pressure include educating patients about limiting sodium intake, ensuring adequate sodium solute removal during hemodialysis, and achieving target “dry weight.” However, most patients require a number of antihypertensive medic...

Inrig, Jula K.

2010-01-01

210

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

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Full Text Available An enzyme immuno assay for hepatitis C core antigen was recently developed and its performance was compared with that of the hepatitis C virus (HCV RNA in the screening of HCV infection in patients on hemodialysis. One hundred and eleven chronic renal failure patients undergoing haemodialysis between May 2003 and October 2004 were included in the study. All the patients were tested for anti HCV antibody, core antigen and RNA. Fifteen patients were anti HCV antibody positive, three patients were positive for HCV core antigen and RNA, three patients were positive for HCV RNA, while two patients were positive only for core antigen but negative for RNA. In anti HCV antibody positive patients, the core antigen was negative while the viral RNA continued to be present. Hence, relying solely on a single HCV core antigen assay may not be useful for a definite diagnosis of early HCV infection. The sensitivity and specificity of the assay were 60% and 83% respectively, while the positive predictive value was 14.3%, negative predictive value was 97.7% and the efficiency was 81.9%.

Reddy A

2006-01-01

211

Hemodialysis  

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212

The Impact of Intima-media Thickness of Radial Artery on Early Failure of Radiocephalic Arteriovenous Fistula in Hemodialysis Patients  

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This study was performed to investigate the impact of intima-media thickness (IMT) of radial artery on early failure of radiocephalic arteriovenous fistula (AVF) in hemodialysis (HD) patients. Ninety uremic patients undergoing radiocephalic AVF operation were included in this study. During the operation, 10-mm long partial arterial walls were removed with elliptical form for microscopic analysis. Specimens were stained with trichrome and examined by a pathologist blinded to the clinical data....

Kim, Young Ok; Choi, Yeong Jin; Kim, Ji Il; Kim, Young Soo; Kim, Byung Soo; Park, Chul Whee; Song, Ho Cheol; Yoon, Sun Ae; Chang, Yoon Sik; Bang, Byung Kee

2006-01-01

213

Hormonal regulation of energy-protein homeostasis in hemodialysis patients: an anorexigenic profile that may predispose to adverse cardiovascular outcomes  

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To assess whether endocrine dysfunction may cause derangement in energy homeostasis in patients undergoing hemodialysis (HD), we profiled hormones, during a 3-day period, from the adipose tissue and the gut and the nervous system around the circadian clock in 10 otherwise healthy HD patients and 8 normal controls. The protocol included a 40-h fast. We also measured energy-protein intake and output and assessed appetite and body composition. We found many hormonal abnormalities in HD patients:...

Suneja, Manish; Murry, Daryl J.; Stokes, John B.; Lim, Victoria S.

2011-01-01

214

The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial  

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Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments. To study this further, we randomized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week, all with single-use high-flux dialyzers. The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/Vurea, a 1.74-fold higher average number of treatments per week, and a 2.45-fol...

Rocco, Michael V.; Lockridge, Robert S.; Beck, Gerald J.; Eggers, Paul W.; Gassman, Jennifer J.; Greene, Tom; Larive, Brett; Chan, Christopher T.; Chertow, Glenn M.; Copland, Michael; Hoy, Christopher D.; Lindsay, Robert M.; Levin, Nathan W.; Ornt, Daniel B.; Pierratos, Andreas

2011-01-01

215

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

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Full Text Available Fourty three patients with chronic renal failure undergoing chronic hemodialysis in Division of Nephrology and Hypertension, Faculty of Medicine, University of Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, since October 2003 until February 2004, were examined for echocardiography (2-D, M-mode, Doppler imaging.Diastolic dysfunction was found in 58.1 % of chronic renal failure patients on hemodialysis. There was no significant difference between left ventricular mass in the group with or without left ventricular diastolic dysfunction. (Med J Indones 2006; 15:105-8Keywords: Left ventricular mass, diastolic function, chronic renal failure, hemodyalisis

Idrus Alwi

2006-05-01

216

Vascular access-related infection in nocturnal home hemodialysis.  

Science.gov (United States)

Frequent hemodialysis is associated with increased vascular access adverse events. We hypothesized that bacteremia would be more frequent in patients with central venous catheter (CVC) than arteriovenous fistula or arteriovenous graft (AVF/AVG) in nocturnal home hemodialysis (NHHD). We reviewed blood culture reports and concurrent clinical data for a cohort of one hundred eighty-seven NHHD patients between January 1, 2006 and June 30, 2012. The primary outcome was time to first bacteremia, technique failure, or death after commencing NHHD. Types of bacteremia and clinical consequences were analyzed. Analyses were adjusted for a priori defined confounders. One hundred eighty-seven patients were included with a total follow up of six hundred five patient years. Initial vascular access was AVF in seventy-eight (42%) patients, AVG in eleven (6%) patients, and CVC in ninety-eight (52%) patients. A total of 79.3% of patients with a CVC reached the composite endpoint of bacteremia, technique failure, or death in the study period; 44.5% of patients with an AVF or AVG reached this composite endpoint. Adjusted time to first bacteremia, technique failure, or death was significantly shorter in patients with initial CVC access (hazard ratio 2.42, 95% confidence interval 1.50-3.90, p Coagulase negative staphylococcus was the commonest organism cultured accounting for 51.4% bacteremias. The second commonest organism was staphylococcus aureus (20.3% bacteremias). Patients undergoing NHHD with a CVC have a shorter duration to first infection, technique failure, or death than those with permanent vascular access. PMID:24467296

Hayes, Wesley N; Tennankore, Karthik; Battistella, Marisa; Chan, Christopher T

2014-04-01

217

Osteoarthropathy in long-term hemodialysis patients  

International Nuclear Information System (INIS)

The authors reviewed hand and wrist films of 81 patients who had undergone hemodialysis for a minimum of 5 and a mean duration 7.5 years. The films of 32 patients showed arthritic changes consisting of articular erosions, joint space narrowings, periarticular cysts, and osteopenia. Five of these patients had subcutaneous or periarticular calcific deposits. The frequency and severity of the radiographic findings increased with increasing duration of dialysis. It appears that in addition to the well-recognized secondary hyperparathyroidism there is a second commonly occurring osteoarthropathy (40% in this series) related to long-term hemodialysis

1986-12-05

218

Nocturnal sleep, daytime sleepiness, and quality of life in stable patients on hemodialysis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background Although considerable progress has been made in the treatment of chronic kidney disease, compromised quality of life continues to be a significant problem for patients receiving hemodialysis (HD). However, in spite of the high prevalence of sleep complaints and disorders in this population, the relationship between these problems and quality of life remains to be well characterized. Thus, we studied a sample of stable HD patients to explore relationships b...

Parker Kathy P; Kutner Nancy G; Bliwise Donald L; Bailey James L; Rye David B

2003-01-01

219

Intradialytic versus home based exercise training in hemodialysis patients: a randomised controlled trial  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Exercise training in hemodialysis patients improves fitness, physical function, quality of life and markers of cardiovascular disease such as arterial stiffness. The majority of trials investigating this area have used supervised exercise training during dialysis (intradialytic, which may not be feasible for some renal units. The aim of this trial is to compare the effects of supervised intradialytic with unsupervised home-based exercise training on physical function and arterial stiffness. Methods and design This is a randomised, controlled clinical trial. A total of 72 hemodialysis patients will be randomised to receive either six months of intradialytic exercise training, home-based exercise training or usual care. Intradialytic patients will undergo three training sessions per week on a cycle ergometer and home-based patients will be provided with a walking program to achieve the same weekly physical activity. Primary outcome measures are six-minute walk distance (6 MWD and aortic pulse wave velocity (PWV. Secondary outcome measures include augmentation index, peripheral and central blood pressures, physical activity and self-reported health. Measures will be made at baseline, three and six months. Discussion The results of this study will help determine the efficacy of home-based exercise training in hemodialysis patients. This may assist in developing exercise guidelines specific for these patients. Trial Registration ACTRN12608000247370

Fassett Robert G

2009-01-01

220

Serum Lipid Profile Constituents as Markers of Cardiovascular Morbidity in Patients on Chronic Hemodialysis  

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We designed the present case-control study in order to examine the validity of apolipoprotein (apo) A-I, B, apoB/apoA-I ratio and Lp(a) as alternative markers of cardiovascular morbidity in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis (HD). Twenty-five HD patients (18 males, mean age 63, range 52–69 years) comprised the group with prevalent cardiovascular disease (CVD) and 50 HD patients (35 males, mean age 62, range 40–77 years) with non evident cardiovascular ...

Kirmizis, Dimitrios; Koutoupa, Evangelia; Tsiandoulas, Apostolos; Valtopoulou, Aphroditi; Niavis, Georgios; Markou, Phani; Barboutis, Konstantinos

2007-01-01

 
 
 
 
221

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

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

Lin, Yi-sheng; Hung, Szu-chun; Wei, Yau-huei; Tarng, Der-cherng

2009-01-01

222

Individualized reduction in dialysate sodium in conventional in-center hemodialysis  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Recent studies have focused on the association between dialysate sodium (Na+) prescriptions and interdialytic weight gain (IDWG). We report on a case series of 13 patients undergoing conventional, thrice-weekly in-center hemodialysis with an individualized dialysate Na+ prescription. Individualized dialysate Na+ was achieved in all patients through a stepwise weekly reduction of the standard dialysate Na+ prescription (140 mEq/L) by 2–3 mEq/L until reaching a Na+ gradient of ?2 mEq/L (dia...

Arramreddy, Rohini; Sun, Sumi J.; Mendoza, Jair Munoz; Chertow, Glenn M.; Schiller, Brigitte

2012-01-01

223

Underlying kidney disease and duration of hemodialysis: an assessment of its effect on oral health.  

Science.gov (United States)

Background: Dental health among the patients undergoing haemodialysis therapy has been found to be debilitated and gets worsened with the increased duration of hemodialysis.Hence the present study aimed to assess the effect of duration of hemodialysis and the underlying kidney disease on the dental health status of patients. Settings and Design: A cross-sectional study was conducted on 400 patients and 400 controls selected through stratified random sampling method from five zones of Delhi, India. Materials and Methods: The patient group was divided into following five groups in order to evaluate influence of duration of hemodialysis therapy on dental status of the subjects-a)? three months b)four to six months c)seven to nine months d) ten to twelve months and e) more than twelve months. Dental health was assessed using WHO dentition status and treatment needs, community periodontal index, oral hygiene index, prosthetic status and needs. Statistical Analysis Used: Student t-test, Chi-square test, one-way analysis of variance (ANOVA) and Pearson's correlation was used to determine the difference in clinical parameters among the subgroup and between the patients and controls. Results: Positive correlation was found between the frequency of dialysis and maximum CPI scores (p-value=0.018). 81.25% of patients and 74.75% of the controls had CPI score 2. Loss of attachment scores in patients was higher than the healthy controls (p-value 0.035). Mean OHI scores for the patients was 5.15±1.975 and for controls was 5.01±2.213 (p=0.635). Mean DMFT score of patients and controls was 3.552 and 3.559 respectively (p=0.937). 23%of controls showed presence of dental prosthesis in comparison to only 14.5 % of patients (p=0.05). Type of underlying kidney disease and duration of hemodialysis had significant influence on O.H.I scores and Prosthetic needs. Conclusion: Dental health status was found to be debilitated among the hemodialysis patients and got worsened with the duration of hemodialysis and the type of underlying kidney disease mainly due to oral health negligence contributing to morbidity and potential mortality. Further emphasis on the effective implementation of oral health promotion programme for medically compromised patients is thus advocated. PMID:24995249

Jain, Swati; Singla, Ashish; Basavaraj, P; Singh, Shilpi; Singh, Khushboo; Kundu, Hansa

2014-05-01

224

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Background: Exercise training during the dialytical procedure may have positive cardiovascular effects and prevent or revert muscle wasting in patients undergoing chronic hemodialysis. Aim: To evaluate the effects of an exercise training program in patients undergoing chronic hemodialysis. Material [...] and Methods: Fifteen patients on chronic hemodialysis aged 21 to 69 years (three females) were included in the study. Nine of these were included in an exercise training program. During 16 weeks, exercise sessions were carried out during each dialytical procedure that included a warm-up period, aerobic exercises done using standing cycles, and resistance exercises, performed using Thera-Band® elastic bands and loops. Borg scale was used to control the intensity of training. At baseline and at the end of the study, a blood sample prior and after the dialytical procedure was obtained to measure C reactive protein, tumor necrosis factor ? and interleukin 6. Quadriceps muscle strength, six minutes´ walk and quality of life using the SF-36 questionnaire, were also measured. Results: Four experimental subjects did not complete the study period, two that withdrew before starting, one due to problems with the venous access and one that decided to withdraw after 1 month of training. Among the five patients that finished the training period, significant improvements in the six minutes´ walk and quadriceps strength were observed in the experimental group. No significant changes were observed among controls. No changes were observed in either group in C reactive protein, tumor necrosis factor and interleukin 6 levels or quality of life. Conclusions: Among patients undergoing chronic hemodialysis exercise training improves endurance and muscle strength.

María Soledad, Oliveros R; Marcelo, Avendaño; Daniel, Bunout; Sandra, Hirsch; María Pía, De La Maza; Cristian, Pedreros; Hans, Müller.

225

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

Directory of Open Access Journals (Sweden)

Full Text Available Background: Exercise training during the dialytical procedure may have positive cardiovascular effects and prevent or revert muscle wasting in patients undergoing chronic hemodialysis. Aim: To evaluate the effects of an exercise training program in patients undergoing chronic hemodialysis. Material and Methods: Fifteen patients on chronic hemodialysis aged 21 to 69 years (three females were included in the study. Nine of these were included in an exercise training program. During 16 weeks, exercise sessions were carried out during each dialytical procedure that included a warm-up period, aerobic exercises done using standing cycles, and resistance exercises, performed using Thera-Band® elastic bands and loops. Borg scale was used to control the intensity of training. At baseline and at the end of the study, a blood sample prior and after the dialytical procedure was obtained to measure C reactive protein, tumor necrosis factor ? and interleukin 6. Quadriceps muscle strength, six minutes´ walk and quality of life using the SF-36 questionnaire, were also measured. Results: Four experimental subjects did not complete the study period, two that withdrew before starting, one due to problems with the venous access and one that decided to withdraw after 1 month of training. Among the five patients that finished the training period, significant improvements in the six minutes´ walk and quadriceps strength were observed in the experimental group. No significant changes were observed among controls. No changes were observed in either group in C reactive protein, tumor necrosis factor and interleukin 6 levels or quality of life. Conclusions: Among patients undergoing chronic hemodialysis exercise training improves endurance and muscle strength.

María Soledad Oliveros R

2011-08-01

226

Sleep disorders in hemodialysis patients  

Directory of Open Access Journals (Sweden)

Full Text Available The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years chronic hemodialysis (HD patients at the Urology and Nephrology Center, Mansoura Uni-versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS, obstructive sleep apnea syndrome (OSAS, excessive daytime sleepiness (EDS, narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques-tions of Hatoum?s sleep questionnaire. The prevalence of sleep disorders was 79.5% in our pa-tients, and the most common sleep abnormality was insomnia (65.9%, followed by RLS (42%, OSAS (31.8%, snoring (27.3%, EDS (27.3%, narcolepsy (15.9%, and sleep walking (3.4%. Insomnia correlated with anemia (r=0.31, P= 0.003, anxiety (r=0.279, P= 0.042, depression (r=0.298, P= 0.24 and RLS (r=0.327, P= 0.002. Also, RLS correlated with hypoalbuminemia (r=0.41, P= < 0.0001, anemia (r=0.301 and P= 0.046, hyperphosphatemia (r=0.343 and P= 0.001. EDS correlated with OSAS (r=0.5, P= < 0.0001, snoring (r=0.341, P= 0.001, and social worry (r=0.27, P= 0.011. Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno-graphy, is necessary to confirm our results. Interventional studies for management of sleep disor-ders in HD patients are warranted.

Sabry Alaa

2010-01-01

227

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)

2013-09-01

228

Blastocystis sp. and other intestinal parasites in hemodialysis patients  

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Chronic renal insufficiency disease (CRI) leads to uremia in hemodialysis patients and induces a state of immunodepression that results in higher frequencies of infections and diarrhea. Hemodialysis patients resident in the city of Campo Mourão, Paraná, Brazil were analyzed from April 2006 through September 2007 for Blastocystis sp. and other intestinal parasites and for associated diarrhea. Fecal samples from 86 hemodialysis patients and 146 healthy (reference) persons were examined by sta...

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

2008-01-01

229

Topical Capsaicin Therapy for Uremic Pruritus in Patients on Hemodialysis  

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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 d...

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

2010-01-01

230

The influence of autonomic neuropathy on hypotension during hemodialysis.  

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Many patients with chronic renal failure experience profound hypotension during hemodialysis. This phenomenon may be caused by hypovolemia, autonomic or cardiac dysfunction, vascular resistance defects or vasoactive substances such as nitric oxide or adrenomedullin. The aim of the study was to evaluate the influence of autonomic neuropathy on the occurrence of hypotension during hemodialysis. Fifty-three patients with chronic renal failure on maintenance hemodialysis underwent a standard batt...

Cavallo Perin, Paolo

2002-01-01

231

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

LENUS (Irish Health Repository)

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.

Quinlan, Catherine

2012-08-27

232

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

DEFF Research Database (Denmark)

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

Pakpour, Amir H.; Nourozi, Saeedeh

2011-01-01

233

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

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

Azar BARADARAN

2010-12-01

234

Prevalence of Occult Hepatitis B Virus Infection in Hemodialysis Patients From Egypt With or Without Hepatitis C Virus Infection  

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Full Text Available Background: While prevalence of Hepatitis B virus (HBV in patients with end-stage renal failure (ESRF who are undergoing dialysis has decreased significantly during the past few decades, it still remains a distinct clinical problem. The immunosuppressive nature of renal disease often leads to chronicity of the HBV infection and an opportunity for nosocomial spread of the infection among dialysis patients. Egypt is among the countries with intermediate endemicity of HBsAg (range, 2%–7%. Large-scale geographic heterogeneity in HBV prevalence has been reported worldwide and HBV prevalence is especially heterogeneous in Egypt.Objectives: To assess the prevalence of occult HBV infection (OBI in hemodialysis patients with or without chronic hepatitis C (HCV from Minia and Assuit, Upper Egypt, using HBV DNA assays.Patient and Methods: Sera from 145 hemodialysis patients with negative HbsAg were investigated for HBV DNA using real-time polymerase chain reaction (RT-PCR. Only serum samples with repeatedly detectable HBV DNA were considered positive. Patients were divided into 2 groups: HCV RNA positive and HCV RNA negative, based on the results of a third generation enzyme linked immunosorbent assay (ELISA anti-HCV test and HCV RNA PCR.Results: HBV DNA was detected in 6 of the 145 patients (4.1% and HBcAb was detected in 29/145 patients (20%. There were no statistically significant differences in the age, duration of hemodialysis, biochemical parameters, serological markers of HBV, or HBV DNA between patients with and without HCV infection.Conclusions: Four percent of the hemodialysis patients had OBI. There was no significant difference in the prevalence of OBI between hemodialysis patients with or without HCV co-infection.

Lamia Hamdy

2012-04-01

235

Insomnia and limb pain in hemodialysis patients: what is the share of restless leg syndrome?  

Science.gov (United States)

Insomnia and limb pain are common problems in dialysis patients. In addition, restless leg syndrome (RLS) as a specific cause of insomnia and limb pain has been reported in many studies. The purpose of this study was to estimate incidence of insomnia and RLS as a cause of insomnia in these patients. Twenty-six patients undergoing hemodialysis were investigated for insomnia, limb pain and RLS as per the defined criteria. They were evaluated for dialysis quality, dialysis duration, hemoglobin, serum phosphorous, ionized calcium, iron and ferritin levels. These variables between patients with insomnia and those with normal sleep were evaluated by independent "t" test. Without considering the etiology or pathogenesis of insomnia, we evaluated the occurrence of insomnia and limb pain in these patients, and specifically, restless leg syndrome. Insomnia and limb pain were common in dialytic patients. 46% of patients had insomnia. 91% of sleepless group had limb pain as a persistent, annoying complaint. Limb pain was not seen in groups with a normal sleep pattern. Restless leg syndrome was found in 8% of total cases (2 out of 26) and 17% among the insomnia group (2 out of 12). In spite of high incidence of insomnia among patients undergoing regular hemodialysis, role of RLS is trivial. There is a strong relationship between hemoglobin levels and duration of renal replacement therapy to insomnia occurrence. PMID:22237212

Malaki, Majid; Mortazavi, Fakhr Sadat; Moazemi, Sussan; Shoaran, Maryam

2012-01-01

236

Time in hemodialysis modulates the levels of genetic damage in hemodialysis patients.  

Science.gov (United States)

It is assumed that hemodialysis treatment can diminish the levels of genetic damage in circulating lymphocytes by cleaning the blood of uremic toxins that cause oxidative stress. However, the hemodialysis process by itself may also induce genomic damage by producing reactive oxygen species (ROS). We conducted a follow-up study in a group of 70 hemodialysis patients followed for a mean time of 15 months. We investigated the effect of exposure time in hemodialysis on the levels of genetic damage in peripheral blood lymphocytes using the micronucleus assay. In addition, genetic damage after in vitro irradiation with 0.5 Gy was also analyzed to evaluate changes in radiosensitivity. Our results showed that, at the end of the study, there was a decrease in both the basal levels of genetic damage (9.9?±?1.0 vs. 7.6?±?0.7) and radiosensitivity values (38.5?±?3.0 vs. 27.6?±?2.4). We conclude that hemodialysis procedures may act as an ameliorating factor reducing the genetic damage present in chronic kidney disease patients. Environ. Mol. Mutagen. 55:363-368, 2014. © 2014 Wiley Periodicals, Inc. PMID:24436196

Rodríguez-Ribera, Lara; Stoyanova, Elitsa; Corredor, Zuray; Coll, Elisabet; Silva, Irene; Diaz, Juan Manuel; Ballarin, José; Marcos, Ricard; Pastor, Susana

2014-05-01

237

An overlooked complication of hemodialysis: hoarseness.  

Science.gov (United States)

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

Zumrutdal, Aysegul

2013-10-01

238

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

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese INTRODUÇÃO: As osteotomias laterais têm papel importante na rinoplastia e podem ser realizadas através de diferentes técnicas. OBJETIVO:Este trabalho visa comparar o resultado final de estreitamento do dorso e base nasal por meio de dois tipos de osteotomia laterais, via microperfuração e contínua. [...] MÉTODO: Foram selecionados 74 pacientes submetidos à rinoplastia, em Curitiba, 37 pacientes tiveram osteotomia lateral realizada por microperfuração e os outros 37 por osteotomia contínua, todos pelo mesmo cirurgião. Analisados fotografias frontais, pré-operatórias e pós-operatórias de 6 meses, avaliando a largura do dorso e base nasal. Estudo retrospectivo. RESULTADOS E CONCLUSÃO: Por meio de análise estatística t de Student, concluímos que, em ambas as técnicas de osteotomia lateral há uma diferença estatística significativa no estreitamento do dorso e base nasal pós-operatório e não há diferença estatística entre os dois tipos de osteotomias. Abstract in english INTRODUCTION: Lateral osteotomies play an important role in rhinoplasty and can be performed with different techniques. OBJECTIVE: To compare the results of narrowing of the nasal dorsum and base through 2 types of lateral osteotomy: continuous and microperforating. METHOD: We selected 74 patients u [...] ndergoing rhinoplasty: 37 patients underwent lateral continuous osteotomy and the other 37 underwent microperforating osteotomy, all performed by the same surgeon. We analyzed frontal photography from the pre- and post-operative (6 months) periods, evaluating the width of the nasal dorsum and base. This was a retrospective study. RESULTS AND CONCLUSION: Using Student's t-test, statistical analysis concluded that there was a statistically significant difference in the post-operative narrowing of the nasal dorsum and base following both osteotomy techniques, and there was no statistically significant difference between the 2 techniques.

Pizzamiglio, Diego Sherlon; Berger, Cezar Augusto Sarraf.

239

Innovative strategy with potential to increase hemodialysis efficiency and safety  

Science.gov (United States)

Uremic toxins are mainly represented by blood urine nitrogen (BUN) and creatinine (Crea) whose removal is critically important in hemodialysis (HD) for kidney disease. Patients undergoing HD have a complex illness, resulting from: inadequate removal of organic waste, dialysis-induced oxidative stress and membrane-induced inflammation. Here we report innovative breakthroughs for efficient and safe HD by using a plasmon-induced dialysate comprising Au nanoparticles (NPs)-treated (AuNT) water that is distinguishable from conventional deionized (DI) water. The diffusion coefficient of K3Fe(CN)6 in saline solution can be significantly increased from 2.76, to 4.62 × 10-6 cm s-1, by using AuNT water prepared under illumination by green light-emitting diodes (LED). In vitro HD experiments suggest that the treatment times for the removals of 70% BUN and Crea are reduced by 47 and 59%, respectively, using AuNT water instead of DI water in dialysate, while additionally suppressing NO release from lipopolysaccharide (LPS)-induced inflammatory cells.

Chen, Hsiao-Chien; Lin, Hsiu-Chen; Chen, Hsi-Hsien; Mai, Fu-Der; Liu, Yu-Chuan; Lin, Chun-Mao; Chang, Chun-Chao; Tsai, Hui-Yen; Yang, Chih-Ping

2014-03-01

240

Mechanisms underlying sCD40 production in hemodialysis patients.  

Science.gov (United States)

CD40 and its ligand (CD40L) regulate several cellular functions, including T and B-cell activation. The soluble form of CD40 (sCD40) antagonizes CD40/CD40L interaction. Patients undergoing hemodialysis (HD) present elevated sCD40 serum levels, which underlying molecular mechanisms are unknown. We studied sCD40 serum and urinary levels, CD40 membrane and gene expression and membrane shedding in HD, uremic not-HD patients (UR) and healthy subjects (N). We found that in HD sCD40 serum levels were higher than UR and N, being significantly elevated in anuric patients, and that sCD40 correlated to renal function in UR subjects, who presented also a reduced sCD40 urinary excretion rate. HD and UR presented reduced CD40 membrane and gene expression. The concentration of TNF-? converting enzyme (TACE), responsible for CD40 cleavage was not different between HD and N. Therefore the reduced renal clearance is the main cause of elevated sCD40 levels in HD. This finding could have relevant clinical implications. PMID:23121970

Esposito, Pasquale; Rampino, Teresa; Gregorini, Marilena; Gabanti, Elisa; Bianzina, Stefania; Dal Canton, A

2012-01-01

 
 
 
 
241

Why home hemodialysis? A systematic "marketing" analysis.  

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Abstract Background: Home hemodialysis (HHD) has met with alternating fortunes. The present revival of interest is due to lower costs and more frequent/efficient treatments. HHD is underdeveloped, and a marketing approach may help in defining development strategies. The aim of this study was to systematically review the recent literature (2000-2010) according to a marketing approach, defining the potential of HHD according to the classical marketing items: market size, growth rate, profita...

Piccoli, Giorgina Barbara

2012-01-01

242

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)

1980-01-01

243

Bone Densitometric Analysis in Egyptian Hemodialysis Patients  

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

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

2008-01-01

244

Biofeedback systems and adaptive control hemodialysis treatment  

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

Azar Ahmad

2008-01-01

245

Phosphorus Binders and Survival on Hemodialysis  

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Although hyperphosphatemia is a risk factor for mortality, there are limited data on whether therapy with phosphorus binders affects survival. We analyzed a prospective cohort study of 10,044 incident hemodialysis patients using Cox proportional hazards analyses to compare 1-yr all-cause mortality among patients who were or were not treated with phosphorus binders. We performed intention-to-treat analyses to compare patients who began treatment with phosphorus binders during the first 90 d af...

Isakova, Tamara; Gutie?rrez, Orlando M.; Chang, Yuchiao; Shah, Anand; Tamez, Hector; Smith, Kelsey; Thadhani, Ravi; Wolf, Myles

2009-01-01

246

Rationale for Antioxidant Supplementation in Hemodialysis Patients  

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Oxidative stress, which results from an imbalance between reactive oxygen species (ROS) production and antioxidant defense mechanisms, is now a well recognized pathogenic process in hemodialysis (HD) patients that could be involved in dialysis-related pathologies such as accelerated atherosclerosis, amyloidosis and anemia. This review is aimed at evaluating the rationale for preventive intervention against oxidative damage during HD as well as the putative causal factors implicated in this im...

Morena Marion; Martin-Mateo Maria; Cristol Jean-Paul; Canaud Bernard

2001-01-01

247

Fusarium incarnatum/equiseti hemodialysis graft infection  

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

James Riddell; Woodside, Kenneth J.; Leavitt, Matthew A.; Newton, Duane W.; Punch, Jeffery D.

2010-01-01

248

Intradialytic Exercise Programs for Hemodialysis Patients  

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Although it is widely accepted that exercise is beneficial in patients with end-stage renal disease as in the general population, it is not easy to incorporate exercise programs into routine clinical practice. This review aimed to investigate the beneficial effects of exercise during hemodialysis and also to introduce various intradialytic exercise programs and their advantages as a first step in combining exercise programs into clinical practice. Aerobic and resistance exercise are beneficia...

2011-01-01

249

The Clearance of Cyclosporine by Hemodialysis  

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The pharmacokinetics of cyclosporine were studied in five liver transplant patients when they were on and off hemodialysis. There was no significant difference in the blood clearance of cyclosporine between these two periods. Less than 1 per cent of the dose of cyclosporine was recovered in the dialysate. The mean dialysis clearance was less than 1 ml/min. This represents less than 1 per cent of the total blood clearance of cyclosporine. Dosage alterations of cyclosporine during or after hemo...

Venkataramanan, Raman; Ptachcinski, Richard J.; Burckart, Gilbert J.; Yang, Shin L.; Starzl, Thomas E.; Theil, David H.

1984-01-01

250

Ultrasound Evaluation Before and After Hemodialysis Access  

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

Daryoush Saedi

2009-01-01

251

Malnutrition-Inflammation Score in Hemodialysis Patients  

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

Behrooz Ebrahimzadehkor

2014-08-01

252

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

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

Huebsch, P.; Trattnig, S.; Barton, P.; Seidl, G.; Traindl, O.; Kovarik, J.; Wolszczuk, W.

1989-01-01

253

Fatigue Is a Predictor for Cardiovascular Outcomes in Patients Undergoing Hemodialysis  

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Background and objectives: Despite potential significance of fatigue and its underlying components in the occurrence of cardiovascular diseases, epidemiologic data showing the link are virtually limited. This study was designed to examine whether fatigue symptoms or fatigue's underlying components are a predictor for cardiovascular diseases in high-risk subjects with ESRD.

2010-01-01

254

Periodontal parameters and BANA test in patients with chronic renal failure undergoing hemodialysis  

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OBJECTIVES: The aim of this study was to analyze the periodontal parameters of patients with chronic renal failure. MATERIAL AND METHODS: The periodontal status of 16 Brazilian patients aged 29 to 53 (41.7±7.2) years with chronic renal failure (CRF) and another matched group of 14 healthy controls with periodontitis was assessed clinically and microbiologically. Probing pocket depth (PPD), gingival recession (GR), dental plaque index (PLI), gingival index (GI), and dental calculus index (CI)...

Sérgio Aparecido Torres; Odila Pereira da Silva Rosa; Mitsue Fujimaki Hayacibara; Maria do Carmo Machado Guimarães; Hayacibara, Roberto M.; Walter Antônio Bretz

2010-01-01

255

Periodontal parameters and BANA test in patients with chronic renal failure undergoing hemodialysis  

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Full Text Available OBJECTIVES: The aim of this study was to analyze the periodontal parameters of patients with chronic renal failure. MATERIAL AND METHODS: The periodontal status of 16 Brazilian patients aged 29 to 53 (41.7±7.2 years with chronic renal failure (CRF and another matched group of 14 healthy controls with periodontitis was assessed clinically and microbiologically. Probing pocket depth (PPD, gingival recession (GR, dental plaque index (PLI, gingival index (GI, and dental calculus index (CI were the clinical parameters recorded for the entire dentition (at least 19 teeth, while the anaerobic periodontopathogen colonization in four sites with the highest PPD was evaluated using the BANA test ("PerioScan"; Oral B. RESULTS: The results for the CRF group and control group, respectively were: PPD: 1.77±0.32 and 2.65±0.53; GR: 0.58±0.56 and 0.51±0.36; PLI: 1.64±0.56 and 1.24±0.67; GI: 0.64±0.42 and 0.93±0.50; CI: 1.17±0.54 and 0.87±0.52. Comparison between groups using the "t" test revealed a significantly increased PPD (p<0.001 in the control group. Comparison of the other clincial parameters by the Mann-Whitney test showed differences only for PLI, which was significantly higher (p<0.05 in the CRF group. Spearman's test applied to each group showed a positive correlation among all clinical parameters, except for GR (p<0.05. None of the groups showed any correlation between GR and GI, while a significant negative correlation between GR and PPD was observed for the CRF group. The percentage of BANA-positive sites was 35.9% for the CRF group and 35.7% for the control group. The BANA test correlated positively with PPD only in the control group and with GR only in the CRF group. CONCLUSIONS: In spite of a higher PLI and dense anaerobic microbial population even in shallow PPD, patients with CRF exhibited better periodontal conditions than periodontitis patients, which is an evidence of altered response to local irritants.

Sérgio Aparecido Torres

2010-06-01

256

Intensive hemodialysis compared to conventional hemodialysis: looking at recent evidence in an old debate.  

Science.gov (United States)

Despite a significant research effort, the optimal dialysis regimen remains a topic of major controversy. There is a growing interest in intensive hemodialysis regimens as they have been associated with positive outcomes in several observational studies. However, recent evidence from a large cohort study casts doubts on the benefits of intensive hemodialysis. In this paper, we review the evidence on this topic and discuss the most recent results in the context of the existing literature to provide a global appraisal of the state of the evidence. PMID:24178753

Aguilar, Martin; Pilozzi-Edmonds, Laura; Mucsi, Istvan

2014-04-01

257

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

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

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

2007-01-01

258

Efeitos de diferentes FiO2 sobre variáveis ecocardiográficas em cães submetidos à infusão contínua de propofol / Effects of several FiO2 on the echocardiographic parameters in dogs undergoing continuous infusion of propofol  

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Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO2) em cães anestesiados com infusão contínua de propofol e mantidos em ventilação espontânea sobre os parâmetros ecocardiográficos, obtidos em modo M. Oito cães adultos foram submetidos a cinco protocolos anesté [...] sicos diferenciando um do outro pela FiO2 fornecida ao paciente. Formaram-se cinco grupos denominados G100 (FiO2=1), G80 (FiO2=0,8), G60 (FiO2=0,6), G40 (FiO2=0,4) e G20 (FiO2=0,21). Os animais foram induzidos à anestesia com propofol na dose necessária para intubação e, ato contínuo, iniciou-se a infusão do fármaco. Os cães receberam oxigênio conforme a FiO2 determinada para cada grupo. As primeiras mensurações foram efetuadas antes da administração do fármaco (M0), aos 30 minutos (M30) após o início da infusão do anestésico e a cada 15 minutos (M45, M60, M75 e M90) durante 60 minutos. Para espessura do septo interventricular ao final da sístole (ESIVs) registrada em M60, a média de G100 foi maior do que as obtidas de G60 e G20. Em M30, o espessamento fracional da parede livre do ventrículo esquerdo (ELPVE) de G100 foi menor que de G80, e, em M75, G80 foi maior que G40. Em relação ao índice de volume ventricular esquerdo ao final da sístole (IVVEFs), em M45, G40 foi maior que G80. Conclui-se que as variáveis ecocardiográficas estudadas não são afetadas pelo emprego de diferentes FiO2. Abstract in english The effects of several inspired oxygen fractions (FiO2) on the echocardiographic parameters by M-mode were evaluated in eight adult spontaneously breathing mongrel dogs anesthetized with continuous infusion of propofol. Each animal underwent five anesthesia procedures. In each procedure, the patient [...] was allowed to breath a different FiO2, thereby resulting in five groups, namely: G100 (FiO2 = 1), G80 (FiO2 = 0.8), G60 (FiO2 =0.6), G40 (FiO2 = 0.4), and G20 (FiO2 = 0.21). To induce anesthesia, propofol was given until the animals allowed orotracheal intubation, followed by immediate continuous infusion of propofol. The initial measurement (M0) was performed before any drug administration, the second was recorded 30 minutes after the infusion of propofol (M30), and additional recordings were performed at 15-minute intervals (M45, M60, M75, and M90), during 60 minutes. At M60, for the end-systolic interventricular septum thickness (IVSs), the mean of G100 was greater than G60 and G20. Regarding left ventricular wall fractional thickness (LVWF) at M30, G100 was lower than G80; and at M75, G80 was greater than G40. In relation to left ventricular end-systolic volume index (ESVI), at M45, G40 was greater than G80. In conclusion, different FiO2 does not impair echocardiographic parameters.

P.C.F., Lopes; N., Nunes; M.G., Sousa; D.P., Paula; R., Carareto; C.T.D., Nishimori; P.S.P., Santos; A.A., Camacho.

259

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

International Nuclear Information System (INIS)

Objective: To assess the clinical value of transcatheter thrombolysis in treating acute arteriovenous fistula thrombosis in hemodialysis patients and to discuss its technical points. Methods: During the period from Jan. 2008 to Jan. 2011, 67 times of acute arteriovenous fistula thrombosis occurred in 50 hemodialysis patients. The diagnosis was confirmed by angiographic findings. First the guide-wire was inserted and pushed forward to pass through the thrombus, then bolus injection (pulse spray) of urokinase (250000 units) through catheter was performed. If the thrombus could not be cleared away, transcatheter micro-pump continuous infusion of urokinase was employed for 1-3 days until the thrombosis was completely dissolved, which was confirmed by angiographic re-examination at 24, 48 and 72 hours after the start of thrombolysis. Results: Of the total 67 times of acute arteriovenous fistula thrombosis, the arteriovenous fistula reopened in 8 cases after transcatheter thrombolysis with pulse spray of urokinase. At 24, 48 and 72 hours after the initiation of thrombolysis treatment, the thrombus was completely dissolved in 34, 18 and 5 cases, respectively. The thrombolysis treatment failed in two cases. No serious complications such as pulmonary embolization, hemorrhage, etc. occurred during the therapeutic course. Conclusion: For the treatment of acute arteriovenous fistula thrombosis in hemodialysis patients, transcatheter thrombolysis is an easily-manipulated, effective, minimally-invasive and safe technique. Therefore, it is of great clinical value. (authors)

2012-04-01

260

Trace elements in the hair of hemodialysis patients.  

Science.gov (United States)

Trace element disturbance is often observed in hemodialysis patients. While trace element concentrations have been reported in blood samples from hemodialysis patients, they have not been well investigated in scalp hair. In the present study, 22 trace elemental concentrations were measured by inductively coupled plasma-atomic emission spectrometry in the scalp hair of 80 male hemodialysis patients and compared with those of 100 healthy male subjects. In hemodialysis patients, the concentrations of beryllium, arsenic, magnesium, chromium, manganese, iron, selenium, molybdenum, iodine, vanadium, and cobalt were significantly higher than those in healthy subjects, while lead, mercury, copper, germanium, and bromine were significantly lower than those in the former group. No significant differences were observed for lithium, aluminum, cadmium, zinc, boron, or nickel. There were significant positive correlations between the duration of hemodialysis and the magnesium and manganese concentrations. There was a significant negative correlation between cadmium concentration and the duration of hemodialysis. There were significant positive correlations between dialysis efficacy (Kt/V) and magnesium, manganese, zinc, and selenium concentrations. In conclusion, trace element concentrations of the scalp hair are different between hemodialysis patients and healthy subjects. Essential trace elements, such as magnesium, manganese, zinc, and selenium, may be affected by the duration of hemodialysis and Kt/V. PMID:21234813

Ochi, Akinobu; Ishimura, Eiji; Tsujimoto, Yoshihiro; Kakiya, Ryusuke; Tabata, Tsutomu; Mori, Katsuhito; Shoji, Tetsuo; Yasuda, Hiroshi; Nishizawa, Yoshiki; Inaba, Masaaki

2011-11-01

 
 
 
 
261

Determining lung water volume in stable hemodialysis patients.  

Science.gov (United States)

Lung water (LW) reflects the water content of the lung interstitium. Because hemodialysis patients have expanded total body water (TBW) they may also have increased LW. Hypertonic saline promotes a flux of water from lung to blood, which is measured by ultrasound flow probes on hemodialysis tubing. The volume of flux is an indirect measure of LW. Our purpose was to determine the feasibility and reproducibility of LW derived with ultrasound velocity dilution, to determine the effect of ultrafiltration on LW in stable hemodialysis patients, and to compare changes in LW with fluid compartment shifts using bioimpedance. Lung water, cardiac output, total body water, and extracellular and intracellular fluid volumes were measured in 24 stable hemodialysis patients at the beginning of hemodialysis and after ultrafiltration. The LW values at the beginning of hemodialysis (298.8 +/- 90.2 ml or 3.67 +/- 1.47 ml/kg) fell during hemodialysis (250.8 +/- 55.8 ml or 3.12 +/- 0.96 ml/kg; p < 0.05), as did TBW and extracellular fluid volumes (p < 0.001). Cardiac output, cardiac index, and central blood volume also decreased significantly with ultrafiltration (p < 0.005, p < 0.005, and p < 0.01, respectively). Results showed that stable hemodialysis patients have higher specific LW values (3.67 ml/kg) than the normal population (2 ml/kg) and ultrafiltration produces a significant decline in LW values. PMID:16883124

MacRae, Jennifer M; Joseph, Geena; Kislukhin, Victor; Krivitski, Nikolai M; Heidenheim, A Paul; Lindsay, Robert M

2006-01-01

262

Intradialytic Hypertension: A Less-Recognized Cardiovascular Complication of Hemodialysis  

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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...

Inrig, Jula K.

2010-01-01

263

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

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Sulfobutylether-beta-cyclodextrin (SBECD), a large cyclic oligosaccharide that is used to solubilize voriconazole (VRC) for intravenous administration, is eliminated mainly by renal excretion. The pharmacokinetics of SBECD and voriconazole in patients undergoing extracorporeal renal replacement therapies are not well defined. We performed a three-period randomized crossover study of 15 patients with end-stage renal failure during 6-hour treatment with Genius dialysis, standard hemodialysis, o...

Hafner, Verena; Czock, David; Burhenne, Ju?rgen; Riedel, Klaus-dieter; Bommer, Ju?rgen; Mikus, Gerd; Machleidt, Christoph; Weinreich, Thomas; Haefeli, Walter E.

2010-01-01

264

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

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

Alireza Bari

2009-01-01

265

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

Science.gov (United States)

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

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

2013-12-01

266

Effects of the Intermittent Pneumatic Circulator on Blood Pressure during Hemodialysis  

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Hypotension is frequently reported during hemodialysis. This study aimed to examine the effect of the intermittent pneumatic circulator on blood pressure during hemodialysis. Sixteen subjects with chronic hemodialysis were recruited. Each subject randomly received two test conditions on separate days, hemodialysis with and without the circulator. The circulator was applied to the subject on lower extremities during 0.5–1 hr, 1.5–2 hr, 2.5–3 hr, and 3.5–4 hr of hemodialysis. Systolic a...

Hsu, Tzu-chao; Chang, Ya-ju; Huang, Yu-yao; Hsu, Miao-ju

2010-01-01

267

Prevalence and Correlates of Cognitive Impairment in Hemodialysis Patients: The Frequent Hemodialysis Network Trials  

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Background and objectives: Cognitive impairment is common among persons with ESRD, but the underlying mechanisms are unknown. This study evaluated the prevalence of cognitive impairment and association with modifiable ESRD- and dialysis-associated factors in a large group of hemodialysis patients.

Tamura, Manjula Kurella; Larive, Brett; Unruh, Mark L.; Stokes, John B.; Nissenson, Allen; Mehta, Ravindra L.; Chertow, Glenn M.

2010-01-01

268

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)

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

M. Abbasi

2007-09-01

269

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

Science.gov (United States)

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

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

270

320-row computed tomography coronary artery screening in the beginning period of maintenance hemodialysis  

International Nuclear Information System (INIS)

Sixty-one patients at this hospital have been undergoing outpatient hemodialysis for 80 years of age, 10 who underwent conventional coronary angiography (CAG), and 13 who did not consent to participation in this study. Among the 32 patients, CT imaging demonstrated that 6 had coronary stenosis, and 20 did not have coronary stenosis. The remaining 6 patients were indeterminate (5, advanced calcification; 1, poor image quality). The average age of patients with coronary stenosis (67.3±9.5 years) and indeterminate cases (68.3±9.7 years) was significantly higher (p<0.05 and p<0.01, respectively) than that of those without coronary stenosis (54.0±11.8 years). The calcification score of indeterminate cases (1088±907) was significantly higher (p<0.05 and p<0.01, respectively) than that of patients with (351±356) or without (100±217) coronary stenosis. Four of the 6 coronary stenosis patients also had diabetes (67%), which was higher than the rate of 5/20 patients without coronary stenosis (25%), but the difference was not significant. Five of 6 patients with CT-detected coronary stenosis who underwent CAG had significant stenosis requiring treatment. One patient underwent coronary artery bypass surgery, 2 percutaneous coronary intervention (PCI), and the other 2 were administered drugs. One of 5/6 patients who were indeterminate on CT was found to have significant coronary artery stenosis, and PCI was performed. CT coronary artery screening detected coronary artery disease requiring treatment in 6/32 (19%) asymptomatic hemodialysis patients, on whom CAG was performed. Since 320-row CT coronary artery screening can detect untreated and latent coronary stenosis, it is useful to screen patients at the initiation of maintenance hemodialysis. (author)

2011-05-01

271

Filtration fluid for hemodialysis treatment.  

Science.gov (United States)

Bacterial contamination of dialysis fluid has long been recognized as a problem in hemodialyis. Cytokines released as a consequence of contaminated dialysis fluid are believed to be responsible for many acute and chronic side effects in patients undergoing renal replacement therapy. For several years now, attempts have been made to eliminate pyrogenic substances and ensure a sterile and endotoxin-free dialysis fluid. A recent dialysis fluid filter known as DIASAFE, containing a membrane based on Polysulfone (Fresenius), was tested for a period of 1,000 hours (approx. 14 weeks). Dialysis fluid samples were collected once weekly before and behind the filter and cultivated for detection of microorganisms and endotoxins. Additionally, starting after the fourth week of the study, serum samples were collected weekly and the beta2-microglobulin concentration was determined. The filter reduced microorganisms at a rate of at least 10(5) and in the majority of cases (86% of samples) by more than 106. Under clinical conditions the stability and microbiological functionality of the filters could be demonstrated for more than 1,000 hours and 150 disinfecting cycles. In four cases of endotoxin burden (> 0.5 IU/ml) in the dialysis fluid in front of the filter the concentration behind the filter was lower than 0.1 IU/ml, indicating effective reduction of endotoxins. A tendency to a reduction of beta2-microglobulin in serum from 32.5+/-3.9 mg/L to 21.5+/-5.3 mg/L was observed. These results indicate that the dialysis fluid filter used was effective, dramatically reducing the bacterial contaminants in dialysis fluid, thus protecting patients from the potentially harmful acute and long-term life-threatening consequences of contaminated dialysis fluid. PMID:12074334

Ikonomov, V; Haase, G; Stefanidis, I; Melzer, H; Mann, H

2002-05-01

272

Continuous Renal Replacement Therapy Clearance Rate for Salicylate Toxicity in Multi-System Trauma  

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Full Text Available The management of patients with concomitant xenobiotic toxicity and multisystem trauma can be complex. While hemodialysis is generally the modality of choice for extracorporeal elimination of salicylates, the potential for large volume shifts and hypotension may pose a risk in patients with traumatic brain injury. An alternative therapy to hemodialysis is continuous renal replacement therapy, which has slower clearance rates than hemodialysis, but has decreased adverse effects in cases of traumatic brain injury. However, there are few published reports of clearance rates of salicylates using continuous renal replacement therapy. We report a case of multisystem trauma with concomitant intentional salicylate overdose in which continuous renal replacement therapy was employed. The salicylate clearance rate that was obtained in this case was 7.5 mL/minute using continuous veno-venous hemodiafiltration, a form of continuous renal replacement therapy.

Robert G. Hendrickson

2012-11-01

273

Ekofisk pipelines undergo requalification  

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Requalification of 19 pipelines and 29 risers in the Ekofisk field required new approaches for loads, capacities, and deterioration evaluations and predictions. Requalification is a re-assessment of an installation`s design with changed design parameters so that the facility can continue to operate. In some cases, original design requirements may have been unrealistically conservative. The Ekofisk field experienced seabed subsidence as a result of compaction of the producing formation. A total of 25 pipeline systems with diameters of 6--36 inches now run within the subsidence bowl. The existing pipelines and the risers had to be requalified because of new design conditions. The paper describes Ekofisk subsidence, reasons and regulations for requalification, structural design, materials and corrosion, deterioration mechanisms, subsidence effects, calculation of forces, capacities, accumulated strain, local buckling, and mine lessons learned from the requalification projects.

Tangeland, T.G. [Phillips Petroleum Co. Norway, Stavanger (Norway); Collberg, L. [Det Norske Veritas AS, Oslo (Norway)

1996-09-23

274

Functional Status of Patients on Maintenance Hemodialysis  

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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.

Akash Nabil

1999-01-01

275

Restless legs syndrome in patients with hemodialysis  

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Full Text Available Objective: The restless legs syndrome (RLS is characterized by unpleasant sensations and pain in the legs, irresistible urge to move the legs, especially when resting and often accompanied by sleep disorders. RLS prevalence is up to 80% in hemodialysis patients. It is such an important clinical condition that is associated with increased mortality. Moreover etiopathogenesis is not clear. We aimed to evaluate vascular disorders, heart rate variability, oxidative stress parameter in hemodialysis patients with RLS. Material and Methods: Study was conducted with hemodialysis patients. Twenty five patients diagnosed as RLS with International Restless Legs Study Group criteria, and twenty five patients without RLS (control group were included to the study. Patients were examined with complete blood count and biochemical assays, Kt/V, oxidative stress parameter such as malon dialdehyde and sulphydryl, lower extremity Doppler ultrasonography and 24 hour holter heart rate variability. Results: Patients with RLS had significantly lower hemoglobin and sodium levels (p:0.025 ve p:0.038. Tibialis posterior and anterior artery ?ow was significantly reduced in patients with RLS (p:0.011 ve p:0.010. There was significant correlation about low hemoglobin and sodium level and reduced tibialis posterior and anterior artery ?ow. With logistic regression analysis, only hemoglobin was determined as independent factor on RLS (OR 6.211 [%95 CI 1.368-26.176] p=0.018. Conclusion: It is concluded that hemoglobin is an important independent factor for progression to RLS. Therefore hemoglobin level must be maintained in normal range especially in patients with RLS.

Hüseyin Atl?

2008-01-01

276

Plasma Brain-derived Neurotrophic Factor in Hemodialysis Patients  

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Full Text Available Objective: Brain-derived neurotrophic factor (BDNF is a neurotrophin which modulates neuronal survival and proliferation. Recently, plasma BDNF is associated with inflammatory conditions. The present study was to investigate the changes of the plasma BDNF level in hemodialysis patients and to evaluate the relationship between the plasma BDNF and uremic inflammation.Method: We measured the plasma BDNF, serum IL-2, IL-4, IFN-? and TNF-? in hemodialysis patients and control subjects. In addition, we investigated the associations of the plasma BDNF with clinical or biochemical parameters.Results: The plasma BDNF level was significantly higher in hemodialysis patients than in the control subjects (median, 312.3 vs. 630.3 pg/ml, p < 0.05. In subgroup analysis, hemodialysis patients with diabetes showed higher values of the plasma BDNF than the patients without diabetes. However, there were no significant differences in age and gender subgroups of the hemodialysis patients. The logBDNF was positively correlated with hs-CRP and IFN-?, and negatively correlated with serum albumin. In multivariate regression analysis, the logBDNF was independently associated with the presence of diabetes (?-coefficient = 0.399, p = 0.041 and IFN-? (?-coefficient = 0.538, p = 0.003.Conclusion: The plasma BDNF may increase in hemodialysis patients, and more prominently in the patients with diabetes. Furthermore, the plasma BDNF might reflect inflammatory condition in hemodialysis patients.

Seok Joon Shin, Hye Eun Yoon, Sungjin Chung, Yong Gu Kim, Dai-Jin Kim

2012-01-01

277

SERUM TRACE ELEMENTS IN CHILDREN ON MAINTENANCE HEMODIALYSIS  

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

S. T. Esfahani

2007-08-01

278

Restless legs syndrome in patients on hemodialysis  

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

Salman Saleh Mohammad

2011-01-01

279

The gasotransmitter hydrogen sulfide in hemodialysis patients.  

Science.gov (United States)

Hydrogen sulfide, H2S, is the third endogenous gas with cardiovascular properties (the others are nitric oxide and carbon monoxide). In fact, among other important signaling functions, H2S plays a key role in regulating blood pressure. Cystathionine ß-synthase, cystathionine ?-lyase (CSE) and 3-mercaptopyruvate sulfurtransferase are the principal enzymes devoted to H2S formation. We have recently shown that H2S levels are decreased in patients on chronic hemodialysis through the transcriptional deregulation of the CSE gene, hinting at the possibility that a link exists between this finding and hypertension and the high cardiovascular mortality typical of these patients. PMID:21170893

Perna, Alessandra F; Sepe, Immacolata; Lanza, Diana; Capasso, Rosanna; Di Marino, Veronica; De Santo, Natale G; Ingrosso, Diego

2010-01-01

280

[Vascular grafts as access for hemodialysis].  

Science.gov (United States)

Prosthetic arteriovenous grafts have an inferior patency rate and greater morbidity than those with autogenous vessels and are therefore considered as secondary or tertiary vascular access for hemodialysis in patients with fatigued or unsuitable superficial arm veins. Prior access planning in accordance of patient characteristics, careful operative procedure and appropriate revision of complications can ensure long-term functioning of a vascular access using a large variety of possible prosthetic conduits. Arteriovenous grafts remain essential in vascular access surgery and their role may be increasing with higher comorbidities of patients and should be preferred to tunnelled cuffed catheters. This article reviews the indications, alternative configurations and characteristics of arteriovenous grafts. PMID:22930063

Zanow, J; Settmacher, U

2012-09-01

 
 
 
 
281

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

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OBJECTIVES: In this study, we aimed to investigate plasma homocysteine (Hcy) and serum C-reactive protein (CRP) levels in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients, and the relation among them. MATERIALS AND METHODS: This study was carriedout on 52 HD patients, 26 CAPD patients and a control group of 22 healthy persons. Blood samples were taken from the patients for Hcy and CRP measurements. RESULTS: Serum CRP level was found to be high in 48.1% of HD pat...

2004-01-01

282

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

2002-04-01

283

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

Energy Technology Data Exchange (ETDEWEB)

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.

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

284

Individualized reduction in dialysate sodium in conventional in-center hemodialysis.  

Science.gov (United States)

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

Arramreddy, Rohini; Sun, Sumi J; Munoz Mendoza, Jair; Chertow, Glenn M; Schiller, Brigitte

2012-10-01

285

Health Related Quality of Life among Egyptian Patients on Hemodialysis  

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The present research was carried out to evaluate the physical (PCS) and mental (MCS) component summary scales in hemodialysis patients as compared to healthy subjects at a baseline and two years later. 130 patients on hemodialysis (mean age 40.6±8.1 years) were enrolled in the study between February 2003 to February 2005. The short-form with 36 (SF-36) questionnaire was given every 6 months to hemodialysis patients. Results were compared to the general population and changes in QoL over time...

Heba Sayed Assal; Emam, Hanaa M.; Nagwa Abd EL-Ghaffar

2006-01-01

286

Relays undergo seismic tests  

International Nuclear Information System (INIS)

Utilities are required by the Nuclear Regulatory Commission to document that seismic vibration will not adversely affect critical electrical equipment. Seismic testing should be designed to determine the malfunction level (fragility testing). Input possibilities include a continuous sine, a decaying sine, a sine beat, random vibrations, and combinations of random vibrations and sine beat. The sine beat most accurately simulates a seismic event. Test frequencies have a broad range in order to accommodate a variety of relay types and cabinet mounting. Simulation of motion along three axes offers several options, but is best achieved by three in-phase single-axis vibration machines that are less likely to induce testing fatigue failure. Consensus on what constitutes relay failure favors a maximum two microsecond discontinuity. Performance tests should be conducted for at least two of the following: (1) nonoperating modes, (2) operating modes, or (3) the transition above the two modes, with the monitoring mode documented for all three. Results should specify a capability curve of maximum safe seismic acceleration and a graph plotting acceleration with sine-beat frequency

1977-01-15

287

Hyperhemocysteinemia and cardiovascular risks in hemodialysis patients  

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Full Text Available The risk of premature and progressive occlusive vascular disease is high in chronic uremic patients, and it accounts for more than 40% of the mortality in dialysis patients. End stage renal failure (ESRF patients exhibit elevated plasma homocystein levels, about four fold as much as those in the controls, and it is now considered as a causative factor for increased risk of cardiovascular death among these patients. The aim of this study was to evaluate the relationship of total plasma homocysteine level and echocardiographic abnormalities as a surrogate of cardiac disease outcome in hemodialysis patients. 123 adult patients on maintenance hemodialysis and having echocardiography done during January till November 2006 were enrolled in this cross-sectional study. Plasma homocysteine level was directly related to the presence of aortic regur-gitation r= 0.27 P= 0.009. There were negative correlations between ejection fraction (EF, left ventricular systolic dimension (LV.S (r= - 0.71, P= 0.0001, left ventricular diastolic dimension (LV.D (r= -0.23 p= 0.01 and age (r= - 0.021 P= 0.02. In conclusion we did not find the para-doxical reverse epidemiology in our patients and plasma total homocysteine level was in direct correlation with cardiac risk factors such as left ventricular mass index and aortic regurgitation.

Sagheb Mohammad

2010-01-01

288

Serum Protein Profile Alterations in Hemodialysis Patients  

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

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

2003-11-18

289

Systemic barriers to optimal hemodialysis access.  

Science.gov (United States)

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

Donca, Ionel Z; Wish, Jay B

2012-11-01

290

[Hemodialysis in patients with chronic renal insufficiency].  

Science.gov (United States)

Hemodialysis is the most advanced form of artificial renal support. It ensures the survival of almost 2 million patients wordwide. Considerable progress has been made in recent years thanks to a better understanding of uremia, optimization of treatment modalities and more personalized treatment schedules. Increase of uremic toxins removal, improvement of hemodynamic tolerance of the sessions, reduction of proinflammatory reactions due to the bioincompatibility system are major advances that may explain the reduction of morbidity and mortality in dialysis patients. New technologies (nanotechnology, biotechnology, microelectronics) are now expected to introduce further progresses by miniaturizing devices and providing them with an "artificial intelligence" capable of interacting with the patient. The main obstacle remains ageing of uremic patients, increasing prevalence of comorbidities and shortage of social resources that are not conducive to innovation. By promoting a more physiological, longer and more effective hemodialysis performed at home with help of teledialysis monitoring that would probably be an interesting option to evaluate on a medico-economical point of view. PMID:22335068

Canaud, Bernard; Leray-Moragués, Hélène; Chenine-Koualef, Leila; Patrier, Laure

2012-01-01

291

Correlates of ADL difficulty in a large hemodialysis cohort.  

Science.gov (United States)

Needing assistance with activities of daily living (ADL) is an early indicator of functional decline and has important implications for individuals' quality of life. However, correlates of need for ADL assistance have received limited attention among patients undergoing maintenance hemodialysis (HD). A multicenter cohort of 742 prevalent HD patients was assessed in 2009-2011 and classified as frail, prefrail and nonfrail by the Fried frailty index (recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, low physical activity). Patients reported need for assistance with 4 ADL tasks and identified contributing symptoms/conditions (pain, balance, endurance, weakness, others). Nearly 1 in 5 patients needed assistance with 1 or more ADL. Multivariable analysis showed increased odds for needing ADL assistance among frail (odds ratio [OR] 11.35; 95% confidence interval [CI] 5.50-23.41; P?

Kutner, Nancy G; Zhang, Rebecca; Allman, Richard M; Bowling, C Barrett

2014-01-01

292

Obesity, diabetes and survival in maintenance hemodialysis patients.  

Science.gov (United States)

Increased body mass index (BMI) confers a survival advantage in maintenance hemodialysis (MHD) patients. Diabetic (diabetes mellitus (DM)) patients undergoing MHD have worse survival. There are limited studies examining the effect of obesity on the risk of death among MHD patients with diabetes. Ninety-eight MHD patients were studied for median follow-up time of 33 months. Patients were classified according to the presence of obesity (BMI ? 30 kg/m(2)) or DM. Primary outcome was all-cause mortality. Cox regression was used to evaluate the effect of obesity on time to death. Effect modification and mediation analysis were also performed. Mean age was 49 ± 13 years, 66% were male, 48% were obese and 34% were diabetic. Mortality rates (per 100 person-years) were: 3.4 for non-diabetic obese, 8.6 for non-diabetic non-obese, 14.3 for diabetic non-obese and 18.1 for diabetic obese patients. Log-rank comparing diabetic obese versus non-diabetic obese was significant (p=0.007). Diabetes was associated with an increased risk of mortality after adjustment for potential mediators. Effect modification of obesity in the mortality risk was different between patients with and without diabetes. With adjustment for adipokines, a greater effect modification by diabetes was observed; whereas, adjustment for inflammatory marker did not influence the effect modification. Diabetic obese MHD patients have increased mortality risk compared to non-diabetic obese. Obesity does not offer survival benefits in diabetic obese MHD patients and potentially may have detrimental effects. Larger studies evaluating the effect of adipokines and obesity in outcomes in the diabetic MHD population need to be undertaken. PMID:24467439

Deger, Serpil M; Ellis, Charles D; Bian, Ahuia; Shintani, Ayumi; Ikizler, T Alp; Hung, Adriana M

2014-05-01

293

Hemochromatosis (HFE) gene mutations in Brazilian chronic hemodialysis patients  

Scientific Electronic Library Online (English)

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

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

294

Hemochromatosis (HFE gene mutations in Brazilian chronic hemodialysis patients  

Directory of Open Access Journals (Sweden)

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.

F.V. Perícole

2005-09-01

295

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

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

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

296

Metformin induced severe hypophosphatemia in a patient on hemodialysis  

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

Tsitsios Tilemachos

2010-01-01

297

The brachioaxillary interposition graft as a successful tertiary vascular access procedure for hemodialysis.  

Science.gov (United States)

There is a steady increase in the number of patients with chronic renal insufficiency undergoing long-term hemodialysis, and an increasing number of these patients have exhausted veins due to multiple vascular access and salvage procedures. These patients may be candidates for an alternative vascular access procedure, the brachioaxillary interposition arteriovenous graft. This graft was used in 13 patients with a 100% patency rate and no significant complications at 81 patient months. The results indicate that the large axillary vein, which provides an adequate runoff, and a narrow graft-to-vein inflow angle may lessen the turbulence inherent in the more conventional grafts and may contribute to an improved long-term patency. If these assumptions prove correct, this graft may find more frequent application in the future. PMID:8209940

Bittner, H B; Weaver, J P

1994-06-01

298

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

1981-01-01

299

Prevalence of Hepatitis C Antibodies Among Hemodialysis Patients in Al-Hasa Region of Saudi Arabia  

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Full Text Available The prevalence of anti-HCV antibodies among hemodialysis (HD patients was studied at King Fahad Hospital, Hofuf, Saudi Arabia. The records of 189 patients undergoing HD were reviewed. The overall prevalence of anti-HCV antibodies was 43.9%. Anti-HCV antibody prevalence was more common among female patients. There was no correlation between repeated blood transfusions and anti-HCV positivity as 4.8% of the patients who did not receive any blood transfusion during HD were positive for anti-HCV antibodies. A positive correlation was observed between the duration on dialysis and anti-HCV antibodies. An annual serocoversion rate of 6.8% was observed in this study.

Saxena Anil

2001-01-01

300

COMPARISON BETWEEN NATIVE ARTERIOVENOUS FISTULA AND GRAFT IN PATIENTS REFERRED FOR HEMODIALYSIS ACCESS PLACEMENT  

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Full Text Available Arteriovenous fistula is considered as a prerequisite in patients with chronic renal failure undergoing hemodialysis. The purpose of this study was to compare the effectiveness and side effects if any of native vein and synthetic grafts in these patients. From April 2002 till July 2003, a total of 37 patients were referred to us for the utilization of these grafts. In 16 out of these patients we utilized native vein at the elbow joint, and in 21 patients we used polytetrafluoroethylene (PTFE graft. In the native group, the results were better and side effects minimal and economically was in the interest of the patients. We advocate native vein as far as possible and give it a top priority.

M. Moini A. Shojaeefard

2006-11-01

 
 
 
 
301

Plasma platinum elimination in a hemodialysis patient treated with cisplatin.  

Science.gov (United States)

The pharmacokinetics of intravenously administrated cisplatin (CDDP) were studied in a patient with meduloblastoma receiving regular hemodialysis for chronic renal failure. The patient received four CDDP infusions of 25 mg/m2 in two courses and underwent hemodialysis before each treatment and in intervals of 48 h thereafter with blood sampling at the beginning and the end of each hemodialysis. The data obtained were compared with the pharmacokinetic data from follow-up studies of 19 CDDP treatments in 15 patients suffering from various malignancies with no renal failure where a biexponential pharmacokinetic curve was recorded. The data of platinum (Pt) elimination of the patient receiving hemodialysis resembled the curve of those who had not, but following the second CDDP treatment in each course the peak Pt level in plasma was doubled, with a somewhat slower rate of elimination. PMID:7624912

Gorodetsky, R; Vexler, A; Bar-Khaim, Y; Biran, H

1995-04-01

302

Sublethal microcystin exposure and biochemical outcomes among hemodialysis patients  

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

303

Hemodialysis membranes for acute and chronic renal insufficiency.  

Science.gov (United States)

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

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

2013-08-01

304

Volume-associated ambulatory BP patterns in hemodialysis patients  

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Although volume excess causes hypertension whether it also affects circadian patterns of arterial pressures among hemodialysis patients remains unknown. To test the notion whether volume overload is associated with a unique BP “signature” a post-hoc analysis was performed among 145 patients participating in the dry-weight reduction in hypertensive hemodialysis patients (DRIP) randomized controlled trial. Using 400 ambulatory BP recordings over 8 weeks comprising 35,302 measurements the tr...

Agarwal, Rajiv

2009-01-01

305

Modifiable Risk Factors for Early Mortality on Hemodialysis  

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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...

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

2012-01-01

306

Hemodialysis-associated pseudoporphyria resistant to N-acetylcysteine  

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

Bahadi Abdellali

2011-01-01

307

Hypervolemia is associated with increased mortality among hemodialysis patients  

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Among chronic hemodialysis patients, 217 hospitalizations/1000 patient-years are due to congestive heart failure; some are attributable to unrecognized hypervolemia. Hypervolemia can be detected by relative plasma volume (RPV) monitoring. The purpose of this study was to examine among 308 patients on long-term hemodialysis the value of slope of RPV compared to either ultrafiltration volume or ultrafiltration rate index in determining all-cause mortality. RPV slopes were calculated by least-sq...

2010-01-01

308

Blood Pressure Guided Profiling of Ultrafiltration during Hemodialysis  

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

2001-01-01

309

Comparison of microbiologic assay methods for hemodialysis fluids.  

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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...

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

1991-01-01

310

Oral Microflora in Patients on Hemodialysis and Kidney Transplant Recipients  

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

Azadeh Ahmadieh

2010-07-01

311

Oral Microflora in Patients on Hemodialysis and Kidney Transplant Recipients  

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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 ...

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

2010-01-01

312

Quantification of hemodialysis dose: what Kt/V ?to choose.  

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Background: Quantification of hemodialysis became more accurate and easier after the advent of ionic dialysance and the use of methods for estimating urea distribution volume (V). The aim of this study was to compare different methods of hemodialysis dose assessment: Kt/VDau (Daugirdas ?2nd generation), Kt/VOCM (Kt by OCM (Online Clearance Monitor) and V by Watson), and Kt/VBCM ?(Kt by OCM and V by bio-impedance); and to assess the dialysis adequacy, defined by a Kt/V>1.4.?Design: Prospective, observational study.?Methods: 35 hemodialysis sessions were evaluated in 35 chronic hemodialysis patients. During each session, we measured simultaneously, Kt/VOCM, Kt/VBCM and calculated Kt/VDau by performing blood samples before and after each session. ?Results: 35 patients, gender (M/F: 19/16), mean age of 50.49 years, were evaluated. We noted a difference between the three methods of evaluating Kt/V index: Kt/VDau, Kt/VOCM and Kt/VBCM (1.82 ± 0.29; 1.45 ± 0.23; 1.8 ± 0.33, p<0.001). Comparison of Kt/VOCM with Kt/VDau and Kt/VBCM leads to a significant systematic underestimate of Kt/V by 22% and 20.5% respectively. Better agreement between Kt/VDau and Kt/VBCM was observed. The adequate hemodialysis was achieved, according to three methods: ?Kt/VDau, Kt/VOCM and Kt/VBCM respectively in 100%, 57,1% and 88.6% of the cases. ?Conclusions: The Kt/V index is different depending on the method used for its evaluation. The three methods can be used for quantification of hemodialysis with a better agreement between Kt/VDau and Kt/VBCM. In this study, Kt/VOCM results underestimate hemodialysis efficiency. This difference has to ?be considered when applying quantification of hemodialysis to clinical practice. PMID:24634332

Aatif, Taoufiq; Hassani, Kawtar; Alayoud, Ahmed; Zajjari, Yassir; Maoujoud, Omar; Benyahia, Mohamed; Oualim, Zouhair

2014-01-30

313

The Association of Uremic Toxins and Inflammation in Hemodialysis Patients  

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Background Cardiovascular disease is the leading cause of mortality in hemodialysis patients and is associated with chronic inflammation. Elevation of uremic toxins, particular protein-bound uremic toxins, is a possible cause of hyper-inflammation in hemodialysis patients. But the association between uremic toxins and inflammatory markers in hemodialysis is still unclear. Methods We conducted a cross-sectional study to evaluate the association of the serum uremic toxins and inflammatory markers in hemodialysis patients. Results The uremic toxins were not associated with inflammatory markers- including high sensitivity C-reactive protein, IL(Interleukin) -1?, IL-6, tumor necrosis factor-?. In multiple linear regression, serum levels of total p-cresol sulfate (PCS) were independently significantly associated with serum total indoxyl sulfate (IS) (standardized coefficient: 0.274, pPCS levels in hemodialysis with co-morbidity of DM and CAD were significantly higher than those without co-morbidity of DM and CAD (34.10±23.44 vs. 16.36±13.06 mg/L, pPCS (standardized coefficient: 0.239, p?=?0.001), and synthetic membrane dialysis (standardized coefficient: 0.139, p?=?0.046). Conclusion The study showed that serum levels of total PCS and IS were not associated with pro-inflammatory markers in hemodialysis patients. Besides, serum levels of total PCS were independently positively significantly associated with co-morbidity of CAD and DM.

Hsu, Heng-Jung; Yen, Chiung-Hui; Wu, I-Wen; Hsu, Kuang-Hung; Chen, Chih-Ken; Sun, Chiao-Yin; Chou, Chia-Chi; Chen, Chun-Yu; Tsai, Chi-Jen; Wu, Mai-Szu; Lee, Chin-Chan

2014-01-01

314

Beta-2 Microglobulin Levels in Hemodialysis Patients  

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Full Text Available The objective of the study was to determine the level of ?2-microglobulin (?2-m in hemodialysis (HD patients and the factors affecting it. This cross sectional, hospital based study was conducted between September and December 2008 at the Hemodialysis unit of Shalamar Hospital, Lahore. All patients with end-stage renal disease (ESRD who were on main-tenance HD for more than three months were included in the study. Patients with acute renal failure and on dialysis for less than three months were excluded. Demographic data were collec-ted and details of dialysis (type of dialyzers, dialysate bath, membrane used were recorded. Blood samples of the patients were drawn for hematological (hemoglobin, hematocrit, bioche-mical (urea, creatinine, uric acid, albumin and ?2-m level measurement. The total number of patients studied was 50. The major causes of ESRD included diabetes mellitus and hypertension seen in 37 (74% and 10 patients (20%, respectively. The ?2-m levels were significantly elevated in the study patients; 92.6 ± 17.1 mg/L with a range of 54 to 130 mg/L as compared to 2.0 ± 1.29 mg/L in the control group. The patients? age had a statistically significant relationship with the ?2-m level. The major reason for increased ?2-m level was use of low-flux dialyzers. Synthetic polysulphone membrane, bicarbonate, ultra pure dialysate and duration on HD were not asso-ciated with high ?2-m levels. Also, we found an inverse relationship between ?2-m levels and serum albumin of the study patients. Our study suggests that the ?2-m levels are significantly high in dialysis patients. Use of low-flux dialyzer seems to be the major reason for the high ?2-m levels. Age and albumin have statistically significant relationship with ?2-m levels.

Mumtaz Asim

2010-01-01

315

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

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Hemodialysis was initiated in Qatar in 1981, since then the hemodialysis population has been expanding rapidly. This report describes the demographics and outcome of our hemo-dialysis patients during a five years study period. Data of all the patients on regular hemodialysis from January 1 st , 2002 to December 31 st , 2006 were included in this study was collected from the medical records and entered into an especially designed questionnaire. The prevalence...

Fituri Omar; Shigidi Mazin; Ramachandiran Gajaraj; Rashed Awad

2009-01-01

316

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

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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...

Grange?, Steven; Hanoy, Me?lanie; Le Roy, Frank; Guerrot, Dominique; Godin, Michel

2013-01-01

317

Comparison between two dialytic populations undergoing renal transplantation.  

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The outcome of renal transplantation in CAPD patients is still controversial since age and clinical differences often make comparison with hemodialysis patients difficult. The aim of this study was to analyse two homogeneous groups of patients, on CAPD and on hemodialysis. 18 CAPD (Group A) and 18 hemodialysis patients (Group B) were selected for a case-control analysis, matched for age, presence of acute tubular necrosis and Cyclosporine A regimen. Group A and B were not different for male/f...

1990-01-01

318

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

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

West Kenneth A

2011-05-01

319

[Use of fragmin in program hemodialysis of patients with terminal chronic renal failure].  

Science.gov (United States)

The subjects of the study were 60 patients at the end stage of chronic renal failure of various origins, who were on program hemodialysis (PHD) in Dialysis Center of City hospital #20. The main group consisted of 25 patients, who were administered fragmin (Pfizer, USA), a low-molecular heparin, for hypocoagulation during the procedure of hemodialysis. The drug was administered in a bolus dose of 5000 aXa ICU into the arterial line after connecting it to a fistula needle. The control group (35 patients) received unfranctionated heparin (UFH) in a conventional way (a bolus of 2000 to 2500 IU before the beginning of the procedure, followed by 1200 to 1500 IU/h in a continuous infusion, stopped 1 hour prior to the end of the dialysis). The following parameters were measured at the beginning and the end of the procedure: the number of thrombocytes, hemoglobin and hematocrit levels, activated partial thromboplastin time, activated coagulation time, antithrombin III level, and anti-Xa factor activity. Standard regimen of UFH administration allowed satisfactory hypocoagulation, but the necessary dose was hard to select. A bolus dose of fragmin led to adequate hypocoagulation in all the patients: there were no fibrin or blood clots in the lines or the dialyzer, or hemorrhage from the sites of puncture after the procedure. Anti-Xa-factor activity grew after a bolus injection of fragmin. By the end of the procedure the inhibitory activity of fragmin towards Xa-factor remained at the level of 0.44 +/- 0.7 IU/ml. The results show that a single dose of fragmin is effective and safe during a standard procedure of hemodialysis lasting up to 5 hours. PMID:16279040

Kozlova, T V; Shilo, V Iu; Denisov, A Iu

2005-01-01

320

Evaluation of an electronic warfarin nomogram for anticoagulation of hemodialysis patients  

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Abstract Background Warfarin nomograms to guide dosing have been shown to improve control of the international normalized ratio (INR) in the general outpatient setting. However, the effectiveness of these nomograms in hemodialysis patients is unknown. We evaluated the effectiveness of anticoagulation using an electronic warfarin nomogram administered by nurses in outpatient hemodialysis patients, compared to physician directed therapy. Methods Hemodialysis patie...

Ka, Thomson Benjamin; MacRae Jennifer M; Barnieh Lianne; Zhang Jianguo; MacKay Elizabeth; Manning Megan A; Hemmelgarn Brenda R

2011-01-01

 
 
 
 
321

The Potential Economic Value of a Staphylococcus aureus Vaccine among Hemodialysis Patients  

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Staphylococcus aureus infections are a substantial problem for hemodialysis patients. Several vaccine candidates are currently under development, with hemodialysis patients being one possible target population. To determine the potential economic value of a Staphylococcus aureus vaccine among hemodialysis patients, we developed a Markov decision analytic computer simulation model. When Staphylococcus aureus colonization prevalence was 1%, the incremental cost-effectiveness ratio (ICER) of vac...

Song, Yeohan; Tai, Julie H. Y.; Bartsch, Sarah M.; Zimmerman, Richard K.; Muder, Robert R.; Lee, Bruce Y.

2012-01-01

322

The influence of maintenance quality of hemodialysis machines on hemodialysis efficiency.  

Science.gov (United States)

Several studies suggest that there is a correlation between dose of dialysis and machine maintenance. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or patient outcome, and machine maintenance. In order to evaluate the impact of hemodialysis machine maintenance on dialysis adequacy Kt/V and session performance, data were processed on 134 patients on 3-times-per-week dialysis regimens by dividing the patients into four groups and also dividing the hemodialysis machines into four groups according to their year of installation. The equilibrated dialysis dose eq Kt/V, urea reduction ratio (URR) and the overall equipment effectiveness (OEE) were calculated in each group to show the effect hemodialysis machine efficiency on the overall session performance. The average working time per machine per month was 270 hours. The cumulative number of hours according to the year of installation was: 26,122 hours for machines installed in 1998; 21,596 hours for machines installed in 1999, 8362 hours for those installed in 2003 and 2486 hours for those installed in 2005. The mean time between failures (MTBF) was 1.8, 2.1, 4.2 and 6 months between failures for machines installed in 1999, 1998, 2003 and 2005, respectively. Statistical analysis demonstrated that the dialysis dose eq Kt/V and URR were increased as the overall equipment effectiveness (OEE) increases with regular maintenance procedures. Maintenance has become one of the most expedient approaches to guarantee high machine dependability. The efficiency of dialysis machine is relevant in assuring a proper dialysis adequacy. PMID:19112219

Azar, Ahmad Taher

2009-01-01

323

The influence of maintenance quality of hemodialysis machines on hemodialysis efficiency  

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Full Text Available Several studies suggest that there is a correlation between dose of dialysis and machine maintenance. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or patient outcome, and machine maintenance. In order to evaluate the impact of hemodialysis machine maintenance on dialysis adequacy Kt/V and session performance, data were processed on 134 patients on 3-times-per-week dialysis regimens by dividing the patients into four groups and also dividing the hemodialysis machines into four groups according to their year of installation. The equilibrated dialysis dose eq Kt/V, urea reduction ratio (URR and the overall equipment effectiveness (OEE were calculated in each group to show the effect hemodialysis machine efficiency on the overall session performance. The average working time per machine per month was 270 hours. The cumulative number of hours according to the year of installation was: 26,122 hours for machines installed in 1998; 21,596 hours for machines installed in 1999, 8362 hours for those installed in 2003 and 2486 hours for those installed in 2005. The mean time between failures (MTBF was 1.8, 2.1, 4.2 and 6 months between failures for machines installed in 1999, 1998, 2003 and 2005, respectively. Statistical analysis demonstrated that the dialysis dose eq Kt/V and URR were increased as the overall equipment effectiveness (OEE increases with regular maintenance procedures. Maintenance has become one of the most expedient approaches to guarantee high machine dependability. The efficiency of dialysis machine is relevant in assuring a proper dialysis adequacy.

Azar Ahmad

2009-01-01

324

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

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

Vanessa Giendruczak da Silva

2011-03-01

325

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

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

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

326

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

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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.

Reza Hekmat

2009-03-01

327

Selected indices of peritoneal fibrosis in patients undergoing peritoneal dialysis  

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Full Text Available Peritoneal dialysis is an alternative to hemodialysis in the treatment of patients with end-stage renal disease. Long-term use of peritoneal dialysis is limited by progressive alterations in the peritoneal membrane. The pathological changes in the peritoneum are due to the exposure to traditional nonphysiological peritoneal dialysis fluids that have low pH, high glucose and glucose degradation product content, and high molarity. Repeated episodes of bacterial peritonitis are another cause of peritoneal membrane damage. The characteristic features of peritoneal alterations include peritoneal fibrosis and morphologic changes in the peritoneal microvasculature with the accumulation of extracellular matrix in the submesothelial area and loss of mesothelial cells. These changes in the peritoneal membrane cause ultrafiltration failure and loss of dialysis efficacy. The pathogenesis of the peritoneal membrane damage is very complicated and understanding the processes involved in these alterations will be crucial in improving treatment with peritoneal dialysis. Some points of view on fibrosis of peritoneal membrane in patients undergoing peritoneal dialysis are presented here.

Józef Penar

2009-04-01

328

Effect of acupressure on fatigue in patients on hemodialysis  

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Background: Fatigue is considered as a major problem in hemodialysis patients and can impair their quality of life. The purpose of this study was to investigate the effectiveness of acupressure on fatigue in hemodialysis patients. Materials and Methods: This is a clinical trial study in which 96 hemodialysis patients participated. Patients were randomly assigned into acupressure, placebo, and control groups (32 subjects fulfilling the inclusion criteria assigned to each group). The measures included the form of demographic characteristics, visual analog scale of fatigue, and Piper Fatigue Scale. Patients in the acupressure and placebo groups received acupressure intervention during the early 2 h of dialysis on six acupoints with massage for 20 min/day, 3 days per week for 4 weeks. In the placebo group, acupressure intervention was performed as mentioned above with a distance of 1 cm away from the actual intervention site. Patients in the control group received routine unit care only. Chi- quare test, Kruskal-Wallis, paired t-test, one-way analysis of variance (ANOVA), and Duncan test were used for data analysis. Results: One-way ANOVA tests showed significant differences in the total mean score of fatigue and fatigue mean scores in the behavioral, emotional, sensory, and cognitive dimensions in the acupressure, placebo, and control groups. Conclusion: The results of this study showed that acupressure may reduce fatigue in hemodialysis patients, and use of this non-pharmacologic technique for hemodialysis nurses is suggested.

Sabouhi, Fakhri; Kalani, Leila; Valiani, Mahboubeh; Mortazavi, Mojgan; Bemanian, Mahboobeh

2013-01-01

329

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

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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.

Johnson David W

2011-10-01

330

Persistence of immunologic memory in long-term hemodialysis patients and healthcare workers given hepatitis B vaccine: role of a booster dose on antibody response.  

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Hepatitis B (HB) vaccine is effective in producing protection against HB virus infection, but the persistence of immunity remains largely unknown. Seventy-six hemodialysis (HD) patients (60 after primary HB vaccination and 16 with natural immunity) and 46 healthcare workers (32 after primary HB vaccination and 14 with natural immunity) were followed up for 10 years to evaluate the persistence of immunity. Ten years after vaccination, the analysis showed a lower seroconversion rate (38 vs. 75%, p < 0.001) in HD patients as compared with healthcare workers. In the follow-up period, the protective immunity developed through HB virus infection also showed a lower seroconversion rate (44 vs. 86%, p < 0.025) in HD patients as compared with healthcare workers. To assess the status of immunologic memory, we administered a booster dose of HB vaccine 3-12 years (mean 6.7 +/- 0.6 years) after primary vaccination in a selected group of 37 HD patients who presented a decline of their antibodies or were nonresponders. In another group of 12 healthcare workers who had a decline of their antibodies, we also administered a booster dose of HB vaccine 5-8 years (mean 5.8 +/- 0.3 years) after primary vaccination. Nineteen of the 37 HD patients (51%) presented an anamnestic response to the booster dose, and 15 of these (40%) were high responders. All of the healthcare workers responded to the booster dose with a high antibody response. We conclude that patients undergoing HD not only have lower rates of immunization to HB than healthy adults, but also that these are frequently transient. Booster doses after a primary course of vaccine are effective in about the half of HD patients who presented a decline of their antibodies or were nonresponders but whether they are necessary is unclear. The majority of healthcare workers continue to have high levels of protective HBs antibody for at least 10 years and routine boosters are not required. PMID:11549899

Peces, R; Laurés, A S

2001-10-01

331

The effects of nocturnal hemodialysis compared to conventional hemodialysis on change in left ventricular mass: Rationale and study design of a randomized controlled pilot study  

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Abstract Background Nocturnal hemodialysis (NHD) is an alternative to conventional three times per week hemodialysis (CvHD) and has been reported to improve several health outcomes. To date, no randomized controlled trial (RCT) has compared NHD and CvHD. We have undertaken a multi-center RCT in hemodialysis patients comparing the effect of NHD to CvHD on left ventricular (LV) mass, as measured by cardiac magnetic resonance imaging (cMR). Methodology/design All p...

2006-01-01

332

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

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

Zhang, Qinglei; Lu, Xiaolong; Zhao, Lihua

2014-01-01

333

Effect of ANF and iPTH on hypotension during hemodialysis  

International Nuclear Information System (INIS)

To study the effect of ANF and iPTH on hypotension during hemodialysis, the serum ANF and iPTH levels of 36 maintenance hemodialysis patients were detected by radioimmunoassay and immunoradiometricassay. Results showed that both ANF and iPTH average levels in hemodialysis patients were markedly higher than those in normal controls (P<0.01), and decreased significantly after hemodialysis (P<0.01). Before hemodialysis, both ANF and iPTH levels in hypotensive patients were significantly higher than those in normotensive patients (P<0.05). After hemodialysis in hypotensive patients, ANF levels decreased significantly (P<0.05), and iPTH levels increased significantly (P<0.05). Conclusions: The high serum level of ANF and iPTH might be related to hypotension during hemodialysis

2002-06-01

334

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

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

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

2001-09-01

335

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

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

Salimi J

2007-09-01

336

Pharmacokinetics of multiple-dose cefoperazone in hemodialysis patients.  

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We studied the pharmacokinetics of cefoperazone 2 g i.v. every 12 h for 7 days in 12 patients on hemodialysis with normal hepatic function. The half-life of indocyanine green was determined in each patient via ear oximetry. Serum levels of cefoperazone during dialysis were well described by a two-compartment multidose infusion model. From this model we determined the steady state volume of distribution (Vdss), elimination phase half-life during dialysis T1/2D) and off hemodialysis (T1/2), and the corresponding elimination rate constants (KeD and Ke). Multiple correlations between pharmacokinetic parameters, liver function, and physical characteristics of the patients were evaluated. The T1/2 of cefoperazone was 2.9 h off compared to 2.3 h during hemodialysis. The corresponding elimination rate constants were Ke = 0.45/h versus KeD = 0.80/h. Cefoperazone clearances were 78 ml/min off dialysis compared to 140 ml/min during hemodialysis. Vdss was 0.20 liters/kg. The indocyanine green half-life ranged from 1.8 to 4.6 min with a mean of 2.7 min. The ages of the patients correlated with the beta phase half-life (r = 0.68, p = 0.015). We found no significant correlations among the other parameters including hepatic enzymes and indocyanine green half-life. Thus, hemodialysis approximately doubles the elimination rate constant (clearance), but, assuming drug redistribution kinetics remain unchanged, only shortens half-life by about 20%. Scheduling of a 12-hour dosing regimen to coincide with the end of hemodialysis should obviate any need for alteration of dose. Cefoperazone is thus unique among cephalosporins, since the half-life does not change appreciably with end-stage renal disease or dialysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4061504

Spyker, D A; Richmond, J D; Scheld, W M; Bolton, W K

1985-01-01

337

Reduced requirement for erythropoietin with quotidian hemodialysis therapy.  

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Quotidian (daily) hemodialysis has many potential advantages over conventional three times weekly hemodialysis, including improved control of anemia. However, previous reports do not consistently describe beneficial effects regarding anemia and erythropoietin requirements. We sought to determine whether erythropoietin dose is altered in this form of therapy, and elucidate the potential contributing factors. An analysis of an ongoing, nonrandomized, prospective trial of daily nocturnal, daily short, and their cohort of conventional hemodialysis controls was performed. Those patients who had completed 15 months of the trial were analyzed, which include nine patients in the quotidian dialysis group and nine cohort controls receiving conventional three times weekly dialysis. At 15 months, the weekly Kt/V in the quotidian group was 6.8 (+/-0.6) and 4.5 (+/-0.4) in the conventional group (p = 0.001). Mean erythropoietin dose fell in the quotidian group from 87 (+/-66) to 53 (+/-50) U/week per kg (p = 0.020). The mean hemoglobin rose from 115 (+/- 18) to 129 (+/- 14) g/L (p = 0.008). There was no significant change in erythropoietin dose or hemoglobin in the conventional hemodialysis group. Serum ferritin and the transferrin-saturation did not change significantly and remained above 100 microg/L and 20%, respectively, throughout. Serum albumin and C-reactive protein were similar between the quotidian and conventional dialysis groups and did not change over time. In patients who were receiving conventional thrice weekly hemodialysis, initiation of quotidian hemodialysis led to a 39% reduction in erythropoietin dose at 15 months, most likely due to the increased dose of delivered dialysis. PMID:11814098

Klarenbach, Scott; Heidenheim, A Paul; Leitch, Rose; Lindsay, Robert M

2002-01-01

338

Blood leptin levels and erythropoietin requirement in Iranian hemodialysis patients  

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

Rahimi A

2008-12-01

339

The cost of hemodialysis in Iran  

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

Arefzadeh Alireza

2009-01-01

340

Electrocardiographic manifestations of hyperkalemia in hemodialysis patients  

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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.

Nemati Eghlim

2010-01-01

 
 
 
 
341

Acute hemodialysis effects on doppler echocardiographic indices.  

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Conventional echocardiographic (ECHO) parameters of systolic and diastolic func-tion of the left ventricular (LV) have been shown to be load dependent. However, the impact of pre-load reduction on tissue Doppler (TD) parameters of LV function is incompletely understood. To evaluate the effect of a single hemodialysis (HD) session on LV systolic and diastolic function using pulsed Doppler echocardiography and pulsed tissue Doppler imaging (TDI), we studied 81chronic HD patients (40 males; mean age 52.4 ± 16.4 years) with these tools. ECHO parameters were obtained 30 min before and 30 min after HD. Fluid volume removed by HD was 1640 ± 730 cm [3] . HD led to reduction in LV end-diastolic volume (P flow velocity (P flow after HD was noted. Early and late diastolic (E') TDI velocities and the ratio of early to late TDI diastolic velocities (E'/A') on the lateral side of the mitral annulus decreased signi-ficantly after HD (P = 0.013; P = 0.007 and P = 0.008, respectively). Velocity of flow progres-sion (Vp) during diastole was not affected by pre-load reduction. Pulmonary artery systolic pressure and the diameter of the inferior vena cava decreased significantly (P flow progression was minimally affected by pre-load reduction in HD patients. PMID:24969184

Abid, Leila; Rekik, Hajer; Jarraya, Fayçal; Kharrat, Ilyes; Hachicha, Jamil; Kammoun, Samir

2014-01-01

342

Trace elements in renal disease and hemodialysis  

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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.

Miura, Yoshinori E-mail: yomiura@iwate-med.ac.jp; Nakai, Keiko; Suwabe, Akira; Sera, Koichiro

2002-04-01

343

Rationale for Antioxidant Supplementation in Hemodialysis Patients  

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Full Text Available Oxidative stress, which results from an imbalance between reactive oxygen species (ROS production and antioxidant defense mechanisms, is now a well recognized pathogenic process in hemodialysis (HD patients that could be involved in dialysis-related pathologies such as accelerated atherosclerosis, amyloidosis and anemia. This review is aimed at evaluating the rationale for preventive intervention against oxidative damage during HD as well as the putative causal factors implicated in this imbalance. The antioxidant system is severely impaired in uremic patients and impairment increases with the degree of renal failure. HD further worsens this condition mainly by losses of hydrophilic unbound small molecular weight substances such as vitamin C, trace elements and enzyme regulatory compounds. Moreover, inflammatory state due to the hemo-incompatibility of the dialysis system plays a critical role in the production of oxidants contributing further to aggravate the pro-oxidant status of uremic patients. Prevention of ROS overproduction can be achieved by improvement of dialysis biocompatibility, a main component of adequate dialysis, and further complimented by antioxidant supplementation. This could be achieved either orally or via the extracorporeal circuit. Antioxidants such as vitamin E could be bound on dialyzer membranes. Alternatively, hemolipodialysis consisting of loading HD patients with vitamin C or E via an ancillary circuit made of vitamin E-rich liposomes may be used.

Morena Marion

2001-01-01

344

Reducing sodium intake in hemodialysis patients.  

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A low salt diet is beneficial for the whole population but has particular advantages for hemodialyis patients because of the role of salt restriction in the management of hypertension and interdialytic weight gain (IDWG). Education on dietary salt intake based on general healthy eating guidelines, such as the "DASH-sodium" diet, should be provided for staff, families, and carers as well as patients. Anuric hemodialysis patients will need to take in approximately 1 l of water for every 8 g salt consumed. Patients who restrict salt intake to <6 g/day, and drink only when thirsty, should gain no more than 0.8 kg/day. Those with significantly greater weight gains, but predialysis serum sodium close to or higher than the dialysate sodium, need further review of their salt intake. Attempts to restrict fluid intake in these patients will be futile. Patients with high interdialytic weight gain (IDWG) and low predialysis sodium should be assessed for other reasons for fluid intake, such as high blood glucose or social drinking. For patients with poor tolerance of fluid removal during dialysis, and those who are hypertensive in the absence of fluid overload, a salt intake 5 g/day or less may be required. Dietary advice for these patients should be customized to ensure that they do not become malnourished. PMID:19573006

Lindley, Elizabeth J

2009-01-01

345

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

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

1990-01-01

346

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

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

Laude-Sharp, M.; Caroff, M.; Simard, L.; Pusineri, C.; Kazatchkine, M.D.; Haeffner-Cavaillon, N. (INSERM U 28, Hopital Broussais, Paris (France))

1990-12-01

347

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

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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.

Mehmet Akkaya

2012-02-01

348

Comments on the interpretation of tissue impedance measurements during hemodialysis.  

Science.gov (United States)

Comparison of electrical impedance measured in vivo with the in vitro impedance of several types of tissue shows that the former is mainly determined by the presence of striated muscle in the region between the electrodes. This means that fluid shifts occurring during hemodialysis, in the blood or any tissue other than skeletal muscle, do not affect tissue impedance. This implies that measurement of tissue impedance as a means of monitoring the process of hemodialysis lacks a model for a reliable interpretation in terms of fluid balance. PMID:8718559

Verheij, R; Veenman, C S; den Bakker, J V; van Duyl, W A

1996-01-01

349

Occult Hepatitis C Virus Infection among Hemodialysis Patients  

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Occult hepatitis C virus (HCV) infection (i.e., detectable HCV-RNA in the liver or peripheral blood mononuclear cells) in the absence of both serum HCV-RNA and anti-HCV antibodies has not been investigated in hemodialysis patients. In this study, real-time PCR and in situ hybridization was used to test for the presence of genomic and antigenomic HCV-RNA in peripheral blood mononuclear cells of 109 hemodialysis patients with abnormal levels of liver enzymes. Occult HCV infection, determined by...

Barril, Guillermina; Castillo, Inmaculada; Arenas, Mari?a Dolores; Espinosa, Mario; Garcia-valdecasas, Juan; Garcia-ferna?ndez, Nuria; Gonza?lez-parra, Emilio; Alcazar, Jose? Mari?a; Sa?nchez, Carmen; Diez-baylo?n, Jose? Carlos; Martinez, Pilar; Bartolome?, Javier; Carren?o, Vicente

2008-01-01

350

Psychological Symptoms in Healthcare Providers of Patients with Hemodialysis  

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Full Text Available Objective: This study was aimed to investigate the psychological symptoms in the healthcare providers of patients with hemodialysis. Material and Methods: 77 health proffessionals were participated in this study. All subjects were asessed with Maslach Burnout Inventory, Brief Seymptom Inventory, Traumatic Stres Inventory Turkish versions. Results: Burnout, traumatic stres and other psychopathological symptoms were determined in healthcare providers. Doctors and nurses had higher psychopathological findings. Conclusion: Healthcare providers of hemodialysis patients have psychological diffuculties. Doctor and nurses were a high-risk group. This finding might be related with their primary responsibilities in the treatment. Establishment of psychosocial support programs for the health Professional seems to be essential.

Ufuk Sezgin

2009-01-01

351

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

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Full Text Available BACKGROUND: Markers of an acute phase reaction, such as C-reactive protein (CRP or tumor necrosis factor-alpha (TNF-α and interleukin (IL-6, are predictive for cardiovascular morbidity and mortality in normal subjects and in chronic renal failure patients. In this study, we aimed to investigate serum TNF-α, IL-6, IL-10 and CRP levels in continuous ambulatory peritoneal dialysis (CAPD and hemodialysis (HD patients.

Ahmet Yilmaz

1992-01-01

352

Clearance of imidapril, an Angiotensin-converting enzyme inhibitor, during hemodialysis in hypertensive renal failure patients: comparison with quinapril and enalapril.  

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The dialyzability of imidaprilat, an active metabolite of the angiotensin-converting enzyme (ACE) inhibitor imidapril, was determined and compared with those of enalaprilat and quinaprilat in hypertensive patients on chronic hemodialysis. Imidapril (5 mg/d, n = 6), enalapril (2.5 mg/d, n = 6), or quinapril (2.5 mg/d, n = 6) was given for at least 8 weeks prior to the trial. During dialysis, enalaprilat, but not imidaprilat or quinaprilat, concentrations in both sides decreased significantly. Compared to enalaprilat, the dialyzabilities of imidaprilat and quinaprilat were significantly lower (dialyzer clearance [mL/min/m(2)]: enalaprilat, 41.8 +/- 7.4; imidaprilat, 19.0 +/- 7.8; quinaprilat, 8.9 +/- 1.3). The dialyzabilities of the 3 drugs were negatively correlated with their respective protein-binding rates. During hemodialysis, blood pressure did not change significantly in any group. These results suggest that imidapril provides good blood pressure control without a large fluctuation of drug concentration in hypertensive patients undergoing chronic hemodialysis. PMID:17244777

Tsuruoka, Shuichi; Kitoh, Yasuhiko; Kawaguchi, Atsuhiro; Sugimoto, Koh-ichi; Hayasaka, Tokie; Saito, Tetsuo; Fujimura, Akio

2007-02-01

353

Anesthetic recovery and hemodynamic effects of continuous thiopental infusion versus halothane for maintenance anesthesia in patients undergoing ocular surgery Recuperação anestésica e efeitos hemodinâmicos da infusão contínua de tiopental versus halotano na manutenção da anestesia em pacientes submetidos à cirurgia ocular  

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PURPOSE: To investigate anesthesia recovery and hemodynamic status in patients under thiopental infusion or halothane maintenance anesthesia undergoing ocular surgery. METHODS: Fifty-nine voluntary patients undergoing ocular surgery in Farabi hospital were allocated to one of two maintenance anesthesia groups: inhaled halothane, 0.8 to 1 per cent, (group I, n=37) and thiopental infusion, 10 to 12 mg/kg/hour, (group II, n=22). Hemodynamic parameters were recorded at the time of patient entranc...

Mehrdad Shoroghi; Farshid Farahbakhsh; Mehrdad Sheikhvatan; Mahmood Sheikhfathollahi; Ali Abbasi; Azam Talebi

2011-01-01

354

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

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

Cristian Paul Leon Rabanal

2010-12-01

355

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

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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

Bonet J

2013-09-01

356

Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results  

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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.

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

357

Peripheral Stent Placement in Hemodialysis Grafts  

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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.

2009-09-01

358

Restless legs syndrome in patients on hemodialysis  

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

Salman Saleh Mohammad

2011-01-01

359

Continuous ambulatory peritoneal dialysis: no longer experimental.  

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Many patients with end-stage renal disease have now been maintained for 5 years or more with continuous ambulatory peritoneal dialysis (CAPD). Viewed initially as an experimental alternative to be used only when hemodialysis was not feasible, CAPD is now seen as the treatment of choice in an increasing number of situations. CAPD is suitable for self-care. The main concern in the early years--peritonitis--is now less frightening and less frequent (one episode occurring every 18 patient-months ...

1984-01-01

360