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  1. Tuberculosis in children undergoing hemodialysis

    Gargah Tahar

    2010-04-01

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

  2. Dislipemia in patients undergoing continuous ambulatory peritoneal dialysis: pharmacological therapy (simvastatin) versus hemodialysis.

    Marangoni, R; Civardi, F; Masi, F; Cimino, R; Maltagliati, L; Romei Longhena, G

    1993-01-01

    Peritoneal dialysis can worsen dislipemia, which is frequent in chronically uremic patients. In order to verify the therapeutic possibilities, we retrospectively studied 20 chronically uremic patients who had been previously treated with continuous ambulatory peritoneal dialysis (CAPD) and who had developed an IV-type dislipemia. Twelve have continued CAPD treatment and have been simultaneously treated with simvastatin; 8 have withdrawn from CAPD and have begun HD, without any antidislipemic pharmacological support. The results, after 3, 6, 12, and 18 months of treatment, showed the following: in patients treated with CAPD and simvastatin, highly significant decreases were noted in total cholesterol (T-cho) and triglycerides (TG) (p dislipemia only, can continue the treatment, because simvastatin is capable of correcting dislipemia, while those patients who have displemia as well as other complications strictly due to CAPD must abandon treatment and must be transferred to extracorporeal methods. PMID:8399632

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

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

    2015-02-01

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

  4. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis

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

    2009-01-01

    BACKGROUND: Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved. METHODS: We conducted an international, multicenter, randomized, double-blind, prospective...... trial involving 2776 patients, 50 to 80 years of age, who were undergoing maintenance hemodialysis. We randomly assigned patients to receive rosuvastatin, 10 mg daily, or placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke......: In patients undergoing hemodialysis, the initiation of treatment with rosuvastatin lowered the LDL cholesterol level but had no significant effect on the composite primary end point of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. (ClinicalTrials.gov number...

  5. Periodontal status in patients undergoing hemodialysis

    Parkar, S. M.; C G Ajithkrishnan

    2012-01-01

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

  6. Anterior ischemic optic neuropathy in patients undergoing hemodialysis

    DoorenbosBot, ACC; Geerlings, W; Houtman, IA

    1996-01-01

    Four patients are discussed who underwent hemodialysis and developed anterior ischemic optic neuropathy (AION). Three patients had been treated by hemodialysis for several years. One patient developed bilateral optic neuropathy after the first hemodialysis session, So far, only four hemodialysis pat

  7. Clinical Implication of the Renin-angiotensin-aldosterone Blockers in Chronic Kidney Disease Undergoing Hemodialysis

    Morishita, Yoshiyuki; Kusano, Eiji; Nagata, Daisuke

    2014-01-01

    The renin-angiotensin-aldosterone system (RAAS) blockers have been widely used in chronic kidney disease patients undergoing hemodialysis; however, whether RAAS blockers have beneficial effects for cardiovascular disease in those patients has not been fully defined. This review focuses on the effects of RAAS blockers in chronic kidney disease undergoing hemodialysis for cardiovascular disease.

  8. Anti-ENA antibody profile in hepatitis C patients undergoing hemodialysis

    Raymond G Batchoun

    2011-01-01

    Full Text Available Infection with hepatitis C virus (HCV is increasing all over the world, especially among hemodialysis patients. HCV is one of the major autoantibody inducing viruses, where anti-nuclear antibodies (ANA, anti-smooth muscle antibodies (ASMA, anti-liver kidney microsome antibodies (LKM-1, and rheumatoid factor (RF have been related to HCV. Few studies have investigated the presence of anti-extractable nuclear antigens (ENA antibodies in chronic liver diseases, especially in chronic hepatitis C cases, but none investigated its immunostimulation role in hemodialysis units. The aim of the study was to assess the prevalence of HCV among chronic kidney disease- Stage 5 (CKD5 patients undergoing hemodialysis and the prevalence of ENA antibodies among them. Sera of 134 patients with chronic kidney disease undergoing hemodialysis, were screened for HCV antibodies and ENA antibodies profile, using ELISA and Immunoblot technique. 41 HCV-positive blood bank donors were used as controls. Sixty-four (47.7% of 134 patients undergoing hemodialysis were infected with HCV. Thirty-three (51.6% of 64 patients with HCV infection undergoing hemodialysis had anti-ENA antibodies: 9 (27.3% showed anti-SSA antibodies and 22 (66.7% had anti-SSB antibodies. The prevalence of anti-ENA antibodies was significantly higher in the patients with HCV infection, undergoing hemodialysis, compared with both control groups (hepatitis C-positive blood bank donors and hepatitis C-negative patients undergoing hemodialysis. Seventeen of 33 HCV antibodies-positive males undergoing hemodialysis had anti-ENA antibodies, compared with 16 of 31 females, indicating no sex related difference. This study emphasizes the high prevalence of HCV infection in our hemodialysis patients, comparable to that of other Middle Eastern countries, but higher than Western ones. A strong association was observed between anti-HCV positivity and hemodialysis duration, as well as anti-ENA antibody profile. However

  9. [Determinants of vascular wall stiffness in patients with chronic renal disease undergoing hemodialysis].

    Kharlamova, U V; Il'icheva, O E

    2012-01-01

    Examination of 109 patients with chronic renal disease undergoing hemodialysis revealed significant impairment of arterial wall distensibility (accordingly, decreased Peterson's and Young's elastic moduli, distensibility coefficient). The relative thickness of the common carotid artery and pulse wave velocity were significantly greater than in practically healthy subjects. Independent factors influencing arterial wall rigidity included age, arterial pressure, total cholesterol and homocystein, stable metabolites of nitric oxide, creatinine, calcium, phosphorus levels, calcium x phosphorus product, duration of hemodialysis, interdialytic weight gain. PMID:23516853

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

    Perihan Öztürk; Neslihan Dokur; Ergül Kurutaş; Ekrem Doğan; Tuğba Karakaş; Murat Kalender; Hasan Ekerbiçer

    2012-01-01

    Objective: Nail changes are often observed in patients with end-stage renal disease. These changes may occur due to chronic renal failure itself or to the treatment. This study aims to investigate the frequency of nail findings in patients undergoing hemodialysis therapy and to compare with healthy controls. Methods: One hundred and four patients with chronic renal failure treated with hemodialysis, and 104 healthy controls without any dermatological and sistemic diseases, were examined fo...

  11. HEARING ASSESSMENT IN CHRONIC RENAL FAILURE PATIENTS UNDERGOING HEMODIALYSIS

    Arjun Singh

    2014-01-01

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

  12. Use of herbal remedies among patients undergoing hemodialysis.

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

    2013-11-01

    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

  13. Noninvasive continuous monitoring of digital pulse waves during hemodialysis

    Burkert, Antje; Scholze, Alexandra; Tepel, Martin

    2009-01-01

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

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

    Leeming, Diana Julie; Karsdal, Morten A; Rasmussen, Lars M;

    2013-01-01

    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....

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

    Perihan Öztürk

    2012-06-01

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

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

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

    2014-01-01

    OBJECTIVE: to analyze the relationship between the hope and spirituality of patients with chronic kidney disease undergoing hemodialysis.METHOD: this is a cross-sectional, correlational study. The sample was composed of 127 patients of a Renal Replacement Unit. Data were collected through individual interviews guided by the following instruments: participant characterization, Herth Hope Index (HHI), and Pinto Pais-Ribeiro Spirituality Scale (PP-RSS).RESULTS: the average HHI score was 38.06 (±...

  17. Factors affecting the range of motion of the ankle and first metatarsophalangeal joints in patients undergoing hemodialysis who walk daily.

    Matsui, Nobumasa; Shoji, Morio; Kitagawa, Takashi; Terada, Shigeru

    2016-05-01

    [Purpose] Increased plantar pressure during walking is a risk factor for foot ulcers because of reduced range of motion at the ankle and first metatarsophalangeal joints. However, the range of motion in patients undergoing hemodialysis has not yet been determined. A cross-sectional study was performed to investigate the factors affecting the range of motion of the ankle and first metatarsophalangeal joints in patients undergoing hemodialysis who walk daily. [Subjects and Methods] Seventy feet of 35 patients receiving hemodialysis therapy were examined. Measurements included the passive range of motion of plantar flexion and dorsiflexion of the ankle joint, and flexion and extension of the first metatarsophalangeal joint. [Results] Hemodialysis duration was not associated with ankle and first metatarsophalangeal joint range of motion in patients undergoing hemodialysis. Diabetes duration was significantly associated with limited ankle joint mobility. Finally, blood hemoglobin levels, body mass index, and age were associated with first metatarsophalangeal joint range of motion. [Conclusion] The present study identified age, diabetes, and decreased physical activity, but not hemodialysis duration, to be risk factors for limited joint mobility of the ankle and first metatarsophalangeal joints in patients undergoing hemodialysis. PMID:27313371

  18. Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis

    Nie, Yuxin; Zou, Jianzhou; Liang, Yixiu; Shen, Bo; Liu, Zhonghua; Cao, Xuesen; Chen, Xiaohong; Ding, Xiaoqiang

    2016-01-01

    Background Sudden cardiac death is one of the primary causes of mortality in chronic hemodialysis (HD) patients. Prolonged QTc interval is associated with increased rate of sudden cardiac death. The aim of this article is to assess the abnormalities found in electrocardiograms (ECGs), and to explore factors that can influence the QTc interval. Methods A total of 141 conventional HD patients were enrolled in this study. ECG tests were conducted on each patient before a single dialysis session and 15 minutes before the end of dialysis session (at peak stress). Echocardiography tests were conducted before dialysis session began. Blood samples were drawn by phlebotomy immediately before and after the dialysis session. Results Before dialysis, 93.62% of the patients were in sinus rhythm, and approximately 65% of the patients showed a prolonged QTc interval (i.e., a QTc interval above 440 ms in males and above 460ms in females). A comparison of ECG parameters before dialysis and at peak stress showed increases in heart rate (77.45±11.92 vs. 80.38±14.65 bpm, p = 0.001) and QTc interval (460.05±24.53 ms vs. 470.93±24.92 ms, p<0.001). After dividing patients into two groups according to the QTc interval, lower pre-dialysis serum concentrations of potassium (K+), calcium (Ca2+), phosphorus, calcium* phosphorus (Ca*P), and higher concentrations of plasma brain natriuretic peptide (BNP) were found in the group with prolonged QTc intervals. Patients in this group also had a larger left atrial diameter (LAD) and a thicker interventricular septum, and they tended to be older than patients in the other group. Then patients were divided into two groups according to ΔQTc (ΔQTc = QTc peak-stress- QTc pre-HD). When analyzing the patients whose QTc intervals were longer at peak stress than before HD, we found that they had higher concentrations of Ca2+ and P5+ and lower concentrations of K+, ferritin, UA, and BNP. They were also more likely to be female. In addition, more cardiac

  19. Testosterone Undecanoate for Improving Quality of Life of Male Patients Undergoing Continuous Hemodialysis:A Randomized Controlled Trial%十一酸睾酮改善维持性血液透析男性患者生存质量的随机对照试验

    潘松球; 黎琦; 吴曙粤; 蒙陆丹; 曾巧; 张劲; 钟庆荣; 周瑞玲; 李江宁

    2014-01-01

    目的:观察十一酸睾酮( TU)在改善维持性血液透析男性患者生存质量方面的作用及其安全性和耐受性。方法将血清睾酮低于9.02 nmol/L的维持性血液透析男性患者70例,随机分为观察组和对照组,每组35例。观察组除了常规血液透析外加用口服TU 80 mg/早、40 mg/晚,2周后改为40 mg早晚各1次,疗程6个月;而对照组仅常规血液透析。用生存质量测定量表( WHOQOL-100)评价生存质量,用国际勃起功能指数-5(IIEF-5)评价性功能,同时检测血红蛋白(Hb)、血清前蛋白(PA)、血清白蛋白(AlB)、血清转铁蛋白(TRF)、血肌酐(Scr)及血清睾酮水平(T)变化。结果(1)口服TU 6个月后,观察组Hb、PA、AlB、TRF及T值明显高于对照组(P<0.05),Scr、PSA值差异无统计学意义(P>0.05)。(2)治疗后观察组生理领域、独立性领域及总的生存质量评分高于对照组(P<0.05),余因子分差异无统计学意义(P>0.05)。(3)观察组经TU治疗后IIEF评分优于对照组。(4)排尿困难、下肢水肿等不良反应两组比较,差异均无统计学意义(P>0.05)。结论 TU能明显改善维持性血液透析男性患者生存质量、性功能、贫血及营养状况,具有良好的安全性和耐受性。%Objective To study the effectiveness,safety and tolerance of testosterone undecanoate(TU) in improving quality of life ( QOL) of male patients undergoing continuous hemodialysis .Methods Seventy male patients undergoing continuous hemodialysis whose serum total testosterone (T) levels were lower than 9.02 nmol/L were randomly divided into observation group and control group ,with 35 cases in each group .The observation group was treated with routine hemodialysis and TU(80 mg/morning and 40 mg/night,and then 40 mg/morning and 40 mg/night after two weeks),the treatment lasted for 6 months.The control group was

  20. Unfermented grape juice reduce genomic damage on patients undergoing hemodialysis.

    Corredor, Zuray; Rodríguez-Ribera, Lara; Coll, Elisabeth; Montañés, Rosario; Diaz, Juan Manuel; Ballarin, José; Marcos, Ricard; Pastor, Susana

    2016-06-01

    Chronic kidney disease (CKD) patients in dialysis (HD) are considered to be submitted to a continuous oxidative stress. This stress can cause damage on DNA and, consequently, contribute to the high levels of DNA damage observed in these patients. Due to the well-known role of polyphenols as antioxidant agents we proposed its use to reduce the levels of genotoxicity present in HD-CKD patients. The objective of this study was to evaluate the antigenotoxic effects of unfermented grape juice (UGJ) on HD-CKD patients. The levels of DNA damage were analyzed using different biomarkers, such as breaks and oxidized DNA bases by the comet assay, chromosome damage by the micronucleus test. In addition, TEAC (Trolox equivalent antioxidant capacity) was also evaluated. Thirty-nine patients were followed for six months, of whom 25 were supplemented by UGJ and 14 were not supplemented. The obtained results showed a significant decrease in the underlying levels of oxidative DNA damage, in the supplemented group. Regarding the clinical parameters, LDL and cholesterol, were significantly reduced in the patients studied after the supplementation period, although cholesterol was also decreased in the non-supplemented patients. In conclusion, in our studied group the supplementation with UGJ reduced the levels of oxidative DNA damage of HD-CKD patients. PMID:27016493

  1. Quality of Life in Patients Undergoing Hemodialysis or Peritoneal Dialysis Treatment

    Theofilou, Paraskevi

    2011-01-01

    Background “Does the type of dialysis treatment make a difference to the quality of life (QoL) and mental health of renal patients in Athens?” The study investigated the differences in 84 in-center hemodialysis (HD) and 60 continuous ambulatory peritoneal dialysis (CAPD/PD) patients. Methods Patient-reported assessments included: WHOQOL-BREF inventory of World Health Organization, General Health Questionnaire (GHQ-28) of Goldberg, State-Trait Anxiety Inventory, Center for Epidemiologic Studie...

  2. Hemodialysis

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  3. Prognosis of Elderly Japanese Patients Aged ≥80 Years Undergoing Hemodialysis

    Shingo Hatakeyama

    2013-01-01

    Full Text Available Although the number of elderly patients requiring dialysis has increased, data regarding the prognosis of elderly patients undergoing hemodialysis are limited. In the present study, prognosis in Japanese hemodialysis patients aged ≥80 years was evaluated. From January 1988 to July 2013, 1144 consecutive patients with end-stage renal disease required renal replacement therapy at our institution; of these, 141 were aged ≥80 years. These patients’ charts were retrospectively reviewed for relevant clinical variables and survival time. The life expectancies table from the National Vital Statistics database was used, and prognostic factors were assessed by multivariate analysis. In total, 107 deaths (76% were recorded during the study period. The median survival time and estimated life-shortening period in the patients were 2.6 years and −5.3 years, respectively. Eastern Cooperative Oncology Group Performance Status and hemoglobin level were revealed as prognostic factors in the multivariate analysis. Estimates of prognosis and prognostic factors may provide useful information for physicians as well as elderly patients with end-stage kidney disease.

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

    Gombart, Adrian F; Bhan, Ishir; Borregaard, Niels;

    2009-01-01

    hemodialysis. Case patients (n = 81) were those who died of an infectious disease within 1 year; control patients (n = 198) were those who survived at least 1 year while undergoing dialysis. RESULTS: Mean (+/-SD) baseline levels of hCAP18 in case patients and control patients were 539 +/- 278 ng/mL and 650...

  5. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis

    Huang, Wen-Hung; Lin, Jui-Hsiang; Weng, Cheng-Hao; Hsu, Ching-Wei; Yen, Tzung-Hai

    2016-08-01

    Uremic pruritus (UP), also known as chronic kidney disease–associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution–induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of pollutants such as NO2 and CO might be associated with UP in patients with MHD.

  6. A successful pregnancy and parturition in a patient with anuria undergoing maintenance hemodialysis for 6 years: a case report of a 3-year-follow-up

    Yu, Panxi; Diao, Wenqi; Tang, Qionglan; JIANG, XUEFENG

    2015-01-01

    Background Pregnancies in hemodialysis patients are uncommon and difficult to study. Although the chance of a successful pregnancy and parturition in hemodialysis women has increased over the years, it still remains extremely low with a high maternal and fetal mortality and morbidity rate. Case presentation We reported a case of successful pregnancy and parturition in a 22-year-old Chinese female in uremic stage of chronic renal failure and undergoing maintenance hemodialysis (three sessions ...

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

    Nurten KALENDER

    2015-09-01

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

  8. Prevalence and correlates of Willis-Ekbom's disease/restless legs syndrome in patients undergoing hemodialysis.

    Bathla, Nitik; Ahmad, Sohaib; Gupta, Ravi; Ahmad, Shahbaj

    2016-01-01

    Willis-Ekbom's disease/restless legs syndrome (WED/RLS) has been described in subjects undergoing hemodialysis (HD). Different studies have reported varying prevalence rates and different factors associated with this condition; however, the results are inconsistent. Thus, this study was conducted to assess the prevalence of WED/RLS in patients undergoing HD. Another aim of the study was to identify if any comorbidities or biochemical factors were associated with this condition. A total of 194 adult patients undergoing maintenance HD were included in this study. They were screened for WED/RLS using International RLS Study Group criteria on the face-to-face interview and clinical examination. Most recent laboratory parameters were gathered from the medical records. In addition, seroreactivity to hepatitis B and C was also recorded. The mean age of all the subjects included in the study was 54.4 ± 15 years (range: 18-92 years); 58.2% were males. The mean duration on HD was 36.6 ± 19.3 months. WED/RLS was seen in 5.2% of the study subjects. Subjects with and without WED/RLS were comparable with regard to gender (P = 0.23), adequacy of dialysis (P = 0.82), shift of dialysis (P = 0.93), presence of diabetes mellitus (P = 0.91), hypertension (P = 0.26), smoking (P = 0.22), alcohol use (P = 0.45), and reactivity to hepatitis C (P = 0.19) and hepatitis B (P = 0.80), as well as various hematological and biochemical parameters. The prevalence of WED/RLS of 5% in the HD group was higher than in the general population. However, this study could not find any correlation between RLS and any biochemical parameters or comorbidities. This is an important area to be considered in future and requires more work with larger sample size. PMID:27424684

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

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

    2007-08-15

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

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

    Ana Carolina Ottaviani

    2014-04-01

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

  11. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis.

    Huang, Wen-Hung; Lin, Jui-Hsiang; Weng, Cheng-Hao; Hsu, Ching-Wei; Yen, Tzung-Hai

    2016-01-01

    Uremic pruritus (UP), also known as chronic kidney disease-associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution-induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD. PMID:27507591

  12. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis

    Huang, Wen-Hung; Lin, Jui-Hsiang; Weng, Cheng-Hao; Hsu, Ching-Wei; Yen, Tzung-Hai

    2016-08-01

    Uremic pruritus (UP), also known as chronic kidney disease–associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution–induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD.

  13. Environmental NO2 and CO Exposure: Ignored Factors Associated with Uremic Pruritus in Patients Undergoing Hemodialysis

    Huang, Wen-Hung; Lin, Jui-Hsiang; Weng, Cheng-Hao; Hsu, Ching-Wei; Yen, Tzung-Hai

    2016-01-01

    Uremic pruritus (UP), also known as chronic kidney disease–associated pruritus, is a common and disabling symptom in patients undergoing maintenance hemodialysis (MHD). The pathogenesis of UP is multifactorial and poorly understood. Outdoor air pollution has well-known effects on the health of patients with allergic diseases through an inflammatory process. Air pollution–induced inflammation could occur in the skin and aggravate skin symptoms such as pruritus or impair epidermal barrier function. To assess the role of air pollutants, and other clinical variables on uremic pruritus (UP) in HD patients, we recruited 866 patients on maintenance HD. We analyzed the following variables for association with UP: average previous 12-month and 24-month background concentrations for nitrogen dioxide (NO2) and carbon monoxide (CO), and suspended particulate matter of environmental NO2/CO levels were positively associated with UP, and serum albumin levels were negatively associated with UP. This cross-sectional study showed that air pollutants such as NO2 and CO might be associated with UP in patients with MHD. PMID:27507591

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

    Santos Paulo

    2012-08-01

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

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

    El-Nakib GA

    2013-08-01

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

  16. Different response to human recombinant erythropoietin in patients undergoing hemodialysis treatment

    Petković Nenad; Ristić Siniša; Stošović Milan; Đukanović Ljubica

    2013-01-01

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

  17. Dynamic Limb Bioimpedance and Inferior Vena Cava Ultrasound in Patients Undergoing Hemodialysis.

    Tiba, Mohamad H; Belmont, Barry; Heung, Michael; Theyyunni, Nik; Huang, Robert D; Fung, Christopher M; Pennington, Amanda J; Cummings, Brandon C; Draucker, Gerard T; Shih, Albert J; Ward, Kevin R

    2016-01-01

    Assessment of volume status in critically ill patients poses a challenge to clinicians. Measuring changes in the inferior vena cava (IVC) diameter using ultrasound is becoming a standard tool to assess volume status. Ultrasound requires physicians with significant training and specialized expensive equipment. It would be of significant value to be able to obtain this measurement continuously without physician presence. We hypothesize that dynamic changes in limb's bioimpedance in response to respiration could be used to predict changes in IVC. Forty-six subjects were tested a hemodialysis session. Impedance was measured via electrodes placed on the arm. Simultaneously, the IVC diameter was assessed by ultrasound. Subjects were asked to breathe spontaneously and perform respiratory maneuvers using a respiratory training device. Impedance (dz) was determined and compared with change in IVC diameter (dIVC; r = 0.76, p < 0.0001). There was significant relationship between dz and dIVC (p< 0.0001). Receiver-operator curves for dz at thresholds of dIVC (20% to70%) demonstrated high predictive power with areas under the curves (0.87-0.99, p < 0.0001). This evaluation suggests that real-time dynamic changes in limb impedance are capable of tracking a wide range of dynamic dIVC. This technique might be a suitable surrogate for monitoring real-time changes in dIVC to assess intravascular volume status. PMID:26919184

  18. Dialysis - hemodialysis

    Artificial kidneys - hemodialysis; Dialysis; Renal replacement therapy - hemodialysis; End-stage renal disease - hemodialysis; Kidney failure - hemodialysis; Renal failure - hemodialysis; Chronic kidney disease - hemodialysis

  19. Effect of systemic inflammation on level of ferritin seminal in chronic renal male patient undergoing hemodialysis

    Silva, Gilmar Pereira; Elena, Carlos Daniel De La Vega; Carneiro, Fabiana Pirani; Veiga, Joel Paulo Russomano

    2014-01-01

    Background Most hemodialysis patients present with chronic systemic inflammation characterized by the elevation of serum C-reactive protein (CRP) levels and/or the production of proinflammatory interleukins by the immune system in response to the hemodialysis process. Plasma ferritin(PF) is one of the parameters used to correct anemia. An PF level of >500 ng/mL is not recommended for correction of anemia because of the uncertainty of whether these levels are elevated because of anemia or a me...

  20. Multiple cephalic vein aneurysms with calcification in a patient undergoing hemodialysis: An unusual entity

    Mukesh K Yadav

    2015-01-01

    Full Text Available Peripheral venous aneurysms are a known complication following autogenous arteriovenous fistula (AVF for hemodialysis. We present a case of aneurysms involving the cephalic vein associated with calcification, a condition that, to the best of our knowledge, has not been reported earlier in the literature.

  1. Barriers to and facilitators of care for hemodialysis patients; a qualitative study

    Nobahar, Monir; Tamadon, Mohammad Reza

    2016-01-01

    Introduction: Patients undergoing hemodialysis require direct and continuous care. Identifying the barriers to and factors facilitating hemodialysis care can improve care quality. Objectives: The aim of this study was to assess the barriers and facilitators of care for hemodialysis patients. Patients and Methods: This study was conducted as a qualitative study and it utilized content analysis approach. The study was performed in hemodialysis ward of Kowsar hospital in Semnan, in 2014. We used...

  2. Different response to human recombinant erythropoietin in patients undergoing hemodialysis treatment

    Petković Nenad

    2013-01-01

    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.

  3. Systolic blood pressure and heart rate in cats with chronic kidney disease undergoing chemical restraint during hemodialysis

    Karine Kleine Figueiredo dos Santos

    2016-04-01

    Full Text Available Dialysis is one of the used methods for treatment of Acute Renal Injury (ARI and Chronic Kidney Disease (CKD to replace the function of the kidneys when refers to blood depuration. Hemodialysis removes toxins accumulated in the body directly from the blood, being a useful alternative therapy for dogs and cats with CKD in advanced stages. Because of the difficulty on handling the patient feline, this procedure requires sedation. However, few studies have been conducted to assess the safety of anesthesia in dogs and cats with CKD undergoing dialysis. The present study aimed to evaluate two different protocols of chemical restraint in cats with CKD and the effect of these on systolic blood pressure (SBP and heart rate (HR, since the procedure of extracorporeal circulation leads the patient to a hypotensive frame. Twelve adult cats were used, with an average weight of 4 kg, CKD, underwent two anesthetic protocols: Group GP (n = 6 using propofol, and group GCM (n = 6 using ketamine-midazolam association for the implantation procedure of central venous catheter (CVC and hemodialysis. Cats in GP as well as the GCM group showed statistical difference in the change in SBP and HR only from baseline compared to the other time points evaluated. The two protocols maintained SBP and HR within physiological values.

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

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

    1992-01-01

    textabstractPatients 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

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

    Tucker Burgin

    2015-12-01

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

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

    Carlos E. Figueroa Castro

    2008-12-01

    Full Text Available Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When infections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required.

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

    Castro, Carlos E Figueroa; Madariaga, Miguel G

    2008-12-01

    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. PMID:19287844

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

    Hamed Enas A

    2012-10-01

    Full Text Available Abstract Background Tissue injury due to hypoxia and/or free radicals is common in a variety of disease processes. This cross-sectional study aimed to investigate effect of chronic kidney diseases (CKD and hemodialysis (HD on hypoxia and oxidative stress biomarkers. Methods Forty pediatric patients with CKD on HD and 20 healthy children were recruited. Plasma hypoxia induced factor-1α (HIF-1α, 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-1α 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-1α and OSI correlated positively with TPX, but, negatively with TAC. In after-dialysis session, HIF-1α 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-1α and TAC at before- compared to after-dialysis levels.

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

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

    2016-04-01

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

  10. Association of Continuous-Equivalent Urea Clearances with Death Risk in Intermittent Hemodialysis

    Aarne Vartia

    2016-01-01

    Full Text Available Background. Several reports describe favorable results from frequent hemodialysis, but due to the lack of unequivocal dose measures it is not clear whether the benefits are due to more efficient toxin removal or other factors. Methods. The associations with death risk of six continuous-equivalent urea clearance measures were compared in 57 conventional in-center hemodialysis treatment periods of 51 patients, together 114 patient years. The double pool dose measures were calculated with the Solute-Solver program and separately scaled to urea distribution volume or normalized with body surface area. Results. Mortality associated significantly with equivalent renal urea clearance (EKR scaled to urea distribution volume (V (p=0.033 and with EKR normalized with body surface area (BSA (p=0.044 but not with V-scaled (p=0.059 nor BSA-normalized (p=0.183 standard clearance (stdK. Women had significantly higher normalized protein catabolic rate (nPCR, EKR/V, and stdK/V than men but slightly lower BSA-normalized dose measures and lower mortality. Protein catabolic rate and dialysis dose correlated positively with each other and with survival. Conclusions. The prognostically most valid continuous-equivalent clearance in the present material was EKR/V, calculated from double pool urea generation rate, distribution volume, and time-averaged concentration.

  11. A new approach to optimizing urea clearances in hemodialysis and continuous ambulatory peritoneal dialysis.

    Nolph, K D; Keshaviah, P; Emerson, P; Van Stone, J C; Twardowski, Z J; Khanna, R; Moore, H L; Collins, A; Edward, A

    1995-01-01

    Recent studies suggest that the relationship of the net normalized protein catabolic rate (which is the normalized protein equivalent of nitrogen appearance [nPNA]) to the weekly clearance of urea normalized to total body water (Kt/V urea) in patients on continuous ambulatory peritoneal dialysis (CAPD) is curvilinear, rather than linear, as has been thought. The authors have reexamined the relationship of nPNA to weekly Kt/V urea in a CAPD population by cross-sectional analysis to see if the curvilinear definition of the relationship is as good as or better than the usual linear description. They also examined this relationship in the hemodialysis populations at the Dialysis Clinics Inc. in Columbia, Missouri, and in the Renal Kidney Disease Program in Minneapolis, Minnesota. It seems obvious that there should be a plateau of nPNA in each therapy because extension of linear regressions would predict protein intakes of normal individuals exceeding 8 g/kg/body weight/day. The authors compared their findings to other published results. Intuitively and analytically, the curvilinear relationships seem likely. The authors observed that the nPNA plateau is achieved at lower Kt/V in patients on CAPD than in those on hemodialysis, which is compatible with the peak concentration hypothesis. Asymptotes for CAPD and hemodialysis are similar. Weekly Kt/V urea requirements to achieve nPNA values at 95% of the asymptote are greater than those usually delivered. However, such nearly complete elimination of uremic appetite suppression may not be practical or necessary for achieving acceptable nutritional status and long-term survival in most patients. Optimum therapy may be well above adequate therapy relative to minimizing appetite suppression by uremia. PMID:8573843

  12. Assessment of nutritional status in patients undergoing maintenance hemodialysis: a single-center study from Iran.

    Afshar, Reza; Sanavi, Suzan; Izadi-Khah, Akram

    2007-09-01

    Malnutrition is a relatively common problem in patients on hemodialysis (HD) and is associated with increased morbidity and mortality in affected patients. With the aid of subjective global assessment (SGA), a semi-quantitative scale for estimating nutritional status, the malnutrition score (MS), has been developed. The MS incorporates advantages of the SGA while extending the reliability and precision. This study was performed to assess the nutritional status in patients on HD at the Mostafa Khomeini Hospital, Tehran, Iran. Based on the MS, which consists of seven components--weight change, dietary intake, gastrointestinal (GI) symptoms, functional capacity, comorbidity, subcutaneous fat, and muscle wasting--we conducted a cross-sectional descriptive-analytic study on 54 HD patients (35 males, 19 females) with age range of 18 to 82 years (mean 44.2 +/- 19.8 years). Each component of the MS has a score from one (normal) to five (very severe). Anthropometric measurements including triceps skin-fold thickness (TSF), mid-arm circumference (MAC) and mid-arm muscle circumference (MAMC) were taken on all patients. Also, the body mass index and TSF/MAC ratio were calculated. Relevant laboratory parameters were checked. The duration of HD of the study patients ranged between 5 and 36 months (mean 19.5 +/- 1.5 months). Data analysis was carried out using the SPSS, Pearson correlation, 't' test and regression. Based on the MS, 40.7% of patients had malnutrition (mean score 13.8 +/- 2.8). There were statistically significant correlations between TSF (p sample size and longer duration are required to confirm this observation. PMID:17679753

  13. Effect of Blood Cadmium Level on Mortality in Patients Undergoing Maintenance Hemodialysis.

    Hsu, Ching-Wei; Yen, Tzung-Hai; Chen, Kuan-Hsing; Lin-Tan, Dan-Tzu; Lin, Ja-Liang; Weng, Cheng-Hao; Huang, Wen-Hung

    2015-10-01

    Previous studies of general populations indicated environmental exposure to low-level cadmium increases mortality. However, the effect of cadmium exposure on maintenance hemodialysis (MHD) patients is unclear.A total of 937 MHD patients from 3 centers in Taiwan were enrolled in this 36-month observational study. Patients were stratified by baseline blood cadmium level (BCL) into 3 groups: high BCL (>0.521 μg/L; n = 312), intermediate BCL (0.286-0.521 μg/L; n = 313), and low BCL (death were analyzed.The analytic results demonstrated patients in the high BCL group had a significantly higher prevalence of malnutrition and inflammation than patients in the low and intermediate BCL groups. After 3 years of follow-up, 164 (17.5%) patients died and the major cause of death was cardiovascular disease. A Cox multivariate analysis indicated the high BCL group had increased hazard ratios (HRs) for all-cause mortality (HR = 1.72; 95% confidence interval [CI]: 1.14-2.63; P = 0.018), cardiovascular-related mortality (HR = 1.85; 95% CI: 1.09-3.23; P = 0.032), and infection-related mortality (HR = 2.27; 95% CI: 1.12-4.55; P = 0.035). A Cox multivariate analysis of MHD patients who never smoked (n = 767) indicated the high BCL group had increased HRs for all-cause mortality (HR = 1.67; 95% CI: 1.04-2.63; P = 0.048) and cardiovascular-related mortality (HR = 2.08; 95% CI: 1.08-4.00; P = 0.044).In conclusion, BCL is an important determinant of mortality in MHD patients. Therefore, MHD patients should avoid cadmium exposure as much as possible, such as tobacco smoking and eating cadmium-containing foods. PMID:26496294

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

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

    1992-01-01

    textabstractPatients 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 w...

  15. Enhanced elimination of dabigatran: Identifying the appropriate patient for the use of continuous venovenous hemodialysis instead of intermittent hemodialysis-A simulation analysis.

    Liesenfeld, Karl-Heinz; Gruenenfelder, Fredrik; Clemens, Andreas

    2016-05-01

    There are clinical situations where rapid elimination of dabigatran is beneficial. Intermittent hemodialysis (IHD) removes dabigatran effectively but is not always available and requires a hemodynamically stable patient. We therefore investigated the continuous venovenous hemodialysis (CVVHD) technique for its potency in the elimination of dabigatran. Based on pharmacometric characterization of dabigatran in IHD, we simulated a broad range of dialysis settings for CVVHD and then applied the model to specific clinical situations. Dialysis of 3 hours' duration with typical clinical settings (dialysate flow rate 50 mL/min; blood flow rate 150 mL/min) reduced dabigatran plasma concentration by 14-17% in addition to the patient body clearance. Extending dialysis duration to 8 or 16 hours for patients with severe renal dysfunction resulted in additional reductions from 26% up to 40%. When comparing with IHD for different endpoints (reaching 50% of initial dabigatran concentration, or nondetectability of dabigatran by the Hemoclot test), CVVHD did not reach comparable elimination rates. CVVHD is not fast enough to prepare for urgent interventions in patients with high bleeding risks. However, in situations where less hemodynamically stressful modalities seem indicated, CVVHD might be useful in moderately to severely renally impaired patients to accelerate dabigatran elimination. PMID:26272714

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

    Janssen IM

    2015-06-01

    Full Text Available Inger Miriam Janssen,1 Ansgar Gerhardus,2,3 Gero D von Gersdorff,4 Conrad August Baldamus,4 Mathias Schaller,4 Claudia Barth,5 Fueloep Scheibler6 1Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany; 2Department for Health Services Research, University of Bremen, Bremen, Germany; 3Health Sciences Bremen, University of Bremen, Bremen, Germany; 4Department of Internal Medicine II, University Hospital of Cologne, Cologne, Germany; 5KfH Kuratorium fuer Dialyse und Nierentransplantation e.V., Neu-Isenburg, Germany; 6Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Cologne, Germany Background: Chronic kidney disease is an increasing health problem worldwide and in its final stage (stage V can only be treated by renal replacement therapy, mostly hemodialysis. Hemodialysis has a major influence on the everyday life of patients and many patients report dissatisfaction with treatment. Little is known about which aspects of treatment are considered important by hemodialysis patients. The objective of this study was to rate the relative importance of different outcomes for hemodialysis patients and to analyze whether the relative importance differed among subgroups of patients.Patients and methods: Within the framework of a yearly questionnaire which is distributed among patients receiving hemodialysis by the largest hemodialysis provider in Germany, we assessed the relative importance of 23 outcomes as rated on a discrete visual analog scale. Descriptive statistics were used to rank the outcomes. Subgroup analyses were performed using Mann–Whitney U or Kruskal–Wallis tests.Results: Questionnaires of 4,518 hemodialysis patients were included in the analysis. The three most important outcomes were safety of treatment, health-related quality of life, and satisfaction with care. Further important outcomes were hospital stays, accompanying symptoms, hemodialysis

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

    Číž, Milan; Kubala, Lukáš; Čížová, Hana; Soška, V.; Černý, J.; Lojek, Antonín

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

  18. Hypotension due to Chemotherapy in a Patient with Small Cell Lung Cancer and Lambert-Eaton Myasthenic Syndrome Undergoing Hemodialysis: A First Case Report

    Taiji Kuwata

    2012-01-01

    Full Text Available We present the first case of small cell lung cancer with Lambert-Eaton myasthenic syndrome during hemodialysis (HD. A 72-year-old male patient receiving HD experienced progressive muscle weakness. He was diagnosed with small cell lung cancer with Lambert-Eaton myasthenic syndrome due to an increased serum level of anti-voltage-gated calcium channel antibody and aspiration cytology on endobronchial ultrasonography for the swelling of a subcarinal lymph node. He received chemotherapy consisting of carboplatin (300 mg/m2 and etoposide (50 mg/m2, to which he had a partial response. However, the second therapy course could not be administered because of the unexpected development of severe hematological adverse events, which also prevented him from undergoing further HD. This case indicates that caution should be taken when using chemotherapy for such patients because of hypotension due to chemotherapy, with which it is impossible to undergo HD.

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

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

    2011-01-01

    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 state...

  20. Systolic blood pressure and heart rate in cats with chronic kidney disease undergoing chemical restraint during hemodialysis

    Karine Kleine Figueiredo dos Santos; Daniel Paulino Junior; Julio César Cambraia Veado; Juliana de Abreu Pereira

    2016-01-01

    Dialysis is one of the used methods for treatment of Acute Renal Injury (ARI) and Chronic Kidney Disease (CKD) to replace the function of the kidneys when refers to blood depuration. Hemodialysis removes toxins accumulated in the body directly from the blood, being a useful alternative therapy for dogs and cats with CKD in advanced stages. Because of the difficulty on handling the patient feline, this procedure requires sedation. However, few studies have been conducted to assess the safety o...

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

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

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

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

    2010-01-01

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

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

    Zakharov, S.; Pelclová, D.; Navrátil, Tomáš; Běláček, J.; Kurcová, I.; Komzák, O.; Šálek, T.; Latta, J.; Turek, R.; Boček, R.; Kučera, C.; Hubáček, J. A.; Fenclová, Z.; Petřík, V.; Čermák, M.; Hovda, K. E.

    2014-01-01

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

  4. A comparison of the quality of life of the patients undergoing hemodialysis versus peritoneal dialysis and its correlation to the quality of dialysis

    Abdolamir Atapour

    2016-01-01

    Full Text Available Over the years, there has been a steady increase in the number of patients requiring dialysis. However, no consensus exists between choosing either hemodialysis (HD or peritoneal dialysis (PD as the preferred method of dialysis for patients. In this study, we have compared the quality of life of the patients undergoing either HD or PD. This cross-sectional study was performed in the dialysis center of the Noor and Saint Ali Asghar University Hospital in Isfahan, Iran in 2012. Forty-six patients who underwent PD (28 males and 18 females and 46 similar patients undergoing HD (26 males and 20 females were compared. A standardized Persian version of the short form-36 (SF-36 tool was used to assess the quality of life and to assess the quality of dialysis weekly Kt/V in patients undergoing PD and single random Kt/V sampling in HD patients were assessed. Patients undergoing PD reported higher scores in physical functioning. The lowest scores in both groups were reported in mental health section. In physical functioning section, physical role functioning section and overall score of the SF-36 tool, PD patients reported significantly higher scores compared to the HD patients (P <0.05. There was no significant difference between the qualities of the dialysis in the two patient groups. Aspects of quality of life such as physical functioning, physical role functioning, bodily pain, general health perceptions, and overall score were significantly different between the two groups. If these results are substantiated by subsequent longitudinal studies, then the choice of dialysis could be better guided in patients by the quality of life issues.

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

    AA Shojaie

    2006-04-01

    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

  6. Peritonitis by Scedosporium apiospermum in a patient undergoing continuous ambulatory peritoneal dialysis

    SEVERO Luiz Carlos

    1999-01-01

    Full Text Available A case of peritonitis due to Scedosporium apiospermum in a boy undergoing continuous ambulatory peritoneal dialysis is reported. The finding of suggestive tissual form of the fungus in the effluent hastened the diagnosis of the infection.

  7. Peritonitis due to Brevibacterium otitidis in a patient undergoing continuous ambulatory peritoneal dialysis.

    Wauters, Georges; Van Bosterhaut, B; Avesani, V; Cuvelier, R.; Charlier, Jacqueline; Janssens, Michèle; Delmée, Michel

    2000-01-01

    Brevibacterium otitidis is a coryneform rod and, as far as is known, is isolated only from infected ears. We report the first known case of peritonitis caused by B. otitidis in a patient undergoing continuous ambulatory peritoneal dialysis.

  8. Population Pharmacokinetics of Meropenem in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

    Isla, A; Rodriguez-Gascón, A. (Alicia); Troconiz, I.F. (Iñaki F.); Bueno, L.; Solinis, M.A. (María Ángeles); J. Maynar; Sanchez-Izquierdo, J.A. (José Ángel); Pedraz, J L

    2008-01-01

    BACKGROUND AND OBJECTIVE: Meropenem is a carbapenem antibacterial frequently prescribed for the treatment of severe infections in critically ill patients, including those receiving continuous renal replacement therapy (CRRT). The objective of this study was to develop a population pharmacokinetic model of meropenem in critically ill patients undergoing CRRT. PATIENTS AND METHODS: A prospective, open-label study was conducted in 20 patients undergoing CRRT. Blood and dialysate-ultra...

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

    Xin LIU

    2015-10-01

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

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

    Joffe, P; Olsen, F; Heaf, J G;

    1989-01-01

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

  11. Heat stroke with multiple organ failure treated with cold hemodialysis and cold continuous hemodiafiltration: a case report.

    Wakino, Shu; Hori, Shingo; Mimura, Takuya; Fujishima, Seitaroh; Hayashi, Koichi; Inamoto, Hajime; Saruta, Takao; Aikawa, Naoki

    2005-10-01

    A 23-year-old comatose man was presented in the emergency room. He had been working inside a building under construction on a hot summer's day. His core body temperature was 42.1 degrees C and he was diagnosed with heat stroke. Urgent cooling procedures, including applying cold vapor to the patient's skin, a gastric lavage with cold water and an intravenous cold saline infusion, were not completely successful and his body temperature remained above 40 degrees C. Because his high temperature was refractory to conventional cooling procedures and we suspected that acute renal failure (ARF) by rhabdomyolysis would develop, we applied hemodialysis (HD) using cold dialysate (initially 30 degrees C and later 35 degrees C), followed by continuous hemodiafiltration (CHDF) with cold dialysate (35 degrees C) at a high flow rate of 18,000 mL per hour. The patient's body temperature fell below 38.0 degrees C within 3 h and was kept below 38.0 degrees C. Continuous hemodiafiltration was continued for one week. During the first week, the patient suffered from multiple organ failure (MOF) involving renal failure, as well as the failure of heart, liver, lung, and central nervous systems. Disseminated intravascular coagulation also developed. However, by virtue of cold CHDF, he almost recovered 3 weeks after the onset, except for remaining mild liver and renal dysfunction. In severe heat stroke, cold HD and high flow, cold CHDF should be a therapeutic choice for cooling and treatment of MOF. Considering mild liver and renal dysfunction still remained, this case suggested these procedures should be initiated at the very beginning of the treatment of severe heat stroke. PMID:16202019

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

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

    2015-01-01

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

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

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

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...... postoperatively compared with preoperatively (P < or = 0.01). Epidural infusion was discontinued in three patients due to either persisting resting or orthostatic hypotension. There was no correlation between ASA classification, intraoperative bleeding, or postoperative dizziness and incidence of orthostatic...... hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients....

  14. Dysnatremia, its correction, and mortality in patients undergoing continuous renal replacement therapy: a prospective observational study

    Han, Seung Seok; Bae, Eunjin; Kim, Dong Ki; Kim, Yon Su; Han, Jin Suk; Joo, Kwon Wook

    2016-01-01

    Background Although dysnatremia has been reported to be correlated with mortality risk, this issue remains unresolved in patients undergoing continuous renal replacement therapy (CRRT). Furthermore, it has not been determined whether change in or correction of sodium is related to mortality risk in this subset. Methods A total of 569 patients were prospectively enrolled at the start of CRRT between May 2010 and September 2013. The patients were divided into 5 groups: normonatremia (135–145 mm...

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

    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.

  16. Clinical study of cerebral infarction in hemodialysis patients

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

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

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

    2005-10-15

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

  18. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Ounissi M

    2009-01-01

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

  19. HEMODIALYSIS MEMBRANES: PAST, PRESENT AND FUTURE TRENDS

    Gautham A

    2013-06-01

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

  20. Home hemodialysis

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

    2015-01-01

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

  1. 21 CFR 876.5665 - Water purification system for hemodialysis.

    2010-04-01

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

  2. 21 CFR 876.5860 - High permeability hemodialysis system.

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false High permeability hemodialysis system. 876.5860... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5860 High permeability hemodialysis system. (a) Identification. A high permeability hemodialysis system is a device intended for...

  3. Depression in hemodialysis patients

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

  4. Dosagem de marcadores de lesão endotelial em pacientes com doença renal crônica em hemodiálise Endothelial lesion markers dosage in chronic renal disease patients undergoing hemodialysis

    Cláudia Maria Pereira Alves

    2010-06-01

    Full Text Available INTRODUÇÃO: Pacientes com doença renal crônica (DRC em diálise têm como principal causa de morte doença cardiovascular (DCV aterosclerótica, tendo a inflamação e a disfunção endotelial relação direta com a aterosclerose. Além disso, a infecção pelo vírus da hepatite C (HCV, comum nestes pacientes, seria outro fator de piora do estado inflamatório. Níveis aumentados de marcadores de disfunção endotelial são encontrados em pacientes com DRC e hepatite C, e poderiam ser importantes marcadores de aterosclerose nestes indivíduos. OBJETIVO: Comparar atividade endotelial de pacientes em hemodiálise com e sem hepatite C. METODOLOGIA: Selecionamos 28 pacientes em hemodiálise que foram divididos em dois grupos: 1-HCV(+: 18 pacientes (anti-HCV[+] e PCR[+] e 2-HCV(-: 10 pacientes (anti-HCV[-]. Antes da primeira diálise da semana foi coletada amostra de sangue para dosagem sérica de molécula de adesão intercelular-1 (ICAM-1, fator de crescimento vascular endotelial (VEGF, aspartato alanina aminotransferase (ALT e tempo de atividade da protrombina (TAP dos grupos. RESULTADOS: Os níveis de ICAM-1 foram elevados em 60,71%, sendo maiores no grupo HCV(+, porém não estatisticamente significativos (p = 0,2024. Não houve correlação entre os níveis de ICAM-1 e tempo de diálise ou níveis de ALT em nenhum dos grupos. Já os níveis de VEGF foram normais em 92,85%; apenas dois pacientes HCV(+ tinham níveis elevados. Também não houve correlação com tempo de diálise ou níveis de ALT em nenhum grupo. CONCLUSÃO: Pacientes em hemodiálise possuem elevada lesão endotelial, porém a presença de infecção crônica pelo HCV não se mostrou um fator agravante deste quadro. Este resultado pode ter ocorrido por conta do pequeno número de pacientes, sendo necessárias análises com maior número de indivíduos para conclusões mais definitivas.INTRODUCTION: Chronic renal patients undergoing hemodialysis treatment have cardiovascular

  5. Anti-Brucella Antibodies in Chronic Hemodialysis Patients

    Esmaeli H

    2013-03-01

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

  6. 老年维持性血液透析患者症状困扰与希望的相关性研究%Correlation between Symptom Distress and Hope of Elderly Patients Undergoing Maintenance Hemodialysis

    高云; 李亚洁; 陈媛; 董文

    2012-01-01

    Objective To explore the correlation between symptom distress and hope of elderly patients undergoing maintenance hemodialysis. Methods A self-designed general information questionnaire. Dialysis Symptom Index and the Herth Hope Scale were applied among 103 elderly maintenance hemodialysis patients. Results The total score of hope of elderly patients was (31.272±3.587) and the score of the Herth Hope index from patients of different age groups revealed statistic significance (P<0.05). The prevalence of the symptoms in elderly maintenance hemodialysis patients varied from 16.5% to 100%. Itching, dry- month, tiredness or listlessness, dry skin, trouble staying asleep, bone or joint pain, restless legs, trouble falling sleep, difficulty concentrating and feeling worrying were the top ten serious symptoms. The total score and all the sub-scores of the Herth Hope Index were negatively correlated with the score of the symptoms presence and the symptoms distress degree (r=-0.975~-0.691, P=0.000). Conclusion The level of hope in elderly maintenance hemodialysis patients remains in moderate level and the patients are troubled by different degrees of symptom distress. The more serious the symptoms are. The lower the level of the hope. The symptom management should be taken according to the characteristic of the symptoms to improve the level of hope of patients.%目的 探讨老年维持性血液透析患者希望水平、症状困扰特点及其相关性.方法 用自行设计的患者一般情况调查表、中文版Herth 希望量表、透析患者症状困扰量表对广州3所三级甲等医院血液透析中心的103例维持性血液透析患者进行调查.结果 老年维持性血液透析患者希望总分为(31.272±3.587)分.不同年龄段老年患者希望量表得分差异有统计学意义(P<0.05).在被测的30个症状中,各症状发生率为16.5%~100%,困扰患者生活最严重的10个症状依次为:瘙痒、口干、感到疲乏或精力不足、皮

  7. Life Quality of Hemodialysis Patients

    Noorallah Tahery

    2013-05-01

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

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

    Mitsue FUJIMAKI

    1998-04-01

    Full Text Available 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 diferença 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.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 regarding 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.

  9. Music for Hemodialysis patients

    Gross, B; Ketema Wassie, F; Agnholt, Hanne;

    Music for hemodialysis patients Background Patients starting a new regimen of dialysis often experience anxiety and other psychological disturbances. They struggle with the unknown situation, feelings of uncertainty and on top of that, a high level of sophisticated technological equipment. Music...... is known from literature to influence and dampen anxiety and tension and has been used for millennia in the treatment of illness. Here we report a study on the influence of music on patients undergoing dialysis and whether music has a potential for lowering discomfort in patients during first-time dialysis.......   Purpose To investigate whether music can reduce feelings of anxiety, tension and restlessness in patients new to dialysis treatment and make them more relaxed during the treatment.   Method Twenty patients aged 42-84 were selected for participation in the study, which took place over two separate dialysis...

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

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

    2015-01-01

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

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

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

    2016-01-01

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

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

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

    2011-01-01

    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.......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....

  13. Combined acute interstitial pneumonitis and pancytopenia induced by low-dose methotrexate in a hemodialysis patient treated for bullous pemphigoid*

    Liu, Haibo; Liu, Fang; Zhang, Min; Yan, Wenliang; Sang, Hong

    2015-01-01

    Methotrexate has been widely used for many years in the treatment of a variety of diseases. Acute pneumonitis and bone marrow suppression are very serious side effects in methotrexate treatment. A 48-year-old man with end-stage renal disease undergoing chronic hemodialysis developed combined acute pneumonitis and pancytopenia after a cumulative dose of 20 mg methotrexate for bullous pemphigoid. Continuous renal replacement therapy (CRRT) can effi ciently decrease serum methotrexate concentrat...

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

    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

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

    Stanković-Popović Verica

    2008-01-01

    Full Text Available Background/Aim. Peritoneal dialysis (PD patients have an increased risk for cardiovascular diseases. The aim of the study was to evaluate the cardiovascular changes in patients undergoing chronic PD and the eventual existing differences depending on biocompatibility of dialysis solutions. Methods. After 3±2 years of starting PD, 21 PD patients on the treatment with bioincompatible dialysis solutions (conventional glucose- based solutions: PDP-1, average age 47.43±12.87 years, and 21 PD patients on the treatment with biocompatible dialysis solutions (neutral solutions with lower level of glucose degradation products, lower concentration of Ca2+ and neutral pH: PDP-2, average age 68.62±13.98 years, participated in the longitudinal study. The average number of episodes of peritonitis was similare in both groups: 1 episode per 36 months of the treatment. The control group included 21 patients with preterminal phase of chronic renal failure (Glomerular Filtration Rate: 22.19±10.73 ml/min, average age 65.29± 13.74 years. All the patients underwent transthoracal echocardiography (in order to detect: eject fraction (EF, left ventricular hypertrophy (LVH, and valvular calcification (VC and B-mode ultrasonography of common carotid artery (CCA: IMT, lumen narrowing, and plaque detection. Results. The values of EF were: in PDP-1 group 62.05±5.65%, in PDP-2 group 53.43±7.47%, and in the control group 56.71±8.12% (Bonferroni test, p = 0.001. The recorded LVH was: in PDP-1 group in 47.6% of the patients; in PDP-2 group in 61.9% of the patients; and in control the group in 52.4% (χ2 test; p = 0.639. The detected VC was: in PDP-1 in 52.4% of the patients, in PDP-2 group in 42.9% of the patients, and in the control group in 23.8% of the patients (χ2 test; p = 0.776. The IMT was: in PDP-1 group 1.26±0.54 mm, in PDP-2 group 1.23±0.32, and in the control group 1.25±0.27 mm (Bonferroni test; p = 0.981. An average lumen narrowing was: in PDP-1 group 13

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

    Spooner, Almath M

    2011-08-04

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

  17. Destructive spondyloarthropathy in hemodialysis patients

    A wide variety of musculoskeletal abnormalities may be seen in patients with chronic renal failure. Recently a destructive spondyloarthropathy has been described in patients undergoing hemodialysis. The characteristic features include marked disk space narrowing associated with vertebral end-plate erosion and sclerosis, without significant osteophyte formation. Ten patients with changes of destructive spondyloarthropathy involving the cervical or lumbar spine are presented in this exhibit. The appearance on plain radiographs, multiplanar tomography, CT and MR imaging is discussed. The importance of recognizing these changes as un unusual manifestation of chronic renal failure and their differentiation from infection are stressed

  18. Continuous Renal Replacement Therapy May Increase the Risk of Catheter Infection

    Parienti, Jean-Jacques; Dugué, Audrey E.; Daurel, Claire; Mira, Jean-Paul; Mégarbane, Bruno; Mermel, Leonard A.; Daubin, Cédric; Du Cheyron, Damien

    2010-01-01

    Background and objectives: Little is known about the risks of catheter-related infections in patients undergoing intermittent hemodialysis (IHD) as compared with continuous renal replacement therapy (CRRT) techniques. We compared the two modalities among critically ill adults requiring acute renal replacement therapy (RRT).

  19. Epidemiology of hemodialysis patients in Aleppo city

    Moukeh Ghamez

    2009-01-01

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

  20. Intensive Home Hemodialysis: An Eye at the Past Looking for the Hemodialysis of the Future.

    Naso, Agostino; Scaparrotta, Giuseppe; Naso, Elena; Calò, Lorenzo A

    2015-09-01

    Multiple observational studies along with a limited number of randomized clinical trials suggest that intensive hemodialysis (IHD) not only improves outcomes for uremic patients undergoing chronic dialysis but does so with a more favorable cost/benefit ratio compared with conventional hemodialysis. As a result of this, there has been a rapid increase in the interest in home hemodialysis (HHD) as HHD represents the easiest means of implementing IHD. While HHD has generated increased interest given its association with better outcomes/reduced hospitalizations, there are very few randomized controlled trials comparing HHD with other hemodialysis methods. Reported HHD-associated increased survival benefits compared with in-center hemodialysis are from uncontrolled studies, which raise patient selection bias as underlying the differences found. Thus, while HHD draws increasing attention, studies that pay careful attention to the psychosocial, demographic, and clinical factors associated with patients selected to undergo HHD will be needed to ultimately demonstrate its benefits, clarify the clinical applications, and determine the limits of IHD use in dialysis patients. PMID:25920990

  1. Effect of Auricular Acupressure on Uremic Pruritus in Patients Receiving Hemodialysis Treatment: A Randomized Controlled Trial

    Cui-na Yan; Wei-guo Yao; Yi-jie Bao; Xiao-jing Shi; Hui Yu; Pei-hao Yin; Gui-zhen Liu

    2015-01-01

    Background. Uremic pruritus (UP) is a common symptom in patients undergoing maintenance hemodialysis for end-stage renal disease (ESRD). Objective. To determine the clinical efficacy of auricular acupressure therapy on pruritus in hemodialysis patients and to explore possible underlying mechanisms. Methods. Patients receiving maintenance hemodialysis at a referral medical center were recruited and assigned to intervention (n = 32) and control (n = 30) groups. The intervention group underwent ...

  2. Effect of telmisartan on insulin resistance in elderly patients undergoing maintenance hemodialysis%替米沙坦对老年维持性血液透析患者胰岛素抵抗的影响

    王瑞; 丁国华; 刘红燕

    2009-01-01

    Eleven elderly patients undergoing maintenance hemodialysis without ARB or ACEI within 4 weeks were enrolled. Anti-hypertensive agents were replaced by telmisartan gradually to maintain stable blood pressure. Before and after 6 or 12 weeks of treatment, blood biochemical profiles, fasting blood glucose, fasting plasma insulin, insulin resistance index(HOMA-IR), blood pressure, and body weight were recorded. Our results showed that telmisartan did not affect body weight, high-density lipoprotein (HDL), triglyceride (TG), SCr, BUN, Alb, K+ , and PTH, although led to a significant decrease in TC and low-density lipoprotein (LDL). Following telmisartan treatment, FPG did not change significantly, but fasting insulin decreased from 13.9±3.6 mU/ml to 9.9±2.7 or 9.1±2.3 mU/ml at 6 and 12 week (P<0.01), and HOMA-IR decreased from 3.5±1.4 to 2.4±0.8 or 2.2±0.8 at 6 and 12 week (P<0.05). These results suggest that insulin resistance in elderly patients with MHD may be improved by telmisartan.%以11例稳定规律透析且近4周未用血管紧张素IIAT1受体阻滞剂或血管紧张素转化酶抑制剂药物的老年血液透析患者为研究对象,逐步换用替米沙坦降压并使血压保持基本稳定,分别于换用替米沙坦降压治疗前及治疗6周和12周时,透析当天空腹抽血检测血生化、空腹血糖和空腹胰岛素,评估胰岛素抵抗指数,并比较治疗前后体重及血压.结果提示替米沙坦治疗后患者体重、高密度脂蛋白、甘油三酯、血肌酐、尿素氮、白蛋白、血钾和甲状旁腺索无明显变化,总胆固醇、低密度脂蛋白有所下降.空腹血糖无明显变化,但空腹胰岛素从(13.9±3.6)mU/ml下降到(9.9±2.7)mU/ml(6周)和(9.1±2.3)mU/ml(12周),均P<0.01;胰岛素抵抗指数从3.5±1.4下降至2.4±0.8(6周)和2.2±0.8(12周),均P<0.05.提示替米沙坦可改善老年血液透析患者胰岛素抵抗状态.

  3. [Improvement of tumoral calcinosis of the right hand after parathyroidectomy in a patient on chronic hemodialysis].

    El Maghraoui, Jaouad; Hammou, Mohamed; Kabbali, Nadia; Arrayhani, Mohamed; Houssaini, Tariq Sqalli

    2016-01-01

    Periarticular tissue calcifications are common in patients with chronic renal failure undergoing hemodialysis. We report the case of a patient on chronic hemodialysis for 10 years with significant improvement of isolated pseudotumoral calcinosis of the right hand after parathyroidectomy The aim of this study was to show the impact of parathyroidectomy on pseudotumoral calcinosis. PMID:27583094

  4. Polymerase chain reaction with investigation of occult Hepatitis B infection in hemodialysis patients

    Savcı, Ünsal; Bulut, Yunus

    2015-01-01

    Aim: It is known as the occult Hepatitis B that Hepatitis B virüs DNA (HBV DNA) exists in serum very little if Hepatitis B virus surface antigen in serum is negative. The studies about occult Hepatitis B infection prevalence are limited in patients who undergo hemodialysis implements for along time. HBV existence is able to continue in plasma and liver tissue of some patients whose HBsAg test is negative. This condition causes many diagnostic problems. It is very crucial the description of pe...

  5. Pharmacokinetics of amikacin during hemodialysis and peritoneal dialysis

    Regeur, L; Colding, H; Jensen, H;

    1977-01-01

    The pharmacokinetics of amikacin were examined in six bilaterally nephrectomized patients undergoing hemodialysis and in four patients with a minimal residual renal function undergoing peritoneal dialysis. The mean elimination half-life before the dialysis was 86.5 h in the anephric patients and 44...... renal function. During hemodialysis the half-life decreased to less than 10% (5.6 h) of the pretreatment value. The effectiveness of peritoneal dialysis was less as the half-life decreased to only about 30% (17.9 h) of the pretreatment value. During the dialyses a significant correlation between...... the half-life of amikacin and the decrease in blood urea and serum creatinine was demonstrated. The pharmacokinetic data were used to make dosage regimen recommendations for the treatment of patients undergoing intermittent hemodialysis or peritoneal dialysis....

  6. Melatonin improves sleep quality in hemodialysis patients

    Edalat-Nejad, M.; Haqhverdi, F.; Hossein-Tabar, T.; Ahmadian, M.

    2013-01-01

    Disturbed sleep is common in end-stage renal disease (ESRD). Exogenous melatonin has somniferous properties in normal subjects and can improve sleep quality (SQ) in several clinical conditions. Recent studies have shown that melatonin may play a role in improving sleep in patients undergoing dialysis. The goal of the present study was to assess the effect of exogenous melatonin administration on SQ improvement in daytime hemodialysis patients. Lipid profile and the required dose of erythropoi...

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

    Francisca Monsalve-Castillo

    2012-02-01

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

  8. Health-related quality of life in a sample of Iranian patients on hemodialysis

    Pakpour, Amir H; Saffari, Mohsen; Yekaninejad, Mir Saeed;

    2010-01-01

    This study evaluated the health-related quality of life (HRQOL) in a sample of Iranian patients undergoing maintenance hemodialysis. The data were compared with the HRQOL for the Iranian general population....

  9. Biomedical monitoring of phosphate removal by hemodialysis.

    Michalec, Michał; Fiedoruk-Pogrebniak, Marta; Matuszkiewicz-Rowińska, Joanna; Tymecki, Łukasz; Koncki, Robert

    2016-07-15

    A compact flow analysis system for non-invasive, dialysate-side monitoring of phosphate removal in the course of clinical hemodialysis treatment is presented. The monitor is based on solenoid operated micro-pumps and extremely cheap optoelectronic flow-through detector allowing photometric determination of phosphate in spent dialysate using a molybdenum blue method. The monitor can operate in both, discrete and continuous modes of measurement. The analytical utility of monitor has been tested with samples of spent dialysate produced by artificial kidney in the course of real hemodialysis sessions. The results of monitoring are comparable with those obtained using reference off-line method recommended for clinical analysis. Additionally, the possibility of two-side (dialysate and blood) monitoring of hemodialysis treatments with optoelectronic flow-through detectors has been announced. PMID:27136282

  10. Anterior chamber depth during hemodialysis

    Gracitelli CPB

    2013-08-01

    Full Text Available Carolina Pelegrini Barbosa Gracitelli,1 Francisco Rosa Stefanini,1 Fernando Penha,1 Miguel Ângelo Góes,2 Sérgio Antonio Draibe,2 Maria Eugênia Canziani,2 Augusto Paranhos Junior1 1Ophthalmology Department, 2Division of Nephrology, Federal University of São Paulo – UNIFESP, São Paulo, Brazil Background: Exacerbation of chronic glaucoma or acute glaucoma is occasionally observed in patients undergoing hemodialysis (HD because of anterior chamber depth changes during this therapy. Purpose: To evaluate anterior chamber depth and axial length in patients during HD sessions. Methods: A total of 67 eyes of 35 patients were prospectively enrolled. Axial length and anterior chamber depth were measured using ultrasonic biometry, and these measures were evaluated at three different times during HD sessions. Body weight and blood pressure pre- and post-HD were also measured. Results: There was no difference in the axial length between the three measurements (P = 0.241. We observed a significantly decreased anterior chamber depth (P = 0.002 during HD sessions. Conclusion: Our results support the idea that there is a change in anterior chamber depth in HD sessions. Keywords: anterior chamber, hemodialysis, axial length, acute angle-closure glaucoma

  11. Vascular Access for Hemodialysis

    ... for short-term use. [ Top ] What is an arteriovenous fistula? An AV fistula is a connection, made by ... to remove and return blood during hemodialysis. An arteriovenous (AV) fistula is a connection, made by a vascular surgeon, ...

  12. Use of Multifrequency Bioimpedance Analysis in Male Patients with Acute Kidney Injury Who Are Undergoing Continuous Veno-Venous Hemodiafiltration.

    Harin Rhee

    Full Text Available Fluid overload is a well-known predictor of mortality in patients with acute kidney injury (AKI. Multifrequency bioimpedance analysis (MF-BIA is a promising tool for quantifying volume status. However, few studies have analyzed the effect of MF-BIA-defined volume status on the mortality of critically ill patients with AKI. This retrospective medical research study aimed to investigate this issue.We retrospectively reviewed the medical records of patients with AKI who underwent continuous veno-venous hemodiafiltration (CVVHDF from Jan. 2013 to Feb. 2014. Female patients were excluded to control for sex-based differences. Volume status was measured using MF-BIA (Inbody S20, Seoul, Korea at the time of CVVHDF initiation, and volume parameters were adjusted with height squared (H2. Binary logistic regression analyses were performed to test independent factors for prediction of in-hospital mortality.A total of 208 male patients were included in this study. The mean age was 65.19±12.90 years. During the mean ICU stay of 18.29±27.48 days, 40.4% of the patients died. The in-hospital mortality rate increased with increasing total body water (TBW/H2 quartile. In the multivariable analyses, increased TBW/H2 (OR 1.312(1.009-1.705, p=0.043 and having lower serum albumin (OR 0.564(0.346-0.919, p=0.022 were independently associated with higher in-hospital mortality. When the intracellular water (ICW/H2 or extracellular water (ECW/H2 was adjusted instead of the TBW/H2, only excess ICW/H2 was independently associated with increased mortality (OR 1.561(1.012-2.408, p=0.044.MF-BIA-defined excess TBW/H2 and ICW/H2 are independently associated with higher in-hospital mortality in male patients with AKI undergoing CVVHDF.

  13. 慢性肾功能衰竭血液透析患者医院感染病原菌分布与临床特征分析%Distribution of pathogens causing nosocomial infections in chronic renal failure patients undergoing hemodialysis and clinical characteristics

    姚洁; 诸伟红; 葛玉英; 陈科威; 王秋妹

    2015-01-01

    OBJECTIVE To explore the distribution of the pathogens causing nosocomial infections in the chronic re‐nal failure patients undergoing hemodialysis and analyze the clinical characteristics so as to reduce the incidence of nosocomial infections in the hemodialysis room .METHODS A total of 850 patients with chronic renal failure who underwent the hemodialysis from Jan 2011 to Dec 2014 were enrolled in the study ,then the clinical data of the pa‐tients were retrospectively analyzed ,the participants were divided into the infection group with 32 cases and the non‐infection group with 818 cases according to the status of nosocomial infections ,the submitted specimens from the patients with infections were cultured for pathogens ,the distribution of the pathogens ,clinical characteristics of the patients ,and related factors for nosocomial infections were observed ,and the statistical analysis was per‐formed with the use of SPSS 18 .0 software .RESULTS The nosocomial infections occurred in 32 of 850 chronic re‐nal failure patients undergoing hemodialysis ,w ith the infection rate of 3 .76% .T he sputum (55 .00% ) w as the major specimen sources ,followed by the blood (30 .32% ) and urine (10 .97% ) .Totally 620 strains of patho‐gens have been isolated ,including 209 (33 .71% ) strains of gram‐positive bacteria ,393 (63 .39% ) strains of gram‐negative bacteria ,and 18 (2 .90% ) strains of fungi .The levels of hemoglobin ,serum albumin ,and serum globulin of the infection group were significantly lower than those of the non‐infection group(P< 0 .05);the level of CRP of the infection group was significantly higher than that of the non‐infection group (P< 0 .05) .The risk factors for the nosocomial infections in the chronic renal failure patients undergoing hemodialysis included the age ,anemia ,dialysis age ,ways of catheterization ,cardiac insufficiency ,hypoproteinemia ,and diabetic nephropathy (P< 0 .05) .CONCLUSION The pathogens causing the

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

    Siminelakis Stavros N

    2010-03-01

    Full Text Available Abstract This the case of a 63 year-old man with end-stage renal disease (on chronic hemodialysis, unstable angina and significantly impaired myocardial contractility with low left ventricular ejection fraction, who underwent off-pump one vessel coronary bypass surgery. Combined continuous levosimendan and norepinephrine infusion (at 0.07 μg/kg/min and 0.05 μg/kg/min respectively started immediately after anesthesia induction and continued for 24 hours. The levosimendan/norepinephrine combination helped maintain an appropriate hemodynamic profile, thereby contributing to uneventful completion of surgery and postoperative hemodynamic stability. Although levosimendan is considered contraindicated in ESRD patients, this case report suggests that combined perioperative levosimendan/norepinephrine administration can be useful in carefully selected hemodialysis patients with impaired myocardial contractility and ongoing myocardial ischemia, who undergo off-pump myocardial revascularization surgery.

  15. Glycemic Variability Assessed by Continuous Glucose Monitoring and Short-Term Outcome in Diabetic Patients Undergoing Percutaneous Coronary Intervention: An Observational Pilot Study

    Annunziata Nusca; Angelo Lauria Pantano; Rosetta Melfi; Claudio Proscia; Ernesto Maddaloni; Rocco Contuzzi; Fabio Mangiacapra; Andrea Palermo; Silvia Manfrini; Paolo Pozzilli; Germano Di Sciascio

    2015-01-01

    Poor glycemic control is associated with unfavorable outcome in patients undergoing percutaneous coronary intervention (PCI), irrespective of diabetes mellitus. However a complete assessment of glycemic status may not be fully described by glycated hemoglobin or fasting blood glucose levels, whereas daily glycemic fluctuations may influence cardiovascular risk and have even more deleterious effects than sustained hyperglycemia. Thus, this paper investigated the effectiveness of a continuous g...

  16. 诱导期血液透析患者疾病不确定感与身体症状困扰的相关性研究%Co-relationship study between uncertainty in illness and symptom distress in patients undergoing hemodialysis in induction period

    单岩; 史小艳; 时秋英; 苗金红

    2012-01-01

    目的 探讨终末期肾脏病住院患者在血液透析诱导期疾病不确定感与身体症状困扰的相关性.方法 采用描述性相关性研究,分别用Mishel疾病不确定感量表和台湾学者陈美玲“的血液透析患者身体症状困扰量表”,调查了59例处于血液透析诱导期的终末期肾脏病住院患者的疾病不确定感和身体症状困扰.结果 诱导期血液透析患者疾病不确定感处于中等水平,症状困扰的程度各自不同,但困扰发生率为100%.疾病不确定感与症状困扰呈正相关(r=0.27~0.54,P<0.05).结论 症状困扰会影响肾病住院患者诱导透析期间的疾病不确定感,护理人员应指导患者进行症状管理,减轻症状对患者生活的困扰,从而降低患者的疾病不确定感.%Objective To study the co-relationship between uncertainty in illness and symptom distress in patients with end stage of renal disease (ESRD) undergoing induced hemodialysis. Method A cross-sectional study was conducted. The Mishel uncertainty in illness scale(MUIS)and the Chen symptom distress scale in kidney disease were used to assess uncertainty in illness and symptom distress among 59 patients with ESRD undergoing hemodialysis. Result The uncertainty in illness of patients in induced period was at middle level, All the patients suffered from symptom distress in various degrees,Uncertainty in illness was positively correlated with symptom distress(r=0. 27 — 0. 54,P<0. 05). Conclusion Uncertainty in illness of ESRD patientsundergoing induced dialysis is related to symptom distress. Nurses should instruct patients to manage symptoms in order to decrease uncertainty in illness.

  17. Lanthanum carbonate vs conventional phosphate binders for the treatment of hyperphosphatemia in maintenance hemodialysis patients: a meta-analysis

    张晓娟

    2013-01-01

    Objective To assess the effect and safety of lanthanum carbonate vs conventional phosphate binders for hyperphosphatemia in patients undergoing maintenance hemodialysis.Methods According to the collaborative search strategy,MEDLINE (1996 to 2012.12) ,EBCO

  18. Survival analysis of patients on maintenance hemodialysis.

    Chandrashekar, A; Ramakrishnan, S; Rangarajan, D

    2014-07-01

    Despite the continuous improvement of dialysis technology and pharmacological treatment, mortality rates for dialysis patients are still high. A 2-year prospective study was conducted at a tertiary care hospital to determine the factors influencing survival among patients on maintenance hemodialysis. 96 patients with end-stage renal disease surviving more than 3 months on hemodialysis (8-12 h/week) were studied. Follow-up was censored at the time of death or at the end of 2-year study period, whichever occurred first. Of the 96 patients studied (mean age 49.74 ± 14.55 years, 75% male and 44.7% diabetics), 19 died with an estimated mortality rate of 19.8%. On an age-adjusted multivariate analysis, female gender and hypokalemia independently predicted mortality. In Cox analyses, patient survival was associated with delivered dialysis dose (single pool Kt/V, hazard ratio [HR] =0.01, P = 0.016), frequency of hemodialysis (HR = 3.81, P = 0.05) and serum albumin (HR = 0.24, P = 0.005). There was no significant difference between diabetes and non-diabetes in relation to death (Relative Risk = 1.109; 95% CI = 0.49-2.48, P = 0.803). This study revealed that mortality among hemodialysis patients remained high, mostly due to sepsis and ischemic heart disease. Patient survival was better with higher dialysis dose, increased frequency of dialysis and adequate serum albumin level. Efforts at minimizing infectious complications, preventing cardiovascular events and improving nutrition should increase survival among hemodialysis patients. PMID:25097332

  19. The economic burden of hemodialysis in Jordan

    Emad Adel Al-Shdaifat

    2013-01-01

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

  20. Uremic Neuropathy: Epiemiological Study in Hemodialysis Patients

    Ricci, Davide

    2012-01-01

    Background/Aims. Uremic Neuropathy (UN) highly limits the individual self-sufficiency causing near-continuous pain. An estimation of the actual UN prevalence among hemodialysis patients was the aim of the present work. Methods. We studied 225 prevalent dialysis patients from two Italian Centres. The Michigan Neuropathy Score Instrument (MNSI), already validated in diabetic neuropathy, was used for the diagnosis of UN. It consisted of a questionnaire (MNSI_Q) and a physical-clinical evaluat...

  1. The effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among hemodialysis patients

    Shahgholian, Nahid; Jazi, Shahrzad Khojandi; Karimian, Jahangir; Valiani, Mahboubeh

    2016-01-01

    Background: Restless leg syndrome prevalence is high among the patients undergoing hemodialysis. Due to several side effects of medicational treatments, the patients prefer non-medicational methods. Therefore, the present study aimed to investigate the effects of two methods of reflexology and stretching exercises on the severity of restless leg syndrome among patients undergoing hemodialysis. Materials and Methods: This study is a randomized clinical trial that was done on 90 qualified patie...

  2. r-HuEPO增强透析患者免疫功能的临床研究%Effect of Recombinant Human Erythropoietin on Immune Function of Patients Undergoing Hemodialysis

    王彬; 王淑英; 李小园; 王靖; 马晓霞

    2013-01-01

    目的 探讨重组人红细胞生成素(r-HuEPO)对维持性血液透析(MHD)患者抗感染免疫功能的影响.方法 选取20例MHD患者,在给予静脉注射r-HuEPO前和静脉注射r-HuEPO后取血清检测细胞白介素-1(IL-1)、细胞白介素-2(IL-2)及肿瘤坏死因子-α(TNF-α)的比例.另15例未注射r-HuEPO治疗的MHD患者作为对照组.结果 r-HuEPO可提高MHD患者血清IL-2的含量;降低血清IL-1和TNF-α的含量.结论 r-HuEPO在改善MHD患者贫血症状的同时,对病人的免疫功能亦有一定的改善作用,可通过对免疫细胞及免疫应答的调节作用即改变血清中免疫细胞因子的含量从而改善患者的免疫系统功能,增强机体的抗感染能力,对降低感染和肿瘤的发生率、提高生存率有重要意义.%Objective To study the effect of recombinant human erythropoietin (r-HuEPO) on immune function in patients with maintenance hemodialysis(MHD).Methods Twenty cases of MHD received the intravenous injection of r-HuEPO.The serum levels of IL-1,IL-2 and TNF-α were tested before and after the injection.Another 15 patients without receiving the intravenous injection of r-HuEPO were selected as control.Results In the experimental group,the levels of IL-2 increased,while the the levels of IL-1 and TNF-α decrease.Conclusion r-HuEPO can not only improve the symptoms of anemia in MHD patients,but also improve their immune function.The change of serum immunocytokine induced by immune cells and immune response may be a mechanism for the improvement of immune system function.This should reduce the incidence of infection and tumors,increase the survival rate of patients.

  3. Predictive factors of restless leg syndrome in hemodialysis patients

    Eftekhari, Adel; Nasiriani, Khadijeh; Mirzaei, Samaneh; Azimpour Ardakani, Somayeh

    2016-01-01

    Introduction: The restless leg syndrome (RLS) is a neurologic disorder suffering the hemodialysis patients. Although the pathophysiology of this syndrome remains unknown yet, an investigation of the parameters pertinent to it may help to develop the related medical knowledge and to improve the therapeutic-care interventions in this regard. Objectives: The correlation between the RLSs on individual, clinical, and laboratory indices in patients undergoing hemodialysis. Patients and Methods: This descriptive-analytic study was conducted on 104 hemodialysis patients. Diagnosis of RLS was made using the International RLS Standard Questionnaire. The data on individual, clinical, and laboratory indices were obtained from patients’ recorded files and interviews. Results: Based on our findings, 28.8% of the patients undergoing hemodialysis were affected with mild RLS, 41.7% with moderate RLS, and 29.5% with severe RLS. There was a statistically significant correlation between affliction with RLS on the one hand, and age and gender, on the other (P < 0.05). However, there was no significant correlation between RLS and education level, occupation, length of hemodialysis, fasting blood sugar (FBS), hepatitis B and C, serum blood urea nitrogen (BUN), creatinine (Cr), iron, hemoglobin (Hb) level and also KT/Vor URR (P < 0.05). Conclusion: Regarding the high prevalence of RLS among the hemodialysis patients, there is the necessity for taking more care of these patients to reduce the somatic complications of the RLS especially among the elderly and female patients and to control the blood sugar of these patients at the normal level. PMID:27471741

  4. Once-Monthly Continuous Erythropoietin Receptor Activator (C.E.R.A.) in Patients with Hemodialysis-Dependent Chronic Kidney Disease: Pooled Data from Phase III Trials

    Locatelli, Francesco; Choukroun, Gabriel; Truman, Matt; Wiggenhauser, Alfons; Fliser, Danilo

    2016-01-01

    Introduction Erythropoiesis-stimulating agents and iron are commonly used in patients with chronic kidney disease with the aim of correcting anemia and maintaining stable hemoglobin levels. We analyzed pooled data from 13 studies with similar designs included in the Umbrella Continuous Erythropoietin Receptor Activator (C.E.R.A.) program to investigate the effects of continuous erythropoiesis receptor activator in clinically relevant subgroups of patients with chronic kidney disease and to de...

  5. 维持性血液透析患者生活质量影响因素分析%Analysis of the influencing factors of life quality in patients undergoing maintaining hemodialysis

    刘文军; 路晓光; 阎丽君; 冯博; 岳玉和

    2010-01-01

    目的 研究维持性血液透析(MHD)患者的生活质量及其影响因素. 方法 选择本院血液透析中心102例MHD患者,采用问卷调查方式,利用慢性肾脏病专用量表KDQOL-SFTM1.3评价患者肾脏病与透析相关生存质量(KDTA)和一般健康相关生存质量(SF-36),并分析其影响因素. 结果 量表各影响因素中,医护人员的鼓励、社会支持、症状、认知功能、社会关系质量和患者满意程度评分较高,而性功能、肾脏病给生活带来的负担、总体健康期望和自我健康评价评分则较低.影响因素方面,女性患者躯体功能、躯体疼痛评分(分)明显低于男性(63.52±17.96比71.65±18.66,64.33±21.23比76.58±19.20,均P60岁患者工作状况、性功能评分(分)较≤40岁和40~60岁患者显著升高(61.98±13.63比52.27±7.54和55.23±19.97,68.33±4.04比5.45±9.34和15.81±26.92,均P60 won higher scores than patients of age≤40 and 4060 in respect to work condition and sex function(61.98±13.63 vs.52.27±7.54 and 55.23±19.97,68.33±4.04 vs.5.45±9.34 and 15.81±26.92,all P<0.05);patients of 60 years old or older won higher scores in respect of satisfaction degree of patients but lower scores in respect of physical functions.Among primary diseases,only patients with diabetes won much encouragement from medical staff(93.57±11.29).Patients whose serum albumin was lower than 3.5 g/L won much lower scores than those with serum albumin higher than 3.5 g/L in respect of scoring of KDTA,influence to daily life due to kidney disease,cognitive function,physical functions,expectation of general health,and scores obtained previously(53.62±8.87 vs.61.26±9.42,44.58±12.52 vs.57.47±17.15,65.56±20.60 vs.78.18±15.73,54.38±19.73 vs.68.87±17.57,31.11±10.23 vs.41.19±66.27,44.44±27.06 vs.68.57±26.94,all P<0.05).Patients who had undergone hemodialysis for longer than 6 years won higher scores in respect to symptoms,body pain,vigour and expectation of general health(86

  6. Regional Anticoagulation with Citrate is Superior to Systemic Anticoagulation with Heparin in Critically Ill Patients Undergoing Continuous Venovenous Hemodiafiltration

    Park, Joon-Sung; Kim, Gheun-Ho; Kang, Chong Myung; Lee, Chang Hwa

    2011-01-01

    Background/Aims Short hemofilter survival and anticoagulation-related life-threatening complications are major problems in systemic anticoagulation with heparin (SAH) for continuous renal replacement therapy (CRRT). The present study examined if regional anticoagulation with citrate (RAC) using commercially available solutions can overcome the associated problems of SAH to produce economical benefits. Methods Forty-six patients were assigned to receive SAH or RAC. We assessed the coagulation ...

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

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

    2011-01-01

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

  8. The Care Burden and the Affecting Factors of Individuals Receiving Hemodialysis Treatment

    Merve Gulpak; Semra Kocaoz

    2014-01-01

    AIM: This study was performed to determine the care burden and the affecting factors of individuals receiving hemodialysis treatment METHOD: The study sample consisted of the caregivers of 235 individuals undergoing hemodialysis treatment. The data were collected by using a survey form of 48 questions and the Zarit Caregiver Burden Scale. The mean, percentage distributions, chi-square, Kruskal-Wallis and Mann-Whitney U tests, and the Spearman Brown correlation coefficient were used in the...

  9. Pharmacokinetics of paclitaxel in a hemodialysis patient with advanced gastric cancer: A case report

    Kawate, Susumu; Takeyoshi, Izumi; Morishita, Yasuo

    2006-01-01

    We report for the first time the possibility of weekly paclitaxel chemotherapy for a patient with advanced, nonresectable gastric cancer undergoing hemodialysis. A 50-year-old man with chronic renal failure due to bilateral polycystic kidneys, who had undergone hemodialysis three times a week for 5 years, presented with hematemesis in December 2004. Based on the diagnosis of gastric cancer with lymph node metastases, surgery was performed. On the 15th postoperative day, the patient was treate...

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

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

    2011-01-01

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

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

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

    2011-01-01

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

  12. Extending the benefits of early mobility to critically ill patients undergoing continuous renal replacement therapy: the Michigan experience.

    Talley, Cheryl L; Wonnacott, Robert O; Schuette, Janice K; Jamieson, Jill; Heung, Michael

    2013-01-01

    Evidence to support improved outcomes with early ambulation is strong in medical literature. Yet, critically ill continuous renal replacement therapy (CRRT) patients remain tethered to their beds by devices delivering supportive therapy. The University of Michigan Adult CRRT Committee identified this deficiency and sought to change it. There was no guidance in the literature to support mobilizing this population; therefore, we reviewed literature from devices with similar technological profiles. Revision of our institutional mobility protocol for the CRRT population included a simple safety acronym, ASK. The acronym addresses appropriate candidacy; secured, appropriate access; and potential device and patient complications as a memorable aid to help nursing staff determine whether their CRRT patients are candidates for early mobility. After implementing our CRRT mobility standard, a preliminary study of 109 CRRT patients and a review of incident reports related to CRRT demonstrated no significant adverse patient events or falls and no access complications related to mobility. This deliberate intervention allows CRRT patients to safely engage in mobility activities to improve this population's outcomes. A simple mobility protocol and safety acronym partnered with strong clinical leadership has permitted the University of Michigan to add CRRT patients to the body of early mobility literature. PMID:23221445

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

    Huang Guey-Shiun

    2009-06-01

    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

  14. 中老年维持性血液透析患者死亡事件的原因分析%Investigation on death events in end-stage renal disease patients undergoing hemodialysis

    杨继红; 吴华; 张燕京; 王松岚; 孙颖; 李湛; 李天慧

    2012-01-01

    Objective To analyze the characteristics of the maintenance hemodialysis (MHD) patients died in this hospital from January 2005 to December 2011, and to investigate the risk factors relating to the death in elderly MHD patients. Methods Retrospective study on MHD patients in the period from January 2005 to December 2011 found 83 death cases that had treated with MHD for more than 3 months. The annual number of death cases and mortality rate were then calculated. These cases were divided into 3 groups: middle age group (80 years of age). Demographic features, diabetes, dialysis age and cause of death were analyzed among the three groups. Results The annual mortality rate in MHD patients from 2005 to 2011 was 11.00%, 10.90%, 8.30%, 8.10%, 10.10%, 8.70% and 6.34%, respectively. Of the 83 death cases, 49 cases were males and 34 cases were females, with the mean age of 71.8± 12.0 years (42 ~94 years). Fourteen cases were in middle age group, 46 cases in elderly group, and 23 cases in very elderly group. Sex difference was insignificant among the three groups. Dialysis age was longer in middle age group, and was shorter in elderly group. Diabetic nephropathy was frequently found in elderly group. The causes of death were different. In middle age group, 50% cases died of cerebral vascular disease, especially cerebral hemorrhage. In very elderly group, 56% cases died of septic shock. In elderly group, death was resulted from various causes, including septic shock, cardiac infarction or heart failure, tumor, malnutrition-inflammation-atherosclerosis syndrome (MIA syndrome) and sudden death (in order of the prevalence rate). Conclusions Most of the death cases in this dialysis center were older than 60 years of age. Diabetes played a role more important than age on the prognosis of MHD patients. Cerebral vascular disease was the major cause of death in middle age patients, and septic shock is the main cause in very elderly patients. The causes leading to death in elderly

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

    Humberto Kukhyun Choi

    2003-01-01

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

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

    Dinaldo Cavalcanti de Oliveira

    2009-07-01

    hemodialysis. METHODS: This is a descriptive study of 20 patients with type 1 diabetes mellitus undergoing hemodialysis without known CAD. CAD was assessed by quantitative coronary angiography (QCA and intravascular ultrasound (IVUS. QCA was performed in all lesions >30%, visually. All proximal 18-mm segments of the coronary arteries were analyzed by IVUS. All other coronary segments with stenosis >30% were also analyzed. RESULTS: Angiography detected 29 lesions >30% in 15 patients (75%. Eleven (55% of the lesions were >50% and 10 (50% >70%. Thirteen patients had all 3 major arteries interrogated by IVUS. Atherosclerosis was present in all patients and in all 51 proximal 18-mm segments analyzed. The mean vessel diameter of these segments was significantly larger at the IVUS than at the QCA, for all vessels. IVUS images of 25 (86.2% of the 29 lesions >30% were obtained. Fibrotic plaques were common (48% and 60% had intermediate vessel remodeling. CONCLUSION: CAD was present in all vessels of all type 1 diabetic patients undergoing hemodialysis. These findings are in agreement with other autopsy, angiography and IVUS studies. Additionally, they indicate the need for additional epidemiological and imaging studies to better understand and treat such a complex and serious clinical condition affecting young people.

  17. Effect of aromatherapy on pruritus relief in hemodialysis patients

    Shahgholian, Nahid; Dehghan, Mahlagha; Mortazavi, Mojgan; Gholami, Farzaneh; Valiani, Mahboobeh

    2010-01-01

    BACKGROUND: Pruritus is one of the commonest problems in patients with end-stage renal failure undergoing hemodialysis. Pruritus is an irritating symptom which can directly affect the life quality of patients with chronic renal failure. However, available treatments have failed to relieve the symptom and kidney transplant remains the definite treatment of the problem. A recently proposed treatment for pruritus is the use of complementary medicine. Thus, the aim of this research is to study th...

  18. 5-year Mortality in Hemodialysis Patients: A Single Center Study in Tripoli

    Buargub Mahdia

    2008-01-01

    Full Text Available To investigate the 5-year mortality of patients undergoing maintenance hemo-dialysis (HD at Al-Shat center Tripoli, we reviewed during June 2007 the records of all the HD patients initiated on HD from Jun 2000 and Jan 2002.There were 124 patients in the study, 77 males (63.6% and 47 (36.4% females, with a mean age of 49 ± 14 years. Diabetic nephropathy (DN was the underlying kidney disease in 34 (27.4% patients. After 5 years; 3 patients were transferred to other centers, 18 (14.9% patients underwent kidney transplan-tation. Out of the 103 patients who continued on hemodialysis, 53 (51.4% expired during the 5-year follow-up. Mortality was associated with older age (p< 0.001 and odd ratio (OR of 4.2 for age > 50 years and DN (p< 0.002 and OR of 3.9. Mortality rate in diabetics was 74.1% and significantly associated with male sex (p< 0.0067 and OR of 2.4, older age (p< 0.004, presence of hypertension (p< 0.003 and OR of 3.9, type 1 diabetes (OR 1.6, and elevated mean body weight (p< 0.046. Mortality was also relatively higher in black patients (OR of 2.0 and smokers (OR of 1.39. In conclusion, the overall 5- year mortality for dialysis patients was elevated and higher in the diabetics.

  19. Annual Decline in Pentraxin 3 Is a Risk of Vascular Access Troubles in Hemodialysis Patients

    Kei Nagai

    2014-01-01

    Full Text Available Pentraxin 3 (PTX3, a multifunctional modulator of the innate immunoinflammatory response, is higher in patients undergoing hemodialysis than healthy control. Our study focused on annual change in PTX3 levels in patients with chronic hemodialysis, because regularly undergoing hemodialysis for many years modifies vascular inflammatory status. To demonstrate whether annual change in PTX3 is associated with vascular events, we measured blood levels of pentraxins (PTX3 and high-sensitivity C-reactive protein (hsCRP at baseline and in the next year in 76 hemodialysis patients and observed 20 patients with vascular access troubles during follow-up years. The annual decline in PTX3, but not hsCRP, is a significant risk of the incidence of vascular access trouble that is a critical and specific complication for hemodialysis patients (hazard ratio; 0.732 per +1 ng/mL/year in PTX3, *P=0.039. This study is the first to focus on the annual change of pentraxins in a hemodialysis cohort.

  20. 辛伐他汀对维持性血液透析患者血脂水平及微炎症状态的影响%Effects of simvastatin on the blood lipids level and micro-inflammation state in patients un-dergoing maintenance hemodialysis

    刘小绿; 孔新保; 张道友

    2014-01-01

    Objective:To investigate the effects of simvastatin on the lipid metabolism and micro-inflammation state in patients undergoing maintenance he-modialysis ( MHD) .Methods:Thirty-two MHD patients in stable condition were included in the Second Affiliated Hospital of Wannan Medical College .All patients were managed with simvastatin in small dosage and examined concerning the level changes of blood fat ( TG,TC,LDL) before and after 12 weeks of medication,micro-inflammatory markers-C-reactive protein(CRP)and interleukin-6(IL-6).Another 32 healthy subjects undergone physical examination on outpatient basis were enrolled as controls for comparison of the results.Results:①The indexes of TG,TC and LDL,CRP and IL-6 were significantly higher in MHD patients before medication than those of the controls(P<0.05);②After 12-week-therapy,the levels of TC,TG and CRP were decreased to certain extent(P<0.05).Conclusion:Simvastatin can bring down the blood lipids and be anti-inflammatory effects on patients undergoing MHD.%目的:探讨维持性血液透析( MHD)患者使用辛伐他汀对脂代谢及微炎症状态的影响。方法:选择皖南医学院第二附属医院病情稳定的MHD患者32例,比较使用小剂量辛伐他汀治疗12周后血脂( TG、TC、LDL)及微炎症状态标志物C反应蛋白(CRP)、白细胞介素6(IL-6)的变化;同时与门诊健康体检者32例作对照比较。结果:①MHD患者治疗前后血脂(TG、TC、LDL)及CRP、IL-6显著高于健康者(P<00.5);②治疗12周后,MHD患者TC、TG、CRP的水平均有所下降(P<0.05)。结论:应用辛伐他汀对MHD患者具有调脂、抗炎作用。

  1. Longitudinal study of leptin levels in chronic hemodialysis patients

    Averbukh Zhan

    2011-06-01

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

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

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

    2010-01-01

    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. PMID:20835557

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

    José Otavio Costa Auler Junior

    2010-06-01

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

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

    Abbas Ghiasi

    2015-02-01

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

  5. Proteomic Investigations into Hemodialysis Therapy

    Mario Bonomini; Vittorio Sirolli; Luisa Pieroni; Paolo Felaco; Luigi Amoroso; Andrea Urbani

    2015-01-01

    The retention of a number of solutes that may cause adverse biochemical/biological effects, called uremic toxins, characterizes uremic syndrome. Uremia therapy is based on renal replacement therapy, hemodialysis being the most commonly used modality. The membrane contained in the hemodialyzer represents the ultimate determinant of the success and quality of hemodialysis therapy. Membrane’s performance can be evaluated in terms of removal efficiency for unwanted solutes and excess fluid, and m...

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

    Baradaran, Azar; Ardalan, Mohammad-Reza; Nasri, Hamid

    2010-01-01

    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 he...

  7. Glycemic Variability Assessed by Continuous Glucose Monitoring and Short-Term Outcome in Diabetic Patients Undergoing Percutaneous Coronary Intervention: An Observational Pilot Study.

    Nusca, Annunziata; Lauria Pantano, Angelo; Melfi, Rosetta; Proscia, Claudio; Maddaloni, Ernesto; Contuzzi, Rocco; Mangiacapra, Fabio; Palermo, Andrea; Manfrini, Silvia; Pozzilli, Paolo; Di Sciascio, Germano

    2015-01-01

    Poor glycemic control is associated with unfavorable outcome in patients undergoing percutaneous coronary intervention (PCI), irrespective of diabetes mellitus. However a complete assessment of glycemic status may not be fully described by glycated hemoglobin or fasting blood glucose levels, whereas daily glycemic fluctuations may influence cardiovascular risk and have even more deleterious effects than sustained hyperglycemia. Thus, this paper investigated the effectiveness of a continuous glucose monitoring (CGM), registering the mean level of glycemic values but also the extent of glucose excursions during coronary revascularization, in detecting periprocedural outcome such as renal or myocardial damage, assessed by serum creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and troponin I levels. High glycemic variability (GV) has been associated with worse postprocedural creatinine and NGAL variations. Moreover, GV, and predominantly hypoglycemic variations, has been observed to increase in patients with periprocedural myocardial infarction. Thus, our study investigated the usefulness of CGM in the setting of PCI where an optimal glycemic control should be achieved in order to prevent complications and improve outcome. PMID:26273664

  8. Glycemic Variability Assessed by Continuous Glucose Monitoring and Short-Term Outcome in Diabetic Patients Undergoing Percutaneous Coronary Intervention: An Observational Pilot Study

    Annunziata Nusca

    2015-01-01

    Full Text Available Poor glycemic control is associated with unfavorable outcome in patients undergoing percutaneous coronary intervention (PCI, irrespective of diabetes mellitus. However a complete assessment of glycemic status may not be fully described by glycated hemoglobin or fasting blood glucose levels, whereas daily glycemic fluctuations may influence cardiovascular risk and have even more deleterious effects than sustained hyperglycemia. Thus, this paper investigated the effectiveness of a continuous glucose monitoring (CGM, registering the mean level of glycemic values but also the extent of glucose excursions during coronary revascularization, in detecting periprocedural outcome such as renal or myocardial damage, assessed by serum creatinine, neutrophil gelatinase-associated lipocalin (NGAL, and troponin I levels. High glycemic variability (GV has been associated with worse postprocedural creatinine and NGAL variations. Moreover, GV, and predominantly hypoglycemic variations, has been observed to increase in patients with periprocedural myocardial infarction. Thus, our study investigated the usefulness of CGM in the setting of PCI where an optimal glycemic control should be achieved in order to prevent complications and improve outcome.

  9. 维持性血液透析与腹膜透析患者血压变异性比较%A comparative study on variability of blood pressure in patients treated by maintenance hemodialysis or continuous peritoneal dialysis.

    王刚; 尹乐; 刘文虎

    2013-01-01

    Objective To explore the difference in variability of blood pressure ( BPV ) in patients treated by maintenance hemodialysis ( MHD ) compared with continuous peritoneal dialysis ( CAPD). Methods Thirty patients with MHD and thirty patients with CAPD in this hospital were recruited for this cross - sectional study. The ambulatory blood pressure ( ABP ) monitoring was proceeded in patients with MHD for 44 hours and in patients with CAPD for 24hours. The mean value of systolic blood pressure ( SBP ),diastolic blood pressure ( DBP ), the declining percentage of nocturnal SBP, the mean value of standard deviation ( SD ) and coefficient of variation ( CV ) were compared between patients with MHD and CAPD. These parameters were also compared between dialysis day and non - dialysis day in patients with MHD. Results The mean value of blood pressure of patients with MHD in non - dialysis day was significantly higher than that of patients with CAPD(SBP, 148. 9 ±20. 6 mm-Hg vs. 129.9±16.4 mmHg, P <0.001; DBP, 89.9±12.5 mmHg vs. 82.9±11.5 mmHg, P =0.028 ). The cases of dipper pattern blood pressure in patients with MHD in dialysis day were much higher than those in patients with CAPD ( 5/30 vs. 0, P =0. 029 ). There was no significant difference on both SD and CV between patients with MHD or CAPD. However, the SD level of DBP in non - dialysis day was larger than that in dialysis day, 10.4±2.9 vs. 12.5±5.0, P -0.031. Conclusion The blood pressure of patients with MHD in non - dialysis day is higher than that of patients with CAPD. There are dipper pattern blood pressure in some patients with MHD after hemodialysis. The variability of blood pressure in patients with MHD is larger in non - dialysis day.%目的 对比维持性血液透析(MHD)和连续性非卧床腹膜透析(CAPD)患者血压变异性,观察不同透析方式血压变化的特点.方法 选择MHD和CAPD治疗的非糖尿病尿毒症患者各30例,对MHD患者进行非透析期间的44 h动态

  10. Oxidative stress and lipoperoxides in patients undergoing hemodialysis treatment

    Soška, V.; Lojek, Antonín; Číž, Milan; Sobotová, D.

    Elsevier. Roč. 144, č. 1 (1999), s. 41-42. ISSN 0021-9150. [Congress of the European Atherosclerosis Society /71./. 26.05.1999-29.05.1999, Athens] Institutional research plan: CEZ:A17/98:Z5-004-9-ii Subject RIV: EC - Immunology

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

    Santos Paulo Roberto; Arcanjo Francisco Plácido Nogueira

    2013-01-01

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

  12. Rosuvastatin in diabetic hemodialysis patients

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

    2011-01-01

    A randomized, placebo-controlled trial in diabetic patients receiving hemodialysis showed no effect of atorvastatin on a composite cardiovascular endpoint, but analysis of the component cardiac endpoints suggested that atorvastatin may significantly reduce risk. Because the AURORA (A Study to...... Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) trial included patients with and without diabetes, we conducted a post hoc analysis to determine whether rosuvastatin might reduce the risk of cardiac events in diabetic patients...... receiving hemodialysis. Among the 731 participants with diabetes, traditional risk factors such as LDL-C, smoking, and BP did not associate with cardiac events (cardiac death and nonfatal myocardial infarction). At baseline, only age and high-sensitivity C-reactive protein were independent risk factors for...

  13. Optimizing lithium dosing in hemodialysis

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

    2006-01-01

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

  14. Technical aspects of home hemodialysis

    Alhomayeed B

    2009-01-01

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

  15. Restless legs syndrome in hemodialysis patients

    Shahram Rafie

    2016-01-01

    Full Text Available Restless legs syndrome (RLS is a neurological disorder characterized by uncomfortable sensation of paresthesia in legs that subsequently causes involuntary and continuous movement of the lower limbs, especially at rest. Its prevalence in hemodialysis is more than that in the general population. Different risk factors have been suggested for RLS. We studied the prevalence and risk factors of RLS in 137 hemodialysis patients followed up at our center. The patients completed at least three months on dialysis and fulfilled four criteria for the diagnosis of RLS. We compared the patients with and without RLS, and the odds ratios (ORs were estimated by the logistic regression models. The prevalence of RLS was 36.5% in the study patients. Among the variables, diabetes was the only predicting factor for the development of RLS. The diabetic patients may be afflicted with RLS 2.25 times more than the non-diabetics. Women developed severe RLS 5.23 times more than men. Neurodegeneration, decrease in dopamine level, higher total oxidant status, and neuropathy in diabetic patients may explain the RLS symptoms.

  16. Spirometric Parameters: Hemodialysis Compared to Peritoneal Dialysis

    Fariba Rezaeetalab

    2015-06-01

    Full Text Available Introduction: Renal failure affects the mechanical and the ventilatory function of the lungs. A few studies have evaluated the ventilatory and pulmonary function in dialysis patients. The present study aimed to compare Pulmonary Function Test (PFT results in patients undergoing Hemodialysis (HD and Peritoneal Dialysis (PD. Materials and Methods: We conducted a cross-sectional study on 50  patients with hemodialysis (HD and 50 cases with PD who  underwent PFT in Ghaem and Imam Reza hospitals Mashhad, Iran from November 2010 to July 2012. Spirometric parameters including forced expiratory volume in 1s (FEV1, FEV1/forced vital capacity (FVC, forced expiratory flow 25-75% (FEF and peak expiratory flow (PEF were compared between the two groups of patients. Results: Approximately 68% of the HD patients, 66% of the PD patients, and 67% of all the studied cases showed a normal spirometric pattern. Moreover, there were no significant differences between the two groups considering the mean of the aforementioned spirometric parameters(restrictive ,obstructive pattern (P=0.969. However, an insignificant inverse correlation was observed between the duration of dialysis with FEV1 (r=0.381, P=0.008, FVC (r=-0.298, P=0.04, FEF 25-75% (r=0.43, P=0.003, PEF (r= 0.349, P=0.02 and FEV1/FVC (r=-0.363, P=0.01, in the HD patients and between the patients’ age with FEV1/FVC (r=0.03, P=0.02 in the PD patients. Conclusion: This study showed no significant difference in pulmonary function in hemo and peritoneal dialysis,so according this result ,both of the dialysis had the same affect on the lung function.

  17. 心脏术后急性肾损伤行连续性静脉-静脉血液透析治疗失败的危险因素分析%Risk factors for failure of continuous veno-venous hemodialysis in the treatment of acute kidney injury following cardiac surgery

    丁文军; 刘华; 季强; 王玺胜; 蔡建志; 梅运清

    2013-01-01

    目的 评估连续性静脉-静脉血液透析(CVVHD)治疗心脏术后急性肾损伤(AKI)失败的危险因素.方法 2005年1月-2012年12月在同济医院心胸外科因心脏手术后AKI行CVVHD治疗的成年患者分为CVVHD治疗失败组和治疗成功组.回顾性分析患者术前、术中、术后相关临床资料.结果 93例患者被纳入该研究,其中63例治疗成功,30例治疗失败,CVVHD治疗失败率为32.2%,病死率19.4%.通过单因素分析和多因素Logistic回归分析,CVVHD治疗心脏术后AKI失败的独立危险因素有:术前LVEF(OR =0.61,95% CI0.42~0.85)和从少尿到透析的间隔时间(OR=2.76,95%CI 1.51 ~5.83).结论 术前左室受损是CVVHD治疗心脏术后AKI失败的危险因素.CVVHD实施越早,患者预后越好.%Objective To evaluate the independent risk factors for failure of continuous venovenous hemodialysis (CVVHD) in the treatment of acute kidney injury (AKI) following cardiac surgery.Methods Adult patients without any prior pre-operative history of chronic renal disease suffering AKI following cardiac surgery and undergoing CWHD at our center from January 2005 to December 2012 were recruited and divided into either a success group or a failure group.All pre-,intra-and post-operative data were collected and retrospectively analyzed.Results Ninety-three adult patients were enrolled.Among them,sixty-three patients survived with a failure rate of 32.2% and a mortality rate of 19.4%.Through univafiate analysis and multivariate Logistic regression,independent risk factors for failure of CVVHD in the treatment of post-operative AKI included pre-operative LVEF (OR =0.61,95% CI O.42-0.85) and duration of oliguria until dialysis (OR =2.76,95% CI 1.51-5.83).Conclusion Pre-operative impaired left ventricular function is an important risk factor for failure of CVVHD in the treatment of AKI after cardiac surgery.The sooner the implementation of CVVHD,the better prognosis.

  18. Effect of hemodialysis on intraocular lens power calculation.

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

    2016-03-01

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

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

    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-α (TNF-α) were assessed by comparison of pre- and post-hemodialysis determinations. Serum levels of ADPN and TNF-α 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-α, 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

  20. Proteomic Investigations into Hemodialysis Therapy

    Mario Bonomini

    2015-12-01

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

  1. Transhepatic venous catheters for hemodialysis

    Mohamed El Gharib

    2014-06-01

    Conclusion: Based on our findings, transhepatic hemodialysis catheters have proven to achieve good long-term functionality. A high level of maintenance is required to preserve patency, although this approach provides remarkably durable access for patients who have otherwise exhausted access options.

  2. Changes in Plasma Copeptin Levels during Hemodialysis : Are the Physiological Stimuli Active in Hemodialysis Patients?

    Ettema, Esmee M.; Kuipers, Johanna; Assa, Solmaz; Bakker, Stephan J. L.; Groen, Henk; Westerhuis, Ralf; Gaillard, Carlo A. J. M.; Gansevoort, Ron T.; Franssen, Casper F. M.

    2015-01-01

    Objectives Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP), are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli fo

  3. Protein intake during hemodialysis maintains a positive whole body protein balance in chronic hemodialysis patients

    Veeneman, JM; Kingma, HA; Boer, TS; Stellaard, F; De Jong, PE; Reijngoud, DJ; Huisman, RM

    2003-01-01

    Protein energy malnutrition is present in 18 to 56% of hemodialysis patients. Because hemodialysis has been regarded as a catabolic event, we studied whether consumption of a protein- and energy-nriched meal improves the whole body protein balance during dialysis in chronic hemodialysis (CHD) patien

  4. 中青年血液透析患者体力活动水平及生活质量的研究%Study on physical activity level and quality of life for young and middle-aged patients undergoing hemodialysis

    张海林; 路潜; 文翠菊; 尹丽霞

    2012-01-01

    目的 了解中青年血液透析患者的体力活动水平和生活质量状况,分析患者体力活动与其生活质量之间的关系.方法 采用国际体力活动短问卷(international physical activity questionnaire-short vision,IPAQ-SV)和简明健康调查量表(Medical Outcomes Study Health Status Short Form,SF-36)对77例中青年血液透析患者体力活动水平及生活质量状况进行测评.结果 在77例血液透析患者中,14例体力活动活跃,31例体力活动适中,32例体力活动不足;体力活动水平与生理健康和心理健康均呈正相关(r分别为0.351和0.274,P<0.05).结论 部分中青年血液透析患者的体力活动不足,可能会降低病人的生活质量,应鼓励中青年血液透析患者根据自身的身体状况参与锻炼.%Objective To investigate the physical activity level and quality of life for young and middle-aged hemo-dialysis patients, and to evaluate the association between physical activity level and quality of life. Method Physical activity level and quality of life was measured using the International Physical Activity Questionnaire-Short Vision (IPAQ-SV) and Medical Outcomes Study Health Status Short Form 36CMQSH SF-36)among 77 young and middle-aged hemodialysis patients. Result Among 77 young and middle-aged hemodialysis patients, 14 cases(18. 2%) was high physical activity, 32 cases(41. 6%) was low physical activity, 31 cases(40. 3%) was moderate physical activity. There was positive correlation between physical activity level, physical health and psychological health(r=0. 351 and 0. 274 respectively, P<0. 05). Conclusion The physical activity inactive is common in young and middle-aged hemodialysis patients, and may lower their quality of life. It is necessary to encourage young and middle-aged hemodialysis patients to participant exercise according to their physical capacity. .

  5. Relationship Between Diastolic Dysfunction and Atherosclerosis and Vascular Calcification in Hemodialysis Patients: Diagnostic Potential of the Cardio-Ankle Vascular Index.

    Unagami, Kohei; Nitta, Kosaku; Tago, Kiichiro; Matsushita, Kazumichi

    2016-04-01

    Diastolic dysfunction (DD) commonly causes heart failure with preserved ejection fraction (EF). Here, we examine associations between DD severity and atherosclerosis/vascular calcification in hemodialysis patients. Echocardiography was performed on 101 patients undergoing hemodialysis therapy. Twelve patients (EF ACAI). Seventy-seven patients (86.5%) with EF ≥ 50% had DD. Associations with advanced age and comorbid diabetes mellitus and cardiovascular disease were observed. The CAVI, TBI, and ACAI, but not ABI, increased proportionally with DD grades. Thus, many hemodialysis patients developed DD, with systolic function maintained. Strong associations between DD grades and progression of both atherosclerosis and vascular calcification could be inferred. PMID:26771064

  6. Hemodialysis clearance of metronidazole and its metabolites.

    Lau, A. H.; Chang, C W; Sabatini, S

    1986-01-01

    Metronidazole is now being used with increasing frequency for various infectious conditions in patients with renal failure. It is commonly administered to septic patients who have developed acute renal failure requiring hemodialysis. The hemodialysis clearances of metronidazole and its metabolites were evaluated in nine renal failure patients on maintenance hemodialysis. The mean +/- standard deviation clearance and the extraction ratio were 106.9 +/- 16.3 ml/min and 0.65 +/- 0.08, respective...

  7. Hemodialysis clearance of intravenously administered ribavirin.

    Kramer, T H; Gaar, G G; Ray, C G; Minnich, L; Copeland, J G; Connor, J. D.

    1990-01-01

    A patient with an implanted artificial heart, acute, anuric renal failure, and disseminated influenza virus type A infection received intravenous ribavirin. Drug elimination by hemodialysis was measured. Plasma dialysis clearance averaged 93.9 +/- 8.6 ml/min. The maximum amount of ribavirin removed from the body during one period of hemodialysis was 79.1 mg. Ribavirin is not removed in important quantities by hemodialysis.

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

    Gede Andry Nicolas

    2013-04-01

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

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

    Francesca G. Iodice

    2014-06-01

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

  10. Urea biosensor for hemodialysis monitoring

    Glass, R.S.

    1999-01-12

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

  11. Urea biosensor for hemodialysis monitoring

    Glass, Robert S. (Livermore, CA)

    1999-01-01

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

  12. Optimizing lithium dosing in hemodialysis

    Bjarnason, N H; Munkner, R; Kampmann, J P;

    2006-01-01

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

  13. Pulmonary hypertenstion ad leading factor in patients undergoing dialysis

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

  14. Sleep disorders in hemodialysis patients

    Sabry Alaa; Abo-Zenah Hamdy; Wafa Ehab; Mahmoud Khaled; El-Dahshan Khaled; Hassan Ahmed; Abbas Tarek; Saleh Abd El-Baset; Okasha Kamal

    2010-01-01

    The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 ± 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni-versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walk...

  15. Transhepatic venous catheters for hemodialysis

    Mohamed El Gharib; Gamal Niazi; Waleed Hetta; Yahya Makkeyah

    2014-01-01

    Purpose: To describe our experience with the technique of transhepatic venous access for hemodialysis and to evaluate its functionality and complications. Patients and methods: From March 2012 till October 2012, 23 patients with age ranging from 12 to 71 years old having end-stage renal disease (ESRD) were included in our study and were subjected to transhepatic venous catheter insertion. In 21 patients there were not any remaining patent peripheral venous accesses. In 2 patients there wer...

  16. An Unusual yet "Mg"nificent Indication for Hemodialysis.

    Bansal, Amar D; Negoianu, Dan; Warburton, Karen M

    2016-05-01

    Hypermagnesemia is an uncommon electrolyte abnormality, due to the fact that magnesium toxicity is only seen in the setting of a massive exposure to exogenous magnesium, often in the setting of renal insufficiency. Here, we report a case of severe hypermagnesemia that resulted in complete paralysis that was secondary to Renacidin administration, a rarely used agent used for intra-renal pelvic or intra-vesicular instillation dissolution of struvite stones. The patient also had concurrent acute kidney injury (AKI). The patient's magnesium was as high as 16.7 mg/dL, and he initially received hemodialysis followed by continuous venovenous hemodialysis. These therapies resulted in a rapid reduction in magnesium levels and eventual resolution of the muscular weakness. The case discussion highlights several key aspects of magnesium homeostasis, the limited mechanistic understanding of Renacidin-induced hypermagnesemia, and the role of renal replacement therapies in the treatment of hypermagnesemia. PMID:26915350

  17. Pulmonary Hypertension in Hemodialysis Patients

    Mahdavi-Mazdeh Mitra

    2008-01-01

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

  18. Carotid artery intima media thickness as a surrogate marker of atherosclerosis in patient with chronic renal failure on hemodialysis

    Jayanta Paul

    2012-01-01

    Full Text Available Background: In patients with chronic renal failure (CRF, carotid artery intima media thickness (CAIMT is increased when the patients are on hemodialysis. Vascular events caused by atherosclerosis are the major cause of death in patients undergoing hemodialysis. Aims: This study was done to find out the relationship between carotid artery intima media thickness and hemodialysis in chronic renal failure patients independent of classical risk factors and also the relationship between CAIMT of hemodialyzed patients and nonhemodialyzed CRF patients. Materials and Methods: In this observational study, CAIMT of 78 CRF patients was examined by B-mode ultrasonography. Glomerular filtration rate (GFR was calculated by using the "Modification of Diet in Renal Disease" formula. CRF patients, who had been on regular hemodialysis treatment (treated thrice weekly for at least 6 months, were identified as hemodialyzed patients. Data were analyzed by software Statistical package for the social Sciences (SPSS (17 th version. Results: There was significant positive correlation between CAIMT and hemodialysis (P=0.045 independent of traditional risk factors. Hemodialyzed patients had higher mean CAIMT (1136.30±21.21 μm, P<0.001 than mean CAIMT of age and sex matched nondialyzed patients (959.30±23.01 μm. Conclusion: Hemodialysis is an independent risk factor for atherosclerosis in CRF patents. Hemodialyzed patients have significantly higher CAIMT than nondialyzed CRF patients.

  19. Thirty years survivor on hemodialysis: A case report

    Konstantina Triga

    2014-01-01

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

  20. Thirty years survivor on hemodialysis: A case report

    Konstantina Triga; Periklis Dousdampanis; Stamatina Aggelakou-Vaitsi; Karen Gellner

    2014-01-01

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

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

    Azar BARADARAN

    2011-12-01

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

  2. Continous venovenous hemodialysis (CVVHD: Report of 3 cases

    Seirafian Sh

    1998-07-01

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

  3. Substance P and intensity of pruritus in hemodialysis and peritoneal dialysis patients

    Œnit, Mirosław; Gawlik, Radosław; Łącka-GaŸdzik, Beata; KuŸniewicz, Roman; Dwornicki, Marek; Owczarek, Aleksander; Walaszczyk, Małgorzata; Grabiec, Piotr; Grzeszczak, Władysław

    2013-01-01

    Background Uremic pruritus is a common complication in patients undergoing dialysis. The pathophysiological mechanisms of pruritus in patients with end-stage renal disease remain unknown. Neuropeptides, including substance P, are postulated to play an important role in the pathogenesis of pruritus. The aim of this study was to evaluate the role of substance P in uremic pruritus in patients on hemodialysis and peritoneal dialysis. Material/Methods We included 197 patients with end-stage renal ...

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

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

    2012-01-01

    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, ...

  5. Endovascular treatment of central venous obstruction as a complication of prolonged hemodialysis – Preliminary experience in a tertiary care center

    Yadav, Mukesh K; Sharma, Madhurima; Lal, Anupam; Gupta, Vivek; Sharma, Ashish; Khandelwal, Niranjan

    2015-01-01

    Background: Central venous disease is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency. Aim: To describe our initial experience in the endovascular treatment of central venous stenosis or obstruction in patients undergoing hemodialysis. Settings and Design: This was a retrospective study carried out in a tertiary care center. Study duration was 24 months. Follow-up was variable. Materials and Methods: Eleven patients of chronic renal failure undergoing hemodialysis presented with central vein stenosis or obstruction having ipsilateral vascular access, between July 2012 and July 2014. All the patients underwent endovascular treatment and were analyzed retrospectively. Results and Conclusion: A total of 11 patients (4 male and 7 female) underwent 18 interventions for 13 stenotic segments during a time period of 2 years. Eight stenotic segments were in brachiocephalic vein, three in subclavian vein, and two in axillary veins. The technical success rate for endovascular treatment was 81.8%. Two patients underwent percutaneous transluminal angioplasty (PTA) alone and presented with restenosis later. Balloon angioplasty followed by stenting was done in seven patients, two of which required reintervention during follow-up. We found endovascular treatment safe and effective in treating central venous disease. PMID:26752817

  6. Hypernatremia: Correction Rate and Hemodialysis

    Saima Nur

    2014-01-01

    Full Text Available Severe hypernatremia is defined as serum sodium levels above 152 mEq/L, with a mortality rate ≥60%. 85-year-old gentleman was brought to the emergency room with altered level of consciousness after refusing to eat for a week at a skilled nursing facility. On admission patient was nonverbal with stable vital signs and was responsive only to painful stimuli. Laboratory evaluation was significant for serum sodium of 188 mmol/L and water deficit of 12.0 L. Patient was admitted to medicine intensive care unit and after inadequate response to suboptimal fluid repletion, hemodialysis was used to correct hypernatremia. Within the first fourteen hours, sodium concentration only changed 1 mEq/L with a fluid repletion; however, the concentration dropped greater than 20 mEq/L within two hours during hemodialysis. Despite such a drastic drop in sodium concentration, patient did not develop any neurological sequela and was at baseline mental status at the time of discharge.

  7. Hepatitis C in hemodialysis patients

    Smaragdi Marinaki; John N Boletis; Stratigoula Sakellariou; Ioanna K Delladetsima

    2015-01-01

    Despite reduction of hepatitis C prevalence afterrecognition of the virus and testing of blood products,hemodialysis (HD) patients still comprise a high riskgroup. The natural history of hepatitis C virus (HCV)infection in dialysis is not fully understood whilethe clinical outcome differs from that of the generalpopulation. HD patients show a milder liver diseasewith lower aminotransferase and viral levels depicted bymilder histological features on liver biopsy. Furthermore,the "silent" clinical course is consistent with a slowerdisease progression and a lower frequency of cirrhosisand hepatocellular carcinoma. Potential explanations forthe "beneficial" impact of uremia and hemodialysis onchronic HCV infection are impaired immunosurveillanceleading to a less aggressive host response to the virusand intradialytic release of "hepatoprotective" cytokinessuch as interferon (IFN)-α and hepatocyte growthfactor. However, chronic hepatitis C is associated witha higher liver disease related cardiovascular and allcausemortality of HD patients. Therapy is indicated inselected patients groups including younger patients withlow comorbidity burden and especially renal transplantcandidates, preferably after performance of a liverbiopsy. According to current recommendations, choice oftreatment is IFN or pegylated interferon with a reportedsustained viral response at 30%-40% and a withdrawalrate ranging from 17% to 30%. New data regardingcombination therapy with low doses of ribavirin whichprovide higher standard variable rates and good safetyresults, offer another therapeutic option. The newprotease inhibitors may be the future for HCV infectedHD patients, though data are still lacking.

  8. Heart valve surgery in hemodialysis-dependent patients: nutrition status impact on surgical outcome.

    Kawahito, Koji; Aizawa, Kei; Oki, Shinichi; Saito, Tsutomu; Misawa, Yoshio

    2016-06-01

    Valve surgery in hemodialysis-dependent patients is associated with postoperative complications and a high mortality rate, and such patients frequently suffer cachexia. This study aimed to determine pre- and intraoperative risk factors associated with in-hospital mortality and long-term survival in hemodialysis-dependent patients undergoing heart valve surgery from the viewpoint of nutrition status. Eighty-seven hemodialysis-dependent patients who underwent valve surgery between January 1998 and October 2015 were retrospectively reviewed. Thirty-seven potential perioperative risk factors were evaluated. The in-hospital mortality rate was 12.6 % (11 patients). Univariate analysis identified New York Heart Association Functional Classification III or IV, emaciation (body mass index 3000 ml as predictors of in-hospital death. Multivariate logistic regression analysis confirmed low serum albumin death. The 1- and 3-year actuarial survival rates were 64.9 ± 5.4 and 51.8 ± 5.8 %, respectively. Long-term survival estimated by log-rank test was negatively impacted by anemia (hemoglobin death. Hypoalbuminemia and emergent/urgent operation are strong predictors of in-hospital and remote death. Malnutrition before surgery should be considered for operative risk estimation, and adequate preoperative nutrition management may improve surgical outcomes for hemodialysis-dependent patients. PMID:26749145

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

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

  10. Radiology of the kidneys in patients under maintenance hemodialysis

    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.)

  11. Continued vorapaxar versus withdrawed clopidogrel both on top of low dose aspirin in patients undergoing heart surgery: A call for randomized trial.

    Serebruany, Victor L; Kim, Moo Hyun; Golukhova, Elena; Pya, Yury; Bekbossynova, Makhabbat; Cattaneo, Marco; Marciniak, Thomas A

    2016-07-15

    Despite advanced techniques and improved clinical outcomes, the optimal antiplatelet strategy following coronary artery bypass grafting (CABG) is an unsolved mystery. Vorapaxar, a novel platelet thrombin receptor (PAR-1/4) blocker, is currently approved for post-myocardial infarction and peripheral artery disease indications on top of clopidogrel or/and aspirin. We here summarize the outcomes in patients after CABG for justification of a future vorapaxar trial. We comprehended the CABG outcomes after vorapaxar yielded from TRACER, TRA2P trials, and affiliated FDA reviews. The verified evidence suggests that composite of death, myocardial infarction and stroke occurred in 2.2% of vorapaxar vs. 8.1% placebo in TRA2P. These data were similar to the endpoint differences (5.9% after vorapaxar vs. 8.3% for placebo) in TRACER. The mortality reduction also consistently suggests vorapaxar advantage (1.7% vs. 2.5% in TRA2P, and 1.7% vs. 3.9% in TRACER). Notably, the post-CABG bleeding risks after vorapaxar were only slightly, but not significantly higher. Moreover, the bleeding disadvantage in the experimental arm was most likely related to overtreatment since majority of patients in both TRACER and TRA2P received triple antiplatelet therapy with aspirin, clopidogrel on top of vorapaxar. Overall, the FDA-confirmed evidence advocate for the future vorapaxar post-CABG outcome-driven trial. The head-to-head trial testing dual therapy with continued over CABG vorapaxar versus withdrawed clopidogrel, both on top of low dose aspirin is warranted. We conclude that the primary outcomes including mortality were consistently better for heart surgery patients after vorapaxar, while the excess of bleeding was mild. Continuing vorapaxar during CABG may be superior to currently recommended withdrawal antiplatelet strategies, and should be tested in an adequately powered randomized outcome-driven trial. PMID:27128545

  12. Food intake in patients on hemodialysis

    Inaiana Marques Filizola Vaz

    2014-12-01

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

  13. Portable home hemodialysis for kidney failure.

    Scott, A

    2007-11-01

    (1) Home hemodialysis has been in limited use in Canada for some time. Newer, portable hemodialysis machines that are easier for patients to operate may encourage the uptake of this technology. (2) One portable system is already available in the US. The NxStage System One hemodialysis machine operates on standard electric current, does not require plumbing or specialized disinfection, and is small enough for patients to travel with. (3) It is not yet clear whether the use of the NxStage system improves long-term survival and quality of life. (4) Home hemodialysis is less costly than conventional in-centre programs, but it is unknown whether these savings extend to portable devices. PMID:18041173

  14. [Surgical preparation planning of hemodialysis candidates].

    Hegglin, J; Häfner, G; Záruba, K; Sikora, J

    1975-03-01

    An early beginning of chronic hemodialysis is postulated to prevent dangerous uremic complications. Subcutaneous arteriovenous fistulas or autologous saphenous vein grafts in cases where multiple attempts to create a sufficiently functioning arteriovenous fistula have failed turned out to be the best procedures to obtain a suitable access to the blood vessels. The problems arising on a total of 57 patients to get an adequate blood flow by the time of first hemodialysis are discussed. PMID:1133018

  15. Vitamin D deficiency in hemodialysis patients

    Beena Bansal; Shyam Bansal; Ambrish Mithal; Vijay Kher; Raman Marwaha

    2012-01-01

    Background : Vitamin D [(25(OH)D] deficiency and insufficiency is common in patients with chronic kidney disease (CKD). 25(OH)D has been found to have beneficial effects on bone, cardiovascular and immune functions. There are little data about vitamin D levels in Indian patients on dialysis. This study was undertaken to determine the vitamin D status of Indian CKD patients on hemodialysis. Materials and Methods : We included 45 patients on maintenance hemodialysis coming to Medanta, Medicity,...

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

    Yanet Parodis López

    2006-03-01

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

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

    Saifan C

    2013-07-01

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

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

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

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

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

    2014-05-15

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

  20. Pharmacokinetics of paclitaxel in a hemodialysis patient with advanced gastric cancer: A case report

    Susumu Kawate; Izumi Takeyoshi; Yasuo Morishita

    2006-01-01

    We report for the first time the possibility of weekly paclitaxel chemotherapy for a patient with advanced,nonresectable gastric cancer undergoing hemodialysis. A 50-year-old man with chronic renal failure due to bilateral polycystic kidneys, who had undergone hemodialysis three times a week for 5 years, presented with hematemesis in December 2004. Based on the diagnosis of gastric cancer with lymph node metastases, surgery was performed. On the 15th postoperative day, the patient was treated with chemotherapy using paclitaxel. Paclitaxel was administered at a dose of 60 mg/m2 as a 1 h iv infusion in 250 mL of saline. Hemodialysis was started 1 h after the completion of the paclitaxel infusion and was performed for 3 h. Paclitaxel was administered weekly on d 1, 8, and 15 on a 28-d cycle. The maximum plasma concentration of paclitaxel was 1390 μg/L. The Grade 2 leukopenia was encountered during the first cycle. The plasma concentrations of paclitaxel from 6to over 24 h after the infusion were 0.01 to 0.1 μmol/L in our patient, and these concentrations have been shown to be effective on inhibiting the growth of gastric cancer cells without producing adverse side effects in the patient. The plasma concentration of paclitaxel was not influenced by hemodialysis. We conclude that the pharmacokinetics of paclitaxel is not altered in a patient with renal failure, and that weekly paclitaxel is a suitable treatment regimen for hemodialysis patients with advanced gastric cancer.

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

    Seyed-Moayed Alavian

    2008-02-01

    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

  2. Bioimpedance analysis versus lung ultrasonography for optimal risk prediction in hemodialysis patients.

    Siriopol, Dimitrie; Voroneanu, Luminita; Hogas, Simona; Apetrii, Mugurel; Gramaticu, Angelica; Dumea, Raluca; Burlacu, Alexandru; Sascau, Radu; Kanbay, Mehmet; Covic, Adrian

    2016-02-01

    Fluid overload is associated with adverse outcomes in hemodialysis (HD) patients. Two bedside methods are increasingly utilized to evaluate objectively fluid status-bioimpedance and lung ultrasonography, but there is no available direct, head-to-head comparison of their prognostic significance. Importantly, their predictive abilities have never been tested in a HD population, alongside those of a classic model that also incorporates established echocardiographic parameters of increased mortality risk. Between 26 May 2011 and 26 October 2012, we included in the study 173 patients undergoing chronic HD treatment for at least 3 months in a single dialysis unit. Relative fluid overload (RFO) and B-lines score (BLS) were used as candidate predictors. From Cox survival analysis we evaluated the increase in the predictive abilities for all-cause mortality of adding continuous RFO or BLS to a model including conventional predictors . 31 patients (17.9 %) died during a median follow-up of 21.3 (interquartile range 19.9-30.3) months. All Cox models showed good calibration. The C statistic for the all-cause mortality prediction increased significantly when the RFO was included into the baseline model (ΔC statistics 0.058 95 %CI = 0.003-0.114), but not when the BLS was included into the baseline model. Only the model that incorporated RFO showed significantly better risk reclassification abilities than the baseline model (IDI = 3.6 % and continuous NRI = 24.8 %). Fluid overload, as assessed by bioimpedance, and not by lung ultrasonography, improves risk prediction for death, beyond classical and echocardiographic-based risk prediction scores/parameters. PMID:26428675

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

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

    2002-01-01

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

  4. ACUTE SYMPTOMS AND COMPLICATIONS OF HEMODIALYSIS

    Bárbara Paula Magalhães de Deus

    2015-07-01

    Full Text Available Backgound and Objectives: Chronic Kidney Disease and the number of patients on renal replacement therapies have become more frequent in recent decades. Even with new technologies used in hemodialysis, which result in greater patient safety, acute symptoms and complications after the procedure may still occur. Recognizing these complications and knowing how to manage them is crucial to ensure a better quality of life for these patients. Content: This is a literature search on symptoms related to hemodialysis, carried out in electronic databases: Periodicals CAPES (Coordination of Higher Education Personnel Training, Brazil, Scientific Electronic Library Online - SciELO, LILACS and Pubmed, from which 30 articles were selected on the main complications observed and described during the course of hemodialysis. Conclusion: There was a prevalence of symptoms related to fluid and electrolyte imbalance and hemodynamic changes, especially headache. KEYWORDS: Renal Insufficiency Chronic; Symptoms; Renal Dialysis.

  5. Chronic Hemodialysis in Small Children.

    Novljan, Gregor; Rus, Rina R; Premru, Vladimir; Ponikvar, Rafael; Battelino, Nina

    2016-06-01

    When peritoneal dialysis is inapplicable, chronic hemodialysis (HD) becomes the only available treatment option in small children. Due to small patient size, central venous catheters (CVC) are mainly used for vascular access. Over the past 4 years, four children weighing less than 15 kg received chronic HD in our unit. A total of 848 dialysis sessions were performed. Altogether, 21 catheters were inserted. In all but one occasion, uncuffed catheters were used. Catheter revision was performed 15 times during the study period, either due to infection or catheter malfunction. The median number of catheter revisions and the median line survival was 3.0/patient-year and 53 days (range; 6-373 days), respectively. There were 14 episodes of catheter related infections requiring 11 CVC revisions (78.6%). The median rate of line infections was 2.8/patient-year. Chronic HD in small children is demanding and labor intensive. Issues pertain mainly to CVCs and limit its long-term use. PMID:27312919

  6. Modalities of hemodialysis: Quality improvement

    Ayman Karkar

    2012-01-01

    Full Text Available Hemodialysis (HD treatment had, over many years, improved the survival rate of patients with end-stage renal disease. However, standard or conventional HD prescription is far from being optimal in replacing the function of normal kidneys. Its unphysiologic clearance pattern and inability to remove all types and sizes of uremic toxins results in inter- and intra-dialysis complications and an unacceptably high rate of cardiovascular morbidity and mortality. Efficiency of HD can be improved by increasing blood and dialysate flow rates, dialyzer size and surface area and duration and frequency of dialysis sessions. Home HD, where short daily or long slow nocturnal HD sessions can conveniently be performed, provides an excellent option for quality of life improvement and reduction in morbidity and mortality. Recent innovations in the specifications of HD machines and improvement in dialysis membranes characteristics and water treatment technology paved the way for achieving quality HD. These advancements have resulted in efficient implementation of adsorption, diffusion and/or convection principles using adsorption HD, hemofiltration, hemodiafiltration (HDF and online HDF modalities in order to achieve optimum HD. Implementation of these innovations resulted in better quality care achievements in clinical practice and reduction in morbidity and mortality rates among HD patients.

  7. Sleep disorders in hemodialysis patients.

    Sabry, Alaa A; Abo-Zenah, Hamdy; Wafa, Ehab; Mahmoud, Khaled; El-Dahshan, Khaled; Hassan, Ahmed; Abbas, Tarek Medhat; Saleh, Abd El-Baset M; Okasha, Kamal

    2010-03-01

    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 University, 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 questions of Hatoum's sleep questionnaire. The prevalence of sleep disorders was 79.5% in our patients, 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= Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomnography, is necessary to confirm our results. Interventional studies for management of sleep disorders in HD patients are warranted. PMID:20228517

  8. Erectile dysfunction in hemodialysis patients

    Imen Gorsane

    2016-01-01

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

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

    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

    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....

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

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

    2002-02-01

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

  11. Staphylococcus aureus bacteremia in hemodialysis patients.

    Latos, D L; Stone, W J; Alford, R H

    1977-01-01

    Fifteen male hemodialysis patients developed 21 episodes of S. aureus bacteremia. Infections involving vascular access were responsible for 65% of initial bacteremias. The arteriovenous fistula was the most prevalent type of access used, and thus was responsible for the majority of these illnesses. Phage typing indicated that recurrent episodes were due to reinfection rather than relapse. Complications included endocarditis, osteomyelitis, septic embolism, and pericarditis. One patient died of infectious complications. It is recommended that hemodialysis patients developing bacteremia due to S. aureus receive at least 6 weeks of beta lactamase-resistant antimicrobial therapy. PMID:608860

  12. Preservation of residual kidney function in hemodialysis patients: reviving an old concept.

    Mathew, Anna T; Fishbane, Steven; Obi, Yoshitsugu; Kalantar-Zadeh, Kamyar

    2016-08-01

    Residual kidney function (RKF) may confer a variety of benefits to patients on maintenance dialysis. RKF provides continuous clearance of middle molecules and protein-bound solutes. Whereas the definition of RKF varies across studies, interdialytic urine volume may emerge as a pragmatic alternative to more cumbersome calculations. RKF preservation is associated with better patient outcomes including survival and quality of life and is a clinical parameter and research focus in peritoneal dialysis. We propose the following practical considerations to preserve RKF, especially in newly transitioned (incident) hemodialysis patients: (1) periodic monitoring of RKF in hemodialysis patients through urine volume and including residual urea clearance with dialysis adequacy and outcome markers such as anemia, fluid gains, minerals and electrolytes, nutritional, status and quality of life; (2) avoidance of nephrotoxic agents such as radiocontrast dye, nonsteroidal anti-inflammatory drugs, and aminoglycosides; (3) more rigorous hypertension control and minimizing intradialytic hypotensive episodes; (4) individualizing the initial dialysis prescription with consideration of an incremental/infrequent approach to hemodialysis initiation (e.g., twice weekly) or peritoneal dialysis; and (5) considering a lower protein diet, especially on nondialysis days. Because RKF appears to be associated with better patient outcomes, it requires more clinical and research focus in the care of hemodialysis and peritoneal dialysis patients. PMID:27182000

  13. Prolonged hypophosphatemia following parathyroidectomy in chronic hemodialysis patients

    Eda Altun

    2015-01-01

    Full Text Available Secondary hyperparathyroidism (SHPT is a common problem in patients with end-stage renal disease. In cases with severe and resistant SHPT, surgical parathyroidectomy (PTX is recommended. Hungry bone syndrome (HBS following surgical PTX is most often associated with hypocalcemia and hypophosphatemia. The mechanisms for the HBS are not clear, and a method for its prevention has not been established. We present three hemodialysis patients with persistant hypophosphatemia after PTX. In our parathyroidectomized patients, hypocalcemia could be corrected with calcium and vitamin D treatment, but hypophosphatemia continued for eight months in one patient and in two other patients until the last visit (10 and 2 months, respectively. Predisposing factors such as old age, diabetes mellitus and parathyroid adenoma were not found in our patients. All three patients were younger (<35 years old and anuric. Hemodialysis durations were seven, three and two years. In summary, HBS presented with hypocalcemia, and especially hypophosphatemia cannot be developed uncommonly and may persist for a long time following PTX in HD patients.

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

    Seifi S, Mokhtari A

    2008-07-01

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

  15. PRESCRIPTION AND ADEQUACY OF HEMODIALYSIS

    I Gde Raka Widiana

    2013-10-01

    Full Text Available Normal 0 false false false IN X-NONE X-NONE MicrosoftInternetExplorer4 Physiologically, uremic syndrome is a pollutional phenomenone of body fluid caused by uremic substance retention due to failing kidney. Hemodialysis (HD is a substitution therapy to replace native kidney to filter out the toxic substances. The clearance capacity can be measured using urea kinetic modeling, where urea is used as a marker. Prescription of HD will produced prescribed KT/V, namely the amount of HD doses given. On the other hand delivered KT/V is real clearance effect occurred in the body. Each component of dialysis machine can be adjusted to produce adequate delivered KT/V. This KT/V has also to be adjusted with weekly frequency of HD and residual function of the native kidney. Value of KT/V in each HD session according the consensus has to be attained in order the patient live a better life longer /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  16. Sleep disorders in hemodialysis patients

    Sabry Alaa

    2010-01-01

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

  17. Transposition of cephalic vein to rescue hemodialysis access arteriovenous fistula and treat symptomatic central venous obstruction

    Felipe Jose Skupien

    2014-03-01

    Full Text Available It is known that stenosis or central venous obstruction affects 20 to 50% of patients who undergo placement of catheters in central veins. For patients who are given hemodialysis via upper limbs, this problem causes debilitating symptoms and increases the risk of loss of hemodialysis access. We report an atypical case of treatment of a dialysis patient with multiple comorbidities, severe swelling and pain in the right upper limb (RUL, few alternative sites for hemodialysis vascular access, a functioning brachiobasilic fistula in the RUL and severe venous hypertension in the same limb, secondary to central vein occlusion of the internal jugular vein and right brachiocephalic trunk. The alternative surgical treatment chosen was to transpose the RUL cephalic vein, forming a venous necklace at the anterior cervical region, bypassing the site of venous occlusion. In order to achieve this, we dissected the cephalic vein in the right arm to its junction with the axillary vein, devalved the cephalic vein and anastomosed it to the contralateral external jugular vein, providing venous drainage to the RUL, alleviating symptoms of venous hypertension and preserving function of the brachiobasilic fistula.

  18. Effect of Auricular Acupressure on Uremic Pruritus in Patients Receiving Hemodialysis Treatment: A Randomized Controlled Trial.

    Yan, Cui-Na; Yao, Wei-Guo; Bao, Yi-Jie; Shi, Xiao-Jing; Yu, Hui; Yin, Pei-Hao; Liu, Gui-Zhen

    2015-01-01

    Background. Uremic pruritus (UP) is a common symptom in patients undergoing maintenance hemodialysis for end-stage renal disease (ESRD). Objective. To determine the clinical efficacy of auricular acupressure therapy on pruritus in hemodialysis patients and to explore possible underlying mechanisms. Methods. Patients receiving maintenance hemodialysis at a referral medical center were recruited and assigned to intervention (n = 32) and control (n = 30) groups. The intervention group underwent auricular acupressure treatment three times a week for six weeks. Auricular acupressure was not applied to patients in the control group. However, tape without Vaccaria seeds was applied to the same six auricular acupoints as the intervention group. Pruritus scores were assessed using VAS scores, and enzyme-linked immunosorbent assays (ELISA) were used to measure levels of other possible contributory biochemical factors. Results. There was a significant difference in mean VAS scores between the postintervention and control groups during follow-up (3.844 ± 1.687 versus 5.567 ± 2.285, F = 22.32, P acupressure may be a useful treatment in the multidisciplinary management of UP in ESRD patients. PMID:26495017

  19. The role of secondary hyperparathyroidism in left ventricular hypertrophy of patients under chronic hemodialysis

    Randon R.B.

    2005-01-01

    Full Text Available End-stage renal disease (ESRD patients frequently develop structural cardiac abnormalities, particularly left ventricular hypertrophy (LVH. The mechanisms involved in these processes are not completely understood. In the present study, we evaluated a possible association between parathyroid hormone (PTH levels and left ventricular mass (LVM in patients with ESRD. Stable uremic patients on intermittent hemodialysis treatment were evaluated by standard two-dimensional echocardiography and their sera were analyzed for intact PTH. Forty-one patients (mean age 45 years, range 18 to 61 years, 61% males, who had been on hemodialysis for 3 to 186 months, were evaluated. Patients were stratified into 3 groups according to serum PTH: low levels (280 pg/ml; group III = 21 patients. A positive statistically significant association between LVM index and PTH was identified (r = 0.34; P = 0.03, Pearson's correlation coefficient in the sample as a whole. In subgroup analyses, we did not observe significant associations in the low and intermediate PTH groups; nevertheless, PTH and LVM index were correlated in patients with high PTH levels (r = 0.62; P = 0.003. LVM index was also inversely associated with hemoglobin (r = -0.34; P = 0.03. In multivariate analysis, after adjustment for age, hemoglobin, body mass index, and blood pressure, the only independent predictor of LVM index was PTH level. Therefore, PTH is an independent predictor of LVH in patients undergoing chronic hemodialysis. Secondary hyperparathyroidism may contribute to the elevated cardiovascular morbidity associated with LVH in ESRD.

  20. 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

    R. C. Noleto Magalhães

    2011-12-01

    Full Text Available Introduction: Chronic kidney disease promotes changes in the zinc nutritional status and in the antioxidant defense system. This study assessed the relationship between the parameters of the zinc nutritional status and the activity of superoxide dismutase in patients with chronic renal failure who are receiving hemodialysis. Methods: 134 individuals, aged between 18 and 85 years, were divided into two groups: case group (hemodialyzed patients, n = 63 and control group (n = 71. Zinc concentrations in plasma and erythrocytes were determined using the flame atomic absorption spectrophotometry technique. The activity of superoxide dismutase enzyme was determined according to Ransod kit. Results: The mean values of plasma zinc were 62.02 ± 13.59 μg/dL and 65.58 ± 8.88 μg/dL, and for erythrocytary zinc the values were 54.52 ± 22.82 μgZn/gHb and 48.01 ± 15.08 μgZn/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 μg/dL y 65,58 ± 8,88 μg/dL y los valores de zinc eritrocitario fueron 54,52 ± 22,82 μgZn/gHb y 48,01 ± 15,08

  1. Diffusive Silicon Nanopore Membranes for Hemodialysis Applications.

    Steven Kim

    Full Text Available Hemodialysis using hollow-fiber membranes provides life-sustaining treatment for nearly 2 million patients worldwide with end stage renal disease (ESRD. However, patients on hemodialysis have worse long-term outcomes compared to kidney transplant or other chronic illnesses. Additionally, the underlying membrane technology of polymer hollow-fiber membranes has not fundamentally changed in over four decades. Therefore, we have proposed a fundamentally different approach using microelectromechanical systems (MEMS fabrication techniques to create thin-flat sheets of silicon-based membranes for implantable or portable hemodialysis applications. The silicon nanopore membranes (SNM have biomimetic slit-pore geometry and uniform pores size distribution that allow for exceptional permeability and selectivity. A quantitative diffusion model identified structural limits to diffusive solute transport and motivated a new microfabrication technique to create SNM with enhanced diffusive transport. We performed in vitro testing and extracorporeal testing in pigs on prototype membranes with an effective surface area of 2.52 cm2 and 2.02 cm2, respectively. The diffusive clearance was a two-fold improvement in with the new microfabrication technique and was consistent with our mathematical model. These results establish the feasibility of using SNM for hemodialysis applications with additional scale-up.

  2. Diffusive Silicon Nanopore Membranes for Hemodialysis Applications.

    Kim, Steven; Feinberg, Benjamin; Kant, Rishi; Chui, Benjamin; Goldman, Ken; Park, Jaehyun; Moses, Willieford; Blaha, Charles; Iqbal, Zohora; Chow, Clarence; Wright, Nathan; Fissell, William H; Zydney, Andrew; Roy, Shuvo

    2016-01-01

    Hemodialysis using hollow-fiber membranes provides life-sustaining treatment for nearly 2 million patients worldwide with end stage renal disease (ESRD). However, patients on hemodialysis have worse long-term outcomes compared to kidney transplant or other chronic illnesses. Additionally, the underlying membrane technology of polymer hollow-fiber membranes has not fundamentally changed in over four decades. Therefore, we have proposed a fundamentally different approach using microelectromechanical systems (MEMS) fabrication techniques to create thin-flat sheets of silicon-based membranes for implantable or portable hemodialysis applications. The silicon nanopore membranes (SNM) have biomimetic slit-pore geometry and uniform pores size distribution that allow for exceptional permeability and selectivity. A quantitative diffusion model identified structural limits to diffusive solute transport and motivated a new microfabrication technique to create SNM with enhanced diffusive transport. We performed in vitro testing and extracorporeal testing in pigs on prototype membranes with an effective surface area of 2.52 cm2 and 2.02 cm2, respectively. The diffusive clearance was a two-fold improvement in with the new microfabrication technique and was consistent with our mathematical model. These results establish the feasibility of using SNM for hemodialysis applications with additional scale-up. PMID:27438878

  3. Diffusive Silicon Nanopore Membranes for Hemodialysis Applications

    Kim, Steven; Feinberg, Benjamin; Kant, Rishi; Chui, Benjamin; Goldman, Ken; Park, Jaehyun; Moses, Willieford; Blaha, Charles; Iqbal, Zohora; Chow, Clarence; Wright, Nathan; Fissell, William H.; Zydney, Andrew; Roy, Shuvo

    2016-01-01

    Hemodialysis using hollow-fiber membranes provides life-sustaining treatment for nearly 2 million patients worldwide with end stage renal disease (ESRD). However, patients on hemodialysis have worse long-term outcomes compared to kidney transplant or other chronic illnesses. Additionally, the underlying membrane technology of polymer hollow-fiber membranes has not fundamentally changed in over four decades. Therefore, we have proposed a fundamentally different approach using microelectromechanical systems (MEMS) fabrication techniques to create thin-flat sheets of silicon-based membranes for implantable or portable hemodialysis applications. The silicon nanopore membranes (SNM) have biomimetic slit-pore geometry and uniform pores size distribution that allow for exceptional permeability and selectivity. A quantitative diffusion model identified structural limits to diffusive solute transport and motivated a new microfabrication technique to create SNM with enhanced diffusive transport. We performed in vitro testing and extracorporeal testing in pigs on prototype membranes with an effective surface area of 2.52 cm2 and 2.02 cm2, respectively. The diffusive clearance was a two-fold improvement in with the new microfabrication technique and was consistent with our mathematical model. These results establish the feasibility of using SNM for hemodialysis applications with additional scale-up. PMID:27438878

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

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

    2009-01-01

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

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

    Suraj Mammen

    2012-01-01

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

  6. The Effect of Aromatherapy with Lavender Essential Oil on Depression, Anxiety and Stress in Hemodialysis Patients: A Clinical Trial

    Ali Tayebi

    2015-06-01

    Full Text Available Background: Depression, anxiety and stress are common among hemodialysis patients affecting their mental health and quality of life, leading to multiple dysfunctions. Anti-anxiety effects of aromatherapy, as one of the domains of complementary medicine, have been investigated in several studies. Aim: Investigation of the effect of aromatherapy with lavender essential oil on depression, anxiety and stress rates in hemodialysis patients. Methods: This study was a randomized controlled clinical trial performed on 60 patients undergoing hemodialysis in Tehran, Iran in 2014. The patients were randomly divided into intervention and control groups. To measure the rate of depression, anxiety and stress, the Depression Anxiety Stress Scales-21 was used. In the intervention group, the patients were asked to inhale the lavender essential oil smeared on a piece of cloth (three drops of oil for one hour during the hemodialysis procedure. After 4 weeks, the rates of depression, anxiety and stress were re-measured. Data analysis was performed by SPSS software version 14 using chi-square, Wilcoxon and Mann-Whitney U statistical tests. Results: In this study, 33(60% of the participants were male, and 53(96.4% were married.  After the intervention, the scores of depression (P

  7. Erectile Dysfunction in Males on Hemodialysis

    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)

  8. Radioablative therapy with Iodine-131 on a patient with thyroid cancer and chronic renal failure in hemodialysis first experience in Peru

    Apaza Veliz, D. G.; Herrera Vera, R. D.; Cardenas Abarca, C. A.; Oporto Gonzales, C. A.; Aguilar Ramírez, C.; Vega Ramírez, J. L.; Urquizo Baldomero, R. M.

    2016-07-01

    The Iodine-131 (I-131) is a radioisotope used as a standard treatment for radioablation of thyroid remnants. Among thyroid cancer patients, the ones undergoing hemodialysis represent a specific group. The dose of I-131 is given orally to these patients, part of it is absorbed by the thyroid remnants and the rest of it, largely not incorporated, is excreted primarily by renal excretion. The use of a high dose of radioactivity in the process, and the inability of excretion, represents a high risk of exposure to the patient, medical staff and hemodialysis equipment. This work describes the procedure applied on the radioablation therapy for thyroid cancer while receiving hemodialysis, minimizing the risks for the patient and the staff involved. This clinical procedure will establish the dosimetric measures, a plan on radiation protection and a treatment protocol for this specific type of patients.

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

    Vasantha Janardhan

    2011-01-01

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

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

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

  11. Cardiac Biomarkers and Left Ventricular Hypertrophy in Asymptomatic Hemodialysis Patients

    Reneta Yovcheva Koycheva

    2015-12-01

    Full Text Available BACKGROUND: Cardiac biomarkers are often elevated in dialysis patients showing the presence of left ventricular dysfunction. The aim of the study is to establish the plasma levels of high-sensitivity cardiac troponin T (hs TnT, precursor of B-natriuretic peptide (NT-proBNP and high sensitivity C-reactive protein (hs CRP and their relation to the presence of left ventricular hypertrophy (LVH in patients undergoing hemodialysis without signs of acute coronary syndrome or heart failure. MATERIAL AND METHODS: Were studied 48 patients - 26 men and 22 women. Pre and postdialysis levels of hs cTnT, NT-proBNP and hs CRP were measured at week interim procedure. Patients were divided in two groups according to the presence of echocardiographic evidence of LVH - gr A - 40 patients (with LVH, and gr B - 8 patients (without LVH. RESULTS: In the whole group of patients was found elevated predialysis levels of all three biomarkers with significant increase (p < 0.05 after dialysis with low-flux dialyzers. Predialysis values of NT-proBNP show moderate positive correlation with hs cTnT (r = 0.47 and weaker with hs CRP (r = 0.163. Such dependence is observed in postdialysis values of these biomarkers. There is a strong positive correlation between the pre and postdialysis levels: for hs cTnT (r = 0.966, for NT-proBNP (r = 0.918 and for hs CRP (r = 0.859. It was found a significant difference in the mean values of hs cTnT in gr. A and gr. B (0.07 ± 0.01 versus 0.03 ± 0.01 ng /mL, p < 0.05 and NT-proBNP (15,605.8 ± 2,072.5 versus 2,745.5 ± 533.55 pg /mL, p < 0.05. Not find a significant difference in hs CRP in both groups. CONCLUSIONS: The results indicate the relationship of the studied cardiac biomarkers with LVH in asymptomatic patients undergoing hemodialysis treatment.

  12. Changes of Plasma Angiotensin-Converting Enzyme Activity during Hemodialysis *

    Koo, Wan Suh; Lee, Yong Joon; Kim, Hye Su; Kim, Suk Young; Choi, Euy Jin; Chang, Yoon Sik; Yoon, Young Suk; Bang, Byung Kee

    1987-01-01

    Plasma angiotensin-converting enzyme activity was measured by spectrophotometer in normal subjects and in patients with end stage renal failure, serially during a routine hemodialysis. Patients on maintenance hemodialysis tended to be associated with elevated plasma angiotensin-converting enzyme activity versus normal subjects. Plasma angiotensin-converting enzyme activity was significantly elevated in patients with chronic renal failure after 5 hours of hemodialysis(p

  13. HIV Transmission at a Saudi Arabia Hemodialysis Unit

    Mashragi, Faisal; Bernstein, Robert S.; Al-Mazroa, Mohammad; Jaffar A. Al-Tawfiq; Filemban, Sanaa; Assiri, Abdullah; Furukawa, Elaine; Al Hazmi, Mohammad; Alzahrani, Abdullah; Stephens, Gwen; Memish, Ziad A.

    2014-01-01

    Background.  Hemodialysis is associated with increased risk of healthcare-associated infections but considered a low-risk setting for human immunodeficiency virus (HIV) transmission. We investigated 3 hemodialysis unit (HDU) patients with new HIV infections to determine whether transmission was hemodialysis-associated and to correct factors that contributed to transmission. Methods.  Each patient was evaluated for HIV risk factors. Blood samples were tested to determine relatedness of HIV str...

  14. Effect of acupressure on fatigue in patients on hemodialysis

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

    2013-01-01

    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 i...

  15. [Work capacity in patients on hemodialysis].

    Orlić, Lidija; Matić-Glazar, Durdica; Sladoje Martinović, Branka; Vlahović, Ana

    2004-01-01

    The quality of life is considerably impaired in patients on regular hemodialysis has been changed. It is difficult to determine it because there are no general definitions or measuring instruments. There are objective and subjective components of the quality of life, one among them being occupational ability. During the progression of chronic renal disease (CRD) to terminal renal failure (TRF) physical activity of the patients becomes poorer. In this stage, their physical activity is by 40-60% below the value expected for the same healthy age cohort. The intention of this analysis was to determine occupational ability in patients on regular hemodialysis. The analysis included 161 patients on hemodialysis, 78 (48.5%) female and 83 (51.5%) male, mean age 61.2 +/- 13.1 years, and mean time on hemodialysis was 54 +/- 71.9 months. All patients filled-out a self-administered questionnaire on schooling and occupational ability. The cause of TRF was glomerulonephritis in 45 (26.8%), diabetes mellitus in 42 (26.3%), nephrosclerosis in 26 (16.1%), and pyelonephritis in 12 (7.4%) patients. Age distribution was as follows: 0-19 years 1 patient, 20-44 years 14 (8.7%); 45-64 years 64 (39.8%) and 65 years 82 (50.9%) patients. Educational structure: elementary school 65 (40.4%), secondary school 79 (49.1%), college 10 (6.2%), and university 6 (3.7%) patients. Occupational structure: retired 123 (76.4%), housekeeper 20 (12.4%), never employed 4 (2.5%), employed 10 (6.2%), unemployed 2 (1.2%), 1 child and 1 student. Among employed patients there were 7 men and 3 women. Their educational level was as follow: elementary school 1 patient, secondary school 8 patients, college 1 patient. At the beginning of hemodialysis their occupational status was: full-time employment 30 (18.6%) patients, part-time employment 1 patient, longer time on sick-leave payment (3.1%), retired 95 (59%), pupils and students 3, unemployed 2, and 1 child did not attended school. Time interval between the

  16. Five months of physical exercise in hemodialysis patients

    Molsted, Stig; Eidemak, Inge; Sorensen, Helle Tauby;

    2004-01-01

    BACKGROUND: The number of chronic renal failure patients treated by hemodialysis (HD) is continuously increasing. Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases. The aim of this study was to determine the effects of 5 months physical exercise...... by aerobic capacity, '2-min stair climbing', 'squat test', self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. RESULTS: 20 patients completed the intervention. Attendance was 74......: Physical exercise twice a week for 5 months increases physical function and aerobic capacity in HD patients. An exercise program with only two exercise sessions per week seems easy to implement in clinical practice with high attendance among participants. Further investigation is needed to determine...

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

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

    2011-01-01

    Background Hemodialysis (HD) is a catabolic procedure that may contribute to the high frequency of protein-energy wasting among patients receiving maintenance HD. The present study investigated the additional effect of glucose and glucose-insulin infusion on liver protein synthesis during HD...... compared with a meal alone. Methods In a randomized cross-over study with three arms, 11 non-diabetic HD patients were assigned to receive a conventional HD session with either: • no treatment (NT) • IV infusion of glucose (G) • IV infusion of glucose-insulin (GI) During infusions blood glucose levels were...... maintained at 8.0-10.0 mmol/L by additional glucose infusion. Glucose and glucose-insulin infusions were commenced 2 h prior to HD and continued throughout the HD session. Fasting blood samples were collected at baseline before infusion and followed by the only meal allowed during the study. Results Blood...

  18. Changes in Plasma Copeptin Levels during Hemodialysis: Are the Physiological Stimuli Active in Hemodialysis Patients?

    Esmée M Ettema

    Full Text Available Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP, are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli for copeptin release, i.e. plasma osmolality, blood volume and mean arterial pressure (MAP, are operational in hemodialysis patients.One hundred and eight prevalent, stable hemodialysis patients on a thrice-weekly dialysis schedule were studied during hemodialysis with constant ultrafiltration rate and dialysate conductivity in this observational study. Plasma levels of copeptin, sodium, MAP, and blood volume were measured before, during and after hemodialysis. Multivariate analysis was used to determine the association between copeptin (dependent variable and the physiological stimuli plasma sodium, MAP, excess weight as well as NT-pro-BNP immediately prior to dialysis and between copeptin and changes of plasma sodium, MAP and blood volume with correction for age, sex and diabetes during dialysis treatment.Patients were 63 ± 15.6 years old and 65% were male. Median dialysis vintage was 1.6 years (IQR 0.7-4.0. Twenty-three percent of the patients had diabetes and 82% had hypertension. Median predialysis copeptin levels were 141.5 pmol/L (IQR 91.0-244.8 pmol/L. Neither predialysis plasma sodium levels, nor NT-proBNP levels, nor MAP were associated with predialysis copeptin levels. During hemodialysis, copeptin levels rose significantly (p<0.01 to 163.0 pmol/L (96.0-296.0 pmol/L. Decreases in blood volume and MAP were associated with increases in copeptin levels during dialysis, whereas there was no significant association between the change in plasma sodium levels and the change in copeptin levels.Plasma copeptin levels are elevated predialysis and increase further during hemodialysis. Volume stimuli, i.e. decreases in MAP and blood volume, rather than osmotic

  19. Effect of isovolemic, isothermic hemodialysis on cerebral perfusion and vascular stiffness using contrast computed tomography and pulse wave velocity.

    Ansgar Reising

    Full Text Available BACKGROUND: Patients undergoing hemodialysis treatment have a six-fold increased risk for stroke relative to the general population. However, the effect of hemodialysis on cerebral blood flow is poorly studied and confounding factors like blood pressure and ultrafiltration as well as temperature changes have rarely been accounted for. The aim of our study was to use state-of-the-art technology to evaluate the effect of a single dialysis session on cerebral perfusion as well as on vascular stiffness. METHODS: Chronic hemodialysis patients (7 male/3 female, mean age 58 years were recruited. Cerebral blood flow and arterial pulse wave velocity were measured before and immediately after a hemodialysis session. To exclude effects of volume changes we kept ultrafiltration to a minimum, allowing no change in body weight. Isothermic conditions were maintained by using the GENIUS single-pass batch-dialysis system with a high-flux polysulfone dialyser. Cerebral blood flow was measured by contrast-enhanced computed tomography. Pulse wave velocity was measured using the SphygmoCor (AtCor Medical, USA device by a single operator. RESULTS: This study shows for the first time that isovolemic, isothermic hemodialysis neither affected blood pressure or heart rate, nor total or regional cerebral perfusion. There was also no change in pulse wave velocity. CONCLUSIONS: Mechanisms other than the dialysis procedure itself might be causative for the high incidence of ischemic strokes in this patient population. Moreover, the sole removal of uremic toxins does not lead to short-term effects on vascular stiffness, underlying the importance of volume control in this patient population.

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

    Azar BARADARAN

    2010-12-01

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

  1. Portable calibration instrument of hemodialysis unit

    Jin, Liang-bing; Li, Dong-sheng; Chen, Ai-jun

    2013-01-01

    For the purpose of meeting the rapid development of blood purification in China, improve the level of blood purification treatment, and get rid of the plight of the foreign technology monopolization to promise patients' medical safety, a parameter-calibrator for the hemodialysis unit, which can detect simultaneously multi-parameter, is designed. The instrument includes a loop, which connects to the hemodialysis unit. Sensors are in the loop in series, so that the dialysis can flow through this loop and the sensors can acquisitive data of various parameters. In order to facilitate detection and carrying, the integrated circuit part modularly based on the ultralow-power microcontrollers,TI MSP430 is designed. High-performance and small-packaged components are used to establish a modular, high-precision, multi-functional, portable system. The functions and the key technical indexes of the instrument have reached the level of products abroad.

  2. DNA damage in hemodialysis patients with chronic kidney disease; a test of the role of diabetes mellitus; a comet assay investigation.

    Mamur, Sevcan; Unal, Fatma; Altok, Kadriye; Deger, Serpil Muge; Yuzbasioglu, Deniz

    2016-04-01

    The incidence of chronic kidney disease (CKD) is increasing rapidly. Diabetes mellitus (DM) is the most important cause of CKD. We studied the possible role of DM in CKD patients with respect to DNA damage, as assessed by the comet assay in 60 CKD patients (with or without DM) undergoing hemodialysis and in 26 controls. Effects of other factors, such as age, sex, hypertension, duration of hemodialysis, body mass index (BMI), and levels of hemoglobin (HB), intact parathormone (iPTH), and ferritin (FER), were also examined. Primary DNA damage measured by the comet assay was significantly higher in CKD patients than in controls. Among CKD patients, the following correlations were observed. (1) There was no difference in comet tail length or tail intensity between diabetic and non-diabetic individuals. (2) Age, sex, hemoglobin, hypertension, duration of hemodialysis, and ferritin levels affected neither tail length nor intensity. (3) BMI values above 25kg/m(2) and iPTH levels above 300pg/ml were associated with significantly greater comet tail length. Our results indicate that primary DNA damage is increased in CKD patients undergoing hemodialysis, compared to controls; however, DM had no additional effect. PMID:27085471

  3. Ultrasound Evaluation Before and After Hemodialysis Access

    Daryoush Saedi

    2009-01-01

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

  4. The Clearance of Cyclosporine by Hemodialysis

    Venkataramanan, Raman; Ptachcinski, Richard J.; Burckart, Gilbert J.; YANG, SHIN L.; Starzl, Thomas E.; VAN THEIL, DAVID H.

    1984-01-01

    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...

  5. Evaluation of Ulnar neuropathy on hemodialysis patients

    Vahdatpour, Babak; Maghroori, Razieh; Mortazavi, Mojgan; Khosrawi, Saeid

    2012-01-01

    Background: Ulnar nerve entrapment at the elbow is the second most common upper extremity nerve involvement after median nerve involvement at the wrist or carpal tunnel syndrome (CTS) considering the frequency of occurrence in the upper limb with variable causes. Hemodialysis, because of elbow positioning during dialysis, upper extremity vascular-access, and underlying disease is one cause of ulnar entrapment. This study considers evaluating the effect of elbow positioning on ulnar involvemen...

  6. "Quality of life in hemodialysis patients "

    Nabaie B; Shahidzadeh A; Dabiran S

    2001-01-01

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

  7. Prevention and treatment of hemodialysis access thrombosis

    Smits, Johannes Henricus Maria

    2001-01-01

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

  8. Sterilization of heparinized Cuprophan hemodialysis membranes

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

    1996-01-01

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

  9. Increased cerebral water content in hemodialysis patients.

    Kathrin Reetz

    Full Text Available Little information is available on the impact of hemodialysis on cerebral water homeostasis and its distribution in chronic kidney disease. We used a neuropsychological test battery, structural magnetic resonance imaging (MRI and a novel technique for quantitative measurement of localized water content using 3T MRI to investigate ten hemodialysis patients (HD on a dialysis-free day and after hemodialysis (2.4±2.2 hours, and a matched healthy control group with the same time interval. Neuropsychological testing revealed mainly attentional and executive cognitive dysfunction in HD. Voxel-based-morphometry showed only marginal alterations in the right inferior medial temporal lobe white matter in HD compared to controls. Marked increases in global brain water content were found in the white matter, specifically in parietal areas, in HD patients compared to controls. Although the global water content in the gray matter did not differ between the two groups, regional increases of brain water content in particular in parieto-temporal gray matter areas were observed in HD patients. No relevant brain hydration changes were revealed before and after hemodialysis. Whereas longer duration of dialysis vintage was associated with increased water content in parieto-temporal-occipital regions, lower intradialytic weight changes were negatively correlated with brain water content in these areas in HD patients. Worse cognitive performance on an attention task correlated with increased hydration in frontal white matter. In conclusion, long-term HD is associated with altered brain tissue water homeostasis mainly in parietal white matter regions, whereas the attentional domain in the cognitive dysfunction profile in HD could be linked to increased frontal white matter water content.

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

    Quinlan, Catherine

    2012-08-27

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